This report outlines how far national laws and policies for adolescent contraception in Uganda and Kenya are consistent with WHO standards and human rights law. Of the 93 laws and policies screened, 26 documents were included. Ugandan policies have 6 out of 9 WHO recommendations and miss WHO’s recommendations for adolescent contraception availability, quality, and accountability. Kenyan policies consistently address multiple WHO recommendations, most frequently for contraception availability and accessibility for adolescents and address 8 out of 9 WHO recommendations, except for that on accountability. The current policy landscapes for adolescent contraception in Uganda and Kenya include important references to human rights and evidence-based practice. However the authors suggest that there is still room for improvement, and that aligning national laws and policies with WHO’s recommendations on contraceptive information and services for adolescents may support interventions to improve health outcomes, provided these frameworks are effectively implemented.
Values, Policies and Rights
This review sought to contribute to literature in this area by exploring how health policy agendas have been transferred from global to national level in sub-Saharan Africa. Nine articles satisfied the eligibility criteria. The predominant policy transfer mechanism in the health sector in sub-Saharan Africa is voluntarism, but there are cases of coercion, albeit usually with some level of negotiation. Agency, context and nature of the issue are key influencers in policy transfers. The transfer is likely to be smooth if it is mainly technical and changes are within the confines of a given disease programmatic area. Policies with potential implications on bureaucratic and political status quo are more challenging to transfer. The authors propose that policy transfer, irrespective of the mechanism, requires local alignment and appreciation of context by the principal agents, availability of financial resources, a coordination platform and good working relations amongst stakeholders. Potential effects of the policy on the bureaucratic structure and political status are also important during the policy transfer process.
In the early months of the COVID-19 pandemic, Africa’s rapid and coordinated response, informed by emerging data, was remarkable. Now, in 2022, as vast vaccination campaigns have enabled the global north to gain some control over the pandemic, Africa lags behind. In principle, Africa could build on the astonishing gains it has made in surveillance and public-health responsiveness to outbreaks in recent years. It could sufficiently invest in commodities to ensure its health security, and position itself as a world leader in fighting infectious diseases. The authors argue that there is no alternative to this. If the continent does not work towards guaranteeing self-sufficiency, it will fail to address the infectious-disease threats of the twenty-first century and to achieve its development goals. In tracing the history of pandemic responses, the authors suggest that historically, efforts to assist Africa have tended to be siloed. They take a top-down approach, with decision-making coming from a central body outside the continent, not from African institutions and experts. Efforts have generally focused on short-term crisis management, not on the kinds of sustainable systems, such as manufacturing capability for diagnostics, that could help Africa to take charge of its health security. To reconfigure to greater self-determination, the authors propose that the continent honour their commitments to allocate at least 15% of their annual budgets to the health sector, strengthen national public-health institutions, and accelerate translational research and development.
Mandatory human rights due diligence (HRDD) requirements can serve to promote the adoption of a strong international framework of corporate accountability and remedy for human rights violations in the context of business activities. This paper identifies the elements of a human rights due diligence and their implementation through analysing current regional and State practice in the adoption of mandatory HRDD legislation in different sectors. It discusses the principles that characterize the approach taken by the United Nations Open-ended Intergovernmental Working Group on the adoption of a Legally Binding Instrument on transnational corporations and other business enterprises and how it could serve as an important cornerstone for modern rule making on the issue of business and human rights.
The authors mapped the Mozambican legislative and policy responses to domestic violence to analyse their alignment with international treaties and conventions and with each other, using a critical cartography and content analysis. The authors identified a total of fifteen national domestic violence documents of which five were on laws, one on policy and nine institutional strategic/action plans. Most of the national domestic violence documents focused on strategies for assistance/care of victims and prevention of domestic violence. Little focus was found on advocacy, monitoring and evaluation. Mozambique has signed several international and regional treaties and conventions on domestic violence, but the authors found an inconsistency in the alignment of international treaties and conventions with national policies and laws, and a gap in the translation of national policies and laws into strategic plans and multi-sectoral approaches.
The authors raise that the impacts of the COVID-19 pandemic have gone far beyond the disease itself. In addition to the increasing number of COVID-19 deaths, the pandemic has deepened social and economic inequalities. These indirect impacts have been compounded by pervasive gender inequalities, with profound consequences, especially for women, girls, and people of diverse gender identities. There has been an escalation in gender-based violence within households, increasing numbers of child marriages and female genital mutilation, and an increased burden of unpaid care work, with impacts on mental health. Communities of people affected by HIV are, again, at the crossroads of injustice and targeted discrimination. Measures to control the pandemic have reduced access to essential health and social welfare services, including sexual and reproductive health services, reduced employment and labour force participation, and decimated many household incomes. Here again, women have borne the brunt of marginalisation, particularly those working in the informal sector.
In South Africa, an increased risk for gender-based domestic violence against women during the COVID-19 lockdown was reported by various sources including the national gender-based violence call centre (GBVCC), the South African Police Service and the civil society. Public life, which is frequently a coping mechanism and an escape for some women and girls at risk of domestic violence, was curtailed by the lockdown rules that forbade movement. Informal sources of help for victims of abuse were limited due to closure of economic activities, and community-based services for domestic violence were not permitted to open. Some victims of domestic violence struggled with public transport to access informal help, or to visit the police, social workers and other sources of help. Some organisations offered online and telephone services and the authors suggest that the risk of violence during crisis periods could be averted by a more sustained and wider focus on reducing risk of all forms of violations against women.
This policy brief critically analyses the option of a new pandemic treaty or other international legal instrument to enhance the pandemic preparedness and response. Part I provides an account of the origin of the idea of the pandemic treaty. Part II examines whether there is any legal vacuum which prevents the needed pandemic preparedness and response. Part III deals with the fragmentation of international health response and raises the concern that the new treaty will exacerbate fragmentation instead of consolidating the response. Part IV explains what to expect from the new treaty and the major process-related issues involved in the new pandemic treaty negotiations. The authors argue that instead of developing a new international instrument it is better to strengthen or amend the existing IHR.
More than half way into the 74th World Health Assembly, a serious discussion on the efforts to address vaccine inequities is noted in this article to have been conspicuous by its absence. What has instead dominated much of the Assembly proceedings are talks for a pandemic treaty to address health emergencies in the future, and the important, but continuing push towards investigations on the origins of the virus, among other matters. In an issue that recaps the discussions at the current World Health Assembly, the Geneva Health Files in this piece notes "it seems that there has not been enough attention on the here and the now in the midst of all the discussions on preparedness. In our view, this risks looking away from and a silent acceptance to the mounting deaths from COVID-19. It also shows unwillingness to acknowledge and accept the limitations of the current mechanisms that have not met expectations on not only vaccine equity but an overall international mechanism for meeting the needs on diagnostics and treatments for COVID-19". In a packed agenda for the week long remote meeting, the question is raised of why there is no dedicated forum to discuss why vaccines have not been delivered as promised, including to seek accountability for this and to revisit assumptions made about the mechanisms set up for this, including the ACT Accelerator and COVAX.
A recent joint communiqué by 25 Heads of Government and the WHO Director-General have called for the negotiation of a pandemic treaty to enable countries around the world to strengthen national, regional and global capacities and resilience to future pandemics, as a binding instrument to promote and protect health in the context of pandemics. The authors recommend that if WHO Member States decide that an international treaty is the way forward, it would be important to have clarity from the outset on the elements and areas that will be the subject of negotiation, by identifying aspects that the current crisis has revealed are not working. They recommend building on the existing instruments, notably the International Health Regulations and discuss critical issues that should be addressed in such a treaty if negotiations are launched,given that countries differ in needs, levels of development and capacities to implement treaty obligations.