The emergence of a global right to health norm – the unresolved case of universal access to quality emergency obstetric care

Hammonds, Rachel; Ooms, Gorik

doi:10.1186/1472-698x-14-4

Cited by 16 publications

(18 citation statements)

References 43 publications

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“…A group of scholars, building their opinions from a legal and human rights perspective, enshrined in various international covenants and treaties [ 45 – 49 ], argue that the concept of UHC implies the existence of a legal framework to ensure that every resident gets access to affordable health care [ 15 , 50 , 51 ]. This portrays UHC as a reformulation of the “ health for all” goal of the Alma Ata Declaration [ 15 , 22 , 52 – 54 ]. The view of UHC as a legal obligation imposed on all states that ratified the convention on the right to health [ 45 ], implies that UHC calls for all States to create legal entitlements to health care for all their residents [ 50 , 55 , 56 ], thereby placing the responsibility for the delivery of UHC on national governments [ 5 , 17 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

Abiiro

Allegri

2015

BMC Int Health Hum Rights

134

101

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BackgroundThere is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the various dimensions of UHC emerging from these interpretations and argues for the need to pay attention to the complex interactions across the various components of a health system in the pursuit of UHC as a legal human rights issue.DiscussionThe literature presents UHC as a multi-dimensional concept, operationalized in terms of universal population coverage, universal financial protection, and universal access to quality health care, anchored on the basis of health care as an international legal obligation grounded in international human rights laws. As a legal concept, UHC implies the existence of a legal framework that mandates national governments to provide health care to all residents while compelling the international community to support poor nations in implementing this right. As a humanitarian social concept, UHC aims at achieving universal population coverage by enrolling all residents into health-related social security systems and securing equitable entitlements to the benefits from the health system for all. As a health economics concept, UHC guarantees financial protection by providing a shield against the catastrophic and impoverishing consequences of out-of-pocket expenditure, through the implementation of pooled prepaid financing systems. As a public health concept, UHC has attracted several controversies regarding which services should be covered: comprehensive services vs. minimum basic package, and priority disease-specific interventions vs. primary health care.SummaryAs a multi-dimensional concept, grounded in international human rights laws, the move towards UHC in LMICs requires all states to effectively recognize the right to health in their national constitutions. It also requires a human rights-focused integrated approach to health service delivery that recognizes the health system as a complex phenomenon with interlinked functional units whose effective interaction are essential to reach the equilibrium called UHC.

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Section: Discussionmentioning

confidence: 99%

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

Abiiro

Allegri

2015

BMC Int Health Hum Rights

134

101

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“…These challenges and potential opportunities need to be addressed in order to achieve a rights‐based approach to healthcare delivery [47]. Innovative approaches need to be implemented at scale to extend universal coverage of high‐impact interventions and reduce or eliminate inequity while fostering efficiency of the services delivered.…”

Section: Opportunities and Challengesmentioning

confidence: 99%

Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care

Otolorin¹,

Gomez²,

Currie

et al. 2015

Intl J Gynecology & Obste

117

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Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.

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“…An estimated 303,000 maternal deaths occurred in 2015, and 99% of them were reported in developing countries, particularly in Sub-Saharan Africa and South Asia [ 3 ]. This suggests an urgent need to provide equitable, high-quality, evidence-based and respectful maternity care for all women everywhere [ 4 ], specifically, universal access to emergency obstetric care should be prioritized on the global health agenda [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013

2017

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Despite global efforts to improve maternal health, many developing countries including Pakistan have failed to achieve the target of a 75% reduction in maternal deaths by 2015. Addressing socioeconomic inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality rate. This study was done to examine the time trends and socioeconomic inequalities in the utilization of cesarean section (C-section) in Pakistan during 1990-2013. We used data from the Pakistan Demographic and Health Surveys (PDHS) conducted during 1990 to 2013. All these surveys are nationally representative surveys of ever-married women aged 15-49 years with a sample size of 6611, 10,023, and 13,558 women in 1990-1991, 2006-2007, and 2012-2013, respectively, with an overall response rate of over 90%. The unit of analysis for this study was women with their most recent live birth in the five years preceding the surveys. Bivariate analyses and multivariable logistic regression models were employed to investigate the prevalence of cesarean sections according to selected sociodemographic characteristics of women. C-section rates were found to have increased during this period, with an especially significant rise from 2. 7% in 1990-1991 to 15.8% in 2012-2013 with lower utilization among the non-educated women (7.5%), compared with the women with higher education (40.3%). C-section rates ranged from 5.5% in the poorest women to 35.3% in the richest women. Only 11.5% of the rural women had a C-section compared to 25.6% of the urban women. A greater likelihood of having a cesarean section was observed in the richest, highly educated, and urban-living women while there was no significant difference observed in cesarean section rates between the private and public sectors in all three surveys. To improve maternal health, routine monitoring and evaluation of the provision of emergency obstetric services are needed to address the underuse of C-section in poor and rural areas and overuse in rich and urban areas.

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The emergence of a global right to health norm – the unresolved case of universal access to quality emergency obstetric care

Cited by 16 publications

References 43 publications

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates

Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care

Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013

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