Enabling legal environments for universal health coverage
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Effective and sustainable health responses require legal and policy environments that reduce stigma, discrimination, inequality and violence
The United Nations Development Programmes recognises that effective and sustainable health responses require legal and policy environments that reduce stigma, discrimination, inequality and violence against all affected populations, and that empower communities to access their health rights and participate in the governance of the national response.
National strategies, plans and proposals, including Global Fund funding proposals, should include interventions aimed to address strengthened legal and policy frameworks, protect human rights and gender equality – critical enablers for health.
An enabling legal and policy framework that removes human rights and gender-related barriers to health care requires several mutually reinforcing programmes
An enabling legal and policy framework
An enabling legal and policy framework that addresses critical enablers and removes human rights and gender-related barriers to health care requires 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 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 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 affected populations
- Capacity strengthening and mobilisation 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 that address human rights and gender-related barriers to HIV services. These programmes also serve to strengthen health and community systems. They can also be applied to addressing human rights within TB and malaria responses. They are:
- 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 services
- monitoring and reforming laws, regulations and policies
- reducing gender inequality, harmful gender norms and gender-based violence
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
Key populations, including young key populations, are at increased risk of stigma, discrimination and human rights violations and should be targeted with specific efforts to remove legal, policy, human rights and gender-related barriers to their access to HIV-related and other health care services.
Legal, human rights and gender assessments can help identify how laws, regulations, policies and practice can support or hamper health rights
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 legal, human rights and gender assessments and developing engagement scans for health and human rights.
The regulation of health technologies is a critical component of any well-functioning health system, as it enables access and delivery to health technologies of assured quality, safety and efficacy. In some countries, capacity within regulatory systems remains limited, due to inadequate human and financial resources, overburdened staff and incomplete and incoherent policy frameworks.
As a result, many of the national regulatory authorities have limited capacity to approve medicines in a timely manner and to ensure acceptable quality, safety and efficacy standards. With the support of UNDP-lead Access and Delivery Partnership, in 2016 the African Union adopted a Model Law for Medical Products Regulation that provides a comprehensive legislative template for African countries that can be adopted and adapted by national governments and regional economic communities to harmonize regulatory systems and increase South–South cooperation across the region. For more information, ADP issue brief.
Key Resources
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Adolescent Girls and Young Women in High-HIV Burden Settings: Technical Brief Global Fund, 2017PDF 0.8 Mb -
Strategic Investments for Adolescents in HIV, Tuberculosis and Malaria Programs: Information Note Global Fund, 2016PDF 1.7 Mb -
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