In 2008 WHO analysed 186 national constitutions and found that 135 (73%) include provisions on health or the right to health. Of these, 95 (51%) constitutions mention the right to access health facilities, goods and services, which includes medicines. Only four national constitutions (2%) specifically mention universal access to medicines. There are at least three different routes, the study argues, through which the right to health – and essential medicines – can be recognised in national legal frameworks. The strongest government commitment is created by including the right to essential goods and services in the national constitution. The second approach is constitutional recognition that international treaties ratified by the State override or acquire the status of national law. The third option, inclusion of health rights in other national legislation, is easier to create but also easier to change or cancel. The full range of strategies should be used to promote universal access to essential medicines through rational selection, affordable prices, sustainable financing and reliable health systems, the article argues. Constitutional recognition of the right to access essential medicines is an important sign of national values and commitment, but is neither a guarantee nor an essential step – as shown by those countries that have failing health systems despite good constitutional language, and those that have good access without it. Yet constitutional recognition creates an important supportive environment, especially in middle-income countries where health insurance systems are being created and patients are becoming more aware of their rights and are more vocal in demanding them.
Values, Policies and Rights
Although the estimated 600 million people with disabilities have formally been recognized, in reality they are still often being overlooked and by no means enjoy the same rights as the rest of the world's population. The goal is to ensure that all people, disabled and able bodied alike, have the same access to all kinds of services in society, in particular health care.
This United Nations resolution recognises that access to medicines is one of the fundamental elements in achieving progressively the full realisation of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It stresses the responsibility of States to ensure the highest attainable level of health for all, including through access, without discrimination, to medicines, in particular essential medicines, that are affordable, safe, efficacious and of quality. At the same time, the resolution emphasises the crucial role of prevention, the promotion of healthy lifestyles and the strengthening of health systems. The central element of the resolution urges States, as appropriate, to take 16 measures to fulfil their obligations on access to medicines within the right to health framework. The resolution also recognises the innovative funding mechanisms that contribute to the availability of vaccines and medicines in developing countries, such as the Global Fund and the GAVI Alliance. It calls upon all States, United Nations programmes and agencies, relevant intergovernmental organisations and pharmaceutical companies to help safeguard public health from conflict of interest, as well as to further collaborate to enable equitable access to quality, safe and efficacious medicines that are affordable to all.
In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights. In this paper, the authors explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa, as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting. Similarities and differences are discussed, and the authors outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology. For the first time in IDS Bulletin history, themes are explored not only in text but also through a selection of online multimedia content, including a workshop video, a photo story and a documentary. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards UHC and the linked agenda of accountability for health equity. The articles and multimedia in this IDS Bulletin reflect the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.
Kenyan human rights activists have filed an appeal for the release of two men imprisoned for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August 2010, the two men have been held in police remand in Kapsabet for ‘posing a risk to the health of the wider community’. Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. According to Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya, the two men have not been isolated, posing a health risk to other inmates. He warned that the arrests could act as a deterrent to patients needing treatment. ‘This is a negative consequence of the government's action’, he added, denouncing criminalisation of the disease. ‘Counselling of those on treatment will have better outcomes,’ he noted.
Some thirty-five civil society organisations have voiced serious concerns over the World Health Organization's publications policy, arguing that the proposed policy, if implemented, will result in a tendency towards self-censorship by the WHO and its staff and HQ offices, to the detriment of the needs and interests of public health, especially in developing countries. They are also very concerned that this policy will hamper timely advice and support by WHO HQ and regional offices to member states over important issues such as application of intellectual property rights and the use of TRIPS flexibilities, other trade and health matters, reproductive health care and other critical issues.
With young women increasingly exposed to sexualized messages, they are argued to need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates an intervention aimed at reducing the generational barrier in talking about sexuality to contribute to better communication within the family context. The intervention consisted of three weekly one-hour coached sessions in which female adults and young people interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions. The interaction sessions were positively appreciated by the participants and contributed to a change in norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex. By elucidating mechanisms and contextual factors, the study adds knowledge on strategies to improve transgenerational communication about sexuality.
On 11th April 2018, Uganda joined the rest of the world to commemorate the International Day for Maternal Health and Rights under the Theme: “Rights Based Approach to Maternal Health in Uganda: No Woman Should Die Giving Birth.” Civil Society, led by Center for Health, Human, Rights and Development (CEHURD), and other stakeholders including policy makers marched from the Independence Monument to Parliament where a dialogue with Members of Parliament was held to collectively find sustainable solutions to the alarming maternal mortality rate. Civil Society used dialogue to petition Parliament in demand for the implementation of the resolution that was passed by the house on December 15, 2011 urging Government to institute measures to address Maternal Mortality in Uganda. Among these included tasking government through the Ministry of Health to strictly enforce maternal health audits and take actions to the established causes, together with developing a policy of compensation to the families of all women who die as a result of maternal related cases through government facilities.
This joint statement from a range of international development organisations argues that regular, predictable social transfers (cash or in kind) from governments to communities can reduce child poverty and vulnerability by helping to ensure children get access to basic social services. Social insurance offers access to health care for children, as well as services to support communities to reach all households and individuals, including children. The statement propose steps that governments and international development partners can take to further social protection in the interests of children, such as ensuring that existing social protection policies and programmes are child-sensitive and setting priorities and sequence policy development and implementation to progressively realise a basic social protection package that is accessible to all those in need. The statement calls for governments and donors to seek to improve fiscal space and increase available resources for child-sensitive social protection programmes, while making broader efforts to build awareness, political will, capacity and intersectoral coordination. Adequate investment is required, and links should be built between transfers and social services to ensure the reach, effectiveness and impact of social protection. At the same time, ongoing research, monitoring and evaluation are needed to better understand effective programme design and implementation, as well as how child-sensitive approaches can benefit the wider community and national development.