Operationalizing the right to health in health systems Transparency and Accountability

1. 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

2. 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

3. Twoconceptsofthe 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

4. 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) ?

5. 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 realized Premises: • Resource scarcity • Citizens equal in worth, dignity =due equal concern, respect

6. 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.

7. 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

8.  need for transparencyand 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

9. Adequatearansparency and accountabilitymechanisms in health system / policy reform • Transparencyonneed and converage • Who (patientgroups, socialgoups) • Why (determinants ofhealth) • Transparency and participation in setting and reivising goals and priorities • … in relation to HTAs and theiruse • … in relation to guidelines • … in monitoring and implementation

10. Institutional mechanisms for claimingsystemic reform -- and a fair share • System internalmechanisms • Courts • Public protectors

11. Challenge for courts to reconcilethetwoconceptsofthe 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