WHO Essential Drugs Strategy

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Access to essential drugs as a human right
September 2002
Hans V. Hogerzeil, MD, PhD, FRCP Edin Essential
Drugs and Medicines Policy (EDM) World Health
Organization Tel [phone]. Fax
41.22.791.4167
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Human Rights

• Human rights concern the relation the between
  state and the individual they lead to state
  obligations and individual entitlements
• All human rights are interdependent and
  interrelated. Health is a fundamental human right
  indispensable for the exercise of other human
  rights
• Freedom from discrimination underpins all
• Promotion of human rights is one of the principle
  purposes of the United Nations. In 1997 the
  Secretary-General put human rights at the core of
  the UN.

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First expression of the right to healthThe WHO
Constitution (1946)

• The States parties to this Constitution declare,
  in conformity with the Charter of the United
  Nations, that the following principles are basic
  to the happiness, harmonious relations and
  security of all peoples.
• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity.
• The enjoyment of the highest attainable standard
  of health is one of the fundamental rights of
  every human being without distinction of race,
  religion, political belief, economic or social
  condition (...)

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Universal Declaration of Human Rights (1948)

• Art.25.1
• Everyone has the right to a standard of living
  adequate for the health of himself and of his
  family, including food, clothing, housing and
  medical care and necessary social services

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The right to health is also recognizedin
numerous other instruments

• 1961 European Social Charter
• 1966 International Covenant on Economics, Social
  and Cultural Rights (most detailed see Article
  12.1 and 12.2)
• 1978 Declaration of Alma Ata
• 1981 African Charter on Human and Peoples
  Rights
• 1988 Additional Protocol to the American
  Convention on HRs in the Area of Economic, Social
  and Cultural Rights
• 1989 Convention on the Rights of the Child

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The Cold War Civil and political rights
versuseconomic social and cultural Rights

• In 1966 the implementation of the Universal
  Declaration into binding international law lead
  to a split in human rights issues, and to two
  separate treaties
• International Covenant on Civil and Political
  Rights
• International Covenant on Economic, Social and
  Cultural Rights

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International Covenant on Economics, Social and
Cultural Rights (ratified by 145 countries)

• Article 12.1
• recognizes the right of everyone to the
  enjoyment of the highest attainabrile standard of
  physical and mental health
• Article 12.2
• illustrates a number of steps to be taken by
  States parties to achieve
• a. maternal, child and reproductive health
• b. healthy natural and workplace environments
• c. prevention, treatment and control of disease
• d. health facilities, goods and services

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Committee on Economic, Social and Cultural
RightsGeneral Comment nr.14 (May 2000)

• Art.12.2.c
• Right to prevention, treatment and control of
  diseases includes creation of a system of urgent
  medical care in case of accidents, epidemics and
  disaster relief and humanitarian assistance
• Art 12.2.d
• Right to health facilities, goods and services
  includes appropriate treatment of prevalent
  diseases, preferably at community level and the
  provision of essential drugs

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Right to health (like all human rights)
imposesthree levels of obligations

• Right to respect - refrain from interfering do
  not deny or limit equal access to preventive,
  curative, palliative care
• Right to protect - obligation to ensure equal
  access to facilities provided by third parties
• Right to fulfil - obligation to facilitate,
  provide and promote (e.g. administrative,
  budgetary, judiciary and promotional measures)

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International Covenant on Economics, Social and
Cultural Rights, General Comment nr.14 (May
2000) Core obligations

• Minimum essential levels of each of the rights
  enunciated in the Covenant, including essential
  primary care as described in the Alma Ata
  Declaration including
• Non-discriminatory access to health facilities,
  goods and services, especially for the vulnerable
  and marginalized
• Essential food housing sanitation
• Essential drugs as defined by WHO Action
  Programme ED
• Equitable distribution of health services and
  goods
• A national public health strategy and plan of
  action

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Committee on Economic, Social and Cultural
RightsGeneral Comment nr.14 (May 2000)Essential
components of fulfillment of right to health

• Availability - includes essential drugs as
  defined by the WHO Action Programme on Essential
  Drugs
• Accessibility - based on non-discrimination,
  physical accessibility, affordability and access
  to information
• Acceptability - respectful of medical ethics and
  culturally appropriate and sensitive to gender
  and life-cycle
• Quality - scientifically and medically

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Committee on Economic, Social and Cultural
RightsGeneral Comment nr.14 (May 2000)Party
obligations

• Progressive realization, within limits of
  available resources
• But some obligations are immediate
• Exercise right without discrimination (art.2.2)
• Take steps toward the full realization of article
  12 these steps must be deliberate, concrete and
  targeted towards full realization of the right to
  health

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International Covenant on Economics, Social and
Cultural Rights, General Comment nr.14 (May
2000) International obligations

• State parties have to respect and protect the
  enjoyment of the right to health in other
  countries
• Facilitate access to essential facilities/services
  in other countries and provide necessary aid
  when required
• As members of international bodies (IMF, World
  Bank) refrain from imposing embargoes or similar
  measures restricting the supply of another state
  with adequate medicines and supplies

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Committee on Economic, Social and Cultural
RightsGeneral Comment nr.14 (May 2000)Violations

• Adoption of retrogressive measures, repeal,
  suspension
• Failure to take all steps to ensure the right to
  health e.g.
• failure to adopt or implement a national health
  policy designed to ensure the right to health for
  anyone
• insufficient expenditure or misallocation of
  public resources
• failure to monitor realization of the right to
  health in the country
• failure to take measures to reduce inequitable
  distribution of health facilities, goods and
  services

Important distinguish inability from
unwillingness of the State
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Access to essential drugs as a human rightWhere
are we now?

• Health is a human right (Univ.Decl.Hum.Rights).
• The right to health care includes the right to
  emergency care and health facilities, goods and
  services (Covenant)
• The right to facilities, good and services
  includes the provision of essential drugs as
  defined by WHO (GCom.14)
• State parties are under immediate obligation to
  guarantee that the right to health care is
  exercised without discrimination, and that
  concrete steps are taken towards full
  realization, with emphasis on vulnerable and
  marginal groups

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What could it mean in practice?(1) Components of
the rights-based approach

• Process
• HR as framework for health development
• Assess HR implications of any policy and
  programme
• Substantive components
• Focus on marginalized and vulnerable groups
• Equity ensure that health systems are accessible
  to all
• Gender perspective e.g. disaggregated statistics
• Free, meaningful participation by beneficiaries
• Promote right to education and to information
• Transparency, use of indicators and benchmarks
• Safeguards and redress mechanisms

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Access to essential drugs as a human rightWhat
could it mean in practice?(2) Definition of
minimum needs

• A concrete implication of Art.12.2 (d) needs a
  list of priority diseases to describe the minimum
  essential level of primary care and a
  cost-effective treatment for each
• This will lead to a core list of essential
  medicines - can this be the same as the WHO Model
  List of Essential Medicines?

• Question How to define a list of priority
  diseases?
• Global burden of disease?
• Availability of safe and cost-effective
  treatment?
• Availability of evidence-based treatment
  guideline?

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What could it mean in practice?(3) Verification
of obligations under the International Covenant

• State parties can be asked to report regularly
  on
• access to essential medicines
• aspects of equity
• progress through Government efforts
• WHO/EDM can support the UN High Commissioner for
  Human Rights the new Special UN Rapporteur on
  Health by recommending practical indicators for
  such monitoring

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National recognition of a Right to Health
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What could it mean in practice?(4) Support to
national NGOs and patient/consumer advocates

• WHO publication of a list of state parties to the
  various human rights declarations and treaties -
  to be used as a tool for national public pressure
  on their own governments
• WHO promotion of core List of Essential Medicines
  to define government obligations
• Promotion of simple monitoring tools for NGOs
  (e.g. on access and prices of essential medicines)

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World Health Organisation Department of Essential
Drugs and Medicines Policy 1211 Geneva,
Switzerland Fax [phone] Web Site
http//www.who.medicines/ Documentation Centre
darec_at_who.int

WHO