PHA-Exch> Book review: Reclaiming the Resources for Health – A regional analysis of equity in health in East and Southern Africa, EQUINET

[Rebecca Pointer]

Book review: 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.

Reviewed by Elijah Chiwota, MWENGO, Zimbabwe

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 www.equinetafrica.org. To 
order a copy of the book contact admin at equinetafrica.org. Alternatively 
contact one of the African co-publishers: Fountain publishers in east 
and central Africa (sales at fountainpublishers.co.ug); Jacana media in 
South Africa, Botswana, Swaziland and Lesotho (sales at jacana.co.za; 
please note if you are a non profit organisation) and Weaver press for 
all other countries (weaver at mweb.co.zw)