Paper: Human rights & health systems development: Confronting the politics… Duncan Maru & Paul Farmer

paper/article:

Duncan Maru and Paul Farmer

Publication: Health and Human Rights    (From listing of articles/papers Wednesday, August 14, 2013)

Human rights and health systems development: Confronting the politics of exclusion and the economics of inequality

Abstract

The social movements of the last two decades have fostered a rights-based approach to health systems development within the global discourse on national and international health governance. In this piece, we discuss ongoing challenges in the cavernous “implementation gap ”— translating legislative victories for human rights into actual practice and delivery. Using accompaniment as an underlying principle, we focus primarily on constructing effective, equitable, and accountable public sector health systems. Public sector health care delivery is challenged by increasingly exclusive politics and inequitable economic policies that severely limit the participatory power of marginalized people. Finally, we discuss the role of implementation science in closing the delivery gap.

 

Introduction: The right to health

The human rights approach to public health systems development has been a central theme to emerge from the explosive growth in global health awareness and funding in the last two decades.¹  The notion that health care systems are both national and international public goods protecting the essential rights of all citizens, while not wholly embraced, has gained traction in global debates about health care financing, governance, and implementation.² In this piece, we discuss challenges in translating consensus around health as a human right into one particular aspect of the right to health: namely, access to effective health care systems that reach the most vulnerable.

The Universal Declaration of Human Rights was published in 1948,³ marking the start of the modern human rights movement. The poles of civil and political rights versus social and economic rights established during the Cold War era prevailed until the early 1990s, when a relative consensus emerged that the different human rights domains should be integrated. The global movement to combat HIV/AIDS represents the broadest, deepest, most concerted effort to date to forge a link between health and human rights. It is no coincidence that this movement was initiated, expanded, and sustained by individuals from communities bearing the highest burdens of HIV disease.  The movement was successful because it was driven and led by individuals directly affected by the epidemic. This movement both globalized public health and connected it to the rights agenda.⁴

A major challenge in translating the successes of the HIV/AIDS movement into broader health systems change is deepening the involvement of citizens who would be most impacted by such changes—often the most marginalized populations.  Wealthier citizens tend to be able to rely on for-profit, privatized health services and therefore have little incentive to partner with poorer citizens to advance public sector health systems change.

Herein lies a paradox in health and human rights. At no time in human history has health as a human right been as prominent in international and national health discourse as it is now. Yet we also face ongoing expansion of the politics of exclusion and the economics of inequality, which pose immense challenges to implementing human rights-based advances.  Human rights legislation without effective delivery systems is impotent; effective delivery systems without human rights protections (for example, legislative guarantees) will fail to deliver to the most vulnerable.

For health systems development, why does the rights-based view remain relevant today? While much has changed, the underlying forces driving health inequity remain the same. We believe that effective health care systems must guarantee the right to health for our most vulnerable citizens. While this is a sweeping statement, it is important to differentiate this rights-based approach from other approaches that seek merely to reduce population disease, maximize cost-effectiveness, or facilitate rational private investment in health. Our stance is a fundamentally moral one, rooted in the lived experiences of our patients, but it is also deeply pragmatic. To free the world’s poor from the diseases that continue to stalk them, we must build better public sector systems. more….

About the Publication: Health and Human Rights:

Health and Human Rights began publication in 1994 under the editorship of Jonathan Mann. Paul Farmer, co-founder of Partners In Health, assumed the editorship in 2007. Health and Human Rights is an online, open-access publication.

Health and Human Rights provides an inclusive forum for action-oriented dialogue among human rights practitioners. The journal endeavors to increase access to human rights knowledge in the health field by linking an expanded community of readers and contributors. Following the lead of a growing number of open access publications, the full text of Health and Human Rights is freely available to anyone with internet access.

Health and Human Rights focuses rigorous scholarly analysis on the conceptual foundations and challenges of rights discourse and action in relation to health. The journal is dedicated to empowering new voices from the field — highlighting the innovative work of groups and individuals in direct engagement with human rights struggles as they relate to health. We seek to foster engaged scholarship and reflective activism. In doing so, we invite informed action to realize the full spectrum of human rights. more…

This article is important in its own right.  WASHLink believes Hygiene, Sanitation, Water,  & Public Health can not, must not, should not be siloed. If we shall build apart we shall fall together, so while not addressed directly, we  see there is a underlying appeal in this article for such. We encourage you to read on, and explore the invaluable site it is posted on. We can hope this article and other articles found on the Health and Human Rights site  reach the eye of the policy makers and  there minions that execute their edicts. While perhaps trite: we all have  some responsibility  / some role to play in moving this forward.

Get $100K to Reduce the World’s Sh!ts or Other Global Health Idea

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$100,000 Grants Available for New Ideas to: Encourage The World’s Poorest People to Seek Health Care, Develop a New Condom, and  Reduce Diarrhea, One of the Biggest Killers of Children on the Planet

 press release

SEATTLE, September 5, 2013 – The Bill & Melinda Gates Foundation is accepting applications for the latest  of its Grand Challenges Explorations initiative, a ground-breaking grant program encouraging bold approaches aimed at improving the lives of the world’s poorest people. The simple, online, two-page application is open to creative thinkers from any discipline or any organization.

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Grand Challenges Explorations encourages proposals from individuals or groups with anything to offer, from anywhere in the world, and seeks to uncover cross-discipline approaches. Since its launch in 2008, the program has funded more than 850 grants in 50 countries.

To learn more about the topics in this round, visit www.grandchallenges.org. Proposals are being accepted through November 12, 2013.

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About the Bill & Melinda Gates Foundation Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health with vaccines and other lifesaving tools and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to significantly improve education so that all young people have the opportunity to reach their full potential. Based in Seattle, Washington, the foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett. To learn more, visit www.gatesfoundation.org. You can also join the conversation on Facebook, Twitter, and our blog www.impatientoptimists.org.

Bill & Melinda Gates Foundation

206-709-3400

media@gatesfoundation.org

follow @GatesPress

Sections of the Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda

The UN  report is out with Download  PDF here  with the Herculean title of

A NEW GLOBAL PARTNERSHIP: ERADICATE POVERTY AND TRANSFORM ECONOMIES THROUGH SUSTAINABLE DEVELOPMENT

The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda

It’s 81 pages in pdf format that breaks out to the following sections:

Chapter 1: A Vision and Framework for the post-2015 Development Agenda

• Setting a New Course
  • Remarkable Achievements Since 200
  • Consulting People, Gaining Perspective
  • The Panel’s Journey
• Opportunities and Challenges in a Changing World
• One World: One Sustainable Development Agenda

Chapter 2: From Vision to Action—Priority Transformations for a post-2015 Agenda

• Five Transformative Shifts

1. Leave No One Behind

2. Put Sustainable Development at the Core

3. Transform Economies for Jobs and Inclusive Growth

4. Build Peace and Effective, Open and Accountable Public Institutions

5. Forge a new Global Partnership

• Ensure More and Better Long-term Finance

Chapter 3: Illustrative Goals and Global Impact

• The Shape of the Post-2015 Agenda
  • Risks to be Managed in a Single Agenda
  • Learning the Lessons of MDG 8 (Global Partnership for Development)
• Illustrative Goals
  • Addressing Cross-cutting Issues
• The Global Impact by 2030

Chapter 4: Implementation, Accountability and Building Consensus

• Implementing the post-2015 framework
  • Unifying Global Goals with National Plans for Development
  • Global Monitoring and Peer Review
  • Stakeholders Partnering by Theme
• Holding Partners to Account
  • Wanted: a New Data Revolution
  • Working in Cooperation with Others
  • Building Political Consensus

Chapter 5: Concluding Remarks

ANNEX:

• Annex I Illustrative Goals and Targets
• Annex II Evidence of Impact and Explanation of Illustrative Goals
• Annex III Goals, Targets and Indicators: Using a Common Terminology
• Annex IV Summary of Outreach Efforts
• Annex V Terms of Reference and List of Panel Members
• Annex VI High-level Panel Secretariat

Annex 1: While no one section should overshadow the others, The Illustrative Goals and Targets of Annex 1 is one of the ones that will be   most debated  (thus the safe adjective of “illustrative” ?)

It list “5  Transformative Shifts” required to move forward 

We believe five transformative shifts can create the conditions – and build the momentum – to meet our ambitions.

•Leave No One Behind.

We must ensure that no person – regardless of ethnicity, gender, geography, disability, race or other status – is denied basic economic opportunities and human rights.

•Put Sustainable Development at the Core.

We must make a rapid shift to sustainable patterns of production and consumption, with developed countries in the lead. We must act now to slow the alarming pace of climate change and environmental degradation, which pose unprecedented threats to humanity.

•Transform Economies for Jobs and Inclusive Growth.

A profound economic transformation can end extreme poverty and promote sustainable development, improving livelihoods, by harnessing innovation, technology, and the potential of business. More diversified economies, with equal opportunities for all, can drive social inclusion, especially for young people, and foster respect for the environment.

•Build Peace and Effective, Open and Accountable Institutions for All.

Freedom from violence, conflict, and oppression is essential to human existence, and the foundation for building peaceful and prosperous societies. We are calling for a fundamental shift to recognize peace and good governance as a core element of wellbeing, not an optional extra.

•Forge a New Global Partnership.

A new spirit of solidarity, cooperation, and mutual accountability must underpin the post-2015 agenda. This new partnership should be built on our shared humanity, and based on mutual respect and mutual benefit.

 Annex 1, then has 12 targets under the subsection   UNIVERSAL GOAL, NATIONAL TARGETS:

(Where the percentages are graciously  left for others in working committees to arrive at.)

1. End Poverty

1a. Bring the number of people living on less than $1.25 a day to zero and reduce by x% the share of people living below their country’s 2015 national poverty line

1b. Increase by x% the share of women and men, communities, and businesses with secure rights to land, property, and other assets

1c. Cover x% of people who are poor and vulnerable with social protection systems

1d. Build resilience and reduce deaths from natural disasters by x%

2. Empower Girls and Women and Achieve Gender Equality

2a. Prevent and eliminate all forms of violence against girls and women

2b. End child marriage

2c. Ensure equal right of women to own and inherit property, sign a contract, register a business and open a bank account

2d. Eliminate discrimination against women in political, economic, and public life

3. Provide Quality Education and Lifelong Learning

3a. Increase by x% the proportion of children able to access and complete pre-primary education

3b. Ensure every child, regardless of circumstance, completes primary education able to read, write and count well enough to meet minimum learning standards

3c. Ensure every child, regardless of circumstance, has access to lower secondary education and increase the proportion of adolescents who achieve recognized and measurable learning outcomes to x%

3d. Increase the number of young and adult women and men with the skills, including technical and vocational, needed for work by x%

4. Ensure Healthy Lives

4a. End preventable infant and under-5 deaths

4b. Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully vaccinated

4c. Decrease the maternal mortality ratio to no more than x per 100,000

4d. Ensure universal sexual and reproductive health and rights

4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases

5. Ensure Food Security and Good Nutrition

5a. End hunger and protect the right of everyone to have access to sufficient, safe, affordable, and nutritious food

5b. Reduce stunting by x%, wasting by y%, and anemia by z% for all children under five

5c. Increase agricultural productivity by x%, with a focus on sustainably increasing smallholder yields and access to irrigation

5d. Adopt sustainable agricultural, ocean and freshwater fishery practices and rebuild designated fish stocks to sustainable levels

5e. Reduce postharvest loss and food waste by x%

6. Achieve Universal Access to Water and Sanitation

6a. Provide universal access to safe drinking water at home, and in schools, health centers, and refugee camps

6b. End open defecation and ensure universal access to sanitation at school and work, and increase access to sanitation at home by x%

6c. Bring freshwater withdrawals in line with supply and increase water efficiency in agriculture by x%, industry by y% and urban areas by z%

6d. Recycle or treat all municipal and industrial wastewater prior to discharge

7. Secure Sustainable Energy

7a. Double the share of renewable energy in the global energy mix

7b. Ensure universal access to modern energy services

7c. Double the global rate of improvement in energy efficiency in buildings, industry, agriculture and transport

7d. Phase out inefficient fossil fuel subsidies that encourage wasteful consumption

8. Create Jobs, Sustainable Livelihoods, and Equitable Growth

8a. Increase the number of good and decent jobs and livelihoods by x

8b. Decrease the number of young people not in education, employment or training by x%

8c. Strengthen productive capacity by providing universal access to financial services and infrastructure such as transportation and ICT

8d. Increase new start-ups by x and value added from new products by y through creating an enabling business environment and boosting entrepreneurship

9. Manage Natural Resource Assets Sustainably

9a. Publish and use economic, social and environmental accounts in all governments and major companies

9b. Increase consideration of sustainability in x% of government procurements

9c. Safeguard ecosystems, species and genetic diversity

9d. Reduce deforestation by x% and increase reforestation by y%

9e. Improve soil quality, reduce soil erosion by x tonnes and combat desertification

10. Ensure Good Governance and Effective Institutions

10a. Provide free and universal legal identity, such as birth registrations 1,2

10b. Ensure people enjoy freedom of speech, association, peaceful protest and access to independent media and information

10c. Increase public participation in political processes and civic engagement at all levels

10d. Guarantee the public’s right to information and access to government data

10e. Reduce bribery and corruption and ensure officials can be held accountable

11. Ensure Stable and Peaceful Societies

11a. Reduce violent deaths per 100,000 by x and eliminate all forms of violence against children

11b. Ensure justice institutions are accessible, independent, well-resourced and respect due-process rights

11c. Stem the external stressors that lead to conflict, including those related to organised crime

11d. Enhance the capacity, professionalism and accountability of the security forces, police and judiciary

12. Create a Global Enabling Environment and Catalyse Long-Term Finance

12a. Support an open, fair and development-friendly trading system, substantially reducing trade-distorting measures, including agricultural subsidies, while improving market access of developing country products

12b. Implement reforms to ensure stability of the global financial system and encourage stable, long-term private foreign investment

12c. Hold the increase in global average temperature below 20 C above pre-industrial levels, in line with international agreements

12d. Developed countries that have not done so to make concrete efforts towards the target of 0.7% of gross national product (GNP) as official development assistance to developing countries and 0.15 to 0.20% of GNP of developed countries to least developed countries; other countries should move toward voluntary targets for complementary financial assistance

12e Reduce illicit flows and tax evasion and increase stolen-asset recovery by $x
12f. Promote collaboration on and access to science, technology, innovation, and development data

Annex2: Over  20 pages are given  to provide some substance to each of  the 12 Illustrative goals above.

Annex 3:  It focuses on the challenges of  global targets (while titled Goals, Targets and Indicators: Using a Common Terminology)

The mechanic of creating targets that are pragmatic rather than dogmantic, and address each countries social economic political profile will be daunting. Here  are some excepts from the annex, but it should be read in its entirity.

Targets translate the ambition of goals into practical outcomes. They may be outcomes for people, like access to safe drinking water or justice, or outcomes for countries or communities, like reforestation or the registration of criminal complaints. Targets should always be measurable although some may require further technical work to develop reliable and rigorous indicators…

The target specifies the level of ambition of each country, by determining the speed with which a country pursues a goal. That speed can be a function of many things: the priorities of the country, its initial starting point, the technical and organizational possibilities for improvement, and the level of resources and number of partners that can be brought to bear on the problem.

We believe that a process of allowing countries to set their own targets, in a highly visible way, will create a “race to the top”, both internationally and within countries. Countries and sub-national regions should be applauded for setting ambitious targets and for promising to make large efforts. Likewise, if countries and sub-national regions are too conservative in their target setting, civil society and their peers can challenge them to move faster. Transparency and accountability are central to implementing a goals framework.

In some cases, there may be a case for having a global minimum standard for a target, where the international community commits itself to do everything possible to help a country reach a threshold level. That applies to the eradication of extreme poverty by 2030, for example. This could be extended in several other areas, including ending gender discrimination, education, health, food, water, energy, personal safety, and access to justice…

It is important to be clear that allowing countries to set the speed they want for each target is only one approach to the idea of national targets. The other suggestion considered by the Panel is to have a “menu”, whereby a set of internationally agreed targets are established, and then countries can select the ones most applicable to their particular circumstances. For example, one country might choose to focus on obesity and another on non- communicable disease when thinking about their priorities for health.

In the terminology used in this report, national targets refer only to the national differences in the speed with which targets are to be achieved. As an example, every country should set a target to increase the number of good or decent jobs and livelihoods by x but every country could determine what x should be based upon the specific circumstances of that country or locality. Then these can be aggregated up so that you can compare achievements in job creation across countries and over time…

 panel:

1. His Excellency Dr. Susilo Bambang Yudhoyono, President of Indonesia, Co-Chair
2. Her Excellency Ms. Ellen Johnson Sirleaf, President of Liberia, Co-Chair
3. The Right Honorable David Cameron,MP,  Prime Minister of the United Kingdom, Co-Chair
4. H.M. Queen Rania Al Abdullah of the Hashemite Kingdom of Jordan
5. Gisela Alonso, Cuba
6. Fulbert Amoussouga Gero, Benin
7. Abhijit Banerjee,India
8. Gunilla Carlsson, Sweden
9. Patricia Espinosa, Mexico
10. Maria Angela Holguin, Colombia
11. Naoto Kan, Japan
12. Tawakkol Karman, Yemen
13. Sung-Hwan Kim, Republic of Korea
14. Horst Köhler, Germany
15. Graça Machel, Mozambique
16. Betty Maina, Kenya
17. Elvira Nabiullina, Russian Federation
18. Ngozi Okonjo-Iweala, Nigeria
19. Andris Piebalgs, Latvia
20. Emilia Pires, Timor-Leste
21. John Podesta, United States of America
22. Paul Polman, Netherlands
23. Jean-Michel Severino, France
24. Izabella Teixeira, Brazil
25. Kadir Topbas, Turkey
26. Yingfan Wang, China
27. Amina J. Mohammed, Ex-Officio member of the Panel

1 million dollar prize for reducing childhood mortality

The Caplow Children’s Prize is a novel humanitarian contest to save children’s lives.

A $1 million prize will be awarded to the best plan for  preserving the lives of children who would otherwise die before the age of five. All prize finalists will be showcased on our website.

THE PROBLEM:        19,000 children under five die every day.
THE CONTEST:         Seeks to find the best way $1 million might help.
WHO CAN APPLY:    Any person or organization worldwide that:
                                        1) works with or for children
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3) could save those lives within two years
4) has a great but realistic plan
HOW TO APPLY:      It’s easy! Fill out a short online form by May 31st: Apply Now

 source / more…

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