Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity. An HiAP approach is founded on health-related rights and obligations. It emphasises the consequences of public policies on health determinants, and aims to improve the accountability of policy-makers for health impacts at all levels of policy-making. Core features of HiAP include a strong foundation on human rights and social justice, and a focus on policy-making. It is often necessary to prioritise efforts; seek synergies to enhance health and other important societal goals; and seek to avoid harmful impacts on health. Application of HiAP involves identifying policy developments across sectors with potential implications for health and health equity; assessing impacts; and advocating and negotiating for changes. Long term vision and sustained efforts are often needed. This book looks at examples of HiAP from countries across the world, and has specific chapters on low-income countries, including those from Africa.
Values, Policies and Rights
In this study, researchers explored the impact of violence and related human rights abuses on the lives of sex workers, and how they have responded to these conditions, as individuals and within small collectives. They conducted 55 in-depth interviews and 12 focus group discussions with female, male and transgender sex workers in Kenya, South Africa, Uganda and Zimbabwe. In describing their experiences of unlawful arrests and detention, violence, extortion, vilification and exclusions, participants present a picture of profound exploitation and repeated human rights violations. This situation has had an extreme impact on the physical, mental and social well-being of this population. Underlying their stories, however, are narratives of resilience and resistance. Sex workers in this study draw on their own individual survival strategies and informal forms of support and very occasionally opt to seek recourse through formal channels. While criminal laws urgently need reform, the authors argue that supporting sex work self-organisation and community-building are key interim strategies for safeguarding sex workers’ human rights and improving health outcomes in these communities. If developed at sufficient scale and intensity, sex work organisations could play a critical role in reducing the present harms caused by criminalisation and stigma.
In this paper, the authors analysed 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The analysis highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
In the absence of clear regulation, the practice of surrogacy in Kenya grows as an unchecked and unsupervised industry with no policy or law to fall back on if anything goes wrong during the treatment, says the author of this article. South Africa is the only country on the African continent to have surrogacy laws and policies. The growing use of commercial surrogacy, where a woman is paid to carry a child for a couple wanting to adopt, points to an urgent need to develop appropriate legislation, the author argues. She refers to the practice in India, which disproportionately affects the poor girls and women, who use surrogacy as a means of income. But these women are not protected by the law. She makes a number of recommendations for proposed legislation, covering various areas such as the interests of the surrogate mother and commissioning parents, ethical and moral aspects, financial support, dispute mechanisms and regulatory bodies, termination of a surrogate pregnancy, more lenient adoption laws and rights of both parties.
This discussion paper presents key elements of the concept of UHC as promoted by the World Health Organisation and reflects them based on Medicu Mundi International’s (MMI) own ambition of Health for All such as stated in the MMI Network Policy. The paper consists of three sections (1) “What is in Universal Health Coverage?” (2) “Financing UHC”, and (3) “UHC and health equity”. MMI argues that if its Network is to promote Universal Health Coverage in view of improving health equity, then it should be willing to be truly involved in the political and ideological battle that will enfold over the coming period. Unless the international community pushes the right to health up in its scale of values and stops considering health as a dependent variable of the global economy, and unless it makes the respect of human rights mandatory and those who violate them legally accountable, UHC is unlikely to yield the expected results. Issues needing further investigation include: Universal Health Coverage and gender equity (almost entirely missing in the current debate); Universal Health Coverage and sustainability; the political economy of Universal Health Coverage; and the transformative power of the UHC concept for social mobilisation and political change towards Health for All.
This United Nations resolution recognises that access to medicines is one of the fundamental elements in achieving progressively the full realisation of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It stresses the responsibility of States to ensure the highest attainable level of health for all, including through access, without discrimination, to medicines, in particular essential medicines, that are affordable, safe, efficacious and of quality. At the same time, the resolution emphasises the crucial role of prevention, the promotion of healthy lifestyles and the strengthening of health systems. The central element of the resolution urges States, as appropriate, to take 16 measures to fulfil their obligations on access to medicines within the right to health framework. The resolution also recognises the innovative funding mechanisms that contribute to the availability of vaccines and medicines in developing countries, such as the Global Fund and the GAVI Alliance. It calls upon all States, United Nations programmes and agencies, relevant intergovernmental organisations and pharmaceutical companies to help safeguard public health from conflict of interest, as well as to further collaborate to enable equitable access to quality, safe and efficacious medicines that are affordable to all.
In this article, the authors examine how major global health organisations, such as WHO, the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and GAVI approach human rights concerns, including equality, accountability and inclusive participation. The authors use examples of best practice to indicate how such agencies can advance the right to health, covering nine areas: 1) participation and representation in governance processes; 2) leadership and organizational ethos; 3) internal policies; 4) norm-setting and promotion; 5) organisational leadership through advocacy and communication; 6) monitoring and accountability; 7) capacity building; 8) funding policies; and 9) partnerships and engagement. The proposed UN Framework Convention on Global Health (FCGH) would commit state parties to support these standards through their board membership and other interactions with these agencies. The authors also explain how the FCGH could incorporate these organisations into its overall financing framework, initiate a new forum where they collaborate with each other, as well as organisations in other regimes, to advance the right to health, and ensure sufficient funding for right to health capacity building.
On 11 July 2013, the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women (the Protocol) turns 10. The author of this article argues that there is much to celebrate, as the Protocol remains one of the worlds’ most progressive women’s human rights instruments. While ratifications are a welcome measure, the provisions enshrined in the Protocol only have real meaning if governments go further and show their commitment to the protection and advancement of African women’s human rights by domesticating and fully implementing the instrument, she argues. Challenges that require mitigation exist and include limited technical and financial support in many states particularly with regard to the efforts to sensitise and build the capacity of government officials as well as the general public on the provisions of the Protocol; lack of political goodwill and weak institutional mechanisms to support the domestication and implementation of the Protocol; and lastly religious and cultural conservativism.
This study found that globally, 38% of all women who were murdered were murdered by their intimate partners, and 42% of women who have experienced physical or sexual violence at the hands of a partner had experienced injuries as a result. Partner violence was found to be a major contributor to women’s mental health problems, women experiencing intimate partner violence are almost twice as likely as other women to have alcohol-use problems and 1.5 times more likely to acquire certain sexually transmitted infections In some regions like sub-Saharan Africa, they are 1.5 times more likely to acquire HIV. Both partner violence and non-partner sexual violence were associated with unwanted pregnancy, as the report found that women experiencing physical and/or sexual partner violence are twice as likely to have an abortion than women who do not experience this violence. Women who experience partner violence also have a 16% greater chance of having a low birth-weight baby. The study highlights the need for all sectors to engage in eliminating tolerance for violence against women and better support for women who experience it, and was launched with new World Health Organisation’s clinical and policy guidelines (also included in this newsletter).
If access to equitable health care is to be achieved for all, policy documents must address different needs of groups that do not access health care. This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. While reference is broadly made to vulnerable groups, there is lack of detailed specification of the different needs of different groups. The documents suggest that vulnerable groups are homogeneous in their needs, which is not the case. The authors argue for more information and knowledge on the needs of all vulnerable groups and more specific cover of these issues in policy documents.