The writer of this article discusses conflicting conditions for homosexual people in Kenya with impact on health. On the one hand there has been increased visibility of Kenya’s gay community in recent years, despite the fact that homosexuality is illegal in the country, with greater social networking and collaborative efforts between the gay community and sex workers, civil society, parastatals and professional bodies. On the other hand the author also observes harmful practices of ‘corrective rape’ (where lesbians are raped), homophobia in schools, high suicide rates among gays and lesbians, and discrimination such as in the stoning of a suspected gay man in a Nairobi slum.
Values, Policies and Rights
Kenya’s gay community and its direct revolution
Nzioka D: Pambazuka News (597), 13 September 2012
Safe abortion: Technical and policy guidance for health systems
World Health Organisation: 2012
Since first publication of this guidance in 2003, a considerable amount of new data have been produced and published, relating to epidemiological, clinical, service delivery, legal and human rights aspects of providing safe abortion care. Therefore, preparation for this revision of the guidance included extensive literature review and updating of recommendations related to service delivery, legal and policy issues, and the conduct of new systematic reviews and updates of outdated systematic reviews to provide the evidence for recommendations related to clinical questions prioritised by an international panel of experts. The substantial revisions in this update reflect changes in methods of abortion and related care, service delivery as it applies to the availability and use of new methods, and application of human rights for policy-making and legislation related to abortion, among other topics. Recommendations in the 2003 guidance for which there was no new evidence remain unchanged and are also included in the new edition.
State of torture and related human rights violations in Kenya: Alternative report to the UN Human Rights Committee
Kenyan Section of the International Commission of Jurists (ICJ Kenya), Independent Medico-Legal Unit (IMLU), Kenya Alliance for Advancement of Children (KAACR), Kenya Coalition on Violence against Women (COVAW) et al: July 2012
This report was submitted to the United Nations Human Rights Committee to inform its review of Kenya’s implementation of the Provisions of the International Covenant on Civil and Political Rights (ICCPR) in relation to torture. It adopts a thematic approach and specifically focuses on legal issues that relate to protection from torture and cruel and degrading treatment under the Covenant, including extra-judicial killings, the death penalty, the principle of non-refoulement, treatment of prisoners, access to adequate medical care for prisoners and the right to a fair trial. It integrates a gender and child-rights perspective and examines the problems related to domestic violence, female genital mutilation and reproductive health rights. The overall conclusion is that, while Kenya has endeavoured to include the principles of the ICCPR in its newly promulgated Constitution of 2010 and legislative framework, there continue to be important gaps, with inadequate legislation for criminalising torture and lenient sentences for those found guilty.
Urbanisation imperatives for Africa: Transcending policy intertia
African Centre for Cities, University of Cape Town: 2010
Urbanisation is one of Africa’s most pressing issues, according to this publication by African Centre for Cities. However, most political and policy leaders remain in denial about its centrality and urgency. The phenomenon represents the most complex and intractable policy questions and as long as Africans do not take responsibility to shift the contemporary situation of policy failure, we are in for a crisis, says the African centre for Cities. This publication is intended to be a resource to policy activists in African governments, development agencies, social movements, universities and business sectors who are committed to addressing the current inertia surrounding urbanisation policy development and should be of help activists to develop a clear agenda on urbanisation on the continent.
Women, abortion and the new technical and policy guidance from WHO
Fathalla MF and Cook RJ: Bulletin of the World Health Organisation 90(9): 712, September 2012
This editorial welcomes the World Health Organisation’s (WHO) update of its 2003 publication ‘Safe abortion: Technical and policy guidance for health systems’. In updating its guidance on safe abortion, WHO has responded to a major neglected public health need of women, Fathalla and Cook argue here. Unsafe induced abortion is not only a public health problem, it is also a human rights issue. As governments are obligated by their national constitutions or by legally binding international human rights conventions to protect the right to the highest attainable standard of health, they should be increasingly applying human rights principles to facilitate women’s transparent access to safe abortion services in their countries. The WHO update highlights the growing trend for national courts and regional and international human rights bodies, including the United Nations treaty monitoring bodies, to take a rights-based approach to this issue. The authors call for abortion to be decriminalised, as well as for further research aimed at developing simpler, improved methods for performing induced abortion.
High-level Ministerial dialogue on ‘Value for Money, Sustainability and Accountability in the Health Sector’
African Development Bank: July 2012
On 4-5 July 2012, the African Development Bank (AfDB), as a key partner of the Harmonisation for Health in Africa (HHA) mechanism, organised a high-level dialogue on ‘Value for Money, Sustainability and Accountability in the Health Sector’ in Tunis. The conference gathered over African 50 Ministers of Finance and Health and their representatives from 33 African countries, Parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. The conference emphasised the urgent need for greater domestic accountability, reduced dependence on foreign aid and the role of Parliamentarians as well as using e-health in achieving greater value money in the delivery of health services in Africa. Participants also stressed the need to tackle critical shortages, maldistribution and inadequate performance of health workers in Africa. Ethiopia’s Health Extension Worker (HEW) Programme was put forward as a good example of innovative policy interventions to health worker shortages.
Role of fiscal policy in tackling the HIV/AIDS epidemic in Southern Africa
Anyanwu JC, Siliadin YG and Okonkwo E: Working Paper Series No 148, African Development Bank, 2012
Three countries in Southern Africa have the highest adult HIV prevalence in the world: Swaziland (25.9%), Botswana (24.8%), and Lesotho (23.6%). Fiscal policy is crucial for addressing this HIV and AIDS crisis, the authors of this paper argue. Utilising a calibrated model, they investigated the impact of fiscal policy on reducing the HIV and AIDS incidence rates in these countries. In particular, they studied the welfare impact of different taxation and debt paths in reducing the HIV and AIDS prevalence rates. This is particularly important given the current concerns about dwindling foreign aid (especially the Global Fund), and fiscal deterioration and sustainability in these countries. The results show that acting optimally has not only positive societal welfare effect but also positive fiscal effects. For example, it will alleviate the debt burden by 5%, 1% and 13% of the GDP respectively for Botswana, Lesotho and Swaziland by the year 2020. Thus, at a time of fiscal crisis in developed countries and dwindling international HIV and AIDS resources, the future of effective and efficient HIV and AIDS intervention in Africa is clearly domestic, they conclude.
Policy initiation and political levers in health policy: lessons from Ghana’s health insurance
Seddoh A and Akor SA: BMC Public Health (Suppl 1) 12: S10, June 2012
Understanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. This paper attempts to conceptualise the levers of policy formulation using a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study finds that technical experts, civil society, academics and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency. The paper provides lessons which suggest that in understanding the policy process, it is important that actors engage with the content as well as the context to understand viewpoints that may be expressed by interest groups.
South Africa Hopes New Bill Brings Traditional Knowledge Protection
Daniels L: Intellectual Property Watch: May 2012
An Intellectual Property Laws Amendment Bill passed by Parliament is awaiting signature by South African President Jacob Zuma in order for it become the law. It is an ambitious piece of legislation that aims to provide protective mechanisms for indigenous knowledge in South Africa. The bill is far-reaching and aims to: improve the livelihoods of indigenous knowledge holders and communities, benefit the national economy, prevent bio-piracy, provide a legal framework for protection and empower local communities and prevent exploitation of indigenous knowledge. Despite this legal advance, there is another view on the issue of indigenous intellectual property rights which states that the issue will always remain on the margins, given the dominant system of knowledge production which in the main takes place in universities. The article concludes that the prevailing view is that given the history of persecution of indigenous peoples under colonialism, the fight to include their voices in the protection of indigenous knowledge systems is important and necessary to inform the way forward.
Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector
Declaration by the Ministers of Finance and Ministers of Health of Africa: High-level Ministerial conference, Tunis, July 4-5, 2012
The conference gathered Ministers of Finance and Health and/or their representatives from 54 African countries, African parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. The conference recommended:
1. Intensified dialogue and collaboration between ministries of finance and health and with technical and financial partners; 2. Concrete measures to enhance value for money, sustainability and accountability in the health sector to reach universal health coverage; 3. Integrating socio-economic, demographic and health factors into broader development strategies and policies in an effective manner especially in the formulation of medium term strategic plans; 4. Designing effective investments in the health sector, based on evidence-based strategies leading to the prioritization of high impact interventions, which lead to results; 5. Promoting equitable investment in the health sector; ensure that health financing is pro-poor benefiting disadvantaged areas; strengthening regulatory capacity and developing of a strong African pharmaceutical sector as a growth and job creating sector in Africa; 6. Laying out the path to universal health coverage for each country; 7. Improving efficiency in health systems, including equitable access to skilled health workers; 8. Solidifying sustainable health financing systems; 9. Strengthening accountability mechanisms that align all relevant partners, build on the growing citizens’ voice and 10. Increasing domestic resources for health.