Written during the final illness of Hugo Chavez, who died of cancer on 5 March 2013, this article considers the achievements of this visionary leader of Venezuela. Chavez used Venezuela’s abundant oil revenues to build needed infrastructure and invest in the social services: during the last ten years, the government increased social spending by 60.6%, a total of $772 billion. During Chavez’s term of office impressive health gains were made, such as a drop in infant mortality from 25 per 1000 (1990) to only 13/1000 (2010), while 96% of the population now has access to clean water, one of the goals of the revolution. In 1998, there were 18 doctors per 10,000 inhabitants, currently there are 58, and the public health system has about 95,000 physicians. It took four decades for previous governments to build 5,081 clinics, but in just 13 years the Bolivarian government built 13,721 (a 169.6% increase). Barrio Adentro (a primary health care partnership with 8,300 Cuban doctors) has saved approximately 1,4 million lives in 7,000 clinics and has given 500 million consultations. In 2011 alone, 67,000 Venezuelans received free high cost medicines for 139 pathologies conditions including cancer, hepatitis, osteoporosis, schizophrenia, and others. Venezuela now has the largest intensive care unit in the region. A network of public drugstores sell subsidised medicines in 127 stores with savings of 34-40%. Over the past few years, 51,000 people have been treated in Cuba for specialized eye treatment and the eye care programme ‘Mision Milagro’ has restored sight to 1.5 million Venezuelans.
Values, Policies and Rights
In this article, the author reflects on the emergence and contemporary practice of health diplomacy, exploring in particular the potential of niche areas within health diplomacy to become constructive focal points of emerging middle powers’ foreign policies. Middle powers like South Africa often apply niche diplomacy to maximise their foreign policy impact, particularly by pursuing a multilateral agenda. The literature on middle powers indicates that such foreign policy ambitions and concomitant diplomacy mostly act to affirm the global status quo. Instead, the author argues here that there may well be niches within health diplomacy in particular that can be used to actually challenge the existing global order. Emerging middle powers in particular can use niche areas within health diplomacy in a critical theoretical manner, so that foreign policy and diplomacy become a project of emancipation and transformation, rather than an affirmation of the world as it is. The author reviews South African foreign policy and diplomacy, before situating these policies within the context of emerging mechanisms of South-South multilateralism. He advocates for a South African AIDS diplomacy, emphasising its potential to galvanise a global project of emancipation.
This report reports on the impact of Christian conservatism from United States on human rights policies in Africa. A number of churches are reported in this paper to be working in Africa to promote US ‘family values’, campaigning against condom use to prevent HIV transmission, claiming that family planning is a Western conspiracy to reduce African development, and supporting campaigns to pursue the death penalty for gays and lesbians. The author argues that government and civil society should confront the myths of human rights advocacy being western neocolonialism, noting indigenous African human rights agendas and support African advocacy to respect human rights for all.
Gender-based violence (GBV) is a significant human rights violation and a key driver of the HIV epidemic in southern and eastern Africa. In this study, the authors frame GBV from a broad human rights approach that includes intimate partner violence and structural violence. They use this broader definition to review how National Strategic Plans for HIV and AIDS (NSPs) in southern and eastern Africa address GBV. NSPs for HIV and AIDS provide the national-level framework that shapes government, business, external funder, and non-governmental responses to HIV within a country. They authors’ review suggests that attention to GBV is poorly integrated, and few recognise GBV and programme around GBV. The programming, policies and interventions that do exist privilege responses that support survivors of violence, rather than seeking to prevent it. Furthermore, the subject who is targeted is narrowly constructed as a heterosexual woman in a monogamous relationship. There is little consideration of GBV targeting women who have non-conforming sexual or gender identities, or of the need to tackle structural violence in the response to HIV and AIDS.
In sub-Saharan Africa, HIV and maternal mortality and morbidity (MMM) are connected in both outcomes and solutions: HIV is the leading cause of maternal death, while prevention of unintended pregnancy and access to contraception are considered two of the most important HIV-related prevention efforts. Both are central to reducing unsafe abortion, another leading cause of maternal death in Africa. A human rights-based framework helps to identify shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Therefore the authors call for a human rights-based and integrated response to the two health issues. Governments should establish the health-related human rights standards to which all women are entitled and provide remedy for human rights violations related to HIV and maternal mortality and morbidity. No single goal, such as those addressing HIV and MMM, can be achieved without progress on all development goals.
This report argues that Ghana is reported to be violating the African Charter on Human and Peoples’ Rights when people with mental disorders are subjected to prayer camps that advocate complete isolation, being chained to trees, and forced exorcism for demonic possession, and fails to provide services for mentally illness. The author suggests that mental health problems often stem from poor nutrition, depressed socioeconomic status, and elevated, persistent violence. Despite the widespread presence of these factors mental heath problems like depression or undiagnosed schizophrenia are often ignored in health policy agendas in Africa. The author proposes that mental health be recognised as a human right, coupled with de-stigmatisation of mental health disorders, and resource allocation for treatment.
On 5 February, 2013, Uruguay became the tenth country to ratify the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights (ICESCR), which means the Optional Protocol will come into force on 5 May, 2013. Until now, the CESCR has been limited to issuing concluding observations and recommendations to member countries as part of semi-regular country reporting requirements in the ICESCR and to issuing broad general comments on rights under the Convention. The opportunity will now exist at the global level to litigate and begin to develop more concrete standards around the rights in the ICESCR – including the right to of everyone to the enjoyment of the highest attainable standard of physical and mental health (Article 12 of the ICESCR). The authors of this paper highlight emerging opportunities within the framework of the ICESCR and the Optional Protocol to begin serious investigations into the social determinants of health, such as access to sufficient food, water, sanitation, and education. They call for an approach that goes beyond the typical and narrower construction of the right to health based in access to health care services to include the determinants discussed in Article 12.
In this article, the authors propose that the right to health and its imperative of narrowing health inequities should be central to the post-2015 international health agenda. However, they argue that universal health coverage - as defined by the World health Organisation and typically conceived - is not enough to ensure the right to health. Policy-makers will need to address the social determinants of health such as safe drinking water and good sanitation, adequate nutrition and housing, safe and healthy occupational and environmental conditions and gender equality. The post-2015 health agenda should also explicitly describe the accountability mechanisms that will make it possible for people to claim – not beg for – additional national public resources and international assistance, if needed. Furthermore, it must specify how citizens will participate in the decision-making processes surrounding their health services and their physical and social environment. Participation must be genuine and built on a continuing relationship among researchers, governments and those communities, otherwise goals may end up being formulated by policy elites after token and superficial consultations, undermining the rights of the very communities they serve.
The authors of this paper argue that current forms of co-operation are often ineffective, insufficient and incapable of achieving progressive realisation of the right to health. They propose that, after the many international and regional Commissions, Declarations, and institutional innovations of the last 20 years, the logical next step for the promotion of the right to health is the drafting and enforcement of a Global Framework Convention on Health (GFCH). Significant contemporary international challenges make national health an issue that needs to be protected by global agreements. Such challenges include the international but unequal market for health workers that result in the recruitment of health workers from developing countries and the prohibitive cost of essential medicines and of meeting the health needs and rights of migrants and refugees. Developing countries are struggling to bear these financial burdens. The authors call for a GFCH that broadly sets out national and international duties towards health, health challenges and their cost, and helps make people of low income countries less vulnerable to shifting developed-world priorities.
The second meeting of the Open-Ended Working Group on Pandemic Influenza Preparedness was held from 13-17 December 2010 at the World Health Organization (WHO) headquarters in Switzerland. The working group is part of a longstanding effort to agree on a global framework on pandemic influenza preparedness. A key sticking point in past negotiations has been a standard material transfer agreement (SMTA), including intellectual property rights provisions, for the sharing of viruses and other pandemic-related materials and for sharing related benefits. At the meeting, some countries put an SMTA into a larger context as one part of the solution, rather than the only solution. One concern is that developed countries are not increasing efforts to ensure access and benefit sharing, despite the new agreement – the Nagoya Protocol – at the United Nations (UN) Convention on Biological Diversity. This article notes that, instead of collaborating collectively under the auspices of WHO to develop an ambitious framework that delivers sharing of viruses as well as equitable benefits to facilitate pandemic preparedness, the positions taken by developed countries on a range of issues – including benefit sharing by recipients of influenza biological materials, intellectual property and issues of transparency – indicated a lack of interest towards protecting global public health and a focus on protecting the profits of their industries and safeguarding developed countries’ access to vaccines and other treatments in the event of a pandemic. The Mexican Ambassador to the UN in Geneva, a leader in the negotiating process, said he expected an agreement to be reached by the annual World Health Assembly in May 2011.