MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
interventions, an effective means of tackling this tragedy lies in making the
prevention and treatment of HIV, as well as provision of ancillary support
services for affected mothers, an integral part of antenatal care continuing
through delivery and beyond. Reaping the full benefit of this strategy will
require providing services gratis to those unable to pay.
E. Shortage of Skilled Health Personnel (SHP)
Availability of SHP is a major determinant of the performance of health
systems and the state of maternal health in a particular country or region.
Achieving universal access to reproductive health services (one of the
targets of MDG 5) is impossible in the absence of a steady and sustainable
supply of SHP to deliver critical services. 86 That better performing health
systems, most of them in Europe and North America, are also those with
minimal shortages of health human resources (in contrast to huge gaps in
personnel requirements in fragile and often severely under resourced
systems in developing countries) is not happenstance.
Having competent and appropriately trained personnel to deliver
essential services is as important, if not more so, than having the needed
material resources for health. Take Botswana as an example. At 24. 8
percent, the country ranks among the worst in terms of HIV prevalence. 87
A few years ago, the international community, led by the Gates Foundation,
donated enough resources to provide everyone in the country with
antiretroviral therapy (ART). 88 However, a dire shortage of SHP, amongst
other logistical difficulties, forced scaling back of the rollout of ART to
86. For the purposes of this article, universal access to reproductive health services
means the existence of an environment in which antenatal, partum and postnatal services are
available, accessible affordable and of good quality (AAAQ) to all who need them. UN
Comm. on Econ. Soc. & Cultural Rights (CESCR), General Comment No. 14, The Right to
the Highest Attainable Standard of Health, para. 12, U.N. Doc. E/C.12/2000/4 (2000),
reprinted in Compilation of General Comments and General Recommendations Adopted by
Human Rights Treaty Bodies, U.N. Doc. HRI/GEN/1/Rev. 6 at 85 (2003). This is a
reformulation of WHO’s definition of universal access in the context of HIV prevention and
treatment. See WHO, PRIORITY INTERVENTIONS: HIV/AIDS PREVENTION, TREATMENT AND
CARE IN THE HEALTH SECTOR 1 (2009), available at http://www.who.int/hiv/pub/priority_
interventions_web.pdf. But note that this definition does not necessarily imply that everyone
within the target population receives care. Despite the availability, accessibility affordability
and good quality of these services, some pregnant women might choose, for whatever
reason, not to avail themselves of the opportunity. So long as the four conditions (AAAQ)
are met, universal access has been achieved regardless of whether less than 100 percent of
the target population actually accessed services.
87. WORLD HEALTH STATISTICS 2011, supra note 47, at 32.
88. Holly Burkhalter, Misplaced Help in the AIDS Fight, WASHINGTON POST, May 24,
2004, at A17.