Rights-Based Approaches to Health: Possibilities for Zimbabwe

 

‘A human rights-based approach differs from the basic needs approach in that it recognizes the existence of rights… A need not fulfilled leads to dissatisfaction. In contrast, a right that is not respected leads to a violation’ UNFPA

 

Defining the Right to Health

The right to health includes the entitlement to timely and appropriate health care and also encompasses underlying determinants of health, such as access to safe and potable water, adequate sanitation, an adequate supply of safe food, nutrition, housing and access to health-related education and information. Participation by the population in all health-related decision making is also important.

The right to health has the following characteristics which are true of all human rights:

- it is inherent

- it focuses on the dignity and integrity of every human being

- it is universal, interdependent, indivisible and discount on cialis interrelated with all other rights

- it applies to all individuals on the basis of equality and non-discrimination

- it must be guaranteed by law

- it cannot be arbitrarily taken away or waived

- it can and should be claimed.

Health care and the underlying determinants of health are measured by:

- Availability of functioning public health facilities and health care and of the underlying determinants: safe and potable water, sanitation, food etc

- Acceptability which requires respect for medical ethics and cultural appropriateness

- Accessibility including non-discrimination, physical accessibility, economic accessibility (affordability) and access to information

- Quality which requires all health facilities, good and services to be of good quality.

 

What is the Rights-Based Approach?

A rights-based approach to health means integrating human rights norms and principles in the design, implementation, monitoring, and evaluation of health-related policies and www.fleckviehgeneticsea.com programmes. As the premise of all human rights is the inherent dignity of every human being, a rights-based approach to health focuses on human dignity. The principles of equality and non-discrimination, also central to human rights, are key elements of this approach and in this vein, attention is paid to vulnerable and marginalized groups and efforts are made to ensure that the health system is equitably accessible to all.

The rights-based approach empowers communities by ensuring their participation in decision-making processes which affect them and allowing them to set their own priorities both at community and national level.

Human rights require legal protections and similarly a rights-based approach to health must have legal protections for health. It is important that the government operates in a transparent manner that allows it to be held accountable for its actions pertaining to health.

Implementation of the rights-based approach requires fulfillment by the government of its obligations and cheap cialis no prescription buy look there participation and claiming of rights by communities—the rights holders.
 

Government’s Obligations

The Government has 3 types of obligations with regards to human rights. These are to respect, protect and fulfil.
 

Respecting the Right to Health

The State should refrain from interfering with or blocking people’s ability to enjoy the right to health such as introducing policies or programmes that are likely to result in unnecessary morbidity and preventable mortality or undertaking actions that cause physical or mental harm.

Protecting the Right to Health

This requires the government to make effort to minimize risks to health and to take measures that safeguard the population from infringements of the right to health. The government should thus ensure that private enterprises refrain from violating the right of individuals and communities.

Fulfilling the Right to Health

The government is obliged to take legal, administrative and other measures to ensure the progressive provision of health care and development of infrastructure to support this.
 

What Can the Rights-Based Approach Contribute?

The rights-based approach re-frames basic health needs as health rights. Establishing the conditions that enable one to become healthy and the best site buy cheap dapoxetine to remain so is not regarded merely as a medical, technical or economic problem, but as a question of concrete government obligations and entitlements of the population.

For example child immunization within the health rights framework is not just a medical requirement for children and a responsible public health measure; it becomes a right of all children, with corresponding government obligations that cannot be reasoned away because of financial constraints or other priorities as to how money should be spent in the health or other sectors.

The right to health helps answer the question ‘how can we best allocate scarce resources?’. A rights-based approach ensures that the available resources are allocated to those who have the greatest needs or have been excluded the most. It exposes situations where public funds are being used to refurbish hospitals in a capital city, or where expensive equipment is being purchased for elective procedures that only benefit a few while, at the same time, rural populations or vulnerable groups are failing to access minimum standards of health care. It subsequently requires that immediate action be taken to remedy the situation.
 

Outcomes of a Rights-Based Approach to Health


· Increased accountability for health by the government;

· Increased attention to the health needs of the poor and other vulnerable and disadvantaged groups;

· The correction of imbalances between the health status of different population groups;

· More participatory approaches to the provision of health services and the determinants of health;

· Cessation in imposition of retrogressive measures (take-backs) in health-related legislation and budgetary and administrative practices;

· Honouring of concrete obligations by government to immediately provide the minimum standards that are essential for enjoyment of the right to health; and

· Setting of goals, targets and indicators that will allow for monitoring of progress.
 

Possibilities for Zimbabwe

- The rights-based approach can and should be applied to all planning that is currently taking place around resuscitation and um.kepno.pl rebuilding of the health system. There needs to be community participation in setting of priorities and making of decisions.

- The Ministry of Health and Child Welfare should endeavour to increase transparency and accountability by informing the population of its targets and allowing monitoring of progress by health workers and other members of the community so that violations of the right to health do not go unnoticed and without being put right.

- There is a general lack of perception that health as a human right in Zimbabwe. The right to health must be enshrined in the new Zimbabwean constitution that is to be drafted under Global Political Agreement. There should also be a review of all health related legislation to ensure that it is in line with human rights principles.

 
100day Plan

Getting the Zimbabwe Health Care System Moving Again - Health Action Plan for the First 100 Days: March—June 2009 is a plan formulated by the Ministry of Health and Child Welfare in March 2009 following a two day Emergency Health Summit held from 5 to 6 March at the Crowne Plaza Hotel in Harare. The 100 day plan (commencing on the 10th of March 2009) is a proposed starting point for restoring functional basic health services in Zimbabwe.
The conceptual framework below summarizes the key elements of the plan and is in line with the ‘six essential building blocks of a health system’ (WHO, 2007).

The Conceptual Framework of the Plan:


framework

The plan notes the current situation in the health sector regarding leadership, organisation and management, health financing, health workforce, medicines, vaccines and medical equipment, infrastructure, transport and communications and health technology and then recommends actions to be undertaken in these areas between March and June 2009 to begin to address prevailing challenges.
In the long term, the plan is intended to be the foundation for the rehabilitation and reconstruction of health infrastructure and restoration of health services.

Specific policy issues covered in the plan:

Poor people and vulnerable communities do not have access to foreign currency therefore a review of the policy on user and cost recovery is required.
The budget allocation for the health sector needs to be increased in tandem with efficient and responsible use of existing resources to avert shortages of service inputs such as essential drugs, supplies and human resources.
There is need to adopt a human resources policy that will encourage retention of health workers.
 

  • Provincial and central hospitals must rationalize their services through combining service delivery within and between service departments as well as within geographical areas due to limited availability of resources.
  • The Ministry of Health and Child Welfare (MoHCW) should enter memorandum of understandings (MOUs) with various partners such as local government institutions, NGOs and missions to strengthen partnerships in service delivery.
  • Corporate management principles at central and provincial hospitals must be improved.
  • Government should adopt a Sector Wide Approach (SWAp) to health development. This move is likely to send a strong signal to development partners that the government is committed to the principals of partnerships in health development, transparency and accountability in the utilization of its own resources and those flowing as development assistance.

Monitoring Implementation of the Plan

A monitoring committee consisting of stakeholders in the health sector was set up to monitor the implementation of the plan. Members of the Implementation Monitoring Committee include representatives of the MoHCW, the Health Professions Authority, the Health Services Board, the Zimbabwe College of Public Health Physicians (which is serving as the secretariat), the Association of Healthcare Funders of Zimbabwe, the Community Working Group on Health representing community groups, NANGO representing civil society, a representative of the donor community  and a representative of training institutions.
The Monitoring Committee is supposed to meet once a fortnight to review progress on implementation of the plan commencing with a first meeting on 31 March 2009. Delays in implementation are to be acted on by the Minister of Health and stakeholders in the health sector.

Progress

Implementation of the ambitious plan has been slow and it is not likely that it can be completed within 100 days. The plan is also to be aligned with other plans developed by the MoHCW and the plan that came out of the Cabinet Summit held in Victoria Falls in April.
Availability of resources remains a major constraint to implementation with a donor conference scheduled to be held in May. A further update on implementation of the plan will be featured in the June issue of ZADHR News.

If you would like to receive a copy of the Health Action  Plan for the First 100 Days email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it   or write to us at PO Box CY 2415, Causeway, Harare

Report on the Monitoring the Right to Health Training Series

The Monitoring the Right to Health Program is a new initiative of the Zimbabwe Association of Doctors for Human Rights aimed at increasing accountability for health by monitoring the progressive realisation of the right to health in Zimbabwe. The health rights monitoring program will endeavour to generate evidence-based information that the government can use to determine priority areas to focus on and to provide information to rights holders that will enable them to identify areas in which they can play a role in realising these tights and to hold the government to account.


Health professionals, as frontline witnesses of progress in realisation of the right to health are strategically placed to serve as monitors of the right to health. In recognition of this, the program commenced with a series of training workshops for health professionals on Monitoring the Right to Health in March and April 2009 hosted by ZADHR in Harare, Bulawayo and Mutare.


Three one and a half day workshops were conducted in Harare at the Holiday Inn between 27 and 28 March (18 participants); in Bulawayo at the Rainbow Hotel between 3 and 4 April (50 participants) and in Mutare at Mutare Holiday Inn between 8 and 9 April 2009 (20 participants). A similar program covering introductions to the right to health and monitoring the right to health, engaging in research and documentation and frameworks and tools for monitoring was used for all three workshops.


Speakers were pooled from the ZADHR secretariat, board and members as well as partner organizations including a guest speaker Winnie Ngabiirwe, Program Coordinator of the Action Group on Health, Human Rights, HIV and AIDS (AGHA), Uganda that has been engaged in monitoring the right to health in Uganda.


Winnie Ngabiirwe (AGUA, Uganda) making a presentation during the Monitoring the Right to Health Training at Rainbow Hotel in Bulawayo

 

The objectives of this training series were to bring health professionals together to:

 

* develop an understanding of the relationship between health and human rights;
* share experiences in realisation of the right to health in Zimbabwe; and
* discuss their roles in realising the right to health and monitoring its implementation
* identify priorities for monitoring right to health in Zimbabwe begin to design a monitoring framework

Priority areas for monitoring the right to health were identified in the three cities in which training was conducted and various health professionals made a written commitment to be involved in the monitoring process as part of regional monitoring clusters.

Table 1: Priority Areas for Monitoring the Right to Health

ZADHR is now in the process of developing monitoring tools for the health rights monitoring program in consultation with the regional clusters in Harare, Bulawayo and Mutare and is developing a monitoring and advocacy plan around the priority areas identified by these clusters in Table 1.

A training series for areas not covered in March and April is planned for July and August 2009 and it is anticipated that monitoring clusters will subsequently be established in other regions of the country. Information on venues and dates for this training series will be published in the June 2009 issue of ZADHR News.

For more information on the Monitoring the Right to Health Program or to get involved please contact Rutendo Bonde at ZADHR on 0913-254-295 or (04) 703430 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 
Prison Health in Zimbabwe: The Case for Reform

There have been widespread reports of deplorable conditions of detention in Zimbabwe’s prisons. Food shortages, poor sanitation and inadequate supply of safe water, shortages of drugs and health workers and overcrowding are impacting on the health of prisoners across the country.

Food shortages, however, are the main challenge for prisoners. Inmates generally receive one meal a day, comprising sadza served with vegetables and at times served without any relish. Vegetables or other available relish is usually prepared without cooking oil and sometimes without salt. Most prisons are unable to give prisoners any protein rich food such as meat or beans. Prisons that have not been able to get any meat or vegetables have resorted to serving  sadza with salted water.

Inadequate nutrition is closely tied to deterioration in the health of many inmates. Food shortages have resulted in poor drug compliance by patients that are chronically ill as some drugs need to be taken with or after food. Ill inmates tend to skip doses when meals are few.

Cases of pellagra have been reported in several prisons. Diseases such as pellagra, manifesting in the form of diarrhoea, dermatitis and dementia, are caused by lack of nutritious food and a balanced diet, and can simply not be reversed without improved diet. Diets based on maize predominantly predispose to the development of pellagra as some vital elements, particularly protein, are not present in such a diet.

All the prisons have an inadequate supply of drugs. Logistical problems such a delayed processing of requisitions, transport problems as well as central stock-outs are some of the reasons cited for the shortages. Standard treatment protocols for common conditions such as asthma, hypertension and diabetes are difficult to implement. Inmates who enter prison with these illnesses may not continue treatment in a timely manner. If emergency events occur e.g. asthma attack, most prisons do not have an emergency trolley with the standard emergency drugs and equipment. The shortage of some antibiotics means that conditions such as sexually transmitted and urinary tract infections are treated using available (but not necessarily correct) antibiotics thereby encouraging microbial drug resistance. Inmates – who eventually are released back into society – may then be carriers of infective organisms which require special expensive drugs to treat.

Brain drain in the health sector has also affected prisons and most prisons have insufficient numbers of health workers. In some provinces prisons go for years without ever having been visited by a doctor. In addition to the shortage of prison doctors who can conduct on site visits, there is shortage of transport to ferry patients requiring hospitalisation to hospital.

People who are in prison have the same right to health care as everyone else. The right of everyone to the “enjoyment of the highest attainable standard of physical and mental health” applies just as much to prisoners as it does to the entire population. A prisoner’s right to health care does not diminish because they are in detention. Regardless of the circumstances or status in society, all human beings, by virtue of being human beings have fundamental human rights. Apart from being deprived of their liberty for offences in society, prisoners retain all their human rights.

It is in the interest of Zimbabwean society for the Ministry of Health and Child Welfare and the Ministry of Justice to work together to prevent disease in prisons as treating diseases in prisons costs more than preventing them. Furthermore prisoners return to the communities from which they come therefore the prison health system should be integrated into the public health system. It may be a challenge to ensure that public health services reach the people who need them the most, however prisoners are easy to reach and it should not be difficult to ensure that they can access adequate curative and preventive health services.

“One of the strongest lessons from the end of the last century is that public health can no longer afford to ignore prison health. The rise and rapid spread of HIV infection and AIDS, the resurgence of other serious communicable diseases such as tuberculosis and hepatitis and the increasing recognition that prisons are inappropriate receptacles for people with dependence and mental health problems have thrust prison health high on the public health agenda. As all societies try to cope with these serious health problems, it has become clear that any national strategy for controlling them requires developing and including prison policies, as prisons contain, at any one time, a disproportionate number of those requiring health assistance.” (Source: Health in Prisons, A WHO Guide to the Essentials in Prison Health,  2007

 

What’s Coming Up?

User  Fees and Access to Health Project

This project will assess the impact of user fees on the accessibility of health care in Zimbabwe and collect multi-stakeholder views on the issue.

  • The objectives of the project are:

* To ascertain user fees currently being charged by health institutions and practitioners in the private and public sector
* To ascertain the impact of user fees in foreign currency on the ability of patients to access health facilities and various services within those institutions.
* Gather views on possible methods to ensure that safety nets are effective and that user fees do not hinder access to health services
* Give recommendations on reviews of user fees to achieve equitable access to health care and engage government and local authorities on the issue.

Chinhoyi — Training on Health Rights

A right to health awareness training will be conducted in Chinhoyi on Saturday 13th June 2009 for doctors in Mashonaland West province. Further details are available from ZADHR at the contact details below.
 

Light Up Health Campaign

The corridors, wards and operating theatres of our hospitals and clinics are very dim or dark at night due to a shortage of light bulbs. Some sundries in short supply in our health system are difficult or expensive to source and so it is hard for people in the community to see how they can assist. However, light bulbs are available and accessible by all.

ZADHR is encouraging all who can to donate a bulb or 2 ...or 100 to the Light Up Health Campaign that will then distribute bulbs to Zimbabwe’s hospitals and clinics and light up our health facilities for patients in those institutions and the health workers looking after them. We are starting with Parirenyatwa Hospital that has already supplied us with a list of the bulbs they need.

The list of required lights is as follows:

Description Quantity
BC 60W Bulbs                                  1000
40W U Tubes                                   1000
ES 60W Bulbs                                   700
2ft thick Flourescent Tubes               300
4ft thick Flourescent Tubes               300
8ft Slimline Flourescent Tubes           300
20W Single Ballasts/Double              200
75W Single Ballasts/Double              200

Lights may be dropped off at ZADHR’s offices—6th Floor, Beverly Court, 100 Nelson Mandela Ave, Harare or at Well Woman Clinic, East Road, Belgravia, Harare.
 

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