The WHO Director General Dr Ghebreyesus has set universal health coverage (UHC) as one of the main priorities for his term. His goal is a challenging one, especially for low and middle income countries which make up around 84% of the world’s population. They only have access to half the physicians and a quarter of the nurses that high income countries have access to. Similarly low and middle income countries only spend around US $266 per capita on health care. In contrast, high income countries spend US $5 251 per capita. This means that attaining universal health coverage in poorer settings is challenging. Large cuts to foreign aid investment from a number of high income economies only compound this challenge. Low and middle income countries also invest around a third of what high income countries invest in research to generate the knowledge needed for UHC. They also have access to around a fifth of the researchers high income countries have access to. Much of the knowledge required to establish the universal health coverage already exists but poor access presents a major barrier to achieving the goal. To unlock this knowledge for everyone’s benefit, the author proposes that policymakers and publishers consider more innovative ways to provide access to available knowledge.
Values, Policies and Rights
In two years, the uncompleted tasks of the Millennium Development Goals will be merged with the agenda articulated in the 2012 United Nations Conference on Sustainable Development. This process will seek to integrate economic development (including the elimination of extreme poverty), social inclusion, environmental sustainability, and good governance into a combined sustainable development agenda. The first phase of consultation for the post-2015 Sustainable Development Goals reached completion in the May 2013 report to the Secretary-General of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. Health did well out of the Millennium Development Goal (MDG) process, but the global context and framing of the new agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, four strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak—and listen—to the whole sustainable development agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, the authors assert that we need to construct goals that will be truly “universal”, that will engage every nation—a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal Sustainable Development Goals.
Health should not be like playing the lottery - but that is what it has become in Africa. If you’re born rich you win, if you are born poor, you lose.’ This statement was made by Dr Githinji Gitahi, Group CEO of Amref Health Africa at the opening ceremony of the Africa Health Agenda International Conference (AHAIC) which took place in Kigali, Rwanda in March 2019. The conference was focused on Multi-Sectoral Action to achieve Universal Health Coverage (UHC) in Africa by 2030. The conference delegates observed that technology and data are needed to achieve UHC but that most of the technology available is focused on secondary and tertiary sectors and on curative care, rather than at community level. There is also need for regulation of new generation actors that are technology-focused. The authors propose that cross-regional dialogue and knowledge sharing is needed where countries can learn from each other, avoiding traditional silos and engaging multi-stakeholder and multi-sectoral partnerships and shifting the paradigm from a view of health as an investment rather than an expenditure.
The author outlines a court case in which the judgment raises concerns that some judicial officers hold deeply misguided notions regarding people with mental health issues, which deprives them of access to justice. Such attitudes are noted to not be restricted to judicial practitioners and discrimination to be nationwide. The judiciary as protectors of the rule of law are argued to be held to a higher standard. In 2014, Mental Health Uganda and Validity (formerly the Mental Disability Advocacy Centre – MDAC) published research uncovering widespread abuse, ill-treatment and appalling conditions in Uganda’s regional mental health facilities as well as Butabika. The research also investigated the experiences of people in their communities. The report found that most people with mental health issues experience high levels of violence and neglect at the hands of community members and public officials. The lack of local community mental health and psychosocial support services meant that many found themselves pushed towards unregulated traditional and faith-based healers. Many people recounted having endured unspeakably cruel practices including chaining, cutting the skin, being tied to trees, beatings and daily, casual prejudice. The author argues that the law needs to ensure people can access consensual mental health treatment in the community, with the aim of supporting independence and social inclusion.
Gender-based violence (GBV) is a significant human rights violation and a key driver of the HIV epidemic in southern and eastern Africa. In this study, the authors frame GBV from a broad human rights approach that includes intimate partner violence and structural violence. They use this broader definition to review how National Strategic Plans for HIV and AIDS (NSPs) in southern and eastern Africa address GBV. NSPs for HIV and AIDS provide the national-level framework that shapes government, business, external funder, and non-governmental responses to HIV within a country. They authors’ review suggests that attention to GBV is poorly integrated, and few recognise GBV and programme around GBV. The programming, policies and interventions that do exist privilege responses that support survivors of violence, rather than seeking to prevent it. Furthermore, the subject who is targeted is narrowly constructed as a heterosexual woman in a monogamous relationship. There is little consideration of GBV targeting women who have non-conforming sexual or gender identities, or of the need to tackle structural violence in the response to HIV and AIDS.
Aimed at policy makers and advocates this briefing examines proposals for the World Intellectual Property Organization (WIPO) Development Agenda from a human rights perspective. Drawing on the Friends of Development and Africa Group's original submissions it makes recommendations in 6 key areas.
As competition for land intensifies in Africa’s rapidly growing towns and cities, planning laws assume a fundamental importance. They determine how urban growth is managed and directed. In most countries outdated, inappropriate and unintegrated laws are exacerbating urban dysfunction. The reform of planning law is frequently advocated as a necessary step for better management of urbanisation in Africa. But reform initiatives consistently founder. This is inevitable, given the approaches adopted. The promotion of “one-size-fits-all” and “model” planning laws from outside the continent has not served Africa well. Invariably it has created further legal uncertainty and a series of unanticipated, often pernicious consequences. This paper argues that more progressive, realistic urban planning in Africa will require a radically different approach to planning law reform, essential for sustainable and equitable urban development in Africa.
How can patients and health workers be protected from becoming victims of a fight that is aimed an employer? Non-governmental organisations (NGOs) have asked the SA Human Rights Commission to investigate the violations of patients’ and health workers’ rights during a recent strike in South Africa and to offer guidance on how patients can be protected during future strike action. The human rights group Section 27 believes that such a solution lies in “determining essential services from non-essential services, or reaching agreement on the maintenance of some level of services during a legal dispute”. “Addressing the essential services issue is argued to have a two-fold effect. Firstly, those in the public health care system classified as non-essential services personnel would be able to exercise their right to strike. Secondly, patients’ rights would also be protected as they would be ensured of continued access to health care services as those staff properly designated as essential staff would not be striking,” according to a Section 27 opinion on strikes in the essential services.
In this study, researchers explored the impact of violence and related human rights abuses on the lives of sex workers, and how they have responded to these conditions, as individuals and within small collectives. They conducted 55 in-depth interviews and 12 focus group discussions with female, male and transgender sex workers in Kenya, South Africa, Uganda and Zimbabwe. In describing their experiences of unlawful arrests and detention, violence, extortion, vilification and exclusions, participants present a picture of profound exploitation and repeated human rights violations. This situation has had an extreme impact on the physical, mental and social well-being of this population. Underlying their stories, however, are narratives of resilience and resistance. Sex workers in this study draw on their own individual survival strategies and informal forms of support and very occasionally opt to seek recourse through formal channels. While criminal laws urgently need reform, the authors argue that supporting sex work self-organisation and community-building are key interim strategies for safeguarding sex workers’ human rights and improving health outcomes in these communities. If developed at sufficient scale and intensity, sex work organisations could play a critical role in reducing the present harms caused by criminalisation and stigma.
In this paper, the authors examine the growing convergence between human rights and development thinking, particularly with regard to social and economic rights. They ask how the dialogue between human rights and development can contribute to furthering progress on the Millennium Development Goals (MDGs). They argue that developing countries need to secure relatively good rates of economic growth to make progress, but may be hampered by the fact that they remain far behind the developed world in terms of technology. Given a good enabling environment, most developing economies would be able to raise productivity fairly rapidly by absorbing existing knowledge from abroad, rather than inventing it for themselves. The rapid growth of South-South trade and investment flows among developing countries would be another supportive factor, but the authors caution that economic growth alone will not guarantee reaching MDG outcomes: governments need to ensure that the economic benefits of growth are equitably distributed.