Health Systems and the Right to the Highest Attainable Standard of Health

The premise of the document is that the fundamental human right to health underpins and reinforces an effective, integrated, accessible health system. This briefing draws on the consultations of author Paul Hunt as United Nations (UN) Special Rapporteur, as well as the UN report on health systems submitted by the Special Rapporteur to the UN Human Rights Council in January 2008.

These authors describe the historical context of health systems; define a health system; describe the a right-to-health approach to strengthening health systems and the building blocks of health systems; apply some specific measures for health system strengthening; and conclude with how the right to health helps establish a health system.

The following themes from the Declaration of Alma-Ata on primary Health Care (1978) are reflective of the right to the highest attainable standard of health and relevant to health systems in both developed and developing countries:
a. The importance of equity
b. The need for community participation
c. The need for a multi-sectoral approach to health problems
d. The need for effective planning
e. The importance of integrated referral systems
f. An emphasis on health-promotional activities
g. The critical role of suitably trained human resources
h. The importance of international cooperation

The Declaration also highlights these essential health interventions, encompasses the interrelated domains of medicine, public health, and human rights:
a. Education concerning prevailing health problems
b. Promotion of food supply and proper nutrition
c. Adequate supply of safe water and basic sanitation
d. Maternal and child health care, including family planning
e. Immunisation against major infectious diseases
f. Prevention and control of locally endemic diseases
g. Appropriate treatment of common diseases and injuries
h. Provision of essential drugs

The general approach of the right to the highest attainable standard of health towards the strengthening of health systems includes the following:

1. At the centre: the well being of individuals, communities, and population
2. Not only outcomes, but also processes
3. Transparency
4. Participation
5. Equity, equality and non-discrimination
6. Respect for cultural differences
7. Medical care and the underlying determinants of health
8. Progressive realisation and resource constraints
9. Duties of immediate effect: core obligations
10. Quality
11. A continuum of prevention and care with effective referrals
12. Vertical versus integrated interventions
13. Coordination
14. Health as a global public good: the importance of international cooperation
15. Prioritisation and striking balances
16. Monitoring and accountability
17. Legal obligation

The document describes the World Health Organization’s (WHO’s) 6 essential building blocks of a health system, including: health services; health workforce; health information system; medical products, vaccines and technologies; health financing; and leadership, governance, stewardship. The authors apply the right to health to two of the building blocks, the workforce and leadership, to give a sense of the practical implications of the approach. The impact on the health worker building block includes a State responsibility for an up-to-date plan for recruitment of the number of domestically trained health workers commensurate with the health needs of the population. The data on the numbers of workers by job and location category should be made public, along with data desegregation by gender, for example. Health workers’ training must include human rights, including respect for cultural diversity, as well as the importance of treating patients and others with courtesy. Health workers' salaries should be domestically competitive for retention, particularly in rural areas. "Their human rights must be respected, for example, freedoms of association, assembly and expression. They must be provided with the opportunity of active and informed participation in health policymaking. The safety of health workers, who are disproportionately exposed to health hazards, is a major human rights issue."

In the area of leadership, governance, and stewardship, the Declaration of Alma-Ata recognises the need for each government to “formulate national policies, strategies, and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors." This planning process should be participatory, transparent, and inclusive and cover implementation mechanisms, timelines, and mechanisms for monitoring for accountability.

Because the right to health is now a legal right and a legal obligation of States, the authors conclude by comparing its planning and construction to building a judicial system. "Properly understood, the right to the highest attainable standard of health has a profound contribution to make toward building healthy societies and equitable health systems."