Report to the General Assembly (main focus: health financing in the context of the right to health) [ A/67/302 ]

On Mon, Jan 7, 2013 at 9:15 AM, Kripa Basnyat <kbasnyat@pwescr.org> wrote:

From: ESCR-Right-to-Health

Interim report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Conclusions and recommendations:

55. The right to health approach to health financing provides a framework with which to ensure adequate, equitable and sustainable health financing. The approach addresses three critical areas in health financing: how States ensure adequate funds are available for health and the sources from which they raise these funds; how these funds are pooled; and how funds and resources are allocated within health systems towards ensuring universal access to good quality health facilities, goods and services.

56. The Special Rapporteur urges States to take the following steps in order to ensure adequate funds are available for health:

(a) Implement a progressively structured system of general taxation to fund health or improve upon the progressivity of such systems where they already exist;

(b) Ensure that consumption taxes, such as excise taxes and VAT, are not regressive. This may include setting appropriate thresholds below which small enterprises are not subject to taxation and reducing or removing consumption taxes on necessity goods;

(c) Consider earmarking portions of revenue from specific taxes, such as sin taxes and VAT, for spending on health;

(d) Ensure tax liberalization policies resulting from international tax competition, including tax abatements for foreign investors and low or non-existent trade and capital gains taxes, do not result in reduced public funding for health;

(e) Find ways to collect taxes from businesses in the informal sector, contingent upon the provision of State services and other benefits associated with being a taxable entity to such businesses.

57. The Special Rapporteur urges States to take the following steps in order to cooperate internationally towards ensuring the availability of sustainable international funding for health:

(a) Coordinate all donor activities in recipient States, incorporating the participation of civil society and affected communities, towards meeting domestic health needs and promoting the development of self-sustaining health systems;

(b) Develop a treaty-based global pooling mechanism, comprising compulsory progressive contributions from States allocated based upon need and driven by transparent, participatory processes, in order to shift from a donor-based system towards an obligatory system of international funding.

58. The Special Rapporteur urges States to prioritize funding for national and sub-national health budgets in order to reduce over-dependence on international funding and ensure domestic resource self-sufficiency for health.

59. The Special Rapporteur urges States to take the following steps in order to pool funds for health:

(a) Implement a pooling system comprising compulsory, progressive prepayments, such as taxes and insurance contributions, in order to reduce or eliminate out-of-pocket payments for health and ensure access to good quality health facilities, goods and services for the poor;

(b) Develop social health insurance programmes funded through compulsory, progressive contributions, supplemented by general tax revenue, comprising a pool of contributors large enough to promote effective cross-subsidization, with absolute exemptions for the poor;

(c) Ensure that enrollment in social health insurance programmes captures all necessary parts of the populations, particularly vulnerable or marginalized populations, with special attention to informal workers;

(d) Ensure that benefits under social health insurance programmes include a minimum set of health goods and services and are available and universally accessible based on need. Benefits packages must:

(i) Be responsive to the disease burden and health needs of the population;

(ii) Include effective and community-centred primary health-care services;

(iii) Include essential medicines and generic drugs in order to ensure access to safe, effective and affordable medicines.

60. The Special Rapporteur urges States to take the following steps in order to equitably allocate funds for health:

(a) Ensure equitable and efficient allocation of health funds and resources between primary, secondary and tertiary health care, with particular emphasis on primary care;

(b) Ensure that good quality health facilities, goods and services are available and accessible on a non-discriminatory basis for rural and remote populations. This will require:

(i) Increased investment in physical health infrastructure in rural and remote communities;

(ii) Creation of incentives for health workers, such as competitive salaries, tax abatements, rotational postings and accelerated career advancements to work in rural and remote areas.

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