Stories of women giving birth at the gates and stairs of hospitals are rife in our local dailies. Our social media channels are awash with accounts of people let down by healthcare systems that, unfortunately don’t provide access to health nor do they care. People being denied healthcare services because they present in ways that are non-conforming to heterosexual ideas of gender and sexuality, or young people being denied access to contraceptives because the health care providers perceive them as too young to be sexually active or to make independent decisions about their bodies. The plethora of problems are many and while deep frustrations are felt and communicated, the change is slow.
In the heady era of possibilities in post independence Africa, our States made promises to the now free citizens that would ensure the restoration of our dignity and justice in our everyday lives. Education, safety, self-governance and health are a few such promises that governments, autonomously and as organised entities such as the African Union and the African Commission on Human and People’s Rights, created instruments that would ensure, and re-affirm these Independence Day promises and create an independent and free continent that colonialism and systemic oppression had denied it’s people for many decades.
But when we look at the quality of life for majority of Africans today, our States have fallen short of nearly all the promises made. With increased social and political insecurity and unchallenged militarisation of systems and military presence, the idea of safety has become relative, and institutions such as the police force that are trusted with ensuring our safety but are now a source of insecurity and fear. Financial insecurity is also prevalent, with the cost of living consistently rising but State subsidies for healthcare, food and education dropping. The rise in the popularity of neoliberal capitalism and it’s associated policies means a country’s citizens are forced to earn a better quality of life and the promises that governments made are then sold to those who can afford them.
The gap between what States have promised and the lived realities of African citizens when it comes to healthcare remains wide, and keeps widening. Access to healthcare is no longer seen as a right guaranteed in many regional and international instruments which governments have signed. The African Charter on Human and People’s Rights states in Article 16 (1 and 2) that:
Every individual shall have the right to enjoy the best attainable state of physical and mental health; and that States parties to the present Charter shall take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick. All peoples shall be equal; they shall enjoy the same respect and shall have the same rights. Nothing shall justify the domination of a people by another.
Of Africa’s 54 States, only South Sudan is yet to sign or ratify the African Charter. This, in principle means that all other 53 countries in Africa are supposed to create systems and processes that guarantee it’s citizens the kind of healthcare access and availability as enshrined in the Charter. The daily lived realities of people-as seen in our own experiences and as reported in mass and social media indicate that this isn’t the case.
As these instruments only go so far, and the imperative to act on delivering on promises remains with the State, the citizens of many African countries remain on the loosing end of these empty promises, with majority of people unable to access comprehensive and life-saving healthcare because they simply cannot either afford or get to the place where these services are offered. Human rights defenders who challenge States and hold them accountable for the promises made are often subjected to targeted violence and silencing.
Through sharing and conversations over four days, activists from Southern and East Africa came together to help shape work and demands we need to make in order to make access real for all people, everywhere in Southern Africa. The conversation on access to healthcare covers the many ways in which access is enabled and disabled. Activists took the four days to raise various issues around working together to demand, not only the best kind of access and availability to healthcare for Key Populations, but for all people.
Dawn Cavanagh, Director of the Coalition of African Lesbians helped articulate why it is important for even people perceived to be marginalised to demand for widespread access and availability of heath care and healthcare services. As much as there are queer people, trans* people, and the diversity of people who are non-conforming to the heteronorm, a call for recognition of bodies and bodily autonomy should underpin our demands for access to comprehensive access to healthcare. Our bodies, as poor bodies, and women’s bodies and Black bodies are all affected by limited and denied access to healthcare. Whether it is by pricing medical care away from people that cannot afford it, or if it’s State sanctioned policies and guidelines that refuse to acknowledge lived realities and existing situations for the majority of people, access remains a big barrier to the attaining of comprehensive and necessary healthcare.
In calling for guaranteed and consistent access to healthcare for all, conversations about what impediments exist and under what contexts were had by the activists present. Over and again, it emerged that the various oppressions and injustices that necessitate civil society action and dissent are the same issues that create these barriers to healthcare. Because these issues intersect, a call for access to health cannot be voiced without an interrogation of poverty and what systems prevent people living in poverty from accessing healthcare. These same interrogations have to be made for the range of social justice and equality issues and what root causes exist and how to expose these root causes and disrupt and dismantle systems which then address issues of access for majority of people.
Through various health and socio-economic crises, civil society organisations, movements and communities have been able to mobilise people, services and resources that create bridges to accessing healthcare for people. From Home Based Care volunteers for people living with the complications of HIV and Aids, to community caregivers for ebola outbreaks over the years, people have shown that making access to healthcare real for all is possible. But these kinds of efforts need resources by way of people and finances that only go so far. Civil Society can only build so many bridges and part of the efforts should also be used to compel States to deliver on promises made to it’s people.
As activists continue discussing and interrogating how to frame and propose these demands, in this space and beyond, we also dig deeper and ask questions about this work. Questions about the language of groups like Key Populations and Men who have Sex with Men (MSM). We have to keep questioning the language, approach and intention of the work that we do, so that longer lasting solutions to the deeper problems are found.