A step too far? Making health equity interventions in Namibia more sufficient

BACKGROUND: Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries also. Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. METHODS: A framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. RESULTS: In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. CONCLUSION: The goal of equality of health status may not be appropriate in many developing country situations. A stepwise approach based on progressive redistribution of medical services and resources may be more appropriate. This conclusion challenges the views of health economists who emphasise the need to select a single health equality goal and of development agencies which stress that equality of health status is the most important dimension of health equity

Process and impact evaluation of the Greater Christchurch Urban Development Strategy Health Impact Assessment

<p>Abstract</p> <p>Background</p> <p>despite health impact assessment (HIA) being increasingly widely used internationally, fundamental questions about its impact on decision-making, implementation and practices remain. In 2005 a collaboration between public health and local government authorities performed an HIA on the Christchurch Urban Development Strategy Options paper in New Zealand. The findings of this were incorporated into the Greater Christchurch Urban Development Strategy;</p> <p>Methods</p> <p>using multiple qualitative methodologies including key informant interviews, focus groups and questionnaires, this study performs process and impact evaluations of the Christchurch HIA including evaluation of costs and resource use;</p> <p>Results</p> <p>the evaluation found that the HIA had demonstrable direct impacts on planning and implementation of the final Urban Development Strategy as well as indirect impacts on understandings and ways of working within and between organisations. It also points out future directions and ways of working in this successful collaboration between public health and local government authorities. It summarises the modest resource use and discusses the important role HIA can play in urban planning with intersectoral collaboration and enhanced relationships as both catalysts and outcomes of the HIA process;</p> <p>Conclusion</p> <p>as one of the few evaluations of HIA that have been published to date, this paper makes a substantial contribution to the literature on the impact, utility and effectiveness of HIA.</p

Saharawi women and their voices as political representatives abroad

The UN Security Council Resolution 1325 on Women, Peace and Security, invites all members States to introduce gender perspective in framing the re-building of post-conflict nations. The Resolution, stresses the importance to increase women's participation in all aspects of conflict prevention and peace keeping processes. This article looks at gender mainstreaming practices in political representation abroad introduced by the government-in-exile of the self-proclaimed Saharawi Arab Democratic Republic (SADR). Since Spain withdrew its colonial power from the Western Sahara's territory, and Morocco began its occupation, Saharawi men and women have been recruited by the liberation movement Polisario, as foreign representatives abroad. The National Union of Saharawi Women and the women's involvement in the camps' administration have been regarded by scholars and international observers as a distinctive feature of the SADR. In this paper, an ethnographical approach is used to look at Saharawi political representatives in Italy and Australia to examine whether a balanced gender representation in foreign representation can enhance interaction with international supporters. This study shows that women's participation in foreign representative's roles, especially in post-conflict scenarios, can improve third parties understanding of societal, cultural and religious differences of the country represented abroad. Hence, countries coming from post-conflict turmoil could benefit of greater international support if the participation of women could help overcome societal differences