Human Rights and Same-sex Intimacies in Malawi

In recent years, Malawi has received global attention as a global hotspot for human rights violations based on sexual orientation and gender identity since the arrest of Tiwonge Chimbalanga and Steven Monjeza for holding a wedding ceremony in 2009. The violations are a result of negative attitudes against ‘homosexuality’, and the application of anti-gay provisions of the Penal Code and the Marriages Divorce and Family Relations Act, which outlaw consensual adult same-sex relationships and non-conforming gender identities. Malawi’s failure to protect queer persons amounts to the violation of its domestic and international human rights obligations. Paradoxically, the Malawian Constitution and international human rights obligations (to which Malawi subscribes), guarantee equal and effective protection against discrimination, which I have argued that it includes discrimination based on sexual orientation and gender identity. This interdisciplinary study explores the life stories of 44 queer Malawians examining how the lack of human rights protection affects their daily lives. I have found that the majority of queer Malawians are unlikely to come out due to fear of stigma and discrimination. As a result, they are unable to claim the full status necessary to enable them to formally assert their identity, citizenship and relationship rights. Drawing from social construction theories, this study will show that local meanings regarding human rights and sexuality include a misinterpretation of SOGI-based human rights as ‘the right to conduct mathanyula’, which is locally (mis)understood to imply permission to engage in sexual activities between men and young boys. I have recommended a radical shift in the articulation of SOGI-based human rights so that it is understood as the equal entitlement to protections in accordance with Malawi’s domestic and international human rights obligations. If understood as the latter, Malawians are likely to endorse human rights protection based on sexual orientation and gender identity

Stakeholder engagement in the health policy process in a low income country : a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

Abstract Background Inclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through local level stakeholders’ perceptions of their involvement in the NHP II and HSSP II. Methods A qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as CSOs and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed. Results Stakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Five categories were identified: tokenistic involvement; stakeholder hierarchy; mutual distrust; preferred stakeholders; no culture of engagement. Conclusions Serious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in consultation exercises alongside greater top-down efforts to engage stakeholders via diverse and inclusive methods. These issues are not unique to Malawi or to health policy-making

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially