Catalysing Global Action to Eliminate Stigma and Discrimination in Health Care
Geneva, 10 – 11 November 2015
September 2015 marked the transition from one era of global health and development to the next. Seventeen Sustainable Development Goals (SDGs) were adopted by world leaders setting a vision for sustainable development grounded in international human rights standards, ensuring healthy lives, building inclusive societies, and putting equality and non-discrimination at the center of its goals. As with the Millennium Development Goals (MDGs), health is rightly recognized as a fundamental human right and driver of development.
UNAIDS Strategy 2016-2021 was approved by its Board soon thereafter, to fast track ending the AIDS epidemic as a public health threat, anchored in a commitment to Zero discrimination. Without communities as well as health workers at the center, this vision cannot be achieved. An extensive, global consultation on human resources for health has just been completed and the results are currently being translated into an updated draft of WHO’s Global Strategy on Human Resources for Health: Workforce 2030.
In November 2015, key stakeholders came together under these frameworks to participate in a dialogue on how to address stigma and discrimination in health care settings. Meeting participants came with the shared understanding that the attainment of health-related sustainable development goals (SDGs) – including the target of ending the epidemics of HIV, TB, and malaria – is underpinned by the imperative to address discrimination in health care.
Stigma and discrimination in health takes many forms—the denial of health care and unjust barriers to service provision, inferior quality of care and a lack of respect. Abuse and other forms of mistreatment, violation of physical autonomy, mandatory testing or treatment and compulsory detention are other forms of stigma and discrimination encountered by the most marginalized and most affected, including people living with or affected by HIV. The intersectionality of discrimination requires collective action to effectively address discrimination based on race, class, gender and gender identity, geography, sexual orientation, occupation, HIV and other health status, among others. This necessitates a concerted multisectoral response, within and beyond the health sector, cutting across the development, rule of law, education, financial and humanitarian agendas.
The lessons learned through the implementation of human rights programmes and partnerships as part of the HIV response – as well as meaningful involvement of affected communities whose participation has been crucial in tackling the HIV epidemic – can serve as critical entry-points and pathfinders in achieving the health-related SDGs and the UNAIDS Strategy targets. WHO’s draft Global Strategy for Human Resources for Health places similarly priority on ending discrimination in health care settings. It speaks, in particular, to models of health workforce education for nurturing professional ethics, practices, and attitudes necessary to deliver responsive and respectful care.
Meeting participants committed to increase individual and collective efforts around a shared vision: Everyone everywhere needs access to health services without discrimination.
The achievement of this collective vision demands that all stakeholders already working to advance this agenda come together for a Platform to Stop Discrimination in Health, grounded on the health-related SDGs, and the results of the UNAIDS Strategy and upcoming Global Strategy on Human Resources for Health: Workforce 2030. The Platform will prioritize three critical areas of information sharing and collective action:
- Accountability: Promote monitoring and accountability frameworks and mechanisms to build evidence, monitor progress, and ensure accountability of duty-bearers
- Influence development of monitoring and accountability frameworks, including: benchmarks to track progress towards the SDGs; accountability frameworks of relevant global strategies; and leveraging Global AIDS Progress Reporting and WHO Consolidated Guidance on Strategic Information
- Encourage evidence-building including through the development and better dissemination of standardized tools and metrics to capture the forms and prevalence of stigma and discrimination, as well as effective programmatic and policy responses
- Promote empowerment of communities and community-led monitoring – including on transparency of government spending and action– through partnerships with civil society actors and meaningful participation of affected communities
- Promote use of human rights mechanisms (e.g. Universal Periodic review and treaty-based, regional and national human rights institutions),applicable labor rights conventions and recommendations, and the support for remedial and redress mechanisms to operationalize legal and rights protection
- Political impact: Leverage political opportunities through mobilization of action of all key constituencies, to secure prioritization of this agenda at all levels
- Bring the issue of stigma and discrimination in health care settings into focus at strategic political moments, including: the High Level Meeting on HIV/AIDS; the upcoming WHO Strategies – the Global Strategy on Human Resources for Health: Workforce 2030 and the three Global Health Sector Strategies (on HIV/AIDS, Viral Hepatitis, and Sexually Transmitted Infections); regional opportunities; and professional association conferences and meetings, among others
- Build communication strategies and resources to effectively engage and communicate to multiple stakeholders to broaden base of support for this agenda
- Implementation: Foster scale-up of implementation of evidence-informed and effective actions
- Generate better understanding and dissemination of available knowledge, clear guidance, and standards
- Foster innovative capacity-building models and transformative education to nurture public ethics, professional practices, and the attitudes amongst required for the delivery of responsive and respectful care ; respecting both the both the rights of health care workers and users of services
- Catalyze efforts in professional associations to advance a zero discrimination agenda, including through competencies, use of ethics, and deontology codes in the to reassert commitment to human rights-based health care
- Advocate for the empowerment of marginalized persons to claim their rights in the context of health and strengthen the abilities of health care providers to claim their rights, including by fostering enabling work environments and labor rights
- Catalyze efforts to scale up funding for programmes designed to reduce discrimination in health care (e.g., Global Fund concept notes, domestic funding)
The Global Health Workforce Alliance and UNAIDS, through their constituency networks, have committed to a 100 day timeline – leading to 1 March 2016 Zero Discrimination Day – to ensure that voices of all relevant partners will be heard. The aim is to launch a working arrangement, a joint framework, and action plan for multi-sectoral and multi-stakeholder action, with commitments of all relevant actors to move towards a future with zero discrimination.