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  • br In their policy analysis Yusra Ribhi Shawar and

    2019-06-27


    In their policy analysis, Yusra Ribhi Shawar and colleagues (August, 2015) outline the complex responses needed to make surgery a global health priority, highlighting as a major challenge that “consensus needs to be reached on solutions”. Professional interests might have forestalled consensus on the need to train and supervise non-surgeons to deliver surgical services in places where surgeons cannot be retained. However, sceptics are right to call, and donors to wait, for evidence on the feasibility, safety, cost-effectiveness, and outcomes of such models. Clinical Officer Surgical Training in Africa (), a cluster randomised controlled trial funded by the European Community under its Framework Programme, has been training clinical officers to undertake essential elective and emergency surgery at district hospitals in Malawi and Zambia. It is implementing a complex intervention, embedded in these countries\' health systems, which combines training, supervision, and quality assurance systems. It has extended the focus from caesarean sections to training clinical officers to undertake a broader range of procedures including hernia and hydrocele repairs.
    Momentum towards the post-2015 Sustainable Development Goals (SDGs) is encouraging, after the UN Conference on Funding for Development in Addis Ababa, Ethiopia, and the UN Sustainable Development Summit. However, one of the major difficulties in assessment of the Millennium Development Goals (MDGs) has been the absence of effective measurability. Data of better quality and greater quantity, especially at the subnational level, must underpin the SDGs.
    A new report by the UN Committee on Human Rights (UNCOHR) is sharply critical of Canada\'s worsening human rights record. The first such assessment in 10 years (a Glyoxalase I inhibitor weight coinciding with a decade of conservative government), it describes policies that undermine human rights including the ability of civil society to lawfully protest such policies. Most issues cited relate to public health and safety and I illustrate some of them here ahead of Canada\'s federal election next week. The report is particularly concerned about the rights of out-groups (such as prisoners, people with mental illnesses, and refugees) and vulnerable populations. For instance, cuts to basic health services for refugees led Canadian doctors and lawyers to petition the federal courts to restore services; in doing so, the courts described government policy as “cruel and unusual”. Indeed, with a large parliamentary majority, cortex is often left to the courts to provide a check on government power. For example, the federal courts reversed attempts to close harm-reduction services for drug users and legislation that threatened the health and safety of prostitutes, and repeatedly stepped in to protect aboriginal land rights. The UNCOHR highlights violence against women, especially the 1189 murdered or missing aboriginal women and girls and the need for a national inquiry—an issue to which Prime Minister Harper responded on national television—“Um, it isn\'t really high on our radar, to be honest”. Over-representation of aboriginal people in prisons (who make up 44% of the adolescent females in custody) is also cited by the report, as is use of solitary confinement experienced by one in four inmates. Lack of health care services in First Nations communities is another issue mentioned in the report. Glyoxalase I inhibitor weight When child-welfare activist Cindy Blackstock sued the government for failure to provide basic services to First Nations communities, the Royal Canadian Mounted Police and Canadian Security Intelligence Service placed her under surveillance (collecting a 400 page file on her) until the Federal Private Commissioner ordered them to “cease and desist” and destroy their files. The report is especially concerned about the passage of Bill 51 which gives government greater power to undertaken domestic surveillance on groups and individuals such a environmentalists, aboriginal people, or simply any that disagree with government policy—with little or no oversight. One member of the UN committee noted “This is not the Canada that I know”.