Tag: health

Faith leaders find ‘hidden’ children living with HIV — Global Issues

Every hour, 11 children die of AIDS, so finding them and offering treatment is as critical as ever, according to the UN entity UNAIDS, which released a new report about how imams, pastors, and priests are reaching those most in need. While three quarters of adults living with HIV are on treatment, only half of children are, the agency reported.

There are still 1.7 million children around the world living with HIV, and they are particularly vulnerable, said Stuart Kean, author of the Compendium of Promising Practices on the Role of African Faith Community Interventions to End Paediatric and Adolescent HIV, co-published by UNAIDS and the US President’s Emergency Plan for AIDS Relief (PEPFAR).

“If they’re born with HIV, then 50 per cent of them will die by the age of two,” he told UN News. “If they don’t and if they are not found and put on treatment, 80 per cent of them will die by the age of five, so there’s much greater urgency to find these hidden children.”

Promising practices

The new compendium documents 41 promising practices that provide evidence of the core roles that faith communities have played. This includes significant strides in identifying undiagnosed children living with HIV, improving continuity of treatment, supporting adolescents to access psychosocial support, care, and treatment, and enabling peer support groups to empower children and adolescents living with HIV.

“This report shows how vital is the role of faith-based organisations in helping children living with HIV to access life-saving treatment, in advocating in support of their needs, and in tackling stigma,” Jacek Tyszko, Senior Programme Advisor at UNAIDS told UN News. “It demonstrates too the approaches that have been most effective, so that they can be scaled up. It’s a report that will help save lives.”

Zambian influencers

“If you want to find women, go to their places of worship,” said Gibstar Makangila, head of a Zambia-based non-governmental organisation, Circle of Hope.

Since a new community-outreach model unrolled across Zambia’s capital city, Lusaka, in 2018, faith leaders have helped to reach 60,000 people across the country who were not receiving antiretroviral treatment, or ART, he said.

“As a faith community, we are the bridge between the community and health services,” he told UN News. “It is the most influential group in sub-Saharan Africa.”

When social media spread mis- and disinformation about the COVID-19 vaccine, Circle of Hope consulted faith leaders, the “real influencers”, he said. After convincing their congregants of the benefits, vaccination rates in Zambia soared, to 75 per cent from 34 per cent within six months.

Now, these imams, pastors, and priests are now playing a key role in making sure no one is left behind in the global bid to rid the world of HIV/AIDS, according to UNAIDS.

Abstinence and condoms

Contrary to anti-condom or anti-gay myths about religions, faith leaders are driving advocacy efforts to tackle the stigma and discrimination of those living with HIV and advocating for abstinence or at least prevention, including condom use, Mr. Makangila said.

They also readily direct congregants to projects for adolescents and to community health posts, set up as discreet unbranded stalls in markets. Now, 130 community health posts across the country, offer, with Ministry of Health and PEPFAR support, free services, from condoms to on-site treatment. Targeted programmes are also reaching teenagers, he said.

“I’ve seen this result thousands of times in people who would be dead without treatment,” Mr. Makangila said, adding that “the best is yet to come”, with health posts being planned for Côte d’Ivoire, Kenya, Nigeria, South Sudan, and Zimbabwe.

Baby baskets in Nigeria

A new baby is a celebration, commonly in marked in Nigeria in places of worship, where a pregnant congregant typically receives a baby shower basket chock full of goodies, from blankets to diapers.

Now, these welcome baskets include information on HIV testing and support services from local health-care providers, Mr. Kean explained.

Building on a successful trial, the Catholic Caritas Foundation implemented this “congregational approach” in Benue state demonstrating the effectiveness of using on-site confidential testing in such congregational settings as churches.

United Nations

SDG 3

Across Nigeria, this approach has already reached thousands. From April 2018 to March 2019 alone, 22,197 children under age 15 were referred for HIV testing, 21,142 of them were tested, and 106 new HIV-positive children were identified and linked to treatment.

Eswatini: Community action

The faith-based organisation Shiselweni Home Based Care in Eswatini launched an intervention involving community members visiting people who may be living with HIV, referring them to testing facilities and, if testing positive, supporting them to start and adhere to ART medication.

The latest trend indicates a dramatic 71.4 per cent decline in overall client mortality, from approximately one in three clients in 2007 and one in 10 in 2011.

Religious leaders and faith-based organisations like Circle of Hope in Zambia have also enrolled as “Faith Paediatric Champions”, who advocate to governments and community members for all children and adolescents to be supported to access HIV care and treatment.

Race to end AIDS

However, the global response to end AIDS in children continues to be inadequate, UNAIDS Executive Director Winnie Byanyima and John Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, said in the new report.

“The work of faith communities in addressing the challenge of HIV in children has been highly effective,” they wrote. “In that work of practical delivery, faith communities, and faith-based organisations have also reminded the world of a deeper lesson: to truly embrace those who are most vulnerable and excluded, caring, compassion, and love are essential.”

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Nurturing future generations through breastfeeding — Global Issues

On the occasion of World Breastfeeding Week, Christine explained how she is helping other nursing mothers through a UN-supported programme in the Rhino Camp.

“I feel like the proudest mother in the world when I breastfeed him,” said Christine, from South Sudan. “I know that breastfeeding him will help him grow into a strong and healthy and intelligent boy. He is my future.”

Each morning, inside her small house, she gets herself and young son ready for the day. With 12-month-old Alvin snuggled into a wrap tied across her back, she makes her way to the local health centre just a few minutes’ walk from her house. There she is greeted by a small group of women, most of whom have tiny babies in their arms or on their backs.

Christine comes here each day, where she earns a small income as a community worker, mentoring other breastfeeding mothers. She is here to help give her son the best start at life and to help other women do the same.

Lifeline in fragile settings

World Breastfeeding Week 2023

Breastfeeding is always important, but in fragile settings like this, it’s a lifeline. It not only provides all the nutrients a baby needs for the first six months of life, it’s also free of charge and almost always available.

In 2016, when Christine was a 25-year-old college student and aspiring teacher, rebels attacked her hometown of Yei, in South Sudan. She and her family fled into the bush, but shortly afterwards, her father was killed while looking for medicine for a sick family member. Fearing for their lives, Christine and her family fled to Uganda, eventually settling in Rhino Camp.

Her husband has since returned to South Sudan, but Christine has stayed on. In South Sudan, two thirds of the population are facing crisis levels of hunger, the highest number ever, and there is no sign of the situation improving soon.

She has found some stability in Uganda, for herself and her son. She said she was happy with the life she is building there.

Cash for breastfeeding mothers

Ⓒ WFP/Arete/Siegfried Modola

WFP’s nutrition programme supports breastfeeding mothers through cash assistance and nutrition counselling.

Last year, while heavily pregnant, Christine became one of 13,000 pregnant and breastfeeding women from both refugee and host communities to receive Nutricash.

Part of the Swedish-funded Child Sensitive Social Protection Programme, under which the World Food Programme (WFP) collaborates with the UN Children’s Fund (UNICEF) and the Government of Uganda, the project provides each woman with $13 to help meet food and nutrition needs and $4 that is put into savings.

Christine has used some of her savings to plant avocado trees and cassava. She plans to go back to school one day and become a teacher. She hopes her savings will make this a reality. Other women use the money to buy goats and pay for school fees.

Breaking cycles of poverty

Ⓒ WFP/Arete/Siegfried Modola

Every week, Christine meets with her Joy Care Group, where mothers offer each other support and comfort in addition to sharing experiences about breastfeeding.

“By supporting breastfeeding mothers, through cash and nutrition assistance and counselling, we are breaking a vicious poverty cycle and giving the opportunity to these mothers to send their kids to school, to invest in their small business and in the near future, to become fully self-reliant,” said Abdirahman Meygag, WFP’s country director in Uganda.

After receiving nutrition training from WFP’s partner, Save the Children, Christine started supporting women to breastfeed.

“Some women, especially younger mothers, are often scared to breastfeed,” she explained. “Often, they don’t know how to place their babies, and they want to give up because it’s too painful. They have a lot of chores that cause stress, and they don’t produce enough breastmilk.”

Knowledge is power

Ⓒ WFP/Arete/Siegfried Modola

WFP supports women to breastfeed so that children can have the healthiest start in life.

Breastfeeding is one of the simplest, smartest, and most cost-effective ways of ensuring that children survive and thrive. Breastfeeding has broad benefits, and can help to prevent infant death and childhood illness.

Each week, Christine and members of the Joy Care Group come together for friendship, to share information on breastfeeding and to support and comfort each other.

The women gather under the shade of a tree, holding their babies in their laps as they share their struggles, worries and fears. From time to time, they breastfeed their young babies.

Group member Jemma said knowledge is key.

“I know my child is going to be well and not only my child, but everyone’s child in the group,” she said. “Because we have the knowledge and since we are coming together, every week we learn more.”

Learn more about how the UN supports women and their children during World Breastfeeding Week and throughout the year here.

World Breastfeeding Week

Marked annually from 1 to 7 August, World Breastfeeding Week focuses on the invaluable benefits of nursing. The World Health Organization (WHO) and UNICEF recommend: early initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of life; and the introduction of nutritionally-adequate and safe complementary, solid foods at six months together with continued breastfeeding up to two years of age or beyond. This year’s theme is on working and nursing.

Here are some quick facts:

  • More than half a billion working women are not given essential maternity protections in national laws.
  • Just 20 per cent of countries require employers to provide employees with paid breaks and facilities for breastfeeding or expressing milk.
  • Fewer than half of infants under six months of age are exclusively breastfed.
  • Over 820 000 children’s lives could be saved every year among those under age five if they were optimally breastfed from birth to 23 months.
  • Breastfeeding improves IQ, school attendance and is associated with higher income in adult life.
  • Improving child development and reducing health costs through breastfeeding results in economic gains for individual families and at the national level.

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"No" to Sex Education Fuels Early Pregnancies in Central America — Global Issues

Two pregnant girls walk through the center of the capital of El Salvador, a country with one of the highest rates of pregnancies among girls aged 10 to 14, and where, as in the rest of Central America, what prevails are conservative views opposed to the teaching of sex education in schools, which is essential to reducing the phenomenon. CREDIT: Francisco Campos / IPS
  • by Edgardo Ayala (san salvador)
  • Inter Press Service

SAN SALVADOR, Aug 03 (IPS) – Pregnancies among girls and adolescents continue unabated in Central America, where legislation to prevent them, when it exists, is a dead letter, and governments are influenced by conservative sectors opposed to sex education in schools.

The most recent incident reflecting this situation was the Jul. 29 veto by Honduran President Xiomara Castro of an Integral Law for the Prevention of Adolescent Pregnancy, approved by the single-chamber Congress on Mar. 8 and criticized by conservative groups and the country’s political right wing.

“We don’t know the arguments behind the veto, but we could surmise that the law is still being held up by pressure from these anti-rights groups,” lawyer Erika García, of the Women’s Rights Center, told IPS from Tegucigalpa.

The influence of lobbying groups

Conservative sectors, united in “Por nuestros hijos” (“for our children”), a Honduran version of the regional movement “Con mis Hijos no te Metas” (roughly “don’t mess with my children”), have opposed the law because in their view it pushes “gender ideology”, as international conservative populist groups call the current movement for the dissemination of women’s and LGBTI rights.

In June, the United Nations expressed concern about “disinformation campaigns” surrounding the Honduran law.

The last of the marches in favor of “family and children” took place in Tegucigalpa, the country’s capital, on Jul. 22.

These groups “appeal to people’s ignorance, to fear, to religion, with arguments that have nothing to do with reality,” said García. “They say, for example, that people will put skirts on boys and pants on girls.”

According to the United Nations Population Fund (UNFPA), one in four births is to a girl under 19 years of age in Honduras, giving the country the second-highest teenage pregnancy rate in Latin America.

According to the Honduran Penal Code having sexual relations with minors under 14 years of age is statutory rape, whether or not the girl consented.

In 2022, 1039 girls under 14 gave birth.

“The problem is quite serious, and it is aggravated by the lack of public policies to prevent pregnancies among girls and adolescents,” García said.

In the countries of Central America, which have a combined total of some 50 million inhabitants, ultra-conservative views prevail when it comes to sexual and reproductive health and education.

In El Salvador, Honduras and Nicaragua – as well as the Dominican Republic in the Caribbean – abortion is banned under all circumstances, including rape, incest or a threat to the mother’s life.

In the rest of Central America, abortion is only permitted in certain circumstances.

The Honduran president vetoed the law under the formula “return to Congress”, so that it can be studied again and eventually ratified if two thirds of the 128 lawmakers approve it.

Zuleyma Beltrán, 41, talked about becoming pregnant at the age of 15 because there is no proper sex education in El Salvador. A second pregnancy led to a miscarriage that landed her in jail in 1999, where many Salvadoran women who miscarry or have abortions end up due to a draconian anti-abortion law. CREDIT: Edgardo Ayala / IPS

“I didn’t even know what a condom was”

However, having laws of this nature does not ensure that the phenomenon will be reduced, since legislation is not always enforced.

Since 2017 El Salvador has had a National Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents, and although the numbers have declined in recent years, they are still high.

An UNFPA report noted that in this country the pregnancy rate among girls and adolescents dropped by more than 50 percent between 2015 and 2022.

However, “it is worrisome to see that El Salvador is one of the 50 countries in the world with the highest fertility rates in girls aged 10-14 years,” the UN agency said in its latest report, released in July.

Among girls aged 10-14, the study noted, the pregnancy rate dropped by 59.6 percent, from 4.7 girls registered for prenatal care per 1000 girls in 2015 to 1.9 in 2022.

The map of pregnancies in girls and adolescents in El Salvador added that the country “needs to further accelerate the pace of reduction, adopting policies and strategies adapted to the different realities of girls aged 10-14 years and adolescents aged 15-19 years.”

Such actions must be “evidence-based,” the report stressed.

The reference appears to be an allusion to the prevalence of conservative attitudes of groups that, in Honduras for example, reject sexual and reproductive education in schools.

This lack of basic knowledge about sexuality, in a context of structural poverty, led Zuleyma Beltrán to fall pregnant at the age of 15.

“When I became pregnant I didn’t even know what a condom was, I’m not ashamed to say it,” Beltrán, now 41, told IPS.

She added: “I suffered a lot because I didn’t know many things, because I lived in ignorance.”

Two years later, Beltrán became pregnant again but she miscarried, which landed her in jail in August 1999, accused of having an abortion – a plight faced by hundreds of women in El Salvador.

El Salvador not only bans abortion under any circumstances, even in cases of rape. It also imposes penalties of up to 30 years in prison for women who have undergone abortions, and women who end up in the hospital after suffering a miscarriage are often prosecuted under the law as well.

“The State should be ashamed of forcing these girls to give birth and not giving them options,” said Anabel Recinos, of the Citizens’ Association for the Decriminalization of Abortion.

“The State does not provide girls with sex education or sexual and reproductive health, and when pregnancies or obstetric emergencies occur as a result, it is too cruel to them, it only offers them jail,” she added.

Recinos said that, due to pressure from conservative groups, the State has backed down on the strategy of providing sexual and reproductive information in schools.

“Now they are more rigorous in not allowing organizations working in that area to go and give talks on comprehensive sex education in schools,” she noted.

Not even baby formula

In Guatemala, initiatives by civil society organizations that since 2017 have proposed, among other things, that the State should offer reparations to pregnant girls and adolescents, to alleviate their heavy burden, have made no progress either.

These proposals included the creation of scholarships, making it possible for girls to continue going to school while their babies were cared for and received formula.

“But unfortunately we have not been able to take the next step, to get these measures in place,” said Paula Barrios, general coordinator of Women Transforming the World, in a telephone conversation with IPS from the capital, Guatemala City.

Barrios said that most of the users of the services offered by this organization, such as legal and psychological support, “are girls and adolescents who are pregnant because of sexual violence and are forced to have their babies.”

She said that in the last five years some 500,000 girls under 14 years of age have become pregnant, and the number is much higher when teenagers up to 19 years of age are included.

“Today we have half a million girls who we don’t know what they and the children who are the products of rape are eating,” Barrios stressed, adding that as in El Salvador and Honduras, in Guatemala, having sex with a girl under 14 years of age is considered statutory rape.

“Society sees it as normal that women are born to be mothers, and so it doesn’t matter if a girl gets pregnant at the age of 10 or 12 years, they just think she has done it a little bit earlier,” she said.

Patriarchy and capitalism

The experts from Guatemala, Honduras and El Salvador consulted by IPS said the root of the phenomenon is multi-causal, with facets of patriarchy, especially gender stereotypes and sexual violence.

“The patriarchy has an interest in stopping women from going out into the public sphere,” said Barrios.

She said the life of a 10-year-old girl is cut short when she becomes pregnant. She will no longer go to school and will remain in the domestic sphere, “to raise children and stay at home.”

For her part, Garcia, the lawyer from Honduras, pointed out that there is also an underlying “system of oppression” that is intertwined with patriarchy and colonialism, which is the influence of a hegemonic country or region.

“We have girls giving birth to cheap labor to feed the (capitalist) system, and there is a greater feminization of poverty, girls giving birth to girls whose future prospects are ruined,” she said.

In the meantime, to avoid a repeat of her ordeal, Beltrán said she talks to and teaches her nine-year-old daughter about sexuality.

“In order to keep her from repeating my story, I talk to her about condoms, how a woman has to take care of herself and how she can get pregnant,” she said.

“I don’t want her to go through what I did,” she said.

© Inter Press Service (2023) — All Rights ReservedOriginal source: Inter Press Service

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Climate Change Is Making Us Sick, Says WHO Envoy — Global Issues

The World Health Organization says round 7 million people die prematurely each year due to air pollution. Credit: Busani Bafana/IPS
  • by Busani Bafana (bulawayo)
  • Inter Press Service

BULAWAYO, Aug 02 (IPS) – Climate change is making us sick. It has become urgent to build resilient health systems to secure humanity’s well-being, says the special envoy for climate change and health of the World Health Organization (WHO).

“Climate change is unquestionably affecting our health every day,” says Vanessa Kerry– a renowned global health expert and medical doctor – who was appointed the WHO Director-General’s Special Envoy for Climate Change and Health in June.

She has a tall order to amplify WHO’s climate and health messaging and conduct high-level advocacy on tackling climate change to secure global health.

Increasing Disease Burden

“The climate crisis is a health crisis,” Kerry told IPS in an interview, calling for urgent action to mitigate and adapt to the climate challenge, which has increased the burden of disease around the world.

“Climate change poses a fundamental threat to our health. We are  looking at the growing burden of disease, so urgent action is absolutely needed at this  moment not only to address the pipeline of disease that is coming but to ensure that we can mitigate some of the causes of this poor health and  adapt to the complex challenge.”

Vanessa Kerry. Credit: Seed Global Health

According to the WHO, one in four deaths in the world currently is from preventable environmental causes. For example, around 7 million people die prematurely each year due to air pollution, which is more than the deaths during three years of COVID globally, Kerry said.

The  WHO is already estimating an extra 250 000 deaths per year linked to climate change.

Climate change-induced extreme weather has spiked the incidents of infectious and communicable, and non-communicable diseases, while extreme heat has triggered a rise in cardiovascular diseases and mental illnesses.

Malawi and parts of Southern Africa have suffered serious cholera outbreaks. India faced health heat-related illnesses, a  surge of malaria after the flooding in Pakistan last year, and a malaria outbreak in the United States, all linked to climate change.

Vector-borne diseases, including malaria, dengue, schistosomiasis, human African trypanosomiasis, Chagas disease, and yellow fever, are strongly affected by climatic conditions such as temperature, rainfall, and humidity. While water-borne and sanitation-related diseases, such as cholera, typhoid, and dysentery, are a major contributor to global disease burden and mortality, according to the WHO.

The World Meteorological Organization (WMO) forecasts a 90 percent probability of the El Niño event in the second half of 2023, which is set to trigger a rise in global temperatures and more extreme heat in many parts of the world and in the ocean, said WMO Secretary-General, Petteri Taalas.

“The declaration of an El Niño by WMO is the signal to governments around the world to mobilize preparations to limit the impacts on our health, our ecosystems, and our economies,” Taalas said.

El Niño – a naturally occurring climate pattern associated with warming of the ocean surface temperatures in the central and eastern tropical Pacific Ocean – occurs on average every two to seven years, and episodes typically last nine to 12 months.

The IPCC finds that there is a more than 50 percent chance that global temperature rise will reach or surpass 1.5 degrees C (2.7 degrees F) between 2021 and 2040 across studied scenarios, and under a high-emissions pathway, specifically, the world may hit this threshold even sooner — between 2018 and 2037.

According to the IPCC Assessment Report, climate change has adversely affected the physical health of people globally. Furthermore, extreme heat events have resulted in human mortality and morbidity, while climate-related food-borne, water-borne diseases, and vector-borne diseases have also increased.

Health at COP28

2023 is a crucial year for the intersection of climate change and health as the 28th Conference of the Parties of the United Nations Framework Convention on Climate Change (UNFCCC), more commonly referred to as COP28, will hold a  first-ever day dedicated to health at the climate change conference in the United Arab Emirates in December. This will serve as a critical opportunity to emphasize the profound significance of addressing climate change in relation to human health, Kerry said.

“My goal is to ensure our response to the climate crisis could be health-centered and try to mainstream it at COP negotiations, “ said Kerry, who believes in promoting public understanding of the climate crisis as a health crisis that must be managed now.

“I think people tend to associate climate change with just one aspect of health, like infectious diseases. But the truth is we see climate change impacting pretty much every aspect of health, communicable diseases to non-communicable diseases,” she said.

The Paris Agreement of 2015 is seen as a public health agreement with the WHO highlighting that health considerations are critical to the advancement of climate action, and meeting the Paris Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone.

Kerry said, for instance, investment in reducing air pollution would save lives and prevent a future loss of almost $50 trillion spent since 2010 in addressing this challenge.

“We also have an opportunity to reframe how we think about what being healthy means and how that impacts both our environment and how we live, ” said Kerry, stressing the importance of meaningful investment in stronger health systems and a workforce capable of meeting some of the climate burdens.

Investing in Health Systems

Kerry said building resilient health systems through training health workers and investing in infrastructure is key to responding to climate change. Many health systems around the world are already under-resourced and understaffed. They cannot deal with the current burden of disease and what will come as the impacts of climate change grow.

“We also have an opportunity to reframe how we think about what being healthy means and how that impacts both our environment and how we live, ” said Kerry, stressing the need for absolute dollars going into health and a health-centered climate smart response.

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Government Health Financing for All, Not Insurance — Global Issues

  • Opinion by Jomo Kwame Sundaram, Nazihah Noor (kuala lumpur and bern)
  • Inter Press Service

KUALA LUMPUR and BERN, Aug 02 (IPS) – To achieve universal health coverage, people need public healthcare systems providing fair access to decent health care. This should be an entitlement for all, regardless of means, requiring adequate, appropriate and sustainable financing over the long term.

Jomo Kwame Sundaram

Appropriate arrangements can help ensure a financially sustainable, effective and equitable healthcare system. However, insurance-based systems – both private and social – not only incur unnecessary costs, but also undermine ensuring health for all.

Private health insurance

Voluntary private health insurance (PHI) is not an acceptable option for both equity and efficiency reasons. Those with lower health risks are less likely to buy insurance. Paying the same rate will be seen as benefiting those deemed greater risks, especially the less healthy, often also those less well off.

Hence, PHI premiums are often ‘risk-rated’. This means those considered greater risks – e.g., the elderly or those with pre-existing conditions – face higher premiums. As these are often un-affordable, many cannot afford coverage.

This is clearly neither cost-effective nor equitable, but also socially risky, especially with communicable diseases. This typically means poorer health outcomes compared to spending. Also, various insurance premium rate arrangements have different distributional consequences.

‘Fee-for-service’ reimbursement encourages unnecessary investigations and over-treatment. This escalates costs, raising premiums, without correspondingly improving health. But limiting such ‘abuse’ requires monitoring, always costly.

Nazihah Noor

Unsurprisingly, many PHI companies use costly ‘managed healthcare’ services to try to limit rising costs due to such abuses. Thus, Americans spend much more on health than others, but with surprisingly modest, unequal and hardly cost-effective health outcomes.

With PHI, much public expenditure is needed to cover the poor and others who cannot afford the premiums, often also deemed to be at greater risk. Hence, achieving ‘health-for-all’ in such circumstances would require costly public subsidization of PHI.

Social health insurance

Unlike typically ‘voluntary’ PHI, social health insurance (SHI) is usually mandatory for entire national populations. Although often espoused with the best of intentions, SHI is invariably costlier due to its limitations and problems.

SHI incurs additional costs of health insurance administration to enrol, collect premiums, ascertain eligibility and benefits, make payments and minimize abuses. Revenue financed universal coverage need not incur such costs.

Compared to PHI, SHI seems like a step forward for countries with weak or non-existent public healthcare arrangements. But like PHI, SHI encourages over-treatment and cost escalation, as well as costly bureaucratic insurance administration.

Instead of such abuses inherent to insurance systems, a revenue financed health systems would incentivize prioritizing the health and wellbeing of those it is responsible for, thus emphasizing preventive health.

Such a health system contrasts with insurance systems’ emphasis on minimizing costs for the often unnecessary medical services it incentivizes, instead of improving the population’s health and wellbeing.

Government subsidies for health insurance, private or social, would inevitably go to the transnational giants which dominate health insurance internationally.

Financing SHI complications

Hence, SHI involves much more per capita health spending, raising it by 3-4%! But despite being much more costly than revenue-financed systems, there is no evidence health outcomes are improved by switching to SHI from government funding.

Germany’s SHI has been more cost-effective than the US with its PHI. But it is less cost effective than most other economies with revenue-financed healthcare. Nevertheless, healthcare financing consultants, continue to recommend versions of SHI, although it is clearly not cost-effective, appropriate, efficient or equitable.

SHI schemes remain in some rich countries for specific historical reasons, e.g., Germany’s evolved from its long history of union-provided health insurance. But more recently, even these economies rely increasingly on supplementary revenue financing. But again, such hybrid financing does not improve cost-effectiveness.

As SHI typically involves imposing a flat payroll tax, it discourages employers from providing proper employment contracts to staff. SHI is estimated to have reduced formal employment by 8-10% worldwide, and total employment in rich countries by 5-6%!

It is also difficult and costly to collect SHI premiums from the self-employed, or from casual, temporary and informal workers not on regular payrolls. Also, most working people in developing countries are not in formal employment, with far fewer unionized.

SHI schemes are always difficult to introduce as they would reduce take-home incomes. In most developing countries, most families cannot afford such pay-cuts. Hence, government revenue would still be needed to cover the uncovered to achieve health for all.

Many SHI proposals also recommend earmarking revenue from new ‘health’ taxes collected. Such earmarking creates likely conflicts of interest reminiscent of justifications for ‘sin taxes’ on addictive narcotics, smoking, alcohol consumption and gambling.

Will governments perpetuate unhealthy practices and behaviours to secure more tax revenue? Is there an optimum level of smoking or sugar consumption to be allowed, even encouraged, to get such earmarked funding?

Revenue financing

International evidence shows progressive revenue-funded public health financing to be much more equitable, cost-effective and beneficial than SHI. Hence, moving from revenue-financing to SHI would be a step backwards in terms of both equity and efficiency, or cost-effectiveness.

The late World Bank economist Adam Wagstaff and others have long advocated tax- or revenue-financed health provisioning due to the significant additional costs of managing health insurance systems, both private and social.

Revenue-financed public healthcare financing avoids the many insurance administration expenses incurred by both PHI and SHI. There will be no more need for such costly payments for unnecessary medical tests, procedures and treatments, and bureaucratic processes to manage insurance procedures and curb abuses, e.g., those associated with ‘moral hazard’.

Better financing and reorganization of preventive health efforts are needed. Public health programmes requiring mass participation, e.g., breast or cervical cancer screening, generally have much better outcomes with revenue-financing compared to SHI.

Better results can be achieved by improving tax-funded healthcare. More resources need to be deployed to improve preventive and primary healthcare. Strengthening public health services must include improving staff service conditions, morale and retention rates.

There is nothing inherently wrong with revenue-financed healthcare. Underfunding is largely due to political choices and fiscal constraints. These are typically due to externally imposed political limits.

Instead of dogmatically insisting on SHI, as is typical of health financing consultants, revenue financing of public healthcare should be reformed, strengthened and improved by:

  • increasing and improving budget allocations.
  • eliminating waste and corruption with competitive bidding, etc.
  • increasing government revenue with fairer taxation, including wealth, ‘windfall’ and deterrent ‘sin’ taxes, e.g., of tobacco and sugar consumption.

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‘Let’s make breastfeeding at work, work’, urge UN agencies — Global Issues

In the last decade, the prevalence of exclusive breastfeeding has increased by a remarkable 10 percentage points, to 48 per cent globally, according to the UN Children’s Fund (UNICEF) and the World Health Organization (WHO).

Promoting and supporting breastfeeding at workplaces can help drive the progress higher and towards the global target of 70 per cent by 2030, they said.

“Supportive workplaces are key. Evidence shows that while breastfeeding rates drop significantly for women when they return to work, that negative impact can be reversed when workplaces facilitate mothers to continue to breastfeed their babies,” Catherine Russell, UNICEF Executive Director, and Tedros Adhanom Ghebreyesus, WHO Director-General, said in a statement.

Good for mothers, babies, and businesses

Family-friendly workplace policies, such as paid maternity leave, breastfeeding breaks and a room where mothers can breastfeed or express milk, create an environment that benefits not only working women and their families but also employers, the UN officials said.

“These polices generate economic returns by reducing maternity-related absenteeism, increasing the retention of female workers, and reducing the costs of hiring and training new staff,” they added.

Highlighting the benefits of supporting breastfeeding for mothers, babies and businesses, UNICEF and WHO urged governments, donors, civil society, and the private sector to support all working mothers – including those in the informal sector or on temporary contracts.

The UN agencies also called for sufficient paid leave for all working parents and caregivers to meet the needs of their young children, as well as increased investments in breastfeeding support policies and programmes in all settings.

Ultimate child survival intervention

The health benefits of breastfeeding are based on scientific fact and are well documented.

From the earliest moments of a child’s life, breastfeeding is the ultimate child survival and development intervention. It protects babies from common infectious diseases and boosts children’s immune systems, providing the key nutrients children need to grow and develop to their full potential.

WHO and UNICEF recommend that breastfeeding should begin within the first hour of birth and continued through the first six months of a child’s life – meaning no other foods or liquids are provided, including water.

They also recommend that infants should be breastfed on demand – that is as often as the child wants, day and night.

From the age of six months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to two years of age or beyond.

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Nepal Poised To Start HPV Vaccination To Prevent Cervical Cancer, Awaiting GAVI — Global Issues

Girls wait for their vaccination cards to be updated after receiving the HPV vaccine at BP Koirala Cancer Hospital in Bharatpur, Nepal, 10 July 2023. Credit: Marty Logan/IPS
  • by Marty Logan (chitwan district, nepal)
  • Inter Press Service

CHITWAN DISTRICT, Nepal, Jul 31 (IPS) – As Dipak Subedi was organizing a vaccination programme against the human papillomavirus (HPV) in the city of Bharatpur in Chitwan district of southern Nepal he was getting phone calls from neighbouring districts asking if he had extra doses available — people were willing to travel for hours to get their girls vaccinated against HPV, which causes cervical cancer, the deadliest form of cancer for women in Nepal.

Callers had heard about the campaign, which started in 2022, after the city posted the news on its Facebook page, says Subedi, senior public health officer and chief of the Bharatpur public health promotion section. Unfortunately he had no extra doses to meet the demand. “With such demand if the HPV vaccine was to be included in our regular vaccination programme we could get more than 90% coverage,” he adds in an interview in his office in Bharatpur, a city of 370,000 people best known for its location near Chitwan National Park.

Most people approached for this article who were connected to the Bharatpur campaign, or to previous small-scale pilot projects in Nepal, noted similar high demand. In recent years the Nepal Government has pledged repeatedly to provide the HPV vaccine for national distribution but has yet to do so.

Awaiting GAVI response

Earlier this month a national campaign moved a step closer when the child health and immunization section of the health department submitted a request to the global vaccine alliance GAVI for 1.6 million doses. The response should be known by September; if positive, vaccination could start in 2024.

Cervical cancer is the fourth most common form of cancer among women globally and the leading cause of cancer-related deaths for women in 36 countries in Africa, Asia and Latin America. The World Health Organization (WHO) reported recently that 604,000 new cases of cervical cancer were reported globally in 2020 and that 342,000 women died from the disease – a staggering 90% of the new cases and deaths occurred in low and middle-income countries.

HPV is the virus that causes most cases of cervical cancer and is responsible for the majority of sexually transmitted infections of the reproductive system. The HPV vaccine has been shown to prevent up to 90% of HPV-related cancers and pre-cancerous injuries. WHO says that eradicating cervical cancer will require vaccinating 90% of all girls worldwide by the age of 15.

The burden of the disease in Asia is high. In 2020, China and India alone accounted for 40% of global cervical deaths (17% and 23% respectively), according to The Lancet journal. In Nepal, there were an estimated 14.2 cases per 100,000 women in 2020, versus the WHO target for 2030 of less than 4.0. The disease kills about 1,500 women in the country each year, reports the HPV Information Centre.

In 2020, researchers predicted that without any intervention, a total of 170,600 women in Nepal would die from cervical cancer by 2070 and 318,855 by 2120. But according to the UN Population Fund, HPV vaccination could prevent nearly 38,737 cervical cancer deaths in Nepal by 2070, and 165,115 deaths by 2120.

About 400-500 new cases are diagnosed at the BP Koirala Cancer Hospital in Bharatpur alone every year, says Dr Asmita Rana, the head of the hospital’s department of cancer prevention control and research.

Rana is managing the vaccination campaign that includes Bharatpur and two other municipalities, distributing 12,500 doses to girls ages 11-13, two doses each. While the first phase was a big success, the second one has faltered, she says in an interview in her office. That’s mainly because phase one was implemented at the community level (schools and health facilities) by municipal staff. Phase two was centred around the hospital, meaning that caregivers (school officials and/or parents) had to take time to transport children to and from the facility.

Staff members in the hospital’s department of cancer prevention control and research discuss vaccination with a girl about to be receive her second dose of the HPV vaccine, at BP Koirala Cancer Hospital in Bharatpur, Nepal, 10 July 2023. Credit: Marty Logan/IPS

Schools the preferred site

Asked what she has learned from the campaign, Rana says she would do all phases through schools next time to ensure participation. “That would be a more appropriate way to follow up those girls… rather than at the health facilities.”

The second learning is that raising awareness ahead of time is key, says Rana. “From my experience I can say that if we do an awareness programme ahead of time — tell them something about the vaccine, about HPV, and the effectiveness of the vaccine for preventing cancer, then they will be quite positive and participating.”

Even if people are initially sceptical, “gradually when we explain to them that it’s a very good vaccine, it’s free of cost — although it’s expensive if you have to buy it — and will prevent your daughter from getting cervical cancer in the future, most of the people are convinced.”

The vaccine is available at private health facilities in Nepal but two doses costs around 10,000 rupees (US$76). The country’s per capita income was about $1,300 in 2022. Neighbouring India started producing its own vaccine, Cervavac, in 2022. Its price is $4.88-$9.76 for two doses. South Asian neighbours Bhutan, Sri Lanka and the Maldives have launched national vaccination programmes while Bangladesh has done pilot projects.

It’s surprising to hear that vaccine hesitancy hasn’t been a minor issue in the campaign. One school did refuse to participate, says Rana, after they were told that parents had to sign consent forms. “They were thinking ‘it’s like a new Covid vaccine and it’s being tested via our girls’; they were not aware that the vaccine had been approved years before. I tried so hard to convince them but they would not come.”

School nurse Sudeepa Poudel also faced some resistance, but says she overcame it after talking to doubting parents. “They say ‘we were never vaccinated but we are fine till now — why do our kids need to be vaccinated’?… Some parents are easy to convince but many are not because they’re illiterate, so I have to take time to explain carefully to them; sometimes it takes two sessions. After that explanation they easily accept it.”

Poudel works at a secondary school in Bharatpur from where 25 girls were vaccinated earlier this year. Beforehand she spent one hour explaining the process to students. “I conducted classes for those students who were going to be vaccinated as well as those younger students (9-11) who might receive the vaccine in the future, explaining the purpose of the vaccine, where it comes from, how it’s managed, possible side-effects, etc.”

Just down the hall from Rana’s office at the hospital is the room where the vaccine is given. During one recent morning girls arrive in small groups and take turns sitting in a chair and rolling up their sleeves, while caregivers look on.

Later outside the room, three girls from a high school in Bharatpur shake their heads when asked if their shoulders hurt where they got the injection. They had no hesitation getting the vaccine, they add through an interpreter. “We got information from the school nurse and teachers so we are confident,” says one.

Girls from Aadikabi Bhanubhakta Higher Secondary School pose with their caregivers after vaccination, at BP Koirala Cancer Hospital in Bharatpur, Nepal, 10 July 2023. Credit: Marty Logan/IPS

3 reasons for support

“We’re doing this for three reasons,” adds another: to prevent genital problems, or issues having children, and because getting cervical cancer would interfere with menstruation.”

The father of one of the girls says he learned about the vaccine from his daughter, via news reports and social media before being contacted by the school. “I talked to the school nurse… Yes, I’m positive — both my wife and I are positive — because there is news about this vaccine being very good. I don’t know much about the technical part,” he adds, “but I feel good doing this for my child.”

HPV is spread through sexual contact, but Rana says that most Nepalis don’t interpret that to mean their daughters should be vaccinated before they become sexually active, which might be one reason there is little resistance to campaigns. “Their understanding is that it’s early marriage that would expose girls to HPV rather than premarital sex, because that was the experience of women who are now developing cervical cancer, who are around 40-45 years of age,” she says.

“Sometimes people do ask explicitly about the impact of premarital sex, but they do not resist having their girls vaccinated when we explain,” she adds.

At Bharatpur municipality Subedi says his team easily overcame hesitancy they encountered from parents during recent campaigns for Covid-19 and routine immunization for children under 2 years. “There are some rumours and misconceptions, but we can tackle that — I don’t think it’s a big deal. We can convince them. In every vaccination campaign we do the coverage rate is very high.”

Nepal’s health department has prepared an awareness module in preparation for HPV vaccination being added to the national vaccination programme, says Dr Abhiyan Gautam, head of the child health and immunization section. It will be part of what he calls a demonstration campaign ahead of the programme, which will distribute 20,000 doses in various parts of Nepal, still to be identified.

1st time under federal system

A trial phase is needed, adds Gautam, because the health system was reorganized after Nepal enacted federalism in 2017. “We haven’t conducted such a campaign at the local area… so this is a new concept for us,” he says. “The district recording and reporting system is also quite different now… at the operational level we have to be sure that the system will work, so we’ll be piloting first.”

The same system will be used for the national programme, if GAVI approves the request. “We are hopeful that we’ll get the vaccines,” says Gautam. “What we do know is that whenever we operate a vaccine programme GAVI provides some vaccines to Nepal. We submitted our application – now the ball is in their court.”

In response to a query, GAVI said that it does not comment on current applications.

The planned programme will include girls ages 10-14, in classes 6-10, rather than the 9-14 age group recommended by WHO. Gautam says this is to conserve limited resources. “Our national immunization advisory committee recommended 10-14 based on the country situation: if we go to 9-14 our operational costs will almost double.”

If Nepal launches the national programme, the immunization chief anticipates the same results as a previous government-run pilot project in 2016. “The vaccination coverage was very good (97%) because people demand the vaccine when they know about it… Poor people may not go to private settings to get vaccinations but even rich people are waiting for the national programme.”

This feature was supported by the Sabine Vaccine Institute and Internews.

© Inter Press Service (2023) — All Rights ReservedOriginal source: Inter Press Service

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WHO hails Mauritius, Netherlands for tobacco control measures but global risks remain — Global Issues

Hailing Mauritius and the Netherlands for implementing all of the UN health agency’s MPOWER tobacco control measures – a feat matched to date only by only Brazil and Türkiye – the WHO said that 2.3 billion people in 44 countries remain unprotected by tobacco control measures, exposing them to sickness and the economic burden of addiction.

In 53 countries, complete smoking bans are still not in place in healthcare facilities, the UN agency warned in a new report, despite the fact that tobacco use “continues to be one of the biggest public health threats”, with a staggering 1.3 million deaths annually from passive smoking alone.

Tedros appeal

Leading calls for greater efforts to restrict tobacco use, WHO Director-General Tedros Adhanom Ghebreyesus said that progress was being “undermined” by the aggressive promotion of e-cigarettes as a safer alternative to cigarettes.

“Young people, including those who never previously smoked, are a particular target,” he said. “In fact, e-cigarettes are harmful to both the people using them and those around them, especially when used indoors.”

Although new WHO data indicates that the percentage of people who smoke has declined, challenges remain in regulating e-cigarettes and other heated tobacco items, the UN agency said.

“Some products are modifiable by the user so that nicotine concentration and risk levels are difficult to regulate,” said Dr Rüdiger Krech, WHO Director, Department of Health Promotion.

“Others are marketed as ‘nicotine-free’ but, when tested, are often found to contain the addictive ingredient. Distinguishing the nicotine-containing products from the non-nicotine – or even from some tobacco-containing products – can be almost impossible. This is just one way the industry subverts and undermines tobacco control measures.”

Taxing issue

In a bid to protect more people from tobacco, the UN health agency’s MPOWER tobacco control measures offer advice on tackling passive smoking and on how to quit, along with warnings about the dangers of tobacco, information on bans on advertising, promotion and sponsorship and information about raising taxes on tobacco.

Other effective tobacco control recommendations include promoting smoke-free public spaces, so that people can breathe clean air and avoid “deadly” second-hand smoke, WHO said. The measure can also motivate people to quit, the UN agency said, while also helping to “denormalize” smoking and preventing young people from picking up the habit.

“Tobacco continues to be one of the top preventable causes of premature deaths and it is the only commercial product that kills half its users when used exactly as intended,” said Tedros. “The past two decades provide us with rich lessons on how to address this global health threat – we must act now to save lives and stop the spread of this preventable killer.”

In the last 15 years since WHO’s MPOWER tobacco control measures were introduced, smoking rates have fallen, the UN agency said, estimating that the measures have resulted in 300 million fewer smokers in the world today.

According to UN health agency data, at least 151 countries are now covered by at least one of the WHO’s MPOWER measures, but 44 countries have no cover at all. “It is crucial that tobacco control continues to be a global health priority,” insisted Tedros.

Equally worrying is the WHO warning that children who use e-cigarettes and heated tobacco products are up to three times more likely to use tobacco products in the future.

Irrespective of countries’ income levels, the UN health agency insisted that all governments could “drive down the demand for deadly tobacco, achieve major wins for public health and save economies billions of dollars in health care and productivity costs”.

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Vulnerable Women Suffer the Worst Face of Discrimination in Argentina — Global Issues

“Migration is a right,” read the handkerchiefs held by two women at a demonstration in the Argentine capital for migrants’ rights. At left is Natividad Obeso, a Peruvian who came to Buenos Aires in 1994, fleeing political violence in her country. CREDIT: Camilo Flores / ACDH
  • by Daniel Gutman (buenos aires)
  • Inter Press Service

BUENOS AIRES, Jul 27 (IPS) – Remi Cáceres experienced gender-based violence firsthand. She struggled, got out and today helps other women in Argentina to find an escape valve. But because she is in a wheelchair and is a foreign national, she says the process was even more painful and arduous: “Being a migrant with a disability, it’s two or three times harder. You have to empower yourself and it’s very difficult.”

When she came to Buenos Aires from Paraguay, she was already married and had had her legs amputated due to a spinal tumor. She suffered violence for several years until she was able to report her aggressor, got the police to remove him from her home and raised her two daughters watching after parked cars for spare change in a suburb of the capital

On the streets she met militant members of the Central de Trabajadores Argentinos (CTA), one of the central unions in this South American country, who encouraged her to join forces with other workers, to create cooperatives and to strengthen herself in labor and political terms. Since then she has come a long way and today she is the CTA’s Secretary for Disability.

“The places where women victims of gender-based violence are given assistance are not accessible to people who are in wheelchairs or are bedridden. And the shelters don’t know what to do with disabled women. Recently, a woman told me that she was sent back home with her aggressor,” Remi told IPS.

From her position in the CTA, Remi is one of the leaders of a project aimed at seeking information and empowering migrant, transgender and disabled women victims of gender violence living in different parts of Argentina, for which 300 women were interviewed, 100 from each of these groups.

The data obtained are shocking, since eight out of 10 women stated that they had experienced or are currently experiencing situations of violence or discrimination and, in the case of the transgender population, the rate reached 98 percent.

Most of the situations, they said, occurred in public spaces. Almost 85 percent said they had experienced hostility in streets, squares, public transportation and shops or other commercial facilities. And more than a quarter (26 percent) mentioned hospitals or health centers as places where violence and discrimination were common.

One of the trainings held by the “Wonder Women Against Violence” project. On the left is Remi Cáceres, who escaped domestic violence and today is Secretary of Disability at the Central de Trabajadores Argentinos central trade union. CREDIT: María Fernández / ACDH

Another interesting finding was that men are generally the aggressors in the home or other private settings, but in public settings and institutions, women are the aggressors in similar or even higher proportions.

The study was carried out by the Citizen Association for Human Rights (ACDH), an NGO that has been working to prevent violence in Argentina since 2002, with the participation of different organizations that represent disabled, trans and migrant women’s groups in this Southern Cone country.

It forms part of a larger initiative, dubbed Wonder Women Against Violence, which has received financial support for the period 2022-2025 from the UN Trust Fund to End Violence against Women. Since 1996, this fund has supported projects in 140 countries for a total of 215 million dollars.

The initiative includes trainings aimed at providing tools for access to justice to the most vulnerable groups, which began to be offered in 2022 by different organizations to more than 1,000 women so far.

Courses have also been held for officials and staff of national, provincial and municipal governments and the judiciary, with the aim of raising awareness on how to deal with cases of gender violence.

María José Lubertino, president of the Citizen Association for Human Rights, takes part in a feminist demonstration in Buenos Aires. Lubertino coordinates the project on violence against disabled, transgender and migrant women in Argentina that runs from 2022 to 2025. CREDIT: Camilo Flores / ACDH

Fewer complaints

“Argentina has made great progress in recent years in terms of laws and public policies on violence against women, but despite this, one woman dies every day from femicide (gender-based murders),” ADCH president María José Lubertino told IPS.

“In this case, we decided to work with forgotten women. We were struck by the fact that there were very few migrant, trans and disabled women in the public registers of gender-violence complaints. We discovered that they do not suffer less violence, but that they report it less,” she added.

Lubertino, a lawyer who has chaired the governmental National Institute against Discrimination, Xenophobia and Racism (INADI), argues that these are systematically oppressed and discriminated groups that, in her experience, face their own fears when it comes to reporting cases: “migrants are afraid of reprisals, trans women assume that no one will believe them and disabled women often want to protect their privacy.”

Indeed, the research showed that 70 percent of trans, migrant and disabled women who suffered violence or discrimination did not file a complaint.

Many spoke of wanting to avoid the feeling of “wasting their time,” as they felt that the complaint would not have any consequences.

Each group faces its own particular hurdles. Migrant women experience discrimination especially in hospitals. Transgender people, in addition to suffering the most aggression (sometimes by the police), suffer specifically from the fact that their chosen identity and name are not recognized. Disabled women say they are excluded from the labor market.

More than three million foreigners live in this country of 46 million people, according to last November’s data from the National Population Directorate. Almost 90 percent of them are from other South American countries, and more than half come from Paraguay and Bolivia. Peru is the third most common country of origin, accounting for about 10 percent.

Of the total number of immigrants, 1,568,350 are female and 1,465,430 are male.

As for people with disabilities, the official registry included more than 1.5 million people by 2022, although it is estimated that there are many more.

Since 2012, a Gender Identity Law recognizes the legal right to change gender identity in Argentina and by April 2022, 12,665 identification documents had been issued based on the individual’s self-perceived identity. Of these, 62 percent identified as female, 35 percent as male and three percent as non-binary.

Women participate in one of the trainings on gender-based violence in Buenos Aires. The project is carried out by the Citizen Association for Human Rights with financial support from the UN Trust Fund to End Violence against Women. CREDIT: Camilo Flores / ACDH

Different forms of violence

Yuli Almirón has no mobility in her left leg as a result of polio. She is president of the Argentine Polio-Post Polio Association (APPA), which brings together some 800 polio survivors. Yuli is one of the leaders of the trainings.

“Through the trainings, those of us who participated found out about many things,” she told IPS. “We heard, for example, about many cases related to situations of power imbalances. Women with disabilities sometimes suffer violence at the hands of their caregivers.”

The most surprising aspect, however, has to do with the restrictions on access to public policies to help victims of gender-based violence.

The Ministry of Women, Gender and Diversity runs the Acompañar Program, which aims to strengthen the economic independence of women and LGBTI+ women in situations of gender-based violence.

The women are provided the equivalent of one monthly minimum wage for six months, but anyone who receives a disability allowance is excluded.

“We didn’t know those were the rules. It’s a terrible injustice, because disabled victims of violence are the ones who most need to cut economic dependency in order to get out,” said Almirón.

Another of the project’s partner organizations is the Human Rights Civil Association of United Migrant and Refugee Women in Argentina (AMUMRA). Its founder is Natividad Obeso, a Peruvian woman who fled the violence in her country in 1994, during the civil war with the Shining Path guerrilla organization.

“Back then Argentina had no rights-based immigration policy. There was a lot of xenophobia. I was stopped by the police for no reason, when I was going into a supermarket, and they made me clean the whole police station before releasing me,” she said.

Natividad says that public hospitals are one of the main places where migrant women suffer discrimination. “When a migrant woman goes to give birth they always leave her for last,” she said.
“Migrant women suffer all kinds of violence. If they file a complaint, they are stigmatized. That’s why they don’t know how to defend themselves. Even the organizations themselves exclude us. That is why it is essential to support them,” she stressed.

© Inter Press Service (2023) — All Rights ReservedOriginal source: Inter Press Service

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Embracing Our Survival in a Mute System — Global Issues

Lack of accessible information in sign language has made online platforms, education, healthcare inaccessible for the Deaf due to non-provision of information in sign language formats. Credit: Shutterstock.
  • Opinion by Egwelu Timothy (kampala)
  • Inter Press Service

KAMPALA, Jul 27 (IPS) – Every July, the disability community honors its history, accomplishments, and experiences during Disability Pride Month. One such group is the deaf community in Uganda, which makes up 3.4% of the population.

Members of the Deaf community celebrate the positive aspects of deaf culture, activism, and the pride of being Deaf, and feel value. But, we also recognize our oppression and know that we deserve better than the prevalent discrimination, exclusions and inaccessibility we regularly face.

While the inclusion of Deaf persons in organisations such as Uganda National Association of the Deaf (UNAD) , Deaf Youth Advocacy Network, and National Union of Persons with Disabilities enables us to help with some development of policies and best practices, merely having representation in consultations is not enough.

All mainstream laws, policies and services also must be accessible to Deaf persons in sign language beforehand so we can contribute and guide language and outcomes.

Too often, however, Deaf persons are excluded. For instance, in the wake of the COVID-19 pandemic, there was an unfortunate digital gap for over 20,000 Deaf persons who use assistive devices like smart phones to access information.

Today, generally, lack of accessible information in sign language has made online platforms, education, healthcare inaccessible for the Deaf due to non-provision of information in sign language formats.

Furthermore, the lack of adequate support services such as access to interpretation, Sexual Reproductive Health, mental health services and social protection are concerning. In policy consultations, there is no meaningful participation as 60% of deaf participants cannot comprehend the written law.

The Constitution of Uganda is the second in the world to recognize the right to sign language both within the body and under the Cultural Objective Principle XXIV (iii) of the National Directives of State Policy. Article 21(1) on equality before the law, under the law and all spheres of life is equally instrumental.

These are further operationalised under the Persons with Disability Act of 2020. Most notably under Section 6, 7, 9 and 12 on non-discrimination under provision of education and general commercial services, health and employment. Despite this plethora of legal backing, the provision of information in sign language is still lacking.

The Constitution and other relevant laws such as the Penal code Act chapter 120 laws of Uganda are similarly inaccessible in sign language therefore ignorance of law is guaranteed for deaf persons despite it being no exception to criminal liability.

There is widespread agreement around the world that governments and institutions must take proactive measures to ensure that deaf persons have equal access to mainstream policies, systems, and services.

This includes providing accessible communication, transportation, education, healthcare, employment opportunities, and other essential services. However, the law and appropriate implementation are two different things.

Furthermore, regardless of the sector, policymakers must ensure that sign language accessibility is considered from the outset of policy development and implementation. They must engage Deaf persons and their representative organizations in meaningful consultation to understand their needs, preferences, and priorities.

Policymakers must also ensure that the Deaf have equal protection under the law to engage in the policy formulation process, voice their opinions, and influence decision-making. This includes providing accessible venues, information, formats, and technologies to facilitate their participation. In the recent consultations on development of the policy guidelines for television access, I applaud Uganda Communication Commission for inviting stakeholders from the various organisations to partipate in the consultancies and ensuring accesibility to sign language.

To sum up, it is critical for a truly inclusive and accessible society that Deaf persons are involved in the decision-making processes. However, it is only feasible if policies can be understood, deaf people can actually attend meetings, and their voices are heard and taken seriously. In this Disability Pride month, let’s level the playing field and ensure that everyone can participate in meaningful ways to make a truly inclusive society.

Egwelu Timothy is a lawyer and a disability policy & inclusion consultant

© Inter Press Service (2023) — All Rights ReservedOriginal source: Inter Press Service

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