Just Health Care in Nigeria – The Foundations for an African Ethical Framework

Countries in Sub-Saharan Africa share at least three things: cultural heritage, a high burden of disease and a low financial commitment to health care. This thesis asks questions of justice about health care systems in Sub-Saharan Africa, in particular Nigeria. The questions are about access to the available health resources and services within African health care systems. While the sub-region as a whole cannot boast of good health care, certain population groups are relatively more disadvantaged. This suggests either or both of two problems: a) that access to basic health care is not proportionate to the populations’ needs; and/or b) that the distribution of the available health care resources favour some over others. Attempts to improve population health have focused on empirical, economic or social strategies. These tend to overlook the ethical dynamics surrounding access to and the distribution of health care. In view of this moral challenge, Norman Daniels has proposed the ethical framework of Accountability for Reasonableness, which can provide basic guidelines for just health care reforms in Africa. While his approach has been effective in the United States, the theoretical basis has fundamental value differentials from African ideals of justice. Starting from Daniels’ Just Health – Meeting Health Needs Fairly, this PhD study develops an African ethical framework that could inform reforms in African health care systems. Specifically, it establishes four key attributes of the African moral outlook, and three principles of African justice. It further abstracts an African method of ethical analysis: process equilibrium. Against this background, the thesis develops a harmonised framework of just health care. Daniels’ principles are matched with African principles to create a Just Health Theory, which is adapted to the Sub-Saharan Africa context. The resulting African principles are mapped onto the health care sector and finally blended into the Harmonised Framework of Just Health Care. By combining the insights from Daniels with African values and approaches, it is possible that just health care will be attained in Nigeria and beyond

Perspectives of different stakeholders on data use and management in public health emergencies in sub-Saharan Africa: a meeting report

During public health emergencies (PHEs), data are collected and generated from a variety of activities and sources, including but not limited to national public health programs, research and community-based activities. It is critical that these data are rapidly shared in order to facilitate the public health response, epidemic preparedness, as well as research during and after the epidemic. Nonetheless, collecting and sharing data during PHEs can be challenging, especially where there are limited resources for public health and research-related activities. In a symposium that brought together different stakeholders that were involved in the 2013-2016 Ebola outbreaks in West Africa, meeting attendees shared their perspectives on the values and management of data during PHEs in sub-Saharan Africa. Key factors that could inform and facilitate data management during PHEs in sub-Saharan Africa were discussed, including using data to inform policy decisions and healthcare; a coordinated data collection and management scheme; identifying incentives for data sharing; and equitable data  governance mechanism that emphasise principles of reciprocity, transparency and accountability rather that trust between stakeholders or collaborators. Empirical studies are required to explore how these principles could inform best practices for data management and governance during PHE in sub-Saharan Africa.</ns3:p

Perspectives of different stakeholders on data use and management in public health emergencies in sub-Saharan Africa: a meeting report

During public health emergencies (PHEs), data are collected and generated from a variety of activities and sources, including but not limited to national public health programs, research and community-based activities. It is critical that these data are rapidly shared in order to facilitate the public health response, epidemic preparedness, as well as research during and after the epidemic. Nonetheless, collecting and sharing data during PHEs can be challenging, especially where there are limited resources for public health and research-related activities. In a symposium that brought together different stakeholders that were involved in the 2013-2016 Ebola outbreaks in West Africa, meeting attendees shared their perspectives on the values and management of data during PHEs in sub-Saharan Africa. Key factors that could inform and facilitate data management during PHEs in sub-Saharan Africa were discussed, including using data to inform policy decisions and healthcare; a coordinated data collection and management scheme; identifying incentives for data sharing; and equitable data  governance mechanism that emphasise principles of reciprocity, transparency and accountability rather that trust between stakeholders or collaborators. Empirical studies are required to explore how these principles could inform best practices for data management and governance during PHE in sub-Saharan Africa.</ns3:p

Ought-onomy and African Health Care: Beyond the Universal Claims of Autonomy in Bioethics

Autonomy has been labelled as one of the key principles of biomedical ethics on the premise that it has the capacity to impel universally. Although the conceptual ideals of autonomy immediately seem to conflict with other values, it is adopted in health care to address issues in different socio-cultural contexts. The principles which conflict with autonomy tend to be treated in most cases as secondary, assigning autonomy an overarching value in health care. Consequently, there is a general tendency toward autonomy fetishism in health care. The implication is that a patient should not choose to act otherwise than autonomously, and that this autonomy must be respected in health care contexts generally. The ideals of autonomy, however, are derived from particular socio-cultural backgrounds, which does not necessarily mean that they are suitable in other contexts. On what grounds then does autonomy assume such central value that it is espoused as a universal principle in health care? This thesis examines the legitimacy of autonomy as a universal principle in health care. Through conceptual analyses of the notion, it critiques the basis on which autonomy claims universal validity as a principle of practices. Furthermore, using a particular African socio-cultural context as an example, it shows that the applicability of autonomy as a principle of practice is limited only to some parts of world. Hence, it cannot be adopted as a general principle of practice in health care. This thesis proffers ought-onomy as an alternative principle, which subsumes autonomy and equivalent values in other socio-cultural contexts, and thus is the appropriate mediating principle to be adopted in universal health care. Ought-onomy derives partly from the Kantian ought, but differs from it in the sense that it appeals to the reality of the human condition. It qualifies as a principle as its conception is universalizable and its application practicable across socio-cultural boundaries. It is also in a sense a mediating principle as it only finds expression through other values that it subsumes, such as autonomy and communalism

Ought-onomy and African Health Care: Beyond the Universal Claims of Autonomy in Bioethics

Autonomy has been labelled as one of the key principles of biomedical ethics on the premise that it has the capacity to impel universally. Although the conceptual ideals of autonomy immediately seem to conflict with other values, it is adopted in health care to address issues in different socio-cultural contexts. The principles which conflict with autonomy tend to be treated in most cases as secondary, assigning autonomy an overarching value in health care. Consequently, there is a general tendency toward autonomy fetishism in health care. The implication is that a patient should not choose to act otherwise than autonomously, and that this autonomy must be respected in health care contexts generally. The ideals of autonomy, however, are derived from particular socio-cultural backgrounds, which does not necessarily mean that they are suitable in other contexts. On what grounds then does autonomy assume such central value that it is espoused as a universal principle in health care? This thesis examines the legitimacy of autonomy as a universal principle in health care. Through conceptual analyses of the notion, it critiques the basis on which autonomy claims universal validity as a principle of practices. Furthermore, using a particular African socio-cultural context as an example, it shows that the applicability of autonomy as a principle of practice is limited only to some parts of world. Hence, it cannot be adopted as a general principle of practice in health care. This thesis proffers ought-onomy as an alternative principle, which subsumes autonomy and equivalent values in other socio-cultural contexts, and thus is the appropriate mediating principle to be adopted in universal health care. Ought-onomy derives partly from the Kantian ought, but differs from it in the sense that it appeals to the reality of the human condition. It qualifies as a principle as its conception is universalizable and its application practicable across socio-cultural boundaries. It is also in a sense a mediating principle as it only finds expression through other values that it subsumes, such as autonomy and communalism

Inequitable access to healthcare in Africa : reconceptualising the “accountability for reasonableness framework” to reflect indigenous principles

BACKGROUND : The “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA. METHODOLOGY : A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity. RESULTS : Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle. CONCLUSION : A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.The paper is partly an output of a doctoral research conducted at the University of Central Lancashire, Preston, United Kingdom, and further developed during a postdoctoral research fellowship at the University of Pretoria, South Africa. The paper was also presented at the Brocher Foundation Workshop, “African perspectives on the Human Right to Health” Geneva, January 29th-31st, 2020.The Brocher Foundationhttps://equityhealthj.biomedcentral.comam2022Psychiatr

Priorities for global access to life-saving interventions during public health emergencies: Crisis nationalism, solidarity or charity?

Access to COVID-19-vaccines by the global poor has unveiled the impact of global health and scientific inequities on access to life saving interventions during public health emergencies (PHE). Despite calls for global solidarity to ensure equitable global access to COVID-19 vaccines, wealthy countries both in the north and southern hemisphere may find a charity-based approach more appealing and are using the opportunity to forge neo-colonial cooperation ties with some African countries. Solidarity is undoubtedly an ideal equity-based principle of public health emergency of international concern (PHEIC). However, its application may be wanting especially as crisis nationalism is more likely to inform the public health policy of any country during a PHEIC, even when they are strong advocates of global solidarity. African countries, on the other hand, must re-appraise their heavy reliance on international aids during PHE and recognise the importance of boosting their epidemic preparedness including research and translation of its findings to practice