Much debate around the September 2013 meeting of the United Nations General Assembly on the post-2015 Development Agenda, has focused on the health and intersectoral development goals. Little of this debate has to do, however with how the “right to the highest attainable level of health” applies to non-nationals, who normally have no access to health care services, according to this editorial. The right to health obligates governments to facilitate access to health care to nationals and non-nationals alike, the authors argue. Ensuring that governments apply new development goals that include non-nationals is an issue of pressing concern in the post-2015 agenda. The denial of preventive and curative care to non-nationals is often linked to policies regulating cross-border movement. The global health community cannot afford to ignore the in-country inequalities that exist within the public health care systems.
Values, Policies and Rights
Governments meeting at the UN General Assembly (GA) in September have heeded civil society demands for human rights to be at the core of the global commitments succeeding the Millennium Development Goals (MDGs) in 2015. The outcome document of the GA Special Event on the MDGs, held on 25 September, calls for a universal framework of goals applicable to all countries which promotes “human rights for all”. Once a lightning rod at UN development forums, human rights appear to have garnered consensus as a central foundation of development - at least on paper.
Universal health coverage “developed within the particular epidemiological, economic, socio-cultural, political and structural context of each country in accordance with the principle of national ownership”, as it is formulated in the 2012 UN General Assembly resolution, can, it is argued by the author, to possibly mean anything and everything. In low-income countries, it could mean something that looks a lot like selective primary health care, excluding antiretroviral treatment. For AIDS activists, universal health coverage could mean a giant step backwards. However the International HIV/AIDS Alliance came out with a statement in support of “universal health coverage. The words that matter are “rights-based approach”, as the author proposes that universal health coverage anchored in the right to health requires at least comprehensive primary health care, with duty-based international assistance to countries that are unable to provide comprehensive primary health care without assistance.
Beginning with HIV and AIDS cases, the last fifteen years have seen a tremendous growth in the number of health rights cases. Yet questions still persist as to when and how litigation can lead to greater social justice in health and enhance the functioning of health systems, rather than distorting practices. In a number of countries, courts are in effect setting health policy and shaping funding priorities. Yet, little systematic attention has been paid to the equity implications of this litigation. Based on a comprehensive study of litigation in Argentina, Brazil, Costa Rica, Colombia, India and South Africa, this presentation traces the beginnings of health rights litigation; reviews factors leading to judicial activism in health around the world; stresses the importance of differentiating contexts and kinds of interventions; and will discuss different methodologies for measuring impacts of litigation. Health rights litigation is extremely varied around the world. Factors that must be considered in assessing equity implications relate to the legal opportunity structure as well as other dimensions of the legal system, the organization of the health system, and the way in which the executive branch responds to judicial decisions.
This briefing paper explores how UHC can deliver on nutrition, and addresses in particular maternal and child undernutrition. The authors point to the need to ensure that Universal Health Coverage (UHC) can deliver on the fight against undernutrition. They recommend that national, European and global development policies consider a shift from emergency-focused interventions to ones that prevent and treat undernutrition. Budgetary and extra-budgetary resources need to be mobilised within health programs to reach UHC for scaling up the implementation of nutrition interventions. They present evidence that the implementation of community approaches will be mostly effective if designed in an integrated manner combining the most effective child and maternal interventions. Governments, through pooled risk funding,should ensure access for the most vulnerable and marginalised groups as defined by the specific country context and scale up the implementation of effective nutrition specific interventions within the health policies to reach UHC, such as by integrating the prevention and treatment against chronic and sever acute malnutrition into the management of childhood illnesses of WHO guidelines; and integrating at the national level the prevention and treatment of chronic acute malnutrition or severe acute malnutrition into primary health
care packages.
In this report, UN Women calls for a specific commitment to achieving gender equality, women’s rights and women’s empowerment in the post-2015 development framework and Sustainable Development Goals (SDGs), as well as robust mainstreaming of gender considerations across all parts of the framework. To make a difference, the new framework must be transformative, by addressing the structural impediments to gender equality and the achievement of women’s rights. In order to address the structural causes of gender-based discrimination and to support true transformation in gender relations, the report proposes an integrated approach that addresses three critical target areas of gender equality, women’s rights and women’s empowerment. 1. Freedom from violence against women and girls, which includes concrete actions to eliminate the debilitating fear and/or experience of violence as the centre-piece of any future framework. 2. Gender equality in the distribution of capabilities – knowledge, good health, sexual and reproductive health and reproductive rights of women and adolescent girls; and access to resources and opportunities, including land, decent work and equal pay to build women’s economic and social security. 3. Gender equality in decision-making power in public and private institutions, in national parliaments and local councils, the media and civil society, in the management and governance of firms, and in families and communities.
Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity. An HiAP approach is founded on health-related rights and obligations. It emphasises the consequences of public policies on health determinants, and aims to improve the accountability of policy-makers for health impacts at all levels of policy-making. Core features of HiAP include a strong foundation on human rights and social justice, and a focus on policy-making. It is often necessary to prioritise efforts; seek synergies to enhance health and other important societal goals; and seek to avoid harmful impacts on health. Application of HiAP involves identifying policy developments across sectors with potential implications for health and health equity; assessing impacts; and advocating and negotiating for changes. Long term vision and sustained efforts are often needed. This book looks at examples of HiAP from countries across the world, and has specific chapters on low-income countries, including those from Africa.
In this study, researchers explored the impact of violence and related human rights abuses on the lives of sex workers, and how they have responded to these conditions, as individuals and within small collectives. They conducted 55 in-depth interviews and 12 focus group discussions with female, male and transgender sex workers in Kenya, South Africa, Uganda and Zimbabwe. In describing their experiences of unlawful arrests and detention, violence, extortion, vilification and exclusions, participants present a picture of profound exploitation and repeated human rights violations. This situation has had an extreme impact on the physical, mental and social well-being of this population. Underlying their stories, however, are narratives of resilience and resistance. Sex workers in this study draw on their own individual survival strategies and informal forms of support and very occasionally opt to seek recourse through formal channels. While criminal laws urgently need reform, the authors argue that supporting sex work self-organisation and community-building are key interim strategies for safeguarding sex workers’ human rights and improving health outcomes in these communities. If developed at sufficient scale and intensity, sex work organisations could play a critical role in reducing the present harms caused by criminalisation and stigma.
In this paper, the authors analysed 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The analysis highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
In the absence of clear regulation, the practice of surrogacy in Kenya grows as an unchecked and unsupervised industry with no policy or law to fall back on if anything goes wrong during the treatment, says the author of this article. South Africa is the only country on the African continent to have surrogacy laws and policies. The growing use of commercial surrogacy, where a woman is paid to carry a child for a couple wanting to adopt, points to an urgent need to develop appropriate legislation, the author argues. She refers to the practice in India, which disproportionately affects the poor girls and women, who use surrogacy as a means of income. But these women are not protected by the law. She makes a number of recommendations for proposed legislation, covering various areas such as the interests of the surrogate mother and commissioning parents, ethical and moral aspects, financial support, dispute mechanisms and regulatory bodies, termination of a surrogate pregnancy, more lenient adoption laws and rights of both parties.