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.

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

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

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) ?

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

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.

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

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

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

Institutional mechanisms for claiming systemic reform -- and a fair share

• System internal mechanisms• Courts• Public protectors

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