UNAIDS and the Global Health Workforce Alliance are launching an Agenda for Zero Discrimination in Health Care. The agenda supports a vision for a world where everyone, everywhere, enjoys health services without discrimination and where the health workforce is empowered to provide discrimination-free services to all.

Many people around the world face barriers to accessing quality health-care services and realizing the highest attainable standard of health. The multiple reasons for this vary across countries and communities. Even where health-care services are available and of good quality, people often experience or fear stigma and discrimination, which prevent them from accessing the health services they need and are entitled to receive.

A new report by Asia Catalyst produced in collaboration with eight community-based organizations in Cambodia, China, Myanmar and Viet Nam has documented discriminatory practices in health-care settings specifically against people living with HIV. Findings include experiences of involuntary HIV testing, involuntary disclosure of status, segregation, arbitrary additional expenses imposed due to HIV status and medical advice against pregnancy and for sterilization on the sole basis of HIV status.

The agenda offers a space for collaboration between countries, the World Health Organization, UNAIDS, other United Nations and intergovernmental organizations, professional health-care associations, civil society, academics and others to take coordinated action for achieving zero discrimination in health care.

The agenda will prioritize coherent joint actions in three critical areas:

• Political support: by increasing political commitment through mobilization of all key constituencies, to secure prioritization of this agenda at all levels.
• Implementation: by fostering scale-up of implementation of effective actions to achieve discrimination-free health care.
• Accountability: by promoting monitoring and evaluation frameworks and mechanisms to build evidence, monitor progress and ensure accountability.

The action plan outlines seven priorities; these include: building and sharing evidence and best practices; standard-setting; ensuring meaningful engagement of the people most affected by discrimination in the development, implementation and monitoring of policies and programmes; and strengthening the leadership of professional health-care associations.

A virtual community of practice has been created to mobilize more partners around the shared vision and action plan, to join contact ghwa@who.int. 

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Public health leaders and key stakeholders from around the world have come together at the Prince Mahidol Award Conference  to discuss how limited health resources can be used in the most cost-effective way to provide high-quality health care.

Her Royal Highness Princess Maha Chakri Sirindhorn opened the conference by saying it came at a key moment since it followed the adoption of the Sustainable Development Goals by countries late last year. The UNAIDS Executive Director Michel Sidibé delivered a keynote address speaking about the need for a paradigm shift, moving from a disease response to a people-centred approach.

The conference, which is taking place in Bangkok, Thailand from 26 to 31 January, is being held under the theme Priority Setting for Universal Health Coverage. It is welcoming more than 900 government officials, representatives of intergovernmental organizations, international development partners and researchers from around 50 countries.

Thailand is one of the countries that have succeeded in putting people at the centre of their universal health coverage plan. Thailand champions the scale-up of community-led services. The Bangkok Metropolitan Administration, for example, works closely with civil society and communities.

During his visit to Thailand, Mr Sidibé visited two community-led programmes with Ms. Pusadee Tamthai, the Deputy Governor of Bangkok. One was the Service Workers in Group Foundation, better known as SWING, which supports sex workers by providing screening for sexually-transmitted infections, HIV counselling, testing, treatment, care and support services.

Mr Sidibé also visited the Tangerine clinic, housed at the Thai Red Cross AIDS Research Center, which is the first clinic to offer comprehensive sexual health services to transgender people in Thailand. Mr Praphan Phanuphak, Director of the Research Center, is a pioneer in the AIDS movement and demonstrates how science, integrated into community work, brings health care to even the most marginalized people.

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Disasters are an increasing threat to the lives and livelihoods of millions of people around the globe and can have a profound impact on social, economic and health outcomes. Participants at the Third United Nations World Conference on Disaster Risk Reduction, taking place in Sendai, Japan, are discussing how to promote a sustainable development agenda addressing risk and supporting greater resilience for countries and communities.

The high-level meeting, which is taking place from 14 to 18 March, is being attended by UN Secretary-General Ban Ki-moon, several heads of state, a number of UN heads of agencies and more than 100 ministers. It also includes some 8000 delegates from government, civil society, the private sector and donor agencies, as well as tens of thousands of members of the public attending the various public forums.

A broad array of issues are being debated over the five days, ranging from how to cope with emergency disasters, such as earthquakes, droughts and tsunamis, to reducing the risks of epidemics, such as Ebola, bird flu and HIV. Emphasis is being placed throughout on providing practical solutions to protect the most vulnerable. There is also a recognition that efforts to achieve key development, economic and health goals cannot succeed when disasters continue to erode progress and cost hundreds of billions of dollars a year globally. 

UNAIDS has a significant presence at the conference and is co-organizing, with WHO, UNFPA and UNISDR, a number of official events, including a day-long public forum on protecting people’s health from disaster risks.

A dominant theme across these events involves showcasing how risk reduction in the post-2015 development agenda can draw on the experience, lessons learned and successes of the AIDS response. The importance of mobilizing vulnerable communities, putting them at the centre of disaster prevention, preparedness, recovery and rehabilitation efforts, is being highlighted, along with the need to foster effective shared accountability. Mainstreaming health interventions across risk management programmes is also a prominent message. 

A post-2015 framework for disaster risk reduction, which will govern this area for the next 15 years, will emerge from the conference. Health is fully embedded in the current framework, with particular mention of pandemics and epidemics. A Sendai Declaration will also be adopted reaffirming political commitment to strengthen efforts and cooperation for disaster risk reduction worldwide. 

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Global health partners met in Geneva to begin the process of building a new approach to better determine health needs and constraints and addressing them in countries.

The new framework, the Equitable Access Initiative, aims to better inform international decision making processes on health and development, particularly where they rely on traditional gross-national-income classification as a measure of where to invest global health resources.

Relying solely on gross national income to determine investment priorities in global health has been increasingly questioned by partners.

Economic growth is lifting many countries from low- to middle-income status, yet those classifications and criteria may be too simple to capture overall needs and capacities.

Countries classified as middle-income are often in need of substantial resources to respond to disease burden, as a steadily larger percentage of those affected by the diseases live in middle-income countries.

Participants in the meeting discussed how the absence of new strategies to ease the transition of countries from low-income to middle-income status has led to a substantial risk of countries not being able to maintain or improve health outcomes. The initial meeting of the Equitable Access initiative was held on 23 February 2015 and co-chaired by Pascal Lamy, the Honorary President of Notre Europe, and Donald Kaberuka, the President of African Development Bank Group. The meeting, hosted by the WHO, was co-convened by Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, TB, Malaria; UNAIDS; UNICEF; UNDP; UNFPA; UNITAID; WHO and the World Bank.

The meeting looked at a process of engagement that may culminate in recommendations on how to support countries as they make vital health investments as they transition from low-income to middle-income status.

The Equitable Access Initiative seeks to establish a new way to measure a country's health needs and capacities, aimed towards sustainability, and in addition to propose nuanced health classifications that go beyond traditional economic metrics such as national income levels and are more relevant for better health outcomes. The initiative will be firmly grounded in human rights and will uphold the need for zero discrimination in access to medicines and health services. 

Innovations in governance are among the signature achievements of the AIDS response and these innovations have transformed the lives of people living with and affected by HIV. This is one of several key points covered in a compilation co-guest-edited by UNAIDS Executive Director, Michel Sidibé, published on 20 December in a special issue of Global Health Governance.

The overview paper, People, Passion & Politics: Looking Back and Moving Forward in the Governance of the AIDS Response, by Mr Sidibé and colleagues, presents a seven-point AIDS governance action agenda. At the core of the agenda are three mutually reinforcing principles: first, the exceptional role that affected people play to radically alter the construction of vulnerability; second, the pivotal importance that responses are essentially owned by the people that they are meant to serve, and; third, the force of movements and coalitions to tip the scales of power through creative approaches to framing, litigation and transnational political strategies.  

Over the years, the greater participation of vulnerable groups in the global political arena has resulted in more relevant prevention programmes and unprecedented expansion of access to HIV prevention, treatment, care and support services. However, as the article highlights, fundamental shifts in the political and economic context call for yet new approaches; for example, engaging with the academic community to critically review the governance of HIV programmes and services and explore opportunities for advancing the AIDS agenda across all sectors.

The idea for this special issue of Global Health Governance was inspired by widespread recognition of the changes brought about to governance approaches as a result of the AIDS response and how other global challenges can benefit from the lessons learned in addressing the epidemic. Furthermore, the gradual shifts in global power, from the G8 to the G20, and from collective action to ‘hyper-collective action’, require advancements in the manner in which the AIDS response is governed.

“Over the past three decades, the HIV response has been an engine of innovation,” reflects Mr Sidibé. “In so doing, it has delivered tangible results for people while opening and protecting space for more inclusive and rights-based governance of all challenges of the global commons. The changing global order demands that this engine doesn’t stop.”

Working together with the development community, the HIV response can continue to transform the way that it governs the complex challenges in advancing human development, rights and dignity, assert the authors. The papers in this special issue, contributed by people living with HIV, national AIDS programme managers, civil society activists, leading academics and others, provide a concrete step forward in strengthening the norms, rules, institutions and practices to solve long-standing collective action problems.

“We are extremely pleased to see the release of this special issue,” said Prof Yanzhong Huang, Senior Fellow for Global Health at the Council on Foreign Relations and editor of the journal. “Thanks to this special issue, we have a much better idea of how global health governance itself is being constantly shaped by the practice, programmes, and projects aimed at fighting HIV.” 

The special issue of Global Health Governance can be accessed at: http://ghgj.org/Volume%20IV%20Issue%201.htm