Expanded mobility and cross-border trading across the road transport sector in Southern Africa have contributed to increased HIV prevalence rates among key populations and communities living in the region. To support a strengthened and co-ordinated response to the unique public health challenges this presents, the Southern African Development Community (SADC) approved the Regional Minimum Standards and Brand for HIV and other Health Services Along Road Transport Corridors in the SADC Region (RMSB) in November 2015. It includes guiding principles on the right to health; health-promoting workplaces; gender mainstreaming; empowerment of commercial sex workers and effective partnership. It sets minimum standards on service delivery and a minimum package of services for those involved in road transport corridors.
Values, Policies and Rights
A multi-pronged approach is needed to end female genital mutilation (FGM) in one generation. This includes prevention, protection, provision of services, partnerships and prosecutions. States must live up to their international obligations to protect women and girls. Over the last 12 months, the campaign against FGM has received renewed support from different actors committed to ending the practice. According to UNICEF, Kenya has led the way with falls in prevalence from middle-aged women to adolescent girls from 49% to 15%, albeit with an increase in the percentage of FGM performed by health personnel. 2014 also saw a significant increase in the prosecution of FGM cases globally and verdicts in a few countries. This article discusses the global challenges and successes of addressing FGM and makes recommendations towards eliminating FGM in a generation.
Although a substantial literature suggests that orphans suffer disadvantage relative to non orphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love. Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15–25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death. Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47). The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.
2015 is a said to be pivotal year. The post–2015 sustainable development agenda currently being drafted is premised on the reality that the present model of development is not working, given worsening inequalities and straining planetary boundaries. All countries and peoples—and the planet –have the right to live with a better model, one that is inclusive and sustainable. The authors argue that an increasingly urgent imperative for change informs the two–track negotiations unfolding at the United Nations from now until September. One track involves the post–2015 sustainable development agenda; the second focuses on financing for development, an independent process that began at the 2002 Monterrey Conference. While the two talks are separate, the issues in each are observed to be deeply interlinked, and the success of any new model to depend on the outcomes of both. The political stakes are high, but so too the authors argue are the opportunities—perhaps once–in–a–generation—for genuine transformation. The article discusses the implications of these two tracks of negotiation.
The World Health Organisation has included some African countries on its low-risk yellow fever list, which means their citizens no longer need clearance certificates when visiting SA. Visitors from Zambia, Tanzania, Ethiopia, Eritrea, and Sao Tome and Principe would no longer be expected to produce a yellow fever certificate when entering SA. In accordance with international health regulations, SA requires a yellow fever certificate from all citizens and non-citizens over the age of one who have travelled from a yellow fever risk country or have been in transit for more than 12 hours at the airport of such a country.
Rural health advocacy groups in South Africa have developed guidelines aimed at ensuring that policy makers and government address the rural context when developing and implementing policies. The guidelines are proposed to assist government departments in taking into account rural contexts when designing programmes. The guidelines and related presentations from the launch can be accessed through the link.
A new kind of protectionism is argued by the author to be haunting the world: the spectre of ebola protectionism. As ebola ravages the societies of the Mano River Union (MRU) states of Guinea, Liberia and Sierra Leone, the author notes that there are increasing calls from conservative politicians, right-wing groups, and sections of the media to prevent people from these states from interacting with the rest of the world. The protectionist measures range from exit and entry controls, such as temperature checks and mandatory monitoring and quarantining of travellers from MRU states, to flight bans and denial of visas to holders of MRU passports. The virus poses less of a threat to rich countries with sound public health systems than poor West African countries that have extensive links with the MRU states. The author argues that exit and non-intrusive entry controls, not flight bans and visa restrictions that Australia and Canada have imposed, may be enough to manage the few cases that are likely to pop up in rich countries.
The United Nations (UN) Millennium Declaration and eight Millennium Development Goals (MDGs) have been hailed as a unique achievement in international development. Although the MDGs have raised the profile of global health, particularly in low- and middle-income countries, progress has been uneven both between and within countries. A key reason suggested for this lack of progress is that the MDGs fall far short in terms of addressing the broader concept of development encapsulated in the Millennium Declaration, which includes human rights, equity, democracy, and governance. To strengthen the likelihood of realizing the post-2015 Sustainable Development Goals (SDGs), particularly with regard to “planet and population” health and well-being , UN and other decision-makers are urged to consider the adoption of an integrated SDG framework that is based on (i) a vision of global justice – underpinned by peace, security and basic human rights; (ii) the development of interdependent and interconnected strategies for each of the eleven thematic indicators identified in the UN document The World We Want; and (iii) the application of guiding principles to measure the impact of SDG strategies in terms of holism, equity, sustainability, ownership, and global obligation. While current discussions on the SDGs are making progress in a number of areas, the need for integration of these around a common global vision and purpose seems especially crucial to avoid MDG shortcomings.
This article systematically reviews a set of health policy papers on agenda setting and tests them against a specific priority-setting framework. The article applies the Shiffman and Smith framework in extracting and synthesizing data from an existing set of papers, purposively identified for their relevance and systematically reviewed. Its primary aim is to assess how far the component parts of the framework help to identify the factors that influence the agenda setting stage of the policy process at global and national levels. It seeks to advance the field and inform the development of theory in health policy by examining the extent to which the framework offers a useful approach for organizing and analysing data. Applying the framework retrospectively to the selected set of papers, it aims to explore influences on priority setting and to assess how far the framework might gain from further refinement or adaptation, if used prospectively. The article also demonstrates how framework synthesis can be used in health policy analysis research.
As competition for land intensifies in Africa’s rapidly growing towns and cities, planning laws assume a fundamental importance. They determine how urban growth is managed and directed. In most countries outdated, inappropriate and unintegrated laws are exacerbating urban dysfunction. The reform of planning law is frequently advocated as a necessary step for better management of urbanisation in Africa. But reform initiatives consistently founder. This is inevitable, given the approaches adopted. The promotion of “one-size-fits-all” and “model” planning laws from outside the continent has not served Africa well. Invariably it has created further legal uncertainty and a series of unanticipated, often pernicious consequences. This paper argues that more progressive, realistic urban planning in Africa will require a radically different approach to planning law reform, essential for sustainable and equitable urban development in Africa.