Ethics in Global Health Practice

Ethics in Global Health Practice

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Case Study: Fairness and Equity in the Provision of Anti-Retroviral Therapy-Some Reflections from Lesotho

In the Southern African region, HIV epidemic is a gigantic magnitude concern. Despite a massive effort by these governments to scale-up public sector access to ART in the region, as the number of individuals necessitating immediate ART access continues to significantly surpass the health systems capacity to provide it (Armstrong, 2010). Progress is limited by challenges such as inadequate PHC systems, besides the lack of skilled labor towards the delivery and monitoring of treatment programs. Following Armstrong (2010) the region consists of four nations having globally the highest HIV-prevalence in the order of Swaziland: 26.1%, Lesotho: 23.2%, Botswana: 23.1%, and South Africa: 18.1%.

The relevant ethical issues and concepts following Armstrong (2010) include first, an inadequate effective rationing tool, which contravenes the relevant ethical concept of a patient selection process that should be a formal, explicit eligibility standard designed through an inclusive, structured, and deliberation transparent process, besides a publicly accessible process for deliberating on expectations. Second, concerns unfairness regarding patients who are very ill besides being incapable of participating in adherence counseling as well as even providing consent to be tested for HIV; which contravenes the relevant ethical concept of a healthcare provider using fairness as a structured, formalized selection process towards addressing patient needs. Third, concerns patient inequity in receiving ART due to lack of monies to transport them to facilities in order to enroll in the program and paying for the nominal user fee for outpatient provision services.; which is contrary to the relevant ethical concept of all individuals having equal chances of receiving treatment.

The healthcare team that has the responsibilities, including designing and applying an effective patient selection process towards putting the right patients on ART through a process of non-clinical and clinical screening and eligibility determination. Armstrong (2010) urges that it should address these challenges by using more practical tools that can empower them towards the development of context-specific approaches that address the limitation between their model patient selection process and the recommended international criteria.

Reference

Armstrong, R. (2010). Fairness and equity in the provision of anti-retroviral therapy: Some reflections from Lesotho. Developing World Bioethics, 10(3), 129-140.