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<p class=MsoNormal><tt><b><font size=2 color=maroon face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:maroon;font-weight:bold'>EQUINET
Discussion Paper 69: How power relations affect the implementation of policy on
equity in access to anti-retroviral therapy: The case of rural health centres
in Malawi<span class=GramE>,<font size=3 color="#663366" face="Times New Roman"><span
style='font-size:12.0pt;font-family:"Times New Roman";color:#663366;font-weight:
normal'><U1:P></U1:P><O:P></O:P> </span></font><font color="#660000"><span
style='color:#660000'><br>
<u1:p></u1:p>LK</span></font></span></span></font></b></tt><tt><b><font size=2
color="#660000" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#660000;font-weight:bold'> Simwaka</span></font></b></tt> <b><font
size=2 color="#660000" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#660000;font-weight:bold'><br>
<br>
<tt><font face=Arial><span style='font-family:Arial'>Cite as:</span></font></tt></span></font></b><tt><font
size=2 face="Courier New"><span style='font-size:10.0pt'> </span></font></tt><tt><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>Simwaka LK (2008) ‘How power relations affect the
implementation of policy on equity in access to anti-retroviral therapy: The
case of rural health centres in <st1:country-region u2:st="on"><st1:place u2:st="on">Malawi</st1:place></st1:country-region>,’
EQUINET Discussion Paper 69. </span></font></tt><st1:country-region w:st="on"><font
size=2 color=purple face=Arial><span lang=EN-GB style='font-size:10.0pt;
font-family:Arial;color:purple;mso-ansi-language:EN-GB'>Malawi</span></font></st1:country-region><font
size=2 color=purple face=Arial><span lang=EN-GB style='font-size:10.0pt;
font-family:Arial;color:purple;mso-ansi-language:EN-GB'> Interfaith AIDS <span
class=GramE>Association<tt><font face=Arial><span style='font-family:Arial;
mso-ansi-language:EN-US'> <span style='mso-spacerun:yes'> </span></span></font></tt><tt><font
face=Arial><span lang=EN-US style='font-family:Arial;mso-ansi-language:EN-US'>EQUINET</span></font></tt></span></span></font><tt><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>: <st1:City u2:st="on"><st1:place u2:st="on"><st1:place w:st="on"><st1:City
w:st="on">Harare</st1:place></st1:City></st1:City></st1:place>.</span></font></tt><br>
<b><font size=2 color="#990000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#990000;font-weight:bold'><br>
<tt><font face=Arial><span style='font-family:Arial'>Available online at: </span></font></tt></span></font></b><tt><b><font
size=2 color="#993399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#993399;font-weight:bold'><a
href="http://www.equinetafrica.org/bibl/docs/DIS69POLsimwaka.pdf">http://www.equinetafrica.org/bibl/docs/DIS69POLsimwaka.pdf</a></span></font></b></tt><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'><br>
<br>
</span></font><font size=2 color=purple face=Arial><span lang=EN-GB
style='font-size:10.0pt;font-family:Arial;color:purple;mso-ansi-language:EN-GB'>The
national <st1:stockticker w:st="on">ART</st1:stockticker> scale-up plan
contains several measures to promote equity, considering also that there are
insufficient resources to cover everyone who is eligible. Thus study <span
style='mso-spacerun:yes'> </span>focused on four of these covering <st1:stockticker
w:st="on">ART</st1:stockticker> enrolment on an open ‘first-come,
first-served’ basis; targeted gender-sensitive health promotion of ART,
measures to overcome specific geographical barriers to access for remote
populations and prioritisation of <span style='mso-spacerun:yes'> </span>people
already on <st1:stockticker w:st="on">ART</st1:stockticker>, pregnant women and
young children. <span style='mso-spacerun:yes'> </span>Using a case study
approach the study analysed the power relations that influenced outcomes on
these policy measures on four health facilities in <st1:country-region w:st="on"><st1:place
w:st="on">Malawi</st1:place></st1:country-region>. <span
style='mso-spacerun:yes'> </span>The findings indicate that health workers
commonly exercise power in relation to patients, and <span class=GramE>that
patient acquiesce</span> with health worker behaviours. In poorly performing
facilities, implementation of policy measures is negatively affected by managerial
practices that discourage teamwork and de-motivate health workers, while in the
two better performing <span class=GramE>facilities,</span> management practices
had a more positive role in supporting positive health worker practices. The
study findings highlight that <span
style='mso-spacerun:yes'> </span>implementing equity policies needs to
include measures to orient and involve staff, and address power and resource imbalances
that can undermine access. </span></font><font size=2 color=navy face=Arial><span
lang=EN-GB style='font-size:10.0pt;font-family:Arial;color:navy;mso-ansi-language:
EN-GB'><o:p></o:p></span></font></p>
<p class=MsoNormal><b><font size=2 color="#993300" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#993300;font-weight:bold'><br>
<br>
<tt><font face=Arial><span style='font-family:Arial'>December 2008</span></font></tt></span></font></b><b><font
size=2 color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy;font-weight:bold'><br>
<br>
</span></font></b><tt><font size=2 color=purple face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:purple'>/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\</span></font></tt><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'><br>
<br>
</span></font><tt><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>This email alerts to a new publication from the Regional
Network for Equity in Health in East and Southern Africa (EQUINET).</span></font></tt><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'><br>
</span></font><tt><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>Further information on EQUINET can be found at <a
href="www.equinetafrica.org" moz-do-not-send=true><font color=black><span
style='color:windowtext'>www.equinetafrica.org</span></font></a>, where all
publications of the network can be found and downloaded.</span></font></tt><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:windowtext'><br>
<tt><font face=Arial><span style='font-family:Arial'>Comments and peer review
feedback on this or any other EQUINET publication are welcomed and should be
sent to <a href="mailto:admin@equinetafrica.org" moz-do-not-send=true><font
color=black><span style='color:windowtext'>admin@equinetafrica.org</span></font></a></span></font></tt></span></font>
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