Health & Human Rights Combined
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Transcript of Health & Human Rights Combined
Health & Human Rights
in our backyard
Presentations from Kenya, Uganda, Rwanda, the United
States, and Burundi
Recap: critical links
KENYA The human rights dimensions of major
health challenges in Kenya can be understood using the model of AAAQ: Availability Accessibility Acceptability Quality
In Kenya: Availability Population of approximately 33 million ppl. 2 referral hospitals Few health centres are fully equipped Rural Urban migration has affected the
development of rural areas As a result, more money is allocated to urban
areas Following this, the availability of
services, particularly in rural areas, has been compromised.
In Kenya: Accessibility Accessibility encompasses physical,
geographical and financial aspects. Within rural areas, poor infrastructure can
lead to inaccessible health facilities For the rural poor, health care costs can
be prohibitively high In remote areas adequately staffed and
supplied health facilities are difficult to reach.
In Kenya: Acceptability Health services, goods and facilities must be
sensitive to cultural, gender and age differences Many patients in Kenya seek medical attention
from traditional healers Critically, the provision of accurate health-related
information is key to ensuring the acceptability of services (such as awareness of contraceptives)
Provision of information is also part of the underlying determinants of health, and must be addressed by the government in its programming and health workers in their practice.
In Kenya: Quality Quality can be affected by the type of
facilities available. Many health facilities do not embrace
current available technology in order to improve the quality of services.
A shortage of properly trained health care providers, inequitably distributed, also contributes to challenges in terms of ensuring quality services.
Final thoughts & questions…
UGANDA The health and human rights challenges in
Uganda can be categorized into three broad groups: Challenges facing health care workers Challenges facing patients and the community Challenges facing policy makers and the
government
In Uganda: Challenges facing health workers Low salary
Adequate and appropriate salary for health workers is critical for the provision of available, accessible, acceptable and quality health services.
Poor working conditions in public hospitals Health workers have a right to safe working
conditions Government has an obligation to avail supplies
and put protective measures in place, such as vaccination of all health workers against Hep B
Challenges facing health workers, cont’d Inadequate continuous medical training
and education (CME) Adequate opportunities are necessary to
further studies and knowledge regarding the latest innovations in the global medical arena
Leaves health workers with fewer skills to match the ever increasing burden of disease
Gov’t should work to avail these opportunities in order to ensure appropriate training and service provision
Challenges facing health workers, cont’d Heavy workload
Doctor to patient ratio is estimated at 1:120,000 in the outskirts of urban areas and 1:13,000 in urban areas
Strains healthcare workers and affects the quality of care (as well as accessibility and availability of services)
Comments: Health workers have a right to safe
working environments Government has an obligation to provide this
A strong and vibrant health workforce is critical to the provision of available, accessible, acceptable and quality health services
While the lack of supplies or infrastructure is often beyond anyone’s control, it can also be the result of corruption and mismanagement
In Uganda: Challenges faced by patients Inequitable access to health services and
information Traditionally believed that health information is or should
be accessed only at hospitals, clinics and other health facilities
Rural-urban divide Patients have the right to access health
information The government and health workers both have a role to
play in this Information must be accessible: promoting the right to
health requires that the government make progressive steps to improve these aspects of health services
Challenges facing patients, cont’d Promoting equitable access
People’s needs guide the distribution of resources
Governments must work towards eliminating disparities in health that are associated with social disadvantage (being poor, being of a particularly vulnerable group, etc.)
In Uganda, poverty and gender inequality can exacerbate inequities in health service provision
Challenges facing patients, cont’d Gender inequality
Women seek permission on certain health-related decisions (e.g. VCT, RH/FP)
Gender perceptions in the community may lead to the denial of women’s rights (such as right to education, right to health, etc.)
Health care providers respect for women’s health-related decisions
Poverty People lack access to the underlying
determinants of health (clean water, sanitation, etc.)
Challenges facing patients, cont’d Drug stock-outs
Recent stock outs of TB drugs, antimalarials (Coartem) and other basic essential medicines
Mulago National Referral Hospital More extensive stock-outs in rural health
facilities Links with the obligation to provide available,
accessible health goods Severe effects on drug-resistance
Challenges facing the government and policy makers Corruption and poor planning within the health
care system Recent Global Fund and GAVI resources
Inadequate health financing Question of the government’s priorities within the health
budget and how it affects realization of the right to health in Uganda
Poor surveillance network Communication gap between policy makers and service
providers Brain drain!
Affects health workers, consumers, communities and the government
In Uganda: Ethical and organizational issues Illegally charging patient fees “Moonlighting” and running private clinics
in conjunction with public sector work Diversion of drugs and supplies Study leave, which contributes to
workforce shortages, but not to vacancies In the end, these practices negatively
affect the right to health of people throughout Uganda
Final thoughts & questions…
RWANDA Rwanda is currently struggling to establish
improved health conditions for its citizens following the 1994 genocide.
During that period, many health facilities were destroyed and many human rights violations, including the right to health, occurred.
Currently, there are several major health challenges facing Rwanda, all of which have key human rights dimensions.
In Rwanda: Cost of health care Most medication in Rwanda comes from
abroad or as a result of support from NGOs, which increases its cost once it arrives in the country
Recognizing the human right to health, the government has created “mutuelles de sante” in an effort to ensure equal access to health services
Pay up to 1,000 frw per year and receive a 90% cost reduction in services
Cost of health care, cont’d This initiative has had a very positive
impact on the number of people visiting health facilities
Rate of enrollment was 42% in 2006 75% in 2007 85% in 2008
Challenges still remain in terms of access in rural areas
In Rwanda: Health workforce shortage For health services to be available and
reach all in need, there must be enough health workers
In Rwanda, challenges in achieving this include: High density population (total population is 9.3
million) 1 doctor for every 18,000 inhabitants; 1 nurse
for ever 1,690 inhabitants The gov’t and MOH are making great
efforts to orient and deploy health workers where they are needed most
In Rwanda: Maternal and infant mortality Infant mortality stands at 62/1,000 Maternal mortality stands at 750/100,000 Under 5 mortality stands at 103/1,000 52% of deliveries by skilled birth attendants
These are key indicators of the strength of the health system
Convention on the Rights of the Child, Chapter 2 (1) “Measures should be taken to diminish infant and child mortality”
In Rwanda: HIV, TB and Malaria These three diseases remain major
challenges due to Lack of behavior change Lack of access to information Lack of systemic control (for TB)
Human rights aspects of these challenges Must work to improve the availability and
acceptability of information and services to promote behavior change
Improve the provision of medication and counseling for people living with HIV/AIDS and TB
In Rwanda: Health and human rights at the University Every student in the medicine faculty is a
member of MEDSAR, which protects their needs and acts as a welfare body
Members of Mutuelles de Santes at 650 frw per month
Through MEDSAR health students receive funds to undertake community and campus-based projects relating to the right to health
In Rwanda: Health and human rights education Human rights health professionals come to
lead human rights seminars Sharing of knowledge through events and
activities organized through MEDSAR However, human rights are not formally
addressed within the curriculum Students, through MEDSAR, are undertaking
advocacy and lobbying to address this situation
Final thoughts & questions…
UNITED STATES Health Challenges
Human Rights Dimensions
Next steps
In the US: Lack of Universal Access
Challenge: U.S. – only industrialized nation without a universal health care coverage scheme for its citizens
HR dimension: Health care is a basic RIGHT, not a privilege, right to life
Next steps: Many activists/advocacy groups are advocating for universal coverage through a variety of mechanisms, public and private. Aspects of American cultural attitudes and industry voices impede progress.
In the US: Health care disparities Challenge: Different minority groups in the U.S.
have poorer health outcomes (e.g., Latino, Black American, First Nation, immigrant populations)
HR dimensions: Access to healthcare, health care professional assumptions affecting treatment decision-making, health literacy
Next steps: Increase access to health care; standardizing care and addressing stereotyping; improved health literacy outreach; increased funding to research and minimize health disparities vs. genetic differences (e.g., hypertension, diabetes, cancer); narrow SES gap.
In the US: Maternal and women’s health
Challenge: In the US, 2-3 women die of pregnancy-related complications every day, and African American women are 3 times more likely to die than white women.
HR dimension: Preventable deaths, right to life, freedom from any health discrimination
Next steps: Half of these deaths could have been prevented if women had better access to adequate quality healthcare.
http://www.amnestyusa.org/poverty-and-human-rights/health-and-human-rights/maternal-health-in-the-united-states-an-aiusa-research-report/page.do?id=1041211
In the US: AIDS in our capitol
Challenge: Highest HIV infection rate in the U.S. in Washington, DC (2%); 81% new infections in Black Americans and they carry 86% of the HIV/AIDS disease burden overall
HR dimension: Extreme health and wealth disparities in the U.S. and problems with access to care
Next steps: Appropriate targeting of at-risk groups in DC; increased funding for outreach and treatment activities; free-condom distribution and expanded availability of testing.
In the US: Lifestyle disease epidemics
Challenge: Increasing prevalence of obesity, metabolic syndrome
HR dimension: Food deserts, inadequate prioritization of prevention, food industry clout for additives/national diet structure
Next steps: Increased funding and campaigning for preventive health measures, emphasis on lifestyle and behavior modifications, change school cafeteria food options, making fruits/vegetables more accessible and affordable
In the US: Environmental protections Challenge: Environmental pollution and negative
health effects, particularly among minorities and people with low SES
HR dimension: G.W. Bush administration’s weakening of environmental health standards, people at risk of lung and other diseases
Next steps: improving environmental standards (e.g., pollutants) with legislation, “greening” technology, stricter FDA standards of cosmetic chemicals and technologies, improved HCP recognition of occupational and environmental etiologies of disease. Succeeding story: smoking bans in major U.S. cities and many smaller ones.
In the US: Torture of detainees Challenge: Detainee rendition in order to
torture, human rights and legal abuses of detainees
HR dimension: Violation or manipulation of international agreements and declarations, violation of human dignity
Next steps: Instate due of process of law, cease extraordinary rendition practices used for torture, stricter anti-torture practice/legislation.
In the US: Shortage of health workers Challenge: Lack of adequate domestic health
workforce, especially in rural areas and primary care areas of medicine
HR dimensions: Skewed levels of access to care across the U.S., contribution to health care worker “brain-drain” internationally
Next steps: Increase funding and compensation for primary care & geriatric medicine; increase medical school class sizes and/or number of schools; improve access in rural and economically depressed areas of inner cities.
Concluding thoughts:
These are only a few of many more issues health professionals confront and need to confront
Lack of health & human rights educational components in most medical schools needs to be addressed
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
-Martin Luther King, Jr.-
BURUNDI Burundi is an East African Country
bordered by Rwanda in the North, Democratic Republic of the Congo in the West, and Tanzania in the East and South.
8.5 million people, density of 189 Hab./km square
Rural population is 90% 7,000 health workers, half of which work in
urban areas
In Burundi: HIV prevalence
3% of adults (150,000) HIV positive pregnant women
12.6% in 2004 18% in 2005
HIV among women, 15-24 years old 8.6% in 2004 15.5% in 2005
In Burundi: Health rights background Emerging from civil war, lasting from 1993
– 2003 70% of the population lives in poverty Widespread refugee camps
Poor hygiene Malnutrition HIV prevalence
Violence during the period of civil war Lack of human rights awareness and
education
In Burundi: Health care costs Medical consultation costs an average of 1
USD Majority cannot afford this, and resort to
traditional healers Economic accessibility (affordability) is a
key component of the right to health Even in emergency situations, people must pay
before they can access services Patients who fail to pay for their services are
detained in the health facility No insurance schemes for the majority of the
population
In Burundi: Health workforce shortages While the rate of medical students
graduating increases every year, there is still a shortage of doctors and nurses throughout the country Insufficient salary Poor working conditions Lack of materials and sufficient infrastructure
Without an adequate health workforce, it is very difficult to provide services that are available, accessible, affordable and of good quality
In Burundi: Acceptability of services Health workers currently in post are not
adequately trained about effective communication
Many patients have negative experiences in public health facilities
Health workers must appropriately trained to provide culturally sensitive, gender sensitive and ethical services.
In Burundi: Access to health-related information Government has an obligation to “protect”
the right to health from infringement by other parties Nutrition and food products Medicine quality Adequate housing and shelter – pre-fabricated
homes Access to information is an “underlying
determinant of health” – without it, you can’t fully enjoy the highest attainable standard of physical and mental health
In Burundi: Women’s vulnerability
High HIV/AIDS infection rate among women Due to sexual and gender-based violence Social aspects that affect access to health services must
be addressed in rights-based health programming Male condoms are freely distributed, but female
condoms are rarely available Rights-based approach requires special attention be
given to vulnerable and marginalized groups Government must take proactive steps to address
women’s increased vulnerability (and that of other groups)
Women’s vulnerability, cont’d In order to ensure equal access to non-
discriminatory health care, we must address Low levels of access to adequate health care
services Access to information on antenatal and
postnatal care and family planning Economic disempowerment
In Burundi: What is being done? Civil society is widely involved in health rights
advocacy Religious organizations and the media are
contributing to raising awareness of health and human rights
Government has adopted some key policies: Free healthcare for children under 5 Free access to health care for PLWHA Organized vaccination campaigns Reviewing salaries of health professionals and hospital
equipment
Conclusion: Everyone must be engaged and play their
own role Government must plan and link their
policies in the health field to national and international policy
Government must improve the underlying determinants of health and the population’s lifestyle Promote education Fight poverty, malnutrition and endemic
diseases
Conclusion: Civil society must continue to lobby the
government, in collaboration with other NGOs and stakeholders
Health professionals are called upon to provide culturally sensitive, gender sensitive and ethical services to ensure the quality of health services
Health professional students have to advance an understanding of health and human rights in health-related institutions Promote student skill development and activism on key
health and human rights issues