PHM-Exch> 2012: Report to the General Assembly (main focus: health financing in the context of the right to health) [ A/67/302 ]

[Claudio Schuftan]

****

* *

*Interim report of the Special Rapporteur on the right of*

*everyone to the enjoyment of the highest attainable*

*standard of physical and mental health.*

* *

*Conclusions and recommendations:*



55. *The right to health approach to health financing provides a framework*

*with which to ensure adequate, equitable and sustainable health financing.
The*

*approach addresses three critical areas in health financing: how States
ensure*

*adequate funds are available for health and the sources from which they
raise*

*these funds; how these funds are pooled; and how funds and resources are*

*allocated within health systems towards ensuring universal access to good*

*quality health facilities, goods and services.*

56. *The Special Rapporteur urges States to take the following steps in
order to*

*ensure adequate funds are available for health:*

(a) *Implement a progressively structured system of general taxation to*

*fund health or improve upon the progressivity of such systems where they*

*already exist;*

(b) *Ensure that consumption taxes, such as excise taxes and VAT, are not***

*regressive. This may include setting appropriate thresholds below which
small*

*enterprises are not subject to taxation and reducing or removing
consumption*

*taxes on necessity goods;*

(c) *Consider earmarking portions of revenue from specific taxes, such as*

*sin taxes and VAT, for spending on health;*

(d) *Ensure tax liberalization policies resulting from international tax*

*competition, including tax abatements for foreign investors and low or
non-existent*

*trade and capital gains taxes, do not result in reduced public funding for*

*health;*

(e) *Find ways to collect taxes from businesses in the informal sector,*

*contingent upon the provision of State services and other benefits
associated*

*with being a taxable entity to such businesses.*

57. *The Special Rapporteur urges States to take the following steps in
order to*

*cooperate internationally towards ensuring the availability of sustainable*

*international funding for health:*

(a) *Coordinate all donor activities in recipient States, incorporating the*

*participation of civil society and affected communities, towards meeting
domestic*

*health needs and promoting the development of self-sustaining health
systems;*

(b) *Develop a treaty-based global pooling mechanism, comprising*

*compulsory progressive contributions from States allocated based upon need*

*and driven by transparent, participatory processes, in order to shift from
a*

*donor-based system towards an obligatory system of international funding.*

58. *The Special Rapporteur urges States to prioritize funding for national
and*

*sub-national health budgets in order to reduce over-dependence on
international*

*funding and ensure domestic resource self-sufficiency for health.*

59. *The Special Rapporteur urges States to take the following steps in
order to*

*pool funds for health:*

(a) *Implement a pooling system comprising compulsory, progressive*

*prepayments, such as taxes and insurance contributions, in order to reduce
or*

*eliminate out-of-pocket payments for health and ensure access to good
quality*

*health facilities, goods and services for the poor;*

(b) *Develop social health insurance programmes funded through*

*compulsory, progressive contributions, supplemented by general tax revenue,
*

*comprising a pool of contributors large enough to promote effective
cross-subsidization,*

*with absolute exemptions for the poor;*

(c) *Ensure that enrollment in social health insurance programmes*

*captures all necessary parts of the populations, particularly vulnerable or
*

*marginalized populations, with special attention to informal workers;*

(d) *Ensure that benefits under social health insurance programmes*

*include a minimum set of health goods and services and are available and*

*universally accessible based on need. Benefits packages must:*

(i) *Be responsive to the disease burden and health needs of the population;
*

(ii) *Include effective and community-centred primary health-care services;*

(iii) *Include essential medicines and generic drugs in order to ensure*

*access to safe, effective and affordable medicines.*

60. *The Special Rapporteur urges States to take the following steps in
order to*

*equitably allocate funds for health:*

(a) *Ensure equitable and efficient allocation of health funds and*

*resources between primary, secondary and tertiary health care, with
particular*

*emphasis on primary care;*

(b) *Ensure that good quality health facilities, goods and services are*

*available and accessible on a non-discriminatory basis for rural and remote
*

*populations. This will require:*

(i) *Increased investment in physical health infrastructure in rural and*

*remote communities;*

(ii) *Creation of incentives for health workers, such as competitive*

*salaries, tax abatements, rotational postings and accelerated career*

*advancements to work in rural and remote areas.*
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