Who gets to sit at the table? Interrogating the failure of participatory approaches within a right to health framework

An increasing number of global health institutions are focusing on a human rights approach to increasing participation in making health decisions as a means of establishing legitimacy. This article analyses how global health institutions are enabling participation on the ground level. In 2012, the Global Fund to fight AIDS, tuberculosis and malaria came up with a new funding model that required successful applicant countries to put human rights at the core of their proposed health projects. Using fieldwork from Uganda, the article focuses on how Uganda enabled participation among different stakeholders in the run-up to Uganda’s grant application process in 2014. Considering the limitations of these and other participatory approaches, the article proposes an approach to participation that is based on underlying vulnerabilities. This approach would consider intersectional vulnerabilities as a way of prioritising how groups are represented and allocated resources

Human rights mechanisms for anti-corruption, transparency and accountability : enabling the right to health

Background: The presence of corruption in State institutions and broader society presents a significant obstacle to the right to the enjoyment of the highest attainable standard of health. The Universal Periodic Review, a Member State-led peer review system administered by the Human Rights Council, is a core tool of human rights, including the right to health accountability. This paper builds on existing research to examine processes that support State engagement on the issue of corruption. We identify opportunities for States to use the Universal Periodic Review to support anti-corruption, transparency and accountability to control corruption in the health-care sector. Objectives: This paper focuses on health sector how human rights mechanisms, and particularly the Universal Periodic Review, can be a tool for greater accountability for the right to health for corruption in the health sector. Methods: The research team applied qualitative content analysis methods to analyze all 135 Universal Periodic Review documents produced during 2018 in order to analyze how human rights mechanisms address the impact of corruption on the realization of the right to health. Results: Although health rights violations are often addressed within human rights mechanisms such as the UPR, corruption remains under-addressed, suggesting that there are gaps in understanding how corruption can seriously undermine the right to health. Conclusion: Human rights mechanisms should drive greater attention to the importance of addressing corruption in health. In order to make the UPR more effective, this paper suggests that there is a need to generate more awareness of corruption-based violations of the right to health in order to promote greater health accountabilityPractical tools such as strategic litigation and social audits can also contribute to creating greater transparency and accountability in dealing with corruption

Tracking progress of tobacco control in Pakistan against the MPOWER package of interventions : challenges and opportunities

MPOWER is an evidence-based package of the six most effective demand reduction interventions to reduce tobacco use. Global evidence shows that introduction of this package has accelerated and strengthened tobacco control worldwide with over 5 billion people living in 136 countries covered by at least one of these key interventions. This paper comments on how tobacco control laws in a low and middle income country, Pakistan, are meeting the MPOWER package provisions and what the challenges and opportunities for tobacco control are in the country. Pakistan is home to over 24 million tobacco users consuming a variety of tobacco products including 10 million smokeless tobacco users. Pakistan has introduced several laws to meet its international commitments under the framework convention against tobacco control and MPOWER package. However, gaps in existing policies, poor law enforcement, and a conflicting political economy of tobacco in the country pose major challenges for effective tobacco control. The changing political environment with renowned public health activists in current government, an active and independent judiciary, increasing use of social media, and a dynamic civil society offer opportunities to strengthen its efforts for effective policy actions against tobacco use

Categorising the gendered harms to caregivers during humanitarian emergencies : an analysis of law and practice during Ebola crises

Recent global health emergencies have highlighted the critical role of health care workers in stemming the spread of pandemics. Healthcare workers provide an essential service to local communities impacted by epidemics such as Ebola. Global health scholars suggest that carers may suffer harm while performing this essential work. Building on feminist theories of ‘harm’ and ‘social reproduction’, this article uses as case studies the early 21st century Ebola epidemics that broke out in West Africa and the DRC to ask how do women carers in humanitarian crises experience harm? The article illustrates the hierarchical and gendered nature of harm, and how those at the bottom of social hierarchies face intersectional harms stemming from their race, class and economic status. The article highlights an urgent need to rethink how law at both the domestic and international levels has contributed to the reproduction of inequalities faced by these carers

Regime shifting by multinational corporations within constitutional courts in developing countries : analysing tobacco litigation

Increasing awareness of the harms associated with tobacco led governments around the world to introduce a range of measures, from smoke free laws to restrictions in the advertisement of tobacco products, especially in the wake of signing the Framework Convention on Tobacco Control (FCTC). The tobacco industry began challenging this growth of regulation in international courts and courts in developed countries. More recently, they have brought the fight to low- and middle-income countries. Using constitutional case analysis from tobacco litigation in South Africa, India, Uganda and Kenya, this article argues that there is increasing evidence that tobacco companies are engaged in vertical forum shifting through a reappropriation of constitutional rights from corporations. This we argue, has had an adverse impact on human rights in low- and middle-income countries. We end this article by boldly calling on courts to find (and limit) the kinds of rights that are to apply to corporations

What have Rights got to do with it? Evaluating ‘Human Rights’ as a practice within the Global Fund

In this article, we want to understand the relationship between states and global health financing organizations and how they seek to advance human rights in their grant programs. We therefore ask: to what extent can global financing institutions shape human rights practices at the domestic level? The article uses the case study of the GFATM’s experience of adopting human rights as an institutional norm and analyzes the implications for the institution’s new role as a human rights actor within states. In particular, we argue that the institutional design of the institution impacts on the ability of the GFATM to substantively enhance human rights agendas within local health governance contexts

The Role of Civil Society in Mobilizing Human Rights Struggles for Essential Medicines: A Critique from HIV/AIDS to COVID-19

In this paper, we explore the strategies utilized by civil society organizations to improve access to medicines during the HIV/AIDS and COVID-19 health crises. In particular, we seek to illuminate why some of the successful approaches for increasing access to antiretrovirals for HIV/AIDS in the early 2000s failed in creating equitable global access to COVID-19 vaccines. While civil society has historically mobilized human rights to facilitate greater access to essential medicines, we argue that earlier strategies were not always sustainable and that civil society is now mobilizing human rights in radically different ways than previously. Instead of focusing chiefly on securing an intellectual property waiver to the TRIPS Agreement, civil society organizations are now challenging vaccine injustice, rejecting the “charity discourse” that fuels Global South dependency on Global North actors in favor of scaling up manufacture in low- and middle-income countries, and moving to embed the right to access medicines in a new World Health Organization pandemic treaty with civil society organization participation and meaningful representation from low- and middle-income countries. Such approaches, we contend, will lead to more sustainable solutions in order to avert further health care disasters, like those seen with two distinct but related struggles—the fights for equitable access to essential medicines for HIV/AIDS and for COVID-19

Analyzing the human rights impact of increased digital public health surveillance during the COVID-19 crisis

The COVID-19 pandemic has led policy makers to expand traditional public health surveillance to take advantage of new technologies, such as tracking apps, to control the spread of SARS-CoV-2. This article explores the human rights dimensions of how these new surveillance technologies are being used and assesses the extent to which they entail legitimate restrictions to a range of human rights, including the rights to health, life, and privacy. We argue that human rights offer a crucial framework for protecting the public from regulatory overreach by ensuring that digital health surveillance does not undermine fundamental features of democratic society. First, we describe the surveillance technologies being used to address COVID-19 and reposition these technologies within the evolution of public health surveillance tools and the emergence of discussions concerning the compatibility of such tools with human rights. We then evaluate the potential human rights implications of the surveillance tools being used today by analyzing the extent to which they pass the tests of necessity and proportionality enshrined in international human rights law. We conclude by recommending ways in which the harmful human rights effects associated with these technologies might be reduced and public trust in their use enhanced