Health policy

WORLD HEALTH DAY

Rich-Poor Gap in Care Persists More than one billion people worldwide are not getting essential health care, according to a report by the Population Reference Bureau (PRB), which calls for international donors to focus more on closing the growing health gap between the world's wealthy nations and its poorest. The 32-page report, 'Improving the Health of the World's Poorest People', finds that per capita health spending in the world's least developed countries, most of them in sub-Saharan Africa and South Asia, comes to only about 11 U.S. dollars a year. To download see http://www.prb.org (438KB)

PRESS RELEASE: NEW CEO FOR LEADING HEALTH NGO

The Health Systems Trust (HST) announced today that Dr Lilian Dudley has been appointed Chief Executive Officer of the organisation. Making the announcement, Chairperson of the HST board, Mr Patrick Masobe said, we are delighted to have somebody of Dr Dudleys professional standing and calibre to lead the organisation.

Questionable assumptions - why health sector reforms have failed to deliver in Kenya

he Kenyan government is committed to providing health services to all its citizens. But despite major health sector reforms, the population’s health status is falling. Researchers from the Tropical Institute of Community Health and Development, Kisumu, Kenya, explore the reasons for this lack of success.

Call for Applicants: Research Grants/Awards Equity in the Distribution of Health Personnel

The Regional Network for Equity in Health in Southern Africa (EQUINET) and Health Systems Trust South Africa (HST) are inviting expressions of interest from individuals or organisations based within the region to contribute to a programme of work on Equity in the Distribution of Personnel in Southern Africa. Equinet is a network of research and advocacy organizations that have a specific concern for equity in health issues based within the SADC region (see www.equinetafrica.org or email admin@equinetafrica.org). This call closes on March 12th 2004 Objectives of programme ----------------------- The programme seeks to promote the equitable distribution of health personnel in southern Africa through: o Exploring, reviewing and harmonising where relevant policy tools for enhancing health equity in personnel distribution in southern Africa o Analysing and identifying mechanisms for strengthening governance arrangements and industrial relations systems for managing negotiations and policy interactions health professional associations and health unions and state authorities on health personnel issues o Facilitating and informing dialogue on policy options for dealing with attrition of health personnel from southern Africa to selected high income countries. The work is supported by an advisory panel of senior personnel working on Human Resources for Health (HRH) in Southern Africa and internationally. Summary of Areas for further Research, Analysis and Advocacy ---------------------------------------------- The background review identified issues for further research, analysis and advocacy that would guide future work. This does not exclude other priorities that are raised and jusitifed in the response to the call. Production of Health Personnel „h Mapping of the burdens of health personnel losses across the region in relation to the capacity to produce and replace personnel. „h Assessment of the appropriate and most effective mix of personnel and the implications for personnel production „h Impact of migration on the quality and output of training institutions. „h Analysis of the merits of various student recruitment initiatives designed to improve the distribution of health personnel Availability and Distribution „h Accurate information on health personnel distribution and movements across private, public and traditional sectors „h Cost-benefit evaluation of the losses and gains of current flows to health workers, to communities, to health systems and to countries „h Evaluation and analysis of information systems and planning capacities within public health authorities „h Mapping of relationship between resource allocation inequalities and capacity to demand and use resources „h Exploration of the role of traditional health personnel in mitigating gaps in western health services Movement and Migration „h Accurate information on the directions and volumes of health personnel movement and their determinants within each of the southern Africa countries, their impact on equity and performance of health services „h Comprehensive indicators reflecting the consequence of the drain on health within each of the Southern African countries „h Mapping of the specific factors affecting internal and external movements and the extent to which they are linked with wider between- and out-of-country flows „h Further exploration of the regional health personnel brain drain, particularly by skills group „h Study of the replicability of the often unique pull and stay factors within missions to the wider health system Field of work --------------- The programme includes: „« Call for and submissions for research and national activities on equity in health personnel in southern Africa „« A three day review meeting from April 15th to 17th 2004 to review the analysis of HRH issues, draw inputs from policy, research and health worker platforms, review of the proposed research and set the research and programme priorities for the HRH programme „« Support of accepted research proposals and implementation of research studies „« Peer review by the advisory panel of the research reports and publication in a as a discussion paper series „« National and regional meetings and consultations to review findings and identify follow up policy or programme issues „« A follow up regional meeting in mid 2005 to present and review the policy and programme implications and to build alliances towards their implementation, including with international research and policy networks on HRH (UK, Australia and Canada). Successful applicants for involvement in this programme of work will be required to: „h Submit an expression of interest in the format below by March 12 2004 „h Attend the regional meeting in April 2004 in South Africa „h Finalise their protocol for a study on a relevant aspect of equity in HRH in southern Africa by end of May 7th 2004 and be ready to begin implementing their study shortly after this „h Present their study at an Equinet /HST Regional meeting in mid 2005 The total funding available to each successful study will be agreed on with EQUINET/HST Submission procedures for expressions of interest Interested applicants should submit a 1-2 page ¡¥expression of interest¡¦ concept note, a personal CV, and a sample document written by the applicant on any relevant theme. The concept note should include information on: „h A potential topic of focus, with justification for the research and its potential use at local, national, regional or international level „h The applicant¡¦s interest in the topic and in the broad field of work in HRH; „h The applicant¡¦s key experiences and skills that have relevance to this work. Applicants should submit this information by 12th March 2004 to ant@hst.org.za or by Fax to 2731-304-0775 (attention A Ntuli). Applicants will be informed by 2nd April 2004 if they have been successful. Successful applicants will be invited to attend the regional workshop to be held in Johannesburg between 15th and 17th April 2004 (with full funding from Equinet). Applicants must, therefore, be available to attend this workshop. Participants of existing Equinet programmes are welcome to apply. Co-ordination and queries ------------------------- The programme of work will be co-ordinated on behalf of Equinet/HST by Antoinette Ntuli of Health Systems Trust, Durban, South Africa. For any queries about the programme please contact her at ant@hst.org.za. For general queries on Equinet please email the co-ordinator at admin@equinetafrica.org or visit the Equinet website (www.equinetafrica.org)

State health plan shock for medical aid funds

Government is investigating a proposal to create a single compulsory medical aid scheme for its 1,1-million employees, which would have major implications for the healthcare sector and the medical aid industry. Private medical aid funds would potentially lose thousands of their members while medical aid brokers, who rely on state employees as a major source of their commission income, would be forced to find new markets. Also, a significant shift of medical aid funding from the private health sector to public hospitals and clinics would occur, as the scheme would be structured in a manner to make optimal use of the public health sector. An interdepartmental task team has been investigating the proposals, and final research by outside experts is under way. The public service and administration department is expected to finalise its recommendations for submission to the cabinet later this year and, if accepted, it will enter into negotiations with trade unions in the hope of implementing the plan from next year. High-income employees, who would be forced to leave their chosen private medical aid to join the state scheme, have already expressed resistance. Details of the proposals were presented yesterday by the department's chief negotiator and senior manager of labour relations and negotiations, Kenny Govender, to Parliament's public service and administration portfolio committee. About 400 000 of all government employees and their families have no medical aid cover because they cannot afford it. The rest belong to 61 private sector funds of their own choice, to which the government as employer pays a contribution. Govender said uncovered employees posed a financial risk to government, which never knew when these employees would take on medical cover, at which point government would have to start making contributions. The continual rise in private medical aid costs was also a drain on government and had to be contained. (Source: Linda Ensor: Business Day, 28 January 2004) Link \//\ HEALTH INSURANCE AND THE POOR IN LOW INCOME COUNTRIES http://www.hospitalmanagement.net/ihfdocs/health_insurance_in_low_income... Government is investigating a proposal to create a single compulsory medical aid scheme for its 1,1-million employees, which would have major implications for the healthcare sector and the medical aid industry. Private medical aid funds would potentially lose thousands of their members while medical aid brokers, who rely on state employees as a major source of their commission income, would be forced to find new markets. Also, a significant shift of medical aid funding from the private health sector to public hospitals and clinics would occur, as the scheme would be structured in a manner to make optimal use of the public health sector. An interdepartmental task team has been investigating the proposals, and final research by outside experts is under way. The public service and administration department is expected to finalise its recommendations for submission to the cabinet later this year and, if accepted, it will enter into negotiations with trade unions in the hope of implementing the plan from next year. High-income employees, who would be forced to leave their chosen private medical aid to join the state scheme, have already expressed resistance. Details of the proposals were presented yesterday by the department's chief negotiator and senior manager of labour relations and negotiations, Kenny Govender, to Parliament's public service and administration portfolio committee. About 400 000 of all government employees and their families have no medical aid cover because they cannot afford it. The rest belong to 61 private sector funds of their own choice, to which the government as employer pays a contribution. Govender said uncovered employees posed a financial risk to government, which never knew when these employees would take on medical cover, at which point government would have to start making contributions. The continual rise in private medical aid costs was also a drain on government and had to be contained. (Source: Linda Ensor: Business Day, 28 January 2004) Link \//\ HEALTH INSURANCE AND THE POOR IN LOW INCOME COUNTRIES http://www.hospitalmanagement.net/ihfdocs/health_insurance_in_low_income...

Tax breaks on medical aid contributions may remain

The advisory team set up by the health department to look at reforming tax breaks on medical scheme contributions has recommended not scrapping these subsidies as was widely expected and instead wants employees to pay an income-based levy as part of their medical scheme contributions. The team chairman, former Medscheme CEO Anton Roux, said the team was concerned that changes to the tax breaks enjoyed by employers who paid medical scheme contributions might discourage them from providing medical cover for their workers. The proposed levy would be used to fund the difference in cost between providing a basic basket of healthcare (called the prescribed minimum benefits) in the public and private sector. It was expected that the reforms would help lower the price of medical scheme contributions and enable low-income workers who use state hospitals and clinics to buy their own health insurance. The present system was inherently unfair, said Roux, as only high-income earners enjoyed much larger tax breaks on their medical scheme contributions. The effect was that the rich got a much larger health subsidy from government than the poor. The team's recommendations were the culmination of six months of industry-wide consultation with employers and medical schemes. The work was conducted in tandem with a team looking into setting up a Risk Equalisation Fund to share risk between medical schemes. The two teams had published their reports, which were to be scrutinised by an international team of experts at the end of this month, before being finalised by the department. Government hoped the reforms would not only make medical aid more affordable and attract new members, but would also stabilise the industry and make the overall the healthcare system more equitable. The fund's team recommended that government start a new risk-sharing system next year, which would do away with some of the advantages enjoyed by medical schemes with a high proportion of young members, who were generally healthy and therefore low risk and cheap to service. At the moment, people who belonged to schemes with an older age profile frequently paid higher monthly contributions for the same cover as people who belonged to a scheme with a younger profile, said the fund team chairwoman Heather McLeod, director of the Centre for Actuarial Research at the University of Cape Town. It's grossly unfair that if your employer puts you into a scheme with an older profile you pay so much more for the same benefit, she said. Under the proposed fund, schemes would be subsidised for their risk profile, based on a calculation involving the age of its members, and the number of members with chronic diseases, HIV/AIDS, and pregnancy. Schemes with many young and healthy members would pay into the fund, and those with older, sicker members would be paid out from the fund, helping drive down monthly contributions. McLeod said the fund would only cover HIV/AIDS, the prescribed minimum benefits, and deliveries. (Source : Business Day, 14 January 2004).

About Health Systems Trust

Health Systems Trust (HST) is a dynamic not-for-profit organisation (NPO) established in 1992 to support the transformation of the health system in a new democratic South Africa. Subscribing to a primary health care approach, HST actively supports current and future development of a comprehensive health system, through strategies designed to promote equity and efficiency in health and health care delivery in southern Africa. 

Our Vision
“Health systems supporting health for all in southern Africa.”

Recruiting doctors from poor countries: the great brain robbery?

An enormous gap in health staffing exists between the United Kingdom and India. India has fewer than 3000 psychiatrists for its one billion population compared with one psychiatrist for every 9000 people in the United Kingdom, a 27-fold difference.1 Despite this inequality, the NHS has launched a scheme to recruit senior psychiatrists and other specialists from India and other developing countries. This scheme will worsen the brain drain and inequities in global health unless it is explicitly linked with measures to enable the flow of doctors back to developing countries. Opportunities or opportunism? Overseas recruitment schemes are marketed primarily as an opportunity for doctors to experience one of the world's best healthcare systems. Yet it is obvious that the NHS is trying to fill jobs in specialties where there is a shortage of staff. Although shortages are acknowledged in the promotional material for the new NHS international fellowship scheme, the difficulties that doctors will face when they attempt to return home are ignored. Experience with previous schemes, such as the overseas doctors' training scheme, suggests that few doctors returned to their home countries. Indeed, when I finished my training in psychiatry in the United Kingdom in 1992, I found that few routes were available to facilitate my return to India.2 My work in developing countries over the past decade has been entirely funded by research grants, mainly from the Wellcome Trust. Recruitment is being promoted using the obvious advantages the NHS has over employers in developing countries. The code of practice for international recruitment explicitly states that there should be no NHS advertising in developing countries unless that country has specifically invited the UK to undertake a recruitment programme and that recruitment should only be undertaken as part of an inter-governmental cooperation agreement... encouraging the exchange of healthcare personnel, healthcare information, and guidelines.5 The promotional material for the scheme does not indicate that either condition has been met.4 Summary points * The developing world has fewer doctors per population than developed countries * Schemes to recruit doctors from developing countries risk damaging their fragile health systems * Working and training in another country provides valuable experience * Partnerships between institutions in developed and developing countries are needed to encourage doctors to return * Institutions in developed countries need to reform to provide more rewarding professional environments Ultimately, all concerned parties need to define the obligations and responsibilities of institutions in rich and developing countries. Unless these steps are taken urgently, the brain drain will continue to fuel the huge inequities in global health. (Source: Vikram Patel, senior lecturer, London School of Hygiene and Tropical Medicine, London WC1E 7HT BMJ 2003;327:926-928,18 October) //\//Links letters in response to this article yielded some very valid points on both sides of the argument: http://bmj.bmjjournals.com/current.shtml#LETTERS Various discussions and opinions have followed to this article from all over the world on the email discussion list Afro-Nets, See 'Recruiting doctors from poor countries' Information and archives: http://www.afronets.org Brain drain and health professionals. Tikki Pang, Mary Ann Lansang, Andy Haines. BMJ vol 324, 2 March 2002. Medical migration: who are the real losers? Peter Bundred, Cheryl Levitt. The Lancet, vol 356, July 15, 2000 Trade in health services. Rupa Chanda. Bulletin of the WHO, 2002, 80 (2).