In sub-Saharan Africa, HIV and maternal mortality and morbidity (MMM) are connected in both outcomes and solutions: HIV is the leading cause of maternal death, while prevention of unintended pregnancy and access to contraception are considered two of the most important HIV-related prevention efforts. Both are central to reducing unsafe abortion, another leading cause of maternal death in Africa. A human rights-based framework helps to identify shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Therefore the authors call for a human rights-based and integrated response to the two health issues. Governments should establish the health-related human rights standards to which all women are entitled and provide remedy for human rights violations related to HIV and maternal mortality and morbidity. No single goal, such as those addressing HIV and MMM, can be achieved without progress on all development goals.
Values, Policies and Rights
This report argues that Ghana is reported to be violating the African Charter on Human and Peoples’ Rights when people with mental disorders are subjected to prayer camps that advocate complete isolation, being chained to trees, and forced exorcism for demonic possession, and fails to provide services for mentally illness. The author suggests that mental health problems often stem from poor nutrition, depressed socioeconomic status, and elevated, persistent violence. Despite the widespread presence of these factors mental heath problems like depression or undiagnosed schizophrenia are often ignored in health policy agendas in Africa. The author proposes that mental health be recognised as a human right, coupled with de-stigmatisation of mental health disorders, and resource allocation for treatment.
On 5 February, 2013, Uruguay became the tenth country to ratify the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights (ICESCR), which means the Optional Protocol will come into force on 5 May, 2013. Until now, the CESCR has been limited to issuing concluding observations and recommendations to member countries as part of semi-regular country reporting requirements in the ICESCR and to issuing broad general comments on rights under the Convention. The opportunity will now exist at the global level to litigate and begin to develop more concrete standards around the rights in the ICESCR – including the right to of everyone to the enjoyment of the highest attainable standard of physical and mental health (Article 12 of the ICESCR). The authors of this paper highlight emerging opportunities within the framework of the ICESCR and the Optional Protocol to begin serious investigations into the social determinants of health, such as access to sufficient food, water, sanitation, and education. They call for an approach that goes beyond the typical and narrower construction of the right to health based in access to health care services to include the determinants discussed in Article 12.
In this article, the authors propose that the right to health and its imperative of narrowing health inequities should be central to the post-2015 international health agenda. However, they argue that universal health coverage - as defined by the World health Organisation and typically conceived - is not enough to ensure the right to health. Policy-makers will need to address the social determinants of health such as safe drinking water and good sanitation, adequate nutrition and housing, safe and healthy occupational and environmental conditions and gender equality. The post-2015 health agenda should also explicitly describe the accountability mechanisms that will make it possible for people to claim – not beg for – additional national public resources and international assistance, if needed. Furthermore, it must specify how citizens will participate in the decision-making processes surrounding their health services and their physical and social environment. Participation must be genuine and built on a continuing relationship among researchers, governments and those communities, otherwise goals may end up being formulated by policy elites after token and superficial consultations, undermining the rights of the very communities they serve.
The authors of this paper argue that current forms of co-operation are often ineffective, insufficient and incapable of achieving progressive realisation of the right to health. They propose that, after the many international and regional Commissions, Declarations, and institutional innovations of the last 20 years, the logical next step for the promotion of the right to health is the drafting and enforcement of a Global Framework Convention on Health (GFCH). Significant contemporary international challenges make national health an issue that needs to be protected by global agreements. Such challenges include the international but unequal market for health workers that result in the recruitment of health workers from developing countries and the prohibitive cost of essential medicines and of meeting the health needs and rights of migrants and refugees. Developing countries are struggling to bear these financial burdens. The authors call for a GFCH that broadly sets out national and international duties towards health, health challenges and their cost, and helps make people of low income countries less vulnerable to shifting developed-world priorities.
The second meeting of the Open-Ended Working Group on Pandemic Influenza Preparedness was held from 13-17 December 2010 at the World Health Organization (WHO) headquarters in Switzerland. The working group is part of a longstanding effort to agree on a global framework on pandemic influenza preparedness. A key sticking point in past negotiations has been a standard material transfer agreement (SMTA), including intellectual property rights provisions, for the sharing of viruses and other pandemic-related materials and for sharing related benefits. At the meeting, some countries put an SMTA into a larger context as one part of the solution, rather than the only solution. One concern is that developed countries are not increasing efforts to ensure access and benefit sharing, despite the new agreement – the Nagoya Protocol – at the United Nations (UN) Convention on Biological Diversity. This article notes that, instead of collaborating collectively under the auspices of WHO to develop an ambitious framework that delivers sharing of viruses as well as equitable benefits to facilitate pandemic preparedness, the positions taken by developed countries on a range of issues – including benefit sharing by recipients of influenza biological materials, intellectual property and issues of transparency – indicated a lack of interest towards protecting global public health and a focus on protecting the profits of their industries and safeguarding developed countries’ access to vaccines and other treatments in the event of a pandemic. The Mexican Ambassador to the UN in Geneva, a leader in the negotiating process, said he expected an agreement to be reached by the annual World Health Assembly in May 2011.
Out of 192 countries studied in this review, 75 had legislation mandating universal access to health care services independent of income. Of these, 58 met the criteria based on available measures of coverage that serve as broader proxies for access to care. The authors of the review found that most countries have adopted legal commitments to achieve universal health coverage at low- and middle-income stages of development. When they have not, healthcare has tended to expand gradually, leaving many members of the population vulnerable for extended periods of time. However, the authors caution that a legal commitment is insufficient on its own and must be translated into policies that establish a comprehensive, largely publicly financed system. An over-reliance on partial and private sector-focused care appears to disproportionately benefit richer groups, reducing both efficacy and access to coverage. It also creates groups with strong vested interests in the status quo that can block further progress, they argue. Public financing is more equitable and pro-poor, and reflects the shared value of providing care based on need rather than ability to pay.
The United Nations (UN) has passed two resolutions on the right to water and sanitation. The resolution, ‘The human right to water and Sanitation’, was passed by the General Assembly on 28 July 2010, and the resolution, ‘Human rights and access to safe drinking water and sanitation’ was passed by by the Human Rights Council on 30 September 2010. By framing access to water and sanitation as a human right, these resolutions seek to promote ‘national and international justifiable approaches that promote accountability and transparency and provide mechanisms to progressively realise increasing peoples access to water and sanitation’. However, critics point out that the legal basis for recognising the right to water is not adequately established by the resolutions. According to this article, the primary issue confronting the international community will be translating the resolutions into reality. Proposals by the UN include developing tools/mechanisms to achieve the right to safe water and sanitation, ensuring full transparency in the implementation process of delivering safe drinking water and sanitation, focusing on marginalised groups, adopting/implementing effective regulatory frameworks, and putting in place accountability mechanisms to remedy human rights violations.
Government officials, representatives of United Nations agencies and members of the International Campaign to Ban Landmines met from 29 November to 3 December 2010 in Geneva to discuss their efforts and plans to implement the 1997 Mine Ban Treaty. This article is a call to stakeholders at the meeting to address the barriers facing women with disabilities, and to take a participatory approach to policy making that will include the opinions of these women and their self-defined needs. According to the author, a Ugandan activist, women with disabilities have been left out of the agenda to ban landmines over the past decade, in the same way they have been left out of development programmes and shunned in their own communities. Challenges faced by women with disabilities include social isolation, being ignored by relief and recovery efforts and suffering sexual violence. Abuse and abandonment are common, and a lack of access to health care, education and employment opportunities are the reality for most. Unless policymakers take the needs of disabled women into account, the author concludes, these women cannot share fully in the benefits of any new programmes, including employment and health rehabilitation programmes.
The African Youth Conference on Post-2015 Development Agenda, held in Nairobi, Kenya, from 12-16 December 2012, has adopted a Youth Declaration on the Post-2015 Agenda. This Agenda identifies 13 actions for accelerating progress on the Millennium Development Goals (MDGs) and makes recommendations for the post-2015 development agenda. On accelerating MDG progress, the Declaration recommends that governments: increase commitments to achieve the MDGs and honour pledges; strengthen institutions to fight corruption and empower youth; and provide sufficient resources to children, women and youth ministries. It also recommends, inter alia: increasing equitable access to sustainable water and sanitation services and promoting hygienic behaviour; planning and implementing poverty eradication programmes to reach youth; strengthening communication, data collection and monitoring; and empowering and mobilising youth to participate in the MDGs and hold governments accountable. The Declaration asks the UN and its development partners to support projects that mitigate climate change and encourage sustainable consumption. It calls for civil society to engage communities to understand the causes of poverty and to address these challenges.