Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is argued to be needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.
Values, Policies and Rights
These guidelines contain essential information on prevention of mother-to-child transmission, as well as counselling, support and testing, and preventing paediatric HIV infection. Clinical features of HIV-positive children are provided. Care guidelines are given on HIV-positive children on anti-retroviral therapy (ART). Nutritional support is also covered, providing indicators for assessing the nutritional status of children and requirements for nutritional support, including nutrition interventions in situations where children have not been adequately nourished. Treatment guidelines for concomitant tuberculosis are also given, along with responses to adverse advents, like side-effects from ART, and guidelines for treatment of a range of typical secondary infections, like respiratory infections, thrush and gastro-enteritis.
The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data, according to this paper. The paper drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. It concludes that guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. It was unclear if the overall decrease in gunshot homicides applies to women in relationships. In view of the general role guns play in violence against women, the paper urges the government to keep gun control high on the legislative agenda.
The process of mythologizing represents a contestation between symbolism and mythology, writes Firoze Manji. The greatest disservice that we could pay to Mandela is to allow the complexity, courage and humanity of his long life to be reduced to a fairy tale. Mandela represents for so many the finest values of courage, liberation and freedom.
Heads of state and government in September 2018 committed to 13 new steps to tackle non-communicable diseases including cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well-being. World leaders agreed to take responsibility themselves for their countries’ effort to prevent and treat NCDs. They also agreed that these efforts should include robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks. They committed to implement a series of WHO-recommended policies to prevent and control of NCDs - such as public education and awareness campaigns to promote healthier lifestyles, vaccinating against HPV virus to protect against cervical cancer and treating hypertension and diabetes. WHO estimates that implementing all these policies could generate US$ 350 billion in economic growth in low and lower-middle-income countries between now and 2030. Other specific commitments focus on halting the rise of childhood obesity, promoting regular physical activity, reducing air pollution and improving mental health and wellbeing. The political declaration reaffirms WHO’s global leadership of the fight to beat NCDs and promote mental health, and urges the Organization to continue working closely with key partners, including government, civil society and the private sector. In particular, it calls on food manufacturers to take several actions. These include reformulating products to reduce salt, free sugars and saturated and industrially produced trans fats, using nutrition labelling on packaged food to inform consumers, and restricting the marketing of unhealthy foods and beverages to children.
This book highlights the key issues that constitute and affect health law in post apartheid South Africa. It is a constructive, precise and detailed book that has innovative ideas on how the law can be used to protect and serve its people more effectively. It examines the South African health system from a rights perspective and makes recommendations for future policy and legislative development. It draws attention to many complex issues linked to health care and goes on to challenge health personnel, policy makers and users of the health system to defend the human right to health.
The FXB Centre has published Health and Human Rights since 1994. The journal explores the reciprocal influences of health and human rights, including the impact public health programs and policies have on human rights, the consequences human rights violations have on health, the importance of health in realizing human rights, and the ways in which human rights can be integrated into public health strategies. Health and Human Rights may provide free or reduced-price, two-year subscriptions for individuals in developing countries upon request. Some institutions in developing countries - NGOs, universities, and libraries with restricted budgets - may also be eligible for a free or reduced-price subscription.
This Resource Guide brings together two of the Open Society Institute’s largest priorities: public health and numerous law and human rights initiatives.
The second volume of Health and Human Rights brings one more piece to the set of educational materials available from multiple sources, mostly, although not exclusively, in the English language. Intended primarily for health practitioners, the book incorporates a succinct introduction laying out essential concepts, principles and mechanisms relevant to the congruence between public health and human rights. Ten case studies follow, each constructed around clearly set learning objectives, including questions to be addressed, highlights of the public health issue and references to specific human rights relevant to the case study, sources of pertinent information and bibliography. The case studies focus on major public health issues such as maternal mortality, female genital mutilation, access to medicine and prison health. They constitute a useful tool for classroom education as well as self-learning. As Internet access expands in low- and medium-income countries, the material presented could serve to structure a distance-learning facility (a field in which one of the co-authors specialises) with interactivity between learners and their mentors.
What can we take forward, post-2015, from the successes of the Millennium Development Goals (MDGs) and what have we learnt from their shortcomings? In this editorial, the Lancet’s editors argue that the MDGs have led to inequities by narrowing down the goals to a limited number, notably excluding non-communicable diseases. Future directions call for building on the conceptual simplicity of the MDGs, taking a people-centred approach that captures the determinants of health and returning to the notion of health as a human right, with equity at its heart. The editors briefly analyse the United Nations Report of the Global Thematic Consultation on Health. They agree with the decision to measure health status through a hierarchy of goals, with maximisation of healthy life expectancy at the top, instead of using universal health coverage, which they argue does not address the determinants of health, is difficult to measure and compare across countries, and is only an indirect indicator of health status. Three indicators are proposed to measure progress: improved survival (including maternal and child survival), reduced burden of disease (including diseases covered by the MDGs plus non-communicable diseases), and lower levels of risk factors (eg, smoking and lack of access to sanitation).