The right to health in practice:a framework to guide the design of aid-funded health programmes

Abstract

More than 60 years have passed since the nations of the world united in acknowledging the inherent freedom, dignity and equality of all people in the Universal Declaration of Human Rights. Incongruously, ‘development’, another contemporaneous international movement, failed to embed these rights into its practices. As a result, millions of people in developing countries are still denied such rights as freedom from avoidable ill health and premature mortality, with development projects having focused instead on varying economic growth strategies. However, the past decade has witnessed a commendable global effort to reduce health inequities, with vast increases in health aid funding, particularly from the non-state sector to combat specific diseases. But after decades of neglect, the health systems of developing countries are struggling to accommodate these increased resources and many risk collapse. Without well functioning health systems, the right to health cannot be realised. In this thesis, health rights are investigated to seek solutions to these global health issues. I use a right-to-health framework to guide the design of aid-funded health programmes that meet health rights obligations, by working with and strengthening health systems. The thesis describes the development of a set of tools to design activities, then to identify their likely impact on a health system. The tools are derived from reviews of the literature and are tested for validity against case studies in Papua New Guinea. The three tools focus on: • respecting health rights by designing with a full understanding of the health system • fulfilling health rights by designing available, accessible, acceptable and quality services • protecting health rights by conducting a health systems impact assessment. The case studies revealed that the tools were relevant and feasible, and provided a means of early identification (and subsequent avoidance) of negative programme outcomes. Health rights offer a new global health diplomacy; a means by which all parties can be accountable and transparent in their legal duties to respect and protect health systems, so health rights can be fulfilled. Importantly, this framework provides a means of demonstrating that interventions, at the health systems level, do no harm.