Inequitable access to healthcare in Africa: reconceptualising the "accountability for reasonableness framework" to reflect indigenous principles.

BACKGROUND: The "Accountability for Reasonableness" (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA. METHODOLOGY: A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO's "3-by-5" and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity. RESULTS: Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls' theory, and the African communal responsibility principle. CONCLUSION: A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.

Moral residue and health justice for the global south: Addressing past issues through current interventions and research.

This paper introduces the concept of moral residue to global health, and shows how its presence undermines crucial interventions and research, especially in the global south. Lingering feelings of anxiety, anger, blame or frustration often exist among local populations, where previous interventions or research have left traces of harm and/or exploitation. The existence of such feelings reflects the presence of moral residue, recognizing the moral experiences of epistemic injustices, which in turn undermines critical interventions and research through outright rejection or passive non-compliance among affected populations. While such situations have been variously interpreted and relevant strategies developed to address the issues, little to no consideration is made on the implications of moral residue experiences in global health contexts and how to address them. This paper demonstrates the presence of moral residue in global health and proffers an African ethical approach, a harmony framework, for addressing moral residue issues, as part of a holistic approach towards tackling population health crises without compromising health gains for affected populations in the global south.

Priorities for global access to life-saving interventions during public health emergencies: Crisis nationalism, solidarity or charity?

Access to COVID-19-vaccines by the global poor has unveiled the impact of global health and scientific inequities on access to life saving interventions during public health emergencies (PHE). Despite calls for global solidarity to ensure equitable global access to COVID-19 vaccines, wealthy countries both in the north and southern hemisphere may find a charity-based approach more appealing and are using the opportunity to forge neo-colonial cooperation ties with some African countries. Solidarity is undoubtedly an ideal equity-based principle of public health emergency of international concern (PHEIC). However, its application may be wanting especially as crisis nationalism is more likely to inform the public health policy of any country during a PHEIC, even when they are strong advocates of global solidarity. African countries, on the other hand, must re-appraise their heavy reliance on international aids during PHE and recognise the importance of boosting their epidemic preparedness including research and translation of its findings to practice.