The Report was discussed and analyzed today at the Government Palace in Bissau in a meeting on international recommendations on human rights made to Guinea-Bissau.

The meeting, was presided over by  the Minister of State for Energy, Florentino Mendes Pereira, and attended by the Special Representative of the UN SG. In his remarks, Modibo Touré recalled that during the release of the report in the Swiss capital, the UN High Commissioner for Human Rights, Zaid Ra'ad Al Hussein, underscored the State's duty to guarantee the right to health and called on international donors to continue to support Guinea-Bissau in its quest for full realization of the right to health of its citizens.

"We have the opportunity today to review the recommendations that have been formulated and reflect on the extent to which these recommendations have been implemented or even require the State to act and propose plans of action for their full implementation," added the SRSG.

According to the Report, political instability, endemic poverty, deficits in accountability, access to food, education, safe drinking water and sanitation, and a health care system in need of reform, lead to violations of the right to health, particularly regarding maternal and child health, sexual and reproductive health, HIV/AIDS, tuberculosis and malaria -the report says.

While acknowledging improvements over the past few years, the report by the UN Integrated Peacebuilding Office in Guinea-Bissau (UNIOGBIS) and the UN Human Rights Office (OHCHR) makes a series of recommendations aimed at a comprehensive reform of the healthcare system in the country, including improving monitoring and accountability.

The report highlights that most healthcare clinics and basic healthcare posts lack electricity or water supplies and that salaries in the sector are poor. Health care workers in some basic healthcare posts are described as having to deliver babies by candlelight, without access to sterile water.

Given the high mortality rates of newborns and their mothers in Guinea-Bissau, such deficiencies are particularly alarming and need to be addressed. In 2016, the infant mortality rate was 60.3 per 1,000 live births. In 2015, the maternal mortality rate was 549 deaths per 100,000 live births – among the worst in the world.

The inadequate availability of healthcare services is also a massive challenge. There are only three pediatricians in the country, all expatriates, for a population of about 720,000 children under the age of 15. There are only four obstetricians, around 34 skilled midwives – and only one anesthetist in the whole country, which has a population of 1.888 million people. The dearth of medical schools is partly to blame, as is the “brain drain” of medical graduates to other countries with higher incomes and better living conditions. Most of the doctors who do remain in Guinea-Bissau live and work in urban areas, leaving the 50 per cent of the population in rural areas with even less access to healthcare.

In one case the report cites, health care professionals went on strike between March and May 2016, during which time 24 patients reportedly died due to the inability of the remaining health care workers to cope with the demands. “In this case, the failure of both the State and providers of health care services to make adequate services available directly violated the individual rights to life and health,” the report states.

Gender-based discrimination remains a significant problem, as does the distance to healthcare facilities. The lack of mechanisms for patients to claim their rights – whether in cases of negligent or substandard care or where they lack the financial resources to pay for crucial treatment – is also a serious issue.

The report recalls that the right to health is an inclusive right, which contains both freedoms and entitlements. Freedoms include the right to control one’s health, including the right to be free from non-consensual medical treatment and experimentation.

Entitlements include the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable standard of health. More specific entitlements associated with the right to health include the rights to maternal, child and sexual and reproductive health; a healthy workplace and natural environment; the prevention, treatment and control of diseases, including access to vaccination and essential medicines; and access to safe and potable water.

While acknowledging the progress that the country has made towards the respect, protection and fulfillment of the highest attainable standard of physical and mental health, the report makes a number of recommendations, including within the framework of the 2030 Agenda for Sustainable Development, to improve the accessibility and quality of healthcare in Guinea-Bissau.

The Report is based on focused research, consultations with stakeholders, and site visits to monitor the human rights situation at national, regional and specialty health care facilities, with a view to assisting the State in the fulfilment of its obligations to respect, promote and protect the right to health.