Spending on health increase faster than rest of global economy, UN health agency says

According to the UN health agency, “countries are spending more on health, but people are still paying too much out of their own pockets”.

The agency’s new report on global health expenditure launched on Wednesday reveals that “spending on health is outpacing the rest of the global economy, accounting for 10 per cent of global gross domestic product (GDP).

The trend is particularly noticeable in low- and middle-income countries where health spending is growing on average six per cent annually compared with four per cent in high-income countries.

Health spending is made up of government expenditure, out-of-pocket payments and other sources, such as voluntary health insurance and employer-provided health programmes.

While reliance on out-of-pocket expenses is slowly declining around the world, the report notes that in low- and middle-income countries, domestic public funding for health is increasing and external funding in middle-income countries, declining.

Highlighting the importance of increasing domestic spending for achieving universal health coverage and the health-related Sustainable Development Goals (SDGs), Dr. Tedros Adhanom Ghebreyesus, WHO’s Director-General, said that this should be seen as “an investment in poverty reduction, jobs, productivity, inclusive economic growth, and healthier, safer, fairer societies.”

Worldwide, governments provide an average of 51 per cent of a country’s health spending, while more than 35 per cent of health spending per country comes from out-of-pocket expenses. One consequence of this is 100 million people pushed into extreme poverty each year, the report stresses.

When government spending on health increases, people are less likely to fall into poverty seeking health services. But government spending only reduces inequities in access when allocations are carefully planned to ensure that the entire population can obtain primary health care, the UN agency said.

“All WHO’s 194 Member States recognized the importance of primary health care in their adoption of the Declaration of Astana last October,” said Agnés Soucat, WHO’s Director for Health Systems, Governance and Financing. “Now they need to act on that declaration and prioritize spending on quality healthcare in the community,” she added.

The report also examines the role of external funding. As domestic spending increases, the proportion of funding provided by external aid has dropped to less than one per cent of global health expenditure. Almost half of these external funds are devoted to three diseases – HIV/AIDS, tuberculosis (TB) and malaria.

The report also points to ways that policy makers, health professionals and citizens alike can continue to strengthen health systems.

 “Health is a human right and all countries need to prioritize efficient, cost-effective primary health care as the path to achieving universal health coverage and the Sustainable Development Goals,” Dr. Soucat concluded.




South Sudan: ‘Outraged’ UN experts say ongoing widespread human rights violations may amount to war crimes

United Nations investigators on Wednesday denounced a raft of gross human rights violations being perpetrated in South Sudan, where over the past year, incidents of rape have surged and abductions, sexual slavery and brutal killings “have become commonplace.”  

“There is a confirmed pattern of how combatants attack villages, plunder homes, take women as sexual slaves and then set homes alight – often with people in them,” Yasmin Sooka, Chair of the Commission on Human Rights in South Sudan said in Nairobi at the launch of the launch of the three-member expert-body’s third report

“Rapes, gang rapes, sexual mutilation, abductions and sexual slavery, as well as killings, have become commonplace in South Sudan,” she continued. “There is no doubt that these crimes are persistent because impunity is so entrenched that every kind of norm is broken.”

While a lack of accountability during the country’s struggle for independence has helped to fuel the current conflict, the report stresses that sustainable peace requires tangible and credible accountability and justice.

There is no doubt that these crimes are persistent because impunity is so entrenched that every kind of norm is broken – Yasmin Sooka

“We do acknowledge the efforts of the Government to hold some perpetrators accountable for gross violations of human rights and serious violations of international humanitarian law,” Commissioner Andrew Clapham said in Geneva.

“However, we also have to note that pervasive impunity remains the norm.”

The Commission, set up in 2016 by the UN Human Rights Council, urged the Government, the region and the international community to “take urgent steps” to respect the cessation of hostilities, implement the Revitalized Agreement signed five months ago and “push to silence the guns completely.”

South Sudan, the world’s youngest nation, has been mired in instability and conflict for nearly all seven years of its existence.

Earlier in 2018, President Salva Kiir and his former Vice-President and long-time political rival, Riek Machar, signed a new peace accord, and hopes have been high that the deal would finally end the crisis and deliver better and safer conditions for millions that have been left homeless and hungry.

A downward spiral

Since its December 2017 update, the Commission said the magnitude of rape and sexual violence has worsened markedly, with a surge in rapes between November and December.

According to UNICEF, 25 per cent of those targeted by sexual violence are children, including girls as young as seven. Elderly and pregnant women have also been raped, and sexual violence against men and boys remains underreported as the stigma attached to it is higher than that of raping and killing the young and the elderly.

Portrait of a woman resident of Wau Shilluk, South Sudan. The town has been reduced to dust, as ongoing conflict has seen the complete destruction of homes, the school and hospital., by © UNICEF/UN0236862/Rich

The Commission also investigated sexual exploitation and abuse allegations committed by UN peacekeepers.

Cases in 2018, which involved 18 alleged perpetrators of the UN Mission in South Sudan (UNMISS), were registered in the UN Sexual Exploitation and Abuse Database, and peacekeepers from one of the Protection of Civilians sites were repatriated. 

The Commission also noted a link between the conflict and the country’s political economy – pointing to the misappropriation of natural resources, and “a total lack of transparency and independent oversight,” that has allegedly diverted revenues to Government elites.

Victims and vulnerable communities – especially women, the internally displaced and refugees – must be included in designing and implementing mechanisms for the transitional justice agenda, which the Commission deemed “essential for building sustainable peace.”

As it continues to document violations, build dossiers on perpetrators, and collect and preserve evidence for future accountability processes, the Commission has detailed three case studies documenting war crimes, which will be handed over to the Right Commission in Geneva.  

“This evidence may be used beyond South Sudanese bodies – it may be available on request to regional and state parties for future prosecutions,” said Commissioner Barney Afako.

“With sustained political will and effective leadership,” concluded Ms. Sooka, “the transitional justice framework and mechanisms can help to bring accountability, reconciliation and healing as South Sudanese deal with the past and secure their future stability and prosperity.”




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Prospect of lasting peace ‘fading by the day’ in Gaza and West Bank, senior UN envoy warns

The spectres of violence and radicalism in the Occupied Palestinian Territory are growing, and the prospect of sustainable peace is fading by the day, a senior UN envoy in the region told the Security Council on Wednesday.

The Council was briefed by Nickolay Mladenov, Special Coordinator for the Middle East Peace Process, as well as Ursula Mueller, Assistant Secretary-General for Humanitarian Affairs.

In a sombre assessment, Mr. Mladenov characterized the hope of a peaceful two-state solution as “slim.” Extremists are on the rise and that the risk of war looms large, he explained.

Against this backdrop, the immediate challenge is the prevention of an economic and humanitarian implosion in the West Bank and Gaza.

The Palestinian people, he continued, need the support of the international community more than ever, as a range of issues are exerting a “heavy toll” on those living in Gaza and the West Bank. These include ongoing violence, the lack of progress towards peace, financial pressures and unilateral measures by the Government of Israel.

Mr. Mladenov cited a recent decision by Israel to withhold some $140 million in Palestinian tax revenue transfers (the equivalent of money paid to Palestinians convicted of terrorism or security-related offences, and their families), and the decision of the United States Government to halt funding for the UN Relief and Works Agency for Palestine Refugees (UNRWA) as factors driving financial instability in the Occupied Palestinian Territory.

Ms. Mueller also described the “rising vulnerability” of Palestinians in Gaza, with salaries for public sector employees reduced or withheld, including in the health and education sectors, unemployment at over 50 per cent, and the fact that most citizens are dealing with food insecurity.

Funding cuts have forced the World Food Programme (WFP) to suspend assistance to some 27,000 people and reduce rations to another 166,000 beneficiaries. There is still, she continued, a considerable funding gap, and she urged Member States to step up and increase their support for humanitarian operations.

UN Photo/Loey Felipe

Ursula Mueller, Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator in the Office for the Coordination of Humanitarian Affairs (OCHA), addresses the UN Security Council on situation in the Middle East.

A number of political steps, said Mr. Mladenov, are necessary for the establishment of peace, including an end to the designation of land for exclusively Israeli use, as well as the cessation of Israeli settlement construction and expansion, and the creation of opportunities for Palestinian development in the West Bank. Demolitions and seizures of Palestinian-owned structures have continued across the West Bank, with some 900 Palestinians in East Jerusalem facing eviction.

The Special Envoy condemned violence and terror in the region over the past few months, which has seen the deaths of 40 children killed by Israeli forces, and the firing of 18 rockets towards Israel by Palestinian militants. There has been an upsurge in settler violence over the past year, he reported, with 20 recorded incidents of Israeli settlers injuring Palestinians or damaging their property.

The casualty figures are “stretching the capacity of health care providers” in the territory, said Ms. Mueller, putting the entire system at the risk of collapse: “Since the start of demonstrations in March 2018, over 27,000 Palestinians have been injured, more than 6,000 of them by live ammunition. According to the World Health Organization (WHO), 122 amputations have taken place since the start of the mass demonstrations, including 21 paediatric amputations.”

An international community committed to supporting both parties, leadership, and political will for change are, contended Mr. Mladenov, of primary importance and, until they are found, “Palestinians and Israelis will continue to slide into increasingly hazardous territory.”




UN chief urges India and Pakistan to dial down tensions in wake of Kashmir attack

United Nations Secretary-General António Guterres on Tuesday called on India and Pakistan to take steps to defuse tensions in the wake an attack in Kashmir late last week that left dozes of Indian security forces dead.

“The Secretary-General has been following with great concern the situation in South Asia,” UN Spokesman Stéphane Dujarric said in a statement on the 14 February terrorist attack that took place in the Pulwama district of Jammu and Kashmir.

According to media reports, tensions have been rising between India and Pakistan following the attack, which took place in a disputed territory that separates the two countries and resulted in the deaths of 40 Indian security personnel and the attacker.

Mr. Guterres reiterated his strong condemnation of the attack and stressed that it is essential that there be accountability under international law and the perpetrators of terrorist acts be brought swiftly to justice.

At the same time, the Secretary-General urgently appealed to the Governments of both India and Pakistan to exercise maximum restraint to ensure the situation does not further deteriorate.

“It is the belief of the Secretary-General that all difficult challenges can be resolved peacefully and satisfactorily through meaningful mutual engagement,” said the Spokesman.

The UN has long maintained an institutional presence in the contested area between India and Pakistan. According to the Security Council mandate given in resolution 307 of 1971, the UN Military Observer Group in India and Pakistan (UNMOGIP) observes and reports on ceasefire violations along and across the Line of Control and the working boundary between the South Asian neighbours in Jammu and Kashmir, as well as reports developments that could lead to ceasefire violations.