Allowable death and the valuation of Human Life: Do all lives matter? The study of people living with HIV and AIDS in Zimbabwe
The debates on the 'Black Lives Matter' movement in the US, LGBTQ Prides worldwide, and the HIV/AIDS campaigns in Africa have been rallying cries for 'value' of human life.
Each different in its core objectives, they have each questioned 'if human life is valued or not' and protested against 'allowable deaths', humiliation and discrimination. The tenets of the arguments in all these movements are that all lives matter, all lives have value and lives need to be accorded their inherent worth.
These are historical but also current examples of cases in which particular social groups have not been valued enough to be counted, even upon death. But none among these debates have systematically provided an empirical analysis of how human life is valued in policy and practice.
My study provides one of the first contemporary empirical analyses of the ways in which the Value of Human life (VoHL) is framed in health policy and practice using the HIV/AIDS case study in Zimbabwe. This novelty brings with it several new ways of thinking, both concerning the ways of public health policy formulation, implementation and monitoring, and the ways in which we understand the politics and consequences of decision-making on the VoHL.
At the outset, my study identifies the concept of 'allowable death' as one with relevance in Zimbabwe and the broader Sub-Saharan context. But the concept is also particularly important at the global level and in particular on the 2030 agenda for Sustainable Development Goals (SDG), as it provides explicit means to discuss social justice through enforceability of health rights.
Putting the concept of 'allowable death' along with policy discussions on premature mortality has significant implications for decisions made along the path toward universal health coverage and 'leaving no one behind'.
This project is being carried out by Dr Fortunate Machingura. It is funded by ESRC Global Challenge Research Fund (GCRF) grants.
Outputs
- The race for Sustainable Development by 2030: Some baby-steps towards leaving no one behind
- Zimbabwe after Mugabe: three reasons for hope
- Now Mugabe is gone there is a chance to get HIV/AIDS under control
Practice paper
Early experiences on contextualising the health-related sustainable development goals in Zimbabwe

Practice paper | 2018
Fortunate Machingura, McDonald Lewanika, Gibson Mhlanga, and Abigail Msemburi
The Sustainable Development Goals (SDGs) allow each country to contextualise implementation as most relevant to domestic contexts. In this spirit, this practice paper illustrates how a deliberate, participatory approach to SDG contextualisation can lead to the prioritisation of health outcomes and actions at community level. Working with Zimbabwe as a case study, it draws attention to the reconsideration of collaborative rationality as a practice that can not only break through stalemates but also facilitates dialogue and produces creative solutions to complex and sometimes controversial difficulties, winning stakeholders' cooperation for action and results. The paper does not seek to pin down a prescriptive practice of SDG contextualisation, a process central to the success of the SDG agenda. Instead, it sets out broad parameters to offer governments, and other implementers some concrete propositions for methodologies to take, and aims to help build greater understanding among governments as to what SDG contextualisation entails in-situ.
Key messages
- A deliberate, participatory process built on the practice of collaborative rationality provides the means towards contextualising the SDGs for communities.
- SDG contextualisation is essential to the delivery of SDG3 and other health-related targets, and by its very nature demands a focus on leaving no one behind in planning, implementation and reaping the benefits of improved health outcomes.
- An analysis of the SDG contextualisation process must be subjected to a lifecycle perspective that pays strong attention to the temporal dimension of pockets of effectiveness and underlying events, actions and outcomes.
'Leave no-one behind' briefing paper series
Briefing paper | Leave no-one behind | 2018
Fortunate Machingura, Gibson Mhlanga, Candice Mtwazi and David Hulme
With significant progress made since 1980, outcomes of Zimbabwe's investment to improve the human development status of women and girls are clear and wired firmly in the country's constitution.
Among them is the education of girls - with Zimbabwe consistently topping the Literacy Rates in Africa for both girls and boys. Studies repeatedly demonstrate that educated girls become healthier, and more empowered women who contribute to growing economies, shift attitudes and break cycles of violence.
But despite the progress, women and girls still suffer great inequalities and remain mired in poverty and exclusion. They disproportionally bear the burden and impact of HIV/AIDS and continue to experience violence. Accordingly, the status of women and girls remains high on the country's development agenda, and the commitment to leave no woman or girl behind is more important now than ever.
This briefing paper outlines how decision-makers in the Government of Zimbabwe's Ministry of Health and Child Care, the National AIDS Council and other sector ministries can work with community groups, academia, international and local partners to tackle some of the most stubborn pockets of social norms that greatly value gender inequality - to ensure millions of women and girls in Zimbabwe are not left behind in the fight to end the AIDS epidemic.
Briefing paper | Leave no-one behind | 2018
Fortunate Machingura, Gibson Mhlanga, David Hulme, Tapuwa Magure
The commitment to leave no one behind is at the core of the 2030 Agenda for Sustainable Development, emphasising the importance of inclusiveness, empowerment and non-discrimination.
With the scale-up of antiretroviral treatment in Zimbabwe, many people are living past the age of 50 with HIV. But, many others are getting infected by HIV after their 50th birthday. Ageing with HIV infection presents unique challenges for preventing other diseases as both age and HIV heighten the risk of cancers, bone loss and cardiovascular disease.
Additionally, older people are more likely than younger age groups to face isolation due to illness or the loss of family and friends, and stigma may prevent them from seeking care and disclosing their HIV status for fear of abandonment and isolation.
This briefing paper provides an overview of the realities of people 50 years or older living with HIV/AIDS in Zimbabwe. It encourages reform champions to think about people-centred participatory research to understand better the impact of ageing on the course of HIV infection, to develop and implement practical education and prevention measures, and to determine the efficacy and safety of antiretroviral therapy in older HIV-infected patients in Zimbabwe.
Briefing paper | Leave no-one behind | 2018
Fortunate Machingura, Gibson Mhlanga, Tapuwa Magure, David Hulme
HIV prevalence among the prison population in Zimbabwe is at 28%, double the general adult population (13.8%). As such, the commitment to end the AIDS epidemic and leave no one behind in Zimbabwe is impossible without stronger and more sustained action to address the HIV needs of people in the country's prisons.
This briefing paper sets out broad parameters that underscore the importance of acting rapidly to address information gaps that can be bridged to assess the Zimbabwe situation better, and support more effective HIV/AIDS service delivery in prisons.