Poverty reduction and regional integration: a comparative analysis of SADC and UNASUR health policies

在南部非洲和南美洲低收入国家的贫困人口中，卫生保健和药品的获取不足是一个长期存在的问题；它是健康不良的公认社会决定因素，妇女和女孩负担的比例不成比例。该项目审查了通过区域卫生政策加强南方多边区域组织对减贫的贡献的范围，并以下列问题为指导：哪些区域体制做法和区域政策形成方法有助于出现内嵌的扶贫保健战略，国家、区域和国际伙伴可以做些什么来促进这种做法和方法？区域组织在公共政策制定中的作用日益成为南北和南南发展议程的主题，并正在产生发展倡议和研究区域经济一体化对提供公共产品和贫困人口的益处。越来越多的人认识到，区域一体化的雄心和举措超越了商业贸易和投资，延伸到卫生和福利政策，但很少有人知道这些领域是否以及如何执行关于贫穷的区域承诺，以及什么样的区域政策发展进程有助于在区域和国家领域出现有利于穷人的根深蒂固的办法和效果。为此，我们对南共体和南美洲国家联盟在获得保健方面的区域议程和抱负、区域行动纲领和区域政策制定进程进行了比较分析，并在赞比亚、斯威士兰、玻利维亚和巴拉圭等低收入国家进行了深入的实地考察，这些国家面临着严重的社会经济挑战、低水平的服务和巨大的公共卫生挑战。我们采用混合方法、比较和参与的方式和方法进行数据收集和数据分析。我们让来自政策、实践和最终受益社区的利益相关者参与整个研究过程，旨在产生明显的影响潜力。我们使用协作参与式行动研究方法来设计监测工具包。通过这样做，该项目力求为以下辩论提供新的分析和证据：区域组织在卫生减贫方案中的作用和效力，以及国际捐助者、民间社会组织、政府、企业和慈善组织等行为者可以做些什么来支持有利于穷人的区域卫生政策。该项目汇集了一个跨学科的研究小组，将关注加强保健系统和社会公平的社会和卫生政策分析员与关注区域主义的体制、政治和方法基础和后果的区域一体化研究专家联系起来，并关注南美洲和南部非洲的政治、经济、社会和文化的区域研究专家的关切。该项目是南部非洲(南非南非国际事务研究所)、南美洲(布宜诺斯艾利斯FLACSO)和欧洲(比利时联合国大学区域一体化比较研究所、开放大学和英国南安普顿大学)等知名机构的知名国际研究人员之间的研究合作。它汇集了比较分析、政策分析和监测方法、卫生保健系统、区域治理和国际政治经济学方面的互补专业知识，并在两个案例研究区域和国际上建立了出色的联系。项目团队的能力与有效的项目设计和组织相结合，使利益相关者在整个研究过程、传播和影响过程中持续参与

Inadequate access to health care and medicines is a persistent issue among impoverished populations in low-income Southern Africa and South America; it is a recognised social determinant of ill-health, and is disproportionately borne bywomen and girls. This project examines the scope for enhancing Southern multilateral regional organisations' contributions to poverty reduction through regional health policy, and it is guided by the following question: what regional institutional practices and methods of regional policy formation are conducive to the emergence of embedded pro-poor health strategies and what can national, regional and initernational partners do to promote such practices and methods?The growing presence of regional organisations in public policy making is increasingly the subject of North-South and South-South development agendas, and is generating development initiatives and research into the benefits of regional economic integration for public goods provision and for people living in poverty. There is growing recognition that regional integration ambitions and initiatives extend beyond commercial trade and investment to embrace health and welfare policy, but little is known about whether and how regional commitments on poverty are being implemented in these domains and what kinds of regional policy development processes are conducive to the emergence of embedded pro-poor approaches and effects in regional and national spheres. We investigate this by undertaking a comparative analysis of SADC and UNASUR's regional agendas and ambitions, regional programmes of action and regional processes of policy development in relation to access to health care, undertaking in-depth fieldwork in low income countries of Zambia, Swaziland, Bolivia and Paraguay confronted with serious socio-economic challenges, low levels of service delivery and immense public health challenges. We undertake data collection and data analysis using mixed methods, comparative and participatory approaches and methodologies. We involve stakeholders from policy, practice and end-beneficiary communities throughout the research process, designed to have demonstrable potential for impact. We use collaborative Participatory Action Research methods todesign monitoring Toolkits. In doing so, the project seeks to contribute new analytical and evidence to debates about the role and effectiveness of regional formations in health-poverty reduction programmes and what actors such as international donors, civil society organisations, governments and business and philanthropic organisations can do to support pro-poor regional health policies.The project brings together a cross-disciplinary team of researchers linking social and health policy analysts concerned with health care system strengthening and social equity, with regional integration studies specialists concerned with the institutional, political and methodological foundations and consequences of regionalism, with the concerns of area studies specialists concerned with the politics, economies, societies and cultures of South America and Southern Africa. The project is a research collaboration between highly respected international researchers in renowned institutions in Southern Africa (South African Institute of International Affairs, South Africa), South America (FLACSO, Buenos Aires), and Europe (United Nations University Institute for Comparative Regional Integration Studies, Belgium, the Open University and the University of Southampton in the UK). It brings together complementary expertise in comparative analysis, policy analysis and monitoring methodologies, health care systems, regional governance, and international political economy, and excellent contacts in the two case study regions and internationally. The project team's capabilities combine with effective project design and organisation for sustained stakeholder participation throughout the research process, dissemination and impact