Enabling legal & policy environments for universal health coverage
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Effective and sustainable health responses require legal and policy environments that reduce inequalities and social exclusion that drive poor health and promote effective and inclusive governance for health
The United Nations Development Programme supports countries to develop enabling legal and policy environment that support effective and sustainable health responses, including:
- Assessing, reviewing and reforming laws and policies that affect health, HIV, TB, malaria and vulnerable and key populations, to ensure they protect fundamental human rights
- Protecting and upholding the rights to equality, non-discrimination and health, including sexual and reproductive health and rights, and access to medicines
- Providing programmes and services to reduce stigma, discrimination and violence, including gender-based violence, and promote access to justice for all vulnerable and key populations
- Empowerment of adolescent girls and young women and other vulnerable and key populations, to fulfil their rights to equality and health and to foster their meaningful participation in the governance of national health responses.
National health, HIV, TB and malaria strategies, plans and proposals, including Global Fund funding proposals, should include interventions aimed at achieving a strengthened legal and policy environment to protect human rights and gender equality.
An enabling legal and policy framework to address critical enablers for health requires several mutually reinforcing interventions that include
- Monitoring and reviewing laws, regulations and policies to protect human rights and promote gender equality for all populations at risk of poor health, including vulnerable and key populations at risk of HIV, TB and malaria
- Stigma and discrimination reduction programmes to reduce stigma and discrimination against vulnerable and key populations
- Legal literacy to educate communities about human rights, gender equality and protections in law and policy for their rights in the context of health
- Legal support services to support communities to get legal advice, access legal support, challenge violations and seek redress through litigation and other means
- Training for health care workers to prevent stigma, discrimination and human rights violations during the delivery of HIV, TB and malaria and other health services, including sexual and reproductive health services
- Sensitization of law-makers and law enforcers, to strengthen the awareness and understanding of how vulnerable and key populations experience human rights and gender-related barriers to access to health care, and access to justice and the need for rights-based responses and appropriate law enforcement
- Addressing gender inequality, harmful gender norms and gender-based violence that impact on the health rights of vulnerable and key populations
- Capacity strengthening and mobilization of civil society and key populations to participate in and advocate for rights-based health responses, and
- Research and monitoring of ongoing human rights issues and violations and progress towards creating protective, enabling frameworks and advocacy to address law, human rights and gender equality issues through strategies such as law review and reform, strategic litigation and integration of rights-based responses in national health responses.
Since 2012, UNAIDS has advocated seven key programmes to reduce stigma and discrimination and create enabling legal and policy environments for access to HIV-related health care services. These programmes also serve to strengthen health and community systems and can also be applied to addressing human rights within TB and malaria responses.
- stigma and discrimination reduction
- training for health care workers on human rights and medical ethics
- sensitization of law-makers and law enforcement agents
- legal literacy (“know your rights”)
- HIV-related legal support services
- monitoring and reforming laws, regulations and policies
- reducing gender inequality, harmful gender norms and gender-based violence
In Portugal, new HIV infections among people who use drugs fell by 17% from 1999 to 2003, while fewer people died from causes related to drug use. The decrease followed a Portuguese law, which came into effect July 1, 2001 that decriminalised the possession and use of illicit drugs in small enough amounts to suggest personal use.
The Global Commission on HIV and the Law’s 2012 report, Risks, Rights & Health, describes how the law provides for a range of sanctions, including fines, community service and suspension of professional licences, for people found to be in possession of or using drugs and education or treatment for those with drug dependency.
The number of people on methadone and buprenorphine for drug dependency rose to 14,877 from 6,040 after decriminalisation—treatment funded with the money Portugal saves on police and prisons. Portugal now reports one of the lowest rates of lifetime marijuana use (that is, at least one use in a lifetime) in the EU: 8.2%, compared with 25% in the EU generally. Data also shows a drop in drug use by teens; lifetime heroin use in 16- to 18-year-olds dropped from 2.5% to 1.8%. Other countries, such as Switzerland and the Islamic Republic of Iran, have also experienced lower HIV rates and improved health outcomes for people who use drugs by rejecting repressive drug policies.
Guidance: Key interventions to protect the sexual and reproductive health rights of adolescent girls and young women
An effective health response for AGYW should include programmes to address all human rights and gender equality-related barriers that increase AGYW’s vulnerability to ill health or limit their access to sexual and reproductive health services.
These may include initiatives to review and reform laws and strengthen access to justice to protect AGYW from:
- Stigma and discrimination from health care providers, partners, families and communities
- Breaches of the confidentiality and privacy rights of AGYW
- Age of consent laws that make it difficult for AGYW to access sexual and reproductive health services independently of a parent or guardian
- School policies that require pregnant girls to drop out of schools
- Laws that criminalize consensual sexual activity amongst older adolescents
- Laws that criminalize consensual same-sex sex
- Laws that criminalize adult sex work
- Laws that provide for punitive approaches to drug use
- Laws that allow for child marriage
- Laws and law enforcement that provides inadequate protection against gender-based violence
Guidance: Addressing the health needs of vulnerable & key populations
Vulnerable and key populations, including young key populations, may be at increased risk of stigma, discrimination and human rights violations and should be targeted with specific efforts to reduce inequalities and social exclusion that drive HIV and poor health and that create enabling legal, regulatory and policy environments to strengthen their access to HIV-related and other health care services.
Legal, human rights and gender assessments or audits can help identify how a country’s laws, regulations, policies and practices support or hamper access to health care services
Engagement scans provide further information on the opportunities for engaging in law and policy review and reform advocacy and strategic litigation. Programmatic responses should build on this information to ensure a holistic response that works at these various levels. See Identifying Barriers for more information on conducting multi-stakeholder and participatory legal, human rights and gender assessments and developing engagement scans for health and human rights.
Global Commission on HIV and the Law
On behalf of the Joint United Nations Programme on HIV/AIDS (UNAIDS) family, UNDP established an independent Global Commission on HIV and the Law in June 2010 to examine the impact of law on HIV responses and to catalyse country level action for legal environments that protect human rights and halt and reverse HIV.