What are critical enablers and why are they important?

WHAT ARE CRITICAL ENABLERS AND WHY ARE THEY IMPORTANT?

Critical Enablers are activities and policies that strategically support and foster effective and efficient HIV, TB and malaria program outcomes. Critical Enablers include any efforts towards achieving Gender Equality; fostering Human Rights and an Enabling Legal Environment, which:

  • reduce the risk of disease infection and transmission
  • ensure efficacy, equity and roll-out of basic HIV, TB and malaria program activities
  • sustain program responses by encouraging integration into broader health and non-health sectors such as education, law and justice, democratic governance, finance and planning, social and emergency services
  • allow for the reach and empowerment of key populations that are most vulnerable to HIV, TB and malaria infection
  • allow for the reach and empowerment of people who are living with; or affected by HIV, TB and malaria

CRITICAL ENABLERS AND KEY POPULATIONS

Understanding Critical Enablers in the context of a national epidemic and integrating Critical Enablers into programming is essential to the success of any comprehensive HIV, TB and malaria response. The identification and integration of context specific enablers is best achieved through active engagement and partnerships with Key Populations and their representatives who play an important role in identifying needs, ensuring relevance and ownership, and supporting uptake of programs and services.

For the purpose of this toolkit and based on growing literature in this area we will define Key Populations as: Groups that have a higher epidemiological impact of disease, combined with lower access to services, and who belong to populations that are displaced, criminalized or marginalized. Key Populations include but are not limited to:

  • men who have sex with men
  • transgender people
  • people who inject drugs
  • young people
  • people in prison or closed settings
  • migrants, refugees
  • internally displaced people
  • indigenous populations
  • women and girls

These groups are impacted by cultural, socio-political and economic factors and often lack the lived experiences of gender equality, human rights and a legal environment that would allow them to thrive, feel safe and actively participate in all aspects of society including access to high quality health and social services.

For key populations, a number of programming tools exist for MSM, Sex Workers and Transgender.  Each of these tools offer practical advice on implementing HIV and STI programmes for and with MSM, sex workers and transgender, respectively : 

Implementing Comprehensive HIV and STI Programs with Men Who Have Sex With Men: Practical Guidance for Collaborative Interventions (MSMIT)

Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (SWIT)

Implementing Comprehensive HIV and STI Programmes with Transgender People: Practical Guidance for Collaborative Interventions (the “TRANSIT”)

 

THE GLOBAL RESPONSE

UN Support to Critical Enablers

The United Nations together with intergovernmental organizations, development partners and civil society have a history of championing Critical Enablers with human rights efforts dating back to 1948 and the Universal Declaration of Human Rights. Drawing on those principles and agreements, The Right to Health and the Human Rights Framework for HIV, TB and Malaria, affirms the entitlement and enjoyment of the highest attainable standard of health throughout services, policies, laws. The Right to Health is also closely linked to the social determinants of health which consists of both social policy and social protection programmes. Social policy and social protection include rights to: work, housing, food, education, human dignity, life, non-discrimination and equality.

Sustainable Development Goals

Building on the UN’s history and the Right to Health, the UN’s recent launch of The 2030 Development Agenda and the Sustainable Development Goals (SDGs) recognizes Critical Enablers – specifically gender equality and human rights -- as central to the success of the global goals with a strategic focus on SDG-3 (good health), SDG-5 (gender equality), SDG-10 (reducing inequality in and between countries) and SDG-16 (inclusive societies and institutions).

Other Global Initiatives

Other global initiatives such as The End of Poverty Agenda and Universal Health Coverage also call for the use and engagement of Critical Enablers to help the elimination of extreme poverty and in providing health services access to all. These global agendas together compliment other recent initiatives and announcements such as: Zero Discrimination Day;  the  UN Joint Statement to End Violence and Discrimination against LGBTI (Lesbian Gay, Bisexual and Transgender Individuals);  and The 2015 UN Women Summit where world leaders at the  UN General Assembly committed to ending discrimination against women by 2030. The UNAIDS’ 2016-2021 Strategy also highlights Critical Enablers and Key Populations with specific targets linked to the SDGs. The strategy has a specific focus on prevention, treatment and support services; social protection programmes; and gender equality. With the declarations of commitments and goals set, each country is tasked with championing legal and social reform, empowering communities and ensuring equality for each individual regardless of who they are.