Eduardo Gudynas looks at the main trends of the discourse around Buen Vivir in South America as a political platform for different visions of alternatives to development. He notes that any alternative to development must open paths to move beyond the modern Western culture. Buen Vivir, he argues gives that opportunity. Buen Vivir or Vivir Bien, are the Spanish words used in Latin America to describe alternatives to development focused on the good life in a broad sense. The term is actively used by social movements, and it has become a popular term in some government programs and has even reached its way into two new Constitutions in Ecuador and Bolivia. It is a plural concept with two main entry points. On the one hand, it includes critical reactions to classical Western development theory. On the other hand, it refers to alternatives to development emerging from indigenous traditions, and in this sense the concept explores possibilities beyond the modern Eurocentric tradition. The richness of the term is difficult to translate into English. It includes the classical ideas of quality of life, but with the specific idea that well-being is only possible within a community. Furthermore, in most approaches the community concept is understood in an expanded sense, to include nature. Buen Vivir therefore embraces the broad notion of well-being and cohabitation with others and with nature.
Values, Policies and Rights
Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. The authors introduce the supplement, by reviewing how policy analysis can inform: (a) how to frame iCCM and negotiate its boundaries, (b) how to tailor iCCM for national health systems and (c) how to foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritise particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertise alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalised as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.
Memory and African identity are of primordial importance to Jean Pierre Bekolo, who through his films, highlights the desire to “write from a particular place and not for an audience” because one can be easily manipulated by the expectations of an audience. Bekolo spends time in Europe, US and Africa. Travelling becomes a substantial part of his creative process.
Each of his movies stands out as a phase or the break with a phase of his artistic development: Quartier Mozart symbolises origins, family and identity, Aristotle’s Plot represents the identity of an African cineaste, while Les Saignantes is speculation or science fiction. Despite his numerous sojourns, Bekolo’s energy is always focused on Africa and Cameroon in particular, where he believes cinema has to go beyond representation and shed more light on questions which will lead to change, a concept noticeable in his latest movie Le President. Bloke, who describes himself as not just an artist but ‘a radiologist of the society’ emphasises the role that film and fiction has to play in affecting change, ‘we must not forget the aesthetic dimension, because the beauty and the real have a link: aesthetic and ethics.’
The Sustainable Development Goals (SDGs) identify achieving universal health coverage (UHC) as one component of the omnibus health goal, “to ensure healthy lives and promote well-being for all at all ages.” The components of UHC specified in goal 3.8 of the SDGs reflect World Health Organisation’s policy documents and include financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. On the positive side, UHC can be considered to be an expression of the right to health. Indeed, several health and human rights advocates had earlier proposed replacing the various health-related goals in the MDGs with the single overarching health goal of UHC in the SDGs, provided that it specify that international assistance is essential, not optional, for countries otherwise unable to pursue UHC. Significant progress toward UHC, consistent with the requirements of the right to health, would have the potential of enabling the one billion people currently estimated to not have access to the health services they need each year to obtain them. The author argues, however, that not all potential paths to a universal health system are consistent with human rights requirements, even ones that result in some expansion of health coverage. For that reason it is important that health and human rights advocates and scholars identify the essential features of UHC and policies for advancing toward this goal from a human rights perspective.
Despite criticism, the MDGs are widely praised for having galvanised national and international development efforts in unprecedented ways. Currently proposed successor Sustainable Development Goals (SDGs) seek to address newly emerged policy issues and include a call to significantly reduce the burden of non-communicable diseases (NCDs). NCDs directly impact health inequality and poverty. Their recognition is timely and to be welcomed categorically. However, ambiguity in the SDGs’ current guidance risks that states’ efforts to reduce NCDs exacerbate socioeconomic and health inequalities, rather than reduce them. The authors urge that more attention needs to be given to improving the situation of the worst off and make three concrete proposals towards this end. Existing policy guidance highlights cost-effective interventions for NCDs, but focusing just on cost-effectiveness risks exacerbating socioeconomic and health inequalities rather than reducing them. The authors suggest that in implementing the SDGs, targets and interventions that benefit the worst off should be prioritised. The United Nations should develop practical guidance to assist policy makers at the country level with incorporating equity considerations.
Medecins Sans Frontieres (MSF) has called for an investigation by an international humanitarian fact-finding commission into a US airstrike on its hospital in the Afghanistan city of Kunduz and for one of the States, party to the Additional Protocols to the Geneva Conventions, to invoke it. MSF said the attacks took place despite the fact that it had provided the GPS coordinates of the trauma hospital to Coalition and Afghan military and civilian officials as recently as Tuesday, 29 September. The attack continued for more than 30 minutes after MSF first informed US and Afghan military officials in Kabul and Washington that it was a hospital that was being hit. The International Humanitarian Fact-Finding Commission was established under the Additional Protocols to the Geneva Conventions and was officially constituted in 1991 to investigate allegations of violations of international humanitarian law. According to the Commission's website, some 76 countries have recognised the Commission, which is based in Bern, but so far, it has not yet been called upon to conduct any investigation. In her remarks to the media, MSF President Liu said that international humanitarian law is not about ‘mistakes'. "It is about intention, facts and why....This was not just an attack on our hospital - it was an attack on the Geneva Conventions. This cannot be tolerated. These Conventions govern the rules of war and were established to protect civilians in conflicts - including patients, medical workers and facilities. They bring some humanity into what is otherwise an inhumane situation."
The 2030 Agenda for Sustainable Development has been agreed, along with 17 Sustainable Development Goals (SDGs) and their 169 targets seek to build on the Millennium Development Goals (MDGs) and “complete what these did not achieve”. MDG4: Reduce Child Mortality is one the goals which failed to achieve its single target to “Reduce by two-thirds, between 1990 and 2015 the under-five mortality rate (U5MR).” MDG4 mobilised global efforts to promote child survival and health, (and indeed between 1990 and 2013, the annual number of under-five deaths declined by half to 6.3 million) but was also critiqued from many diverse perspectives. Despite global progress towards MDG4, the poorest children and indeed the poorest countries, have been left behind. SDG Target 3.2, states: 'By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under five mortality to at least as low as 25 per 1,000 live births'. For SDGs to build on the lessons of the MDGs, the author indicates that the targets should be framed in the unambiguous terms of reducing inequalities. The author suggests that it is difficult to predict how target 3.2 will be measured, and how countries will be held globally accountable, but proposes that all countries should at least report on the gap in child survival between the richest and the poorest, and their progress towards equality of outcomes. To make sure this happens, civil society and human rights mechanisms need to be mobilized around the child’s right to survival and to health, without discrimination.
It is widely recognised that the Sustainable Development Goals (SDGs) need to be supported by more effective follow-up and review—or accountability—processes than were available to the Millennium Development Goals (MDGs). But what should these processes be? In the last three or four years, this question has generated a wealth of literature within the UN and beyond. Here the author highlights five key points: Monitoring is not accountability, but one step towards accountability; although experts have a significant role to play, accountability should not be reduced to a technocratic exercise; it should be as transparent, accessible and participatory as possible. Accountability at the global level is important, but the primary locus for accountability must be at the national and sub-national levels; it is difficult for States at the national-level to hold accountable stakeholders, including non-state actors, for their transnational contributions and commitments to development, such as SDG17. One of the most important roles for global-level accountability is to strengthen accountability for these transnational contributions and commitments - because the SDGs are a colossal challenge of extraordinary complexity, they need to be supported by diverse accountability arrangements, including independent review of stakeholders’ progress, promises and commitments.
In September 2015 Heads of States and Governments will gather at the United Nations (UN) headquarters in New York City to agree on a new set Sustainable Development Goals (SDGs) and a 'global plan of action for people, planet and prosperity'. The latest draft of this declaration which promises to 'transform our world' by 2030 and ensure that no one will be left behind in the process has just recently been released. However, the PHM notes that many of these same governments, particularly the more powerful ones among them, are also currently negotiating new 'free trade' deals that will have far-reaching implications for peoples in both the global North and South and for the future of the world economy and the planet. These agreements as they are currently framed and when adopted side-by-side, will not usher a new dawn for humanity. Instead they are likely to further concentrate power and wealth in the hands of the 1% on the one hand, and deepen the dispossession, exploitation and oppression of peoples and environmental plunder on the other. A call, initiated by the Campaign for People's Goals for Sustainable Development, notes that people will not accept a development agenda that will serve as a vehicle for strengthening corporate power, re-legitimise the global capitalist growth model and perpetuate neoliberal globalisation.
This report demonstrates the relationship between sexual health, human rights and the law. Drawing from a review of public health evidence and extensive research into human rights law at international, regional and national levels, the report shows how states in different parts of the world can and do support sexual health through legal and other mechanisms that are consistent with human rights standards and their own human rights obligations.