Highest Attainable Standard Research Articles

A nationwide evaluation study of the quality of care and respect of human rights in mental health facilities in Ghana: results from the World Health Organization QualityRights initiative

BackgroundIn 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services.MethodsAssessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology.ResultsThis study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified.ConclusionsThis study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country.

9.A. Workshop: The contribution of Environmental Impact Assessments to better health

As society builds back from COVID-19 we must ensure that policy decisions about the built environment protect and promote human health. This roundtable is organised by 4 EUPHA sections: Health Impact Assessment; Ethics in Public Health; Law & Public Health; Environment & Health. The objective is to consider ethical, legal and methodological issues raised by the requirement for health to be considered in the EU Environmental Impact Assessment (EIA) Directive. This roundtable will cross-examine the advice that EUPHA wrote with the International Association for Impact Assessment (IAIA) to guide health authorities through the EIA process. See https://eupha.org/section_page.php?section_page=200.We contend that human health in EIA cuts across many aspects of public health and that public health must up its game. The EIA Directive provides a high level of protection to the environment and health on land and at sea. It applies to a wide range of projects in all EU Member States, including those co-financed by the EU through its Cohesion, Agricultural and Fisheries Policies. It applies to projects funded by the financial institutions of the EU which operate globally. The directive explicitly requires human health to be considered and yet gets little input from health authorities. EIA is a forward-looking instrument. EIA provides information to a decision-maker before effects occur. This allows for environment and health to be hard-wired into the design of a project. It places public health at the heart of deliberations about the future of infrastructure and the built environment.Format: the roundtable will open with an introduction to the process of EIA and the EUPHA/IAIA reference paper. Panellists will then question the speakers. The chairperson will invite questions from all participants. The organisers will generate debate on social media.Areas of inquiry are provided belowEthics: The construction and operation of projects can have good and bad effects on communities, and these effects can go beyond the current generation. What ethical principles should guide the design of these projects? How can an ethical EIA be ensured and what is the role for public health? Are there overlapping ethical principles in protecting the environment and protecting health?Law: What legal instruments can be used to promote, as well as to protect, health? How can EIA be used to ensure that States uphold their legal obligations to respect, protect and fulfil the enjoyment of the highest attainable standard of health for all?Environment: EIA is involved in granting planning consent for large projects that require resources and which change the environment. Is the argument linking health and environment made strongly enough? What standards are being applied? What is the role of the WHO? How can the strength of the EU Green Deal be utilised?The panel will conclude by formulating crucial points for improving public health in EIA and lessons for other cross-sectoral work.Speakers/Panelists Els Maeckelberghe Wenckebach Institute for Medical Education and Training - University Medical Center Groningen, Groningen, Netherlands Marija Jevtic University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia Amandine Garde Law & Non-Communicable Diseases Unit, Liverpool, UK Sarah Humboldt-Dachroeden Roskilde University, Copenhagen, Denmark Filipe Silva Public Health by Design Limited, Hounslow, UK Key messages Human health in Environmental Impact Assessment is a legal requirement, it cuts across many aspects of public health and public health must up its game.Health in Environmental Impact Assessment provides a test case and a working example of health in other sectors and raises many fascinating questions for the future of public health.

A Human Right Approach of Right to Health During Pandemic

The right to live isn’t the absence of death; it’s living a life with good health and human dignity.’ Human rights are fundamentally linked to global health in the context of the COVID-19 pandemic. Human rights law guarantees everyone the right to the highest attainable standard of health and obligates governments to take steps to prevent threats to public health and to provide medical care to those who need it. The language and principles of human rights relate to the rights that support the survival and basic wellbeing of communities and individuals, including their rights to life, health and an adequate standard of living. Human rights law also recognizes that in the context of serious public health threats and public emergencies threatening the life of the Nation, restrictions on some rights can be justified when they have a legal basis, are strictly necessary, based on scientific evidence and neither arbitrary nor discriminatory in application, of limited duration, respectful of human dignity, subject to review, and proportionate to achieve the objective. The scale and severity of the COVID-19 pandemic clearly rises to the level of a public health threat that could justify restrictions on certain rights, such as those that result from the imposition of quarantine or isolation limiting freedom of movement. At the same time, careful attention to human rights such as non-discrimination and human rights principles such as transparency and respect for human dignity can foster an effective response amidst the turmoil and disruption that inevitably results in times of crisis and limit the harms that can come from the imposition of overly broad measures that do not meet the criteria.

DE-STIGMATISING PSYCHOSOCIAL DISABILITY IN SOUTH AFRICA

Stigma and associated discrimination against persons with psychosocial disabilities constitute a considerable barrier to the realisation of the highest attainable standard of health in South Africa, Africa, and further afield, constituting a significant human rights violation. This situation is evidenced and exacerbated by mental health as a whole remaining under-prioritised in law, policy and resource allocation. States parties to have a duty to address stigma and discrimination through awareness raising and education. Some important commitments have been made in this respect, particularly at the policy level in South Africa. Nevertheless, and as demonstrated by tragic recent events, effective implementation remains lacking. This article lays out the obligations incumbent upon the South African government to address stigma and discrimination on the basis of psychosocial disability as a public health and human rights imperative by examining positive duties incorporated into international instruments and domestic law and policy. It further considers the role of political de-prioritisation of mental health and how this constitutes stigma of a systemic nature, using case law and examples of research and best practice from South Africa, Africa generally, and beyond. We conclude that South Africa is failing to meet its obligations to persons with psychosocial disabilities, and recommend that positive duties be emphasised in potential disability-specific legislation; high-level political commitment and co-ordination issecured for mental health; the CRPD’s independent monitoring requirement is urgently fulfilled; and contextually-relevant interventions are crafted with the active participation of persons with psychosocial disabilities and their representative organisations.

Health Disparities and New Health Technologies - A Patients' and Human Rights Perspective.

The human right to health requires that everyone should have equal opportunities to enjoy the highest attainable standard of health. In practice, this is hard to achieve, as health is shaped by social determinants. This article explores the impact personalized medicine and use of big data may have on health disparities. New health technologies offer a lot of hope for more individual and better health promotion and care, which potentially could be beneficial for the most deprived. However, there are also concerns that not all population groups will profit equally from this new population-based medicine, and that new digital health technologies will maintain - or even reinforce - existing health disparities. This article suggests using insights from poverty studies combined with a patients' and human rights-based approach to ensure that the most deprived are not left behind in the application of new health technologies.

Improving access to healthcare for paediatric sickle cell disease patients: a qualitative study on healthcare professionals\u2019 views

BackgroundIn well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families.MethodsHealthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as “transportation”, or “telecommunication”). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data.ResultsIn 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient’s home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users’ health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings.ConclusionThis qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child.

The Protection of the Environmental Rights and Interests of Children: A South African Perspective

It is becoming increasingly apparent that children are disproportionately vulnerable to environmental harm, taking into account their physical, physiological and developmental characteristics. Environmental degradation threatens children’s enjoyment of fundamental rights and freedoms, such as the right to a clean and healthy environment, the right to life, the right to health, the right to the highest attainable standard of living, and the right to dignity. This article evaluates the extent to which the South African legal framework protects the environment-related rights and interests of children. In order to achieve this objective, the article outlines the body of international and African regional human rights law and the environmental law and policy that protects and promotes the environment-related rights and interests of children. The contribution also discusses the mechanisms for redress at the international, regional and national levels in the event of environmental harm to the rights and interests of children. The body of international and African regional law sets the expectations and normative benchmarks to measure the compliance of the national (South African) legal and policy framework.

RIGHTS-BASED APPROACHES TO IMPROVING FOOD AVAILABILITY FOR TAMARIKI MĀORI: A narrative literature review and theory-based synthesis

Food availability refers to the adequacy of the supply of healthy food. It is a key concern for the wellbeing of tamariki Māori today. A narrative literature review methodology was applied to examine the literature and identify influences that enable the availability of healthy food for tamariki. Findings were synthesised and analysed using the Oranga Mokopuna framework—a rights-based approach grounded in tikanga Māori. Factors enabling healthy food availability for tamariki involve the fulfilment of their rights to (a) an environment that enables access to traditional foods and food practices, (b) be involved in decisions about their food environment, (c) the right to adequate food and (d) the highest attainable standard of health (and within this) to be protected from food marketing. There is limited evidence that the New Zealand government is meeting these obligations to tamariki. Thus, the right to healthy food needs to urgently be embedded across legislation, policy and practices.

Saúde Coletiva e a pandemia da COVID-19: desafios para uma saúde global

A Saúde Coletiva visa alcançar a maior compreensão possível do fenômeno da vida humana relacionado ao processo saúde-doença e a obtenção dos maiores padrões alcançáveis de saúde e bem-estar da população. Este campo de saberes contribui para o combate à pandemia da COVID-19, tendo a epidemiologia como destaque. Objetivo: fomentar uma reflexão sobre saúde e a atual pandemia com a proposta da construção presente e futura de uma saúde global mais integrativa e cooperativa, com serviços de saúde acessíveis às populações. Método: revisão de literatura a partir de pesquisa realizada em livros e base de dados de publicações científicas (BVS e Scielo). Resultados: foram incluídos nessa revisão textos científicos considerados pertinentes para a discussão, tendo como temas Saúde Coletiva e COVID-19. Discussão: a discussão foi organizada em quatro categorias, a saber: desafios epidemiológicos da COVID-19 para a saúde; medidas de contenção da pandemia; o impacto da pandemia na saúde mental; o impacto social e econômico da pandemia. Conclusão: ainda existem muitos desafios para uma saúde global colaborativa entre os diversos países do mundo.

Review of the Health Act 2017 Using the Availability, Accessibility, Acceptability and Quality Framework

The International Covenant on Economic, Social and Cultural Rights (ICESCR) provides for the right to the highest attainable standard of health. Kenya has ratified this Covenant and is, therefore, bound by its provisions. The Constitution of Kenya (2010) further establishes a framework for expanding rights and freedoms under Article 24 (4). The Constitution expressly provides for the right to health under Article 43 (1), which led to the enactment of the Health Act in 2017 (the Act). Article 43 (1) (a) of the Constitution states: 'Every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.' On this light, the right to health will be analyzed in the following lines.

Control of Communicable Diseases as a Global Public Good

The article aims at giving a comprehensive overview on controlling communicable diseases (CCD) and discusses the implications of providing CCD as a global public good (GPG). After a short introductory summary of the history of CCD, Sections “PUBLIC (COMMON) GOODS” and “GLOBAL PUBLIC GOODS” offer a concise definition of the concepts of “public goods” and “global public goods”. Sections “INTERNATIONAL HEALTH REGULATIONS (1969–2005) AS A GPG” and “IHR (2005) AND CCD” critically analyse the International Health Regulations (IHR) (2005) as a means to provide CCD as a GPG, and argues that it falls short of that goal as (a) many countries are not able to provide the “Core Capacity Requirements for Surveillance and Response” because of severe deficits of their health systems, (b) the IHR do not include HIV/AIDS, tuberculosis, malaria, etc. which are a constant threat in infested regions (and to international transmission) and may be called “chronic infectious diseases” and (c) ignore the issue of fighting antimicrobial resistance. Therefore, full global health security (accepting the highest attainable standard of health as a human right) needs an integrated CCD which implied that CCD is provided as a GPG, including minimal standards of health everywhere, a “One-Health” approach, and the perspective of “Health in All Policies” (Section “TOWARDS AN INTEGRATED CONTROL OF COMMUNICABLE DISEASES AS A GPG”). Section “FINANCE OF CCD” discusses the dimension of financing CCD as a GPG and poses the question whether an enhanced transnational norm-building and solidarity can be expected. Improving CCD is not only one step towards the goal of “one healthy world”, but also depends on a comprehensive improvement of health services.

Achieving universal health coverage by 2030: The role of parliaments in ensuring right to health

In October 2018, on behalf of the Bangladesh Parliament, I proposed to the 139th Assembly of the Inter Parliamentary Union (IPU) to adopt a resolution on “Achieving universal health coverage by 2030: The role of parliaments in ensuring the right to health” (Annex-1). After the acceptance of my proposal, I worked as a co-rapporteur along with Mr. Christian Lohr, Member of the National Council, Switzerland and Ms. Mariana Carvalho, Member of the Chamber of Deputies, Brazil for a year to consult with and gather inputs from the parliaments and parliamentarians across the world.
 After several intensive discussions, debates and consultations in different parts of the world, we presented a draft proposal to the IPU member parliaments before presented it to the IPU assembly. Later, following the final debate and discussion, 141st IPU assembly 2019 in Belgrade, Serbia approved this resolution. I believe this global tool will enable parliaments and parliamentarians to contribute in ensuring the highest attainable standard of health and global health targets by 2030.
 I am grateful to the Hon’ble Prime Minister of Bangladesh Jononetry Sheikh Hasina MP and the Hon’ble Speaker of Bangladesh Parliament Dr. Shirin Sharmin Chaudhury MP for their encouragement. I am also thankful to IPU President Ms Gabriela Cuevas Barron, IPU Secretary General Mr Martin Chungong and World Health Organization Director General Dr Tedros Adhanom Ghebreyesus for their regular guidance towards this initiative. My sincere appreciation goes to the colleagues from the Bangladesh Parliament, Ministry of Health and Family Welfare of Bangladesh, Ministry of Foreign Affairs of Bangladesh, IPU Secretariat and WHO Secretariat for their contribution in the process.
 I hope our parliaments and parliamentarians will take full advantage of this resolution in their work to make the right decisions when it’s come to those health issues.
 I am now looking forward to working together with my fellow parliamentarians from home and abroad to deliver the commitment we have made through the IPU resolution on universal health coverage. I would appreciate your comment, suggestion and advice in this regard.

Management of Devolved Health Services and Healthcare Service Delivery in Arid and Semi-Arid Lands in Kenya

The 2010 Constitution provides a legal framework that guarantees an all-inclusive rights-based approach to health service delivery to Kenyans. It provides that Kenyans are entitled to the highest attainable standards of health, which includes the right to healthcare services including reproductive health care (Article 43). The purpose of this study was to investigate the the extent to which management of devolved health services influence health-care service delivery in Arid and Semi-Arid Lands in Kenya. This study was guided by fiscal decentralization theory and theory of performance improvement, as well as sequential theory of decentralization. This study used a triangulation of both positivism and phenomenology. The population under this study constitute the Sub-Counties in ASAL in Kenya with a sample size of 89 Sub-Counties being sampled and 3 patients from each of the 89 sampled sub counties. This study found that, since the onset of devolution, there has been introduction of more healthcare facilities at counties in ASAL resulting with sub-county leaderships have been largely considering the opinions raised by the residents while implementing health services decisions. Management of devolved health services, healthcare has greatly made health facilities and services more accessible to residents compared to before with the previous five years recording great improvement in the quality of the health services at county health centers. The national government should therefore consider increasing financial resources to counties, which would eventually enhance health manpower for better service delivery. This study therefore recommends that the hospitals management should come up with strategies that can help improve financial resources to fund facilities improvement.

‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities

The Convention on the Rights of Persons with Disabilities (CRPD) creates duties for States Parties and UN agencies to ensure that individuals under their protection have equal enjoyment of the full range of human rights. This includes the Article 25 right to enjoy ‘the highest attainable standard of health without discrimination on the basis of disability.’ However, refugees, who are forced to seek protection outside their state, face particular obstacles to maintaining an adequate level of wellbeing and accessing services to meet their health needs. Among this group, those who have a disability may confront multiple intersecting challenges. This paper draws on the findings of research across countries that play host to significant refugee populations. It explores the contribution of the CRPD to the international human rights framework for refugees, with particular attention to the right to health. Incorporating evidence from the field, it discusses the implementation of these rights and related duties in humanitarian responses across the world. This article discusses common barriers to health services for refugees with disabilities in six host countries. Based on the broad conceptualization of health and wellbeing established in the international legal framework, it also examines the relationship between the fulfilment of Article 25 and other basic socioeconomic rights. It provides examples of good practice and identifies strategies to better ensure the rights set out in Article 25 of the CRPD.

Water as Human Right: Impact of Thai Binh 1 Thermal Plant Project on Domestic Water Supply of Riverine People in Chi Thien Village, Vietnam

The research studies on the typical context of Chi Thien village, an area having new- operated coal-power plant as the development project in the northern part of Vietnam. As the focus of the research, domestic water supply is studied. Conventionally, villagers harvest rainwater into big reservoirs that later on were demolished for house renovation after the agricultural compensation for the coal plant construction. Since the establishment of the Thai Binh 1 Thermal plant, locals are recommended not to drink raining water because of potential negative impacts of coal ash on human health. Findings of the research indicate that local households have been provided with tap water service since 2014 by the Chieu River water plant of the local authority. However, doubts on the low tap water quality and its unstable frequency, rainwater returns to be the preferable choice for their domestic water supply. There is a regular check on water affirmed by the engineer from Chieu River plant. Nevertheless, for confidentiality, it was not allowed to publish regardless of the request to have evidence on qualified tap water. This is considered as the violation of the right to information and the participation in environmental decision making of the villagers. For certain disadvantages of water situation, local people have adaptation by buying reverse osmosis(RO)water filters(wealthier family only)and need to pay for water consumption expense with the low quality received. Study on domestic water is a study on human well-being, human rights and state obligation to ensure the water sanitation, the accessibility, and affordability to people. The role of the Vietnamese government is analyzed in addressing these potential impacts caused by the coal plant project towards an adequate standard of living and the highest attainable standard of health in Chi Thien. The thesis is social research using qualitative research methodology of in-depth interviews and referral samples to approach the topic and elicit reliable information, particularly on opinions and hands-on experiences of villagers.

Rights for whom? Linking baby’s right to eat with economic, social, and cultural rights for women

Breastfeeding women are primary food producers par excellence, delivering a custom-made product to fit the exact needs of a favoured clientele. The importance of breastmilk as a first food has been acknowledged in recent years by many states, which have taken measures to protect and encourage breastfeeding in acknowledgment of the World Health Organization’s 2002 Global Strategy for Infant and Young Child Feeding. Within both state and grassroots efforts to promote it, breastfeeding is often framed in terms of “rights,” though it is not always clear what these entail. This perspective article considers the role of breastmilk as a critical food for children that ensures their “right to the highest attainable standard of health” as articulated in Article 24 of the Convention on the Rights of the Child, and interrogates mothers’ (and others’) role in providing it. While food studies, and even more so, food security scholarship and activism should incorporate breastfeeding scholarship, it should avoid the mistake of framing breastfeeding as a “choice” made by individual women. This article advocates incorporating breastfeeding into the right to food/food security agenda by explicitly supporting measures that increase women’s access to broader economic, social, and cultural (ESC) rights. This, in turn, would put breastfeeding within reach, as an option, for more women. Thus breastfeeding becomes more likely and pressure is diverted from individual mothers and the often false ‘choice’ to breastfeed.

Refusing Reproductive Health Services on Grounds of Conscience in Latin America

The years have seen a rise in the use of conscientious objection (CO) as means to deny women their sexual reproductive health rights. While states have an obligation under international human rights law to protect the freedom of thought, conscience and religion of people, they also have obligations to protect the right to the highest attainable standard of health and other fundamental rights. Over the years, International and regional human rights bodies have indicated the need for CO to be limited so as to protect women’s rights. As a means to balance both rights of medical service providers to exercise their moral beliefs and to protect the right to health of women, countries around the world have also sought different ways to regulate the use of CO. Whereas in some countries, some developments have been made to regulate CO so as to protect fundamental rights of women, in others, few guidelines exist in order to ensure availability of services for women in case refusals are made. This article provides an overview of policies regulating CO in Latin America. It considers the regulation of CO under both international law and under various state laws within the region. It suggests that if women’s reproductive rights are to become a reality, then there is a real need that states as well as international and regional human rights bodies continue to find ways to clarify frameworks around CO, so that grounds of conscience do not become an excuse to deny women realisation of their fundamental rights.

Key populations and human rights in the context of HIV services rendition in Ghana

BackgroundIn line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations – populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana’s response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights.DiscussionGhana’s response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana’s guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation’s HIV epidemic is real: criminalization impedes key populations’ access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly.SummaryThe right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to public health services provision to these populations. Doing so will require political will and sufficient planning toward prioritizing HIV prevention, care and treatment programming for key populations.

Gesondheidsorg vir Kinders: Voldoen Suid-Afrikaanse Wetgewing Aan die Land se Verpligtinge Ingevolge die Konvensie Oor die Regte van die Kind en die Grondwet?

Included in the Convention on the Rights of the Child, 1989 (UN Children's Convention) is the right of children to the highest attainable standard of health. In terms of article 4 of the UN Children's Convention, in implementing the UN Children's Convention state parties must "undertake all appropriate legislative, administrative, and other measures for the implementation of the rights recognised in the present Convention". South Africa showed its commitment to protecting and promoting children's health when it ratified the UN Children's Convention and subsequently adopted the Constitution of the Republic of South Africa, 1996, which includes provisions guaranteeing the health rights of children. South Africa also showed commitment to giving legislative effect to the protection and promotion of children's health by promulgating the National Health Act 61 of 2003, the Children's Act 38 of 2005 and the Mental Health Care Act 17 of 2002. The article evaluates existing policy and legislation affecting child health in order to assess how well South African legislation addresses the issue of children's healthcare rights and whether or not it complies with its international law and constitutional obligations in this regard. The article concludes that although much legislation exists, none provides comprehensively for children's healthcare rights, and there are many gaps in existing legislation. Most importantly, there is no reference to the core minimum requirements for the state in providing for the health of children, particularly in the way of healthcare services and nutrition. Further, there is a complete lack of legislation which protects the health needs of children with disabilities. In order to ensure that the health rights of children are protected and promoted, we propose more comprehensive legislative protection.

A Human Rights-Based Approach to Poverty Reduction: The Role of the Right of Access to Medicine as an Element of the Right of Access to Health Care

A Human Rights-Based Approach to Poverty Reduction: The Role of the Right of Access to Medicine as an Element of the Right of Access to Health Care