This training manual is intended to enhance the role of civil society in promoting and protecting of the right to health under the Constitution. It will play an integral part in ensuring that civil society organisations have the knowledge and skills to hold duty bearers accountable to effective and efficient health service delivery. Schedule Four of the Kenya Constitution creates two levels of governance with distinct functions. The national government is mandated to formulate health policy and manage national referral health facilities while the county government is responsible for delivery of health services at the local level. The civil society groups that are working on health issues must therefore understands the roles and responsibilities of the different actors at both levels if they are to meaningfully engage in national and county processes. The manual is presented in four modules. The first module outlines the constitutional provisions on the right to health and what these provisions mean to the implementation of health as a right. The second module addresses the substance of the right to health including the international standards developed for the implementation of this right. The third module outlines the systems and structures of the devolved government and the role of the different state organs and agencies at national and county level in health service delivery. The fourth module then focuses on the role of the civil society in monitoring the implementation of the right to health. It also highlights the key issues concerning the right to health and outlines the specific responsibilities of civil society in holding each level of government to account for their mandates to deliver on the right to health.
Values, Policies and Rights
Rates of gender-based violence (GBV) in South Africa (SA) are among the highest in the world. In societies where social ideals of masculinity encourage male dominance and control over women, gender power imbalances contribute to male perpetration and women’s vulnerability. The drivers that cause men to perpetrate GBV and those that lead to HIV overlap and interact in multiple and complex ways. Multiple risk and protective factors for GBV perpetration by males operate interdependently at a number of levels; at the individual level, these include chronic anxiety and depression, which have been shown to lead to risky sexual behaviours. This study examined psychosocial risk factors (symptoms of anxiety and depression) as well as protective factors (social support and self-esteem) as self-reported by a cohort of males in rural KwaZulu-Natal (KZN) Province, SA; to determine whether there are differences in anxiety, depression, social support and self-esteem between perpetrators and non-perpetrators. A cross-sectional study using quasi-probability cluster sampling was done in 13 wards in Harry Gwala District, KZN. Participants were then randomly chosen from each ward proportionate to size. The participants were relatively young (median age 22 years); over half were schoolgoers, and 91.3% had never married. Over 43% of the sample reported clinical levels of anxiety and depressive symptoms on the Brief Symptom Inventory. Rates of GBV perpetration were 60.9%, 23.6% and 10.0% for psychological abuse, non-sexual physical violence and sexual violence, respectively. GBV perpetration was associated with higher depression, higher anxiety, lower self-esteem and lower social support. The authors propose that interventions to address GBV need to take modifiable individual-level factors into account.
This handbook is designed as a resource for providing up-to-date and practical guidance on national health planning and strategising for health. It establishes a set of best practices to support strategic plans for health and represents the wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs). WHO has been one of the leading organisations to support countries in the development of NHPSPs. The focus on improving plans has grown in recent years, in recognition of the benefits of anchoring a strong national health sector in a written vision based on participation, analysis, and evidence.
Recent legislative developments in Africa have focused international attention on the legal status of lesbian, gay, bisexual and transgender (LGBT) people in the continent. Attempts by various African governments to revise or introduce new legislation on same-sex sexual conduct and marriage, and the response of the international community, has sparked extensive coverage of the associated political, social and cultural controversies. Away from the headlines are several African countries that have never criminalised same- sex sexual conduct and that are outliers to the apparent ‘trend’ of discriminatory legislation in the continent. One of these is Rwanda. Compared with the situation in neighbouring countries, state-sponsored homophobia appears negligible in Rwanda, and violent attacks are minimal. In the international arena, Rwanda has emerged as an unlikely champion for LGBT rights, and domestically has designated sexual orientation as a ‘private matter’. This study explores Rwanda’s relatively progressive position on LGBT-related issues and its implications for Rwandan civil society. It examines the strategies employed by national as well as international actors to advance LGBT rights and to address social and economic marginalisation. The study questions assumptions about the uniformity of the ‘African experience’ and seeks to enhance understanding of the nuance and diversity that exists both within and between countries on the continent.
The author claims that the battle for global sustainability will be won or lost in cities. Yet the UN’s Habitat III conference was argued in a 10-point manifesto that resulted from a convening of the Second World Assembly of Local and Regional Governments to miss the voices of the individuals and groups who actually run those cities. Mayors and other leaders from more than 500 cities formed a collective voice calling for “A Seat at the Global Table.” Their manifesto lays out why local governments need to be integrated into international talks traditionally reserved for national policymakers. With support from key figures such as UN Secretary General Ban Ki-moon, the assembly pushed for a “paradigm shift in global governance” that would give local leaders more say in what strategies to implement and how. sign and adopt it. The UCLG named Parks Tau, the former mayor of Johannesburg, as their new head.
The Zimbabwean study on safe and inclusive cities seeks to research on manifestations of urban violence, poverty exclusion and inequalities informed by the following underlying research questions: Can the State in terms of both its direct and indirect actions, be implicated in promoting urban violence when its role in addressing issues of urban poverty, inequality and exclusion is examined? Has the state embraced laws and policies founded on continuities of inequalities, rather than a focus on structural change in framing state urban policy in townships, in a manner which does not address those factors that link poverty, inequality and exclusion to urban violence? At municipal level, have laws and policies consolidated rather than shifted gender inequalities in urban townships, thereby continuing to contribute to women’s vulnerability to urban poverty, inequality, exclusion and urban violence? Have communities participated in addressing these problems? The research into context and lived realities took place in Kadoma, Zimbabwe, drawing on the services of 38 masters in women’s law research students who worked in six groups in four broad thematic areas: poverty families and employment, urban environmental health issues, security challenges in Kadoma especially for women girls and access to courts and access to justice. The Women’s law approach assessed the gap between what laws such as Legal Aid Act; Maintenance Act, Administration of Estates Act and Domestic Violence Act against women’s lived experiences and impact of such laws on issues of equality, exclusion and poverty related issues. The human rights approach sought to understand the role of the state in practice against human rights standards as provided in selected human rights instruments on matters such as social and economic rights particularly relating to matters such as the right to housing, the right to work; the right to health; the right to food and equality before the law and fair representation.
This article tracks the shifting place of the international right to health, and human rights-based approaches to health, in the scholarly literature and United Nations (UN). From 1993 to 1994, the focus began to move from the right to health toward human rights-based approaches to health, including human rights guidance adopted by UN agencies in relation to specific health issues. There is a compelling case for a human rights-based approach to health, but it runs the risk of playing down the right to health, as evidenced by an examination of some UN human rights guidance. The right to health has important and distinctive qualities that are not provided by other rights—consequently, playing down the right to health can diminish rights-based approaches to health, as well as the right to health itself. Because general comments, the reports of UN Special Rapporteurs, and UN agencies’ guidance are exercises in interpretation, the author discusses methods of legal interpretation. The author suggests that the International Covenant on Economic, Social and Cultural Rights permits distinctive interpretative methods within the boundaries established by the Vienna Convention on the Law of Treaties. The author calls for the right to health to be placed explicitly at the centre of a rights-based approach and interpreted in accordance with public international law and international human rights law.
Health rights litigation is still an emerging phenomenon in Africa, despite the constitutions of many African countries having provisions to advance the right to health. Litigation can provide a powerful tool not only to hold governments accountable for failure to realise the right to health, but also to empower the people to seek redress for the violation of this essential right. With contributions from activists and scholars across Africa, the collection includes a diverse range of case studies throughout the region, demonstrating that even in jurisdictions where the right to health has not been explicitly guaranteed, attempts have been made to litigate on this right. The collection focuses on understanding the legal framework for the recognition of the right to health, the challenges people encounter in litigating health rights issues and prospects of litigating future health rights cases in Africa. The book also takes a comparative approach to litigating the right to health before regional human rights bodies. This book will be valuable reading to scholars, researchers, policymakers, activists and students interested in the right to health.
The High Court in Nairobi has on 7 December 2016 declared unconstitutional a presidential directive seeking to collect names of people living with HIV, including names of school going children among others. The court declared that the directive issued by H.E Uhuru Kenyatta on 23 February 2015 is in breach of the petitioner’s constitutional rights under Articles 31 and 53(2) which safeguard the right to privacy and best interest of the child respectively. The court further declared that the actions and omissions of the respondents in relation to the directive violated fundamental rights and freedoms of the petitioners. The case was filed by KELIN, Children of God Relief Institute (Nyumbani), James Njenga Kamau and Millicent Kipsang challenging the directive in court on the grounds that it was a breach to the right to privacy and confidentiality and was likely to expose persons living with HIV to stigma and discrimination, among other human rights violations.
To mark Universal Health Coverage Day, WHO launched a new data portal to track progress towards universal health coverage (UHC) around the world. The portal shows where countries need to improve access to services, and where they need to improve information. The portal features the latest data on access to health services globally and in each of WHO’s 194 Member States, along with information about equity of access. In 2017, WHO will add data on the impact that paying for health services has on household finances. The portal shows that less than half of children with suspected pneumonia in low income countries are taken to an appropriate health provider. Of the estimated 10.4 million new cases of tuberculosis in 2015, 6.1 million were detected and officially notified in 2015, leaving a gap of 4.3 million. High blood pressure affects 1.13 billion people. About 44% of WHO’s member states report having less than 1 physician per 1000 population. The African Region suffers almost 25% of the global burden of disease but has only 3% of the world’s health workers.