Category Archives: governance

South Africa, Which Once Led On Promoting LGBT Rights Abroad, Could Become A Roadblock

SA mandela LGBTI Ntsoaki NhlapoAdvocates fear South Africa might turn against an LGBT rights resolution at the UN that it sponsored three years ago.

South Africa was once the essential nation to advancing LGBTI rights in international diplomacy. Now it has become a potential roadblock.

Back in 2011, South Africa sponsored a resolution before the United Nations Human Rights Council (HRC) that, for the first time, recognized LGBTI rights as human rights. Other nations, especially from Latin America, had been working to advance LGBTI rights in less high-profile ways for several years before, but South Africa’s leadership was critical to taking the effort to the level of a formal resolution. Such a proposal had to have at least one prominent African backer, its supporters believed. Otherwise, it would play into the hands of LGBTI rights opponents in Africa and other parts of the world that had once been colonized who argue that homosexuality was a Western perversion brought by colonial powers.

An updated version of the resolution was tabled Thursday at a Human Rights Council meeting underway in Geneva. It was sponsored by Brazil, Colombia, Chile, and Uruguay. A vote is expected next week.

Not only is South Africa’s name not on it, but some LGBTI rights supporters tell BuzzFeed News that South Africa’s diplomats are behaving so strangely in negotiations that they worry the country could even turn against the resolution. A South African defection might not only help torpedo the proposal, it would also be a stunning symbolic reversal for a country that set the standard for protecting LGBTI rights. When South Africa adopted its first post-apartheid constitution in 1993, it became the world’s first nation to protect LGBTI rights in its fundamental rights declaration. This came out of a commitment to fighting a broad range of oppression, and it commanded even greater moral authority because it was rooted in the experience of fighting white supremacy.

So some LGBTI rights supporters are looking at South Africa’s reluctance to clearly support the new resolution as a fundamental betrayal.

“We currently have leadership that fails to represent the ethos of what the constitution says and the equality principles they have to uphold,” said Mmapeseka Steve Letsike, a lesbian activist who chairs the South African National AIDS Council’s Civil Society Forum. “We have leadership going out of this country putting their personal beliefs before its own people. We have leaders that fail to protect their own.”

South Africa’s pullback on LGBTI rights internationally comes as homophobia has become an increasingly common political tool across Africa, framed as a form of standing up to the West. Nigeria and Uganda both passed sweeping bills criminalizing LGBTI rights advocacy this winter, the governments of The Gambia and Chad both have pending proposals to stiffen laws against homosexuality, and LGBTI people are being targeted by police from Zimbabwe to Egypt to Senegal.

“Silence in the context of the African Bloc suggests a kind of complicity with the homophobic rhetoric,” said Graeme Reid, a South African who directs Human Rights Watch’s LGBT program. “It speaks of a kind of misplaced solidarity … not aligning with the [LGBTI] people who are the victims of human rights abuse, but with the perpetrators under the rhetoric of supporting our ‘African brothers and sisters.’”

LGBTI rights supporters were also hopeful that some smaller African countries could be persuaded to abstain on the vote — a kind of soft yes — and one or two might even be convinced to back it. This could tip the balance if the vote is close. The 2011 resolution was a nail-biter, passing 23-19 with three abstentions. But that becomes very hard if South Africa can’t counterbalance conservative continental heavyweights that might be lobbying the smaller countries.

“As soon as [South Africa] pulls back, it gives countries like Nigeria and Egypt room to bully and push the smaller countries,” said an LGBTI rights advocate from another southern African country who asked to speak anonymously in order to avoid a backlash in negotiations. “We need South Africa to maintain the same position if not better” than in 2011.

gay rights is humn rights

It’s hard to see why this resolution is so important by reading the plain language — all it really does is order a bi-annual study of LGBTI rights by the United Nations High Commissioner for Human Rights. But there are only a few places where language referring to LGBTI rights exists in any international agreements. This small resolution is a way of giving U.N. staff authority to work on LGBTI issues and means that it will be a regular focus of discussion in Geneva. And it will be a precedent that can be used to broaden the inclusion of LGBTI rights in other human rights agreements.

Most LGBTI rights supporters came into the negotiations that began last week assuming that South Africa would be supportive even if it no longer wanted its name on the resolution. Regional coalitions are very important in the U.N., and other major powers within the Africa bloc, especially Nigeria and Egypt, have been at the forefront of pushing anti-LGBTI policies. South Africa had taken a lot of heat for the 2011 resolution, and many LGBTI supporters might have understood if officials chose not to take a public role in support this year.

But they’ve withheld their support even in private discussions, say sources familiar with the negotiations. The head of South Africa’s Geneva delegation, Ambassador Abdul Samad Minty, took the unusual step of coming personally to an informal meeting on Wednesday, something usually left to staff. But he said virtually nothing in the meeting, said a source in the room, which showed other nations that South Africa isn’t about to go to bat for the proposal.

This posture follows a move by South Africa’s ruling African National Congress party to block a parliamentary motion to condemn anti-LGBTI legislation enacted by Uganda in February (which has since been struck down by the court). It also comes after a vote by South Africa during the June HRC session that stunned LGBTI rights supporters: South Africa joined with conservative nations on a procedural vote to exclude a sentence stating “various forms of the family exist” in an Egyptian-led resolution on the “Protection of the Family.” The resolution passed without this language, and LGBTI rights supporters were concerned that the language could be used as precedent for excluding families from protections under international law if they are not led by a heterosexual couple.

“In the room they’re being a little bit weird,” said a diplomat from a Western country working on the resolution, referring to South Africa’s behavior in the negotiations. But this isn’t entirely new. “They’ve been behaving weird for two or three years on this,” the diplomat said.

The diplomat attributed that more to a change in personnel than an intentional shift in policy: Jerry Matjila, who was South Africa’s ambassador to the Human Rights Council when work began on the 2011 resolution, has since returned to Pretoria to take a senior post in the Department of International Relations and Co-operation. His replacement, Ambassador Minty, lacks his personal commitment to the issue, say sources who have worked with the delegation.

South Africa’s Geneva mission and the Department of International Relations and Co-operation in Pretoria did not respond to requests for comment.

But some South African activists see this dilution of South Africa’s commitment to LGBTI rights internationally as part of a larger trend in the country’s leadership. The late Nelson Mandela and other leaders of the African National Congress embraced LGBTI rights as part of a commitment to fighting a broad range of oppression as they brought South Africa out of apartheid — Matjila is seen as part of that school. But that commitment is not as strong among the younger generation of leaders, most notably President Jacob Zuma, who called same-sex marriage “a disgrace to the nation and to God” around the time the unions won legal recognition in the country.

The shift doesn’t mean South Africa has done a 180 on LGBTI rights. Rather, it’s led to a kind of schizophrenia that is frustrating to LGBTI rights supporters. The lack of support for this resolution is all the more confusing because it comes at a time that there is a new commitment from the government to fighting anti-LGBTI hate crimes inside the country, spurred by a series of horrific rapes and murders of black lesbians.

“Domestically, there is a sense of a real commitment and energy and political will,” said Human Rights Watch’s Graeme Reid. But the international stance is incoherent — the Latin Americans only introduced the resolution at the last minute because South Africa wouldn’t let go of its ownership of the issue until just before the Human Rights Council session began earlier this month.

“There is an air of uncertainty about their position because they have been dragging their feet on this for the last three years, not moving on the resolution and not dropping it,” Reid said.

The resolution’s supporters are optimistic that they will have the votes to pass the resolution if it gets an up or down vote next week, and no one who spoke to BuzzFeed News for this story said they thought it was possible that South Africa would vote against the resolution on the final vote. It could abstain on a final vote, a possibility that some of the resolution’s supporters fear is more likely as the negotiations wear on. Or it could vote for a procedural motion that would kill the resolution by denying an up or down vote — exactly what it did to keep the inclusive language out of the Protection of the Family resolution in June.

“It would be unacceptable, incomprehensible, and almost unconscionable for a relatively new democracy like South Africa to support shutting down debate at the UN’s human rights body [to affirm a principle] that’s in its own constitution,” said Marianne Møllman, program director of the International Gay and Lesbian Human Rights Commission, in an interview from Geneva.

draft resolution

By J. Lester Feer

Source: http://www.buzzfeed.com/lesterfeder/south-africa-which-once-led-on-promoting-lgbt-rights-abroad?utm_term=9vaowf#2dmkbjy

Health Systems Support Needed for Enhanced Global Disease Prevention

How bad can it get 8

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.

 

Health systems strengthening has been paid a lot of lip service over the years, but little progress has been made in many places that need the most help. Blame often falls on donors who tend to concentrate funding on specific diseases, like HIV or malaria, or, to a lesser extent, populations, like women and children. Frequently this funding establishes separate units and programs that just address their own specific issue, not the health burden at large or the system needed to treat it. These “vertical” programs show more immediate, tangible results that can be counted in numbers of individuals receiving treatment or giving birth with a qualified attendant.

 

Cause and effect are less clear when dealing with health systems. If donors invest in health worker training, for example, there is no guarantee the worker will finish the course or remain in his or her country of origin. Even harder to quantify are results from investments in critical system components like drug safety and information networks.

 

But the problem goes beyond donor preferences for tidy measurement tools. Health systems need adequate personnel and supplies, good governance, infrastructure, information systems, financing, and effective service delivery. Each element is in itself a difficult endeavor. While building a clinic may be relatively easy, more complicated is ensuring it has sustained, adequate staff, electricity, and a reliable supply chain. Ensuring proper administration and management is even harder.

 

Engaging adequate numbers of health personnel is notoriously challenging. Those trained to a high enough level are courted by richer countries and frequently leave, especially if their home countries face instability. Liberia, the hardest hit of the countries now facing the Ebola epidemic, was estimated to have fewer than 50 physicians for a population of 4.3 million.

 

Beyond the health system itself, building functional service delivery in poor countries can be stymied by lack of an adequate tax base, frequent turnover in government positions, lack of accountability and corruption, poor transportation, and general infrastructure weaknesses–daunting challenges all.

 

All that said, the problem deserves heightened efforts to provide resources and expertise if we are to avoid the devastating consequences we are now seeing in West Africa. The challenge is more complex than just providing funding since countries must develop management skills and create complex systems. Some innovative approaches are being tried. The Harvard School of Public Health and the Kennedy School sponsor a Ministerial Leadership in Health program that has involved 56 health and finance ministers from 40 countries to increase domestic political commitment for health systems improvements as well as enhancing efficiency and quality of services. Global movement toward universal health coverage focuses on improving access to quality health services at a price all can afford, an advance that requires functional health systems. New tools are being applied there too, including peer-to-peer learning for ministerial staff so they can share successful approaches (see the Joint Learning Network for Universal Health Coverage).

 

While the major push for systems improvement has to come from the countries themselves, the international community has a stake and a role too. International organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, offer systems strengthening support generally focused on bolstering elements related to their primary missions; the Global Fund provides funding primarily to enhance provision of services related to its three-disease focus while Gavi offers support to improve immunization system functions such as cold chain capacity and vaccinator training.

 

 The U.S. has long supported health systems strengthening through provision of technical assistance and funding, but these efforts pale in comparison to the need, and agencies responsible are hampered in their efforts by congressional mandates to produce results in the short term.  Similar to many other donors, Congress appropriates funds largely based on infectious diseases, maternal and child health, and reproductive health. Money often must be siphoned off those accounts to support broader systems efforts. Despite the lack of specific funding, the U.S Agency for International Development (USAID) has developed an Office of Health Systems to coordinate efforts. The agency begins by assessing a system’s current capacities, including its ability to properly use any external funds given to it. It then offers what aid it can in areas such as health financing arrangements and governance, promoting quality medicines, and improving access to pharmaceuticals and services. 

 

The United States can and should do more.  These are not glamourous activities, and they have long been a difficult sell to Congress. They are hard to explain and quantify and lawmakers are under constant pressure to justify foreign aid to a deeply skeptical public. But the Ebola outbreak provides a glaring example of the need.  While the global health appropriations process is not likely to reform itself out of its current funding methodology, Congress can act to send a strong message that health aid can be used more broadly and with a focus on long term results. This would give USAID and other agencies the authority they need to give health systems strengthening the priority it deserves and provide an extra layer of health protection for citizens in developing countries as well as here at home.

 

By Nellie Bristol

Source: http://www.smartglobalhealth.org/blog/entry/health-systems-support-needed-for-enhanced-global-disease-prevention/

AHF Mourns Liberia’s Dr. Taban Dada; Urges African Union and W.H.O. to Accelerate Ebola Response

AHF

KAMPALA, UGANDA (13 October 2014) The AIDS Healthcare Foundation (AHF) mourns the loss of another Doctor, Dr. John Taban Dada who died due to Ebola Virus Disease (EVD) in West Africa. Dr. Dada, a Ugandan national, succumbed to the Disease on 9th October 2014 in Monrovia, Liberia. By the time of his death, Dr. Dada was working at Liberia’s largest hospital, JF Kennedy Memorial Center, and was consulting with the AIDS Healthcare Foundation partner in HIV service provision, People Associated for People’s Assistance (PAPA).

 

The Ebola outbreak in West Africa has continued a persistent spread pushing the death toll over 4,000 as of 9th October 2014. Having been declared an international public health emergency by the World Health Organization, Ebola Virus Disease has infected over 370 health workers and killed 216 doctors and nurses. In July, Dr. Sheik Humarr Khan, 39, who served as Medical Officer for AHF’s Sierra Leone Country Program, succumbed to the disease after being quarantined and cared for by medical providers from Médecins Sans Frontières at the isolation unit in the Kailahun District in Eastern Sierra Leone for several days. In Liberia, Dr. Dada’s death brought to four (4) the number of Doctors who have died since the outbreak.

 

“Our brothers and sisters in West Africa need accelerated action by commissions such as the African Union and the World Health Organization to expand provision of appropriate and adequate personal protective equipment, mobilize and deploy more health workers in the region, and increase and equip more isolation centers specifically established to cater for infected health workers,” said Dr. Penninah Iutung Amor, the AHF Bureau Chief for the African Region. “All these are achievable – but only if the commissions and the World Health Organization prioritize and scale up addressing obstacles that are holding us back in the response.”

 

There was hope late September when President Obama pledged support to the EVD response in the region however the actualization of this support has been delayed due to logistical challenges — inadequate human resources for health, poor state of the runway at the airport, and delays in setting up new isolation centers. “Since we have few isolation centers, we are seeing some people suffering from Ebola re-circulating into the community and therefore driving the infection further,” said Chinnie Sieh, Program Manager with People Associated for People’s Assistance (PAPA). “This is a crisis that requires all the Africa Commissions, the United Nations, all African governments and non-government actors to respond.”

 

“It is high time that the containment of this outbreak became a reality in the West African Countries of Sierra Leone, Guinea and Liberia,” said Dr. Lydia Buzaalirwa, the Director for Quality Management with AIDS Healthcare Foundation Africa Bureau. “Everybody needs to take part in the control of Ebola. We need to cut the chain of new transmissions, get in more volunteers, more logistics, and communities should be involved in building new isolation units. We demand that the African Union step up its leadership and exponentially accelerate its response to the Ebola outbreak in the region.”

 

By The AIDS Healthcare Foundation

South Africa: Pregnant women and girls continue to die unnecessarily

south africa carousel

Hundreds of pregnant women and girls are dying needlessly in South Africa. In part, this is because they fear their HIV status may be revealed as they access antenatal care services, according to a major report published by Amnesty International today.

 

Struggle for Maternal Health: Barriers to Antenatal Care in South Africa, details how fears over patient confidentiality and HIV testing, a lack of information and transport problems are contributing to hundreds of maternal deaths every year by acting as barriers to early antenatal care.

 

“It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed, and because of a lack of transport and basic health and sexuality education. This cannot continue,” said Salil Shetty, Amnesty International’s Secretary General.

 

“The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk.”

 

South Africa has an unacceptably high rate of maternal mortality. There were 1,560 recorded maternal deaths in 2011 and 1,426 in 2012. More than a third of these deaths were linked to HIV. Experts suggest that 60% of all the deaths were avoidable.

 

Antenatal care is free in South Africa’s public health system. However, Amnesty International’s research found that many women and girls do not attend clinics until the later stages of their pregnancy because they are given to believe that the HIV test is compulsory. They fear testing and the stigma of being known to be living with HIV. Nearly a quarter of avoidable deaths have been linked to late or no access to antenatal care.

 

Worryingly, these fears are not without foundation. Amnesty International’s report, based on field research conducted in Mpumalanga and KwaZulu-Natal provinces, contains testimonies from women and girls who say that health care workers inappropriately discuss HIV test results with others.

 

“The nurses are talking about people and their status”, a woman from KwaZulu-Natal explained.

 

Amnesty International also found that several clinics it visited use processes for pregnant women and girls living with HIV that disclose their status, including separate queues for antiretroviral medication, different coloured antenatal files and different days for appointments.

 

“[I]f I go for antiretroviral, my line is that side. All the people in this line they know these people are HIV. That’s why people are afraid to come to the clinic,” one woman in Mpumalanga told Amnesty International.

 

“During antenatal care, if women come out of the counsellor’s room with two files, then everyone knows they are HIV positive,” said another woman.

 

Women and girls said they feared discriminatory treatment even from partners and family members as a result of testing positive for HIV and that HIV-related stigma remained a problem in many communities.

 

“While HIV testing is an important public health intervention it must be done in a manner that respects the rights of women and girls and does not expose them to additional harm. It is deeply worrying that the privacy of pregnant woman and girls is not respected in health facilities. The South African government must take urgent steps to correct this,” said Salil Shetty.

 

“It is vital that health care workers in South Africa receive additional training on providing quality care that is both free of judgement and stigma and that women and girls accessing sexual and reproductive health services are able to trust that their confidentiality will be respected.”

 

Lack of information about sexual and reproductive health

 

Amnesty International’s report also identifies that a lack of information and knowledge about sexual and reproductive health and rights increases risks of unplanned pregnancies and HIV transmission, especially among adolescents. Likewise women and girls are often unaware of the importance of early antenatal checks.

 

Persistent problems relating to transport

 

The report also documents the lack of progress made in KwaZulu-Natal and Mpumalanga to ensure that women and girls can physically access health services. Problems persist relating to shortages of public transport and poor road infrastructure. The roads in some areas visited by Amnesty International are of such poor quality that they become impassable when it rains. Even when it is dry, ambulances will not go beyond a certain point on some roads. Amnesty International had documented the same problems in both provinces in a 2008 report.

 

“The South African government must build better road networks in these rural provinces to guarantee access to healthcare facilities. The government must also ensure that ambulances are always available to transport those who are in need,” said Salil Shetty.

 

Amnesty International is also calling on the government to:

 

  • Ensure that all health system procedures uphold patient privacy, particularly for people living with HIV.
  • Improve knowledge about sexual and reproductive health and rights, including through comprehensive sexuality education that involves men and boys.
  • Urgently address the persistent lack of safe, convenient and adequate transport, and the poor condition of transport infrastructure.

 

Additional information

 

This report builds on Amnesty International’s 2008 report, ‘I am at the lowest end of all’: Rural women living with HIV face human rights abuses in South Africa, in which the organisation documented gender, economic and social inequalities as barriers to health care for women living with HIV.

 

9 October 2014

By Amnesty International

Source: http://www.amnesty.org/en/news/south-africa-pregnant-women-and-girls-continue-die-unnecessarily-2014-10-09

Tell World Leaders it’s Time to #ENDEBOLA

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Ebola is tearing through West Africa, killing up to 70% of those infected and spreading fear through their communities.

 

Children are in danger of catching the virus, or of losing their parents to it. Their long-term futures are also suffering from the knock on effects of prevention measures: schools are closed; vaccines can’t be administered because of the fear of infection.

 

We must act now to stop this epidemic spreading before it destroys the futures of an entire generation of West Africa’s children.

 

As 20 of the world’s biggest countries in terms of both economy and population, the members of the G20 are ideally placed to deliver the resources desperately needed for the international response on Ebola. According to the UN, if states have committed and deployed the required resources by the time of the G20 meeting in November the transmission rate will be on track to decline by the end of the year.

 

Join our call on leaders of the G20 to ensure all people, equipment and funding needed to halt the outbreak are in place by the 15th November.

 

Source: http://www.savethechildren.net/ebola

Leaving no one behind in the post-2015 development agenda: young marginalized people claim their space

missionbrazil_632The sexual and reproductive health rights of young marginalized populations are often neglected and their collective voice in this critical area not always heard. To try to redress this imbalance young people from marginalized communities and key populations in Bangladesh, Ethiopia, Puerto Rico and Uganda met in New York this week to discuss how to put these rights issues firmly on the post-2015 development agenda, leaving no one behind. 

 

Taking place on 25 September, the General Assembly side event which took the form of a panel discussion, examined the vital role of community engagement, advocacy and service delivery in protecting the rights and meeting the needs of young key populations. These include men who have sex with men, sex workers and young people living with HIV.   

 

Young speakers, who were peer educators, directors of national and regional NGOs, actors and community leaders, argued that universal access to HIV services and health coverage could not be achieved without prioritizing the needs of the most marginalized. They also noted the contribution of comprehensive sexuality education to improving young people’s health and the role that communities can play in both promoting rights and challenging stigma and discrimination.

 

The event was hosted by the Government of Brazil and organized by the International HIV/AIDS Alliance, GESTOS, the Global Youth Coalition on AIDS, ATHENA, ICASO, International Civil Society Support, STOP AIDS NOW!, Stop AIDS Alliance, the HIV Young Leaders Fund, the African Services Committee, and the Global Forum on MSM and HIV, in collaboration with UNAIDS.

 

Quotes

"Setting goals is only part of the story. Where we should look for change is the way that we will implement the goals. We need to change the way we are doing business and craft the space for civil society in the new post-2015 agenda."

Luiz Loures, UNAIDS Deputy Executive Director

 

“We are talking about development here and sexual and reproductive rights are development."

Pablo Aguilera, HIV Young Leaders Fund

 

By UNAIDS

26 September 2014

Source: http://www.unaids.org/en/resources/presscentre/featurestories/2014/september/20140925csyoungpops/

Ebola: Where is all the development money?

Truthout.org, CC BY-NC-SA

With each week that passes, the Ebola crisis in West Africa deepens. And amid the horror, the fear and a public health response described by Medicine Sans Frontières as “lethally inadequate”, public health systems face total collapse.

 

While the inadequate international response has loomed large, it is the region’s chronically weak and desperately resourced health infrastructure which is the critical factor. This was underlined by Bruce Ribner, an infectious disease specialist at Emory University Hospital in the US who led the successful treatment of two aid workers who contracted Ebola while working in West Africa.

 

Testing we take for granted

 

According to Ribner: “They [West African Doctors] suffer from a terrible lack of infrastructure and the sort of testing that everyone in our society takes for granted, such as the ability to do a complete blood count – measuring your red blood cells, your white blood cells and your platelets – which is done as part of any standard checkup here. The facility in Liberia where our two patients were didn’t even have this simple thing, which everyone assumes is done as part of your annual physical.”

 

Health systems encompass hospitals, clinics, procurements structures, research programmes, community health workers and training provision, and are the first line of defence in the face of outbreaks such as Ebola. When that bulwark is breached so easily, as it was in Sierra Leone and throughout the region, it raises urgent and uncomfortable questions about the focus of our development priorities.

 

In fact, this crisis exposes the great fallacy of the West’s global development agenda. While the international health and development community obsesses about technocratic development goals, targets, and indicators; the basic building blocks of health provision in poor countries have been desperately neglected.

 

Where’s the swell of money?

 

There is a contradiction here. Isn’t it recognised that global health has done well out of the last 15 years of development spending?

 

Three of the Millennium Development Goals(MDGs) are health related, new philanthropic actors such as the Bill and Melinda Gates Foundation have prioritised global health as an area of concern, and new financing mechanisms to support vaccinations and HIV/AIDS responses such as the Global Fund to Fight AIDS, Tuberculosis and Malaria were created.

 

The result: a swell of new money, big name endorsements, and targeted action in critical but singular areas.

 

This tide of resources, expertise and good will has led to a pre-occupation with “vertical interventions” – programmes that prioritise specific diseases such as malaria. This is of course, not a bad thing in itself. Malaria is a scourge on the health and lives of Africans, and programmes to mitigate its transmission and effects are both vital and badly needed. I’m not proposing that we cut off support for disease-specific programmes nor that development is a zero-sum game – but our limited resources can’t ignore the less glamorous but no less urgent areas of clinics, hospitals and systems.

 

The singular focus on specific diseases, to the detriment of health systems in general, is a major reason why we are where we are in West Africa. The failure of the healthcare infrastructure to cope with Ebola should not be a surprise; it is certainly not for those living and working in the region, many of whom have spent decades decrying the ramshackle state of hospitals, clinics and systems.

 

Will this shift priorities?

 

The WHO has stressed the importance of health systems, and the World Bank began to make them the focus of its regional efforts a few years ago. Yet, the idea that health systems should be a key feature of the new Millennium Development Goal process is gaining little traction in international development circles. In short, without a radical focus on health systems; the future is bleak.

 

The struggle to contain Ebola shows how strongly equipped and fully-functioning health systems are fundamental to the management of health emergencies as well as the everyday health and well-being of people in vulnerable, poorer regions.

 

The stubborn focus on goals and specific diseases over the last 15 years has led to a chronic and senseless neglect of health systems in developing countries. This focus has contributed to a catastrophic public health emergency. If we are to salvage anything from this human and regional tragedy, it should include a commitment to invest money and expertise in regional health infrastructure. That requires an urgent and radical shift in our accepted model of global health and development.

 

Source: http://theconversation.com/ebola-crisis-in-west-africa-where-did-all-the-development-money-go-31544

SA Minister Underscores Reproductive Justice

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It is rare that you can see something you’ve helped to create change the behavior of a government thousands of miles away. So imagine my surprise when I opened my email this morning to read the speech about reproductive justice (RJ) made by South Africa’s Minister of Social Development Bathabile Dlamini in front of the United Nations General Assembly on September 19. She didn’t speak in general language that could be interpreted to suggest reproductive justice; she actually used the specific term, acknowledging the role African-American women played in gifting this theory and framework to the world.

 
In addition to discussing sexual rights, reproductive health issues, and economic justice, she used the speech to explicitly embrace LGBTQ rights. As a representative of an African government that supports gay, lesbian, trans, bi, and intersex rights, her remarks act as an important backstop against the rampant anti-gay hysteria around the continent fomented by the evangelical religious right in Uganda and elsewhere. Yet it was her use of the reproductive justice language that started my heart pounding Tuesday morning.
 
It is no longer surprising that RJ has caught on in the United States among thousands of activists eager to move beyond the paralyzing pro-choice/anti-choice stalemate. It is very simple to embrace RJ as both a theoretical paradigm shift and a model for ideal practices because it’s easy to understand and, in a few words, can state the sum of our expectations. As I’ve written in other places, it comes with its own “elevator pitch:”
 
RJ is about three interconnected sets of human rights: 1) the right to have children; 2) the right not have children; and 3) the right to parent the children we have in safe and healthy environments.
 
As bell hooks says, “Any theory that cannot be shared in everyday conversation cannot be used to educate the public.”
 
Reproductive justice does not privilege the production of babies as the only goal of women’s biology; instead, it is based on the human right to make personal decisions about one’s life, and the obligation of government and society to ensure that the conditions are suitable for implementing one’s decisions. Although the SisterSong Women of Color Reproductive Justice Collective publicized the concept of RJ, it does not only apply to women of color. Human rights are what everyone deserves, and so everyone is included in the RJ framework. In particular, reproductive justice draws attention to the lack of physical, reproductive, and cultural safety that affects our “choices.” Reproductive justice focuses on oppression—the structures of injustice and inequality.
 
In 1994, when 12 Black women sat in a hotel room in Chicago and envisioned the concept of reproductive justice as a way to create new avenues of resistance and strategies for change, we had no idea that 20 years later, we’d be discussing how RJ has changed the pro-choice movement in the United States in addition to being used by activists around the world. I’ve been invited to speak about reproductive justice in Ireland, South Africa, China, and Brazil. Activists in these countries told me that using the RJ framework has opened up political spaces to talk about sexual rights and reproductive health issues in a way that moves the lens from centering only on abortion; instead, it enfolds abortion in a larger conversation about people’s lives and human rights. As in the United States, this paradigm shift has brought new allies into the conversation and has thwarted opponents who only want to focus on fetuses instead of the full spectrum of our lived experiences.
 
In the United States, some adopters of the RJ framework have only focused on the inherent concept of intersectionality, based on the works of Kimberlé Crenshaw. Intersectionality, according to her, “mediates the tension between assertions of multiple identities and the ongoing necessity of group politics,” while at the same time providing a “basis for reconceptualizing” a single identity as coalition, such as “race as a coalition between men and women of color.” Intersectionality is certainly a process that the RJ framework uses as a pathway toward understanding our multiple identities. But it is just that: a process, not a goal. The goal is the full achievement of human rights for everyone.
 
To get there, we need a legal regime that pushes beyond the limited U.S. Constitution and the tenuous interpretation of “privacy” to protect women’s rights. Incidentally, this is also why Crenshaw conceptualized intersectionality as a lawyer in 1989, when she analyzed the inability of U.S. laws to deal with the compounding of race and gender in cases involving Black women plaintiffs.
 
In fact, to not reference “human rights” as an international set of laws and standards in discussions and applications of reproductive justice is to divest RJ of its power to challenge the U.S. government to live up to the obligation to protect our people. When RJ is stripped of its most radical potential, we have to ask ourselves, whose interests does that serve?
 
Nonetheless, back to South Africa. It was wonderful for me that Minister Dlamini referenced the 1994 International Conference on Population and Development (ICPD) in Cairo in her speech. That was where things crystallized for me, 20 years ago: that the ability of any woman to manage her own fertility is directly dependent on the circumstances of the community in which she is embedded. To promote contraceptives in a community that lacks basic health-care infrastructure is a form of population control, not a sincere understanding of the needs of women or their communities. This was the message—in other words, the African philosophical concept of Ubuntu—that global feminists agreed upon at the ICPD, and we pushed it together to ensure that it was included in RJ’s Plan of Action.
 
On Friday, Dlamini called upon all African countries to improve their human rights commitments for everyone and to stop limiting protections by invoking the phrase “in accordance with national laws and policies.” This mealy-mouthed half-stepping basically admits that existing national laws that violate human rights, such as Uganda’s “kill the gays” law, will not be changed. This is a salutary lesson for the United States. The primary reason we have not ratified the majority of the available human rights treaties—including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)—is because of Congress’ reluctance to bring U.S. laws into harmony with international human rights laws.
 
So I celebrate this morning in company with my co-creators Toni Bond Leonard, “Able” Mable Thomas, Cynthia Newbille, Rev. Alma Crawford, Evelyn Field, and seven others who were with us in that hotel room. We’ll have our SisterSong-organized reunion in Chicago from November 7 to 9, but we’ll arrive there celebrating the fact that, in the words of South African women, the stone we tossed in 1994 “dislodged a boulder.” Amandla!
 
By Loretta Ross
23 September 2014
Source: http://rhrealitycheck.org/article/2014/09/23/amandla-south-african-minister-underscores-reproductive-justice-global-framework/

We Can’t Have a Post-2015 Agenda Without SRHR

In 2000, the creators of the Millennium Development Goals (MDGs) completely overlooked sexual and reproductive health and rights (SRHR), a mistake that, if repeated, would cripple the dreams of millions of young girls and women for years and generations to come.

 

Access to SRHR enables individuals to choose whether, when, and with whom to engage in sexual activity; to choose whether and when to have children; and to access the information and means to do so. To some, these rights may be considered an everyday reality. However, that is not the case for millions of young people in the world – particularly girls and women.

 

On Tuesday night, I had the fantastic opportunity to listen to some of the foremost global leaders speak on behalf of ensuring access to sexual and reproductive health and rights in the post-2015 agenda. The benefits of ensuring SRHR are society wide and inevitably translate into improved education, economic growth, health, gender equality, and even environment.

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Education

 

“At my high school, you would be expelled if found with a condom.” – Samuel Kissi, former President, Curious Minds Ghana

 

When girls are healthy and their rights are fulfilled, they have the opportunity to attend school, learn life skills, and grow into empowered young women. Wherever girls’ SRHR are ignored, major educational barriers follow. Child marriage and early pregnancy are major contributors to school dropout rates. In South Asia and Sub-Saharan Africa, girls are married before age 18 at an alarming 50 percent and 40 percent respectively. And in Sub-Saharan Africa, where 90 percent of adolescent pregnancies occur in marriage, it is safe to assume that not all those sexual acts were consensual and not all those pregnancies were planned.

 

Economic Benefits

 

“Initially I used to oppose family planning, but now I fully support. I support it because my wife has more time to work and earn money.” – The Honorable Dr. Tedros Adhanom Ghebreyesus, Minster of Foreign Affairs for the Federal Democratic Republic of Ethiopia, sharing the story of an Ethiopian man’s changed opinion regarding the importance of SRHR

 

Protecting SRHR not only saves lives and empowers people, but it also leads to significant economic gains for individuals and for the community as a whole. As previously stated, ensuring SRHR helps to decrease school dropout rates and, as a result, leads to a more productive and healthy workforce as each additional year of schooling for girls increases their employment opportunities and future earnings by nearly 10 percent.

 

Broader Health Agenda

 

“We cannot eliminate new HIV infections without providing SRHR services to women so they can make informed decisions to protect themselves and their children in the future. Yes, we will end the AIDS epidemic, but first we need to respect the dignity and the equality of women and young girls.” – Dr. Luiz Loures, Deputy Executive Director, UNAIDS

 

Access to SRHR guarantees quality family planning services, counseling and health information. These services are critical, particularly because women are often victims of gender-based violence and sexual assault and thereby face greater risks for sexually transmitted diseases like HIV/AIDS. Failing to secure and uphold SRHR dooms women and girls with an increased risk of unsafe, non-consensual sex and maternal mortality.

 

Gender Equality

 

“How can you control your life if you cannot control your fertility?” – Helen Clark, UNDP Administrator

 

When a woman can easily plan her family, she is more equipped to participate in the economy alongside her male colleagues. When the sexual rights of a woman or girl are fulfilled, she will experience decreased rates of sexual violence and enjoy a healthy relationship with a respectful partner. When a woman or girl does not fall victim to child marriage and early pregnancy, she can stay in school and achieve anything she puts her mind to.

 

Environment

 

“The woman continues to bring life, to bring up the next generation, to stand before you and say, ‘I am ready to embrace my rights and to deliver a better planet to humanity.’” – Joy Phumaphi, former Minister of Health, Botswana; Chair, Global Leaders Council for Reproductive Health

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A 2012 study found that community water and sanitation projects designed and run by women are more sustainable and effective than those that are not. Similarly, women produce 60 to 80 percent of food in developing countries and, with the economic and educational gains that coincide with secured SRHR, a woman is better equipped to effectively manage her land.

 

The post-2015 Sustainable Development Goals will not happen without SRHR being addressed. So far, the world has failed to recognize that SRHR are equally as fundamental to global development as finance and trade. We can no longer afford to view SRHR as a taboo or promiscuous topic. When 90% of first births in low-income countries are to girls under 18; when the leading cause of death among adolescent girls aged 15 to 19 is pregnancy and childbirth; when two-thirds of new HIV infections in sub-Saharan Africa are among adolescent girls; and when 200 million women want to use family planning methods but lack access, the young girls and women of the world do not have a promiscuity problem – they have a human rights problem.

 

By Elisabeth Epstein

25 September 2014

Source: http://girlsglobe.org/2014/09/25/we-cant-have-a-post-2015-agenda-without-srhr/

UN Human Rights Council votes to support LGBT rights

L27 UNHRC Ntsoaki Nhlapo

The UN Human Rights Council ( UNHRC) voted on Friday to pass a resolution supporting LGBT rights around the world, condemning discrimination based on sexual orientation and gender identity. India abstained from voting on the resolution.

 

The Human Rights Council resolution—led by Brazil, Chile, Colombia, and Uruguay—followed a resolution in 2011 on the same topic led by South Africa and asks the UN Office of the High Commissioner of Human Rights to gather and publish information on how best to overcome discrimination and violence.

 

Opponents of the resolution employed procedural tactics to defeat the text, by presenting a total of 7 amendments that would have eliminated all reference to sexual orientation and gender identity from the text, and made it applicable only to countries who proactively declare support for sexual diversity and rights. These amendments were defeated by vote.

 

The resolution passed by 25 votes in favor, 14 against, and 7 abstentions. India abstained from voting, and so did Burkina Faso, China, Congo, Kazakhstan, Namibia and Sierra Leone. Pakistan, Indonesia, Russia and Saudi Arabia were the notable ones among 14 to oppose.

 

LGBT activists and allies from around the world have advocated strongly to bring about a resolution that would ensure regular attention at the Human Rights Council to violations based on real or perceived sexual orientation or gender identity.

 

An earlier version of the resolution had reflected more of that vision, requiring the OHCHR to report biannually. The regular reporting requirement was stricken from the text during negotiations. On Friday, while some expressed disappointment with the limitations of the resolution, activists from across the world celebrated its symbolic value.

 

27 September 2014

Source: http://www.dnaindia.com/world/report-un-human-rights-council-votes-to-support-lgbt-rights-india-abstains-from-voting-2021923