Values, Policies and Rights

De-drug RSA and save the economy … why not?
Schorr D: Pambazuka News, April 2018

South Africa’s GDP is reported to have risen from US $3445 in 1994 to US $5284 in 2016, but far from ushering in overall improvement in health or well-being, the author notes that rising white collar crime, violence, small business failure , un- and underemployment and the flight of skills signpost an unhappy place. He notes that South Africa “… had the highest number of drunk driving incidents at 58 percent” in the world …”. Alcohol is said to account for 40 percent of violent crime. The author calls more regulations to ensure that alcohol companies pays for the consequences that come with heavy drinking in the country.

Press Release on the Settlement Agreement of the TB/Silicosis Compensation Class Suit
Botswana Labour Migrants Association: Botswana, May 2018

Botswana Labour Migrants Association and its members from all the four corners of Botswana, present a press release reporting the news of the finalization of the TB/Silicosis class action, by way of a settlement agreement between mineworkers and the mining companies. The settlement ceremony which was held on the 3 May 2018 in South Africa, was reported in the press release to be groundbreaking and a vindication of the dues, sweat and rights of ex-miners in the region, their spouses and children and especially the efforts of the Association and its leadership..

Further details: /newsletter/id/63446
Upholding the rights of urban refugees in Uganda
Monteith W; Lwasa S; Nsangi G; et al: International Institute for Environment and Development (IIED) Briefing, 2017

Uganda is at the centre of current debate on urban refugees. The country’s Refugees Act 2006, which establishes refugees’ rights to live, work and own land in urban areas, has been hailed as exemplary and a global model for humanitarian responses. However, new evidence on refugee livelihoods in Kampala suggests that the rights to work and move freely, and without fear, are often unmet in urban areas. In the absence of financial assistance, urban refugees often struggle to find gainful employment and report frequent cases of discrimination by both the Ugandan state and the public. This briefing outlines the barriers faced in upholding the rights of urban refugees in Uganda, and recommends ways in which these may be overcome.

Militarized Humanitarianism in Africa
Rock J: Foreign Policy in Focus, May 2014

The U.S. Africa Command (AFRICOM) has rapidly expanded its presence on the African continent since its establishment. Emphasizing a “3D” approach of “defense, diplomacy, and development,” AFRICOM’s charge is described as coordinating “low-cost, small-footprint operations” throughout the African continent. Writing in the New York Times, Eric Schmitt marveled at AFRICOM’s Operation Flintlock, a multinational and multiagency training operation in Niger. He wrote glowingly about fighting terrorism with mosquito nets: “Instead of launching American airstrikes or commando raids on militants,” he wrote, “the latest joint mission between the nations involves something else entirely: American boxes of donated vitamins, prenatal medicines, and mosquito netting to combat malaria.” The author asks however if AFRICOM’s humanitarian undertakings should be approached as gestures of goodwill or conflict-deterrence, or rather as signs of a militarized U.S. approach to foreign policy in Africa.

National policies on the management of latent tuberculosis infection: review of 98 countries
Jagger A; Reiter-karam S; Hamadab Y; et al: Bulletin of the World Health Organisation 96(3) 173–184, 2018

This paper is a review of policies on management of latent tuberculosis infection in countries with low and high burdens of tuberculosis. The authors divided countries reporting data to the World Health Organization Global Tuberculosis Programme into low and high tuberculosis burden, based on World Health Organization criteria. National policy documents on management of latent tuberculosis were identified through online searches, government websites, World Health Organization country offices and personal communication with programme managers. A descriptive analysis was done with a focus on policy gaps and deviations from World Health Organization policy recommendations. Documents were obtained from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of tuberculosis or human immunodeficiency virus (HIV)-associated tuberculosis. Screening for children aged < 5 years with household tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries’ policies did not comply with WHO recommendations: nine (13.2%) recommended tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery. The authors raise that lack of solid evidence on certain aspects of management of latent tuberculosis infection results in national policies which vary considerably and highlight a need to advance research and develop clear, implementable and evidence-based WHO policies.

Extractive Laws in Africa: What is the state of these laws? Why are our laws a problem? Why and on what should we call for reforms?
Graham Y: Alternative Mining Indaba, February 2018

The overarching legal framework for minerals across Africa is public ownership. Citizens should be the collective beneficial owners of the mineral resources that are managed on their behalf by the state as a trustee. Graham asserts, however, that the reality in Africa is different. The collective ownership of minerals and the trustee role of the state has been compromised. Mining activists have tended to focus on accountability and transparency in relation to the regimes of mineral exploitation that governments have adopted. Graham asserts that there is a more fundamental accountability question in how the choices being made advance the inter- generational interests of citizens. Graham identifies that the citizen should at the very least not be made worse off by the development of assets of which he/she is part owner. He argues that there should be a stronger accountability framework where a minerals and development policy provides for inter-generational benefit, with linkages to development. There is a need to retreat from a 'first come first served' approach to awarding mining contracts, to collect more geological information to inform award of concessions and reform revenue law to be sensitive to mining price cycles so revenue collection can be optimised.

Guidelines for responsible short-term global health activities: developing common principles
Lasker J; Aldrink M; Balasubramaniam R; et al: Globalization and Health 14(18) doi: https://doi.org/10.1186/s12992-018-0330-4, 2018

Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is argued to be needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.

Political Priority for Abortion Law Reform in Malawi: Transnational and National Influences
Daire J; Kloster M; Storeng K: Health and Human Rights Journal, March 2018

In July 2015, Malawi’s Special Law Commission on the Review of the Law on Abortion released a draft Termination of Pregnancy bill. If approved by Parliament, it will liberalize Malawi’s strict abortion law, expanding the grounds for safe abortion and representing an important step toward safer abortion in Malawi. Drawing on prospective policy analysis (2013–2017), the authors identify factors that helped generate political will to address unsafe abortion. Notably, the authors show that transnational influences and domestic advocacy converged to make unsafe abortion a political issue in Malawi and to make abortion law reform a possibility. Since the 1980s, international actors have promoted global norms and provided financial and technical resources to advance ideas about women’s reproductive health and rights and to support research on unsafe abortion. Meanwhile, domestic coalitions of actors and policy champions have mobilized new national evidence on the magnitude, costs, and public health impacts of unsafe abortion, framing action on unsafe abortion as part of a broader imperative to address Malawi’s high level of maternal mortality. Although these efforts have generated substantial support for abortion law reform, an ongoing backlash from the international anti-choice movement has gained momentum by appealing to religious and nationalist values. Passage of the bill confronts, for example, the current United States’ government position prohibiting the funding of safe abortion.

Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo: a cross-sectional study
Lusey H; Sebastian M; Christianson M; et al: International Journal for Equity in Health 16(1), doi: 10.1186/s12939-017-0707-7, 2017

This study assessed gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo. A cross-sectional study was carried out among 289 church-going young men, aged 18–24 years, residing in three disadvantaged communes of Kinshasa. The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men agreed that a man is the only decision maker in the home and about half of the respondents supported the statement “There are times a woman deserves to be beaten”. Similarly, around half of the participants agreed with the idea of men’s uncontrollable sex drive and men’s toughness. Close to half of the participants agreed that it is women’s responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found. The study findings indicated that a high proportion of church-going young men do not endorse gender equitable norms. The authors argue that churches and schools urgently need comprehensive gender equality and masculinity policies and programmes to influence young men’s attitudes and behaviours.

Minding the gaps: health financing, universal health coverage and gender
Witter S; Govender V; Ravindran S; et al: Health Policy and Planning 32(Suppl 5)ppv4–v12, 2017

This article provides a reflection on the question of why there is a need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage will automatically be equitable and gender balanced, from a panel of health financing and gender experts. The authors traced the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. The authors found that unless explicit attention is paid to gender and its inter-sectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations, movement towards Universal Health Coverage can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to Universal Health Coverage and the needs of less powerful groups, which can include women and children, are not necessarily given priority. The authors identified the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of Universal Health Coverage decisions, political economy as well as technical research should be prioritized. The authors concluded that countries should adopt an equitable approach towards achieving Universal Health Coverage and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children.

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