This discussion paper presents key elements of the concept of UHC as promoted by the World Health Organisation and reflects them based on Medicu Mundi International’s (MMI) own ambition of Health for All such as stated in the MMI Network Policy. The paper consists of three sections (1) “What is in Universal Health Coverage?” (2) “Financing UHC”, and (3) “UHC and health equity”. MMI argues that if its Network is to promote Universal Health Coverage in view of improving health equity, then it should be willing to be truly involved in the political and ideological battle that will enfold over the coming period. Unless the international community pushes the right to health up in its scale of values and stops considering health as a dependent variable of the global economy, and unless it makes the respect of human rights mandatory and those who violate them legally accountable, UHC is unlikely to yield the expected results. Issues needing further investigation include: Universal Health Coverage and gender equity (almost entirely missing in the current debate); Universal Health Coverage and sustainability; the political economy of Universal Health Coverage; and the transformative power of the UHC concept for social mobilisation and political change towards Health for All.
Values, Policies and Rights
This United Nations resolution recognises that access to medicines is one of the fundamental elements in achieving progressively the full realisation of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It stresses the responsibility of States to ensure the highest attainable level of health for all, including through access, without discrimination, to medicines, in particular essential medicines, that are affordable, safe, efficacious and of quality. At the same time, the resolution emphasises the crucial role of prevention, the promotion of healthy lifestyles and the strengthening of health systems. The central element of the resolution urges States, as appropriate, to take 16 measures to fulfil their obligations on access to medicines within the right to health framework. The resolution also recognises the innovative funding mechanisms that contribute to the availability of vaccines and medicines in developing countries, such as the Global Fund and the GAVI Alliance. It calls upon all States, United Nations programmes and agencies, relevant intergovernmental organisations and pharmaceutical companies to help safeguard public health from conflict of interest, as well as to further collaborate to enable equitable access to quality, safe and efficacious medicines that are affordable to all.
In this article, the authors examine how major global health organisations, such as WHO, the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and GAVI approach human rights concerns, including equality, accountability and inclusive participation. The authors use examples of best practice to indicate how such agencies can advance the right to health, covering nine areas: 1) participation and representation in governance processes; 2) leadership and organizational ethos; 3) internal policies; 4) norm-setting and promotion; 5) organisational leadership through advocacy and communication; 6) monitoring and accountability; 7) capacity building; 8) funding policies; and 9) partnerships and engagement. The proposed UN Framework Convention on Global Health (FCGH) would commit state parties to support these standards through their board membership and other interactions with these agencies. The authors also explain how the FCGH could incorporate these organisations into its overall financing framework, initiate a new forum where they collaborate with each other, as well as organisations in other regimes, to advance the right to health, and ensure sufficient funding for right to health capacity building.
On 11 July 2013, the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women (the Protocol) turns 10. The author of this article argues that there is much to celebrate, as the Protocol remains one of the worlds’ most progressive women’s human rights instruments. While ratifications are a welcome measure, the provisions enshrined in the Protocol only have real meaning if governments go further and show their commitment to the protection and advancement of African women’s human rights by domesticating and fully implementing the instrument, she argues. Challenges that require mitigation exist and include limited technical and financial support in many states particularly with regard to the efforts to sensitise and build the capacity of government officials as well as the general public on the provisions of the Protocol; lack of political goodwill and weak institutional mechanisms to support the domestication and implementation of the Protocol; and lastly religious and cultural conservativism.
This study found that globally, 38% of all women who were murdered were murdered by their intimate partners, and 42% of women who have experienced physical or sexual violence at the hands of a partner had experienced injuries as a result. Partner violence was found to be a major contributor to women’s mental health problems, women experiencing intimate partner violence are almost twice as likely as other women to have alcohol-use problems and 1.5 times more likely to acquire certain sexually transmitted infections In some regions like sub-Saharan Africa, they are 1.5 times more likely to acquire HIV. Both partner violence and non-partner sexual violence were associated with unwanted pregnancy, as the report found that women experiencing physical and/or sexual partner violence are twice as likely to have an abortion than women who do not experience this violence. Women who experience partner violence also have a 16% greater chance of having a low birth-weight baby. The study highlights the need for all sectors to engage in eliminating tolerance for violence against women and better support for women who experience it, and was launched with new World Health Organisation’s clinical and policy guidelines (also included in this newsletter).
If access to equitable health care is to be achieved for all, policy documents must address different needs of groups that do not access health care. This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. While reference is broadly made to vulnerable groups, there is lack of detailed specification of the different needs of different groups. The documents suggest that vulnerable groups are homogeneous in their needs, which is not the case. The authors argue for more information and knowledge on the needs of all vulnerable groups and more specific cover of these issues in policy documents.
In this study researchers investigated the reasons for poor implementation of Ghana’s legal abortion policy to better understand how providers shape and implement policy and how provider-level barriers might be overcome. They conducted in-depth interviews with 43 health professionals of different levels at three hospitals in Accra, as well as staff from smaller and private sector facilities, and analysed relevant policy and related documents. The findings show that health providers’ views shape provision of safe-abortion services. Providers experience conflicts between their religious and moral beliefs about the sanctity of (foetal) life and their duty to provide safe-abortion care. Obstetricians were more moderate while midwives were more driven by fundamental religious values condemning abortion as sinful. In addition to personal views and dilemmas, ‘social pressures’ (perceived views of others concerning abortion) and the actions of facility managers affected providers’ decision to (openly) provide abortion services. Providers tend to use personal discretion in deciding if and when to provide abortion services, and develop ‘coping mechanisms’ which impede implementation of abortion policy. The authors recommend that these findings be included in future evidence-based practice.
This paper aims to contribute to the existing knowledge around a Framework Convention on Global Health (FCGH) from the perspective that any international legal framework conceptualisation on the right to health must involve those whose health is at stake, namely civil society. The two case studies, Senegal and South Africa, were used to look at the international right to health framework within in the context of civil society’s role in combating the HIV and AIDS epidemic. The findings illustrate that these two African states face different challenges regarding the realisation of the right to health in the context of HIV and AIDS, yet civil society has played an important role in both countries in realising the right to health. The authors show the diverse roles that an FCGH could play in empowering civil society, through the formulation of a global standard and framework on the right to health, in the form of an FCGH, particularly if it is as a result of a movement of rights education and advocacy from below.
At the 23rd session of the Council held in Geneva on 27 May to 14 June 2013, the United Nations Human Rights Council adopted a resolution on access to medicines despite opposition from the United States and the European Union (included in this newsletter). According to this article, the resolution is a step forward in addressing the issue of access to medicines within the right to health framework. The new Resolution recognises access to medicines as one of the fundamental elements in the realisation of the right to health. Unlike some earlier resolutions, the scope of the new resolution is not limited to essential medicines and covers all medicines. It clearly calls for the regulation of prices of medicines to make them affordable for people, especially those in developing countries. It also clearly establishes the link between local production and the right to health framework and addresses the research and development (R&D) question within the right to health framework, especially referring to a new R&D model based on de-linking of cost of R&D from the price of health products. It also clearly states that the engagement with stakeholders is based on the principle of safeguarding public health from undue influence by any form of real, perceived or potential conflict of interest.
The continued success in global tobacco control is detailed in 2013’s WHO Report on the Global Tobacco Epidemic. It presents the status of the MPOWER measures, with country-specific data updated and aggregated through 2012. In addition, the report provides a special focus on legislation to ban tobacco advertising, promotion and sponsorship (TAPS) in WHO Member States, as well as in-depth analyses of TAPS bans were performed, allowing for a more detailed understanding of progress and future challenges in this area. The progress in reaching the highest level of achievement in tobacco control is a sign of the growing success of the WHO Framework Convention on Tobacco Control (WHO FCTC) and provides strong evidence that there is political will for tobacco control on both national and global levels. About 2.3 billion people are now covered by at least one tobacco control measure at the highest level of achievement. This is due to the actions taken by many WHO Member States to fight the tobacco epidemic. These countries can be held up as models of action for the many countries that need to do more to protect their people from the harms of tobacco use, the report concludes.