PHA-Exch> Food for a thought with a added value (3)

[Claudio Schuftan]

* *

Human Rights Reader 209



*HEALTH CARE AS A RIGHT: WHAT YOU NEED TO KNOW*. (Part 3 of  3)

16. As rights activists, we are no longer going to go to beg for changes to
be implemented; we are now going to demand them based on existing
international law already in force in most of the countries where we work.
Disseminating this concept is in itself empowering. Note that people in
countries that have not ratified these covenants do have the same rights;
their problem is that their governments have not made a commitment to honour
them.



17. Health activists need to seek to overcome the culture of silence and
apathy about the HR violations in health we all know are happening. This,
because HR and the RTH will never be given to poor, marginalised,
discriminated and indigenous persons. Repeat: *rights are never given, they
have to be fought for!*

* *

18. As regards the added value of adopting a HR-based framework, several
advantages come to mind:

a) A RTH Campaign has a big social mobilisation potential --and this is an
indispensable part of any campaign, b) as said, the HR framework is backed
by international law, c) it demands --from a position of strength-- that
decision-makers take responsibility, d) HR imply correlative duties that are
universal and indivisible (there is no such a thing as ‘basic rights’), and
e) the HR framework is focused on processes that lead to outcomes (just
setting goals, like the MDGs, is thus *not* sufficient in the HR-based
framework).


What may be realistically achieved through the proposed process?



19. It is wrong have the 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 legal reorientations are thus needed --and
such major changes cannot be expected to happen in full in the near future,
given the political economy of health care in most countries of the world
today.



20. However, we *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 are: a) the explicit recognition of the Right
to Health Care at country level, b) the formation, in some countries, of
health rights monitoring bodies (accountability agents) with civil society
participation, c) a clearer delineation of health rights being quite
systematically violated at both global and at country level, d) the shifting
of the focus of WHO towards health rights/universal access systems and the
strengthening of groups within WHO that will work along these lines and
along the lines of more proactively tackling of the social determinants of
health, e) the bringing of the Right to Health Care more into the global
agenda thus making it a central reference point in the global health
discourse, and f), the strengthening of the HR activists’ network in as many
countries as possible so that all its members work around a common and broad
rallying point, along with building partnerships with other networks.



21. Nearly 150 countries around the world are parties to the International
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 operationalisation, the violations and the
suggested means to monitor the implementation of this right. There is now a
need to launch a *global* *process* *of* *mobilisation* to actually
implement the provisions of GC 14 in all ratifying countries. *This clearly
calls for measures to operationalise the RTH and to review and recast all
global and national health sector reform initiatives* in the light of the
framework of health as a right (such as, for instance, recasting the reforms
that are now being pursued to achieve the Millennium Development Goals!).



22. There are a host of reasons to adopt the Right to Health framework.
Among them is the fact that the Basic Human Needs Approach (has) never
delivered. Other, as valid, justifications are: a) the Human Rights-based
framework is the new UN policy, b) it is founded on the principles of an
equitable access to health care services at all levels with no
discrimination, and c) at this moment in time, there is growing recognition
of the need for a *global initiative *to address health system issues in a
rights-based framework*.*



23. There is also a growing worldwide need for solidarity in and mutual
learning from our struggles, so as to strengthen our efforts in the various
countries and regions. There is a related need to challenge the dominant
global discourse of *‘safety nets for those left outside the existing
packages of benefits’* that results from health services being increasingly
commodified and from governments retreating from funding the provision of
universal health care, limiting their role to supporting said ‘safety nets’
or other kinds of reduced public ‘health services for the poor’. We need to
counter this with a strong *‘Health care as a human right’* strategy that
unequivocally asserts the central role of the state and public health
systems --and their responsibility to provide health services for all.



*Claudio Schuftan, Laura Turiano and Abhay Shukla, People’s Health Movement,
Right to Health Campaign (see www.phmovement.org ).*
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