Equinet; Governance And Equity Programme
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Equinet Multi-country Programme:
Impacts of governance mechanisms and participation on integrating
community preferences in planning and equity in resource allocation
Co-ordinated by Training and Research Support Centre (Zimbabwe)
Chessore (Zambia) October 2001
1. BACKGROUND
During the first phase of EQUINET supported research activities, work
was carried out to critically evaluate current and desired forms of
participation within health systems as perceived by communities, tra-
ditional, civil and elected leaders and health providers and as le-
gally and institutionally defined. TARSC (Zimbabwe and WHO (AFRO)
hosted a meeting on participation in health that drew information
from a range of research and intervention programmes taking place in
southern Africa on participation and health and identified policy,
action and research implications for further strengthening participa-
tion and accountability of southern African health systems.
The September EQUINET conference endorsed this work, and followed by
the January 2001 Steering Committee meeting, identified some impor-
tant areas for follow up work in the next phase to deepen the work
done to date, develop stringer networking between countries on these
issues and build stringer understanding of the role of participation
in planning and resource allocation in health systems. Specific work
proposed included:
-Developing tools and materials, including guidelines to PRA methods
for obtaining and organising community inputs; tools for integrating
health evidence and with community; tools for community monitoring of
quality of care; guidelines, norms and standards relating to partici-
patory structures and their functioning; and training materials for
health workers and communities on participation and health.
-Developing skills / capacity, particularly in district health teams
and community members.
-Carrying out research to assess the impact of governance mechanisms
that strengthen participation in the integration of community prefer-
ences in health planning, and in mobilisation and allocation of
health sector resources for low-income communities and for primary
health care and public health priorities
It was agreed that this work be coordinated, and technical support
provided, by Training and Research Support Centre Zimbabwe
(Dr R Loewenson) in co-operation with CHESSORE Zambia (T J Ngulube).
2. PROPOSED WORK FOR 2002/2003
In the EQUINET second phase proposal funding was thus sought for work
to disseminate the study findings and methodological tools used to
date on participation, governance and integration of community pref-
erences in health system planning to other countries in the region
and to undertake further studies in several SADC countries (at this
stage, these countries are likely to be Zambia, Tanzania, Mozambique,
Malawi, Zimbabwe and South Africa).
To achieve this the proposed programme for 2002- 2003 includes:
a.A moderated workshop with participants from Malawi, Mozambique,
Tanzania, South Africa, Zambia and Zimbabwe to review the current
evidence and tools for researching and strengthening governance
mechanisms in health planning (particularly in relation to their im-
pact on resource allocation and integrating community preferences in
health planning); to frame appropriate hypotheses and methods for
follow up research work at country and regional level;
b.Research in at least four countries (at least three of which will
be funded through EQUINET) on the impact of participation in govern-
ance mechanisms for health on resource mobilisation, integration of
community preferences in health planning and equitable resource allo-
cation.
It was proposed that this research incorporate planned and funded
work in Mozambique, build on current work at health centre and dis-
trict level in rural and urban Zimbabwe and Zambia on the role of
health centre committees and district health boards / committees, and
develop proposed work in Tanzania linked to governance mechanisms for
the Community Health Fund. It can also include such work-taking place
in other countries but not known to the steering committee.
The research will seek to unite several concurrent areas of work tak-
ing place in the SADC countries on participation and governance:
Known research includes:
-In Zimbabwe on setting up / strengthening health centre committees
and district health committees involving community and health pro-
vider representatives, identifying tools for integrating community
preferences in health planning and assessing the impact of these com-
mittees on the allocative efficiency of public health funds such as
the health services fund.
-In Zambia assessing the impact of health centre committees and dis-
trict health boards on monitoring performance of health systems in
relation to community preferences and on the allocation of resources
towards identified priority performance areas
-In Tanzania assessing the impact of community health funds on
strengthening community roles in health systems governance and on im-
proving equity in resource allocation
-In Mozambique on strengthening district health system governance
mechanisms and participation
These proposed areas of work and others from other countries will be
used to identify common positive features of governance systems that
enhance participation, effective tools for integrating community evi-
dence and preferences into health planning, and assess their impact
on resource flows within the health sector and communities towards
public health priorities.
c.The programme also provided for exchange visits to exchange experi-
ence and for support of research methods across the countries in-
volved and a moderated workshop to critically analyse and compare the
research findings from these country case studies and develop a col-
laborative regional comparative analysis.
3. Next Steps And A Call For Feedback
EQUINET has now secured the resources to implement this programme
with support from IDRC (Canada). To this end this briefing document
is being circulated to those who participated in the first phase of
the work and to EQUINET members generally to find out whether there
are current or proposed research teams, including those listed in the
previous sections now willing to joint this multi-country programme.
EQUINET invites research and field teams working in this area to join
the work. It is proposed to hold a two to three day southern African
regional meeting on this issue in January 2002 (proposed dates are
17-19 January 2002) that will initiate the work programme. Teams
wishing to join the programme and workshop are asked to send in the
following information to the secretariat
c/o mailto:rloewenson@healthnet.zw or
Fax 263-4-737 220
or mail Box CY2720,
Causeway,
Harare
by November 30 2001:
-The names, institutions, contact information (physical, phone, fax,
email) and areas of work of the country / research team.
-The specific focus of the work proposed or underway within the area
of governance and participation linking to incorporating community
preferences and resource allocation/ mobilisation and an outline of
the proposed work in 2002/2003
-Indication of whether this work is funded, requires full funding
support
-With a budget - or requirements for complementary funding for
specific areas
-With an outline of the areas and budget required
-Proposed delegates (up to 2), institutional affiliation and contact
information for the January 2002 meeting
This information will be used to finalise the delegates for the Janu-
ary meeting and participants to the multi-country programme on Im-
pacts of governance mechanisms and participation on integrating com-
munity preferences in planning and equity in resource allocation Or
'Governance and Equity'.
Please visit the Equinet website www.equinet.org.zw for information
and reports on the participation work to date, and contact us if you
have any queries on the above. We look forward to hearing from you!
R. Loewenson
mailto:rloewenson@healthnet.zw
C/o TARSC 47 Van Praagh Ave,
Milton Park,
Harare,
Zimbabwe
Tel: +263-4-708-835
Fax: +263-4-737-220
mailto:tarsc@icon.co.zw
Web: www.equinet.org.zw
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