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.
Values, Policies and Rights
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”.
Of all the Sustainable Development Goals, few would rival good health as the definition of a country that has a sustainable, inclusive, peaceful and prosperous future. The authors observe that the launch in December 2018 of the pilot phase of Kenya’s journey towards Universal Health Coverage (UHC) heralds a major step towards that future. In Kenya, health-related expenses are driving about one million into poverty every year, and health care is second only in demand on family spending to food in family budgets. Kenya announced that UHC will involve scaling up immunization, prevention of water borne, vector borne, TB, HIV and sexually transmitted diseases, improving maternal and child health as well as nutrition of pregnant women. Kenya will also focus on prevention of non-communicable diseases like diabetes and hypertension. With Kenya’s Vision 2030 ambition of providing a high quality of life to all its citizens, the most urgent need is argued to be that of ensuring that everyone stays healthy to participate in economic development.
The author outlines a court case in which the judgment raises concerns that some judicial officers hold deeply misguided notions regarding people with mental health issues, which deprives them of access to justice. Such attitudes are noted to not be restricted to judicial practitioners and discrimination to be nationwide. The judiciary as protectors of the rule of law are argued to be held to a higher standard. In 2014, Mental Health Uganda and Validity (formerly the Mental Disability Advocacy Centre – MDAC) published research uncovering widespread abuse, ill-treatment and appalling conditions in Uganda’s regional mental health facilities as well as Butabika. The research also investigated the experiences of people in their communities. The report found that most people with mental health issues experience high levels of violence and neglect at the hands of community members and public officials. The lack of local community mental health and psychosocial support services meant that many found themselves pushed towards unregulated traditional and faith-based healers. Many people recounted having endured unspeakably cruel practices including chaining, cutting the skin, being tied to trees, beatings and daily, casual prejudice. The author argues that the law needs to ensure people can access consensual mental health treatment in the community, with the aim of supporting independence and social inclusion.
Clinicians have long known that microbes such as bacteria, viruses and fungi are becoming alarmingly resistant to the medicines used to treat them. But a global response to this complex health threat — commonly termed 'antimicrobial resistance' — requires engagement from a much broader array of players, from governments, regulators and the public, to experts in health, food, the environment, economics, trade and industry. The authors argue that people from these disparate domains are talking past each other. Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations. In 2017, the United Nations formed an interagency group to coordinate the fight against drug resistance urging that, as one of its first steps, the group coordinate a review of the terminology used by key actors. They proposed that drug-resistant infection be the overarching term used (in English) to describe infections caused by organisms that are resistant to treatment, including those caused by bacteria that do not respond to antibiotics. They also noted that a blame narrative is unhelpful, failing to acknowledge symbiotic relationships with bacteria. Because terminology has geographic, disciplinary and societal variations that affect understanding and interpretation, research is argued to be needed to optimize the lexicon across different countries and languages.
Heads of state and government in September 2018 committed to 13 new steps to tackle non-communicable diseases including cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well-being. World leaders agreed to take responsibility themselves for their countries’ effort to prevent and treat NCDs. They also agreed that these efforts should include robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks. They committed to implement a series of WHO-recommended policies to prevent and control of NCDs - such as public education and awareness campaigns to promote healthier lifestyles, vaccinating against HPV virus to protect against cervical cancer and treating hypertension and diabetes. WHO estimates that implementing all these policies could generate US$ 350 billion in economic growth in low and lower-middle-income countries between now and 2030. Other specific commitments focus on halting the rise of childhood obesity, promoting regular physical activity, reducing air pollution and improving mental health and wellbeing. The political declaration reaffirms WHO’s global leadership of the fight to beat NCDs and promote mental health, and urges the Organization to continue working closely with key partners, including government, civil society and the private sector. In particular, it calls on food manufacturers to take several actions. These include reformulating products to reduce salt, free sugars and saturated and industrially produced trans fats, using nutrition labelling on packaged food to inform consumers, and restricting the marketing of unhealthy foods and beverages to children.
In October 2018, United Nations Member States unanimously agreed to the Declaration of Astana, vowing to strengthen their primary health care systems as an essential step toward achieving universal health coverage. The Declaration of Astana reaffirms the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care. The Declaration of Astana comes amid a growing global movement for greater investment in primary health care to achieve universal health coverage. Health resources have been overwhelmingly focused on single disease interventions rather than strong, comprehensive health systems – a gap highlighted by several health emergencies in recent years. The author reports that UNICEF and WHO will help governments and civil society to act on the Declaration of Astana and encourage them to back the movement and will support countries in reviewing the implementation of this Declaration, in cooperation with other partners.
The United Nations International Day for Older Persons falls on 1 October every year. This year it was commemorated under the theme celebrating older human rights champions. Belated commemorations were held on Friday 23 November 2018 at Mahusekwa district hospital in Marondera, Zimbabwe. Representatives from the District Administrator’s office, the Ministry of Public Service Labour and Social Services, Ministry of Health and Child Care, the National Age Network of Zimbabwe (NANZ), chiefs, the private sector, NGOs, older people representative organisations and older people champions among others were in attendance. In line with celebrating older human rights champions the event was run and owned by older persons with Gogo Mufuta and Gogo Nyamande sharing the master of ceremonies platform. Speeches centred on the important role that older people play in society emphasising their role as custodians of culture. Older people were also noted to be key carers of orphaned and vulnerable children. Dr Guvheya, the former chairman of the Zimbabwe Older Persons Association (ZOPO) praised the constitution which enshrines the rights of older people. He challenged government to operationalize provisions of the constitution and other pieces of legislation to enable older people to enjoy their rights. Dr Guvheya also spoke about the challenges faced by older people, including witchcraft accusations and property grabbing. He lamented on the current environment where pharmacies are demanding payment in foreign currency for medicines. This point was emphasised throughout the day as older people are in need of holistic health care and support as many are living with diseases including HIV, cancer, diabetes and dementia yet they have lost the capacity to generate income to access health services.
Members of public interest civil society organisations and social movements, some of whom are participants at the Global Conference on Primary Health Care, produced this statement to re-affirm a commitment to primary health care (PHC) in pursuit of health and well-being for all, aiming to achieve equity in health outcomes. The statement is a re-affirmation of the Alma Ata declaration, which to PHM and others remains the ultimate declaration on primary health care; the principles are clear and remain relevant. This authors invite organisations who agree with the views expressed to sign on to the statement.