An Analysis of the Extent of Social Inclusion and Equity Consideration in Malawi’s National HIV and AIDS Policy Review Process

Document Type : Original Article

Authors

1 Centre for Global Health, Trinity College Dublin, Dublin, Ireland

2 Department of Nutrition, HIV and AIDS, Lilongwe, Malawi

3 Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland

4 Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa

5 Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic

Abstract

Background
Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process.
 
Methods
This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes.
 
Results
Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable
steps were taken to engage and promote participation of vulnerable groups in the planning, development,implementation,
monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy.
 
Conclusion
While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened.

Keywords

Main Subjects

References

  1. World Health Organization. International Conference on Primary Health Care, Alma-Ata, USSR, September 6-12, 1978. http://www1.paho.org/English/DD/PIN/alma-ata_declaration.htm.  Accessed June 7, 2016.
  2. UNAIDS. Fact Sheet 2016: Global Statistics. http://www.unaids.org/sites/default/files/media_asset/20150901_FactSheet_2015_en.pdf. Accessed May 15, 2016.
  3. Global AIDS Report 2016, UNAIDS. http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf. Accessed June 7, 2016.
  4. International HIV and AIDS Alliance. HIV, Health and Rights: Sustaining Community Action -- strategy 2013-2020.https://www.aidsalliance.org/assets/000/000/713/90626-HIV_-Health-and-Rights-Sustaining-Community-Action_original.pdf?1406297608.   Published 2013.
  5. Backman G, Hunt P. Khosla R, et al. Health systems and the right to health: an assessment of 194 countries. Lancet. 2008;372(9655):2047-2085. doi:10.1016/S0140-6736(08)61781-X
  6. Braveman P, Gruskin S. Poverty, equity, human rights and health. Bull World Health organ. 2003;81(7):539-545.
  7. UNAIDS. The GAP Report, 2014. http://www.unaids.org/en/resources/campaigns/2014/2014gapreport/gapreport.  Accessed March 17, 2016.
  8. MacLachlan M, Amin M, Mannan H, et al. Inclusion and human rights in health policies: comparative and benchmarking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia. Plos One. 2012;7(5):e35864. doi:10.1371/journal.pone.0035864
  9. Tamburlin G. Promoting equity in health. Health Policy Dev. 2004;2(3):186-191.
  10. World Health Organization. World Report on Disability. Geneva: WHO; 2011.
  11. UNAIDS (Joint Nations Programme on HIV/AIDS). Getting to zero: UNAIDS 2011-2015 strategy. Geneva, Switzerland: UNAIDS; 2010.
  12. United Nations. Sustainable Development Goals: 17 Goals to transform our world. Available from http://www.un.org/sustainabledevelopment/peace-justice/.  Accessed July 3, 2016. Published 2016.
  13. Solar O, Irwin AA. Conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice); 2010.
  14. Jones H, Higgins K, Bird K. Equity in Development: why is it important and how to achieve it. London: Overseas Development Institute; 2009.
  15. MacLachlan M,Mji G, Chataika T, et al. Facilitating disability inclusion in poverty reduction processes: group consensus perspectives from disability stakeholders in Uganda, Malawi, Ethiopia, and Sierra Leone. Disability & the Global South. 2014;1(1):107-127.
  16. UNDESA. Report of the Expert Group Meeting on Practical Strategies to Promote Social Integration: Lessons Learned from Existing Policies and Practices. Organized by the Department of Social Policy and Development (DPSP). Department of Economic and Social Affairs, in collaboration with the Government of Ghana; 2009.
  17. CESR. The OPERA Framework: Assessing compliance with the obligation to fulfill economic, social and cultural rights. http://www.cesr.org/sites/default/files/the.opera_.framework.pdf.   Accessed July 2016. Published 2012.
  18. Wampler B, McNulty S. Does participatory Governance matter? Exploring the nature and impact of participatory reforms. Washington DC: Woodrow Wilson International Center for Scholars; 2011.
  19. Ivanova O, Drabel T, Tellier S. Are sexual and reproductive health policies designed for all? Vulnerable groups in policy documents of four European countries and their involvement in policy development. Int J Health Policy Manag. 2015;4(10):663-671. doi:10.15171/ijhpm.2015.148
  20. MacLachlan M, Mannan H, HussT, Munthali A, Amin M. Policies and processes for social inclusion: using EquiFrame and EquIPP for policy dialogu: Comment on “Are sexual and reproductive health policies designed for All? Vulnerable groups in policy documents of four European countries and their involvement in policy development.” Int J Health Policy Manag. 2016;5(3):193-196. doi:10.15171/ijhpm.2015.200
  21. National AIDS Commission. National Strategic Plan for HIV and AIDS. Lilongwe, Malawi: Malawi Government Press; 2014.
  22. Mannan H, Amin M, MacLachlan M, the Equitable Consortium. The EquiFrame Manual: A tool for Evaluating and Promoting the Inclusion of Vulnerable Groups and Core Cncepts of Human Rights in Health Policy Documents. Dublin: Global Health Press; 2011.
  23. Huss T, MacLachlan M. Equity and Inclusion in Policy Processes (EquIPP): A Framework to support Equity and Inclusion in the Process of Policy Development, Implementation and Evaluation. Dublin: Global Health Press; 2016.
  24. Turnbull HR, Beegle G, Stowe MJ. The core concepts of disability policy affecting families who have children with disabilities. J Disabil Policy Stud. 2001;12(3):133-143.
  25. International Labour Organization. Decent work and the informal Economy. Geneva. 2002. http://www.ilo.org/public/english/standards/relm/ilc/ilc90/pdf/rep-vi.pdf.   Accessed June 25, 2016.
  26. United Nations Economic and Social Council. Enhancing Social Protection and Reducing Vulnerability in a Globalizing World: Report of the Secretary-General. New York: United Nations; 2000.
  27. United Nations Economic and Social Council Enhancing Social Protection and Reducing Vulnerability in a Globalizing World: Report of the Secretary-General. New York: United Nations; 2002.
  28. United Nations Division for Social Policy and Development. Disability and HIV/AIDS. New York, USA: United Nations Department of Economic and Social Affairs; n.d.
  29. Eide AH, Mannan H, Khogali M, van Rooy G, et al. Perceived barriers for accessing health services among individuals with disability in four African countries. PLoS One. 2015;10(5):e0125915. doi:10.1371/journal.pone.0125915
  30. Mendizabal E, Osborne D, Young J. Policy engagement: How Civil Society Can Be More Effective. London, United Kingdom: Overseas Development Institute;2006.
  31. World Health Organization. Human rights, health and poverty reduction strategies. Geneva: WHO; 2008. Health and Human Rights Publications Series.
  32. Britz JJ. To know or not to know: a moral reflection on information poverty. Journal of Information Science. 2004;30(3):192-204.
  33. MacLachlan M. Macropsychology, policy & global health. Am Psychol. 2014;69:851-863.
  34. Carver R. A new answer to an old question: national human rights institutions and the domestication of international law. Human Rights Law Review. 2010;10(1):1-32.
  35. Chenwi L. Unpacking “progressive realisation”, its relation to resources, minimum core and reasonableness, and some methodological considerations for assessing compliance. De Jure. 2013;46(3):742-769.

Files

History

  • Receive Date: 16 September 2016
  • Revise Date: 02 June 2017
  • Accept Date: 15 July 2017
  • First Publish Date: 01 April 2018

Share

How to cite

Statistics