The WHO Director General Dr Ghebreyesus has set universal health coverage (UHC) as one of the main priorities for his term. His goal is a challenging one, especially for low and middle income countries which make up around 84% of the world’s population. They only have access to half the physicians and a quarter of the nurses that high income countries have access to. Similarly low and middle income countries only spend around US $266 per capita on health care. In contrast, high income countries spend US $5 251 per capita. This means that attaining universal health coverage in poorer settings is challenging. Large cuts to foreign aid investment from a number of high income economies only compound this challenge. Low and middle income countries also invest around a third of what high income countries invest in research to generate the knowledge needed for UHC. They also have access to around a fifth of the researchers high income countries have access to. Much of the knowledge required to establish the universal health coverage already exists but poor access presents a major barrier to achieving the goal. To unlock this knowledge for everyone’s benefit, the author proposes that policymakers and publishers consider more innovative ways to provide access to available knowledge.
Values, Policies and Rights
This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. The authors conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity. This includes leadership that is gender responsive and institutionalised; development of enabling environments for women's leadership; increasing thought leadership events related to women's role in global health; supporting leadership development, including management training and soft skills and building capacity, including formal training in technical skills, research and mentorship. The authors also call for improved policy and practice in terms of the health and safety risks women face in carrying out their health-related roles.
A global coalition of civil society organisations and trade unions presented a report on 'Spotlight on Sustainable Development 2017'. The report provides a comprehensive independent assessment of the implementation of the 2030 Agenda and its Sustainable Development Goals (SDGs). In the 2030 Agenda governments committed to a revitalised Global Partnership between States and declared that public finance has to play a vital role in achieving the SDGs. But in recent decades, the combination of neoliberal ideology, corporate lobbying, business-friendly fiscal policies, tax avoidance and tax evasion has led to a massive weakening of the public sector and its ability to provide essential goods and services. The same corporate strategies and fiscal and regulatory policies that led to this weakening have enabled an unprecedented accumulation of individual wealth and increasing market concentration. The proponents of privatisation and public-private partnerships (PPPs) use these trends to present the private sector as the most efficient way to provide the necessary means for implementing the SDGs. But many studies and experiences by affected communities have shown that privatisation and PPPs involve disproportionate risks and costs for the public sector. PPPs can even exacerbate inequalities, decrease equitable access to essential services and jeopardise the fulfilment of human rights. Therefore, it is high time to counter these trends, reclaim public policy space and take bold measures to strengthen public finance, regulate or reject PPPs and weaken the grip of corporate power on people’s lives. These are indispensable prerequisites to achieve the SDGs and to turn the vision of the transformation of the world, as proclaimed in the title of the 2030 Agenda, into reality. The 160-page report is supported by a broad range of civil society organisations and trade unions, and based on experiences and reports by national and regional groups and coalitions from all parts of the world. Its 35 articles cover all sectors of the 2030 Agenda and the SDGs, and reflect the rich geographic and cultural diversity of their authors.
South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy. However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study aimed to address this knowledge gap, as an empirical case study analysing how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines. It explored state and non-state actors’ perceptions regarding how domestic health policy is integrated into foreign policy to achieve better insights into health and foreign policy processes at the national level. Employing qualitative approaches, the authors examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. The findings showed the interplay among social, political, economic and institutional conditions in determining the success of this integration process. A series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa’s domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilisation of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right. The report concludes that transnational networks may influence government’s decision making by providing information and moving issues up the agenda.
Dr. Tedros Adhanom Ghebreyesus, newly elected Director-General of the World Health Organisation (WHO) for the next five years, believes WHO must evolve and adapt to urgent global health challenges, and “put the right to health at the core of its functions, and be the global vanguard to champion them.” Universal health coverage will be his topmost priority. “The growing momentum around universal health coverage—combined with the global commitment to sustainable development and its motto of “leaving no one behind”—offers unique opportunities to advance equity in health.” In a Q&A with Health and Human Rights Dr Tedros discussed the “hundreds of millions of people missing out on essential health care or falling into poverty trying to pay for it. That is a violation of the human right to health that demands our full attention and urgent action.” He acknowledged that implementation of policies to achieve universal health cover is difficult and requires collaboration and partnership across stakeholders. He explained this collaborative approach guided Ethiopia’s pursuit of equitable health access when he was minister of health. Dr Tedros told Health and Human Rights that he is committed to transforming the way that WHO operates with the core principles of health as a human right and universal health coverage for the most vulnerable are at the forefront of all our work. Too often, Dr Tedros noted, human rights and gender equity are secondary considerations when UN organisations develop programming. He stressed that this is outdated and must change.
Recently, there has been a growing push for countries to achieve universal health coverage (UHC) in order to strengthen health systems and improve health equity and access to health services. Importantly, not all potential paths to a universal health system are consistent with human rights requirements. Simply expanding health coverage, especially if it continues to exclude poor and vulnerable communities, is not sufficient from a human rights perspective. The author in this paper presents the requirements that a human rights approach to UHC imposes. These include locating UHC within the context of a national effort to provide equitable access to the social determinants of health; making access to essential health services and public health protections a legal entitlement, with redress for failures to provide these benefits; paying explicit attention to equity in the design of the universal health system, including in health financing. There should be opportunities for consultation with and the participation of the population in the design of the path to UHC and the determination of benefits packages. The process for pursuing the progressive realisation of UHC should first expand coverage for high-priority services to everyone, with special efforts to ensure that disadvantaged groups are reached. The author notes that the goal of achieving UHC can generally be realised only in stages, through a long process of gradual realisation, given limitations in resource availability and administrative capacity, and that this imposes difficult trade-offs along the way.
This presentation of the ECSA strategic plan provides a situation analysis of the trends in health affecting the region, and health services trends, including a continued inadequacy of human resources for health and high level of out-of-pocket expenditure on health, above 30% of total health expenditure in most countries in the region. The strategic plan seeks to contribute to the health status in the ECSA region by providing leadership towards attainment of the Sustainable Development Goals (SDGs). The plan covers six strategic areas. It includes measures to support and promote efforts to build human resources for health and human capacity development; to strengthen health systems towards Universal Health Coverage and to assist countries to develop capacity to implement reproductive and maternal and child health strategies. It seeks to reduce communicable and non-communicable diseases, chronic conditions, injuries and all forms of malnutrition, and to promote the generation, management and utilisation of knowledge to inform decision making and programming in health. A final objective for the ECSA health community in the plan is to set a regional health policy agenda and foster strategic partnerships and collaboration towards achieving of international commitments, including of the SDGs. Several enabling factors are identified, including continued support from the member states as shown through ownership of ECSA resolutions and activities and the remittance of subscriptions; and a diversified funding base through securing new funders and income generation activities such as training.
This research assessed the extent to which the occupational safety and health act in Kenya safeguards the safety and health of workers in its coal mines. From a comparison with law in other countries, the author identifies gaps and recommends that Kenya should enact more comprehensive clauses for occupational safety and health of coal mine workers, should revise the compensation amounts provided for by the Work Injury Benefits Act; set guidelines and directions encompassing duties of employers and employees in mining and provide for medical services in coal mines.
At an official side event of the 34th Session of the Human Rights Council, panelists discussed how people’s sexual and reproductive health rights (SRHRs) around the world could be better protected and promoted. This report presents perspectives raised on challenges and good practices in ensuring full access to SRHRs, environmental dimensions of family planning, the linkages between a human rights-based social protection framework and access to these rights, and current global trends, and what these mean for implementation of the SDGs and their achievement by 2030. Men, women and gender non-conforming persons are all entitled to SRHRs and require these services. And while everyone is affected by limited access to these rights, individuals from already marginalized groups such as children and adolescents, lesbian, gay and trans persons, men who have sex with men, sex workers, drug users, indigenous peoples, and people living in poverty were reported to be the most affected, sometimes fatally.
This joint UNDP-UNRISD report reviews recent trends in six areas that are fundamentally important to achieving the 2030 Agenda. These six “mega-trends” relate to (i) poverty and inequalities, (ii) demography, (iii) environmental degradation and climate change, (iv) shocks and crises, (v) development cooperation and financing for development, and (vi) technological innovation. The report explores whether these trends are having positive or negative effects on development and discusses policy implications for the implementation of the 2030 Agenda. The report raises that some of the trends displayed currently are positive and supportive, including in the reduction of absolute poverty and technological innovation. Yet negative trends in several of the other target areas pose a significant risk to the realisation of the SDGs. They suggest that evidence-generating processes should be designed so as to take interactions between areas into account, whether that be through the use of interdisciplinary teams who can bring different insights to research, or through modelling and simulations of complex interactions. The potential for policy coherence manifests itself in two ways in the 2030 Agenda. First, there is a need to pursue progress across goals at the same time (e.g. employment guarantee programmes that focus on the provision of the safeguarding of environmental goods and services), while recognising and minimising the negative interactions. Second, there is the issue of coherence at different levels of decision-making and implementation, primarily local, national, regional and global—for example, whether local policies on education service provision are supported by fiscal policies at the national level, especially the decentralisation of tax policy. All of the issues discussed in the report are argued to point to the need for collective action so as to maximise the positive dynamics in these areas and minimise risk, and for processes that build trust and inclusiveness of participation.