Out of 192 countries studied in this review, 75 had legislation mandating universal access to health care services independent of income. Of these, 58 met the criteria based on available measures of coverage that serve as broader proxies for access to care. The authors of the review found that most countries have adopted legal commitments to achieve universal health coverage at low- and middle-income stages of development. When they have not, healthcare has tended to expand gradually, leaving many members of the population vulnerable for extended periods of time. However, the authors caution that a legal commitment is insufficient on its own and must be translated into policies that establish a comprehensive, largely publicly financed system. An over-reliance on partial and private sector-focused care appears to disproportionately benefit richer groups, reducing both efficacy and access to coverage. It also creates groups with strong vested interests in the status quo that can block further progress, they argue. Public financing is more equitable and pro-poor, and reflects the shared value of providing care based on need rather than ability to pay.
Values, Policies and Rights
The United Nations (UN) has passed two resolutions on the right to water and sanitation. The resolution, ‘The human right to water and Sanitation’, was passed by the General Assembly on 28 July 2010, and the resolution, ‘Human rights and access to safe drinking water and sanitation’ was passed by by the Human Rights Council on 30 September 2010. By framing access to water and sanitation as a human right, these resolutions seek to promote ‘national and international justifiable approaches that promote accountability and transparency and provide mechanisms to progressively realise increasing peoples access to water and sanitation’. However, critics point out that the legal basis for recognising the right to water is not adequately established by the resolutions. According to this article, the primary issue confronting the international community will be translating the resolutions into reality. Proposals by the UN include developing tools/mechanisms to achieve the right to safe water and sanitation, ensuring full transparency in the implementation process of delivering safe drinking water and sanitation, focusing on marginalised groups, adopting/implementing effective regulatory frameworks, and putting in place accountability mechanisms to remedy human rights violations.
Government officials, representatives of United Nations agencies and members of the International Campaign to Ban Landmines met from 29 November to 3 December 2010 in Geneva to discuss their efforts and plans to implement the 1997 Mine Ban Treaty. This article is a call to stakeholders at the meeting to address the barriers facing women with disabilities, and to take a participatory approach to policy making that will include the opinions of these women and their self-defined needs. According to the author, a Ugandan activist, women with disabilities have been left out of the agenda to ban landmines over the past decade, in the same way they have been left out of development programmes and shunned in their own communities. Challenges faced by women with disabilities include social isolation, being ignored by relief and recovery efforts and suffering sexual violence. Abuse and abandonment are common, and a lack of access to health care, education and employment opportunities are the reality for most. Unless policymakers take the needs of disabled women into account, the author concludes, these women cannot share fully in the benefits of any new programmes, including employment and health rehabilitation programmes.
The African Youth Conference on Post-2015 Development Agenda, held in Nairobi, Kenya, from 12-16 December 2012, has adopted a Youth Declaration on the Post-2015 Agenda. This Agenda identifies 13 actions for accelerating progress on the Millennium Development Goals (MDGs) and makes recommendations for the post-2015 development agenda. On accelerating MDG progress, the Declaration recommends that governments: increase commitments to achieve the MDGs and honour pledges; strengthen institutions to fight corruption and empower youth; and provide sufficient resources to children, women and youth ministries. It also recommends, inter alia: increasing equitable access to sustainable water and sanitation services and promoting hygienic behaviour; planning and implementing poverty eradication programmes to reach youth; strengthening communication, data collection and monitoring; and empowering and mobilising youth to participate in the MDGs and hold governments accountable. The Declaration asks the UN and its development partners to support projects that mitigate climate change and encourage sustainable consumption. It calls for civil society to engage communities to understand the causes of poverty and to address these challenges.
In this report, the Special Rapporteur considers criminal laws and other legal restrictions relating to sexual and reproductive health and the right to health. These include criminal and other legal restrictions on: abortion; conduct during pregnancy; contraception and family planning; and the provision of sexual and reproductive education and information. These restrictions violate the right to health by restricting peoples’ access to quality goods, services and information, as well as violating their right to make their own decisions about their bodies. Moreover, the application of such laws as a means to achieving certain public health outcomes is often ineffective and disproportionate, according to the report. In cases where a barrier is created by a criminal law or other legal restriction, it is the obligation of the State to remove it. In response to countries that are calling for the progressive realisation of the right to health, the Rapporteur argues that the removal of such laws and legal restrictions is not subject to resource constraints; therefore he calls for the immediate scrapping of laws and policies undermining sexual and reproductive health to ensure everyone can enjoy full realisation of their right to health.
Recognising the intrinsic role of health in achieving international development goals, the United Nations (UN) General Assembly has adopted a resolution on global health and foreign policy which encourages Member States to plan or pursue the transition towards universal access to affordable and quality health-care services. It urges Member States, civil society and international organisations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals. The Assembly also recognised the importance of universal coverage as part of a transition to a more sustainable, inclusive and equitable economy. The resolution encourages Member States to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations. It calls on Member States to recognise the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalisation, inclusive and equitable growth and sustainable development.
In a landmark case, South Africa’s Constitutional Court ruled on 10 December 2012 in favour of a claimant who contracted tuberculosis (TB) during a stint in Pollsmoor Prison, Cape Town. The Constitutional Court decided that prison authorities had failed to implement adequate TB prevention measures among inmates, arguing that there was a causal link between this and the spread of TB. Section 27, a health rights group, has meanwhile warned prison authorities against neglecting TB prevention in prisons. Crowded cells in the prison leading to the spread of TB are argued to be a violation of prisoners’ right to health.
The authors of this paper draw on the experiences of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organisations in the Western Cape, South Africa. The LN’s work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates important lessons for human rights practice, they argue. These include: actively translating knowledge and awareness into action to make rights real; civil society’s role in holding services accountable in terms of the right to health; the need for civil society to promote rights in general; and the critical importance of networking and solidarity for building civil society capacity to act for health rights. Civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realising services and policies that enable the most vulnerable members of society to advance their health. Rights violations can be redressed through access to information and the creation of safe, participatory spaces. Civil society agency is critical to such action.
How can an integrated and inclusive approach of human rights and sustainable development be applied to financial regulation? CIVICUS argues that it will have to begin by giving the financial sector a role that is subservient to the ‘real’ economy, a real economy that in turn should support ecological sustainability and human rights and not a ‘paper’ economy based on futures trading. It points out that the recent financial crisis shows that market self-regulation does not work, calling for government intervention and regulation. CIVICUS makes three major proposals. First, given that markets in natural resources offer a field to expand paper profits while worsening equity in access to resources and conservation, CIVICUS call for new economic benchmarks and note that the Gross Domestic Product-based (GDP) is not an accurate benchmark of progress. Second, financing should be provided for sustainable modes of production, often small scale endeavours. Third, financial regulation should incentivise investment in production activities vs the paper economy.
This regional assessment showed that the foundations for integration and harmonisation of child and adolescent HIV, TB, malaria policies and programming frameworks are already in place in the SADC region. However, in all countries’ national strategic frameworks/plans and guidelines, there is a need to reinforce child specific issues in prevention, diagnostics, and treatment and care. Major gaps remain in strategic frameworks/plans in articulating the integration of HIV-malaria and TB-malaria programmes, and on linking TB and malaria programmes to basic child services. In addition, policies and programming frameworks on HIV are not harmonised across the region, and monitoring and evaluation of all child- and adolescent-focused health programmes is urgently required. Despite these shortcomings, SADC argues that member states can build on the strong foundations and seize invaluable opportunities to scale up a harmonised continuum of care for the three diseases and integrate them with basic child services. This could have a real impact on child health, survival and development in the region and help SADC member states to achieve Millennium Development Goals 4 (reduce child mortality) and 6 (combat HIV, malaria and other diseases), as well as other regional and international commitments.