BISSAU/GENEVA (8 June 2017) – A UN report released Thursday reveals the major challenges Guinea-Bissau is facing in the realization of the right to health.
Political instability, endemic poverty, and deficits in accountability, access to food, education, safe drinking water and sanitation, as well as a health care system in need of reform, lead to violations of the right to health, particularly maternal and child health, sexual and reproductive health, and healthcare for people living with HIV/AIDS, tuberculosis and malaria, the report says.
While acknowledging improvements over the past few years, the report by the UN Peacebuilding Office in Guinea-Bissau (UNIOGBIS) and the UN Human Rights Office calls for comprehensive reform of the healthcare system in the country and makes a number of recommendations, including in relation to improving monitoring and accountability.
The report states that most healthcare clinics and basic healthcare posts lack electricity or water supplies and that salaries in the sector are low. Health care workers in some basic healthcare posts are described as having to deliver babies by candlelight, without access to sterile water. Given the high mortality rates of newborns and their mothers in Guinea-Bissau, such deficiencies are particularly alarming and need to be addressed. In 2016, the infant mortality rate was 60.3 per 1,000 live births. In 2015, the maternal mortality rate was 549 deaths per 100,000 live births – among the worst in the world.
The report also details the inadequate availability of healthcare services. There are only three pediatricians in the country, all expatriates, for a population of about 720,000 children under the age of 15. There are only four obstetricians, around 34 skilled midwives – and only one anesthetist in the whole country, serving a population of 1.888 million people. The dearth of medical schools is partly to blame, as is the “brain drain” of medical graduates to other countries with higher incomes and better living conditions. Most of the doctors who do remain in Guinea-Bissau live and work in urban areas, leaving the 50 per cent of the population in rural areas with even less access to healthcare.
In one case the report cites, health care professionals went on strike between March and May 2016, during which time 24 patients reportedly died due to the inability of the remaining health care workers to cope with the demands. “In this case, the failure of both the State and providers of health care services to make adequate services available directly violated the individual rights to life and health,” the report states.
Gender-based discrimination remains a significant problem, as does the distance to healthcare facilities. The lack of mechanisms for patients to claim their rights – whether in cases of negligent or substandard care or where they lack the financial resources to pay for crucial treatment – is also a serious issue.
The report states that the right to health is an inclusive right, which contains both freedoms and entitlements. Freedoms include the right to control one’s healthcare, including the right to be free from non-consensual medical treatment and experimentation.
Entitlements include the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable standard of health. More specific entitlements associated with the right to health include the rights to maternal, child and sexual and reproductive health; a healthy workplace and natural environment; the prevention, treatment and control of diseases, including access to vaccination and essential medicines; and access to safe and potable water.
While acknowledging the progress that the country has made towards the respect, protection and fulfillment of the highest attainable standard of physical and mental health, the report makes a number of recommendations, including within the framework of the 2030 Agenda for Sustainable Development, to improve the accessibility and quality of healthcare in Guinea-Bissau.
“The realization of the right to health has a strong link with the peacebuilding process in Guinea-Bissau,” said Modibo I. Touré, the Special Representative of the Secretary-General in Guinea-Bissau. “A healthy society is more able to assert its rights, and to participate positively in the political life and development of the country.” UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein underscored the State’s duty to ensure the right to health, as well as calling on international donors to continue to support Guinea-Bissau in its efforts towards the full realization of the right to health.
“Poor general health of a population can be a strong driving factor for a whole host of human rights deficiencies and violations in a country. It means lower literacy levels, lower levels of participation in public life and economic activity and more poverty,” High Commissioner Zeid said. “I call on the Government and the international community to view the right to health as indeed a right. This is not about charity. It is a human right that we all must ensure the people of Guinea-Bissau can enjoy fully.”
The report is based on focused research, consultations with stakeholders, and site visits to national, regional and specialty health care facilities, with a view to assisting the State in the fulfilment of its obligations to respect, promote and protect the right to health.
The report will be discussed and analyzed at a meeting in Bissau tomorrow, 9 June at 8:30 a.m. at the Salão Nobre Víctor Saúde Maria, at the Government Palace.