How equitable is the scaling up of HIV service provision in South Africa?

OBJECTIVES. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS. There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION. The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness

How equitable is the scaling up of HIV service provision in South Africa?

Objectives. To assess the extent of inequalities in availability and utilisation of HIV services across  South Africa.Design. Cross-sectional descriptive study.Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV  infection, were purposively sampled.Outcome measures. Availability and utilisation of HIV services and management and support  structures for programmes were assessed through the collection of secondary data supplemented by site visits.Results. There were marked inequalities in service delivery between the three sites. Compared with  two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v.9  and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the  other 2 sites.Conclusion. The process of scaling up of HIV services seems to be accentuating inequalities. The  urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been u':lable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness

Global equity gauge alliance: reflections on early experiences

The paper traces the evolution and working of the Global Equity Gauge Alliance (GEGA) and its efforts to promote health equity. GEGA places health equity squarely within a larger framework of social justice, linking findings on socioeconomic and health inequalities with differentials in power, wealth, and prestige in society. The Alliance's 11 country-level partners, called Equity Gauges, share a common action-based vision and framework called the Equity Gauge Strategy. An Equity Gauge seeks to reduce health inequities through three broad spheres of action, referred to as the 'pillars' of the Equity Gauge Strategy, which define a set of interconnected and overlapping actions. Measuring and tracking the inequalities and interpreting their ethical import are pursued through the Assessment and Monitoring pillar. This information provides an evidence base that can be used in strategic ways for influencing policy-makers through actions in the Advocacy pillar and for supporting grassroots groups and civil society through actions in the Community Empowerment pillar. The paper provides examples of strategies for promoting pro-equity policy and social change and reviews experiences and lessons, both in terms of technical success of interventions and in relation to the conceptual development and refinement of the Equity Gauge Strategy and overall direction of the Alliance. To become most effective in furthering health equity at both national and global levels, the Alliance must now reach out to and involve a wider range of organizations, groups, and actors at both national and international levels. Sustainability of this promising experiment depends, in part, on adequate resources but also on the ability to attract and develop talented leadership.0000-0001-7305-85940000-0003-3258-28370000-0003-1094-7655650742145

HIV/AIDS and health sector responses in South Africa : treatment access and equity; balancing the act

Produced in co-operation with Oxfam G

Human Resources for Health Research (HR-HR) : an African Perspective - Conference; final report and record of expert consultations, Nairobi, July 2006

A cross-disciplinary group of experts looked at how improved research skills and practices in health research can increase the effectiveness of research for health. The initiative goes beyond the need for high-level researcher capabilities, to better understand all human resources required to make health research work in Africa. The emphasis is on translating research into action, and specifically how networks can help achieve this. Expert consultations were held in four HR-HR themes: the Health Research environment; how networks can improve health research; communities and their role in shaping health research agendas; communication and Knowledge Translation approaches to improve effectiveness of health research