1. Operationalizing the right to health in health systems Transparency and Accountability Siri Gloppen Professor, Comparative Politics, UiB & CMI, Bergen Norway 4TH LATIN AMERICAN MEETING ON THE RIGHT TO HEALTH AND HEALTH SYSTEMS Bogotá, Colombia. April 2 to 4, 2014.

2. Accountability for what? How? Two concepts of the Right to Health Transparency and accountability mechanisms – Enabling rights holders to claim rights – Enabling duty-bearers to provide Courts and beyond – Challenges of court based mechanisms for accountability in health – Transparency and accountability in reform and policy processes

3. Two concepts of the right to health (R2H) ”right to the hightest attainable standard of physical and mental health” R2H = individual (justiciable) claim R2H ind R2H = an equitable health system R2H sos

4. R2H ind “Right to the highest attainable standard of physical and mental health” – Individual right to everything that is technically possible to preserve/advance health? regardless of costs – Limited by resources (equivalent rights of everyone) ?

5. R2H sos “Right to the highest attainable standard of physical and mental health” = Right to an equitable health system And (as large as possible) equitable share Progressively realized Premises: -Resource scarcity -Citizens equal in worth, dignity = due equal concern, respect

6. Resource scarcity unavoidable condition and constraint in all health systems particular challenge in highly unequal societies  Decisions to spend resources on particular patients/ services (implicitly) entail priority-setting /trade-offs  To not take seriously issues of justice in priority- setting denies others (who may have stronger entitlements) the right to health.

7. Fair health system Reasonable allocation of (inevitably limited) resources Between patient groups – Cost-effectiveness of treatment (and strength of evidence) – Severity of the health condition Within patient groups – Social status, gender, sexual orientation, ethic groups etc – Based on vulnerability analysis; barriers to R2H

8.  need for transparency and accountability mechanisms to ensure:  Fair and well functioning health system distributing resources equitably  Fair priority to health relative to other social goods/rights  Fair treatment of each within – and equal access to – the system

9. Adequate aransparency and accountability mechanisms in health system / policy reform Transparency on need and converage – Who (patient groups, social goups) – Why (determinants of health) Transparency and participation in setting and reivising goals and priorities … in relation to HTAs and their use … in relation to guidelines … in monitoring and implementation

10. Institutional mechanisms for claiming systemic reform -- and a fair share System internal mechanisms Courts Public protectors

11. Challenge for courts to reconcile the two concepts of the right to health ”right to the hightest attainable standard of physical and mental health” R2H ind = individual (justiciable) claim R2H sos = an equitable health system R2H sos-ind = right to an equitable share