Equal access to health, more important than ever: EQUINET

Nyasha Chingono

WHILE it remains difficult to achieve equity in all its forms, it is both essential and possible to tackle the growing inequalities affecting health, Dr Rene Loewenson, director of the Training and Research Support Centre in EQUINET has said.

Loewenson maintains the next decade will be crucial to achieve this feat.

The recently held Conference of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) first day on ‘Reclaiming the Resources for Health’ revealed the deep need for a robust approach to ensure equal access to health products.

The conference revealed the need to improve access to the living conditions and promote healthier local food and production systems to tackle longstanding deprivation.

Although challenges have persisted in tackling equity, including from the COVID-19 pandemic, gains have been registered and can be built on, delegates agreed.

Opening speakers from the East Central and Southern African Health Community, from the World Health Organisation and from the Southern African Co-ordination Council said there is both demand and opportunity to act on inequalities on health.

“We are not here to describe the problems but we are here to share experiences of self determination and alliance action,” Loewenson said.

Since 1998, EQUINET has worked as a catalyst to advancing health equity among 16 countries of eastern and southern Africa, with its work mainly supporting and nourishing networks across the continent.

From contesting structural adjustment programmes, in the early 90s, EQUINET has been consistent in advocating for social justice in health.

“While our values have been consistent throughout this period, we have responded to growing strategic priorities within the three areas articulated in this conference, ‘Reclaiming the Resources for Health’, ‘Reclaiming the state’ and ‘Reclaiming collective agency and solidarity’. And while we seek to attain the highest attainable standard of health as a standard for all people in our region, we also recognize that we cannot do this at the cost of the degradation of our environment and that we need to respect and protect nature for our long term wellbeing,” Loewenson said.

She maintains that the next decade was pivotal if Africa is to attain equity in health.

“This is a pivotal decade. If we don’t tackle the multiple crises we face, whether in relation to climate, to ecological degradation in relation to pandemics, to energy crises, to food crises, inflation, cutting across these crises-the inhuman inequalities cutting across countries,” she added, “We do not only risk wellbeing, we actually risk the very survival of humanity.”

Health Inequality in ESA countries 

Eastern and Southern African (ESA) countries have faced an onslaught on public goods and services, with the attainment of basic health services remaining acute for most members.

The Covid-19 pandemic that swept across the world early 2020, did not spare ESA countries, most of whom were caught unprepared.

With many countries’ health systems facing headwinds on basic provisions like medicines and equipment, the pandemic exposed deep inequalities.

As the pandemic ravaged, the shortages of and inequalities in access to oxygen, ventilators, medications and personal protective equipment, became more apparent, with a growing gap between rich and poor countries.

Vaccine hoarding by richer countries, at the expense of Africa left the continent scrounging for the ‘leftovers’.

Rangarirai Machemedze of the Southern and East African Negotiations Institution (SEATINI) in EQUINET weighed in on the challenges faced.

“For over three decades, ESA countries have faced an onslaught on public goods and services, aided by multilateral and bilateral trade rules legitimized through the IMF and World Bank. The health equity imbalance has manifested through various means, including but not limited to speculative financial activities and the commodification of everything, including biodiversity. Widespread inequalities to the provision of basic services,” Machemedze said.

He however said ESA countries had made progress to rebuild public health services to narrow the gap between the rich and the poor.

“Notwithstanding these challenges, ESA countries through various state and non-state actors made tremendous progress towards reclaiming the policy space to rebuild public infrastructure and provide services essential for public health. We now have institutions in ESA countries that recognize the right to life and the health that supersedes all the other rights,” Machemedze said.

“These rights open up the space for us to mobilize for and secure the resources to secure these rights.” Machemedze added.

Local production of essential health products, more critical than ever

Closely tied to the growing inequalities, is Africa’s overreliance on foreign countries for technology and health equipment, as key resources for health.

Machemedze said Covid-19 pandemic made clearer the need for local production of essential health products such as vaccines, medical equipment and medicines, to ensure equity and self- determination.

“Africa continues to rely on other continents for the procurement of Essential Health Products (EHP): medicines, vaccines, therapeutics, diagnostics, PPE,” he said.

This, he said, impacted access to and raising costs of these EHPs, calling for local production of such essential supplies.

“Our work in EQUINET has aimed to Investigate and present evidence for policy dialogue on equitable access to EHPs through progress in local production capacities,” he said.

Research into Africa’s trade in pharmaceuticals showed that most African pharmaceuticals are imported, most from EU, India or China, with few exports from African countries.

Mapping ESA countries’ pharmaceutical manufacturers made a grim reading into the region’s inability to produce home grown essential health products.

Only a few countries in the region have local manufacturers, most in South Africa with between 80-100 pharmaceutical companies, Kenya 30-40, and Uganda and Zimbabwe with nine and seven respectively.

Machemedze admitted that the Covid-19 pandemic had increased demand for essential health products.

“PPE and medical device shortfalls during COVID-19 showed weaknesses in dependence on imports,” he added.

Apart from PPE, Africa’s demand for oxygen and ventilators surged, while supply remained critical.

With the challenges posed by the pandemic, despite the deficit between what was expected in the TRIPS Waiver negotiations on lifting barriers to local production and what was achieved in June, he said that calls for equitable distribution of health products will continue to grow, now and in the face of future pandemics.

“We are contributing evidence and advocacy for African global engagement at WHO and WTO to treat EHPs as global public goods, and to remove obstacles to access and distributed production of all EHPs.”

Harmonizing regional health standards for the extractive sector in east and southern Africa

The conference also touched on other areas of action to reclaim the resources for health.

Of importance, is the increased global trade in minerals, much of which is from African countries, and the engagement on improved health standards in extractives.

Most ESA countries are richly endowed with a range of mineral reserves and are home to Extractive industries (EIs) that extract these raw materials – minerals, oil and gas- from the earth through mining, dredging and quarrying-with resources taken from the region generating transnational company wealth, such as in the cadmium used in smartphones, while workers and surrounding communities do not fairly benefit from this wealth.

EQUINET in collaboration with several trade unions and other organisations in the region is advocating for mining that not only protects environments but also improves the social wellbeing of communities in and living around the mines and more widely, and that does not impose costs in the future.

In an EQUINET presentation, Nathan Banda of the Southern African Trade Union Co-ordination Council said: “Escalating resource extraction from ESA depletes ecosystems, public sector capacities, social wellbeing and costs our future The largest burden falls on poorest workers, communities, youth and future generations.”

Union networks in EQUINET have thus called for authorities to implement health impact assessments with local community involvement before giving licenses, for mines to promote public health in accordance with both national laws and international standards, and to not leave a legacy of ill health after closing that falls on poor communities and public health services.

“We need to ensure and invest in non-polluting, inclusive economies, in infrastructures, in technologies that prioritize fair and shared local benefit, in beneficiation and decent job creation; and in protection of ecosystems and indigenous species and knowledge,” Banda said.

The conference heard the negotiations and efforts underway by ‘watchdog’ organisations in the region to monitor and engage on these rights and duties, linking workers on mines with communities surrounding mines and with ex-mineworkers experiencing chronic diseases from work in mines.

The EQUINET Conference, with the overall theme of ‘Catalyzing change for health and social justice” continues with its second day on the theme of “Reclaiming the State” in September.