A new universal health coverage law received parliamentary approval in mid-December in Europe after years of discussion and planning. Health care will be provided for everyone including the estimated 30% of Egyptians who cannot afford to pay at present. Enrolment in the scheme will be obligatory, with fees set according to income with additional sources of funding to include taxes on tobacco and polluting industries including cement. Egypt's population is forecast by the UN Population Fund to reach 119 million in 2030. UNICEF says about three in every ten children suffer from multidimensional poverty, which includes factors such as poor health and lack of education. Tedros Adhanom, director-general of WHO, praised the law for including people with major catastrophic conditions such as cancer. The scheme will be mandatory, with those on low incomes to be covered by the state; with split roles for health-care providers and those bodies to oversee quality and accreditation; and patients would be allowed to choose their own doctor and hospital. However, he raised worries about the level of co-payments that patients might have to make and the long period of implementation that might lead to worsening health disparities.
Values, Policies and Rights
The first-ever WHO Independent Global High-level Commission on Noncommunicable Diseases (NCDs) aims to identify and propose bold and practical ways to curb the world’s leading causes of death and illness. The Commission was announced in 2017 by Dr Tedros Adhanom Ghebreyesus, Director-General WHO. The Commissioners will recommend actions to accelerate progress in tackling NCDs, primarily cardiovascular disease, cancers, diabetes and respiratory disease, and promoting mental health and well-being. NCDs kill 15 million people between the ages of 30 and 69 each year. Low- and lower-middle income countries are particularly affected by NCDs with almost 50% of premature deaths from NCDs occurring in these countries. In addition, NCDs are responsible for the deaths of 7 in 10 people across all ages globally, equivalent to approximately 40 million people. In 2015, world leaders committed to reduce premature deaths from NCDs by one third by 2030 as part of the Sustainable Development Goals. Recent WHO reports indicate that the world will struggle to meet that target.
This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems; illustrate how gender power relations affect access to important resources; and demonstrate that gender norms, poverty and patriarchy interplay to limit women’s choices and chances both within household interactions and within the health sector. The authors note that health systems researchers have a responsibility to promote the incorporation of gender analyses into their studies in order to inform more strategic, effective and equitable health systems interventions, programmes, and policies. Responding to gender inequitable systems, institutions, and services in this sector requires an ‘all hands-on deck’ approach. They note that it is not possible to claim to take a ‘people-centred approach’ to health systems if the status quo continues.
In this statement civil society organisations call for a change to the business-as-usual approach to achieving UHC and raise following principles that need greater emphasis in national and global efforts: Health is a human right and the achievement of UHC should ensure that no one is left behind; Out-of-pocket payments should be progressively abolished and public financing for health should be significantly increased; and good governance, robust transparency, and sound accountability must be ensured.
Ensuring that all people can access the health services they need – without facing financial hardship – is key to improving the well-being of a country’s population. This report argues that universal health coverage (UHC) is more than that: it is an investment in human capital and a foundational driver of inclusive and sustainable economic growth and development. It is a way to support people so they can reach their full potential and fulfil their aspirations. However, the report indicates that despite some progress on UHC, at least half of the world’s population still cannot obtain essential health services. And each year, close to 100 million people are being pushed into extreme poverty because they must pay for health expenses out of their own pockets, pointing to the challenges in reaching the global goal of UHC by 2030.
This article assesses factors that contributed to the success of the farm input support programme in Malawi in 2005–15, and the lessons from this experience in relation to climate change adaptation. Important factors were the ability to balance external and internal drivers that affected policy formulation, national ownership and prestige that influenced and motivated implementation capability, creation of conducive conditions its demand-driven nature. However, the flooding in 2015 and the drought in 2016 revealed that Malawi needs more effective measures to reduce long-term vulnerability to future adverse impacts of climate change. The authors argue that the lessons learned from this social protection programme can prove useful in relation to efforts to achieve sustainable responses to climate change that could reduce the need for humanitarian assistance.
These short videos provide an overview of the history of human rights; health and human rights; and health, human rights and development. They were developed to make human rights more accessible to non-lawyers and non-academics. The videos are accompanied by tools for further learning, including an annotated bibliography, glossary of terms, timeline of key events, and fact sheet on universal health coverage. The first video provides an explanation on what human rights are and why they are important. The second video offers a brief history of health and human rights since World War II. The third video gives a description of how health-related human rights developed during the era of the Millennium Development Goals (2000-2015) and the Sustainable Development Goals (2016-2030). The series concludes by considering the vital role that human rights plays in diverse political environments.
In a letter to his five children written en route to Bolivia, Ernesto Che Guevara said: “Always be able to feel deep within your being all the injustices committed against anyone, anywhere in the world. This is the most beautiful quality a revolutionary can have.” This article about Che Guevara, 50 years after his execution, explores Che’s story and legacy. His tutelage in revolutionary thought came from his experiences among the leprosy patients of Venezuela and the tin miners of Bolivia, among the revolutionaries of Argentina and the 1954 coup in Guatemala. Reality radicalised him. Mario Terán Salazar, the soldier who shot Che, went into hiding. Many years later, in 2006, the Cuban government operated on Che’s killer to remove a cataract from his eye without charge. The author points to this to highlight that Che’s legacy was not revenge, but doctor’s love for humanity.
With adolescents and youth constituting a quarter of the global population – for a total of 1.8 billion people – it has never been more critical that their human rights be fully recognised and realised within global arenas and at the regional, national, and community level. This publication sets forth the barriers adolescents face in realising their sexual and reproductive health and rights, discusses recent critical developments in the human rights framework underpinning these rights, and proposes a way forward for guaranteeing all adolescents the full exercise of their sexual and reproductive health and rights.
The authors argue that applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women's, children's, and adolescents' health in East Africa, a priority under the Sustainable Development Goals. They point to a gap between global rhetoric of human rights and ongoing health reform efforts,. and seeks to fill part of that gap by setting out principles of human rights-based approaches, and then applying those principles to questions that countries undertaking efforts toward UHC and promoting women's, children's and adolescents' health, will need to face. The paper focuses in particular on ensuring enabling legal and policy frameworks, establishing fair financing; priority-setting processes, and meaningful oversight and accountability mechanisms. In a region where democratic institutions are argued to be weak, the authors argue that the explicit application of a meaningful human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of health reform initiatives being undertaken in the region.