Right-based approach to health is key to universal health coverage in Africa

Healthcare is a human right.

This means children should have access to healthcare when they need it. It implies pregnant women should be able to receive antenatal care and deliver safely in the presence of skilled birth attendants. If the right is protected, young people should adequate information about sexual and reproductive health and rights. Women should not be denied correct information about family planning.

The National Economic and Social Rights Initiative asserts that, “the human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment.”

In clinical practice, I see that that poor people seem to ‘bereft of this right to health’ as the co-founder of Partners of Health, Dr. Paul Farmer, once asserted. Rich people can readily access healthcare without difficulty. They can pay for medical checkups and curative services. It is not so for many poor patients I have come across as a doctor who worked in a tertiary, secondary or primary health facility.

To many people, the right to health means nothing. To others, it means a lot. To poor people, the fact that health is a human right speaks of hope if the right is protected. Many a time, they do not have enough to pay for healthcare. They rarely go to hospitals because of perceived high healthcare cost. If there is an institution that protects the right to health for the poor, they will surely be glad.

According to the World Health Organization (WHO) constitution, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” This is the foundation of the right-based approach to health, which is also enshrined in many international declarations such as the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, Convention on the Elimination of All Forms of Racial Discrimination and Convention on the Rights of the Child.

Every country of the world is a party to one or two of these declarations. Health as a human right is also written into many constitutions of the world. It is the responsibility of government to protect this right of good health for all. It is a fundamental responsibility that policy makers should fulfill so that citizens of every nation are guaranteed healthy lives. It is however sad that this is not the case in many parts of Africa.

Social amenities are grossly insufficient. Health facilities are not enough. When they are available, they are far from the people who need to use them, ill-equipped or understaffed. Poverty, hunger and lack of access to clean water undermine health in many parts of the sub-Saharan Africa. Although the region has almost a quarter of the global disease burden, it has an acute shortage of health workers.

Health professionals are insufficient to meet the demands at facilities. Although community health workers can bridge this gap, there is limited investment in the cadre of workers in many countries. Government budget on health is low; less than ten countries have met the Abuja declaration to fund healthcare with at least 15% of national budget.

These challenges erode the fabric of the right of health for many people especially the poor. What makes it particularly worse is the weak civil society in the region. There is ample investment by donors in strengthening the capacity of community-based organizations (CBOs) in the region however it has been largely focused on vertical programs such as HIV and AIDS, malaria and tuberculosis.

It is time to change the game plan. Policy makers, health workers, civil society including faith-based organizations and traditional leaders need to see health as a human right that clearly protects other inalienable rights. “In seeing health as a human right, there is a call to action now to advance people’s health in the same way that the 18th-century activists fought for freedom and liberty.” says Harvard University don, Amartya Sena.

This calls for action by African leaders increase funding for health in an atmosphere that promotes transparency and efficient use of resources. It requires that they guarantee access to quality healthcare for all, and ensure people do not suffer untold financial hardship because of ill-health. It requires consistent investment in capacity building for civil society in the region who can demand change and mobilize communities to demand right to health. The right-based approach should guide the move towards universal health coverage on the continent including Nigeria.

The fight for freedom in the 18-century was a tough battle but the accomplishments of the struggle have created a safer world for us. It is incumbent on us to profess and protect this right so that we can leave a better world for our children and grandchildren.

This is a submission for the 2013 Blog Action Day by Dr. Biodun Awosusi, founder and editorial chair of this blog. #BAD2013