Conventions, customs and beliefs: Social determinants and realizing the right to health in Malawi and Uganda

This article will focus on the importance of committed and participating civil communities in the realisation of health rights on the African continent. The various social, material, organisational, religious and cultural conceptions unique to the Malawian and Ugandan communities will be touched upon to show that community-specific responses to health rights are shaped by and are being informed by the social and cultural milieu of these African societies. From the examples put forward in this article it will become clear that the realisation of health rights on the African continent will remain a mere pipe dream if the social and cultural milieu of health needs and rights in Malawi and Uganda are ignored. First, the constitutional and legislative frameworks for health rights in Uganda and Malawi will be outlined whereafter the most pertinent social, religious and cultural conceptions that currently impact on the realisation of the right to health in these two countries will be discussed. The importance of recognising and addressing these social determinants of health on the African continent will be emphasised and a more contextualised approach to the realisation of health rights will be advocated for.

“…human rights law has so far had only limited success in actually improving the lives of persons living with HIV/AIDS in sub-Saharan Africa.”
Over the past fifty years many countries have experienced vast improvements with regard to national health indicators and the health status of their citizens, some of these improvements include an improved life expectancy and child mortality rates, the eradication and successful treatment of many communicable diseases and the improved provision of primary health care services to the broader population without discrimination. These achievements can, however, not be extended to all countries on the African continent: For some countries in sub-Saharan Africa the average age of death declined from five years to two years over this same period, and in post-apartheid South Africa the infant mortality in 2001 was five times higher among black persons than compared to white individuals. This article is concerned with these inequities in health outcomes — inequities that are especially evident on the African continent.

The crucial insight in this article is that certain obstacles to the realisation of the right to health on the African continent cannot be addressed without the assistance of committed and participating civil communities. However, such community-specific responses to health rights are, in turn, influenced and sustained by various social, material, organisational, religious and cultural conceptions, unique to and historically deeply imbedded in the social order of the particular community/society. The milieu of changing African societies and cultures can therefore not be separated from the civil society organisations operating therein. This article will focus specifically on the social and cultural milieu of health needs and rights in Malawi and Uganda. The choice of these two countries is informed by the fact that they share many of the same socio-economic challenges as highlighted by, for instance, studies on the realisation of the Millennium Development Goals. “Culture” in this article will refer to “…that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society”.