If access to equitable health care is to be achieved for all, policy documents must address different needs of groups that do not access health care. This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. While reference is broadly made to vulnerable groups, there is lack of detailed specification of the different needs of different groups. The documents suggest that vulnerable groups are homogeneous in their needs, which is not the case. The authors argue for more information and knowledge on the needs of all vulnerable groups and more specific cover of these issues in policy documents.
Values, Policies and Rights
In this paper, the authors analysed 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The analysis highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
Delivering health services to vulnerable populations is a significant challenge in many countries. Groups vulnerable to social, economic, and environmental challenges may not be considered or may be impacted adversely by the health policies that guide such services. In this study, the authors report on the application of EquiFrame, a policy analysis framework, to ten Namibian health policies, representing the top ten health conditions in Namibia identified by the World Health Organisation. Health policies were assessed with respect to their commitment to 21 Core Concepts of human rights and their inclusion of 12 Vulnerable Groups. Substantial variation was identified in the extent to which Core Concepts of human rights and Vulnerable Groups are explicitly mentioned and addressed in these health policies. Four health policies received an Overall Summary Ranking of High quality; three policies were scored as having Moderate quality; while three were assessed to be of Low quality. Health service provision that is equitable, universal, and accessible is instigated by policy content of the same. EquiFrame may provide a tool for health policy appraisal, revision, and development.
The cultures of indigenous peoples have frequently been ignored when global standards on intellectual property have been set, says a new United Nations report, The State of the World's Indigenous People. It notes that global intellectual property (IP) standards are mainly based on Western legal and economic principles that emphasise private ownership of knowledge and resources. Such principles, it says, 'stand in stark contrast to indigenous worldviews, whereby knowledge is created and owned collectively and the responsibility for the use and transfer of the knowledge is guided by traditional laws and customs.' As a result, IP rules leave 'most indigenous traditional knowledge and folklore vulnerable to appropriation, privatisation, monopolisation and even biopiracy by outsiders,' the report says. Some indigenous peoples believe, the report says, that the World Intellectual Property Organization is 'not an appropriate forum to set standards because it is limited by its mandate to promoting intellectual property rights as the only viable path to protecting traditional knowledge'.
The World Health Organization’s Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control. A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. It involved document review and key informant interviews. Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country’s socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.
This study aimed to investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and assess which factors, including organisational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Some key messages merged. Under the right conditions, health policy analysis institutes can play a positive role in promoting evidence-informed decision making in government. Factors critical in supporting effective policy engagement include: a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. Motivation and capacity within government to process and apply policy advice developed by a health policy analysis institute was found to be key to the institute’s ultimate success.
The current system for the research and development (R&D) of new medicines does not adequately meet the needs of the majority of the world's population, argue the authors of this paper. There is a lack of new medicines for the “neglected diseases”, namely those that primarily affect populations with little purchasing power, and therefore offer an insufficient incentive for industry to invest in R&D. Despite the emergence of many new approaches to generating R&D that meets the needs of poorer populations, efforts remain ad hoc, fragmented, and insufficient. The authors discuss how an R&D treaty could complement and build on existing initiatives by addressing four areas where the system remains particularly weak: affordability, sustainable financing, efficiency in innovation, and equitable health-centered governance. They argue that effective tools for global governance are required to generate medical R&D as a global public good, based on the understanding that a politically and financially sustainable system will require both fair contributions from all, and fair benefit-sharing for all.
At the 70th World Health Assembly, the “BRICS countries” – Brazil, the Russian Federation, India, China and South Africa – convened a side event sponsored by China. The aim was to share experiences and innovations on people-centred reforms as a means to making progress towards universal health coverage, The Executive Deputy Director, Office of State Council Healthcare Reform Leading Group in China, Dr Liang Wannian highlighted the importance the Chinese government has placed on providing improved primary health services, by transforming the primary service model and enhancing division and cooperation to build an integrated health service system. For Brazil, Mr Ricardo Barros, Minister of Health shared the aspiration that “what we want is to have 80% of problems resolved in primary-level care so that people don’t need to go to the hospital”. He noted that “(delivering) primary-level care is the great challenge that we have” and that although “we have resources available for health, we don’t use them very wisely, so we are trying to improve that.” Dr Veronika Skvortsova, Minister of Health of the Russian Federation also highlighted the important role of designing a patient-focused system for health care based on accessibility and quality. For India, Mr Sanjeev Kumar, Additional Secretary, Ministry of Health and Family Welfare highlighted that the country had adopted a new national policy linked to universal health coverage in March 2017. Dr Aaron Motsoaledi, Minister of Health of South Africa, concluded the series of country presentations by returning the conversation to the importance of reorienting the model of care to focus on primary care. He shared South Africa’s “ideal clinic” innovation, which encourages the development of more attractive primary care clinics to draw patients away from tertiary care centres.
In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation and of the institutions involved in the policy process. iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children’s Fund (UNICEF) and implementing organisations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organisational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channeling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development.
One of the most fundamental human rights is the assumption that each person matters, and everyone deserves to be treated with dignity—this is the tenet from which all other human rights flow. Another is that those who are most vulnerable deserve special protection. However, in many developing countries, vast numbers of children are born but never counted, and their health and welfare throughout their lives remains unknown. And because single-mean measures of population health mask inequalities among the best-off and worst-off, the health of vulnerable populations is not effectively documented and acknowledged. Health information systems can play an important role in supporting these rights by documenting and tracking health and health inequities, and by creating a platform for action and accountability.