The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a ‘digital health revolution’. While this is true, the authors note that there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. The authors propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In the proposed approach, they argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Their decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.
Values, Policies and Rights
After negotiations spanning over 2 years, International Health Regulations (IHR) 2005 was amended by consensus during the 77th Session of World Health Assembly (WHA77) in the first week of June 2024 (WHO, 2024). The amendments set out the legal framework for delivery of equity in health emergency preparedness and response. One of the drawbacks of the IHR adopted in 2005 was the lack of explicit legal provisions requiring WHO and States Parties to ensure equitable access to health products to prevent disease outbreaks from becoming public health emergencies of international concern (PHEIC). The amendments adopted by WHA77 address this gap. Around 24 Articles out of 66 Articles, and 6 Annexes out of 9 Annexes were amended substantively and 2 new Articles were added. Amendments in Articles 1, 3, 13, 15-18, 44, and Annex 1 and the two new Articles, 44 bis and 54 bis, help in particular addressing the gaps relating to equitable access to health products. Article 3 now recognises equity and solidarity as principles of IHR implementation. The Amended Article 3 now mandates that the implementation of the IHRs needs to “promote” equity and solidarity. It means there should be demonstrated enhancement in the delivery of equity, in the implementation of IHR.
The East, Central and Southern Africa Health Community 73rd Health Ministers Conference was held in Arusha in the United Republic of Tanzania from June 20 -21, 2024. The Conference was attended by Honourable Ministers, Heads of Delegations, senior officials from ECSA Health Community Member States, partner organizations, research institutions, civil society organizations and other key stakeholders. The Conference was organized under the theme: 50 Years of Leadership and Excellence in Regional Health Collaboration. Deliberations at the Conference proceeded under the following sub-themes: 1. Human Resources for Health 2. Health Financing 3. Emerging and Re-emerging infectious diseases and health emergencies 4. Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition 5. Non-communicable, mental health and Substance use 6. Mitigating the effects of climate change on health 7. Technology and Innovations in health At the end of the conference, the Ministers considered and passed the resolutions presented in each of these areas in this document.
Food fraud (often called fake food in South Africa) or the deliberate misrepresentation or adulteration of food products for financial gain, is a growing problem in South Africa, with severe public health and financial consequences for consumers and businesses. It has generated a public outcry against food fraud practices especially in communities and reputational damage to food manufacturers. Despite the risks, food fraud often goes undetected, as perpetrators are argued to be becoming increasingly sophisticated. The precise magnitude of food fraud remains obscure, as incidents that do not cause consumer illnesses are frequently unreported and, as a result, are not investigated. Food fraud can occur at any stage of the food supply chain, from production to processing to retailing or distribution. This is due in part to the limitations of current analytical methods, which are not always able to detect food fraud. This review of food fraud in South Africa looks at several factors that may be contributing to epidemic of food fraud, including inadequate penalties, inadequate government commitment, a complex labelling regulation, emerging threats such as e-commerce, and shortage of inspectors and laboratories. The review recommends establishing a single food control/safety authority, developing more food safety laboratories, and adopting innovative technologies to detect and prevent food fraud. South Africa faces a serious food fraud crises unless decisive action is taken.
To address this question this study undertook a 4-step approach, including (i) a compilation of international policy recommendations, (ii) an online survey, (iii) four regional workshops with international experts and (iv) a ranking for prioritisation. Policies were identified and prioritised based on their double- or triple-duty potential, synergies and trade-offs. Using participatory and transdisciplinary approaches, policies were identified to have potential if they were effective in tackling two or three of the primary outcomes of interest: (1) undernutrition, (2) obesity/NCDs and (3) environmental degradation. A final list of 44 proposed policies for healthier and more environmentally sustainable food systems created was divided into two main policy domains: ‘food supply chains’ and ‘food environments’. Of the top five expert-ranked food supply chain policies, two were perceived to have high potential: (a) incentives for crop diversification; (b) support for start-ups, and small- and medium-sized enterprises. For food environments, three of the top five ranked policies had perceived high potential: (a) affordability of healthier and more sustainable diets; (b) subsidies for healthier and more sustainable foods; (c) restrictions on children's exposure to marketing through all media.
The COVID-19 pandemic highlighted an urgent need for harmonised requirements for the regulation of medicines. The authors compared outer packaging labelling requirements and transition terms for harmonization for countries in the Southern African Development Community (SADC) region. Data on legislation and/or regulatory guidelines for medicine outer packaging labelling from National Medicines Regulatory Authorities were obtained for countries in the SADC region by February 2023. A detailed comparative content analysis was conducted to determine alignment with the requirements of the SADC harmonised labelling guidelines to assess readiness levels of each country to transition to the SADC harmonised labelling guideline for outer packaging of medicines. Content analysis showed at least 11 out of 16 countries require national legal reform to transition to the SADC harmonised labelling guideline. In all cases where countries specified labelling requirements for outer packaging of medicines, these were stipulated in national medicines legislation. Even though there is a high level of alignment across the countries in terms of national labelling requirements, most countries in the SADC region would still require national legislative reform to transition to regional harmonised labelling requirements and then ultimately to continental requirements of the African Medicines Agency.
This declaration was made by the delegates at the Inaugural Uganda National Conference on Health, Human Rights and Development held in Kampala in September 2023. The declaration makes several commitments, including that the Ministry of Health provide leadership for an integrated and multi-sectoral approach which recognises the intersectionality between SDG 3, human rights and other SDGs. It also commits to strengthen collaboration across all sectors in advancing the right to health; fast-track Government’s process of passing and implementing the National Health Insurance scheme in order to realise Universal Health Coverage; and urges Government through the Parliament to progressively increase financing for health in order to realise the Abuja Declaration of allocating 15% of national budget towards health. The declaration proposes to increase the generation and use of evidence in planning and implementing health interventions, including on social determinants of health; to make more progress on the Right to health in Uganda to realise Sustainable Development Goals.
A first-ever WHO initiative to join the global negotiations on a plastics treaty, as well as the first WHO decision on climate and health since 2008, are set to come before the World Health Assembly in May 2024. The draft decision on climate change and health, led by eight member states, including Peru, Kenya, the United Arab Emirates and the United Kingdom, reflects new evidence on the linkages between climate and health. The WHO propose to make health-related inputs into the new treaty instrument on plastics, including about particularly hazardous plastics or polymers that should be phased out, and play an active role in a UN science-policy panel on plastics pollution. A range of non-state actors criticised the absence of reference to “fossil fuels” as a driver of climate change in the draft climate and health decision, with one suggesting that WHO should treat fossil fuels like tobacco. The draft document calls upon WHO to clean up its own house by “firmly integrating climate across the technical work of the WHO at all three levels” and develop a “Roadmap to Net Zero by 2030 for the WHO Secretariat, in line with the UN Global Roadmap.”
This article summarises points made In July 2023, by Amb Dr. John Nkengasong, the US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, addressing African journalists in Washington DC on the gains of PEPFAR. He noted that the recent signing of the Anti-Homosexuality Act 2023 means that Uganda stands to lose funding of about $400 million from PEPFAR as annual support to HIV/Aids care and treatment.
The United Nations Secretary-General has stated that the safe deployment of new technologies, including artificial intelligence (AI), can help the world to achieve the sustainable development goals. Large language models generate responses that can appear authoritative and plausible to an end-user; however, without adequate controls in place, the veracity and accuracy of responses may be extremely poor. These models may be trained on data for which explicit consent may not have been provided, and they may not protect sensitive data (including health data) that users voluntarily feed into the AI-based tool. AI tools are increasingly being applied to public health priorities, and have the potential to assist with pattern recognition and classification problems in medicine – for example, early detection of disease, diagnosis and medical decision-making. For any beneficial impact, especially in low- and middle-income countries, ethical considerations, regulations, standards and governance mechanisms must be placed at the centre of the design, development and deployment of AI -based systems, with oversight by governments and their appropriate regulatory agencies. WHO has published guidance on Ethics and governance of AI for health, and has convened an expert group to develop additional guidance. The authors call for a multiagency global initiative on AI for health to improve coordination, leverage collective agency, and ensure that the evolution of AI steers away from a dystopian future towards one that is safe, secure, trustworthy and equitable.