Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure
Abstract Realization of the individual’s right to health in settings such as sub-Saharan Africa, where health care adequate resources are lacking, is challenging. This paper demonstrates this challenge by illustrating the example of dialysis, which is an expensive but life-saving treatment for peopl...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-022-01715-3 |
| _version_ | 1828178558917279744 |
|---|---|
| author | James Tataw Ashu Jackline Mwangi Supriya Subramani Daniel Kaseje Gloria Ashuntantang Valerie A. Luyckx |
| author_facet | James Tataw Ashu Jackline Mwangi Supriya Subramani Daniel Kaseje Gloria Ashuntantang Valerie A. Luyckx |
| author_sort | James Tataw Ashu |
| collection | DOAJ |
| description | Abstract Realization of the individual’s right to health in settings such as sub-Saharan Africa, where health care adequate resources are lacking, is challenging. This paper demonstrates this challenge by illustrating the example of dialysis, which is an expensive but life-saving treatment for people with kidney failure. Dialysis resources, if available in sub-Saharan Africa, are generally limited but in high demand, and clinicians at the bedside are faced with deciding who lives and who dies. When resource limitations exist, transparent and objective priority setting regarding access to such expensive care is required to improve equity across all health needs in a population. This process however, which weighs individual and population health needs, denies some the right to health by limiting access to health care. This paper unpacks what it means to recognize the right to health in sub-Saharan Africa, acknowledging the current resource availability and scarcity, and the larger socio-economic context. We argue, the first order of the right to health, which should always be realized, includes protection of health, i.e. prevention of disease through public health and health-in-all policy approaches. The second order right to health care would include provision of universal health coverage to all, such that risk factors and diseases can be effectively and equitably detected and treated early, to prevent disease progression or development of complications, and ultimately reduce the demand for expensive care. The third order right to health care would include equitable access to expensive care. In this paper, we argue that recognition of the inequities in realization of the right to health between individuals with “expensive” needs versus those with more affordable needs, countries must determine if, how, and when they will begin to provide such expensive care, so as to minimize these inequities as rapidly as possible. Such a process requires good governance, multi-stakeholder engagement, transparency, communication and a commitment to progress. We conclude the paper by emphasizing that striving towards the progressive realization of the right to health for all people living in SSA is key to achieving equity in access to quality health care and equitable opportunities for each individual to maximize their own state of health. |
| first_indexed | 2024-04-12T05:18:09Z |
| format | Article |
| id | doaj.art-6c285bb23db642f6bc63cf462ead8168 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-04-12T05:18:09Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-6c285bb23db642f6bc63cf462ead81682022-12-22T03:46:34ZengBMCInternational Journal for Equity in Health1475-92762022-09-0121111410.1186/s12939-022-01715-3Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failureJames Tataw Ashu0Jackline Mwangi1Supriya Subramani2Daniel Kaseje3Gloria Ashuntantang4Valerie A. Luyckx5Internal Medicine and Nephrology, Jura Bernois HospitalDepartment of Law Science and Technology at the School of Law, Jomo Kenyatta University of Agriculture and TechnologyInstitute of Biomedical Ethics and History of Medicine, University of ZurichGreat Lakes University of KisumuYaounde General Hospital Faculty of Medicine and Biomedical Sciences, University of Yaoundé IDepartment of Nephrology, University Children’s HospitalAbstract Realization of the individual’s right to health in settings such as sub-Saharan Africa, where health care adequate resources are lacking, is challenging. This paper demonstrates this challenge by illustrating the example of dialysis, which is an expensive but life-saving treatment for people with kidney failure. Dialysis resources, if available in sub-Saharan Africa, are generally limited but in high demand, and clinicians at the bedside are faced with deciding who lives and who dies. When resource limitations exist, transparent and objective priority setting regarding access to such expensive care is required to improve equity across all health needs in a population. This process however, which weighs individual and population health needs, denies some the right to health by limiting access to health care. This paper unpacks what it means to recognize the right to health in sub-Saharan Africa, acknowledging the current resource availability and scarcity, and the larger socio-economic context. We argue, the first order of the right to health, which should always be realized, includes protection of health, i.e. prevention of disease through public health and health-in-all policy approaches. The second order right to health care would include provision of universal health coverage to all, such that risk factors and diseases can be effectively and equitably detected and treated early, to prevent disease progression or development of complications, and ultimately reduce the demand for expensive care. The third order right to health care would include equitable access to expensive care. In this paper, we argue that recognition of the inequities in realization of the right to health between individuals with “expensive” needs versus those with more affordable needs, countries must determine if, how, and when they will begin to provide such expensive care, so as to minimize these inequities as rapidly as possible. Such a process requires good governance, multi-stakeholder engagement, transparency, communication and a commitment to progress. We conclude the paper by emphasizing that striving towards the progressive realization of the right to health for all people living in SSA is key to achieving equity in access to quality health care and equitable opportunities for each individual to maximize their own state of health.https://doi.org/10.1186/s12939-022-01715-3EquityRight to healthHuman rightsKidney diseasePriority settingRationing |
| spellingShingle | James Tataw Ashu Jackline Mwangi Supriya Subramani Daniel Kaseje Gloria Ashuntantang Valerie A. Luyckx Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure International Journal for Equity in Health Equity Right to health Human rights Kidney disease Priority setting Rationing |
| title | Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure |
| title_full | Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure |
| title_fullStr | Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure |
| title_full_unstemmed | Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure |
| title_short | Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure |
| title_sort | challenges to the right to health in sub saharan africa reflections on inequities in access to dialysis for patients with end stage kidney failure |
| topic | Equity Right to health Human rights Kidney disease Priority setting Rationing |
| url | https://doi.org/10.1186/s12939-022-01715-3 |
| work_keys_str_mv | AT jamestatawashu challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure AT jacklinemwangi challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure AT supriyasubramani challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure AT danielkaseje challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure AT gloriaashuntantang challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure AT valeriealuyckx challengestotherighttohealthinsubsaharanafricareflectionsoninequitiesinaccesstodialysisforpatientswithendstagekidneyfailure |