Health and human rights: What can ten years of democracy in South Africa tell us?

Health and Human Rights

Volumn 8, Issue 1, 2004, Pages 1-25

  London, Leslie ^a  

^a UNIVERSITY OF CAPE TOWN   (South Africa)

Author keywords

[No Author keywords available]

Indexed keywords

DEMOCRACY; HEALTH POLICY; HUMAN RIGHTS;

AFRICA; EASTERN HEMISPHERE; SOUTH AFRICA; SOUTHERN AFRICA; SUB-SAHARAN AFRICA; WORLD;

EID: 20544461872     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/4065374     Document Type: Review

References (158)

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6. C. Ngwena, "The Recognition of Access to Health Care as a Human Right in South Africa: Is It Enough," Health and Human Rights 5/1 (2000): pp. 26-44;
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9. P. Sidley, "South Africa Will Not Pay for Antiretroviral Therapy," British Medical Journal 322/7300 (2001): pp. 1441;
10. D. Knapp-van Bogaert, A. Dhai, L. J. van Bogaert, G. Howarth, D. Hanekom, and G. Ogunbanjo, "The State Attitude to Antiretroviral Treatment - The Doctor's Duty to Speak Out," South African Medical Journal 92/4 (2002): pp. 272-3;
11. and N. Nattrass, The Moral Economy of AIDS in South Africa (Cambridge, UK: Cambridge University Press, 2004).
12. D. Fassin and H. Schneider, "Denial and Defiance: A Socio-Political Analysis of AIDS in South Africa," AIDS 16/4 (2002): pp. S45-51;
13. H. Schneider and D. Fassin, "The Politics of AIDS in South Africa: Beyond the Controversies," British Medical Journal 326/7387 (2003): pp. 495-7;
14. Nattrass (see note 4)
15. Benatar (see note 1)
16. See note 2
17. Department of Health, White Paper for the Transformation of the Health Services (Pretoria: Department of Health, 1995);
18. and Benatar (see note 1)
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20. S. Gruskin and B. Loff, "Do Human Rights Have a Role in Public Health Work?," The Lancet 360/9348 (2002): p. 1880.
21. P. Hunt, "The Right to Health: From the Margins to the Mainstream," The Lancet 360/9348 (2002): p. 1878.
22. World Health Organization (WHO), "Twenty-Five Questions and Answers on Health and Human Rights," Health and Human Rights Publication Series 1/1 (Geneva: WHO, 2002).
23. See note 8.
24. C. de Beer, The South African Disease: Apartheid Health and Health Services (London: Catholic Institute for International Relations, 1984);
25. and L. Baldwin-Ragaven, J. de Gruchy, and L. London, An Ambulance of the Wrong Colour: Health Professionals, Human Rights and Ethics in South Africa (Cape Town: University of Cape Town Press, 1999).
26. M. Susser and V. P. Cherry, "Health and Health Care Under Apartheid," Journal of Public Health Policy 3/4 (1982): pp. 455-75;
27. de Beer (see note 13)
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29. H. C. Van Rensburg and A. Fourie, "Inequalities in South African Health Care. Part I. The Problem - Manifestations and Origins," South African Medical Journal 84/2 (1994): pp. 95-9;
30. Truth and Reconciliation Commission (TRC), Truth and Reconciliation Commission Report (Cape Town: Juta, 1998);
31. Baldwin-Ragaven et al. (see note 13)
32. and H. Marais, South Africa: Limits to Change - The Political Economy of Tranformation (London: Zed Press, 1998).
33. See notes 13 and 14.
34. See notes 13 and 14
35. See, for example, the History of the Early Learning Resources Unit, Availbale at http://www.elru.co.za/history3.asp;
36. A. Letsebe and J. Loffel, "Restructuring Social Services in South Africa," pp. 17-20;
37. N. Hlatswayo, "Building a Welfare State: Conceptual Framework and Practical Steps," pp. 15-16;
38. F. Lund, "Moving Beyond Slogans: Transforming Welfare in South Africa," pp. 12-14, all in Critical Health 1990;
39. Special Edition, 31/32; Health and Welfare in Transition: A Report on the International Conference on Health in South Africa (Maputo, Mozambique: April 1990).
40. C. P. Owen and E. M. Thomson, People's Health: The Way Forward - Report of the 1988 NAMDA Annual Conference (Cape Town: NAMDA, 1991).
41. L. Baldwin-Ragaven et al. (see note 13)
42. J. Baskin, Striking Back: A History of COSATU (Johannesburg: Raven Press, 1991).
43. See note 13.
44. I b i d.
45. See, for example, E. Buch, "Primary Health Care in South Africa," Nursing RSA 4/11 (1989): pp. 34-5;
46. and L. Patel and C. de Beer, "Transforming Health and Welfare Challenges: Problems and Prospects," Critical Health 31/32 (1990): pp. 8-11.
47. See, for example, C. P. Owen (ed), Towards a National Health Service: Proceedings of the 1987 NAMDA Annual Conference (Cape Town: NAMDA, 1988);
48. and C. P. Owen (ed), The Case for a National Health Service (Cape Town: Department of Adult Education and Extra-Mural Studies and NAMDA [Western Cape]: University of Cape Town, 1989).
49. T. Solomons, "A Community Perspective," C. P. Owen (ed), Towards a National Health Service: Proceedings of the 1987 NAMDA Annual Conference (Cape Town: NAMDA, 1988).
50. These included the National Medical and Dental Association (NAMDA), the South African Health Workers Congress (SAHWCO), the Organisation for Appropriate Social Services in South Africa (OASSSA), and others.
51. M. Rayner, Turning a Blind Eye: Medical Accountability for Torture in South Africa (Washington, DC: American Association for the Advancement of Science, 1987);
52. N. Pityana, "Medical Ethics and South Africa's Security Laws: A Sequel to the Death of Steven Biko," N. Pityana (ed), Bounds of Possibility: The Legacy of Steve Biko and Black Consciousness (Cape Town: David Phillip, 1991);
53. American Association for the Advancement of Science (AAAS), Apartheid Medicine: Health and Human Rights in South Africa. Based on an AAAS Medical Mission of Inquiry to South Africa in April 1989 (Washington, DC: American Association for the Advancement of Science, 1990);
54. Baldwin-Ragaven et al. (see note 13).
55. L. Baldwin-Ragaven et al. (see note 13)
56. I b i d.
57. S. Saunders, Vice-Chancellor on a Tightrope: A Personal Account of Climatic Years in South Africa (Cape Town: David Philip, 2000);
58. F. Ames, "Biko Revisited," South African Medical Journal 79/11 (1991) pp. 635-6;
59. J. Van Heerden, "The Meaning of the MASA Apology," South African Medical Journal 86/6 (1996): pp. 656-60;
60. and E. M. Barker, "The Steve Biko Case," South African Medical Journal 63/21 (1983): p. 796.
61. See note 8.
62. See note 11.
63. Marais describes a process where organizations of resistance (overtly political formations) and organizations of survival (providing services and advocacy oriented to community needs, including health organizations) were subject to a "homogenizing sweep" in the liberation movement. In this environment, distinctions between overtly political objectives, and organizational responses to community needs became "porous," a process driven both by grassroots demands, and by state repression directed at any form of political activity (see note 14: pp. 206-07).
64. G. Perez and L. London, "'Forty-Five Years Apart': Confronting the Legacy of Racial Discrimination at the University of Cape Town," South African Medical Journal 94/9 (2004): pp. 764-770.
65. L. Baldwin-Ragaven et al. (see note 13).
66. R. Malan, My Traitors's Heart (New York: Vintage, 1991)
67. L. Baldwin-Ragaven et al. (see note 13).
68. L. Baldwin-Ragaven et al. (see note 13).
69. D. Budlender (ed), Health in Our Hands: Proceedings and Policies of the 1994 Women's Health Conference (Johannesburg: Women's Health Project, 1995).
70. J. de Gruchy, L. London, L. Baldwin-Ragaven, and S. Lewin, "The Difficult Road to Truth and Reconciliation - The Health Sector Takes Its First Steps," South African Medical Journal 88/8 (1998): pp. 975-9;
71. and B. B. Mandell, G. P. Damster, and H. A. Hanekom, "MASA and a Truth Commission for the Medical Profession," South African Medical Journal 86/9 (1996): pp. 1070-1.
72. See, for example, R. D. Le Roex, C. Viljoen, J. Gluckman, "Medicine and South Africa," British Medical Journal 292/6519 (1986): p. 560;
73. C. E. Viljoen, "Medical Care of Detainees in South Africa," The Lancet 2/8469-70 (1985): p. 1428;
74. and Medical Association of South Africa, "Statements Made in the USA by the President of the National Medical and Dental Association Regarding the MASA and Health Services and Conditions in the RSA," South African Medical Journal (supplement, 1987).
75. L. Baldwin-Ragaven, J. de Gruchy, S. Lewin, and N. Walaza, "Health Science Faculties - How Committed Are They to Building a Culture of Human Rights in Health?" South African Medical Journal 88/9 (1998): pp. 923-924;
76. J. Hattingh, "Biomedical Ethics in South Africa: Current Challenges and Institutional Responses," Biomedical Ethics 5/1 (2000): pp. 3 8-41;
77. and L. London and G. McCarthy, "Teaching Medical Students on the Ethical Dimensions of Human Rights: Meeting the Challenge in South Africa," Journal of Medical Ethics 24/4 (1998): pp. 257-62.
78. L. London, T. Rangaka, S. Ratamane, et al., "Medical Complicity in Torture," South African Medical Journal 86/9 (1996): pp. 1069-1070;
79. S. Benatar, R. Kirsch, T. Jenkins, and M. Price, "The Medical Council's Submission to the TRC - A Further Betrayal of the Profession," South African Medical Journal 87/1385 (1997);
80. J. Giddy, "Disillusionment with the Medical Council at the TRC," South African Medical Journal 87:/1144 (1997);
81. J. de Gruchy and L. S. Rubenstein, "Will South African Physicians Build a Culture of Human Rights?," The Lancet 355/9206 (2000): p. 838;
82. M. de Villiers and A. Stulting, "Establishment of the Committee for Human Rights, Ethics and Professional Practice of the Medical and Dental Professional Board," South African Dental Journal 55/6 (2000): p. 301;
83. and L. Baldwin-Ragavan, L. London, J. de Gruchy. "Learning from Our Apartheid Past: Human Rights Challenges for Health Professionals in Contemporary South Africa," Ethnicity and Health 5/3 (2000): pp. 227-241.
84. L. London and G. Perez, "Reconciliation in the UCT Health Sciences Faculty: A Vision for Transformation," South African Medical Journal 91 (2001): pp. 1027-8;
85. and T. Goodman and M. Price, "Using an Internal Reconciliation Commission to Facilitate Transformation at a Health Sciences Faculty in Post-Apartheid South Africa: The Case of Witwatersrand Health Sciences Faculty," Health and Human Rights 6/1 (2002): pp. 211-227.
86. J. Stuurman, L. Sait, and P. Long, "Health Legislation," in P. Barron (ed), South African Health Review 1997 (Durban: Health Systems Trust 1998);
87. M. de Villiers and A. Stulting, "Establishment of the Committee for Human Rights, Ethics and Professional Practice of the Medical and Dental Professional Board," South African Dental Journal 55/6 (2000): p. 301;
88. H. Hanekom, "A MASA for the Future," South African Medical Journal 86/2 (1996): pp. 188-9;
89. and M. Naude, "SAMA Passes Milestone Resolution," South African Medical Journal 90 (2000): p. 964.
90. J. R. Williams, "Ethics and Human Rights in South African Medicine," Canadian Medical Association Journal 162/8 (2000): pp. 1167-70.
91. Health Systems Trust, "Turmoil in the Nursing Profession," Update: A Newsletter for Health Workers, Planners and Managers (Durban: Health Systems Trust, 1995).
92. See note 1
93. H. Schneider and J. Stein, "Implementing AIDS Policy in Post-Apartheid South Africa," Social Science and Medicine 52/ 5 (2001): pp. 723-731.
94. B. Klugman and S. Varkey, "From Policy Development to Policy Implementation: The South African Choice on Termination of Pregnancy Act," in B. Klugman, D. Budlender (eds), Advocating for Abortion Access: Eleven Country Studies (Johannesburg: School of Public Health, University of the Witwatersrand, 2001): pp. 251-282.
95. S. J. Varkey and S. Fonn, "Termination of Pregnancy," N. Crisp, A. Ntuli (eds), South African Health Review 1999 (Durban: Health Systems Trust, 1999).
96. R. Smart and A. Strode, "South African Labor Law and HIV/AIDS," AIDS Analysis Africa 10/3 (1999): pp. 7-10;
97. and C. Ngwena, "HIV in the Workplace: Protecting Constitutional Rights to Equality and Privacy," South African Journal on Human Rights 15/4 (1999): pp. 513-540.
98. S. J. Reid, "Compulsory Community Service for Doctors in South Africa - An Evaluation of the First Year," South African Medical Journal 91/4 (2001): pp. 329-36.
99. Open Democracy Advice Centre (ODAC), "Blowing the Whistle: In Support of a New Culture of Openness in South Africa" (2003). Available at http://www.opendemocracy.org.za/documents/ ODAC%20%20PDA%20Issue%20Paper%20Response.htm.
100. H. Marais (see note 14)
101. S. Nadasen, Public Health Law in South Africa (Durban: Butterworths, 2000).
102. South Africa's Human Rights Commission (SAHRC) is established in the Constitution as one of the key institutions to protect and promote democracy. Criticisms made of the SAHRC have included its limited resources and capacity, its temerity in challenging government over policy decisions and perceived political partisanship in some appointments.
103. I. Friedman, "Poverty, Human Rights and Health," in A. Ntuli, N. Crisp, E. Clarke, P. Barron (eds), South African Health Review 2000 (Durban: Health Systems Trust, 2001);
104. and South African Human Rights Commission, "National Inquiry into Human Rights in Farming Communities" (SAHRC, 2002). Available at http://www.sahrc.org.za/main_frameset.htm).
105. Notable exceptions are, for example, government's increasing sensitivity to journalists' criticism, which results in a perception of antipathy to freedom of the press; and a recent survey of government departments' unwillingness to provide access to the public to information. See "The Challenge of Implementation: The State of Access to Information in South Africa," Results of an ODAC survey into the implementation of access to information in South Africa 2003 in association with Open Society Justice Initiative, September 2004. Available at http://www.open-democracy.org.za/documents/ results_SA_OSJI_study.doc.
106. Smart and Strode (see note 51)
107. Department of Education, Draft National Policy on HIV/AIDS for Learners and Educators in Public Schools, and Students and Educators in Further Education and Training Institutions. Notice Number 1926 of 1999 (Pretoria: Department of Education, 1999).
108. R. Jennings, J. Mulaundzi, D. Everatt, M. Richter, M. Heywood, "Discrimination & HIV/AIDS," Report researched and written for the Department of Health. AIDS Law Project and Strategy and Tactics, October 2002. Available at http://www.alp.org.za/resctr/rpaprs/pdf/ 200210_Reserch.pdf;
109. and G. Solomon, "What New Policies Should South Africa's Life Insurance Industry Adopt?" AIDS Analysis Africa 6/6 (1996): pp. 12-3.
110. Sidley (see note 4)
111. Nattrass (see note 4)
112. P. Sidley, "South African Government Forced to Give Mothers Antiretroviral Drug," British Medical Journal 325/7356 (2002): p. 121;
113. and K. Cullinan, "Court Orders South Africa to Treat Pregnant HIV-Positive Women with Nevirapine," Bulletin of the World Health Organisation 80/4 (2002): p. 335.
114. See Department of Health, "HIV/AIDS/STD Strategic Plan for South Africa, 2000-2005," (Pretoria: Department of Health, 2000). Priority Area of the Plan is human rights and includes two goals - that of creating an appropriate social environment (Goal 14) and developing an appropriate policy and legal environment (Goal 15).
115. R. Naidoo, "The BIG: Poverty, Politics and Policy-making," South African Labor Bulletin 23/6 (2002): pp. 23-25.
116. H. C. Cawthra, A. Helman-Smith, D. Moloi, "Annual Review: The Voluntary Sector and Development in South Africa 1999/2000," Development Update 3/3 (2001). Available at http:// www.interfund.org.za/pdffiles/vol3_three/part4.pdf;
117. and Marais (see note 14)
118. B. Peek, "Doublespeak in Durban: Mondi, Water Management and the Struggles of the South Durban Community Environmental Alliance," in D. McDonald (ed), Environmental Justice in South Africa (Athens: Ohio University Press, 2002);
119. A. Habib, "State-Civil Society Relations in Post-Apartheid South Africa," South African Labor Bulletin 27/6 (2003): pp. 14-18;
120. M. Dorsey and T. Guliwe, "Environmentalism, the WSSD and Uneven Political Development," in P. Bond (ed) Unsustainable South Africa: Environmental, Development and Social Protest (Scottsville: University of Natal Press, 2002);
121. and Marais (see note 14)
122. M. Heywood, D. Altman, "Confronting AIDS: Human Rights, Law and Social Transformation," Health and Human Rights 5/1 (2000): pp. 149-179.
123. L. London, "Can Human Rights Serve as a Tool for Equity?" Equinet Discussion Paper 14. Co-published by the Regional Network for Equity in Health in Southern Africa (EQUINET) and the University of Cape Town School of Public Health and Family Medicine (Harare: December 2003). Available http://www.equinetafrica.org/bibl/docs/POL14rights.pdf.
124. I b i d.
125. See note 4
126. H. Marais (see note 14)
127. and H. Schneider and J. Stein (see note 48).
128. See note 4.
129. Dr. Manto Tshabalala-Msimang, Minister of Health. Speech given at World Aids Day 2003 (December 1, 2003). Available at http://www.info.gov.za/ speeches/index.html.
130. C. Ngwena, "Right of Access to Antiretroviral Therapy to Prevent Mother-to-Child Transmission of HIV: An Application of Section 27 of the Constitution," South Africa Public Law 18/1 (2003): pp. 83-102.
131. M. Heywood, "Preventing Mother-to-Child HIV Transmission in South Africa: Background, Strategies and Outcomes of the Treatment Action Campaign's Case Against the Minister of Health," South African Journal of Human Rights 19/2 (2003): pp. 278-315;
132. Sidley, note 63
133. Cullinan, note 63.
134. See note 48.
135. H. Marais (see note 14).
136. L. London, "Human Rights and Public Health: Dichotomies or Synergies in Developing Countries? Examining the Case of HIV in South Africa," Journal of Law, Medicine and Ethics 30/4 (2002): pp. 677-691;
137. Nattrass (see note 4).
138. J. Head, "Health and Development: Some Concerns about South Africa's Health Policy," Urbanization and Health Newsletter, 30 (1996): pp. 33-48;
139. P. Bond, Y. G. Pillay, D. Sanders, "The State of Neoliberalism in South Africa: Economic, Social, and Health Transformation in Question," International Journal of Health Services 27/1 (1997): pp. 25-40;
140. P. Bond, G. Dor, "Uneven Health Outcomes and Political Resistance under Residual Neoliberalism in Africa," International Journal of Health Services 33/3 (2003): pp. 607-30;
141. and H. Marais, South Africa: Limits to Change - The Political Economy of Tranformation (London: Zed Press, 1998).
142. V. Thoka and I. Lesufi, "Social Movements in the Context of Globalization: Experiences and Lessons for South Africa," (National Land Committee, 2003). Available at http://www.nlc.co.za/pubs2003/ social-movements.pdf;
143. N. Vink, "Patience Running Out," The World Today 60/3 (2004): pp. 21-23;
144. and National Land Committee, "Declaration of the African Perspectives on Land and Sustainable Development Forum," World Summit on Sustainable Development, Johannesburg, August 27, 2002. Available at http://www.nlc.co.za/wssd/africanperspectivedeclar.htm.
145. M. Burger and C. Gould, Secrets and Lies: Wouter Basson and South Africa's Chemical and Biological Warfare Programme (Cape Town: Zebra Press, 2002).
146. South Africa Department of Health, 1999.
147. See, for example, K. Bloch, M. Hlope, P. Langa, L. Redman, and M. Wessels, "Epidemiological Study on the Quality of Care Pertaining to the Patients' Charter in the Brown's Farm Community" (Fourth year medical student project, Department of Public Health and Family Medicine, University of Cape Town, 2001);
148. J. Knighton-Fitt, "The Patients' Rights Charter as a Tool for Claiming One's Rights as a Patient" (Student project, Department of Education, University of Cape Town, 2003);
149. M. L. Sebokedi, "Patients' Rights Charter: The Impact on the Quality of Care" (MBA Dissertation, University of Pretoria, 2002).
150. See, for example, the description of a Health Rights Charter developed in 1999 in the Thukela District near Ladysmith in KwaZulu-Natal, as an example of a bottom-up participatory approach to operationalizing rights in health care settings, in Friedman (see note 57); or the experience of the CARE project in Malawi using a scorecard approach based on shared community-provider judgements -
151. D. F. Kalomba, "Adopting the Rights Based Approach (RBA) to Achieve Equity in Health," paper presented to the third Southern African Conference on Equity in Health, South Africa, June 2004.
152. The Community Working Group on Health (CWGH) in Zimbabwe has mobilized civic and rural community groups in committees that are able to engage with health services, giving communities opportunities to influence the allocation of the HIV levy, and interacting with clinic staff to improve the quality of services, for example, by improving the privacy afforded to patients and attitudes of nurses.
153. See London (note 69).
154. British Medical Association, The Medical Profession and Human Rights: Handbook for a Changing Agenda (London: British Medical Association, 2001).
155. L. S. Rubenstein, L. London, L. Baldwin-Ragaven, and the Dual Loyalty Working Group, "Dual Loyalty and Human Rights in Health Professional Practice: Proposed Guidelines and Institutional Mechanisms," A Project of the International Dual Loyalty Working Group, Physicians for Human Rights and University of Cape Town (Boston: Physicians for Human Rights, 2002).
156. See L. London, "Dual Loyalties, Health Professionals and HIV Policy in South Africa," South African Medical Journal 92/11 (2002): pp. 882-883.
157. S. Reid and E. de Vries, "Do South African Medical Students of Rural Origin Return to Rural Practice?" South African Medical Journal 93/10 (2003): pp. 789-93.
158. L. London, S. Ismail, M. Alperstein, D. Baqwa, "Diversity in the Learning Environment and Curriculum Reform in the Health Sciences - Challenges for a Country in Transition," Perspectives in Education 20 (2002) pp. 21-32.