Governments have a legal obligation under international human rights law to ensure progressively that all citizens and health professionals have access to the healthcare knowledge they need to protect their health and the health of others.

The map below shows examples of alleged positive and negative actions by governments to meet the information needs of citizens and/or health professionals. In addition, we have started to explore, with assistance from the New York Law School, how the commitment of governments can be measured. A paper on this subject was completed in May 2014 by NYLS law student Hannah Glass, with assistance from Professor Molly Land of the University of Connecticut School of Law and Human Rights Institute: 'Health Information Indicators - A preliminary attempt to measure commitments by governments to fulfil their obligations under international human rights law to ensure the progressive availability of healthcare information for citizens and health workers'. The paper looks at India, Nigeria and Rwanda.

View map on GeoCommons

'Should governments be held responsible for ensuring that every citizen and every health professional has access to the information they need to protect their own health and the health of those they care for? Should governments be held to account for, and to stop, any action that denies the availability of health information, or that misinforms the public or health professionals contrary to scientific evidence? The answers to these questions are yes and yes, as clearly stated in international human rights law.' (Bhaumik S, Pakenham-Walsh N, Chatterjee P, & Biswas T. Governments are legally obliged to ensure adequate access to health information. The Lancet Global Health, 2013)

HIFA-Watch was launched in 2013 and provides examples worldwide of positive actions taken by governments that promote the availability of essential healthcare knowledge for citizens and health professionals, and also examples where governments are perceived not to be meeting their responsibilities. Please send your examples to: info AT hifa2015.org
Disclaimer: Please note that these examples may highlight observations made by HIFA members and others. Global Healthcare Information Network/HIFA does not have the resources to investigate and verify all observations and allegations.

Examples of alleged positive actions by governments to meet the information needs of citizens and/or health professionals

Kenya (2014) 'A national mass media campaign across Kenya entitled “Tobacco Kills – Quit Now!” was launched today by Dr. Khadijah Kassachoon, the Principal Secretary for the Ministry of Health, to warn people about the harmful effects of smoking tobacco and particularly the harms of second-hand tobacco smoke to the unborn, babies and young children; and to encourage smokers to heed the country’s smoke-free laws and to quit smoking...'

Rwanda (2013) 'The president of the Republic of Rwanda, Paul Kagame, has committed to increase nationwide access to Information Communication Technologies (ICTs). On his government’s official website it is written that "...access to information will no longer be a luxury as high-speed internet connectivity becomes affordable and accessible." [Kagame] recently struck a deal with South Korea’s biggest telecommunications provider, Korea Telecom (KT), to create a high-speed broadband network that would reach 95% of Rwandan citizens in three years.

Kenya, Rwanda, Nigeria and Ethiopia (2013) have committed to implementing national eHealth programs that target HIV care, primary health care and maternal and child health. In: Getting Healthier Around the World: Information and Communication Technologies for Child Health and Development (2013 - page 8)

Ghana (2010): 'Ghana’s health burden is unduly exacerbated by ignorance and superstitious beliefs and practices of the people. Investment in dissemination of science and technology on radio and television to change the world-view of the Ghanaian people would save more lives and reduce health care.' Ministry of Environment, Science and Technology, National Science, Technology and Innovation Policy, February, 2010

India (2011) (PDF, 4.9Mb) published the 4th edition of the National Formulary of India, providing reliable, unbiased information on 431 drugs. The Ministry of Health and Social Welfare has made the publication freely available for download, and it is also freely available as an app for smartphones. The 3rd edition was published in 1979 - a gap of more than 30 years.

Botswana (2013) 'HIV/AIDS has had a devastating impact on Botswana. An estimated 320,000 of Botswana’s population over the age of 15, or 25 percent of all adults, are living with HIV/AIDS. Another estimated 16 percent of children, ages 0-14, are infected with the virus. Life expectancy had fallen to 40 years in 2005, but in 2011 life expectancy at birth had risen to around 53 years, in part due to the expanding access to information and services to prevent and/or treat people living with HIV/AID in recent years. A central component of the strategy to ensure everyone has access to such information is a nation-wide government initiative to offer free computer and internet access in all public libraries.'

'All former Soviet countries (excluding Tajikistan and Uzbekistan) (2013) have either ratified or acceded to the Framework Convention on Tobacco Control and implemented (to varying degrees) tobacco advertising restrictions, product warnings, health warning labels, smoking bans in public places, awareness-raising campaigns, and some tax increases' says a review in The Lancet... '[However,] public understanding of the adverse health effects of smoking varies substantially across the region, and, although understanding of the measures that governments might take to tackle smoking is generally poor, the widespread view is that they should do more.'

Over 70 countries worldwide have developed national e-health strategies (2013): 'In September 2010 the Secretary-General of the United Nations, Ban Ki Moon, launched the Global Strategy for Women’s and Children’s Health, with the aim of saving the lives of 16 million mothers and children worldwide by 2015 in 75 target countries, including the world’s 49 poorest nations. CoIA’s recommendations to improve accountability and transparency emphasize the essential role of information and communication technologies (ICT) in achieving the goals set out by the Global Strategy. Specifically, Recommendation 3 states that by 2015, all target countries should have integrated the use of ICT in their national health information systems and health infrastructure. In support of CoIA’s Recommendation 3, the Global Observatory for eHealth has created an online directory of eHealth-related national policies and strategies from Member States.'

Pakistan (2013): legislation to restrict infant formula milk manufacturers 'The recent introduction of laws on protection of breastfeeding and child nutrition in Sindh makes it clear that now in major areas of the country no commercial milk formula maker or their distributor can assert that their product is a substitute, equivalent or superior to mother's milk.'

Examples of alleged actions (or non-action) by governments that are perceived to be a barrier to meeting the information needs of citizens and/or health professionals

Egypt (2014) 'Egypt's military leaders unveil devices they claim can detect and cure Aids. Egypt's military leaders have come under ridicule after the chief army engineer unveiled what he described as a "miraculous" set of devices that detect and cure Aids, hepatitis and other viruses.' 'Over 70,000 people from signing up via email to to try the new treatment'. A few months later, the Egyptian President backtracked on the claims saying that 'further testing' is needed.

India (2013): 'India’s ministry of health and family welfare revoked a ban that it placed on the antidiabetes drug pioglitazone just six weeks ago because of the drug’s association with bladder cancer... Jaykaran, assistant professor of pharmacology at the Government Medical College in Surat, Gujarat, said, “The whole process of banning first and revoking later is shocking. This shows how incompetent the system is. Drug control authorities in India are hardly aware about evidence based medicine and seem to rely mostly on [the] personal opinions of some clinicians.” The ban on pioglitazone was apparently triggered by a letter [...] to the prime minister’s office detailing the risk of bladder cancer with pioglitazone use.'

Tanzania (2013) passed a Finance Bill adding a 14.5% excise duty on all mobile airtime, mobile services, as well as landline and wireless telecommunication services. The country’s Internet Service Providers argue that the new tax would make internet services unaffordable.

Vietnam (2013) appears to be the only country in the world where rhino horn is popularly gaining a reputation as an aphrodisiac. Rhino horns are sold for more that 300,000 US dollars each, and are used as a hangover cure, for cancer, and many other diseases. 'Several respected physicians claimed rhino horn could be part of an effective cancer treatment. Some said they prescribed it in pill form as a palliative for patients receiving chemotherapy and radiation treatments. Others, including Tran Quoc Binh, director of the National Hospital of Traditional Medicine, which is part of Viet Nam’s Ministry of Health, believe that rhino horn can retard the growth of certain kinds of tumors. "First we start with modern medicine: chemotherapy, radiation, surgery," Tran said. "But after that, maybe some cancer cells still exist so then we use traditional medicine to the fight the cells." He said that a mixture of rhino horn, ginseng, and other herbs could actually block the growth of cancer cells, but he could not produce any peer-reviewed studies to support his claims'

India (2013): 'The medical profession [prescribes] irrational and useless drugs. A contributory factor is the absence of unbiased and reliable information on drugs in the country. Most medical practitioners depend on promotional materials supplied by pharmaceutical companies that often make false or exaggerated claims, using incomplete or misleading evidence to promote medicines. There is no effective law that prevents drug companies from bribing doctors to prescribe their medicines either. The government came out with a draft voluntary code of ethics for marketing of medicines in June 2011 but it is clearly not enough.'

India (2012) reversed a ban on smoking actors in films that would be watched by children, due to pressure Bollywood that cited “loss of creative freedom.” 'It has been calculated that Bollywood delivers 14.3 billion [positive] tobacco images to Indian audiences each year'. (Health information includes the use of images to convey messages; film stars who smoke on screen serve as powerful role models for others to copy.)

China, Russia, sub-Saharan Africa (2010?): Picture warnings - graphic colour photographs that show disease caused by smoking - are vital to inform citizens about the dangers of tobacco. Seeing is believing. The World Health Organization notes: 'Research on pictorial warnings show that they are: (i) more likely to be noticed than text-only warning labels; (ii) more effective for educating smokers about the health risks of smoking and for increasing smokers’ thoughts about the health risks; and (iii) associated with increased motivation to quit smoking.' The same WHO web page lists 28 countries worldwide that legally require picture warnings on cigarette packages, and refers to to a longer list (38 countries) compiled by Rob Cunningham of the Canadian Cancer Society. Most of the countries that are protecting their citizens in this way are high-income countries. India is included and so is Pakistan, but not Bangladesh. China and Russia are not listed, and the list does not include a single country in sub-Saharan Africa.

Uganda (2013): "Government should also actively promote the use of contraceptives by women and men in Uganda rather than sending conflicting messages about family planning" A 2012 Technical Guide to Understanding the Legal and Policy Framework on Termination of Pregnancy in Uganda, by the US-based Center for Reproductive Rights, found the country's abortion laws to be "inconsistent, unclear and often contradictory... women, healthcare providers and regulators often lack comprehensive information about the content of the law and what it permits.". Annociata Kampire, director of the Alliance for Integrated Development and Empowerment (AIDE): "The government has a responsibility to ensure medical professionals and women understand the country's abortion policy. One easy step that Uganda should take to reduce death and disability from unsafe abortion is disseminating information about the existing law and implementing existing guidelines... [This] urgently needed step would dramatically improve the health and save the lives of Ugandan women. They can start by widely disseminating and popularizing the 2012 Ministry of Health's National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, which describe circumstances under which abortion is permitted in Uganda." Peter Ibembe, director of programmes at Reproductive Health Uganda (RHU): "Women and men need appropriate counselling so they understand the facts about modern contraception and are not influenced by myths. They also need a choice of affordable contraceptive methods that meet their needs."

South Africa (early 2000s): Mbeki Aids denial "caused 300,000 deaths" "We contend that the South African government acted as a major obstacle in the provision of medication to patients with Aids," write Pride Chigwedere and colleagues from the Harvard school of public health in Boston in the Journal of Acquired Immune Deficiency Syndrome. The authors estimate that more than 330,000 people died unnecessarily in South Africa over the period and that 35,000 HIV-infected babies were born who could have been protected from the virus and would probably have a limited life. The authors conclude: "Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available ARVs to prevent and treat HIV/Aids in a timely manner." Also, a 2012 Lancet article showed that 'broad improvements have been made in most social determinants of health. Data from the 2011 census show that 77·5% of South Africans have formal housing, 73·4% have access to water inside their house or in their yard, 57% have flushing toilets, 84·7% have electricity in their dwelling, and 88·9% own a cellphone.'