Charter on Access to Health

Health is a fundamental human right and yet is denied to many: at the root of ill health is inequality, poverty, exploitation, violence and injustice.

As key populations and other marginalised groups in Southern Africa we are systematically denied access to health services in general and HIV programmes and services specifically. Our interactions with health providers are traumatic, abusive and oppressive and our specific needs are not recognised nor addressed.

This Charter outlines a set of seven areas of concern and related priorities which must be urgently addressed to ensure our rights to health as members of key populations and other marginalised groups are realised. Many of the demands in this Charter are applicable to everyone, because as members of key populations or other marginalised groups we do not live single issue lives nor do we hold single identities. We also do not live in isolation from others in society – our health is interdependent on each others.

The Charter is intended to support advocacy and policy work aimed at ensuring access to health for all. The Charter is both a product of – and a call to action for – participatory, collaborative and powerful KP-led activism. We encourage activists and organisations who work in the fields of health, sexuality and gender to use and adapt these principles to their work and contexts and in doing so to help us popularise and mobilise support for the Charter. We also do not see the Charter as a final product – and encourage activists to send us comments and suggestions on how to strengthen it.


People-centered, rights based systems and services

Our health system and services must be people centered. A human rights based and people centered approach is essential to the creation, provision, regulation and evaluation of healthcare services and should include the rights to self-determination, autonomy, privacy, access to information, the right to full participation in social, cultural and political life and the right to social and economic development and the right to freedom of expression.

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Enabling legal and policy framework

The legal and policy healthcare framework must respond to the realities, experiences and rights violations of marginalised people based on their sexuality, gender and occupation. It should also support access to healthcare services without discrimination on any grounds based on race, colour, sex, gender identity or expression, language, religion, political or other opinion, national or social origin, property, birth or any other status.

Laws and policies from the district to the regional levels must decriminalise marginalised people and their dependents based on their “non-normative” sexual practices such as sex work and same-sex practices, or based on drug use and the transmission of infectious diseases. Laws and policies must also clearly set out responsibilities of the state and private sector in upholding the rights of all people to health and create redress mechanisms for when these rights are violated.

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Public, universal & comprehensive healthcare

Healthcare services must be holistic and accessible. This means that services should include all facets of physical and mental health, including comprehensive sexual and reproductive health services. Our healthcare systems must be public and free and should be able to support all patients who require general or specialised care.

Tighter state regulation and community based oversight mechanisms on private health providers – including health care services, medical insurance and pharmaceutical manufacturing industries – must be put in place to ensure that these are held accountable to health rights: placing people before profits.

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Meaningful and democratic leadership and participation

Nothing for us, without us. Everyone has the right to participate in healthcare governance and decision-making processes. National and regional healthcare governance frameworks must be open, inclusive, accountable, transparent and collaborative. Decision-making processes, in particular in local clinics and health services, must be participative and democratic, and must foster the involvement of all who will be affected by these processes, and in particular of key populations and marginalised people.

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Safety & security

We call on all healthcare practitioners, policy makers, decision-makers and service users to address the issues of stigma, discrimination, harassment and violence towards women, key populations and marginalised people. The attacks on and policing of our lives and identities impact on us individually and our families and networks and also constitute a serious obstacle to achieving the goal of healthy societies and communities. While individual acts of violence and discrimination take place at the interpersonal level, it is also important to name and address the ways in which patriarchy, racism, classism and other forms of oppression are expressed at the systemic, institutional levels and in popular understanding or thinking.

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Money: Economic access, accountable funding, sufficiency and decent work

People before profits. We must interrogate and challenge the capitalist framework that drives our healthcare systems towards privatisation, profit and corporate control. We must also challenge the monopoly of pharmaceutical companies that control the intellectual property of life saving medicines. Our health and our lives depend on access to free and non-privatised health services and drugs.

In the same way, we must interrogate funding of our health services, such as the conditionalities of aid, our States’ dependency on foreign aid to provide health services as well as the important void filled by NGOs and CSOs in the provision of those services.

Access to food, work, land, water, education and shelter for the poor, the marginalised and key populations are also social determinants that define our health. Our health depends on our capacity to fulfil our basic human needs.

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Information is power. Information on sexuality, sexual and reproductive health, pleasure, safe abortion for all, including information on sexual orientation and gender identity and expression and sex work must be unrestricted and available to all. We acknowledge the regulation and the censorship of information related to sexuality by state and non-state actors as the expression of patriarchy and policing of women’s and non-normative people’s lives. The right to control the disclosure or nondisclosure of one’s personal data and information must be universal to all patients and seekers of health services. The confidentiality, privacy and anonymity of all people must be guaranteed by all health practitioners, decision-makers and policy-makers.

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