Reclaiming the resources for health

Regional Network for Equity in Health in East and Southern Africa (EQUINET) Steering committee (2007), Reclaiming the Resources for Health – A regional analysis of equity in health in East and Southern Africa, EQUINET, Weaver Press, Zimbabwe, Fountain Publishers, Uganda, Jacana, South Africa, 228 pages.

The authors and one of the publishers of Reclaiming the Resources for Health – A regional analysis of equity in health in East and Southern Africa, EQUINET, are clear about their intention right from the onset. They write, “It is possible to learn from existing experiences in order to act.” This statement defines the book as one that stimulates social action and not some coffee table kind that one browses through while waiting for the doctor’s appointment or in a petrol or bread queue depending on which part of East and Southern Africa (ESA) one hails from.

Written by EQUINET’s steering committee (the acknowledgements section gives the names of the principal author and contributors), the book draws from a wealth of experience from this diverse and expert group. Most of the analysis comes from positions of authority and knowledge, backed by substantial research.

Reclaiming the Resources for Health is a critical resource book and a must read for policy makers and those working in equity in health in ESA countries such as civil society organisations (CSOs), faith-based organisations and community or grassroots level social actors.

Academics can also comprise another group that this publication will be of immense value to as the book pulls together sources that include work in progress by institutions working in health equity in ESA. The book refers to published reports, surveys, testimonials and experiences’ from communities, health workers, state and CSOs and country case studies and stories.

Comparative analysis of country case stories is critical to regional integration and economic development especially if ESA policymakers can learn from each other and replicate good practices in their own neighbourhoods. Such case stories feature in all sections of the publication together with other comparative information and data cited in the text.

For the social activist in health equity the book is a tool kit. It has all the ammunition one needs to understand the dynamics of health equity and captures important statistics in intelligent ways when presenting arguments. Furthermore, definitions of terminologies are beneficial to non-academics.

The media rarely covers the development story in detail and recently there has been renewed interest in highlighting issues such as poverty and its links to HIV and AIDS. Social determinants of poverty such as inequalities in wealth and limited provision of affordable and accessible health care and other social services are critical to fighting the pandemic.

Arguably health and citizen journalists will find the book a good source of information in understanding the multi-dimensional issues surrounding equity in health issues in ESA. Importantly also, after reading the book journalists will be able to critique international agreements by the International Monetary Fund, World Bank, World Trade Organisation and Economic Partnership Agreements in the context of health equity.

Reclaiming the resources for health refers to grey material that can be a good starting point for further academic research. In most instances, such material is difficult to access as it is mainly unpublished thus gathering dust in some offices. It provides the references used at the end of each section. Even from a cursory reading, consultation of wide sources is evident from the analysis and the book might meet the rigorous standards synonymous with social science and academic research.

Although produced in expensive full-colour format, the design is eye-catching with cartograms, charts, illustrations, maps, photographs, pull-quotations, tables, figures and statistics that make the book reader friendly. The index also provides a quick reference to information in the book.

Its seven sections, consisting 30-odd pages each, cover the entire spectrum of issues dealing with health equity and constitute the main theme of the book. A summary of key issues introduces each section thus providing the reader with a gist of the information and data. One can read a section as a stand-alone chapter or module because of the references at the end. This is useful to those interested in particular sections relevant to their work or adapting the book for training purposes.

Reclaiming the resources for health touches on key development issues that groupings such as the World Social Forum continue to grapple with. These include the negative impact of neo-liberal globalisation and structural adjustment policies; resource outflows caused by debt and unfair trade regimes promoted by the World Trade Organisation (WTO); difficulties in attaining Millennium Development Goals in the absence of equity; and most importantly building alternatives to the status quo by demanding more resources for health.

Abuja PLUS strategies mentioned in the book are an example of initiatives that can go a long way towards achieving equity. The strategies call for more resources for health, especially from debt cancellation, which governments can direct to primary health care. This is in addition to the fifteen per cent as stipulated in the Abuja agreement.

The book points out that inequalities put a brake on poverty reduction, and that absolute poverty is a challenge to health equity but that so too are the growing gaps between rich and poor. The publication identifies manifestations of poverty and its various forms. These include lack of income and productive resources sufficient to ensure sustainable livelihoods; hunger and malnutrition; and ill health; limited or lack of access to education and other basic services; increased morbidity and mortality from illness; and homelessness and inadequate housing. Social discrimination, exclusion and lack of popular participation in decision-making processes are additional impediments to achieving health equity.

The publication further amplifies the need for governments to grab opportunities for health equity such as those provided by WTO trade related intellectual property rights flexibilities in Doha agreement 2001 to produce affordable generic drugs especially antiretrovirals. Compulsory licensing by government allows for the production of drugs at reduced cost.

Reclaiming resources for health identifies the central role of health workers and calls for measures to arrest the brain drain especially migration to high-income countries. These include improving salaries and conditions of service inclusive of access to antiretroviral therapy and training for health workers.

The book advocates for people centred health systems. “When health systems are organised to involve and empower people, as people centred health systems they can create powerful constituencies to protect public interests in health.” (Page 172).

Reclaiming the resources for health identifies that the realisation of socio-economic rights in health equity requires not only resource-allocations but also accountability and commitment by ESA governments. The onus falls on the state not to only give lip service but fulfil policy or legally binding obligations.

Whilst some ESA countries are signatory to international instruments that promote health equity, others have adapted the obligations into their domestic law. However, limited resources affect the need for progressive realisation of economic and social rights in ESA countries. Additionally, although states are ultimately responsible as duty-bearers, non-state actors, notably the private sector and civil society organisations, also have a role in meeting citizens’ socio-economic needs.

The book also reviews achievements made so far since the regional meeting on ‘Equity in Health – Policies for survival in Southern Africa’ held in Kasane, Botswana in 1997. The meeting, which committed itself to regional networking and equity in health, formed the basis upon which EQUINET, the book’s author and publisher, came into existence.

EQUINET, which promotes knowledge and policy dialogue through social partners, clearly spells out its agenda in the book.

“Our concept of equity includes the power and ability people (social groups) have to direct resources to their health needs, particularly for those with worst health. This refers to people’s collective ability to assert their own needs and interests, influence the allocation of societal resources towards their needs, and challenge the distribution of power and resources that block their development.” (Page 211).

As mentioned earlier, the book does not only identify problems, it provides solutions in the form of alternatives and possible choices in reclaiming resources for health. The book lists three central points. The first one is that poor people should claim a fairer share of national resources. Secondly, there should be a return by east and southern Africa countries from the global economy. Thirdly, investments should be committed at global and national resources towards health systems. In return, such health systems should allocate resources to those with greater health needs.

In conclusion, one may easily say that EQUINET achieved its objectives in this book as the publication goes beyond assessing achievements made so far since Kasane 1997. It calls for an evaluation of strategies to achieve health equity by identifying what has worked out and what failed. In a sense, the publication is radical as it calls for social action, a proactive state and an alternative global economic order.

For more information on EQUINET you can visit To order a copy of the book contact [email][email protected] Alternatively contact one of the African co-publishers: Fountain publishers in east and central Africa ([email protected]); Jacana media in South Africa, Botswana, Swaziland and Lesotho ([email protected]; please note if you are a non profit organisation) and Weaver press for all other countries ([email protected])

* Elijah Chiwota works with MWENGO, Zimbabwe