Countdown to 3rd Global Symposium on Health Systems Research

The 3rd Global Symposium on Health Systems Research is scheduled to take place in Capetown from 30th September - 3rd October 2014. Organized by the Health Systems Global and its partners, the symposium will bring together its members with full range of players involved in health system and policy research. The participants will include researchers , policy makers , implementers , civil society and other relevant stakeholders from national and regional associations and professional organizations. There is a lot of enthusiasm already on what is going to happen in this symposium. In the recent blog post , Kristof  puts it  in perspective on  the Neymer  Hazard and Messi of health system research who are expected to contribute to the symposium. The Emerging voices for Global health will join the old dinosaurs ( as he puts it )  to make the ball rolling in health system research.
The theme for this conference is ''People- centered health systems'', that is reorienting health systems to be people-centered.
In order to overcome the current challenges in the health systems (especially in developing economies where there is considerable fragmentation of the health system building blocks), the relevance of this symposium need not be overemphasized.
The core values of people-centered health systems ; empowerment , participation , the central  role of family and community in in any process of development and ending gender and all other forms of discrimination, will be met by the health systems if the patient is considered across all levels of the system.
Will this symposium give solutions to contemporary challenges in governing health systems?- For example the low participation of civil society organizations and in particular the crackdown on civil societies that are in the front line of giving voice  to the people.The fact that there are still many patients who suffer from catastrophic expenditures ( as  a result of out of pocket payments) when they fall ill   and the limited funding to health care interventions (Most African countries for example have never reached the Abuja Declaration target of allocating 15% of the country budget to health care).
Many more challenges still:- human resource for health crisis, poor information on health services and policies  and the problem of counterfeit medicines.
Okay,amid such challenges, I am optimistic that  the symposium is going to shade light on the possible solutions.

Getting to Zero -World AIDS day 2013

Getting to Zero means Zero new HIV infection, Zero stigma, Zero babies born with HIV, Zero death from HIV/AIDS.
That sounds good, right?
Last year I posted my reflections on what AIDS day means to me and called upon everyone of us to contribute to getting to Zero. This year, I ask every one of us to keep the promise and in that regard join the global community to make "getting  to Zero" a reality. The  UNAIDS global report on HIV/AIDS, highlights on  the achievements we have attained to-date on the fight against HIV/AIDS and the challenges ahead.The challenges ahead can not be tackled by a single nation, but a global community that works in solidarity to address the challenges. On his official statement, Ban Ki-moon calls upon all partners contributing to the Global fund to continue to support this most important fund that has significantly contributed to achievements in the fight of the HIV/AIDS pandemic.

VIDEO: The many paths towards universal health coverage

At some point in their lives, everyone needs health care....but today not everyone has access to the care that they need.

Universal health coverage ensures that all people get the health services they need without suffering financial hardship. The goal of moving towards universal health coverage is gaining momentum around the world.

This video, produced by the World Health Organization, explains the concept of universal coverage and uses examples from six countries -- China, Oman, Mexico, Rwanda, Thailand and Turkey -- to show ways that all countries can provide accessible and affordable care for their people

http://www.youtube.com/watch?v=VQ3sHfYzcv8#t=94

Citizens’ lack of information on health policies in Tanzania: Implications for widening inequities

Poor people face a variety of barriers when accessing health care in Sub-Saharan Africa. Some of these barriers could no doubt be eliminated if poor people were actually more aware of health policies, as a lack of information often leads to undesirable results such as delayed medical treatment, improper health seeking behaviours, and even foregoing medical treatment. This situation contributes to morbidities and mortalities among this group of poor people that could otherwise be avoided, at least to some extent. The example of a lady in her late 30s called “Sikitu” (a Swahili name, which literally means “Nothing”), provides a snapshot of how things are on the ground. Sikitu is a widow living with her four children in a village in Southern Tanzania.

Sikitu had symptoms of cervical cancer when she went to see a doctor in a public district hospital. The doctor later on referred her to the cancer institute in Dar es Salaam for further treatment on account of advanced cervical cancer. After physical examination, Sikitu asked the doctor: “How much should I pay you for all these services I have received?’ The doctor replied: “Cancer services in this country are offered for “free” (without payment) like other chronic diseases such as HIV/AIDS and tuberculosis; you are not supposed to pay directly to the doctor if there are associated costs”. Sikitu was surprised to hear that and was pretty much speechless when she reflected on what has been happening to her and other poor people. She went home and sold the few goats she had to get money for her travel and living expenses (when she will be receiving treatment in Dar es Salaam). A few days later, before travelling to the city for treatment, she went back to see the doctor (ready for the journey) in order to collect the referral documents. She offered him some cashew nuts, as a gift. Then she burst into tears. When asked why she was crying, she explained that she had been coming to the hospital almost every month for the past year or so, to see a certain doctor. She had always paid the doctor after the service but the problem was still going on despite the fact that some procedures had been performed on her. She was scheduled to come again regularly for follow-up visits and was required to pay some money whenever she accessed services. She was very surprised that this time (because the usual doctor was travelling) she was attended free of charge, informed of her problem and  referred to the big hospital for further care.

Sikitu’s story is by no means an exception in Tanzania and in other sub-Saharan African countries that still have user fee policies in place, but is just the tip of the iceberg. Many poor people are unaware of user fee exemption policies. Many people, especially the poor, have been denied access to health care and live now in extreme poverty because of lack of information about user fee exemption policies. Corrupt practitioners take advantage of this knowledge gap, induce demand and ask for informal payments (bribes) from their (mostly poor) clients.

There are several reasons as to why ordinary citizens often lack information on available health policies. The (trademark) top-down approach of policy formulation that denies active participation of ordinary citizens in setting the agenda and overseeing the implementation of policies, contributes to this gap. Moreover, the absence of pressure groups that can hold the government accountable if these policies are not addressing ordinary citizens’ problems plays a major role. These two major reasons are interrelated in Tanzania: the political atmosphere in my country (characterised by the dominance of one political party) has for a long time supported a top-down approach and limited democratic practices – in the past civil society organisations(CSOs) that weren’t affiliated to the ruling party were even banned. However, since the end of the 80s (when there was a severe economic crisis), regulation of CSOs has changed  as a result of conditional ties of international aid. The same process also led to the introduction of a multiparty system in 1992.

So the situation is slowly changing, for the better, even if until recently Tanzania could be characterized as a “de facto one party state in a context of multi-party elections”. Little by little, citizens are more empowered (at least in other social sectors) due to actions of CSOs and opposition political parties. In fact, even in the health sector, there have been some active  local CSOs  that work as ‘health policy entrepreneurs’ such as Sikika, but  they have not been vigorous enough to push forward an agenda that promotes poor people’s access to information (in order to empower them to advocate for their health rights). Nevertheless, Sikika has shown the way by using research evidence as an advocacy tool for quality health services in partnership with other local CSOs. Sikika’s activities are geographically confined, though, mainly focusing on urban areas. The capacity of the organization also needs to be improved. Many international NGOs are also working in the country, but it is very complex to understand how they relate to the government and local CSOs, and not the focus of this editorial. More importantly perhaps, the recent emergence of strong opposition political parties that have been challenging the status quo is seen as a window of opportunity. Many of them promote the health sector agenda in their election manifestos for the coming general elections (scheduled for 2015).

It is unfortunate, however, that until now there has never been a serious attempt (and mass movement) to change the current situation that creates major inequalities in the society in terms of access to health care, unlike in other sectors such as education and land rights. This is probably because health activists have never worked in unity to address such issues, and health worker unions are too fragmented to put successful pressure on decision makers and address such inequalities (apart from isolated doctors’ strikes that have typically been suppressed by authorities). The government on the other hand tries to make sure that health issues do not feature in mainstream party politics because of their potential sensitivity; they therefore find ways (sometimes barbaric ones) to suppress initiatives that appear to advocate the right to access health care or that suggest mechanisms which promote equity (not that Tanzania is alone in this – the crackdown on civil society is, unfortunately, a global phenomenon). However, things are finally changing, and it could very well be that the ‘access to health care’ agenda will feature quite prominently in the 2015 general elections, even more so because a series of mediatised actions have happened in the health sector recently such as persistent doctors’ strikes to demand good working conditions and the kidnapping and torture of the frontline leaders of these movements.

Since realities on the ground and research evidence have already demonstrated the inequalities caused by user fee  policies and the fact that people are unaware  of exemption procedures (or sometimes they are aware but  there exists no functioning (social and legal) framework that can support them in the fight for their rights), it seems high time for health activists ( individuals, CSOs and political parties) to join hands and  advocate the right to health and work towards boosting citizens’ awareness  and empowering them to know their right  to health care. They can also start advocating the abolition of user fee policies like in other Sub-Saharan African countries. Obviously, they can and should also jump on the global UHC bandwagon to make universal health coverage a reality in Tanzania.

As Jim Kim noted in his speech at the World Health Assembly earlier this week, “Now is the time to act. WE MUST BE the generation that delivers universal health coverage.”

This article is also available at International health policies (IHP) blog as a guest editorial 

MPs Call for Universal Health Insurance

(AllAfrica.com)Members of Parliament have called for health insurance coverage for all Tanzanians, noting that the government should find ways of making the National Health Insurance Fund (NHIF) accessible to every Tanzanian, regardless of whether they are in the formal sector or not.

Debating budget estimates for the Ministry of Health and Social Welfare here, the legislators decried weaknesses in the current distribution system of drugs and medical equipment and the scarcity of health workers, noting that a sure way of keeping Tanzanians safer was by enrolling all of them in the national health insurance scheme.

Contributing to the debate, Mrs Margaret Sitta (Special Seats - CCM) noted that enrolling all Tanzanians with the National Health Insurance Fund would go far in ensuring access of quality healthcare, singling out mothers and children who are some of the people who need to be kept safe.

She asked the government to fast-track review of the structure of the Medical Stores Department so that it becomes more effective in distributing drugs and medical equipment across the country. She also urged the government to consider using nursing assistants at health centres to offset staff shortage in rural areas.

The Mp asked the minister of Health to explain to the public what pregnant mothers are obliged to pay at a government hospital when they go to give birth. Making her contribution, Josephat Kandege (Kalambo - CCM) also asked the government to devise means of getting every Tanzanian to enrol with NHIF .

Civic United Front (CUF) Special Seat MP Magdalena Sakaya said political leaders should pay attention to the interests of medical workers, arguing that would in turn have a positive impact on the quality of health care they give. She decried some medical personnel who engage in malpractices in rural health centres.

Nyamagana MP Ezekiel Wenje (Chadema) decried the lack of enough health workers in rural health centres, noting that the number was dismal compared with the number of patients. He said financial resources for Bugando Referral Hospital should be increased to enable it handle more complicated cases in the lake zone.

He also appealed to the minister to intervene in his area where two dispensaries have been built, but bureaucratic processes of registering them meant people in the area would still not access health services from the new structures.

US doctors cure a child born with HIV

Doctors in the US have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.

The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.

Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.

Doctors did not release the name or sex of the child to protect the patient's identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

For more infomation click here

Putting the patient at the forefront of healthcare in Africa

On February 19^th and 20^th 2013, a two-day conference on health care reforms will take place in Cape Town, South Africa. The conference will focus on identifying health care solutions designed to meet patient needs. Healthcare in Africa will once again gather 180+ influential healthcare stakeholders from government, providers, suppliers and patient groups to explore the key issues around healthcare systems in the continent.

Humphrey Opondo’s article provides detailed infomation about the conference.