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Health & Human Rights Combined


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Background on Health and Human Rights from country delegations to the institute.

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Health & Human Rights Combined

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