Joint Action and Learning Initiative


that address WHO’s health system building blocks (services, workforce, medicines and medical tech- nologies, information, financing, and governance). While encompassing the building blocks of the health system, these essential services should en- sure access to targeted interventions for HIV and other communicable diseases, maternal and child health, non-communicable diseases (NCDs), and other health conditions. Within this framework, specific services would be determined nationally through participatory processes.


The right to health places the primary responsibility on governments to ensure the health needs of all their inhabitants. National responsibility includes health sector funding, addressing the socio-eco- nomic determinants of health, and good governance.


Moreover, “key” health interventions must also encompass fundamental human needs, such as sanitation, nutritious food, potable water, safe housing, vector abatement, tobacco control, and healthy environments. Critically, universal cover- age, now discussed in terms of interventions delivered through the health sector, should be re-conceptualized to encompass fundamental hu- man needs given their major impact on health.


Efforts to ensure access to quality health systems and fundamental human needs must go hand-in- hand with efforts to address broader social de- terminants of health, such as gender equality, social inclusion, education, and fair employment. Ensuring universal health coverage can lead and be integrated into national efforts and the global movement towards systems of universal social protection.


How much would this cost? In describing a set of critical interventions for communicable diseases, maternal and child health, and NCDs, costing an average of $60 per capita in low-income countries,


the 2010 World Health Report observes that coun- tries spending this level “cannot relax” and that these interventions are “just the beginning.”4


We


envision an even more comprehensive set of in- terventions to ensure all people their fundamental human needs. This goes well beyond the selec- tive primary health care approach that took hold after the 1978 Declaration of Alma-Ata, whose vi- sion of comprehensive primary health care for all has yet to be realized.


These interventions would represent only one step—though a significant one—towards the highest attainable standard of health. States, even wealthy ones, will need to continue to progress towards universal coverage. The right to health re- quires states to spend the “maximum of … avail- able resources” towards progressively realizing health and other socioeconomic rights.5


States


have a duty under international law “to move as expeditiously and effectively as possible towards” fully realizing the right to health.6


2. What responsibilities do all states have for the health of their own populations?


The right to health places the primary responsibil- ity on governments to ensure the health needs of all their inhabitants. National responsibility in- cludes health sector funding, addressing the so- cioeconomic determinants of health, and good governance.


There is no universally agreed level of health sec- tor funding adequate to meet the population’s needs. African heads of state agreed to a bench- mark of at least 15% of national budgets devoted to the health sector, and to allocating at least 10% of their national budgets for agricultural develop- ment. Additionally, 32 African countries set a tar- get, as an aspiration, to have public sector budget allocations for sanitation and hygiene programs reach at least 0.5% of gross domestic product. Today’s spending too often falls far short of these targets. Health spending in Africa is increasing, but at the present rate of growth (an increase


ILSA Quarterly » volume 20 » issue 1 » October 2011 25


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