A global social contract to reduce maternal mortality: the human rights arguments and the case of Uganda
Bibliographic record
Abstract
Progress towards Millennium Development Goal 5a, reducing maternal deaths by 75% between 1990 and 2015, has been substantial; however, it has been too slow to hope for its achievement by 2015, particularly in sub-Saharan Africa, including Uganda. This suggests that both the Government of Uganda and the international community are failing to comply with their right-to-health-related obligations towards the people of Uganda. This country case study explores some of the key issues raised when assessing national and international right-to-health-related obligations. We argue that to comply with their shared obligations, national and international actors will have to take steps to move forward together. The Government of Uganda should not expect additional international assistance if it does not live up to its own obligations; at the same time, the international community must provide assistance that is more reliable in the long run to create the ‘fiscal space’ that the Government of Uganda needs to increase recurrent expenditure for health – which is crucial to addressing maternal mortality. We propose that the ‘Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa’, adopted by the African Union in July 2012, should be seen as an invitation to the international community to conclude a global social contract for health.RésuméLes progrès vers l’OMD 5a, une réduction de 75% des décès maternels entre 1990 et 2015, ont été substantiels, mais néanmoins trop lents pour espérer le réaliser cet objectif d’ici à 2015, en particulier en Afrique subsaharienne, y compris en Ouganda. Cela laisse entendre que ni le Gouvernement ougandais ni la communauté internationale ne respectent leurs obligations liées au droit à la santé envers la population ougandaise. Cette étude de cas de pays explore certaines questions clés soulevées lors de l’évaluation des obligations nationales et internationales relatives au droit à la santé. Nous avançons que pour s’acquitter de leurs obligations partagées, les acteurs nationaux et internationaux devront prendre des mesures pour avancer ensemble. Le Gouvernement ougandais ne doit pas attendre d’aide internationale supplémentaire s’il n’honore pas ses propres obligations ; en même temps, la communauté internationale doit prodiguer une assistance plus fiable à long terme dans le but de créer « l’espace fiscal » dont le Gouvernement ougandais a besoin pour relever les dépenses de santé récurrentes, ce qui est essentiel pour lutter contre la mortalité maternelle. Nous proposons que la « Feuille de route sur la responsabilité partagée et la solidarité mondiale dans la riposte au SIDA, à la tuberculose et au paludisme en Afrique », adoptée par l’Union africaine en juillet 2012, soit considérée comme une invitation lancée à la communauté internationale en vue de conclure un contrat social mondial pour la santé.ResumenSe han logrado considerables avances hacia la consecución del Objetivo 5a de Desarrollo del Milenio, reducir la mortalidad materna en un 75% entre 1990 y 2015; sin embargo, estos han sido demasiado lentos para cumplir el objetivo para 2015, particularmente en Ãfrica subsahariana, incluida Uganda. Esto indica que tanto el Gobierno de Uganda como la comunidad internacional no están cumpliendo sus obligaciones para con el pueblo de Uganda respecto al derecho a la salud. Este estudio de caso de país explora algunos de los asuntos clave planteados al evaluar las obligaciones nacionales e internacionales relacionadas con el derecho a la salud. Argumentamos que para cumplir sus obligaciones compartidas, los actores nacionales e internacionales deberán tomar medidas para seguir adelante de manera conjunta. El Gobierno de Uganda no debería esperar recibir más ayuda internacional si no cumple sus obligaciones; asimismo, la comunidad internacional debe brindar asistencia que sea más fiable a la larga para crear el ‘espacio fiscal’ que el Gobierno de Uganda necesita para aumentar los gastos recurrentes en salud, que es crucial para tratar el problema de mortalidad materna. Proponemos que el ‘Mapa de responsabilidad compartida y solidaridad mundial en respuesta al SIDA, la TB y la malaria en Ãfrica’, adoptado por la Unión Africana en julio de 2012, debe considerarse como una invitación a la comunidad internacional para concluir un contrato social mundial para la salud.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.013 | 0.025 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.001 | 0.014 |
| Research integrity | 0.008 | 0.007 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".