- While not universally embraced, the notion that health care systems are public goods protecting an inalienable right of all human beings is increasingly invoked in debates about health care financing, and about global health governance.
- But herein also lies a paradox in health and in human rights. At no time in human history has the notion of health as a human right enjoyed such prominence in the international and national health discourse as it does now. Yet this newfound prominence of the human right to health clashes with the ongoing expansion of the politics of exclusion and the economics of inequality.
- Perhaps the major challenge in translating the many local successes of health activism into concrete health systems change is to increase the awareness and active involvement of those who stand to benefit the most from such changes, i.e., the most marginalized people.
- Effective delivery systems without explicit human rights protections (for example, legislative guarantees or easier access to working redress mechanisms) will fail to deliver to those most marginalized. The point to be made here is that it is not the task of the private sector –whether for-profit or not-for-profit– to guarantee access to health care for the marginalized. It is the task of the latter themselves.
We must learn to better accompany governments
- Accompaniment, in a human rights-based approach to public sector services, has two elements: working with governments as duty bearers to build their capacity to deliver services while working with communities as claim holders to hold governments accountable for the quality and equality of those services.
- The concept of justice-in-action, i.e., of actually delivering health, nutrition, housing, water, and other services as a human right remains as powerful and important today as it ever was. (Perhaps even more powerful since it is impossible, in the 21st century, to argue that any of these challenges are somehow technically insuperable; they can be overcome, and we all know it).
- To work towards providing health care as a human right is a good thing, but is it sustainable? Can it ever be brought to scale? Responses to these two questions will be different whether they are asked to start the conversation or to end it. To sustain such efforts requires that a new generation of practitioners, policymakers, scholars, researchers, and advocates take up the cause of human rights and of equality in global health. To bring such efforts to scale requires that we engage the public sector since only governments can confer rights to those living within their borders.
- We cannot stop repeating: Acknowledging injustice is not enough; linking knowledge of injustice to reparative action is what we are all called to do.*
*: There is a Sanskrit-based word: nyaya; it means “justice in action” and is, perhaps, a shorter and more elegant term for global health delivery in the spirit of human rights; in the context of the pervasive current politics of exclusion, we suffer from a lack thereof. Nyaya!
- A veritable people’s war for the human right to health (RTH) emerges as a response to the prevailing exclusion of several groups from the economic, political, and social power base, be it due to caste, gender, sexual orientation, religion, ethnicity and/or geography.
- So far, motivation to bring RTH work to scale is constrained by the lack of an active constituency that musters the power to demand the needed changes. Building a solid base of citizens engaged in political mobilization for health takes time (for claim holders to build up their hope so as to truly believe they can demand the investments and the human and physical health infrastructure the state has the obligation to provide for them).
- This is where the human rights framework is central to build-up that power. It is in fact the best frame to apply in settings of extreme poverty, where the social, historical, and cultural roots of under-utilization and under-implementation are fundamentally tied to a long long standing chronic lack of access to economic resources.
- Without the political and social backing and pushing from organized claim holders, even responsive and progressive policy makers (duty bearers) will not have the needed clout to see needed changes through.**
**: It is not enough to have ‘a sound science’ about how to best solve problems and deliver interventions; what is further required is a social-action-plan that translates what we know from science into human rights realizations.
- Local interventions that are not developed and carried out with the larger policy perspective in mind –those with human rights implications– are unlikely to achieve a broad, sustainable impact. Similarly, scaled-up interventions that are not rooted in smaller, more local realities are likely to face logistical, as well as practical implementation challenges.
- At global level, a bit of the same is true. Protocols in global health are to include a social action strategy, as well as include clear plans for achieving the social and political mobilization needed to achieve any sustainable impact.
- Some components of such a social action strategic plan have been proposed by Maru and Farmer:
| Key Component | Related Questions |
| Current political, policy, and economic barriers to implementation | What are the major constraints to implementation? What are the actual numbers for utilization, financing, staffing, and supplying for the services under consideration? What are the major institutions and actors (duty bearers) that may have a stake in the status quo? Private sector providers? Pharmaceutical companies? |
| Key constituents, actors, and partners involved in overcoming these barriers | Who are the individuals and groups who are capable and essential in overcoming these barriers? (At a local level, these may be government staff and local politicians. At a national level, these may include politicians, policy makers, non-governmental organizations, and aid agencies.) |
| Concrete plan for the dissemination of findings and actions to implement them | What will be the immediate next steps? Who will be lobbied with demands? Who will receive an in-person meeting? Where will community or public meetings be conducted, and who will be invited? |
- The direct corollary of the application of human rights to health systems development is that the government must be deeply involved in ensuring its poorest citizens have access to health care. But it cannot do so without resources. Accompaniment of the public sector means working with governments to build capacity to finance and deliver services, as well as working with communities to hold governments accountable for the quality and equality of those services. This complex vision is central to the task of translating human rights declarations into human rights realized.
Claudio Schuftan, Ho Chi Minh City