MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

�� Communities should, as far as possible, be involved in
the planning and implementation of any activities at the
community level such as LLIN distributions, IRS campaigns,
surveys and case investigation for surveillance.
�� Apart from working together with the Shehia Health
Custodian Committees and the Village Health Committees,
the ZMCP should also engage with existing community
groups such as women associations and youth groups and
involve them in strategic planning for malaria elimination by
inviting them to relevant stakeholder meetings.
CONCLUSIONS
Community involvement and participation will be essential not
only to achieve elimination but also to maintain it. It will be
important to ensure community ownership and buy-in to avoid
elimination fatigue due to the disappearing disease burden.
Communities will therefore need to be involved in planning,
implementation and evaluation of relevant malaria elimination
activities. Their representatives will need to be provided with
the necessary information and technical capacity to make a
relevant contribution to the elimination program. However,
community participation should not be a bottleneck and needs
to be carefully targeted to areas where the community can truly
make a difference. Also, community interventions should, where
possible, not only be based on information obtained from
community representatives but also on hard data from relevant
surveys. Continuous IEC/BCC activities will need to ensure that
communities remain informed about the importance of activities
for a disease that is no longer present.
LEGAL CONSIDERATIONS FOR ELIMINATION
INTRODUCTION
Many public health interventions have legal and human rights
implications. Historically, individuals and vessels were commonly
quarantined to restrict the spread of infectious diseases. The
recent threats of Severe Acute Respiratory Syndrome (SARS) and
avian influenza have renewed interest in and discussion of the
legal tools that countries can employ to control disease. Malaria
control generally does not require any restriction of human rights
to effectively achieve its goals, although governments commonly
use their authority on regulation and oversight to shape certain
practices (e.g., restricting the drugs that can be imported and sold
to treat malaria). Malaria elimination, however, due to its need
for greater precision and coverage of some interventions, may lead
to actions that have important legal implications. For example,
6 The Republic of Tanzania is a State Party to, inter alia, the International
Covenant on Civil and Political Rights (ICCPR), the African (Banjul) Charter
on Human and People’s Rights (ACHR), the International Convention on the
Elimination of All Forms of Racial Discrimination (ICERD), the Convention
on the Elimination of All Forms of Discrimination Against Women (CEDAW),
the Convention on the Rights of the Child (CRC), the International Covenant
on Economic, Social, and Cultural Rights (ICESCR), the Convention relating
to the Status of Refugees, the Rome Statute of the International Criminal Court
2 | Operational Feasibility
a country may wish to make it mandatory for individuals to
provide blood to surveillance officers or accept indoor residual
spray teams into their homes in order to achieve the necessary
coverage of these interventions to prevent an emerging outbreak.
This step would infringe on individuals’ rights of privacy and
choice and therefore requires legal analysis before putting into
practice.
This chapter considers the legal principles that would apply to
relevant malaria elimination decisions, including as articulated
in treaties that Zanzibar has signed, and analyzes several of the
restrictive interventions that the country may wish to employ in
an elimination program against this framework. This chapter
does not seek to foresee every potential legal decision the
government of Zanzibar may have to make in an elimination
program nor does it present detailed legal analysis to guide firm
decisions on particular issues. Rather, it provides an overview
of the relevant issues, principles, and considerations to provide
a foundation for more detailed analysis later as relevant. The
principal international treaty on public health measures is the
International Health Regulations (IHR), which was recently
updated in 2005 to reflect the evolving needs and challenges of the
increasingly interconnected world. As is explored in detail in this
chapter, the IHR provides considerable leeway for governments
to take restrictive action if there is a significant threat to the
health of its populace. However, the view and recommendation
of this expert group is that those measures should generally only
be used as a last resort, with the greatest focus instead being
placed on increasing the willingness of the target populations to
comply with the needed interventions. As the legal expert David
Fidler stated, “the best way to promote and protect public health is
to promote and protect human rights.”
PRINCIPLES
Under a number of international treaties that the Republic of
Tanzania has ratified (and that also bind Zanzibar), 6 States Parties
commit to respect, protect, and promote individual human rights,
including non-discrimination; the right to life; the prohibition
on torture or cruel, inhuman or degrading punishment, or of
medical or scientific experimentation without consent; freedom
from arbitrary arrest or detention; liberty of movement; privacy;
freedom of thought, conscience and religion; and, among others,
freedom of association.
States may derogate from or otherwise limit obligations under
human rights treaties in two ways. Prior to ratification they may
make a reservation to a specific provision, as long as the goal or
purpose of the treaty is not defeated by the reservation. Once the
treaty is in place, States may limit or restrict certain rights in
(ICC), Freedom of Association and Protection of the Rights to Organise
Convention, Right to Organise and Collective Bargaining Convention, and the
Convention Governing the Specific Aspects of Refugee Problems in Africa. It is
also a Member State of the World Health Organization.
61