UNRISD director Paul Ladd shares his reflections on the Sustainable Development Goals (SDGs). He argues that social development means keeping people at the centre, and recognising the contributions that can be made by all people, regardless of gender, age, race, ethnicity, physical ability, sexuality or any other characteristic. Enhancing well-being means that processes, relationships and institutions need to be transformed into ones that are based on equity and justice. This is critically shaped by how governments are run, how technology is used, how people adapt to demographic change, and how economies are structured, all of which depends on the political agenda. He argues that the 17 SDGs have many welcome innovations, including the aspiration to not tackle issues in silos, to leave no one behind and the recognition that all countries have problems. This presents a more political agenda than the Millennium Development Goals (MDGs) that preceded them, with solutions largely found in policy change and doing things differently, rather than solely spending more money on technocratic 'solutions' that, while well-meaning, ignored the power dynamics that determine who benefits from them and who is left by the wayside. Finally he observes that UNRISD’s three research programmes—social policy, gender and development, and the social dimensions of sustainable development—intend to make a critical contribution to debates on which policies and institutions, in which contexts, will make the most progress towards achieving the SDGs.
Values, Policies and Rights
Universal Health Coverage UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals. For WHO, “UHC is, by definition, a practical expression of the concern for health equity and the right to health”; thus promoting UHC advances the overall objective of WHO, namely the attainment by all peoples of the highest possible standard of health as a fundamental right, and signal a return to the ideals of the Declaration of Alma Ata and the WHO Global Strategy for Health for All by the Year 2000. Yet some argue that the “current discourse on UHC is in sharp contrast with the vision of Primary Health Care envisaged in the Alma Ata declaration of 1978”. The underlying assumption of this paper is that efforts towards achieving UHC do promote some, but not necessarily all, of the efforts required from governments for the realisation of the right to health. While this publication explores how efforts to advance towards UHC overlap with efforts to realise the right to health, its main focus is the gaps that exist between UHC efforts and right to health efforts.
Widespread HIV-related stigma and discrimination in the health-care sector impedes access to services and impairs the quality of health-care delivery for people living with HIV and other key populations. It also undermines efforts to achieve the highest attainable standard of health for everybody. At a two-day meeting held in Geneva, Switzerland, on 10 and 11 November 2015, key stakeholders came together to discuss ways to eliminate all forms of discrimination in health-care settings, using the lessons learned from the AIDS response as an entry point. The event, organised by UNAIDS and the Global Health Workforce Alliance, also focused on the UNAIDS 2016–2021 Strategy and the upcoming Global Strategy on Human Resources for Health: Workforce 2030. Stigma and discrimination in health takes many forms—the denial of health care and unjust barriers to service provision, inferior quality of care and a lack of respect. Abuse and other forms of mistreatment, violation of physical autonomy, mandatory testing or treatment and compulsory detention are other forms of stigma and discrimination encountered by people living with HIV. The meeting concluded with a clear call for more coordinated action. UNAIDS and the Global Health Workforce Alliance were asked to develop a plan before next year’s Zero Discrimination Day, on 1 March 2016, to work towards ending discrimination in health-care settings. Priorities include political advocacy, strengthening accountability mechanisms, sharing existing evidence and best practices and building evidence-informed policy for implementation and scale-up of programmes to reduce stigma and discrimination at all levels.
Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels are reviewing the International Health Regulations' functions and urging reforms. The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations.
As a key supporter of universal health coverage (UHC), The Lancet recently partnered with Medical Education Cooperation with Cuba (MEDICC), a non-governmental organisation based in the United States, to produce a Spanish-language translation of The Lancet’s series on UHC in Latin America. This translation was launched as part of Cuba Salud 2015, an international health conference held during April 2015 in Havana, Cuba. Despite its often ambiguous definition, UHC is often used to refer to a financial reform extending insurance coverage in varying degrees to a larger part of a country’s population. This is different to “healthcare for all” (HCA) – a healthcare delivery system that provides equal services for the entire population regardless of an individual’s or family’s financial resources. UHC as a more limited insurance concept has received wide criticism because it does not necessarily create a unified, accessible system; because it usually encourages a role for private, for- profit insurance corporations; and because it involves tiered benefits packages with differing benefits for the poor and non-poor. Although the UHC orientation has become “hegemonic” in global health policy circles, its ideological assumptions have not been confirmed empirically. The authors urge that the Lancet and MEDICC Review provide “equal time” for critiques of UHC and presentations of endeavours to achieve HCA.
In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation and of the institutions involved in the policy process. iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children’s Fund (UNICEF) and implementing organisations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organisational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channeling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development.
The 62nd ECSA Health Ministers’ Conference (HMC) was held at InterContinental Resort Balaclava Fort, Republic of Mauritius under the theme: Transitioning from Millennium Development Goals to Sustainable Development Goals with the following sub-themes; Enhancing Universal Health Coverage Through Innovations in Health Financing for Risk Protection; Surveillance and Control of Emerging Conditions: (NCDs and Trauma); Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training Using the ECSA College of Health Sciences Model. The Conference passed Resolutions on: Transitioning From MDGs to SDGs in the ECSA Region; Enhancing UHC through innovation in Health Financing for Risk Protection; Surveillance and Control of Non- Communicable Diseases and Trauma; Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training using the ECSA College of Health Sciences Model; Global Health Diplomacy and Strengthening Ministries of Health Leadership and Governance Capacity for Health in the ECSA-HC Region; and Strengthening the Use of Evidence in Health Policy.
Eduardo Gudynas looks at the main trends of the discourse around Buen Vivir in South America as a political platform for different visions of alternatives to development. He notes that any alternative to development must open paths to move beyond the modern Western culture. Buen Vivir, he argues gives that opportunity. Buen Vivir or Vivir Bien, are the Spanish words used in Latin America to describe alternatives to development focused on the good life in a broad sense. The term is actively used by social movements, and it has become a popular term in some government programs and has even reached its way into two new Constitutions in Ecuador and Bolivia. It is a plural concept with two main entry points. On the one hand, it includes critical reactions to classical Western development theory. On the other hand, it refers to alternatives to development emerging from indigenous traditions, and in this sense the concept explores possibilities beyond the modern Eurocentric tradition. The richness of the term is difficult to translate into English. It includes the classical ideas of quality of life, but with the specific idea that well-being is only possible within a community. Furthermore, in most approaches the community concept is understood in an expanded sense, to include nature. Buen Vivir therefore embraces the broad notion of well-being and cohabitation with others and with nature.
Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. The authors introduce the supplement, by reviewing how policy analysis can inform: (a) how to frame iCCM and negotiate its boundaries, (b) how to tailor iCCM for national health systems and (c) how to foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritise particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertise alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalised as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.
Memory and African identity are of primordial importance to Jean Pierre Bekolo, who through his films, highlights the desire to “write from a particular place and not for an audience” because one can be easily manipulated by the expectations of an audience. Bekolo spends time in Europe, US and Africa. Travelling becomes a substantial part of his creative process.
Each of his movies stands out as a phase or the break with a phase of his artistic development: Quartier Mozart symbolises origins, family and identity, Aristotle’s Plot represents the identity of an African cineaste, while Les Saignantes is speculation or science fiction. Despite his numerous sojourns, Bekolo’s energy is always focused on Africa and Cameroon in particular, where he believes cinema has to go beyond representation and shed more light on questions which will lead to change, a concept noticeable in his latest movie Le President. Bloke, who describes himself as not just an artist but ‘a radiologist of the society’ emphasises the role that film and fiction has to play in affecting change, ‘we must not forget the aesthetic dimension, because the beauty and the real have a link: aesthetic and ethics.’