Public Disclosure Authorized
August 2011 REGIONAL INITIATIVE ON PRIORITY SETTING, EQUITY, AND CONSTITUTIONAL MANDATES IN HEALTH Creating a Sustainable Platform for Multi-stakeholders to Coalesce and Address the Progressive Realization of the Right to Health
PROGRESS REPORT | ARGENTINA, BRAZIL, CHILE, COLOMBIA, COSTA RICA, PERU, AND URUGUAY
The Regional Initiative on Priority Setting, Equity, and tial actions that maximize the benefits and minimize
Public Disclosure Authorized Constitutional Mandates in Health was launched in the limitations of the current use of PSS and JRH; and 2010, by the Health Systems Practice of the World Bank (iv) support participating countries in strengthening Institute. Seven Latin American countries—Argentina, leadership, building consensus, and establishing Brazil, Chile, Colombia, Costa Rica, Peru, and Uru- sustainable multi-stakeholder coalitions for the design guay—are currently participating in the Initiative. and implementation of policy actions to increase and The ultimate goal of this multi-year program is to enforce sustainable and equitable progressive access contribute toward the creation of a sound process to to healthcare. achieve a sustainable, equitable and progressive real- The Initiative has four phases structured around ization of the right to health. To achieve this objective, regional and country level priority setting, equity, and the Initiative supports a capacity building and leader- constitutional mandates issues. ship program for multiple stakeholders from several Public Disclosure Authorized sectors, including the executive, judiciary, health The Challenge authorities, physicians, and civil society. This process The number of health rights litigation cases in Latin intends to: (i) create awareness of the existence of Pri- America has increased dramatically since the 1990s. ority Setting Strategies (PSS) and judicialization of the This has occurred despite the fact that Latin American right to health (JRH) mechanisms to improve health- countries have improved access to health care, and care access; (ii) establish a sustained dialogue across that aggregate health indicators have shown steady countries in the region to contribute to a collective improvements in the last two decades. During this understanding of the nature, uses, and limits of the period, governments have also increased the allocation status-quo of these mechanisms; (iii) enhance national of public resources to deliver health care to its citizens, and regional capacity among branches of the govern- reducing in some cases the financial burden of health- ment and other key stakeholders, to develop poten- related shocks on households, especially the poor. It is Public Disclosure Authorized important to note, however, that large inequalities still This resource constraint is being further exacer- persist in these countries. bated in the region by epidemiological and demo- While these lawsuits may provide individuals access graphic transitions, and the spiraling costs triggered to health services, the judicialization of the right by the rapid incorporation of new medical technolo- to health can collide with the limited availability of gies. As a result, countries face increasingly hard resources faced by the health systems, and may even choices on how best to use available funds. increase inequality in healthcare delivery and access. As This scenario implies that the challenge of the recognized by the 2010 World Health Report, pooled full realization of the right to health for all cannot be funds will never be able to cover all the costs of all ser- achieved immediately, but it is instead a continuous vices needed for all the population. process in which countries have an obligation to
Chart 1. The Four Phases of the Initiative
Regional
National National National National
PHASE 1 PHASE 2 PHASE 3 PHASE 4 Identification Consensus building Implementation of Monitoring and diagnostics national plans and evaluation
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FOCUS FOCUS FOCUS FOCUS
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Activities of the Regional Initiative Date Participants
Sharing experiences of a regional June 2010 Governments of Argentina, Brazil, Chile, Colombia, Peru, and Costa Rica phenomenon
Understanding the concepts of October 2010 Constitutional Tribunal of Peru and Governments of Argentina, Brazil, reasonability and proportionality Chile, Colombia, Peru, and Costa Rica in the Peruvian right to health jurisprudence
Understanding a multi- December 2010 ACAMI, OSDE, Universidad Nacional del Cuyo, and Supreme Court of stakeholder dialogue experience and March 2011 Mendoza in Health in Argentina
Learning from the use of right to February 2011 PRODISA–Fiocruz and Ministry of Health–Brazil, National Resources health litigation to ensure access Fund–Uruguay, NICE–UK to health services: experiences of Uruguay and Brazil
Political Mapping Exercise of March 2011 Ministry of Public Health, Supreme Court of Justice, National Resources stakeholders’ perception towards Fund, Center for Judicial Studies, Health Services Administration health litigation in Uruguay Services, Republic University, Montevideo University, Physician unions, Insurers, and Patients
Understanding court decisions April 2011 PRODISA–Fiocruz–Brazil, Pan American Health Organization and in Latin America: legal, academic institutions in Guatemala, Argentina, Colombia, Chile, and economic and medical/sanitary Uruguay characteristics and their impact on developing and implementing health policies
Understanding the evolution of May 2011 Cuyo University, Central America Autonomous University, Warwick Law the jurisprudence on the right to School, Silva Henriquez Catholic University, Peruvian Catholic University, health in seven LAC countries Montevideo University, Pan-American Health Organization, and DeJuSticia
First Regional Symposium on June 2011 Inter American Court of Human Rights, Constitutional Tribunal of Peru, Right to Health and Health Supreme Court of Costa Rica, Supreme Court of Uruguay, Supreme Systems Court of Buenos Aires, Supreme Court of Rionegro, Constitutional Court of Colombia, Supreme Federal Court of Brazil, Constitutional Tribunal of Chile, Justice Center for the Americas, and McGill University on the findings and outcomes of this exercise is progressive realization of the right to health; and currently being prepared. explored the challenges faced by the judiciary Study findings suggest that Uruguay’s health and potential alternatives to support the progres- priority setting processes are perceived to be sive realization of the right to health. The partici- overall inclusive, and efficient. In a similar way, pants agreed on the need to engage in a broader inequity is not perceived as one of the main and sustained multi-stakeholder dialogue. problems of the system. Furthermore, the number of litigations is relatively low, compared to other Next Steps countries in the region. Findings also suggest that Phase 2 will focus on building a core team of regional Uruguay could potentially become an important and country-level multi-stakeholder champions. case study in determining the extent to which This team will lead the Initiative towards a common different characteristics of a country’s benefit plan understanding of the achievements and challenges could contribute to a reduction in litigation and with regard to the progressive realization of the right the progressive realization of the right to health. to health. The team will also contribute to the design UÊ Electronic Resources for the Regional Initiative: and implementation of action plans. In collaboration with WBI’s e-Learning Practice A series of national and regional roundtables, Team, a web-based platform has been estab- videoconferences using the Global Development lished for practitioners to connect, share and Learning Network (GDLN), academic events and create policy implementation knowledge. The immersive learning activities will promote the partici- website (www.saluderecho.net) was launched pation of different actors of the health system. during the First Regional Symposium on Right to This Regional Initiative will continue to partner Health and Health Systems. with international, regional, and local organizations to UÊ High-Level Roundtable Meeting for the Judiciary: enhance knowledge (see table 2). Partners and partici- The First Regional Symposium on Right to Health pants of this Initiative remain key players in the design and Health Systems (June 23–24, 2011) was hosted and implementation of academic events, coalition- by the Inter-American Court of Human Rights, building activities and in the follow-up of national and the Constitutional Tribunal of Peru and the World regional progress. Information on these activities will Bank Institute. The event brought together supe- be provided in the electronic resource center (www. rior court judges, law and health systems experts saluderecho.net). from the region. Participants shared knowledge on the evolution of the right to health and health systems. They also discussed contributions and main challenges of the health system to the Table 2. Partners and Participants of the Regional Initiative on Priority Setting, Equity, and Constitutional Mandates in Health
International and regional Inter-American Court of Human Rights, National Institute of Health and Clinical Excellence agencies (NICE), Justice Center for the Americas – Organization of American States, Pan American Health Organization, International Justice Academy, Harvard School of Public Health, Warwick Law School
Argentina National Ministry of Health, Supreme Court of Buenos Aires, Supreme Court of Rionegro, Supreme Court of Mendoza, Cuyo University, Ombudsman, Organization of Direct Company Services (OSDE)
Brazil Ministry of Health, PRODISA Health Rights Program, Fiocruz, University of Sao Paulo
Costa Rica Costa Rican Health Administration, Constitutional Chamber of the Supreme Court, Central American Autonomous University
Colombia Ministry of Social Protection, Constitutional Court, Health Regulation Commission, National Planning Department, Andes University, Center for the Study in Law, Justice and Society, DeJuSticia
Chile Ministry of Health, Constitutional Tribunal, National Health Fund (FONASA), Silva Henriquez Catholic University
Peru Ministry of Health, Constitutional Tribunal, Intangible Solidarity Fund for Health (FISSAL), Peruvian Catholic University
Uruguay Public Ministry of Health, Supreme Court of Justice, National Resources Fund, Center for Judicial Studies, Montevideo University Notes For more information The World Bank Institute [email protected] www.worldbank.org www.saluderecho.net