Values, Policies and Rights

Christiana Figueres, newly appointed executive secretary of the United Nations (UN) Framework Convention on Climate Change (UNFCCC), has voiced the UN’s position on the state of climate change negotiations and said that there is a constructive atmosphere and a growing sense of urgency among governments about climate change mitigation. At Cancun, Mexico, where the sixteenth Conference of the Parties will be held from 29 November–10 December 2010, governments need to go from the politically possible to the politically irreversible, she said. During the last meeting in Bonn, Germany, in June 2010, Figueres said that countries decided that the ‘text before them is now a negotiation text,’ and a ‘party text,’ which shows serious commitment, she said. In addition, comments were heard from ‘very important countries’ that their confidence and trust in the negotiation process was restored, which was not the case at the end of the 2009 conference at Copenhagen. Figueres said that she was expecting governments attending the Cancun meeting to make decisions on the relevant financing mechanism and technology for fighting global climate change, on how to push forward reduction of emissions from deforestation, on adaptation, and on monitoring, she said. At Cancun, four or five decisions could be taken to establish the operational entities that would be the basis for the next chapter of the climate regime.

Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. The authors introduce the supplement, by reviewing how policy analysis can inform: (a) how to frame iCCM and negotiate its boundaries, (b) how to tailor iCCM for national health systems and (c) how to foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritise particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertise alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalised as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.

Some countries have considered using immunity certification as a strategy to relax restrictive measures by issuing an immunity passport for people certified as having protective immunity against SARS-CoV-2, the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification because of uncertainty about the length of time of immunity and concerns over the reliability of methods for determining immunity. However, even if immunity certification became well supported by science, the authors note many ethical issues in terms of the implementation process, its uses, measures in place to reduce potential harms, prevention of disproportionate burdens on non-certified individuals and potential violation of individual liberties and rights.

Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, the authors of this study conducted facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons, as well as 46 key informant interviews with government and non-governmental organisation officials and representatives of international agencies and external funders. A review of Zambian legislation and policy governing prisons and the criminal justice system was also conducted. The findings indicated serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. The authors call on the government to make immediate improvements to the situation and they recommend that external funders to co-operate with the Zambian government to ensure that funding in such areas as health services respect human rights standards.