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WHO Essential Drugs Strategy

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WHO Essential Drugs Strategy Powered By Docstoc
					    Access to essential drugs
       as a human right




                September 2002
 Hans V. Hogerzeil, MD, PhD, FRCP Edin
Essential Drugs and Medicines Policy (EDM)
        World Health Organization
         Tel: +41.22.791.3528. Fax: +41.22.791.4167
        Human Rights

    Human rights concern the relation the between state and the
      individual; they lead to state obligations and individual
      entitlements
    All human rights are interdependent and interrelated. Health is
       a fundamental human right indispensable for the exercise
       of other human rights
    Freedom from discrimination underpins all
    Promotion of human rights is one of the principle purposes of
      the United Nations. In 1997 the Secretary-General put
      human rights at the core of the UN.


                                                   WHO - EDM
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       First expression of the right to health:
       The WHO Constitution (1946)

    “The States parties to this Constitution declare, in conformity
    with the Charter of the United Nations, that the following
    principles are basic to the happiness, harmonious relations
    and security of all peoples.
    Health is a state of complete physical, mental and social well-
    being and not merely the absence of disease or infirmity.
    The enjoyment of the highest attainable standard of health is
    one of the fundamental rights of every human being without
    distinction of race, religion, political belief, economic or
    social condition (...)”


                                                    WHO - EDM
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       Universal Declaration of Human Rights (1948)

    Art.25.1
    “Everyone has the right to a standard of living
    adequate for the health of himself and of his family,
    including food, clothing, housing and medical care
    and necessary social services”




                                             WHO - EDM
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        The right to health is also recognized
        in numerous other instruments

       1961: European Social Charter
       1966: International Covenant on Economics, Social and
        Cultural Rights (most detailed; see Article 12.1 and 12.2)
       1978: Declaration of Alma Ata
       1981: African Charter on Human and People’s Rights
       1988: Additional Protocol to the American Convention on
        HRs in the Area of Economic, Social and Cultural Rights
       1989: Convention on the Rights of the Child


                                                      WHO - EDM
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        The Cold War:
        Civil and political rights versus
        economic social and cultural Rights

        In 1966 the implementation of the Universal Declaration
        into binding international law lead to a split in human
        rights issues, and to two separate treaties:


       International Covenant on Civil and Political Rights
       International Covenant on Economic, Social and Cultural
        Rights




                                                     WHO - EDM
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        International Covenant on Economics, Social and
        Cultural Rights (ratified by 145 countries)

       Article 12.1:
        recognizes the “right of everyone to the enjoyment of the
        highest attainabrile standard of physical and mental
        health”
       Article 12.2:
        illustrates a number of steps to be taken by States parties
        to achieve:
           a. maternal, child and reproductive health
           b. healthy natural and workplace environments
           c. prevention, treatment and control of disease
           d. health facilities, goods and services


                                                              WHO - EDM
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       Committee on Economic, Social and Cultural Rights
       General Comment nr.14 (May 2000)

    Art.12.2.c:
       Right to prevention, treatment and control of diseases
       includes creation of a system of urgent medical care in
       case of accidents, epidemics; and disaster relief and
       humanitarian assistance
    Art 12.2.d:
       Right to health facilities, goods and services includes
       appropriate treatment of prevalent diseases, preferably at
       community level; and the provision of essential drugs



                                                    WHO - EDM
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        Right to health (like all human rights) imposes
        three levels of obligations

       Right to respect - refrain from interfering; do not deny or
        limit equal access to preventive, curative, palliative care
       Right to protect - obligation to ensure equal access to
        facilities provided by third parties
       Right to fulfil - obligation to facilitate, provide and promote
        (e.g. administrative, budgetary, judiciary and promotional
        measures)




                                                        WHO - EDM
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         International Covenant on Economics, Social and
         Cultural Rights, General Comment nr.14 (May 2000):
         Core obligations

         Minimum essential levels of each of the rights enunciated in
         the Covenant, including essential primary care as described
         in the Alma Ata Declaration; including:
        Non-discriminatory access to health facilities, goods and
         services, especially for the vulnerable and marginalized
        Essential food; housing; sanitation
        Essential drugs as defined by WHO Action Programme ED
        Equitable distribution of health services and goods
        A national public health strategy and plan of action



                                                      WHO - EDM
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         Committee on Economic, Social and Cultural Rights
         General Comment nr.14 (May 2000)
         Essential components of fulfillment of right to health

        Availability - includes “essential drugs as defined by the
         WHO Action Programme on Essential Drugs”
        Accessibility - based on non-discrimination, physical
         accessibility, affordability and access to information
        Acceptability - respectful of medical ethics and culturally
         appropriate and sensitive to gender and life-cycle
        Quality - scientifically and medically




                                                       WHO - EDM
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         Committee on Economic, Social and Cultural Rights
         General Comment nr.14 (May 2000)
         Party obligations

        Progressive realization, within limits of available resources


     But: some obligations are immediate:
        Exercise right without discrimination (art.2.2)
        Take steps toward the full realization of article 12; these
         steps must be deliberate, concrete and targeted towards
         full realization of the right to health




                                                       WHO - EDM
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         International Covenant on Economics, Social and
         Cultural Rights, General Comment nr.14 (May 2000):
         International obligations

         State parties have to respect and protect the enjoyment of
         the right to health in other countries:


        Facilitate access to essential facilities/services in other
         countries and provide necessary aid when required
        As members of international bodies (IMF, World Bank)
         refrain from imposing embargoes or similar measures
         restricting the supply of another state with adequate
         medicines and supplies



                                                         WHO - EDM
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         Committee on Economic, Social and Cultural Rights
         General Comment nr.14 (May 2000)
         Violations

        Adoption of retrogressive measures, repeal, suspension
        Failure to take all steps to ensure the right to health; e.g.
            failure to adopt or implement a national health policy designed to
             ensure the right to health for anyone
            insufficient expenditure or misallocation of public resources
            failure to monitor realization of the right to health in the country
            failure to take measures to reduce inequitable distribution of health
             facilities, goods and services


                          Important: distinguish inability
                          from unwillingness of the State

                                                                 WHO - EDM
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         Access to essential drugs as a human right:
         Where are we now?

        Health is a human right (Univ.Decl.Hum.Rights).
        The right to health care includes the right to emergency
         care and health facilities, goods and services (Covenant)
        The right to facilities, good and services includes the
         provision of essential drugs as defined by WHO (GCom.14)
        State parties are under immediate obligation to guarantee
         that the right to health care is exercised without
         discrimination, and that concrete steps are taken towards
         full realization, with emphasis on vulnerable and marginal
         groups


                                                      WHO - EDM
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         What could it mean in practice?
         (1) Components of the “rights-based” approach

        Process
             HR as framework for health development
             Assess HR implications of any policy and programme
        Substantive components
             Focus on marginalized and vulnerable groups
             Equity: ensure that health systems are accessible to all
             Gender perspective: e.g. disaggregated statistics
             Free, meaningful participation by beneficiaries
             Promote right to education and to information
             Transparency, use of indicators and benchmarks
             Safeguards and redress mechanisms

                                                        WHO - EDM
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         Access to essential drugs as a human right:
         What could it mean in practice?
         (2) Definition of minimum needs

        A concrete implication of Art.12.2 (d) needs a list of priority
         diseases to describe the minimum essential level of primary
         care; and a cost-effective treatment for each
        This will lead to a core list of essential medicines - can this
         be the same as the WHO Model List of Essential Medicines?

             Question: How to define a list of priority diseases?
             • Global burden of disease?
             • Availability of safe and cost-effective treatment?
             • Availability of evidence-based treatment guideline?


                                                           WHO - EDM
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         What could it mean in practice?
         (3) Verification of obligations
         under the International Covenant

        State parties can be asked to report regularly on:
            access to essential medicines
            aspects of equity
            progress through Government efforts

        WHO/EDM can support the UN High Commissioner for
         Human Rights the new Special UN Rapporteur on Health
         by recommending practical indicators for such monitoring




                                                      WHO - EDM
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        National recognition of a Right to Health


           200       193

           150                  142
                                                 109
           100                           83               Nr.of countries
             50

              0
                     All      ICESCR Regional   Const.




                                                         WHO - EDM
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         What could it mean in practice?
         (4) Support to national NGOs and
         patient/consumer advocates

        WHO publication of a list of state parties to the various
         human rights declarations and treaties - to be used as a
         tool for national public pressure on their own
         governments
        WHO promotion of core List of Essential Medicines to
         define government obligations
        Promotion of simple monitoring tools for NGOs (e.g. on
         access and prices of essential medicines)




                                                       WHO - EDM
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            World Health Organisation
Department of Essential Drugs and Medicines Policy
            1211 Geneva, Switzerland
 WHO            Fax 41-22-7914167
Web Site: http://www.who.medicines/
Documentation Centre: darec@who.int

				
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