A human rights-based framework to assess gender equality in health systems: the example of Zika virus in the Americas.

BACKGROUND: The right to health was enshrined in the constitution of the World Health Organization (WHO) in 1946 and in the Universal Declaration of Human Rights in 1948. The latter Declaration, which also guaranteed women's rights, was signed by almost all countries in the world. Subsequent international conventions reinforced these rights, requiring that women be able to realize their fundamental freedoms and dignity. Although the value of incorporating gender into health systems has been increasingly acknowledged over the years, gender inequalities in health persist. OBJECTIVE: To introduce a tool to help countries assess their performance in addressing gender inequalities in their health systems, using the example of the Zika virus (ZIKV) in countries of the Americas. METHODS: This paper is based on comprehensive reviews of the literature on the links between gender equality, health systems and human rights, and available scientific evidence about an adequate response to ZIKV. RESULTS: The authors present a simple two-part framework from the human rights perspectives of the health system as duty bearer, incorporating WHO's six health system building blocks, and of its clients as rights holders. The authors apply the framework to ZIKV in the Americas, and identify strengths and weaknesses at every level of the health system. They find that when considering gender, health systems have focused mainly on dichotomous sex differences, failing to consider broader gender relations and processes affecting access to services, quality of care, and health outcomes. CONCLUSIONS: The authors' framework will permit countries to assess progress toward gender equality in health, within the context of their human rights commitments, by examining each health system building block, and the degree to which clients are realizing their rights. By applying the framework to specific health conditions, gender-related achievements and shortcomings can be identified in each health system component, fostering a more comprehensive and gender-sensitive response.

El Reglamento Sanitario Internacional, la enfermedad por el virus del Ébola y las enfermedades infecciosas emergentes en América Latina y el Caribe / International Health Regulations, Ebola, and emerging infectious diseases in Latin America and the Caribbean

La determinación por parte de la Organización Mundial de la Salud de que el brote de enfermedad por el virus del Ébola constituía un evento de salud pública de importancia internacional llevó a los países que no estaban afectados a aplicar medidas para prevenir y detectar la introducción del virus en sus territorios y para reaccionar frente a ella. El brote brindó la oportunidad de evaluar la aplicación operativa de las capacidades básicas del Reglamento Sanitario Internacional y la preparación de los sistemas de salud para hacer frente a un caso posible o confirmado de enfermedad por el virus del Ébola. Un marco rector de salud pública aplicado en los países de América Latina y el Caribe, que abarca autoevaluaciones preparatorias, visitas a los propios países y seguimiento, sugiere que esa región debe aumentar sus esfuerzos por consolidar y mantener los progresos en las capacidades básicas y en la preparación del sistema de salud para hacer frente a eventos de salud pública que tengan repercusiones a escala nacional o internacional.

The World Health Organization’s determination of the Ebola virus disease outbreak as a public health event of international concern prompted non affected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations’ core capacities and health systems’ preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.

International Health Regulations, Ebola, and Emerging Infectious Diseases in Latin America and the Caribbean.

The World Health Organization's determination of the Ebola virus disease outbreak as a public health event of international concern prompted nonaffected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations' core capacities and health systems' preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.

Border screening for SARS.

With the rapid international spread of severe acute respiratory syndrome (SARS) from March through May 2003, Canada introduced various measures to screen airplane passengers at selected airports for symptoms and signs of SARS. The World Health Organization requested that all affected areas screen departing passengers for SARS symptoms. In spite of intensive screening, no SARS cases were detected. SARS has an extremely low prevalence, and the positive predictive value of screening is essentially zero. Canadian screening results raise questions about the effectiveness of available screening measures for SARS at international borders.