The aim of this analysis is to describe the content of mental health policy and the process of its development in South Africa. Quantitative data regarding SA's mental health system was gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development. The study found that the process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation. National leadership in the development of new mental health policy is required, with improved communication, provincial-level responsibility for implementation and commitment to capacity building.
Values, Policies and Rights
Debate has emerged that pits health-systems support against targeted health campaigns. In classical terms, the debate may be framed as the Bismarck model versus the Beveridge model, but this dichotomy is increasingly viewed as being as false as that which seeks to pit vertical schemes of health against horizontal. In truth, development of systems capable of delivering health, generally, or specifically targeted campaigns and health initiatives, all rely on the existence of health financing mechanisms that offer universal access to health. The specific nature of such financing schemes and service delivery models will vary between nations. To assume that universal health coverage necessarily requires a single-payer government mechanism would be a mistake, and adherents to that position doom the people of the poorest nations to generations of medical deficiency. Whether a nation chooses a mixed economy model of coverage, single-payer mode, donor-issued voucher mechanism, or other innovative models of universal financing is not the issue. Provision of universal health coverage is the issue facing the entire global health construct. Sadly, for most of the world's populations universal health coverage remains a mirage, blurred further out of focus by the present world financial crisis.
This book brings together leading researchers from a variety of disciplines to examine three areas: health disparities and inequity due to gender, the specific problems women face in meeting the highest attainable standards of health, and the policies and actions that can address them. It also brings together experts from a variety of disciplines, such as medicine, biology, sociology, epidemiology, anthropology, economics and political science, who focus on three areas: health disparities and inequity due to gender; the specific problems women face in meeting the highest attainable standards of health; and the policies and actions that can address them. Highlighting the importance of intersecting social hierarchies (such as gender, class and ethnicity) for understanding health inequities and their implications for health policy, contributors detail and recommend policy approaches and agendas that incorporate, but go beyond commonly acknowledged issues relating to women’s health and gender equity in health.
Aggravated homosexuality will be punished by death, according to a new bill tabled in Parliament of Uganda on 13 October 2009. The private member’s bill was tabled by Ndorwa West MP, David Bahati (NRM). A person commits aggravated homosexuality when the victim is a person with disability or below the age of 18, or when the offender is HIV-positive. The bill thus equates aggravated homosexuality to aggravated defilement among people of different sexes, which also carries the death sentence. The Bill, entitled the Anti-Homosexuality Bill 2009, also states that anyone who commits the offence of homosexuality will be liable to life imprisonment. A person charged with the offence will have to undergo a mandatory medical examination to ascertain his or her HIV status. The bill further states that anybody who attempts to commit the offence is liable to imprisonment for seven years. The same applies to anybody who aids, abets, counsels or procures another to engage in acts of homosexuality or anybody who keeps a house or room for the purpose of homosexuality. The bill also proposes stiff sentences for people promoting homosexuality – a fine of 100 million Ugandan shillings or prison sentences of five to seven years.
This study considered whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes. It used data from a 2003 nationally representative household survey of youths aged 15–24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. The variable was aggregated to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths. The study found that youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom non-use. Programmes to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
Strict observance of state sovereignty, once a mainstay of international relations, has given way to a global concern to protect human rights wherever they are threatened. On paper, at least, Africa shares this international commitment in its establishment of monitoring bodies like the African Commission on Human and Peoples’ Rights and the African Union’s Peace and Security Council. But how central are human rights to the actual conduct of international relations by the continent? Are they merely a ‘variable concern’? There are no simplistic answers to this question. Africa has long been committed to supporting the rule of law, safeguarding refugees, protecting women and children, encouraging youth participation, and promoting democracy. But, as ever, national interest still plays an important role when it comes to defining how the continent relates to the world. The author argues that China’s policy of non-interference in the internal affairs of its trading partners has the potential to foster corruption, fuel armed conflicts and encourage human rights violations. African governments, it is proposed, should ensure that their emerging foreign policy solutions, whatever they are, do not compromise the commitment they have already made to foster human rights and good governance.
The Universal Periodic Review mechanism of the UN Human Rights Council, which came into effect in 2008, has established itself as a mechanism with huge potential and which promotes dialogue and a level playing field for all countries undergoing the review of their human rights record. Building on the Commonwealth Secretariat’s observations and analysis of the process, and the seminars it has conducted with member states, Universal Periodic Review of Human Rights consolidates the lessons learned so far, speaking equally to the three major stakeholders in the process – to states, to national human rights institutions, and to civil society organisations. An effective UPR mechanism will enhance the promotion of human rights across the world. It is therefore essential for the key players to understand and advance the UPR process including at the implementation phase. This publication describes UPR, shares experiences and provides analysis of the Commonwealth countries that reported in the first year of the UPR process.
The second volume of Health and Human Rights brings one more piece to the set of educational materials available from multiple sources, mostly, although not exclusively, in the English language. Intended primarily for health practitioners, the book incorporates a succinct introduction laying out essential concepts, principles and mechanisms relevant to the congruence between public health and human rights. Ten case studies follow, each constructed around clearly set learning objectives, including questions to be addressed, highlights of the public health issue and references to specific human rights relevant to the case study, sources of pertinent information and bibliography. The case studies focus on major public health issues such as maternal mortality, female genital mutilation, access to medicine and prison health. They constitute a useful tool for classroom education as well as self-learning. As Internet access expands in low- and medium-income countries, the material presented could serve to structure a distance-learning facility (a field in which one of the co-authors specialises) with interactivity between learners and their mentors.
Several health-related budget decisions taken in the past financial year in South Africa are reported to have violated the Constitution, the National Health Act, the Public Finance Management Act and the Promotion of Administrative Justice Act, according to a group of activists, researchers, unionists, health workers and academics, called the Budget and Expenditure Monitoring Forum (BEMF). The Forum has written to the ministers of health and finance, expressing concern over the effect of budgeting practices within the public health system on HIV and AIDS programmes, including on antiretroviral (ARV) treatment and prevention of mother-to-child transmission programmes, citing the moratorium on starting new patients on ARVs in the Free State as one example of such a decision.
The United Nations Educational, Scientific and Cultural Organization (UNESCO) has drafted the 98-page International Guidelines on Sexuality Education. The guidelines are still being finalised but a draft version suggests key areas that a sex education curriculum should cover at four different age levels between five and 18. The topics include relationships, reproduction, gender inequality and various aspects of sexuality, but conservative groups in the United States have focused on a handful of suggested learning areas that they view as overly explicit and inappropriate for young children. Various critics have taken issue with suggestions that teachers discuss homosexuality, contraception, and gender-based violence. However, defenders of the guide assert that ‘it's better they have the right information than the wrong information.’ A report in the New York Times asserted that the controversy had caused the UN Population Fund (UNFPA), a key partner, to pull out of the project, but a UNFPA spokesperson refused to confirm this, saying only that the organisation was still in discussion with UNESCO about making the publication ‘more context specific’.