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REACH Trust Malawi Southern African Network on Equity in Health (EQUINET) World Health Organisation (WHO)

Monitoring equity in ART provision in the context of Health Systems

Meeting report: 29-30 August 2005
Lilongwe, Malawi

REACH Trust Malawi, Southern African Network on Equity in Health (EQUINET) and the World Health Organisation (WHO)

SARPN acknowledges the Training and Research Support Centre as the source of this document -
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Approximately 15 million adults and children in southern Africa are currently infected with HIV and an estimated 700, 000-1million currently have AIDS. HIV and AIDS have had, and continue to have, a deep impact on health and health equity issues in Southern Africa, imposing challenges in mounting a response to an epidemic that cuts across its economic, social and public health dimensions. As HIV and AIDS related mortality rates have fallen with new treatments available in high income countries, treatment access has become a central issue in the response to the HIV and AIDS epidemic even in developing countries. Treatment activism has opened a real window of opportunity for meeting rights of access to treatment and overcoming unjust barriers to ART (EQUINET, Ensuring universal treatment access through sustainable public health systems, Discussion Documents: Guiding Principles, February 2004).

A regional meeting (hosted by EQUINET/Oxfam working with SADC in February 2004) identified the need to monitor equity in access and health systems issues as critical to supporting visibility, policy dialogue and programme planning on these issues of equity and health system strengthening. EQUINET, through Training and Research Support Centre, carried out work to assess the existing monitoring taking place in relation to expanding ART coverage and contracted the Equi-TB Knowledge Programme – now REACH Trust - Malawi, to write a paper on the area of monitoring equity and health systems impacts of ART expansion at subnational and national level, with recommendations for regional level monitoring. Malawi was used as an example to illustrate which equity-related data are available or can be collected to measure equity in ART implementation, and their sources. In October 2004 a regional meeting of state, academic, and civil society representatives held in Malawi reviewed the policy commitments/ issues/ questions being monitored and proposed parameters for monitoring equity and health systems issues at national and regional level. The meeting also identified the follow up pilot work, training, and other measures to be taken to implement all or part of the system and roles in taking this forward.

WHO, EQUINET, REACH have developed a proposal to monitor equity and health system in ART expansion. This proposal aims to build working examples of equity and health systems monitoring and analysis at country level in southern Africa for country planning of health systems strengthening approaches to ART expansion. It aims to provide input to WHO and SADC regional reports to the Integrated Council of Ministers on equity and health systems outcomes in ART scale up.

The work conducted through the joint co-operation of EQUINET, WHO and the REACH Trust will:

  • test, build capacities for and produce reports on monitoring of equity and health systems strengthening in ART expansion and health sector responses to HIV and AIDS (development of country reports on equity in ART scale up and health systems strengthening that use pre-existing quantitative data)
  • develop and implement qualitative research projects to explore key questions that arise from the quantitative analysis. (identify and systematise the health systems elements that act as facilitators or barriers to equity in access to preventive and therapeutic services for HIV/AIDS control )
  • develop a risk exclusion index for vulnerable groups in ART access.
  • feed into the development of training materials and regional guidelines on equity in ART provision
  • promote dialogue on and use of the monitoring and evidence of barriers and facilitators at district, national, regional level to propose equitable health system development and ART policy and programme interventions and to inform WHO work and technical advice
  • promote dialogue around equity in ART provision and recommendations on interventions for strengthening health systems (at multiple levels - district, national, regional, SADC).
The work will also lead to the development of a training module on equity and health systems monitoring, that outlines how available monitoring evidence under unified national monitoring systems can be analysed to provide information for planning on equity in health systems outcomes in ART provision.

A regional meeting was therefore hosted by WHO, EQUINET and REACH Trust, to launch this initiative and put together a plan of action. The aim of the meeting was:

  • for all the different parties to meet each other;
  • to present the work that has led up to the proposal, the proposal and proposed terms of reference for REACH, EQUINET and WHO/EIP;
  • to present and discuss the Malawi equity report;
  • to agree the timetable to produce the quantitative reports for all partner countries;
  • to develop a strategy to identify and support qualitative researcher in all partner countries;
  • to agree the time table to produce the qualitative reports for all partner countries;
  • to discuss the proposal on Gender equity analysis – WHO;
  • to discuss the proposal on Health worker’s access to CT and ART - WHO; and
  • to finalise budgets for all partner countries.

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