Nordic School of Public Health (Backman); University of Essex (Hunt, Khosla, Mekuria Fikre, Rumble, Pevalin); Office of the Mayor of Bogata, Colombia (Jaramillo-Strouss); Foundation for Alterative Social Development, Ecuador (Acurio Paez, Armijos Pineda); CARE Peru, Peru (Frisancho); Ministry of Health, Peru (Tarco); WHO-Western Pacific Regional Office, Philippines (Motlagh); Centre of Health Policies and Services, Romania (Farcasanu); Victor Babes University of Medicine and Pharmacy, Romania (Vladecu)

This Lancet: Right to Health article reports on a survey of health and human rights in 194 countries over 18 months. It is based on General Comment 14, an understanding of the right to health care established in 2000 through the work of the United Nations (UN) Committee on Economic, Social, and Cultural Rights. This describes the right to the highest attainable standard of health as encompassing medical care, access to safe drinking water, adequate sanitation, education, health-related information, and other underlying determinants of health. It includes freedoms, such as the right to be free from discrimination and involuntary medical treatment, and entitlements, such as the right to essential primary health care.

Using the Declaration of Alma-Ata, which identifies some the components of an effective health system, among other documents,  the authors sought compelling guidance on the core obligations of the right to health. As stated here, a major challenge for human rights is to apply or integrate the right to health across these six building blocks: health services, health workforce, health information, medical products, financing, and stewardship. The document recommends the following features as part of any health system:

• Legal recognition of the right to health - including treaty ratifications and follow-up from social movements, health workers, progressive government ministers and public officials, activist courts, and international support for respecting the rule of law once established;
• Standards - detailed provisions clarifying what society can expect by way of health-related services and facilities;
• Participation - institutional arrangements for the active and informed participation in strategy development, policy making, implementation, and accountability by all relevant stakeholders;
• Transparency - increasing transparency of information on the quality, availability, and pricing of essential medicines, including countries, international organisations, public–private partnerships, business enterprises, and civil-society organisations;
• Equity, equality, and non-discrimination - a health system responsive to all groups, ages, both genders, with mechanisms to ensure that marginalised groups receive appropriate care;
• Respect for cultural difference - sensitivity to issues of culture, ethnicity, and sex, including strategies to enable indigenous people to study medicine and public health, and so on;
• Quality - including not only treatment, but such things as water quality and authentic medicines.
• Planning - with clear objectives (and how these are to be achieved), time frames, effective coordination mechanisms, reporting procedures, a detailed budget, financing arrangements (national and international), assessment arrangements, indicators and benchmarks to measure achievement, and one or more accountability devices;
• Referral systems - between alternative health systems (e.g., traditional health practitioners) and mainstream health systems, including all levels of general practise and specialisation;
• Coordination - across a range of public and private stakeholders at the national and international levels, including international cooperation;
• Legal obligation of States - states legally obliged to take all appropriate steps to implement the right-to-health features of health systems.
• Monitoring and accountability - the opportunity for individuals and communities to understand how those with responsibilities have discharged their duties and for those with responsibilities to explain what they have done and why, including redress when mistakes have been made.

The project intended to establish indicators and benchmarks, with the hope of future periodic measurements to monitor progress, and identify commonly neglected features and good practices arising from the right to health. 72 indicators, selected in a 5-step process which included an external review process (listed in panel 4, page 11 of the document) were used for the survey. The document contains several data tables. Table 1 summarises the degree to which health systems of countries, on a country-by-country basis, met the indicators. Table 2 summarises national data from 5 countries.

An example from its findings is data on high rates of vaccination with measles-containing vaccine (MCV) and diphtheria, tetanus, pertussis (DTP3) vaccine, correlated to General Comment 14, which places a high priority on immunisation programmes. An example of a challenge in the findings is that most countries do not currently recognise the right to health in their national constitutions or statutes, although every country has ratified at least one international treaty that recognises the right to health.

Health information is, as reported here, "the life-blood of effective, accessible health systems and the right to health. Information enables individuals and communities to promote their own health and allows governments to formulate evidence-based health plans. Monitoring, accountability, and participation depend upon access to information....However, our research suggested that health information systems in many countries are seriously deficient in several ways. Health information systems include a range of data sources, such as censuses, household surveys, vital registration systems, and other health-facility data sources....Data for maternal and neonatal deaths, for example, should be included within the vital registration system....Accurate recording of cause of death according to international standards is important, and the statistics generated should then form a part of the situational analysis that contributes to health-system planning. We recommend that all countries should legally require registration of births, deaths, and cause of death according to international standards (using the international classification of disease)....Descriptive information is needed to understand the issues behind quantitative data. As part of their human-rights responsibility of international assistance and cooperation in health, donors should accelerate their coordinated efforts to provide training and technical assistance for sustainable data collection and processing and to make data available worldwide."

Panel 12 of the document contains recommendations for various national and international actors on the international effort to apply, protect, and sustain the right to health. Included among these are the following communication-related recommendations:

"We recommend WHO [World Health Organization] and the Office of the High Commissioner for Human Rights:

• adopt a stewardship role in the collection and collation of data for right-to-health features of a health system
• lead the process to establish universal definitions for commonly used terms and standardised units of measurement regarding the right-to-health features of a health system
• maintain and regularly update a global data repository on the right-to-health features of a health system
• lead the process to establish, where appropriate, international benchmarks to assess country performance regarding the right-to-health features of health systems
• ensure that the Global Health Workforce Alliance gathers data relevant to the right to health, such as for human rights training for health workers.

We recommend other UN specialised agencies and bodies:

• coordinate with WHO, national governments, civil-society organisations, and other international, regional, and national stakeholders to ensure coherence in global monitoring with respect to the right-to-health features of a health system
• provide technical assistance to national governments to facilitate data collection on the right-to-health features of a health system
• record descriptive and numerical data.

We recommend national governments:

•  explicitly recognise the right to health, and right-to-health features, such as access to essential medicines, in the national constitution or statute
• ensure explicit recognition of the right to health in the comprehensive national health plan
• collect data on marginalised groups to inform the planning and development of the health system
• do health and human-rights impact assessments before finalising the comprehensive national health plan
• in partnership with WHO, UN specialised agencies, civil society, and others, collect and regularly update information on right-to-health features of health systems
• ensure registration of births and deaths within a civil registration system
• establish national human-rights institutions with a mandate that includes the right-to-health and budgeted programme of activities for raising awareness about the right to health
• ensure the mandate of the national human-rights institution includes monitoring and accountability with respect to international assistance and cooperation in health
• include compulsory human-rights and right-to-health training for health workers, judges, and lawyers.

We recommend national and international civil society:

• participates in health system planning and monitoring
• advocates that right to health is properly incorporated in health system planning, along with the inclusion of marginalised groups in health decision making
• advocates that the mandates of national human-rights institutions include the right-to-health and budgeted programme of activities for raising awareness of right-to-health
• disseminate information about key judicial decisions about the right to health.

We recommend research institutions:

• do or commission research on the right-to-health features of health systems;
• actively promote knowledge sharing among academics on the right-to-health and right-to-health features of health systems
• collaborate with national governments, WHO, UN bodies, civil-society organisations, and others to promote a greater understanding of the right to health and right-to-health features of a health system.

We recommend donors:

• ensure donor accountability for international assistance and cooperation in health in both donor and recipient countries
•  align international assistance and cooperation strategies with the comprehensive national health plans of recipient countries.

Lancet Journal 2008; 372: 2047-85, accessed on March 16 2009.