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.
Values, Policies and Rights
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.
The idea of a Framework Convention for Global Health (FCGH), using the treaty-making powers of the World Health Organisation (WHO), has been promoted as an opportunity to advance global health equity and the right to health. The idea has promise, but the authors argue that it needs more thought regarding risks, obstacles, and strategies. The reform of global health governance must be based on a robust analysis of the political economy, drivers of inequality and the denial of the right to health arise. The authors warn against limiting analysis to questions of inter-governmental financial transfers because of the risk of neglecting the underlying structural determinants of health injustice, which would help to legitimise an unjust and unsustainable global economic regime. While a FCGH can alert to areas for global regulation, the authors call for popular mobilisation around the right to health in ways that link to the local priorities of different communities.
This issue of the Africa Environment Outlook conveys the following key messages to policy makers and other stakeholders: 1. Environmental and health issues deserve priority consideration in national development. 2. Although indoor air pollution is a profound health problem in Africa, it has been inadequately addressed. 3. Biodiversity provides goods and services such as food and medicinal plants that promote human health in Africa. 4. Climate change and variability severely impact human health owing to individuals’ and communities’ limited coping capacities. 5. Coastal and marine resources are integral to the health of coastal populations and need to be conserved and used sustainably. 6. Access to safe water and adequate sanitation is vital to human health and needs to be scaled up by eliminating impediments such as inadequate infrastructure, pollution of water sources, poor hygiene, retrogressive cultural taboos and gender disparities. 7. Sustainable land management is central to human health because land provides the resource base for the provision of ecosystem services such as food, fibre and medicines. 8. The magnitude of domestic and global uncertainties that decision makers have to grapple with imply that espousing the business as usual model when dealing with environmental problems does not only result in failure to meet internationally set goals and targets, it also undermines human health. 9. Although a number of good policies for addressing environmental challenges that affect human health exist, their implementation has been weak. Making policies more effective requires elimination of barriers to implementation.
In this paper, researchers reviewed how government policies in low and middle income countries (LMICs) outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. They carried out a structured content analysis of national nutrition, non-communicable diseases (NCDs), and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organisation (WHO). They found policies to be available in 83% of the countries. NCD strategies were found in 47% of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two WHO regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% proposed a policy that addressed all four risk factors, and 25% addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers. This review indicates the disconnect between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity, the authors conclude.