Several health-related budget decisions taken in the past financial year in South Africa are reported to have violated the Constitution, the National Health Act, the Public Finance Management Act and the Promotion of Administrative Justice Act, according to a group of activists, researchers, unionists, health workers and academics, called the Budget and Expenditure Monitoring Forum (BEMF). The Forum has written to the ministers of health and finance, expressing concern over the effect of budgeting practices within the public health system on HIV and AIDS programmes, including on antiretroviral (ARV) treatment and prevention of mother-to-child transmission programmes, citing the moratorium on starting new patients on ARVs in the Free State as one example of such a decision.
Values, Policies and Rights
Despite international agreements and national laws, marriage of girls under 18 years of age is common worldwide and affects millions. Child marriage is a human rights violation that prevents girls from obtaining an education, enjoying optimal health, bonding with others their own age, maturing, and ultimately choosing their own life partners. Child marriage is driven by poverty and has many effects on girls' health: increased risk for sexually transmitted diseases, cervical cancer, malaria, death during childbirth, and obstetric fistulas. To stop child marriage, policies and programs must educate communities, raise awareness, engage local and religious leaders, involve parents, and empower girls through education and employment.
Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity. An HiAP approach is founded on health-related rights and obligations. It emphasises the consequences of public policies on health determinants, and aims to improve the accountability of policy-makers for health impacts at all levels of policy-making. Core features of HiAP include a strong foundation on human rights and social justice, and a focus on policy-making. It is often necessary to prioritise efforts; seek synergies to enhance health and other important societal goals; and seek to avoid harmful impacts on health. Application of HiAP involves identifying policy developments across sectors with potential implications for health and health equity; assessing impacts; and advocating and negotiating for changes. Long term vision and sustained efforts are often needed. This book looks at examples of HiAP from countries across the world, and has specific chapters on low-income countries, including those from Africa.
Zimbabwe is a party to the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women and the African Charter on Human and Peoples’ Rights. It has a legally binding obligation to respect, protect and fulfill these rights for all people within its jurisdiction. The report argues that a causal chain runs from Mugabe’s economic policies, to Zimbabwe’s economic collapse, food insecurity and malnutrition, and the current outbreaks of infectious disease. The determinants of health, such as broken sewerage systems, chronic food insecurity and widespread starvation, underlie disease epidemics such as cholera and anthrax and a deterioration of maternal health care. The authors recommend that the international community needs to resolve the political impasse, launch an emergency health response with services controlled by a United Nations-designated agency or consortium, refer the situation to the International Criminal Court for Crimes against Humanity, convene an emergency summit on HIV, AIDS and TB and prevent further deterioration of household food supply.
As the 2015 deadline for the Millennium Development Goals approaches, the People’s Health Movement (PHM) has produced this statement in which they set out an agenda for the political leaders who will formulate the next set of post-2015 ‘development goals’. First, development must not be construed solely as economic growth and industrialisation; it must include cultural and institutional development and include the rich world as well as low- and middle-income countries. Second, addressing the global health crisis requires that we confront the social, economic, political and environmental determination of health, recognising the negative consequences of neoliberalism. Third, reform of the global economic and political architecture must be an inclusive process. Nation states must achieve sustainable development and universal social protection before the interests of multinationals are even considered. Fourth, the post 2015 development agenda must work towards new approaches to national and global decision making, based on popular participation, direct democracy, solidarity, equity and security. Finally, sustainable and equitable development will be achieved only if people’s movements unite across sectors, cultures and national boundaries and articulate a coherent set of goals and strategies for change.
The Millennium Development Goals (MDGs) galvanised attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution. The authors argue that success in realising the agenda requires a paradigm shift in: 1) ensuring leadership for intersectoral coherence and coordination on the structural drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. The authors are concerned that neither the international nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.
The death of apartheid - symbolised by the multiracial elections in South Africa on April 27, 1994 - was a defining moment of the 20th century. The tenth anniversary of this event is a time to consider how well the post-apartheid government is fostering health and human rights through reforms in health research policy. The realisation of health care depends, to an extent, on the formulation of a rational and responsive national research agenda; this has proven a challenge in post-apartheid South Africa. Notwithstanding its laudable attempts to redress the country's skewed national health research agenda, only when the South African government commits itself to transparent, competent research leadership free of ideological bias will the country truly graduate from erstwhile pariah nation to celebrated champion of health and human rights. (This article requires registration.)
Much debate around the September 2013 meeting of the United Nations General Assembly on the post-2015 Development Agenda, has focused on the health and intersectoral development goals. Little of this debate has to do, however with how the “right to the highest attainable level of health” applies to non-nationals, who normally have no access to health care services, according to this editorial. The right to health obligates governments to facilitate access to health care to nationals and non-nationals alike, the authors argue. Ensuring that governments apply new development goals that include non-nationals is an issue of pressing concern in the post-2015 agenda. The denial of preventive and curative care to non-nationals is often linked to policies regulating cross-border movement. The global health community cannot afford to ignore the in-country inequalities that exist within the public health care systems.
Lynn Freedman argues in the journal Development that achieving the MDGs will require massive new investment in the health sector but also notes that success is not only about money but also the way in which the connection between health and development is constructed. She writes: "This is the hidden opportunity of the MDGs: With health recognized as a central part of a wider development agenda, we have a chance to push past the conventional target-based public health approach and to re-ground health policy in the most critical debates of the day, including globalization, human security, equity, human rights, and poverty reduction."
In this paper, some of the right-to-health features of health systems are identified, such as a comprehensive national health plan, and 72 indicators are proposed that reflect some of these features. Globally processed data on these indicators was collected for 194 countries. Globally processed data was not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where available, indicators show where health systems need to be improved to better realise the right to health. The paper provides recommendations for governments, international bodies, civil-society organisations, and other institutions and suggests that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are obligations under human rights law.