Health equity, not a pipe dream:EQUINET
The Regional Network for Equity in Health in East and Southern Africa (EQUINET) has called for collective agency and action that embeds equity values in the region to promote health, amid deeply-rooted multiple challenges that are widening the gaps between rich and poor.
The four-day EQUINET conference in 2022 (with session videos available on the EQUINET site) was held under the theme ‘Catalysing change for equity and social justice in health’.
During the conference delegates raised calls for collaborative efforts between states, professionals and communities to tackle the harmful commercial practices, driving underfunding, privatisation of public sector services and the promotion of profit over people that undermine health and wellbeing for the majority.
While delegates noted strides made to improve comprehensive primary health care and the role public sector health services played in responding to the COVID-19 pandemic, participants raised alarm on the unbridled extraction of natural and financial resources, worsening environmental, economic and social conditions and food security, including for the future wellbeing of young people in the region.
“We will expose harms, inequities, rights violations and health and disease consequences in current experience, and future wellbeing risks, including: the harms caused by extractive industries depleting our resources for health and driving climate injustice,” delegates resolved at the EQUINET conference.
Delegates agreed that communities are drivers of change.
Building collective agency in communities will champion access to food and health care and healthy cities. This calls for constitutional and legal provisions that protect these rights in all countries in the region.
To promote these rights, delegates resolved to promote actions to widen health literacy and social pressure for the critical role of adequate and progressively funded public sector services.
Delegates also called for, “fair allocation for comprehensive primary health care oriented, universal, equitable, socially accountable public sector health, social and essential services, including in pandemics.”
Given the health and environmental consequences of global policies and commercial practices, conference delegates, including those from trade unions and communities, proposed to actively research, monitor and engage on the ill-health “caused by extractive industries depleting our resources for health and driving climate injustice”, and to gather and share evidence to advocate for local production of medicines, vaccines and other technologies essential for health (EHPs).
Given the transnational nature of many of the corporations in the extractive sectors, and the global nature of many policies affecting the region, the conference also resolved to develop, sustain and work with pro-equity networks and alliances for action within and across countries in ESA region, and to engage with other regions.
Focus on issues affecting health equity
With the four days of the conference bringing to light several key issues affecting health equity and justice, EQUINET resolved to promote the updating and implementation of laws in the region that protect the right to health, including in in national constitutions.
Conference delegates noted the need for a range of areas of reform of law and practice, including : “Public interest national law reform, harmonised regional standards on and improved monitoring, inspection and enforcement of standards in commercial practices, extractive industries, in private sector health services”.
Delegates also raised the need to update laws regulating food risks, waste management and water pollution, given their impact on promoting healthy lives.
Research presented at the conference into Africa’s trade in pharmaceuticals showed that most medicines used in the region are imported, such as from Europe, India or China, with limited local production concentrated in only a few 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 , Kenya, Uganda and Zimbabwe.
The COVID-19 pandemic has increased demand for essential health products.
The proposals at the World Trade Organisation (WTO) to lift intellectual property barriers to local production of medicines, vaccines, test kits and other equipment for the pandemic thus had unified support from African countries.
While the WTO outcome in June 2022 was less than what was proposed or needed, EQUINET conference delegates urged for sustained engagement and: “Domestic government investment in research and development at higher learning institutions and in local producers and civil society to promote local innovation, demonstration, production, and expansion of EHPs and health promoting technologies”.
ESA countries have lagged behind in allocating enough resources towards public sector health care. Conference delegates heard how the COVID-19 pandemic showed the social and economic costs of underfunding public health services both to prevent and treat COVID-19, including for other areas of care. do not
EQUINET resolved to track and push for health financing targets to be met, including the allocation of domestic financing for health systems equivalent to 5% of GDP and meeting the Abuja commitment of 15% government spending on health.
Delegates also pointed to the need to ensure that out of pocket spending due to fee charges at services does not rise above 20% of total health spending, given the impact that excessive demand for fee charges has on household poverty.
While funding for health care was noted to call for progressive taxes and tariffs in countries, delegates also raised the need to reform an unfair tax system at global level to meet the funding gap for public sector health services.
African leaderships raised this in promoting a successful resolution in December 2022 at the United Nations (UN) for policy dialogue on transnational taxes to take place in the UN.
In support of this, EQUINET conference delegates called for “National efforts to boost domestic revenue capacities, to avoid tax competition and expand wealth and progressive tax revenues, to increase barriers to illicit financial outflows, to assess and engage on global rules, systems and conditionalities that undermine public sector revenues and their equitable use, including to support the tax justice movements and African finance ministers’ negotiations for a fairer global tax system”.
Changing the narrative
Delegates at the conference underscored the need for organisations in the region to work together to reclaim health resources and to change the profile of and narrative on health equity in ESA countries.
While state action was seen to be essential to address inequalities and public sector services essential to reach the low income majority in ESA countries, delegates recognised that a negative social view has grown around poor quality and unreliable public services.
The conference resolved to provide evidence to show the critical role of the public sector for equity and to build a ‘pro-public’ discourse to generate societal and political support for this role for wellbeing. At the same time, delegates also resolved to strengthen actions to advocate for and monitor the resourcing and quality of these services.
“We will expose which communities and population groups in our region and in our countries bear the consequences of deficits in policies, laws and resources that impact on healthy living conditions – with particular concern for the deficits in, and drivers of health and wellbeing in youth, migrant and cross-border populations and marginalized communities”.
With many organisations and professionals in EQUINET working in research and in community health systems, delegates indicated that they would better co-ordinate to generate and promote evidence, and to ensure community voice in research, including through community monitoring, photo voice, and participatory research. ..
The conference delegates came from a range of institutions, disciplines and sectors that have a role to play in health. In their resolutions, delegates recognised the need to engage beyond the health sector to promote health equity and to invest in young people to protect their future health.
Delegates resolved to “Bring our views into new platforms, such as those on eco-social justice, climate justice, tax justice, and strengthen alliances in the region and continent with others with shared values”.
The resolutions present a demanding agenda of work, but one seen to be needed “at a time of deep-seated and multiple crises that have decimated the basic foundations for provision of public goods (the state, resources and collective agency) in our region, with the poor and marginalised communities left behind to shoulder the burden”.
Additional Editing by Dr Rene Loewenson