operationalizing the right to health in health systems transparency and accountability
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4TH LATIN AMERICAN MEETING ON THE RIGHT TO HEALTH AND HEALTH SYSTEMS Bogotá, Colombia. April 2 to 4, 2014. Operationalizing the right to health in health systems Transparency and Accountability. Siri Gloppen Professor, Comparative Politics, UiB & CMI, Bergen Norway. - PowerPoint PPT PresentationTRANSCRIPT
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Operationalizing the right to health in health systems
Transparency and Accountability
Siri Gloppen Professor, Comparative Politics, UiB & CMI, Bergen Norway
4TH LATIN AMERICAN MEETING ON THE RIGHT TO HEALTH AND HEALTH SYSTEMS Bogotá, Colombia. April 2 to 4, 2014.
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Accountability for what? How?• Two concepts of the Right to Health
• Transparency and accountability mechanisms– Enabling rights holders to claim rights– Enabling duty-bearers to provide
• Courts and beyond– Challenges of court based mechanisms for accountability in
health– Transparency and accountability in reform and policy
processes
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Two concepts of the right to health (R2H)”right to the hightest attainable standard of physical and mental health”
R2H = individual (justiciable) claim
R2Hind
R2H = an equitable health system
R2Hsos
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R2Hind “Right to the highest attainable standard
of physical and mental health” – Individual right to everything that is technically
possible to preserve/advance health? • regardless of costs
– Limited by resources (equivalent rights of everyone) ?
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R2Hsos “Right to the highest attainable standard
of physical and mental health”
= Right to an equitable health system And (as large as possible) equitable share
Progressively realizedPremises:
- Resource scarcity- Citizens equal in worth, dignity = due equal concern, respect
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Resource scarcity unavoidable condition and constraint in all health systems • particular challenge in highly unequal societies
Decisions to spend resources on particular patients/ services (implicitly) entail priority-setting /trade-offs
To not take seriously issues of justice in priority-setting denies others (who may have stronger entitlements) the right to health.
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Fair health system
Reasonable allocation of (inevitably limited) resources
• Between patient groups– Cost-effectiveness of treatment (and strength of evidence)– Severity of the health condition
• Within patient groups– Social status, gender, sexual orientation, ethic groups etc– Based on vulnerability analysis; barriers to R2H
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need for transparency and accountability mechanisms to ensure:
Fair and well functioning health system distributing resources equitably Fair priority to health relative to other social goods/rights
Fair treatment of each within – and equal access to – the system
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Adequate aransparency and accountability mechanisms in health system / policy reform• Transparency on need and converage– Who (patient groups, social goups) – Why (determinants of health)
• Transparency and participation in setting and reivising goals and priorities
• … in relation to HTAs and their use• … in relation to guidelines• … in monitoring and implementation
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Institutional mechanisms for claiming systemic reform -- and a fair share
• System internal mechanisms• Courts• Public protectors
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Challenge for courts to reconcile the two concepts of the right to health
”right to the hightest attainable standard of physical and mental health”
R2Hind = individual (justiciable) claim
R2Hsos= an equitable health system
R2Hsos-ind = right to an equitable share