The aim of this analysis is to describe the content of mental health policy and the process of its development in South Africa. Quantitative data regarding SA's mental health system was gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development. The study found that the process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation. National leadership in the development of new mental health policy is required, with improved communication, provincial-level responsibility for implementation and commitment to capacity building.
Values, Policies and Rights
The Lancet's current Sexual and Reproductive Health Series encompasses the annual 16 days of campaigning against gender violence that began on November 25, International Day Against Violence Against Women. The emphasis is on the connection between violence to women and HIV.
This paper identifies South Africa as a country with much internal and cross-border migration within a region of high population mobility, and argues that the country urgently needs to develop, implement and monitor an evidence-based, coordinated, multilevel national response to migration and health. This includes acknowledging the developmental benefits of migration, ensuring ‘healthy migration’ and engaging with a ‘place-based’ approach to addressing the diverse health needs and health impacts of the multiple migrant groups present within South Africa. The paper recommends that South Africa develop a co-ordinated regional response to migration and health. It should support the implementation of a regional framework for communicable diseases and population mobility. Four priority areas were identified: monitoring migrant health, developing partnerships and networks, developing migrant-sensitive health systems and putting in place policy and legal frameworks for migrants’ health. Migrants and migrant communities should be involved in health and migration responses, the paper argues.
According to this paper, the gap between practice and policy - those providing health services to migrants versus those making policies about migrants' entitlements - is increasingly evident. At the same time that clinicians are treating more diverse migrant groups, policy-makers are attempting to implement restrictive or exclusive immigration-related health policies that contradict public health needs and undermine medical ethics that operate on the ground. Policies that respond to the diversity of migrant groups and their differential health risks and service access must be developed and implemented, the authors of this paper argue. Moreover, to make real advances in the protection of both individual and public health, interventions must target each stage of the migration process and reach across borders. Services should be based on human rights principles that foster available and accessible care for individual migrants.
The mountain kingdom of Lesotho faces a number of unique hurdles with regard to HIV and AIDS. The country is landlocked within South Africa, the epicentre of the pandemic and, because of limited job opportunities and high unemployment rates within Lesotho, many of its citizens work as migrant labourers in South Africa. In addition, Lesotho has a particularly weak public health infrastructure due to rural isolation, lack of skilled health workers and high poverty rates. Migrant labourers, particularly all those working in South African mines, are a huge concern because they pose a high risk of having multiple concurrent partnerships and of taking HIV infections across the border. The health departments of Lesotho and South Africa should come up with cross-border health policies to deal with this public health problem.
The U.S. Africa Command (AFRICOM) has rapidly expanded its presence on the African continent since its establishment. Emphasizing a “3D” approach of “defense, diplomacy, and development,” AFRICOM’s charge is described as coordinating “low-cost, small-footprint operations” throughout the African continent. Writing in the New York Times, Eric Schmitt marveled at AFRICOM’s Operation Flintlock, a multinational and multiagency training operation in Niger. He wrote glowingly about fighting terrorism with mosquito nets: “Instead of launching American airstrikes or commando raids on militants,” he wrote, “the latest joint mission between the nations involves something else entirely: American boxes of donated vitamins, prenatal medicines, and mosquito netting to combat malaria.” The author asks however if AFRICOM’s humanitarian undertakings should be approached as gestures of goodwill or conflict-deterrence, or rather as signs of a militarized U.S. approach to foreign policy in Africa.
This article provides a reflection on the question of why there is a need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage will automatically be equitable and gender balanced, from a panel of health financing and gender experts. The authors traced the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. The authors found that unless explicit attention is paid to gender and its inter-sectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations, movement towards Universal Health Coverage can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to Universal Health Coverage and the needs of less powerful groups, which can include women and children, are not necessarily given priority. The authors identified the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of Universal Health Coverage decisions, political economy as well as technical research should be prioritized. The authors concluded that countries should adopt an equitable approach towards achieving Universal Health Coverage and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children.
This study focuses on the African Mining Vision (AMV), which was adopted by the African Union in 2008, an agreement that seeks to shift mineral policy beyond a focus on extracting minerals and sharing revenue. Instead, it relates mineral policy to the transformation of Africa’s economies and views an industrialisation strategy anchored on minerals and other natural resources as critical for achieving the Millennium Development Goals, eradicating poverty and securing sustainable growth. The study looks at regulation of artisanal and smallscale mining in Africa, the increasing importance of corporate social responsibility initiatives in the mining sector, and perspectives on capturing, managing and sharing mineral revenue for the befit of all. It highlights the fact that policy design works best when instruments are available to carry it out, and for much of Africa, that plan remains part of the rhetoric of official declarations, dissociated from real policy. So far, the policy position of stakeholders, especially government, is limited to short-term responses to immediate concerns or focused on extracting and exporting unprocessed natural resources. The AMV and this report affirm the need for Africa to transform its mining sector from an enclave of raw material supplies to an integrated industry that will help drive the continent's socio-economic development.
As the G8 Summit comes to a close, international agency Oxfam criticized the leaders for their failure to deliver on their promises and for trying to divert attention by cobbling together a small initiative for maternal and child health. “No maple leaf is big enough to hide the shame of Canada’s summit of broken promises,” said Mark Fried, spokesperson for Oxfam. “The G8’s failure will leave a sad legacy of kids out of school, denied medicines for the sick, and no food for the hungry.” With total G8 aid frozen, their five billion dollar commitment to maternal health will likely be taken from vital areas such as education and food, cautioned Oxfam. Oxfam also urged the G20 to adopt a financial transaction tax to raise the funds necessary to fight poverty and climate change.
This article reports Zambia's First Lady, Dr Christine Kaseba-Sata, calling for an end to discrimination against sexual minorities. Speaking at a UNAIDS hosted reception, she said that the "silence around issues of Men who have Sex with Men should be stopped and no one should be discriminated against on the basis of their sexual orientation. Rather, we should address reproductive health issues around this issue." She went further to assure people working in the sexual and reproductive health sector of her and the president's support.