A judgment handed down in May 2016 in the South Gauteng High Court in the case of Bongani Nkala and 68 Others v Harmony Gold Mining Company Ltd and 31 Others is reported an important step toward providing just compensation for the many thousands of miners who contracted silicosis or tuberculosis on South Africa’s gold mines. The court certified two classes. The first and larger is gold miners and former gold miners who have contracted silicosis and the second is those who have contracted TB. The class requires that a person has worked underground in the mines for at least two years since 1965 and contracted either disease. The lawsuit, unless settled, will now proceed into trials in which common issues relevant to all class members will be determined. The court confirmed that for mineworkers, “it is class action or no action at all. Class action is the only realistic option open to mineworkers and their dependents. It is the only way they would be able to realise their constitutional right of access to court bearing in mind that they are poor, lack the sophistication to litigate individually, have no access to legal representatives and are continually battling the effects of two extremely debilitating diseases.” [para 100] The judgment is also important for all vulnerable people in South Africa. A class action is a powerful mechanism by which poor or vulnerable people can access justice. It is however not commonly used in South Africa. This judgment is argued to help those who do not have resources on their own to pool efforts in order to access justice. The authors argue that it recalibrates the balance of power to give the poor a better chance of holding the powerful to account.
Values, Policies and Rights
Member States of the African Union endorsed in 2015 the milestones for the establishment of a single medicines regulatory agency in Africa within the context of the African Medicines Regulatory Harmonization programme. Concerned that the proliferation of Substandard/Spurious/Falsified/Falsely- labelled/Counterfeit medical products on the continent poses a major public health threat and noting that regulatory systems of many African countries remain inadequate the states called for legislation relating to medical products through Regional Economic Communities and the African Union to ensure access to medical products that are safe, efficacious, and of assured quality to the African population. They called for the adoption and domestication of a model law on medical products regulation in Africa for the creation of a harmonized regulatory environment on the continent; and adopted the African Union Model Law on Medical Products Regulation.
The population of older people throughout the world is increasing rapidly, with Africa projected to have about 210 million older people by 2050. In addition to the usual physical, mental and physiological changes associated with ageing, old people in Africa are argued to be particularly disadvantaged due to lack of social security for everyday social and economic needs. This policy framework binds all AU member countries to develop policies on ageing and is being used as a guide in the formulation of national policies to improve the lives of the continent’s older people. The authors argue that advocacy efforts need improve the adaptation and domestication of the policy and encourage appropriate consultations with older people in these processes, including to ensure the allocation of resources for the implementation of commitments. Notably, the International Plan of Action on Ageing agreed upon in Madrid during the Second World Assembly on Ageing in April 2002, borrowed significantly from the AU Policy Framework.
UNRISD director Paul Ladd shares his reflections on the Sustainable Development Goals (SDGs). He argues that social development means keeping people at the centre, and recognising the contributions that can be made by all people, regardless of gender, age, race, ethnicity, physical ability, sexuality or any other characteristic. Enhancing well-being means that processes, relationships and institutions need to be transformed into ones that are based on equity and justice. This is critically shaped by how governments are run, how technology is used, how people adapt to demographic change, and how economies are structured, all of which depends on the political agenda. He argues that the 17 SDGs have many welcome innovations, including the aspiration to not tackle issues in silos, to leave no one behind and the recognition that all countries have problems. This presents a more political agenda than the Millennium Development Goals (MDGs) that preceded them, with solutions largely found in policy change and doing things differently, rather than solely spending more money on technocratic 'solutions' that, while well-meaning, ignored the power dynamics that determine who benefits from them and who is left by the wayside. Finally he observes that UNRISD’s three research programmes—social policy, gender and development, and the social dimensions of sustainable development—intend to make a critical contribution to debates on which policies and institutions, in which contexts, will make the most progress towards achieving the SDGs.
Universal Health Coverage UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals. For WHO, “UHC is, by definition, a practical expression of the concern for health equity and the right to health”; thus promoting UHC advances the overall objective of WHO, namely the attainment by all peoples of the highest possible standard of health as a fundamental right, and signal a return to the ideals of the Declaration of Alma Ata and the WHO Global Strategy for Health for All by the Year 2000. Yet some argue that the “current discourse on UHC is in sharp contrast with the vision of Primary Health Care envisaged in the Alma Ata declaration of 1978”. The underlying assumption of this paper is that efforts towards achieving UHC do promote some, but not necessarily all, of the efforts required from governments for the realisation of the right to health. While this publication explores how efforts to advance towards UHC overlap with efforts to realise the right to health, its main focus is the gaps that exist between UHC efforts and right to health efforts.
Widespread HIV-related stigma and discrimination in the health-care sector impedes access to services and impairs the quality of health-care delivery for people living with HIV and other key populations. It also undermines efforts to achieve the highest attainable standard of health for everybody. At a two-day meeting held in Geneva, Switzerland, on 10 and 11 November 2015, key stakeholders came together to discuss ways to eliminate all forms of discrimination in health-care settings, using the lessons learned from the AIDS response as an entry point. The event, organised by UNAIDS and the Global Health Workforce Alliance, also focused on the UNAIDS 2016–2021 Strategy and the upcoming Global Strategy on Human Resources for Health: Workforce 2030. Stigma and discrimination in health takes many forms—the denial of health care and unjust barriers to service provision, inferior quality of care and a lack of respect. Abuse and other forms of mistreatment, violation of physical autonomy, mandatory testing or treatment and compulsory detention are other forms of stigma and discrimination encountered by people living with HIV. The meeting concluded with a clear call for more coordinated action. UNAIDS and the Global Health Workforce Alliance were asked to develop a plan before next year’s Zero Discrimination Day, on 1 March 2016, to work towards ending discrimination in health-care settings. Priorities include political advocacy, strengthening accountability mechanisms, sharing existing evidence and best practices and building evidence-informed policy for implementation and scale-up of programmes to reduce stigma and discrimination at all levels.
Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels are reviewing the International Health Regulations' functions and urging reforms. The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations.
As a key supporter of universal health coverage (UHC), The Lancet recently partnered with Medical Education Cooperation with Cuba (MEDICC), a non-governmental organisation based in the United States, to produce a Spanish-language translation of The Lancet’s series on UHC in Latin America. This translation was launched as part of Cuba Salud 2015, an international health conference held during April 2015 in Havana, Cuba. Despite its often ambiguous definition, UHC is often used to refer to a financial reform extending insurance coverage in varying degrees to a larger part of a country’s population. This is different to “healthcare for all” (HCA) – a healthcare delivery system that provides equal services for the entire population regardless of an individual’s or family’s financial resources. UHC as a more limited insurance concept has received wide criticism because it does not necessarily create a unified, accessible system; because it usually encourages a role for private, for- profit insurance corporations; and because it involves tiered benefits packages with differing benefits for the poor and non-poor. Although the UHC orientation has become “hegemonic” in global health policy circles, its ideological assumptions have not been confirmed empirically. The authors urge that the Lancet and MEDICC Review provide “equal time” for critiques of UHC and presentations of endeavours to achieve HCA.
In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation and of the institutions involved in the policy process. iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children’s Fund (UNICEF) and implementing organisations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organisational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channeling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development.
The 62nd ECSA Health Ministers’ Conference (HMC) was held at InterContinental Resort Balaclava Fort, Republic of Mauritius under the theme: Transitioning from Millennium Development Goals to Sustainable Development Goals with the following sub-themes; Enhancing Universal Health Coverage Through Innovations in Health Financing for Risk Protection; Surveillance and Control of Emerging Conditions: (NCDs and Trauma); Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training Using the ECSA College of Health Sciences Model. The Conference passed Resolutions on: Transitioning From MDGs to SDGs in the ECSA Region; Enhancing UHC through innovation in Health Financing for Risk Protection; Surveillance and Control of Non- Communicable Diseases and Trauma; Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training using the ECSA College of Health Sciences Model; Global Health Diplomacy and Strengthening Ministries of Health Leadership and Governance Capacity for Health in the ECSA-HC Region; and Strengthening the Use of Evidence in Health Policy.