Transcript Document

IHP+ Civil Society Consultative Group
Meeting
December 10-11, 2012, Nairobi, Kenya
Overview
 What is the Framework Convention on Global Health
(FCGH)?
 Why an FCGH?
 The FCGH, from proposal to law
 Post-2015 development agenda
 Towards the FCGH itself
Background to the FCGH: Persisting
Health Inequities and Challenges
 Health inequities
 Life expectancy in Sub-Saharan Africa (2011): 54 years
 Life expectancy in high-income countries (2008): 80 years
 Continued and emerging global health challenges
 Pressures requiring global response
 Growing but insufficient funding
 Health worker migration
 Population growth
 Trade and intellectual property (access to medicines)
 Global industry (e.g., tobacco, “big food”)
Background to the FCGH: Global
Response Required and Possible
 Power of law
 Framework Convention on Tobacco Control
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176 countries party to FCTC
Action: more than 60% of 72 long-term state parties have
increased tobacco taxes and expanded smoke-free public
places
 Right to health
 Responsibilities lack precision, especially global
responsibilities
Framework Convention Approach
 Therefore, proposal for a Framework Convention on Global
Health (FCGH)
 FCGH would be a legally binding global treaty
 Could establish norms that create pressure for countries not
ratifying (i.e., formally agreeing to be bound by the treaty) FCGH to
follow nonetheless
 Framework convention/protocol approach
 Initial framework convention establishes key principles, goals,
processes of the legal regime
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May also include specific, detailed commitments
 Later protocols, which countries would need to separately ratify,
provide additional detail on commitments or address relevant
issues not adequately addressed in initial framework convention
 Useful approach for complex and evolving field of global health
Joint Action and Learning Initiative on National
and Global Responsibilities for Health (JALI)
 In response, coalition forms JALI
 What is JALI?
 A global civil society-led coalition advocating for and supporting
development of a Framework Convention on Global Health
 Committed to an ambitious treaty that will truly be grounded in the
right to health
 Initiating broad and inclusive process to develop FCGH contents
 With partners, developed Manifesto on Global Health Justice and
an FCGH, laying out key principles and the case for an FCGH
 Developing a “framework of a framework” to give more detail on
the proposed FCGH
 Draft planned for early 2013
 www.jalihealth.org
Support for the FCGH
 Health and human rights leaders including SECTION27 (South
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Africa), Lawyers Collective (India), Paul Farmer
UN Secretary-General Ban Ki-moon (2011): “Let the AIDS
response be a beacon of global solidarity for health as a human
right and set the stage for a future United Nations framework
convention on global health.”
UNAIDS: “We join others in calling for a critical debate and for
unprecedented social and political mobilization towards a
framework convention on global health.” Michel Sidibe and Kent
Buse (2012)
UN human rights Special Rapporteurs on health, extreme
poverty, water and sanitation endorsed
Representatives of 25 developing countries – members of
Partners in Population and Development – call for their
governments to support FCGH (November 2012).
Central FCGH Elements
 Universal health coverage
 Standards for health systems, public health interventions,
underlying determinants of health
 Financing framework covering domestic and global health
financing
 Right to health grounding, including accountability,
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participation, equity
Elevate health in other regimes (e.g., trade, financing,
agriculture)
Alignment with national health strategies and systems
Innovative financing mechanisms
Strong mechanisms of monitoring, evaluation, and compliance
As a framework convention, anticipate protocols on specific
issues (e.g., R&D, health worker migration)
More FCGH Possibilities
 Right to health capacity building fund (to support
NGOs, government institutions, and others building
public understanding of and advocating for the right
to health)
 Global Fund for Health
 Multi-sector forum with strong civil society
participation to help integrate the right to health in
various global health regimes
 You tell us!
Financing
 Develop agreed upon domestic and international funding
responsibilities that will provide sufficient, sustained, and
predictable funding for global health
 Establish legal norms and mechanisms to increase development
partner alignment with national health plans developed through
inclusive, participatory processes
 Possibility of including innovative financing mechanisms and
rationalizing global health financing architecture
 Could include agreement on measures to increase domestic tax
revenue
 Strong correlation between tax revenue and development indicators
 Direct taxes (e.g., income, corporate) more progressive than
indirect taxes (e.g., value added tax)
Defining Universal Health Coverage Up
 Establish guidelines on universal health coverage that
define UHC up – a robust, comprehensive UHC that
will not create poor care for poor people, or fail to
cover essential yet more expensive health
interventions (e.g., AIDS treatment)
 Bring underlying determinants of health (e.g., food
and nutrition, water and sanitation) within the realm
of universal health coverage
 Inclusive and participatory processes to translate
FCGH norms to national targets and policies
Health and Equity
 Legal framework for policies and funding to significantly close health
inequities and benefit health especially of least healthy populations
 Health equity
 Country-specific equity targets and strategies
 Prioritize and support policies and processes to meet health needs of
marginalized populations
 Women’s rights
 Address violence against women (e.g., legal capacity-building, norm
change)
 Maternal and child mortality audits
 Other possibilities
 Require reforms of discriminatory laws that undermine health and
hinder certain people from accessing health-services
 Ensure universal health coverage for all immigrants (including
undocumented)
Accountable Health Systems
 Potential to build right to health accountability at all levels
 Require community health accountability strategies (e.g., village
health committees, community scorecards)
 Build social health rights capacity (e.g., NGO capacity, media,
popular education on right to health)
 Strengthen national institutions (e.g., human rights commission,
right to health legal training, parliamentary human rights
committees)
 Clearer right to health standards of international cooperation and
assistance
 FCGH – and so right to health – compliance
 Reporting and transparency requirements
 Accountability mechanisms built into FCGH (e.g., justiciability of
right to health, strengthen civil society capacity)
 Innovative approaches to incentives and sanctions
Access to Medicines and Health
Workers
 Protect access to medicines
 Require bilateral and multilateral trade agreements to protect
access to medicine
 R&D
 Protocol based on WHO’s Consultative Working Expert
Group
 Targets on public financing for R&D to address health needs
in the South
 Research outcomes as global public goods
 Health worker migration
 Build on WHO Global Code of Practice on the International
Recruitment of Health Personnel
Integrating FCGH Principles into
the Post-2015 Development Goals
 Post-2015 development framework likely to set stage for
health and development through 2030
 Platform for key FCGH principles and potential stepping
stone to the FCGH
 JALI has developed 10 principles to inform post-2015 health
goal(s), building on idea of universal health coverage
 Also recommendations on the process
 Establish separate community/civil society committee(s) that
must approve framework before UN approves
 Some targets and indicators could be adapted at country level
 Develop guidelines to accompany the post-2015 goals, targets,
and indicators to capture critical yet difficult to measure
actions
Post-2015 FCGH Principles (1-5)
1) Broadly defined universal health coverage, including
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underlying determinants of health (e.g., nutritious
food, clean water)
“Equality through equity,” emphasizing closing
health inequities, including strategies addressing
marginalized populations and removing
discriminatory laws
Build on current commitments
“Universal” as truly universal, leaving out no one
Continued progress, with all countries progressing
towards fully realizing the right to health
Post-2015 FCGH Principles (6-10)
6) Accountability and compliance, including strategies,
7)
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targets, and indicators to ensure accountability to the
right to health
Inclusive, participatory processes
Incorporate a financing framework to ensure sufficient
and equitable funding
Forward-looking, addressing R&D, changing
circumstances, and ensuring everyone benefits of
scientific advances
Health-in-all-policies, by all actors, advancing the right
to health throughout the goals, national policies, and
international regimes
Process of Establishing the FCGH
 States decide to develop the treaty
 Create initial treaty draft (e.g., UN working group)
 Treaty negotiations (often multiple rounds of talks and broader consultations)
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Treaty may change significantly from initial draft
Process often takes several years, or even longer
 Often formal negotiations only among states, but precedents for civil society
involvement (e.g., working groups drafting treaty, country delegations)
 States adopt the treaty through chosen forum (e.g., UN, WHO)
 Individual states must sign and ratify treaty before becoming fully bound by it
 Ratification process varies by country
 Often parliamentary approval required
 Once states ratify, they are legally bound by the treaty
 Varies by country and nature of treaty whether it will be “self-executing” –
people can immediately enforce treaty in courts – or first require separate
“implementing legislation” before courts will enforce
Possible Legal Pathways Towards
the FCGH
 UN General Assembly
 Establish committee to explore possibility (and begin drafting?) an
FCGH
 Request member states to submit to Secretariat views on an FCGH
 World Health Assembly
 Request Director-General to initiate process towards an FCGH
 Establish working group to negotiate and draft an FCGH
 UN Human Rights Council
 Human Rights Council Advisory Committee to explore or negotiate
an FCGH
 Outside United Nations
 States can develop treaty through separate multilateral initiative, as
with the Ottawa Process to develop the Mine Ban Treaty
 Could still link to UN (e.g., UN endorsement, file reports with UN)
Before We Arrive at the
FCGH….We Need You!
 FCGH cannot be achieved – or effective implementation
ensured – without strong civil society support, and diverse
social movements mobilized around an FCGH
 Participate in JALI consultations (in-person, online) and
research to help develop content of the FCGH
 Extensive set of research questions
 JALI expects to ramp up this process in 2013
 Blogs, surveys, more
 Bring your networks into these processes so FCGH can truly
represent the concerns and demands of civil society and
communities, especially of those whose health most suffers
due to health injustice
FCGH Advocacy
 Support FCGH principles in post-2015 development goals
 Advocate with your governments to support an FCGH
 Develop national and regional FCGH coalitions to feed into
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FCGH development and advocacy
Build support for an FCGH among your networks and
institutions, as well as regional bodies (e.g., SADC, AU)
Help draw in social justice movements beyond health (e.g.,
sustainable development, labor)
Join the budding International Campaign for an FCGH
(being developed in 2013)
Share with us your advocacy ideas!
For Further Information….
 www.jalihealth.org
 Join the JALI listserv to stay informed of opportunities
(please contact us to join)
 Contacts
 Mayowa Joel ([email protected]),
Communication for Development Centre Nigeria
 Attiya Waris ([email protected]), University of Nairobi,
Kenya
 Eric Friedman ([email protected]),
Georgetown University Law Center, USA