Inaug.-Diss.--Universität Erlangen-Nürnberg, Erlangen. / Vita. Bibliography: p. 162-175.

Inaug.-Diss.--Universität Erlangen-Nürnberg, Erlangen. / Vita. Bibliography: p. 162-175.

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The protection of human health and the environment are two major goals of international environmental law. However, there has been little coherent scrutiny of their scope or implementation at international and domestic levels in developing countries and Africa in particular. This thesis shows that international environmental law regimes with a health protection objective have not maximized opportunities to reinforce the promotion and protection of public health in Africa. Through inter alia a study of sustainable management of shared freshwaters, trans-boundary movement of hazardous wastes and their disposal and international climate law, the thesis shows that a range of legal frameworks comprised of substantive, institutional and procedural law mandates States to advance the health objective in international environmental law. However, the thesis demonstrates the limits of these regimes and suggests options to enhance their potential in promoting and protecting public health. An enhanced framework of adaptive governance is proposed to improve environmental health governance. The thesis illustrates how the discourse on health in international environmental law can strengthen international environmental health governance to improve environmental and public health outcomes. It contains seven publications that analyse the strengths and weaknesses and options for reform of the international environmental law regime for health. The implications of these findings for theory, practice and public policy are discussed.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2014. / Developing countries are faced with a number of health-care challenges: long waiting hours of patients in long queues is just one of such challenges. The key cause of this has been identi ed to be a lack, or uneven distribution human resources among health facilities. This sets the stage for poor and ine cient delivery of quality primary health care, especially to the rural dweller as they usually have a fewer medical professionals in their area. The impact of this a ects not only the state of health of the population, but also the economy, and population growth of the a ected community. To try and address this, the introduction of Information Technology (IT) into health-care has been suggested by many health governing bodies like theWorld Health Organization (WHO) and other authorities in health care. The ability of IT to go beyond physical boarders and extend professional care has been the key characteristic that supports its integration into health-care. This has eventually lead to the development of Health Information Systems (HIS) that support remote consultation. Despite all these innovations, there is still evidence of poor and ine cient delivery of services at health facilities in many developing countries. We propose a completely di erent approach of addressing the problem of poor and ine cient delivery of health-care services. The key challenge we address is that of lengthy queues and long waiting hours of patients in health facilities. To cut down on the use of nancial resources (whose lack or shortage is a major challenge in developing economies), we propose an approach that focuses on the routing of patients within and between health facilities. The hypothesis for this study is based on a suggestion that alterations to the routing of patients would have an e ect on the identi ed challenges we seek to address in this study. To support this claim, a simulator of the health system was built using the OMNET++ simulation package. Analysis of test-runs for di erent scenarios were then tested and the simulation results were compared against controls to validate the functioning of the simulator. Upon validation of the simulator, it was then used to test the hypothesis. With data from the di erent health-care facilities used as input parameters to the simulator, various simulation runs were executed to mimic di erent routing scenarios. Results from the di erent simulation runs were then analyzed. The results from the simulator and analysis of these results revealed that: In a case where patients where not given the liberty to consult with a doctor of their choice but rather to consult with the next available doctor/specialist, the average time spent by patients dropped by 26%. The analysis also revealed that moving a receptionist from the rst stage upon patient entry into the health facility reduced the average patient life time by 85%. This was found to be a consequence of a drop in queue length (a 28% drop in queue length). On the other hand, the analysis also revealed that the total removal of a general receptionist increased patient life-time in a facility by 30.19%. This study also revealed that if specialists were deployed to certain health facilities rather than having referred patients come to them in the urban health facilities, patient population in the urban health centers will drop by 32%. This also saw a drop in patient waiting time in the rural health centers as more doctors were available (a reduced patient-to-doctor ratio in rural health facilities). The results from the analysis support our hypothesis and revealed that indeed, alterations to the way patients are routed does have an e ect on the queue lengths and total waiting time of patients in the health system.

Existing literature on foreign aid does not indicate what type of political regime is best to achieve human development outcomes or use aid funds more efficiently. I contend that political leaders of different regime types have personal incentives that motivate them to utilize foreign aid to reflect their interests in providing more or less basic social services for their citizens. Using a data set of 126 aid-recipient countries between the years of 1990 and 2007, I employ fixed effects estimation to test the model. The overall results of this research indicate that foreign aid and democratic institutionalization have a positive effect on total enrollment in primary education, while political regime types show little difference from one another in providing public health and education for their citizens.

In 2001 the Declaration on the TRIPS Agreement and Public Health (‘Doha Declaration’), affirmed the right of member states of the World Trade Organisation (‘WTO’) to interpret and implement the TRIPS Agreement as supportive of the protection of public health and, in particular, access to medicines. While initially well-received, consternation soon arose over the interpretation of a specific paragraph in the Doha Declaration dealing with compulsory licensing. After a further two years of deliberation, the WTO Decision on the Interpretation of Paragraph 6 (‘Paragraph-6 Decision’) was announced in August 2003 specifying when countries can import drugs produced elsewhere under compulsory licence. With one third of the world's population is still denied access to essential medicines - a figure which rises to over 50 per cent in Asia and Africa - the problems facing the public health community are two-fold. The first is the capacity of developing countries (‘DCs’) actually to use the flexibilities afforded under the TRIPS Agreement, the Doha Declaration, and the Paragraph- 6 Decision amid stark inequalities in health resources and the world trading system as a whole. These include provisions for compulsory licensing, parallel importation, and addressing imbalances in research and development (‘R&D’). The pending ratification of the Paragraph-6 Decision, from an interim solution to a permanent amendment, is accompanied by considerable uncertainty: will the protections be accessible under the system currently proposed? The second problem concerns the undermining of the above hard-won flexibilities by provisions adopted under various bilateral and regional trade agreements. Known as ‘TRIPS-plus’- or ‘WTO-plus’- measures, the level of intellectual property rights (‘IPRs’) rights protection being negotiated and even adopted under other trade agreements are more restrictive as regards public health protection. These two sources of concern have led to an increase in rather than a lessening of tensions between the public health and trade policy communities. The thesis opens with a brief analysis of the interplay between patents and medicines. This includes an overview of the human rights framework and the right of access to medicines as a manifestation of human rights. The historical development of the TRIPS Agreement, its legitimacy, and the effect of the introduction of patents for pharmaceuticals are critically analysed. The terms of the Doha Declaration as it relates to public health, the Paragraph-6 Decision and its system, the December 2005 Amendment, and the progress made to date on the public health protections available under the TRIPS Agreement are reviewed and discussed in detail. The thesis describes how, despite these important clarifications, concerns as to the capacity of DCs to implement specific measures persist. This thesis further addresses the development of compulsory licensing in India and South Africa, and the legal framework for compulsory licensing in these countries. The role of competition law and constraints faced by DCs in implementing the flexibilities offered by the TRIPS Agreement and Doha Declaration are considered before turning to the threat posed by TRIPS-plus measures and calls for their critical reassessment. The thesis considers the role of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG), the WHO Commission on IPRs, Innovation and Public Health (CIPIH), Patent Pools, and international and multilateral donors in access to medicines. The thesis concludes by reviewing potential ways forward to ensure that access to medicines by the poor living in DCs is secured in all trade agreements. / Mercantile Law / LL.D.

In 2001 the Declaration on the TRIPS Agreement and Public Health (‘Doha Declaration’), affirmed the right of member states of the World Trade Organisation (‘WTO’) to interpret and implement the TRIPS Agreement as supportive of the protection of public health and, in particular, access to medicines. While initially well-received, consternation soon arose over the interpretation of a specific paragraph in the Doha Declaration dealing with compulsory licensing. After a further two years of deliberation, the WTO Decision on the Interpretation of Paragraph 6 (‘Paragraph-6 Decision’) was announced in August 2003 specifying when countries can import drugs produced elsewhere under compulsory licence. With one third of the world's population is still denied access to essential medicines - a figure which rises to over 50 per cent in Asia and Africa - the problems facing the public health community are two-fold. The first is the capacity of developing countries (‘DCs’) actually to use the flexibilities afforded under the TRIPS Agreement, the Doha Declaration, and the Paragraph- 6 Decision amid stark inequalities in health resources and the world trading system as a whole. These include provisions for compulsory licensing, parallel importation, and addressing imbalances in research and development (‘R&D’). The pending ratification of the Paragraph-6 Decision, from an interim solution to a permanent amendment, is accompanied by considerable uncertainty: will the protections be accessible under the system currently proposed? The second problem concerns the undermining of the above hard-won flexibilities by provisions adopted under various bilateral and regional trade agreements. Known as ‘TRIPS-plus’- or ‘WTO-plus’- measures, the level of intellectual property rights (‘IPRs’) rights protection being negotiated and even adopted under other trade agreements are more restrictive as regards public health protection. These two sources of concern have led to an increase in rather than a lessening of tensions between the public health and trade policy communities. The thesis opens with a brief analysis of the interplay between patents and medicines. This includes an overview of the human rights framework and the right of access to medicines as a manifestation of human rights. The historical development of the TRIPS Agreement, its legitimacy, and the effect of the introduction of patents for pharmaceuticals are critically analysed. The terms of the Doha Declaration as it relates to public health, the Paragraph-6 Decision and its system, the December 2005 Amendment, and the progress made to date on the public health protections available under the TRIPS Agreement are reviewed and discussed in detail. The thesis describes how, despite these important clarifications, concerns as to the capacity of DCs to implement specific measures persist. This thesis further addresses the development of compulsory licensing in India and South Africa, and the legal framework for compulsory licensing in these countries. The role of competition law and constraints faced by DCs in implementing the flexibilities offered by the TRIPS Agreement and Doha Declaration are considered before turning to the threat posed by TRIPS-plus measures and calls for their critical reassessment. The thesis considers the role of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG), the WHO Commission on IPRs, Innovation and Public Health (CIPIH), Patent Pools, and international and multilateral donors in access to medicines. The thesis concludes by reviewing potential ways forward to ensure that access to medicines by the poor living in DCs is secured in all trade agreements. / Mercantile Law / LL.D.