9. A human right to health (RTH) strategy is to be seen as both a technical and a political task in the realm of our struggle for health-as-a-right-for-everyone-NOW. The question that this calls for is: What kind of a political mobilization do we need to bring about as we face the non-satisfaction of the people’s RTH? The local context will ultimately determine this, but a way must be found.
10. The motto of such a mobilization will be: “Health is a human right of everyone and is the duty of the State”…with needed action at national, regional and local level, including the regulation of the private sector –i.e., public and private institutions both have the obligation to fulfill the universal right to health. [Claims by individual states that they lack sufficient resources for health a) does not free them from the obligation of fulfilling the well-identified core obligations in health, and b) does not exonerate them from setting benchmarks for the progressive realization of the RTH. To this, one should add the (right-now-being-discussed) obligation of other states to respect, protect and fulfill the RTH as a global obligation].
11. The RTH strategy, furthermore, calls for defining, from the RTH-based framework and from a Health-For-All-Now perspective, what the good, the fair, the desirable and the equitable is in health so that the magnitude of the current gap and of the actual violated rights can be quantified and the actions to be taken sketched. Such an exercise unquestionably requires understanding health in a broad sense, i.e., including its social, economic and political determinants.
12. On top of the indvisible triad of universal coverage, comprehensive care and equity in health, additional principles that working on the RTH will certainly have to tackle are:
• Social and community participation with decision-making power (direct democracy).
• Descentralization of the health system management and financing.
• Health care financed by global tax income with a more progressive tax regime and direct income transfers to the poor.
• Provision of essential drugs for patients at the PHC level and beyond.
• An effective health promotion strategy.
• Availability of human resources with the needed profiles and with fair remuneration, and finally,
• Because HR are indivisible, concomitant public policies for universal access to education and to social security.
[Your attention is drawn to register how the indivisible triad and these additional principles were already appeals for action in the Alma Ata Declaration –thirty years ago!].
13. Women’s, youth and religious organizations, as well as unions, parlamentarians and political parties will need to be brought-in to the process of getting issues of equity in health de-facto incorporated into the RTH strategy.
14. All the above means that we cannot place the needed RTH-based discussions and actions within the existing, ruling paradigm since it sets the limits and the rules-of-the-game of what can be done, so that, as proactive RTH workers, we would be constrained to apply solutions within what the gatekeepers of the paradigm set as “doable”. New bottom-centered pressures will thus need to be exerted to bring about the unavoidable and called-for paradigm shift.
15. In this paradigm-shifting endeavor, our ‘creative anger’ is to be considered a resource! It just needs to be channeled into a strategy of social mobilization with concrete tactical steps that will lead to reverse existing unfair power relations in the health sector, as well as to question and act-upon the structural causes of preventable malnutrition, ill-health and deaths. (The ongoing People’s Health Movement Global Right to Health and Health Care Campaign is a move in that direction www.phmovement.org).
16. The bases of the capacity analysis that will need to be carried out to lead to an active claim-holders/duty-bearers dialectical interaction necessary for the implementation of the RTH process have been covered elsewhere in this Reader.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org