Assessing the Right to Health in the Sixth Millennium Development Goal in the Eastern Caribbean

• Date: 01 September 2016
• DOI: http://doi.org/10.1002/wmh3.192
• Published date: 01 September 2016
• Author: Jennifer R. Reddock

Assessing the Right to Health in the Sixth Millennium

Development Goal in the Eastern Caribbean

Jennifer R. Reddock

Millennium Development Goal 6 aimed to combat HIV/AIDS, and target 6B specif‌ically focused on

universal access to antiretrovirals. Global Millennium Development Goal (MDG) reporting based

on national averages missed smaller populations and did not include a human rights viewpoint. Six

countries in the Eastern Caribbean that endorsed the 2000 Millennium Declaration that were not

included in global UNAIDS estimates were selected for this study. In this paper, physicians in the

Eastern Caribbean provide a qualitative assessment of the sixth MDG from a right to health

perspective that includes the dimensions of availability, accessibility, acceptability, and quality.

KEY WORDS: right to health, access to health care, physicians

Introduction

The commitment to “universal access,” prevention, treatment, and care for

HIV in the Millennium Development Goals (MDGs) and Declarations invites

analysis of human rights in health-related development initiatives. The 2000

Millennium Declaration heralded a global commitment to “peace, development,

and human rights” (United Nations, 2000a). The MDGs were said to be “suffused

with human rights content” and presented an opportunity for human rights to

inf‌luence development because of the “overlap between the health-related

Millennium Development Goals and the right to health” (Economic and Social

Council, 2005; United Nations General Assembly, 2004). The United Nations

Special Rapporteur on the right of everyone to the enjoyment of the highest

attainable standard of physical and mental health identif‌ied HIV/AIDS as

deserving of special attention (Hunt, 2004).

Although the importance of human rights was acknowledged in the

Millennium Declaration, MDG progress was tracked by quantitative targets and

indicators that did not explicitly include a human rights perspective (Darrow &

Arbour, 2009; United Nations, 2000b). Universal access was initially taken to

mean “as close as possible to universal access,” and later 80 percent of those

eligible to receive antiretrovirals (UNAIDS, 2015a; United Nations, 2005). For

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example, the target to achieve “universal access to treatment for HIV/AIDS for all

those who need it” was measured by indicator 6.5—“proportion of population

with advanced HIV infection with access to antiretroviral drugs” (United Nations,

n.d.).

The MDGs were criticized for aiming to alleviate the effects of poverty for

some of the population, while effectively leaving a large number of individuals

behind (Pogge, 2004). The human rights treaty monitoring mechanism (which is

not without its f‌laws) focuses on the rights of each person and allows each

individual to seek redress if rights are violated (Alston, 2005). Many in the human

rights community have been skeptical of the MDGs, citing the Goals’ inattention

to the deeper causes of poverty, reliance on monetary pledges (which were not

always fulf‌illed), and the absence of strong accountability measures (Holder,

2007).

The original indicators measuring progress toward MDGs and their targets

were decided with input from governments and international organizations and

formally presented to the United Nations in 2001 (United Nations Development

Group, 2003; United Nations General Assembly, 2001). These indicators led to

policy interventions such as the Accelerated Access Initiative that reduced the

cost of antiretrovirals in developing countries and subsequently inf‌luenced the

direction of the HIV response (World Health Organization, 2002). Even if they are

assessing the right to health, indicators need to be supplemented with qualitative

information to provide a more comprehensive picture (Backman et al., 2008). This

paper proposes a qualitative review of the right to health for HIV treatment and

care in six Eastern Caribbean countries—Antigua and Barbuda, Dominica,

Grenada, St. Kitts and Nevis, St. Lucia and St. Vincent, and the Grenadines. These

countries, because of their small populations, were not included in global

HIV/AIDS MDG estimates.

Eastern Caribbean Countries Are Too Small to Appear in the Big Picture

Although all countries are encouraged to submit data to UNAIDS, which

leads the interagency response on HIV/AIDS, only countries with populations of

250,000 or more are included in global estimates (UNAIDS, 2014a). The six

countries’ combined population is approximately 579,000, ranging from approxi-

mately 54,000 in St. Kitts and Nevis to 109,000 in St. Lucia (World Bank, 2015).

From the sparse HIV surveillance data for these countries, prevalence rates for

none of the six countries has been estimated above 1.1 percent. The most recent

HIV prevalence rates for the respective countries are as follows: Antigua and

Barbuda (1.1 percent);

1

Dominica (0.75 percent);

2

Grenada (0.57 percent);

3

St. Kitts

and Nevis (0.5 percent);

4

St. Lucia (less than 1 percent);

5

St. Vincent and the

Grenadines (1.14 percent).

6

As of June 2015, there were a total of 1,139 people in

these six countries receiving antiretrovirals through the public system.

7

While Sub-Saharan Africa, with the highest number of people living with

HIV globally, has been highlighted in HIV research (World Health Organization,

UNAIDS, UNICEF, 2011), the unique challenges of people living with a disease

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