1. Group work, application
HUMAN RIGHTS AND HEALTH EQUITY: IMPLICATIONS FOR ADVOCACY, ACTION, AND GOVERNANCE
Session 6.
Group work, application
Ramadan Hamed (SRC)
Sherine Shawky (SRC)
November 3, 2014

2. 5. Presentation of Group Work Summary
Session Overview
1. Case Study: Basic Information
2. Case Study: Points for Discussion
3. Preparation for Group Work
4. Group Work
5. Presentation of Group Work Summary
This is another option for an Overview slide.
Monday, November 3, 2014

3. 1. Case Study: Hepatitis C in Egypt
Monday, November 3, 2014

4. Hepatitis C Burden in Egypt
Egypt has the highest prevalence of hepatitis C in the world
14.7% have antibodies to HCV in their blood (~ million)
9.8% of Egyptian adults are hepatitis C seropositive (~8-10 million)
~2-6‰ new cases per year (at least 170,000 new cases per year)
HCV infection is linked to the poorly sterilized needles dating back to the 1970s in widespread campaigns to eradicate schistosomiasis
Monday, November 3, 2014

5. Distribution of Hepatitis C Seroprevalence in Egypt
El-Zanaty, Fatma and Ann Way, Egypt Demographic and Health Survey 2008
Monday, November 3, 2014

6. Hepatocellular Carcinoma among Chronic Liver Diseased Patients in Egypt
El-Zayadi et al. Hepatocellular carcinoma in Egypt: A single center study over a decade. World J Gastroenterol, 2005; vol 11 (Number 33):
Monday, November 3, 2014

7. Hepatitis C Awareness in Egypt
El-Zanaty, Fatma and Ann Way, Egypt Demographic and Health Survey 2008
Monday, November 3, 2014

8. Egypt Commitment to Human Rights
Signature
Ratification, Accession
Right to Health related reservation
International covenant on economic, social and cultural rights (ICESCR)
4 Aug 1967
14 Jan 1982
Convention on the Elimination of All Forms of Discrimination against Women
16 Jul 1980
18 Sep 1981
Convention on the Rights of the Child
5 Feb 1990
6 Jul 1990
Convention on the rights of persons with disabilities
4 Apr 2007
14 Apr 2008
International convention on the protection of the rights of all migrant workers and members of their families
19 Feb 1993 a
Monday, November 3, 2014

9. Egypt Commitment to Human Rights
Egypt 2014 constitution respects human rights and right to health
The President of Egypt insisted on humans rights in his speech in the United Nations in New York in September 2014
Egypt has an established National Council for Human Rights
Egypt submits progress report to United Nations in Geneva (2010, 2014)
The Government of Egypt responds to all claims submitted by the National Council for Human Rights
Monday, November 3, 2014

10. Egypt Commitment to Hepatitis C Control
Egypt has established the National Committee for the Control of Viral Hepatitis
Multisectoral National Control Strategy for Viral hepatitis with targets to be achieved by 2012
~100 equipped hospital beds for HCV patients
~400 specialists in tropical diseases
Several specialized public and private hepatology centers
Public Sector
Egypt Ministry of Health and population (2008). Egypt National Control strategy for Viral Hepatitis
Monday, November 3, 2014

11. Egypt closes deal with Gilead Sciences for Sovaldi at 99% discount
Awareness campaigns
Screening of blood
Screening of non-Egyptians seeking work visa
Health insurance
Public employees
School children
Widows
Egypt is allowed to sell Sovaldi (sofosbuvir), for just one percent of its market price
The drug is provided to Egyptians living with the virus for just LE2,200 (or about $300) for a 12-week course of treatment
The drug is offered to Egyptian patients who are being treated at the expense of the country and to those who have health insurance
Around 170,000 dose of treatment was estimated to be provided until the end of September and will reach 225,000 doses by February 2015
Monday, November 3, 2014

12. 2. Case Study: Points for Discussion
Monday, November 3, 2014

13. Structural Indicators
Let’s discuss
International human rights treaties relevant to the right to health ratified by the State
Date of entry into force and coverage of the right to health in the constitution or other forms of superior law
Date of entry into force and coverage of domestic laws for implementing the right to health
Number of registered and/or active NGOs (per 100,000 persons) involved in the promotion and protection of the right to health
Estimated proportions of births, deaths and marriages recorded through vital registration systems
Time frame and coverage of national policy/strategy for hepatitis
Monday, November 3, 2014

14. Process Indicators Let’s discuss
Proportion of received complaints on the right to health investigated and judged by the national human rights institution, other human rights institutions or other mechanisms and the proportion of these responded to effectively by the Government
Net official development assistance for the promotion of the health sector received or provided as a proportion of public expenditure on health or gross national income
Monday, November 3, 2014

15. Process Indicators
Per capita government expenditure on HCV health care and medicines
Density of medical and paramedical personnel, hospital beds and other health-care facilities providing HCV prevention and treatment services
Proportion of HCV cases covered by health insurance
Rate of refusal of medical consultations or hospitalization of HCV positive cases
Proportion of HCV positive persons with disabilities accessing healthcare services
Monday, November 3, 2014

16. Process Indicators (cont’d)
Proportion of population covered under awareness-raising programmes on transmission of HCV
Proportion of population applying effective HCV preventive measures
Proportion of HCV cases detected, treated and cured
Proportion of population injecting drugs and inhaling cocaïne infected with HCV detected, treated and cured
Monday, November 3, 2014

17. Stratify by at risk populations and socially disfavored strata
Outcome Indicators
Let’s discuss
Mortality
HCV cause-specific mortality
HCV case-fatality rate
HCV proportional mortality
HCC mortality among HCV cirrhotic patients
Morbidity
Prevalence of hepatitis C
Incidence of hepatitis C
Prevalence of HCC among HCV cirrhotic patients
Incidence of HCC among HCV cirrhotic patients
Proportion of HCV positive children born to HCV infected mothers
Proportion of persons with knowledge of HCV
Stratify by at risk populations and socially disfavored strata
Monday, November 3, 2014

18. 3. Group Work: Commitment, Efforts and Outcomes
Monday, November 3, 2014

19. Guidelines for Group Work
Select a health issue Discuss relevant indicators (structural, process, outcome) Discuss the availability of data Summarize the needs to improve the quality of available information to assess the State human rights obligation
Monday, November 3, 2014

20. 4. Group Work: Human Rights and Specific Health Issues Presentations
Monday, November 3, 2014

21. References
World health Organization (2014). Guidelines For The Screening, Care And Treatment Of Persons With Hepatitis Infection April WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Available at
Egypt Ministry of Health and population (2008). Egypt National Control strategy for Viral Hepatitis. Available at
El-Zayadi et al. (2000). Current Status of Hepatitis C in Egypt, Second Edition. Cairo Liver Center, Cairo, Egypt
El-Zanaty, Fatma and Ann Way, Egypt Demographic and Health Survey Cairo, Egypt: Ministry of Health , El Zanaty and Associates and Macro International. Evidence Based Population Policy (EPDI), Population Status in Egypt: 15. IDSC and UNFPA, Cairo, Egypt. Available at
El-Zayadi et al. Hepatocellular carcinoma in Egypt: A single center study over a decade. World J Gastroenterol, 2005; vol 11 (Number 33):
Monday, November 3, 2014