In his address to the 72nd session of the World Health Assembly, Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation (WHO) said that strong primary health care is the front-line in defending the right to health, including sexual and reproductive rights. According to WHO, the “triple billion” targets that are at the heart of its strategic plan for the next five years are: one billion more people benefiting from universal health coverage (UHC); one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. Dr Tedros cited various initiatives in countries that demonstrate progress and new normative products developed by WHO that are being used globally to protect and promote health. He highlighted three priorities that must guide discussions to make advances in primary health care: health is about political leadership; health is about partnership; and health is about people.
Values, Policies and Rights
Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, reports that HCs' potential can, however, be limited by a lack of local health providers' (HPs) understanding of HC roles and functions as well as lack of engagement with HCs. This study was the first to evaluate HPs' responsiveness towards HCs following participation in an interactive rights-based training. Thirty-four HPs, from all Cape Metropole health sub-districts, participated in this qualitative training evaluation. Two training groups were observed and participants completed pre- and post-training questionnaires. Semi-structured interviews were held with 10 participants 3–4 months after training. Following training, HPs understood HCs to play an important role in the communication between the local community and HPs. HPs also perceived HCs as able to assist with and improve the quality and accessibility of PHC, as well as the answerability of services to local community needs. HPs expressed intentions to actively engage with the facility's HC and stressed the importance of setting clear roles and responsibilities for all HC members. This training evaluation reveals HPs' willingness to engage with HCs and their desire for skills to achieve this. Moreover, it confirms that HPs are crucial players for the effective functioning of HCs. This evaluation indicates that HPs' increased responsiveness to HCs following training can contribute to tackling the disconnect between service delivery and community needs. Therefore, the training of HPs on HCs potentially promotes the development of needs-responsive PHC and a people-centred health system.
More than 75% of emerging infectious diseases are zoonotic in origin and a transdisciplinary, multi-sectoral One Health approach is a key strategy for their effective prevention and control. In 2004, US Centers for Disease Control and Prevention office in Kenya established the Global Disease Detection Division of which one core component was to support, with other partners, the One Health approach to public health science. A Zoonotic Disease Unit has provided Kenya with an institutional framework to highlight the public health importance of endemic and epidemic zoonoses including Rift Valley Fever, rabies, brucellosis, Middle East Respiratory Syndrome Coronavirus, anthrax and other emerging issues such as anti-microbial resistance. The programme is implementing capacity building programs, surveillance, workforce development, research, coordinated investigation and outbreak response. This has led to an improved outbreak response and generated data that has informed disease control programs to reduce the burden of and enhance preparedness for endemic and epidemic zoonotic diseases, enhancing global health security. Since 2014, the Global Health Security Agenda implemented through Centers for Disease Control and Prevention office in Kenya and other partners in the country has provided additional impetus to maintain this effort and Kenya’s achievement now serves as a model for other countries in the region. Significant gaps remain in implementation of the One Health approach at subnational administrative levels. however, with sustainability concerns, competing priorities and funding deficiencies.
Humanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. This mixed-methods study assessed SRH experiences, knowledge and access to services of 260 refugee girls 13-19 years old in the Nakivale settlement, Uganda between March and May 2018. The majority of girls were born in DR Congo and Burundi. the findings showed weak knowledge of SRH and methods for preventing HIV and pregnancy, school days missed due to menstruation and that 30 of the 260 girls were sexually active, of which 11 had experienced forced sexual intercourse. The latter occurred during conflict, in transit or within the camp. The preferred sources for SRH information was parents or guardians, although participants expressed that they were afraid or shy to discuss other sexuality topics apart from menstruation with parents. Only 30% of the female adolescents had ever visited a SRH service centre, mostly to test for HIV and to seek medical aid for menstrual problems. The authors found that adolescent refugee girls lack adequate SRH information, experience poor SRH outcomes including school absence due to menstruation, sexual violence and FGM and recommend comprehensive SRH services including sexuality education, barrier-free access to SRH services and parental involvement for refugee communities.
Health should not be like playing the lottery - but that is what it has become in Africa. If you’re born rich you win, if you are born poor, you lose.’ This statement was made by Dr Githinji Gitahi, Group CEO of Amref Health Africa at the opening ceremony of the Africa Health Agenda International Conference (AHAIC) which took place in Kigali, Rwanda in March 2019. The conference was focused on Multi-Sectoral Action to achieve Universal Health Coverage (UHC) in Africa by 2030. The conference delegates observed that technology and data are needed to achieve UHC but that most of the technology available is focused on secondary and tertiary sectors and on curative care, rather than at community level. There is also need for regulation of new generation actors that are technology-focused. The authors propose that cross-regional dialogue and knowledge sharing is needed where countries can learn from each other, avoiding traditional silos and engaging multi-stakeholder and multi-sectoral partnerships and shifting the paradigm from a view of health as an investment rather than an expenditure.
The Supreme Court in the United Kingdom announced in April a verdict in the landmark case of the Zambian communities consistently polluted by Konkola Copper Mines (KCM), a subsidiary of British miner Vedanta Resources Plc, allowing them to have their case against the parent company and its subsidiary tried in the UK. The ruling sets a strong legal precedent which will allow people with claims against subsidiaries of British multinationals to sue the parent company in the UK. The judgment by Chief Justice Lady Hale, and four further judges, re-affirms the rulings of the Court of Technology and Construction in 2016 and the Court of Appeal in 2017. Lady Hale refused Vedanta’s pleas in appealing the former judgments stating that, contrary to the claims of Vedanta’s lawyers the claimants do have a bona fide claim against Vedanta; the company does owe a duty of care to the claimants, especially in view of the existence of company-wide policies on environment and health and safety. The judgement noted that the size and complexity of the case, and the lack of funding for claimants at ‘at the poorer end of the poverty scale in one of the poorest countries of the world’ means that they do not have substantive access to justice in Zambia. This has wider implications for other communities affected by multinational mining.
This review identified health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique. It used three methods - policy document review, key informant interview and literature review. Three main themes were identified from the qualitative review as establishment of the community health worker programme and early challenges, revitalization of the community health workers programme and the integration of maternal health in the community health tasks. In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the community health worker programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995. In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. The study observe that the role of community health workers has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling, but do not yet include some possible areas, like management of emergency conditions of pregnancy including pre-eclampsia and eclampsia.
This paper assesses the extent to which Health in All Policies (HiAP) is being translated into the process of governmental policy-making and is supported by international development partners and non-state actors. A qualitative case study was performed, including a review of relevant policy documents and 40 key informants with diverse backgrounds. Kenya is facing major health challenges that are influenced by various social determinants, but the implementation of intersectoral action focusing on health promotion is still arbitrary. On the policy level, little is known about HiAP in other government ministries. Many health-related collaborations exist under the concept of intersectoral collaboration, which is prominent in the country’s development framework of Vision 2030, but with no specific reference to HiAP. The paper highlights that political commitment from the highest office would facilitate mainstreaming the HiAP strategy, for example by setting up a department under the President’s Office. The budgeting process and planning for the Sustainable Development Goals were found to be potential windows of opportunity. While HiAP is being adopted as policy in Kenya, it is still perceived by many stakeholders as the business of the health sector, rather than a policy for the whole government and beyond. The authors propose that Kenya’s Vision 2030 use HiAP to foster progress in all sectors with health promotion as an explicit goal.
This statement from the People’s Health Movement (PHM) asserts a commitment to Comprehensive Primary Health Care and addressing the Social, Environmental and Economic Determinants of Health. To make health care accessible to all, African governments are considering or have implemented policy reforms with a focus on achieving Universal Health Coverage (UHC). Examples include, the Community Based Health and Planning Services (CHPS) and National Health Insurance Scheme in Ghana; National Health Insurance Scheme in Uganda, expansion of the National Hospital Insurance Fund in Kenya, National Health Insurance in South Africa and Health Financing Policy and Strategy in Zimbabwe. These policy reforms in different ways aim to provide health financing to protect populations from impoverishing health care costs. Despite this momentum, many African countries still provide limited access to quality health services and only a small percentage of the population is protected from financial risks associated with health care costs. PHM identify that the dialogue on UHC in Africa is strongly influenced by the World Bank and other multilateral and bilateral donors, which promote UHC as predominantly a health financing mechanism. Issues of health equity, including a focus on access for the ‘uncovered’ poor, community participation and the strengthening of public health systems are largely ignored. Where UHC is framed as a health financing issue, rather than a human right or public good, and supports charging the poor for health coverage and the creation of health markets (privatisation). Instead PHM assert that PHC is the key to achieving health for all. Efforts to achieve UHC should prioritise reviving and strengthening public health systems in African countries within the Primary Health Care framework which permeates all levels of health care including addressing social determinants of health. The statement identifies actions needed towards addressing the social determinants of health, including: that policies for UHC need to clearly prioritise PHC at the primary and community levels. They argue that a whole of government approach must be applied to support UHC, including Health in All Policies, so that all ministries and departments of government are coordinated in promoting healthier working and living conditions and healthy lifestyles, preventing causes of disease and mortality, and supporting equitable access to health services. Further, governments should increase health sector spending to at least 15% of national budgets, as agreed in the 2001 Abuja Declaration. The PHM call for increased fiscal space by expanding and improving current tax collection measures; as well as implementing new taxes that ensure progressiveness and sustainability and strengthening prepayment mechanisms that pool resources.
The Southern African Development Community (SADC) Member States joined the global community to raise their voices against gender based violence (GBV) during the 16 Days of Activism against GBV Campaign. This global Campaign runs from the 25 November to the 10 December of every year. For 2018, this Campaign was implemented under the global theme Orange Your World: #HearMeToo. The SADC Member States commemorated the 16 Days Campaign through localized themes and different activities involving stakeholders and the community. Key messages from some Members States are as follows: Botswana commemorated this Campaign day under the theme: “#HearMeToo; End Violence Against Women and Children”. His Excellency the President of Botswana Mokgweetsi Eric Keabetswe Masisi highlighted Botswana’s commitment to various gender instruments among which is SADC Protocol on Gender and Development. Namibia used this Campaign to bring to the forefront the voices of women and girls who have survived violence and those who are defending women’s rights. The Ministry of Family Affairs launched the 16 Days of Activism against GBV under a local theme of: “Orange Seychelles: Say NO to Gender-Based Violence”.