Health and Human Rights: New challenges for social responsiveness

South Africa’s struggle against apartheid discrimination, including struggles in the health sector, laid the basis for a vibrant engagement of staff and students in human rights research, teaching and outreach in the Health Sciences Faculty at the University of Cape Town (UCT). This article provides a brief overview of this background context, then shows how this engagement has continued with new challenges emerging in the post-apartheid democratic period. Teaching at undergraduate and postgraduate levels has been complemented by a programme of ‘Training the Trainers’ in health and human rights. The programme targets teachers of health professionals at institutions in South and Southern Africa, resulting in national adoption of human rights competencies as an essential component of health professionals’ skills base. Research has also extended lessons learnt from the apartheid period into work with vulnerable groups, such as rural farm workers and the deaf, and seeks to build the capacity of marginal populations to change the conditions of their vulnerability in order to realize their rights. Partnerships with civil society organisations have been a strong thread, creating new knowledge and new ways of joint work towards realizing the right to health, including advocacy engagement in civil society movements and regional networks. Further, a focus on health professionals’ practice, in terms of dealing with potential dual loyalty conflicts and their role as gatekeepers in the health services on matters of patients’ rights, has shaped the research agenda. This article illustrates how knowledge production for the public good extends beyond notions of enhancing economic productivity for national development and provides a base for transdisciplinary and transinstitutional engagement. Additionally, non-traditional forms of knowledge networking and transfer have also been explored, including engagement with policy-makers and health managers. Finally, it is shown how the portfolio of social responsiveness activities in the health and human rights envelope has offered significant and novel mutual benefits to the University and the community

Developing human rights competencies for South African health professional graduates.

Human rights are social or material entitlements which are recognised universally in national and international law and that address fundamental human needs. They inhere in all people by virtue of their humanity, and represent a standard to which governments can be held accountable

The difficult road to truth and reconciliation – the health sector takes its first steps

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Training Trainers in health and human rights: Implementing curriculum change in South African health sciences institutions

BACKGROUND: The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning. METHODS: A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication. RESULTS: Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were still employed in academic settings (67%). Twenty-two respondents (48%) implemented a total of 33 formal human rights courses into the curricula at their institutions. Respondents were nine times more likely (relative risk 9.26; 95% CI 5.14-16.66) to implement human rights education after completing the training. Seventy-two extracurricular activities were offered by 21 respondents, many of whom had successfully implemented formal curricula. Enabling factors for implementation included: prior teaching experience in human rights, general institutional support and the presence of allies - most commonly coworkers as well as deans. Frequently cited barriers to implementation included: budget restrictions, time constraints and perceived apathy of colleagues or students. Overall, respondents noted personal enrichment and optimism in teaching human rights. CONCLUSION: This Train-the-Trainer course provides the historical context, educational tools, and collective motivation to incorporate human rights educational initiatives at health sciences institutions. Increased implementation of human rights instruction, both formally and extracurricularly, has demonstrated the training's significance not only within academic institutions but more broadly across the health sector. Coworkers are vital allies in teaching human rights to health sciences students, helping to alleviate institutional barriers. Training fellow staff members and those in key leadership roles is noted as vital to the sustainability of human rights education

Training trainers for health and human rights

Manual for South African health professional trainers originating from the Train-the-Trainer course at UCT. The aims of this manual are: To provide those interested in doing human rights teaching with a framework for training of trainers in health and human rights To provide resources which will be of use to the training of trainers and students To support alumni of our Train-the-Trainer courses, who now number nearly 200 people To share our eight years of experience in running this course with others so as to begin a dialogue around educational issues in teaching human rights To build additional teaching capacity in health and human rights

Personal tobacco use and attitudes towards cessation among undergraduate health professional students in South Africa

Background Advice from health professionals helps tobacco users to quit. Despite evidence that even simple advice about quitting during routine clinical care increases the likelihood of success, it is unclear whether these skills are taught and mastered during health professional training. What impact does personal tobacco use have on students' abilities to appropriately counsel; and, how well-equipped do South African health professional students feel to effectively assist tobacco users to quit? Methods A modified Global Health Professional Student Survey (GHPSS) was administered to all undergraduate health sciences students at two South African universities (University of the Witwatersrand - Wits and University of Cape Town - UCT) in 2012-13. In addition to personal tobacco use, students were asked whether they had been taught about the dangers of tobacco, reasons why people smoke, smoking cessation approaches and counselling preparedness. Results Of 469 Wits and 573 UCT respondents, 56% and 52% respectively had tried smoking at least once; 14% of respondents from Wits and 10% from UCT were active smokers at the time of the study. 89% of students at Wits and 79% at UCT believed that specific training on tobacco cessation techniques is necessary. They acknowledged receiving training on the dangers of smoking (74% UCT and 94% Wits) and discussing the reasons why people smoke (55% UCT and 76% Wits). However, only 31% at UCT and 44% at Wits said that they received formal training in smoking cessation approaches to use with patients. On confidence to counsel patients about the dangers of smoking, 43% of the respondents from Wits and 26% from UCT felt they were equipped to do so. Conclusions This research highlights gaps in the curricula of health sciences students. There is an urgent need address personal smoking cessation among students and improve their competence in clinical settings to become more effective advocates

Child and adolescent food insecurity in South Africa: A household-level analysis of hunger

Food insecurity impacts childhood nutritional status, physical and cognitive development, and increases lifetime risk for chronic disease. Previous South African studies have examined hunger at the sub-national level without a specific focus on children and adolescents. This study determines the national prevalence of childhood food insecurity, from birth to adolescence, and identifies factors associated with hunger within the household. Individual and household-level data were extracted from the South African National Health and Nutrition Examination Survey (SANHANES-1). Prevalence of food insecurity was assessed using the Community Childhood Hunger Identification Project (CCHIP) index. Multinomial logistic regression analyses were conducted on all households (with and without children) to determine the predictors of food insecurity, with additional analyses adjusting for child dependency and sociodemographic characteristics of household heads in households with children. Of 5 098 households surveyed, 68.6% had children and adolescents present (0–19 years). Of these households, 32.5% (95% Confidence Interval [CI]: 29.5–35.7) were experiencing hunger and 26.3% (95% CI: 23.9–28.8) were at risk of hunger. Among all the households, significant associations for experiencing hunger were the presence of children and adolescents: Adjusted Odds Ratio (AOR) = 1.68 (95% CI: 1.12–2.53); being female-headed: AOR = 1.53 (95% CI: 1.21–1.94) and informally-located; AOR = 1.6 (95% CI: 1.07–2.43). Of the racial groups, having a non-African household head, Coloured: AOR = 0.29 (95% CI: 0.19–0.44) and White/Indian/Asian: AOR = 0.12 (95% CI: 0.04–0.33) conferred lower odds of experiencing hunger; and, the household head having secondary/tertiary education conferred lower odds of experiencing hunger; AOR = 0.40 (95% CI: 0.28–0.56) as well as being at risk of hunger; AOR = 0.69 (95% CI: 0.52–0.92). Receiving social grants, pensions, or remittances more than doubled the odds of experiencing hunger; AOR = 2.15 (95% CI: 1.49–3.09). After adjusting for child dependency in households with children, having at least one older child (age 15–19 years old) did not change the odds of food insecurity. In summary, only 41% of South African households with children and adolescents were food secure. The associations between household head sociodemographics, household location and size on household food insecurity indicate a need for multi-sectoral interventions to bolster sustainable food systems for households with children and adolescents and to improve public protections for female-headed, African-headed and informally-located households dependent on social grants