Dr Tlaleng Mofokeng: Promoting the right to health in the wake of Covid-19

“Every business has a moment where you stop and do a stocktake,” says Dr Tlaleng Mofokeng, UN Special Rapporteur on the Right to Health, speaking to Geneva Solutions from her base in Johannesburg. “You see what’s there, shift things around, you clean up, rearrange, and then you go on.”

In Dr Mofokeng’s analogy, the ‘business’ is global health - specifically, the structures, practices and policies that make up health systems across the world, all of which have come under unprecedented pressure and scrutiny in the past months during the Covid-19 pandemic.

“The pandemic has really shown us that even at our best, as a global health community, we were not prepared,” she adds. “A lot of the world is so militarised in terms of security... but we forgot that health and illness and disease can also lead to real disasters on a global scale.”

Among the fault-lines highlighted by the pandemic, drastic inequalities that exist in health and access to health care are among the most prominent.  Almost everywhere in the world, the poor, minorities and vulnerable populations are far more susceptible to serious illness from Covid-19.

“We don't do enough introspection and reflection as a global health community,” says Dr Mofokeng. “It's really important to look at these systemic and structural spaces and laws and policies, and do some form of stocktake.”

UN Special Rapporteur. Dr Mofokeng, a trained medical doctor, sexual and reproductive health expert and human rights advocate, assumed her new role as UN Special Rapporteur in July, at a time when governments around the world were beginning to reflect on what lessons Covid-19 has taught them about their health systems - lessons she will be examining in more detail.

Appointed by the United Nations Human Rights Council (HRC), Dr Mofokeng’s terms of reference include examining efforts to implement the universal ‘right to health’ through healthcare services and strategies that address the environmental and lifestyle risks that may undermine people’s long-term health prognosis.

This includes reporting on issues like access to clean water and safe sanitation, safe workplaces and healthy, pollution-free cities and communities, as well as access to health-related education and information affecting health. She says the overarching focus of her work will be to draw more attention to the root causes of ill health, and related health inequalities - many of which have been highlighted by the pandemic - and explore how these can be better addressed.

“I think it's important for me to articulate in my work that people are not inherently vulnerable,” she says. “There are situations and there are oppressive systems that then create vulnerable situations that people find themselves in.”

An expert in the field. Working as a doctor in South Africa for 13 years, Dr Mofokeng witnessed firsthand how factors such as age, ethnicity, disability, gender and sexual orientation can leave people vulnerable to “negative health outcomes” because of the failure of health systems to meet their needs. Growing up as a young black woman in the country also made her acutely aware of “some of the daily struggles” that people face when these systems do not represent them, or when policies do not translate into accessible services for all.

She started working in sexual and reproductive health during medical school, and became a passionate advocate for sexual and reproductive health rights (SRHR) - a personal area of expertise, and one she developed further when appointed to the South African governments’ Commission for Gender Equality (CGE), which aims to end all oppression that leads to gender inequality, including gender-based violence (GBV).

“I merged my clinical training of being a doctor with my activism and issues around human rights,” she explains, “because if you work in the public health sector, it’s quite glaring how disproportionately certain health outcomes impact certain people.”

Through her experiences, Dr Mofokeng became sensitised to the ways in which public health structures, particularly in developing countries, remain embedded with colonialist attitudes and approaches - a key issue she intends to focus on in her role as UN Special Rapporteur. “Why are countries in the developing world so reliant on foreign aid, on donors and philanthropists, for really essential and key services to their populations?” she asks. “It’s a question of who sets the agenda.”

The flawed system of global health financing has been starkly highlighted by the pandemic, when many developing countries were cut off from essential imports as basic as reproductive health tools and personal protective equipment (PPE).

Decolonising global health. Dr Mofokeng says the need to “decolonise” global health is also evident in areas such as medical research, often conducted by people far removed from the populations and communities they are supposed to be serving. In her role, she also hopes to highlight the urgent need to have “difficult discussions around the impact of racism on health.”

“It's really looking at the entire system - these issues are systematic” she adds. “My drive is to identify what sort of structural changes need to happen so that people can truly thrive; because many of us are stuck in survival mode. We may live in countries where policies and the laws are not inclusive enough of our experiences and who we are, and those policies may not directly be able to be translated into services that are accessible.”

Reporting on and advocating for equitable access to, and representation in, healthcare will be central to her role as rapporteur on ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ - to use her full title. She says her expertise in sexual and reproductive health rights means that she will pay particular attention to gender equality and issues such as GBV. In the area of mental health in particular, she hopes to bring more light to the psychological needs of survivors of GBV and the importance of having mental health support services at the heart of public health systems around the world.

Change begins when communities set their own agendas. Dr Mofokeng says changes need to be made at both a national and international level to achieve greater equity in global health - beginning with communities and people setting their own health priorities. Donor aid programmes that are designed for developing countries are often created by medical experts who have no in-depth knowledge of the populations they are trying to serve, meaning their solutions may have little impact.

“Equity requires that the very beneficiaries of the work… must actually lead,” she explains. “All of us must be supporting them, not leading them or saving them, we must be asking them: ‘For your life to be fulfilled and affirmed and for you to thrive, what are the things that you require?”

When the most vulnerable communities have a voice in their own healthcare, then international organisations such as the UN will be able to better serve them. Having joined the UN at a time when multilateralism is facing a myriad of challenges, Dr Mofokeng believes collaboration is key to upholding the right to health, and protecting human rights as a whole.

“The only way that we, as a global community, will get through any challenge that we have [is] if we are collaborating,” she explains. “When we are collaborating, when we are using best practice, when we are responsive to good research, we are able to truly have a positive impact not only on health outcomes but on the quality of services.”

As a special rapporteur, this is vital. Her mandate is to encourage dialogue on the right to health, to gather information from diverse stakeholders, and to make recommendations across countries about a broad range of issues that determine health outcomes. After just a few months in the role, she will be addressing the UN General Assembly today to present the final report of the former UN Special Rapporteur Dainius Pūras, and talk about her vision for her term.

The restoration of dignity. Discussing her intentions for her term, Dr Mofokeng says her goal is to promote the right to health to “restore dignity” - by gaining a deeper understanding of the impact of the oppressive structures that are “embedded in global health, and how they disproportionately impact black people, indigenous people, and people of colour communities, especially in the global south ”. Ultimately, she hopes to help reform health systems that are equal, transparent, accountable, and uphold human rights.

“We need to make sure that human rights are expressed in programmes and affirmed in programmes,” she says “and that, even in the delivery of healthcare, we are affirming and promoting and protecting human rights.”