Afrya s Constitutional Articles 23 and 38

Afrya s Constitutional Articles 23 and 38 Every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care. It is a fundamental duty of the State and every State organ to observe, respect, protect, promote and fulfill these rights, and the State shall take legislative, policy and other measures, including the setting of standards, to achieve the progressive realization of the rights guaranteed under Article 23.

Afrya indicators Type of indicator Demographic Population proportion under 15 42.4% Total fertility rate (per woman) 4.5 Financing Total health expenditure as proportion of GDP 4.5% Per capita health expenditure US$ 36.2 Per capita government health expenditure US$ 14.3 Out of pocket expenditure as a proportion of total expenditure on health 43% Mortality IMR (per 1,000 live births) 49 MMR (per 100,000 live births) 360 Main causes of death 1. HIV/AIDS 2. Lower respiratory infections 3. Cerebrovascular and ischemic heart diseases 4. Tuberculosis 5. Malaria Access and coverage Children aged <5 years with ARI symptoms taken to a health facility 56% Children aged <5 years with ARI symptoms who took antibiotic treatment 50% Children aged <5 years with fever who received treatment with any antimalarial 26%

The (narrow) Right to Health playing field Source: http://www.who.int/health_financing/strategy/dimensions/en/

The (broader) Right to Health playing field Access to and utilization of health care is vital to good and equitable health. Source: http://www.who.int/social_determinants/final_report/ [but] The Commission s main finding is straightforward: the conditions in which people are born, live, and work are the single most important determinant of good health, or ill health; of a long and productive life, or a short and miserable one.

The need for a broader perspective: example of tobacco World Health Organization. WHO report on the global tobacco epidemic, 2008: the MPOWER package. World Health Organization, 2008.

The full Right to Health playing field Urban (rural) planning Clean air acts Regulating failing markets Source: http://www.who.int/health_financing/strategy/dimensions/en/ Daniels, N., 1993. Rationing fairly: Programmatic considerations. Bioethics 7(2/3): 224 33 Prioritizations: Narrow-broad Sequence&interact ion of 3 dimensions Benefit package: Priority: (How much) priority to worse-off? Aggregation: Minor benefits to large numbers vs major benefits to fewer?

Recognizing that not all needs can be met Accountability for Reasonableness Four conditions: publicity; relevance; revision and appeals; regulation Relevance: [Decision is] reasonable if it appeals to evidence, reasons and principles that are accepted as relevant by [fair minded] people who are disposed to finding mutually justifiable terms of cooperation. Daniels 2007. Just Health: Meeting Health Needs Fairly. Cambridge: CUP Daniels, N., Sabin, J. 1999. Decisions about access to health care and accountability for reasonableness. Journal of Urban Health 76 (2):176 191

Why engage the public? Ranking different rationales Fact Values Legitimacy Acceptability Dissemination NICE GBA HAS Kreis, J., Schmidt, H. 2013. Public Engagement in Health Technology Assessment and Coverage Decisions: A Study of Experiences in France, Germany, and the United Kingdom. Journal of Health Policy, Politics and Law.* 38(1), 89-122

Goold, S. D., Biddle, A. K., Klipp, G., Hall, C. N., & Danis, M. (2005). Choosing healthplans all together: A deliberative exercise for allocating limited health care resources. Journal of health politics, policy and law, 30(4), 563-602. Choosing Health Plans altogether (CHAT)

Ethical evaluation of personal responsibility policies: 7 tests Evidence, rationale and feasibility intrusiveness attributability and opportunity of choice affected third parties coherency Solidarity/risk pooling equity Holism of justification Schmidt, Harald. "Bonuses as incentives and rewards for health responsibility: A good thing?." Journal of Medicine and Philosophy 33.3 (2008): 198-220.