World Bank policies and the obligation of its members to respect, protect and fulfil the right to health

The majority of World Bank donors are States parties to the main inter-national human rights conventions. This article uses the right to health as a lens for examining the obligations of donor States parties with re-spect to their involvement in the World Bank's development activities, which use the Poverty Reduction Strategy Paper (PRSP) process as their framework. The article uses the concept of core obligations to examine and assess public expenditure budgeting in the health care sectors of Mozambique, Rwanda, and Uganda, as provided for in the PRSP process. It argues that the current PRSPs make it impossible to fund public health care at a level that satisfies the requirements of core obligations. It concludes by calling on donor countries to comply with their interna-tional human rights obligations

Fiscal space for health expenditure in Mozambique: blocking effectiveness of international funds through budget support

Mexico AIDS Conference 200

Shifting paradigms: how the fight for 'universal access to AIDS treatment and prevention' supports achieving 'comprehensive primary health care for all'

In a recent issue of Globalization and Health, Yu et al. examine the impact of HIV/AIDS programs on health care systems. This editorial considers their position and confirms that the former actually supports the latter aim; the two approaches are not at odds with one another, but could be viewed as complementary. A key requirement towards meeting both objectives is to ensure sustained international aid

Impossible to 'wean' when more aid is needed

Kirigia and Diarra-Nama from the WHO Regional Office for Africa say that funding for health in the WHO Africa Region remains inadequate and that, in some countries, is significantly dependent on donor funding. They propose five strategies for these countries to “wean themselves off” donor funding. While each of the proposed strategies might have some value in itself, they will not succeed in the double objective the authors set: to wean countries from depending upon international health aid and to achieve the US$34 per person annual health expenditure target suggested by the Commission on Macroeconomics and Health1 – an amount that must now be adjusted to US$ 40 due to inflation.

Global constitutionalism, responsibility to protect, and extra-territorial obligations to realize the right to health: time to overcome the double standard (once again).

If human rights are "inalienable rights of all members of the human family", as is enshrined in the Universal Declaration of Human Rights, then no government should be allowed to deny people of them. When some governments fail to realize them for the people under their jurisdiction, the international community has a responsibility to step in. This extra-territorial effect of human rights was not included in the original conception of human rights. It is of recent date, and, in practice, limited to interventions to end severe violations of civil and political human rights. For economic, social and cultural human rights, extra-territorial obligations are still contested. In this paper, we elaborate three contentions: first, that the realization of social human rights requires the acceptance of and compliance with extra-territorial obligations; second, that compliance with extra-territorial obligations would help transform the international assistance paradigm from charity into legal obligation; and third, that for global constitutionalism to succeed in improving the fairness of the international legal order requires acceptance of the indivisibility of human rights

Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies.

BACKGROUND: Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. ANALYSIS: This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. DISCUSSION: Leading global health institutions are structurally skewed to preserve high incomes countries' disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. CONCLUSION: A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power

The emergence of a global right to health norm--the unresolved case of universal access to quality emergency obstetric care.

BACKGROUND: The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. METHODS: In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. RESULTS: Kingdon's model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. CONCLUSIONS: Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for utilising right to health based arguments to push for policy priority for universal access to emergency obstetric care in the post-2015 global agenda

Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health

lobal health research is essentially a normative undertaking: we use it to propose policies that ought to be implemented. To arrive at a normative conclusion in a logical way requires at least one normative premise, one that cannot be derived from empirical evidence alone. But there is no widely accepted normative premise for global health, and the actors with the power to set policies may use a different normative premise than the scholars that propose policies – which may explain the ‘implementation gap’ in global health. If global health scholars shy away from the normative debate – because it requires normative premises that cannot be derived from empirical evidence alone – they not only mislead each other, they also prevent and stymie debate on the role of the powerhouses of global health, their normative premises, and the rights and wrongs of these premises. The humanities and social sciences are better equipped – and less reluctant – to approach the normative debate in a scientifically valid manner, and ought to be better integrated in the interdisciplinary research that global health research is, or should be