The U.S. Africa Command (AFRICOM) has rapidly expanded its presence on the African continent since its establishment. Emphasizing a “3D” approach of “defense, diplomacy, and development,” AFRICOM’s charge is described as coordinating “low-cost, small-footprint operations” throughout the African continent. Writing in the New York Times, Eric Schmitt marveled at AFRICOM’s Operation Flintlock, a multinational and multiagency training operation in Niger. He wrote glowingly about fighting terrorism with mosquito nets: “Instead of launching American airstrikes or commando raids on militants,” he wrote, “the latest joint mission between the nations involves something else entirely: American boxes of donated vitamins, prenatal medicines, and mosquito netting to combat malaria.” The author asks however if AFRICOM’s humanitarian undertakings should be approached as gestures of goodwill or conflict-deterrence, or rather as signs of a militarized U.S. approach to foreign policy in Africa.
Values, Policies and Rights
This paper is a review of policies on management of latent tuberculosis infection in countries with low and high burdens of tuberculosis. The authors divided countries reporting data to the World Health Organization Global Tuberculosis Programme into low and high tuberculosis burden, based on World Health Organization criteria. National policy documents on management of latent tuberculosis were identified through online searches, government websites, World Health Organization country offices and personal communication with programme managers. A descriptive analysis was done with a focus on policy gaps and deviations from World Health Organization policy recommendations. Documents were obtained from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of tuberculosis or human immunodeficiency virus (HIV)-associated tuberculosis. Screening for children aged < 5 years with household tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries’ policies did not comply with WHO recommendations: nine (13.2%) recommended tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery. The authors raise that lack of solid evidence on certain aspects of management of latent tuberculosis infection results in national policies which vary considerably and highlight a need to advance research and develop clear, implementable and evidence-based WHO policies.
The overarching legal framework for minerals across Africa is public ownership. Citizens should be the collective beneficial owners of the mineral resources that are managed on their behalf by the state as a trustee. Graham asserts, however, that the reality in Africa is different. The collective ownership of minerals and the trustee role of the state has been compromised. Mining activists have tended to focus on accountability and transparency in relation to the regimes of mineral exploitation that governments have adopted. Graham asserts that there is a more fundamental accountability question in how the choices being made advance the inter- generational interests of citizens. Graham identifies that the citizen should at the very least not be made worse off by the development of assets of which he/she is part owner. He argues that there should be a stronger accountability framework where a minerals and development policy provides for inter-generational benefit, with linkages to development. There is a need to retreat from a 'first come first served' approach to awarding mining contracts, to collect more geological information to inform award of concessions and reform revenue law to be sensitive to mining price cycles so revenue collection can be optimised.
Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is argued to be needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.
In July 2015, Malawi’s Special Law Commission on the Review of the Law on Abortion released a draft Termination of Pregnancy bill. If approved by Parliament, it will liberalize Malawi’s strict abortion law, expanding the grounds for safe abortion and representing an important step toward safer abortion in Malawi. Drawing on prospective policy analysis (2013–2017), the authors identify factors that helped generate political will to address unsafe abortion. Notably, the authors show that transnational influences and domestic advocacy converged to make unsafe abortion a political issue in Malawi and to make abortion law reform a possibility. Since the 1980s, international actors have promoted global norms and provided financial and technical resources to advance ideas about women’s reproductive health and rights and to support research on unsafe abortion. Meanwhile, domestic coalitions of actors and policy champions have mobilized new national evidence on the magnitude, costs, and public health impacts of unsafe abortion, framing action on unsafe abortion as part of a broader imperative to address Malawi’s high level of maternal mortality. Although these efforts have generated substantial support for abortion law reform, an ongoing backlash from the international anti-choice movement has gained momentum by appealing to religious and nationalist values. Passage of the bill confronts, for example, the current United States’ government position prohibiting the funding of safe abortion.
This study assessed gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo. A cross-sectional study was carried out among 289 church-going young men, aged 18–24 years, residing in three disadvantaged communes of Kinshasa. The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men agreed that a man is the only decision maker in the home and about half of the respondents supported the statement “There are times a woman deserves to be beaten”. Similarly, around half of the participants agreed with the idea of men’s uncontrollable sex drive and men’s toughness. Close to half of the participants agreed that it is women’s responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found. The study findings indicated that a high proportion of church-going young men do not endorse gender equitable norms. The authors argue that churches and schools urgently need comprehensive gender equality and masculinity policies and programmes to influence young men’s attitudes and behaviours.
This article provides a reflection on the question of why there is a need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage will automatically be equitable and gender balanced, from a panel of health financing and gender experts. The authors traced the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. The authors found that unless explicit attention is paid to gender and its inter-sectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations, movement towards Universal Health Coverage can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to Universal Health Coverage and the needs of less powerful groups, which can include women and children, are not necessarily given priority. The authors identified the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of Universal Health Coverage decisions, political economy as well as technical research should be prioritized. The authors concluded that countries should adopt an equitable approach towards achieving Universal Health Coverage and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children.
A new universal health coverage law received parliamentary approval in mid-December in Europe after years of discussion and planning. Health care will be provided for everyone including the estimated 30% of Egyptians who cannot afford to pay at present. Enrolment in the scheme will be obligatory, with fees set according to income with additional sources of funding to include taxes on tobacco and polluting industries including cement. Egypt's population is forecast by the UN Population Fund to reach 119 million in 2030. UNICEF says about three in every ten children suffer from multidimensional poverty, which includes factors such as poor health and lack of education. Tedros Adhanom, director-general of WHO, praised the law for including people with major catastrophic conditions such as cancer. The scheme will be mandatory, with those on low incomes to be covered by the state; with split roles for health-care providers and those bodies to oversee quality and accreditation; and patients would be allowed to choose their own doctor and hospital. However, he raised worries about the level of co-payments that patients might have to make and the long period of implementation that might lead to worsening health disparities.
The first-ever WHO Independent Global High-level Commission on Noncommunicable Diseases (NCDs) aims to identify and propose bold and practical ways to curb the world’s leading causes of death and illness. The Commission was announced in 2017 by Dr Tedros Adhanom Ghebreyesus, Director-General WHO. The Commissioners will recommend actions to accelerate progress in tackling NCDs, primarily cardiovascular disease, cancers, diabetes and respiratory disease, and promoting mental health and well-being. NCDs kill 15 million people between the ages of 30 and 69 each year. Low- and lower-middle income countries are particularly affected by NCDs with almost 50% of premature deaths from NCDs occurring in these countries. In addition, NCDs are responsible for the deaths of 7 in 10 people across all ages globally, equivalent to approximately 40 million people. In 2015, world leaders committed to reduce premature deaths from NCDs by one third by 2030 as part of the Sustainable Development Goals. Recent WHO reports indicate that the world will struggle to meet that target.
This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems; illustrate how gender power relations affect access to important resources; and demonstrate that gender norms, poverty and patriarchy interplay to limit women’s choices and chances both within household interactions and within the health sector. The authors note that health systems researchers have a responsibility to promote the incorporation of gender analyses into their studies in order to inform more strategic, effective and equitable health systems interventions, programmes, and policies. Responding to gender inequitable systems, institutions, and services in this sector requires an ‘all hands-on deck’ approach. They note that it is not possible to claim to take a ‘people-centred approach’ to health systems if the status quo continues.