In Kenya, access to essential medicines is ensured legislatively for HIV, TB and malaria specifically, but delivery is patchy. The situation is improving, but not universally, and there is a continued assault on the IP Act and generic procurements by those who want to profit from selling essential drugs for the poor. Access to medicines is an issue that needs a balance between political will and public involvement/civil society demands. Civil society can demand their rights are realised through campaigns to implement the WTO rules that were designed to protect peoples' access to essential medicines and by stopping the assaults on the procurement of generics, increasing the availability of essential medicines, funding research and development for the medicines we need and abolishing taxes on essential medicines. Providing free essential medicines is the only affordable option for most of the population. This report was presented at the Africa Regional Civil Society meeting on the IGWG on Public Health, Innovation and Access, in Nairobi, Kenya, 28–29 August, 2007.
Values, Policies and Rights
Health Systems Trust has summarised South Africa’s National Strategic Plan (NSP) for easy reading. The NSP is a strategic guide for South Africa’s national response to HIV, STIs and TB from 2012 to 2016. It is coordinated by the South African National AIDS Council (SANAC). It aims to inform national, provincial, district and community-level stakeholders with strategic directions when developing implementation plans. The Plan contains baseline data on the various diseases and identifies key populations for HIV and TB response. Its goals are to reduce the number of HIV infections by 50%; ensure at least 80% of patients eligible for antiretroviral treatment are receiving it, with 70% alive and being treated after five years; reduce the number of new infections of TB and deaths by 50%; ensure the rights of individuals living with HIV, TB and STIs are protected; and reduce self-reported stigma associated with HIV and TB by 50%. The Plan also outlines how the goals will be reached, who will oversee implementation of goals and how progress of the NSP will be assessed. Implementing the NSP is estimated to cost R130.7 billion over five years.
In this paper, grounded theory procedures were use to analyse literature pertaining to dignity and to conduct and analyse 64 semi-structured interviews with persons marginalised by their health or social status, individuals who provide health or social services to these populations, and people working in the field of health and human rights. The results showed that the taxonomy presented identifies two main forms of dignity – human dignity and social dignity – and describes several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion and the consequences of dignity violation. Together, these forms and elements point to a human rights-based theory of dignity that can be applied to the health sector.
In this report, UN Women calls for a specific commitment to achieving gender equality, women’s rights and women’s empowerment in the post-2015 development framework and Sustainable Development Goals (SDGs), as well as robust mainstreaming of gender considerations across all parts of the framework. To make a difference, the new framework must be transformative, by addressing the structural impediments to gender equality and the achievement of women’s rights. In order to address the structural causes of gender-based discrimination and to support true transformation in gender relations, the report proposes an integrated approach that addresses three critical target areas of gender equality, women’s rights and women’s empowerment. 1. Freedom from violence against women and girls, which includes concrete actions to eliminate the debilitating fear and/or experience of violence as the centre-piece of any future framework. 2. Gender equality in the distribution of capabilities – knowledge, good health, sexual and reproductive health and reproductive rights of women and adolescent girls; and access to resources and opportunities, including land, decent work and equal pay to build women’s economic and social security. 3. Gender equality in decision-making power in public and private institutions, in national parliaments and local councils, the media and civil society, in the management and governance of firms, and in families and communities.
Tradition and culture, the determination and ingenuity of women, and the concern and commitment of health care providers often circumvent the law to find expression. For example, though legal reform is not yet feasible in Mozambique, three large public hospitals have begun to provide elective abortions.
An survey reported by the Zimbabwean on the Constitution found that 40% of those interviewed were in favour of the Constitution preserving full rights for women to have an abortion, while fewer(39%) believed it should be preserved only in certain instances which must be clearly stated by law. Only 19% were completely opposed to the Constitution preserving any rights for a woman to have an abortion. More men than women were in favour of full rights for women to seek an abortion. The government, which says it is aware of the practice of illegal abortions, promotes safe sex as a solution, but a spokesman for the Ministry of Health and Child Welfare admitted this was a huge challenge due to the unavailability of – and cultural resistance to – contraceptives. A largely Christian society, abortion in Zimbabwe is condemned by both the church and the state. Women who do choose the abortion route say that although a safe, legal abortion is exorbitant – around US$350 – it’s still a lot cheaper than the cost of giving birth to a child in a city hospital. Pregnant women who cannot afford the legal option are reported to resort to taking herbal remedies from traditional healers.
HIV/AIDS is a preventable disease, yet approximately 5 million people were newly infected with HIV in 2003, the majority of them through sex. Many of these cases could have been avoided, but for state-imposed restrictions on proven and effective HIV prevention strategies, such as latex condoms. Condoms provide an essentially impermeable barrier to HIV pathogens. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), scientific data "overwhelmingly confirm that male latex condoms are highly effective in preventing sexual HIV transmission." However, many governments around the world either fail to guarantee access to condoms or impose needless restrictions on access to condoms and related HIV/AIDS information. Such restrictions interfere with public health as well as set back internationally recognized human rights - the right to the highest attainable standard of health, the right to information, and the right to life.
"The fact that a very large part of the world’s population has inadequate access or none to essential and often life-saving medicines is of grave concern. It results in a vast loss of life and much suffering, more particularly among the poor and underprivileged. It is in blatant contradiction to the fundamental principles of human rights. And, even if one were to set humanitarian considerations side, it results in serious damage to the economy and to the functioning of society."
The right to health facilities, goods and services specifically includes the provision of essential medicines as defined by WHO. The Human Rights Approach should be incorporated in all national medicine policies and programmes, the selection of medicines for essential public health functions should be further refined, States parties’ international reporting obligations on access to essential medicines should be strengthened, and national NGOs should be empowered to put pressure on governments to fulfil their commitments and obligations under the international and national human rights instruments they have signed and ratified.
In 2008 WHO analysed 186 national constitutions and found that 135 (73%) include provisions on health or the right to health. Of these, 95 (51%) constitutions mention the right to access health facilities, goods and services, which includes medicines. Only four national constitutions (2%) specifically mention universal access to medicines. There are at least three different routes, the study argues, through which the right to health – and essential medicines – can be recognised in national legal frameworks. The strongest government commitment is created by including the right to essential goods and services in the national constitution. The second approach is constitutional recognition that international treaties ratified by the State override or acquire the status of national law. The third option, inclusion of health rights in other national legislation, is easier to create but also easier to change or cancel. The full range of strategies should be used to promote universal access to essential medicines through rational selection, affordable prices, sustainable financing and reliable health systems, the article argues. Constitutional recognition of the right to access essential medicines is an important sign of national values and commitment, but is neither a guarantee nor an essential step – as shown by those countries that have failing health systems despite good constitutional language, and those that have good access without it. Yet constitutional recognition creates an important supportive environment, especially in middle-income countries where health insurance systems are being created and patients are becoming more aware of their rights and are more vocal in demanding them.