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[afro-nets] Global 'Right to Health and Health Care Campaign'


  • From: Claudio Schuftan <claudio@hcmc.netnam.vn>
  • Date: Wed, 11 Jan 2006 14:18:36 +0700

Global 'Right to Health and Health Care Campaign'
-------------------------------------------------

Proposal for a global 'Right to Health and Health Care Campaign'
to be launched by the People's Health Movement.

[Short Version, December 2005]

The context

1. There is an urgent need to replace the dominant discourse in
health by a process aimed at universally achieving the 'right to
health and to health care' as the main objective to achieve more
equitable health care systems in both developing and developed
countries.

2. The People's Health Movement (PHM) is launching a global ini-
tiative to strengthen the 'Right to Health' (RTH) with a focus
on defending and operationalising the 'Right to Health Care'.

3. Since it is predictable socio-political forces at work that
determine the risk of most forms of human rights violations,
this Campaign looks at what additional measures have to be taken
now. 8. It grounds our understanding of human rights violations
in the broader analyses of power and social inequality. Knowing
carries obligations --thus the proposed Campaign.

4. Poverty is the world's greatest killer. It is thus not enough
to improve the situation of the poor within the existing social
relationships. Structures and not just individuals must be
changed if the RTH of the marginalized in the world is to be
achieved.

5. Rights are realised by changing the prevailing power rela-
tions. Rights cannot be advanced but through the organised ef-
forts of the state and of civil society.

6. Public health must be linked to a return to social justice
and equity; this is the central challenge for the future of pub-
lic health. The Campaign here proposed by PHM thus seeks the so-
cial transformations indispensable to resolve the inequities
found in health.

The justification

7. There is now a need to launch a global process of mobiliza-
tion to actually implement the provisions of General Comment 14*
in all countries. The 'Right to Health' will be operationalized
by changing global and national health sector reform initia-
tives.
* Nearly 150 countries around the world are parties to the In-
ternational Covenant on Economic, Social and Cultural Rights.
General Comment 14 (GC 14) of the Committee on Economic, Social
and Cultural Rights (CESCR) adopted in the year 2000 elaborates
on and clarifies the Right to Health by defining the content,
the methods of operationalization, the violations and the sug-
gested means to monitor the implementation of this right. GC14
is the most authoritative interpretation of international law
relating to the right to health.
(http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument)

8. But why do we need a global campaign on the Right to Health?
Much is wrong with the neo-liberal model of global restructuring
in the world. This process is unchecked either by national or
global mechanisms. It is in this context that there is growing
recognition of the need for a global initiative to address
health systems issues in a rights-based framework. What will
this entail?

i. Neo-liberal policies restrict the revenue of the state for
use for welfare purposes so that governments find themselves un-
able to finance health security systems. To put in place mecha-
nisms of effective redistribution of resources is only possible
through a globally coordinated effort, thus the Global Campaign.
ii. We need to establish universal norms regarding a basic stan-
dard of essential health care services that must be ensured.
Further, health care workers distribution must be based on need
rather than on the ability of richer countries to pay more for
human resources from poorer countries.
iii. There is also a need to challenge the dominant global dis-
course of 'Health care as a commodity' and 'safety nets for
those left outside the benefits' wherein health services are in-
creasingly marketized and governments retreat from the provision
of health care. We need to counter this with a 'Health care as a
human right' discourse.
A Campaign focusing on the Right to Health Care

9. PHM struggles for and demands the respect of all aspects of
health rights.

10. This right includes both the Right to health determinants
such as water, food security, housing, sanitation, education, a
safe and healthy working and living environment, etc., and the
Right to health care (the right to the entire spectrum of pre-
ventive, curative and rehabilitative services plus health educa-
tion and selected promotive activities).

11. Naturally, the global health movement has an important role
to play regarding both of the above components of the Right to
Health. However, in practice, this suggests two types of tasks
for the global health movement:


I. Tackling the right to health determinants

12. Supporting campaigns on water, food security, housing, etc.
There are existing initiatives already working for these rights.
This recognition places the obligation on PHM activists to ac-
tively support such initiatives though not necessarily to take
up the responsibility of primary leadership of such groups.

13. A specific role that has to be played by PHM activists is to
document violations of the Right to Health and its underlying
determinants. Health-based arguments can indeed significantly
strengthen the demands to tackle these determinants.


II. Strengthening the right to health care

14. This is a task for which the global health movement has an
unquestionable responsibility to take the lead on.

We suggest the following overall strategy for PHM:

15. Regarding the strengthening the Right to health determi-
nants, PHM country circles would continue to expand their in-
volvement in these initiatives in their countries and regions.
PHM may even co-initiate specific international campaigns on a
particular health determinant (e.g., the Right to Water). How-
ever, it is not strategically possible for a global health move-
ment like PHM to launch a single campaign encompassing all
health determinants on a global scale.

16. We suggest launching a Global Right to Health and Health
Care Campaign. PHM has a primary responsibility regarding this
issue. However, during this campaign, the documenting of viola-
tions will not be restricted to those in the sphere of health
care, but will encompass denouncing violations of health rights
related to the various determinants of health.

17. These two types of activities should be combined as part of
a comprehensive approach to the Right to Health. This differen-
tiated strategy does not reflect any judgement on the relative
importance of health care vs. the underlying and basic determi-
nants of people's health; it is rather a question of the strate-
gic approach chosen.

What is the added value of adopting this focus?

18. A RTH Campaign has a big social mobilization potential; the
HR approach is backed by international legislation; the RTH ap-
proach demands that decision-makers take responsibility; HR im-
ply correlative duties that are universal and indivisible; and
(Unlike the MDGs) the HR approach is focused on processes that
lead to concrete outcomes.

What does the RTH imply?

19. In every development process there are two types of actors:
claim holders and duty bearers. When the State does not respect
human rights, claim holders have to demand their rights from the
duty bearers in government.

20. The marginalized are being denied their rights, in part be-
cause, as claim holders, they do not have the capacity to effec-
tively demand (claim) their rights; rights are also violated be-
cause duty bearers do not have the capacity or the will to ful-
fil their obligations (called 'correlative duties').

21. Therefore, in the HR-based approach (HRBAP) one has to carry
out two types of analyses: a) situation analyses in which one
determines the causes of the problems placing them in a hierar-
chical causality chain of immediate, underlying and basic deter-
minants, and b) capacity analyses in which one determines who
are the individuals/institutions that bear the duty to do some-
thing about the above causes calling on them to fulfil their du-
ties as per their country's obligations as signatory of the
United Nations HR covenants.

22. These two types of analyses have to be carried out with the
community and the beneficiaries of the health system so that the
rights being violated can be identified jointly and those re-
sponsible can be confronted --for them to do something about the
problems identified.

23. As a PHM ultimate goal, we do NOT look for health policies
that favour the poor. We seek significant poverty reduction
policies that directly address the social determinants of the
inequitable distribution of resources, as much as we seek to end
the exiting violations to the RTH. The Campaign gives us the
possibility of advancing PHM's political agenda that strives for
equity and for the structural changes that will do away with the
social, economic and political determinants of health.

24. We are no longer going to go to beg for changes to be imple-
mented; we are now going to demand them based on existing inter-
national law already in force in most of the countries where we
work. Disseminating this concept is in itself empowering and is
part and parcel of this Campaign.

25. We have to overcome the culture of silence and apathy about
the HR violations in health we all know are happening. This, be-
cause HR and the RTH will never be given to poor, marginalized,
discriminated and indigenous persons. Repeat: rights are never
given, they have to be fought for! And this is what the RTH Cam-
paign will attempt to do.

Suggested focus of the Campaign

26. It does not need to be emphasised that specific important
aspects of this Right, such as women's and children's right to
health care, mental health rights, HIV and AIDS-affected persons
health care rights, workers' health rights, the right to essen-
tial drugs, etc. need to (and will) be woven into the Campaign,
bringing diverse branches of the global health movement into a
broad coalition working for public health systems that
strengthen universal access to health care.

27. PHM will document violations, which can help push for
changes in the key wider determinants of health; they will also
denounce and act upon adverse existing and new policies that are
having negative impacts on the Right to Health (such as the pri-
vatisation of services, the weakening of universal access sys-
tems, vertical programmes that fragment health systems, the cur-
rent 90/10 gap in research funding, the unjust international
trade regimes --to name just but a few).

Possible organizational collaboration

28. The United Nations Special Rapporteur on the Right to Health
has already shown interest in the idea of this global Campaign.
WHO will need to be strongly influenced, and could be a poten-
tial collaborator. PHM has been a key actor in the launching of
the Commission on the Social Determints of Health (CSDH) of WHO
which we see having a real potential in the fight for the RTH
care. Most countries have National Human Rights Commissions or
official bodies that can be involved in monitoring the Right to
Health. Present PHM-member organizations will also involve a
broader range of civil society organizations in our network in-
cluding women's organizations, coalitions of HIV and AIDS-
affected persons, trade unions of health sector personnel, peo-
ple's movements, etc.; in this sense the campaign would be led
by PHM-and-partners.

Suggested process to launch the Campaign

29. To move towards implementing the Campaign process, we here
propose a sequence of activities.


I. Preparatory phase (early to mid 2006)

1. Creation of a broad consensus on the Campaign idea. Formation
of a 'Core Campaign Steering Group' of about 6-8 organizations
who are willing to help coordinate the Campaign globally. This
team will actively support a host of regional organizers and
will lead the international networking work, plus the fund-
raising and advocacy work for the Campaign. To support this
team, a global campaign secretariat (of about three to four per-
sons) will need to be formed to coordinate the campaign.

2. Identification of specific (existing PHM or newly associated)
groups that will take regional responsibilities. If possible, at
least one consultation within each region to discuss the cam-
paign will have to be held.

3. Identification of short and long-term sources of funding.

4. Ensure local campaign ownership and active involvement
throughout the process. A mechanism for regular consultation
with allies will be set up.

5. Completion of guidelines for the preparation of status papers
on 'The State of the Right to Health' in each country (early
2006).

6. Contribution to the next (2007) edition of the Global Health
Watch.

30. This phase will culminate in a restricted consultation of
the Steering Group in the first quarter of 2006 in which the de-
velopments so far will be reviewed and plans made for the next
phase of the Campaign.

II. Documentation and analysis phase (the last three quarters of
2006).

31. During this period, country, regional and global reports
will be prepared as follows:

1. Country papers or reports on the Status of the Right to
Health Care will be completed in the countries of at least two
regions; in the other regions, the process will be started and
brought to as an advanced stage as possible. Options are as fol-
lows:

a. Full blown Country Reports: These will be the most extensive
and will analyse all or most aspects of the health care system
in the country and report on their current status with facts and
figures, documenting why and how General Comment 14 has (not)
been fulfilled five years after its adoption (within the frame-
work of a 'progressive realization of the right to health').
b. Country Status Papers: These will be less detailed and may
not cover all components of the health sector, but will be based
on country level information and statistics that bring out major
health care system gaps.
c. Country Overviews: These will only contain a listing of major
issues of concern from the Right to Health perspective (e.g.,
declining health budgets, unregulated privatization, imposition
of user fees, dismantling of the social security system).

32. The aim is that about 40-50 countries will prepare these
country reports or status papers -aiming at a minimum of 5 in
each region.

A Global Health Watch Report chapter on the Right to Health
could be drafted focused on how the various global agencies and
actors are infringing the Right to Health in different ways. It
will also focus on the minimum obligations developed countries
have to contribute to health care development in poorer coun-
tries and to stop the northward migration of health profession-
als.

33. This phase will culminate with the concrete planning of Re-
gional Assemblies on the Right to Health in the seven or eight
regions (to be determined) of the world: Dates, venues, finan-
cial arrangements, major agenda contents and organising agencies
will be identified and given concrete mandates. For this, a pre-
planning meeting to finalise the program of these regional as-
semblies may be held at the end of 2006.

III. Regional Assemblies and subsequent action phase (after the
World Health Assembly of May 2007)

34: Plans are as follows:

1. Sequential Regional assemblies on the Right to Health will be
held in all regions of the world: one assembly in each of the
seven or eight regions, spaced about 2 months apart. These would
be called by PHM, with involvement of the UN Special Rapporteur
on the Right to Health and WHO, and will be attended by national
health officials, national human rights committees and PHM, as
well as other health and human rights activists. Available coun-
try reports/country performance report cards on the Right to
Health will be presented and discussed. These assemblies will
attract wide media coverage. Action plans to implement the Right
to Health will be drawn, discussed and presented in the second
half of the assemblies.

2. This series of regional assemblies may culminate in some kind
of a resolution being proposed for adoption at, say, the World
Health Assembly in Geneva in 2008. Such a resolution will call
for the time-bound implementation of the Right to Health. This
will include demanding governments progressively incorporate RTH
principles and standards into their national laws. Further, the
resolution will put in place mechanisms for monitoring and re-
dressal of this right in all countries of the world. PHM partner
organizations will also use this as a concrete opportunity to
draw-in many more organizations into the network, to dialogue
with their country governments, and to engage with national NGOs
and human rights bodies.

3. Finalisation of the Global Health Watch report on the Right
to Health is envisioned for April 2007. The same could include
summaries of all the regional analysis papers and a one-page
standardized abstract of the available country Right to Health
reports.

4. Preparation of a 'Global Action Plan on the Right to Health
Care'. Such a document will convincingly show how quality essen-
tial health care services could be made available NOW to every
human being on earth, provided certain key reallocation of pri-
orities and resources are enacted. This Global assessment will
be accompanied by practical recommendations for the countries in
each region; the latter will form the basis of a Concrete Agenda
to achieve the goals set out in the People's Charter for Health.

5. The 2008 World Health Assembly will be asked to adopt a 'Dec-
laration on the Right to Health for All' for implementation by
member countries, The same will have time-bound, specific and
monitorable goals and contain the basic principles of a bottom-
up health sector reform. The aim will be to sponsor effective
community involvement and monitoring in health thus operational-
izing the Right to Health. A shift in policies of all the inter-
national agencies working in the health sector will be demanded
so that they progressively move towards a human rights-based ap-
proach to health planning.

35. Some shift in the focus of WHO towards the Human Rights-
based Approach to Health will be needed: a shift that puts uni-
versal access systems at the center and that strengthens a group
inside WHO that will continue to work and provide leadership on
this work.

36. The strengthening and broadening of the PHM network in vari-
ous countries across the globe will be both an outcome, and also
an imperative to take the Movement forward around this rallying
point.

A few conceptual and strategic points

37.
i- The Campaign will challenge the commoditization of health,
asserting the inalienable role of the state in public health
systems with the public at the center.

ii- The Campaign makes health rights operational, and thus re-
quires demanding specific commitments and norms that provide
measurable parameters for monitoring and for the enforcement of
redressal mechanisms.

iii- The Campaign builds a broad strategic alliance involving
various special health rights movements that already (or not
yet) claim the Right to Health as a key human right.

iv- The Campaign is deeply rooted in national initiatives, yet
also addresses key global processes and counters powerful stra-
tegic opponents.

v- The Campaign vies for putting the RTH more at the center of
attention in the health discourse, and engages major actors mak-
ing them take an explicit stand on the Right to Health.

vi- For today, the Campaign represents a strategy of resistance
(i.e., preventing a further weakening of public health systems)
and, for tomorrow, it offers a whole new alternative vision
(i,e., universal access to comprehensive health care plus the
tackling of the key negative determinants of health).

vii- The Campaign will be used to shift the discourse from the
preoccupation with vertical programmes and privatisation-
oriented measures to focusing more on widespread denial and vio-
lations of the Right to Health, on demanding a global consensus
on the implementation of this right, and on asking that all pro-
grammes and measures now be critically evaluated according to
the tenets of health as a right.

What may be realistically achieved through the proposed process?

38. We have no illusion that systematically raising the issue of
the 'Right to Health' will by itself lead to an actual complete
implementation of this right in countries across the globe. The
universal provision of even basic health care services involves
major budgetary, operational and systemic changes; in addition
to shifting to a rights-based framework, major political and le-
gal reorientations are thus needed --and such major changes can-
not be expected to happen in full in the near future.

39. However, we can expect and can work on a number of more
achievable objectives that can take us towards the larger Human
Rights goal. Some of these 'achievables' to be considered in our
Campaign are: the explicit recognition of the Right to Health
Care at country level; the formation, in some countries, of
health rights monitoring bodies with PHM and civil society par-
ticipation; a clearer delineation of health rights at both
global and country level; the shifting of the focus of WHO to-
wards health rights/universal access systems and the strengthen-
ing of groups within WHO that will work along these lines; and,
finally, the strengthening of the PHM network in as many coun-
tries as possible so all its members work around a common and
broad rallying point.

Organization of PHM and of partners and the Campaign

40. Recognizing that PHM country circles --which were formed
during or after the first People's Health Assembly (PHA1) need
to move beyond discussions to develop forceful, shared advocacy
activities; this is crucial if they are to develop further and
to draw-in more groups into our movement. There is now a need to
develop and carry out shared and more effective advocacy actions
at country level. These are to be directed at engaging both
claim-holder groups and decision-makers (duty-bearers) in an ef-
fort to bring about needed changes in the existing (and often
deteriorating) situation. A 'Right to Health and Health Care'
Campaign can be such a catalyst and unifying process bringing
together existing and new PHM circles, as well as involving new
partner groups and networks. The campaign has the potential to
give space to new organizations and networks, which have so far
not been active in PHM. Assessing the campaign's viability will
start by ascertaining the existence of a minimum critical mass
of PHM-and-partners strength and power in a substantial number
of countries. Our appeal is for such a process to start as early
as possible. As a first step, we plan to explore the potential
of this global Right to Health and Health Care Campaign. We have
to make use of the momentum achieved at PHA2 to crystallise and
plan the future courses of action of the Campaign --
understanding that each country will move at its best (individ-
ual) pace.

Abhay Shukla and Claudio Schuftan
People's Health Movement India and Vietnam

mailto:abhayseema@vsnl.com
mailto:claudio@hcmc.netnam.vn