Network for Equity in Health in Southern Africa

Equinet seeks to: * Develop and widen the conceptual understanding of equity in health and identify critical areas of work and policy issues in relation to equity in health. * Make visible existing unfair and avoidable inequalities in health.

The missing medics in Botswana's Aids battle

Eighteen months ago Botswana became the first African country to offer antiretroviral drugs to everyone for free. A huge amount of cash has been dedicated to the cause, but money cannot buy the workers so desperately needed. For example at Princess Marina Hospital in Gaborone people start queuing outside the gates by 5 a.m. The hospital's waiting rooms and corridors are filled to bursting point until the doors close again at the end of the day. Staff admit they cannot treat anyone else. This hospital is dispatching drugs and advice to more than 6,000 people, making it the largest treatment centre for HIV or Aids in the world. Many have presumed that money - or the lack of it - has been the main obstacle to distributing the drugs that are so desperately needed. But here the crunch has come because of a lack of workers. The problem is about to get worse as the drugs distribution programme is rolled out to new areas of the country. At the moment, Achap - a partnership between pharmaceutical giant Merck, the Bill and Melinda Gates Foundation and the Botswana government - has six treatment centres but it desperately needs to better serve rural communities. The skills shortage is much wider than healthcare workers. We need people who can manage the centres, do the finances and put forward budget proposals, says Achap's Brad Ryder. There is another, sadder reason why the problem is becoming more acute. Hospital superintendent Howard Moffat confirms that many health workers have been living in denial when faced with the virus they spend their days treating - and some are being lost to AIDS. The government is desperately negotiating with China and Cuba to get more doctors, but existing staff are simultaneously being lured away by agencies in the West. In 2002, Botswana lost 120 of its nurses to the UK. The net result is that, despite the huge amount of money being dedicated to the cause, progress is happening more slowly than had been expected. 35% of Botswana's 1.8m people are living with HIV. More than 90% do not know their status 9,000 are on treatment 14,500 are enrolled for treatment. We thought that by offering drugs for free we would achieve more. No doubt we are saving lives, but it's not the percentage we wanted, says Ibou Thior, project director at the Harvard Aids Institute in Gaborone. Stigma is still rampant. The foreign minister says he has been instructed to highlight the fight against AIDS at every public speech. And president Festus Mogae - who regularly warns that his people face extinction - himself publicly took an HIV test and declared his status (negative). Despite this enormous effort, 90% or more of the population have still not dared to take the test. There are ongoing discussions about the ethics of routinely testing for HIV. However, the real need is to combat the fear and convince people they can have a meaningful life while living with HIV. Dr Moffat at the Princess Marina hospital says that people delay confronting the truth to such an extent that some are brought in when it's already too late. Each day, a handful of patients will be brought into the Marina's waiting room on stretchers. Those who have waited so long are a significant drain on resources. Up to 10 healthy patients could be given drugs and counselling during the time needed to cope with one patient in intensive care. As the battle goes on, the international donor community and other African countries are watching closely to assess Botswana's success. Dr Howard Moffat is optimistic that the battle will eventually be won. The race to train more staff is already underway, with a medical school under construction in Gaborone and almost 1,000 health care workers having been trained at the Harvard AIDS Institute. But he is also conscious of the implications for the rest of Africa if Botswana - with all the money it has in relation to a relatively small population - cannot find a way to manage the virus. The government - one of the richest in Africa thanks to huge diamond resources - has set aside $70m a year to tackle the disease, while it has also won an unprecedented level of support from the private sector. (Source: BBC News 21 Nov.2003)


Alpha Conference Centre, Midrand, South Africa
The Southern African network on Equity in Health - EQUINET - is a net- work of institutions in Southern Africa who aim to develop and widen the conceptual understanding of equity in health; gather and analyse information and carry out research to support scientific debates and policy decisions on equity in health in Southern Africa; engage stake- holders in the health sector from regional to community level and in- fluence policies and agendas on health at national and regional level in Southern Africa, including at Southern African Development Community (SADC) level.
In September 2000 EQUINET will be holding a Regional Conference on Equity in Health outside Johannesburg, South Africa. The conference will gather people from research institutions, health policy makers and planners, health system managers, consumer groups and health profes- sional groups under the theme Building Alliances for Equity in Health.
The major theme areas for the conference will be:
* The status of equity in health in Southern Africa
* Macroeconomic policy and health
* Monitoring equity in health and triggers for planning
* Equity in resource allocation for health
* Equity in health service issues (human resources, private public sub- sidies, core services etc)
* Governance and participation in health systems
* AIDS and equity
* Building alliances for Equity in Health
The conference will include a mix of presentations on work and findings on equity in health in southern Africa, and interactive discussion on issues, policy and implementation proposals and research areas and methods arising. The working language of the conference will be Eng- lish. The conference aims also to outline future areas of work on equity in health in southern Africa and propose institutional mechanisms for tak- ing forward this work in Southern African, including through EQUINET. It also aims, through links with policy makers, media and internet to build an increased policy and public profile for equity in health in Southern Africa.
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