Despite the cholera epidemic in Zimbabwe continuing for more than six months, sanitation remains poor and lack of access to safe drinking water persists against the backdrop of a collapsed health system with degraded infrastructure and very few health workers. Health in Zimbabwe is presently largely unavailable, unacceptable, inaccessible and of poor quality. This report concludes that Zimbabwe will require long term commitment of the humanitarian and donor agencies working in the country with large scale, multi-faceted assistance to address the situation. It urges the government of Zimbabwe to formulate an emergency health response plan to restore the public health system must be produced and implemented. The authors argue that government should also ensure the supply of clean drinking water and adequate sanitation.
Values, Policies and Rights
Access to medicines forms an indispensable part of the right to the highest attainable standard of health. Numerous court cases, as well as resolutions of the United Nations (UN) Commission on Human Rights, confirm that access to essential medicines is a fundamental element of the right to health. This briefing examines the issue of access to medicines in the context of sexual and reproductive health. Sexual and reproductive health are key elements of the right to the highest attainable standard of health. The briefing considers the responsibilities of pharmaceutical companies for enhancing access to medicines. The briefing also introduces the background and content of the Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines ('the Guidelines'). Based on the right to health responsibilities of pharmaceutical companies, the Guidelines provide a framework for enhancing access to medicines.
In Part 1 of this three-part study, the authors undertook a multi-method study in three phases – a survey, interviews and case descriptions that drew on site visits – and in each of the second and third phases they focused on a purposive sample of those involved in the previous phase. Seven recommendations emerged for those involved in establishing or leading organisations that support the use of research evidence in developing health policy: collaborate with other organisations; establish strong links with policymakers and involve stakeholders in the work; be independent and manage conflicts of interest among those involved in the work; build capacity among those working in the organisation; use good methods and be transparent in the work; start small, have a clear audience and scope, and address important questions; and be attentive to implementation considerations, even if implementation is not a remit.
In Part 2, the authors drew on many people and organisations around the world, including their project reference group, to generate a list of organisations to survey. They sent the questionnaire by email to 176 organisations and followed up periodically with non-responders by email and telephone. They received completed questionnaires from 152 (86%) organisations. More than one-half of the organisations (and particularly HTA agencies) reported that examples from other countries were helpful in establishing their organisation. The findings confirm that the principles of evidence-based medicine dominate current guideline programmes and underline the importance of collaborating with other organisations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organisations from which those establishing or leading similar organisations can draw.
In Part 3, the authors purposively sampled organisations from among those who completed a questionnaire in the first phase of the study, developed and piloted a semi-structured interview guide, and conducted the interviews by telephone, audio-taped them, and took notes simultaneously. They interviewed the director (or his or her nominee) in 25 organisations, of which 12 were GSUs. Using rigorous methods that are systematic and transparent (sometimes shortened to 'being evidence-based') was the most commonly cited strength among all organisations. GSUs more consistently described their close links with policymakers as a strength, whereas organisations producing CPGs, HTAs, or both had conflicting viewpoints about such close links. With few exceptions, all types of organisations tended to focus largely on weaknesses in implementation, rather than strengths.
Zimbabwe is a party to the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women and the African Charter on Human and Peoples’ Rights. It has a legally binding obligation to respect, protect and fulfill these rights for all people within its jurisdiction. The report argues that a causal chain runs from Mugabe’s economic policies, to Zimbabwe’s economic collapse, food insecurity and malnutrition, and the current outbreaks of infectious disease. The determinants of health, such as broken sewerage systems, chronic food insecurity and widespread starvation, underlie disease epidemics such as cholera and anthrax and a deterioration of maternal health care. The authors recommend that the international community needs to resolve the political impasse, launch an emergency health response with services controlled by a United Nations-designated agency or consortium, refer the situation to the International Criminal Court for Crimes against Humanity, convene an emergency summit on HIV, AIDS and TB and prevent further deterioration of household food supply.
In this paper, some of the right-to-health features of health systems are identified, such as a comprehensive national health plan, and 72 indicators are proposed that reflect some of these features. Globally processed data on these indicators was collected for 194 countries. Globally processed data was not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where available, indicators show where health systems need to be improved to better realise the right to health. The paper provides recommendations for governments, international bodies, civil-society organisations, and other institutions and suggests that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are obligations under human rights law.
The People’s Health Movement ((PHM) has significantly advanced in the campaign's expansion since its last update in May 2008. India, Ecuador, Zimbabwe and South Africa are involved in the campaign without receiving funding. New PHM circles have been formed in the last three months in Mali, Kenya, Morocco and Uganda and they will be submitting campaign proposals shortly. The countries that have almost completed the assessment are now eligible for a small additional funding to hold a national workshop in which to present the results to the government, UN agencies, international and national NGOs and the media. Any country not mentioned here is welcome to inquire with PHM how they can get a PHM circle going so as to launch the campaign.
Benchmarking exercises have become increasingly popular within the sphere of regional policy-making. This paper analyses the concept of regional benchmarking and its links with regional policy-making processes. It develops a typology of regional benchmarking exercises and benchmarkers, and critically reviews the literature. It is argued that critics of regional benchmarking fail to take account of the variety and development of regional benchmarking systems. It is suggested that while benchmarking exercises are informing policy adaptation and innovation, they have been constrained by political and financial factors. It is concluded that regional benchmarking is facilitating the heightened regional interaction necessitated by globalisation.
Cancer is causing a lot of suffering and death in Africa but is not considered a major health problem in Africa. This needs to change. Cancer should be given equal emphasis to HIV/AIDS, tuberculosis (TB) and malaria. A national cancer policy is required in Malawi to develop and improve evidence-based cancer prevention, early diagnosis, curative and palliative therapy. A national cancer policy is crucial to ensure a priotised, clear, coordinated and sustained fight against cancer. When no policy exists, events are likely to be random, stakeholders and practitioners in the fight against cancer may not agree on how to proceed, may duplicate efforts or may neglect areas that would have greater nationwide impact resulting in poor quality activities and haphazard development.