اﻷمل املتددة A/HRC/38/36/Add.2 Distr.: General 23 April 2018 اجلمعية العامة Arabic Original: English جملس حقوق اﻹنسان الدورة الثامنة والثﻻثون 18 حزيران/يونيه - 6 متوز/يوليه 2018 البند 3 من جدول اﻷعمال تعزيز ومحاية مجيع حقووق اﻹنسوانا اندنيوة والسيا وية واﻻقتصوايية واﻻجتماعية والثقافيةا مبا يف ذلك احلق يف التنمية تقرير انقرر اخلاص انعين حبق كل إنسان يف التمتع أبعلو مسوتومم ن و م الصحة البدنية والعقلية ع زايرته إىل أرمينيا مذكرة م اﻷمانة يشرررا اﻷمانرر ين إيررل ح وقررﻹ حاررو ا ن رران تاريررر املاررر اخلرراا امل رر لرر ررل ن ان يف التمتر ععقرم م رتوك مرن مرن اللرد البدنير وال اقير ، داينيرو برو ا ، عرن زاي تره ح ي مينيا يف الفرتة من 25 ييقول/سبتمرب ح 5 تشرين اﻷول/ي توبر 2017. لاررد يحرررزم ي مينيررا تارردما بررًا يف وررال عمررال الرر يف اللررد منررل اسررتا ل البقررد. و غرررل الفررررا امليررردة املتاحررر يف الولرررب الرررراإن، يقرررز برررلل ج رررود رررا ي لقتلررردل لقتدررردايم اهليمقيرر وال امررر امل روحررر يف الارررانون واملما سررر عقرررم حرررد سررروا . ويف إرررلا اللررردد، ري رررز املارررر اخلرررراا عقررررم نظررررا اللررررد الرررروح و حررررا اللررررد ال اقيرررر ومررررا تفرررررزة املما سرررر مررررن يوجررررره تفرراوم ومتييررز عنرردما يت قرر اﻷمررر ريما درر ررًو نارري املناعرر البشررري /ا يدز ومرررض ال ررل وال ياسررر املتب ررر يف ورررال املصرررد ام واللرررول عقرررم اﻷدويررر اخلا ررر لقمرالبررر . دوياررر املارررر اخلاا عددا من التوصيام. GE.18-06414(A) A/HRC/38/36/Add.2 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health on his visit to Armenia* Contents Page I. Introduction ................................................................................................................................... 3 II. Right to health in Armenia ............................................................................................................ 3 A. Background ........................................................................................................................... 3 B. Normative and institutional framework ................................................................................ 4 C. National health-care system .................................................................................................. 6 III. Mental health ................................................................................................................................. 10 IV. Communicable diseases: HIV/AIDS and tuberculosis .................................................................. 14 A. HIV/AIDS and the right to health of key populations .......................................................... 14 B. Tuberculosis .......................................................................................................................... 15 V. Drug policy and access to controlled medicines............................................................................ 17 VI. Conclusions and recommendations ............................................................................................... 18 __________ * Circulated in the language of submission only. GE.18-06414 2 A/HRC/38/36/Add.2 I. Introduction 1. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras, visited Armenia from 25 September to 5 October 2017 at the invitation of the Government. The purpose of the visit was to ascertain, in a spirit of dialogue and cooperation, how the country implements the right to health. 2. He met with high-ranking Government officials, members of the parliament and the Constitutional Court and representatives of relevant health-related institutions at central, provincial and local levels. He also held meetings with representatives of the Office of the Human Rights Defender, international organizations and the diplomatic corps, and with a range of civil society actors, including professionals in the health-care sector. 3. The Special Rapporteur visited health facilities in Yerevan, Abovyan, Sevan, Dilijan, Vanadzor and Spitak, including polyclinics, medical centres and mental health-care institutions. He visited the national centre for AIDS prevention, the Narcological Centre, and the National Centre for Tuberculosis Control. He also visited a number of penitentiaries and primary and secondary schools, including those providing inclusive education programmes. 4. The Special Rapporteur is grateful to the Government of Armenia for its invitation and full cooperation during his visit. He appreciates the crucial support provided by the United Nations country team, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund and the World Health Organization (WHO). II. Right to health in Armenia A. Background 5. Armenia gained independence from the Soviet Union in 1991 amidst the Nagorno- Karabakh conflict, which remains unresolved to date. As a result of the conflict and its various consequences, including the lack of progress towards the peaceful resolution of the Nagorno-Karabakh conflict, economic growth, poverty reduction and development have been hampered, which has had a negative influence on the living standards of the population of the Republic of Armenia, especially its vulnerable groups, and on their social and economic rights. 6. Since 2000, economic growth has slowed, partly due to the weaker performance of the country’s main trading partners and a slowdown in those countries that are sources of remittances. In 2009, as a result of the global economic crisis, gross domestic product (GDP) declined by 14.2 per cent, one of the deepest declines in the region.1 7. The incipient recovery of global commodity prices since 2010 has lifted the extractive industries sector and raised private consumption, which could facilitate the renewed growth of other sectors. Although poverty reduction has been impressive over the past few decades, a large proportion of the population remains vulnerable. Persistent geographic disparities require deep understanding of the root causes and possible solutions, particularly bearing in mind that the economy is still heavily reliant on mineral resources and the agriculture sector.2 8. During the first half of 2017, the Armenian economy showed renewed strength, as real GDP grew by 6 per cent more than in the same period in 2016, driven by industry, services and the retail trade. Growth and poverty reduction prospects over the medium term __________ 1 See United Nations Development Programme (UNDP), “Rapid integrated policy assessment in Armenia” (2017). 2 World Bank, Armenia overview, available from www.worldbank.org/en/country/armenia/overview. 3 GE.18-06414 A/HRC/38/36/Add.2 are positive (expected growth for 2017 is 4.5 per cent) but are subject to significant uncertainties, which are the risks on both the external and domestic political fronts.3 9. Since the 1990s, most indicators under the Millennium Development Goals have shown considerable improvement, with important achievements in life expectancy and a reduction in maternal and child mortality and in poverty. Public spending on social protection, education, infrastructure and health care has increased, although in absolute numbers it remains moderate. 10. Of the total of 65 indicators for the Millennium Development Goals, by 2015 Armenia had achieved 22; made good progress towards 10; and was still working on half of them. Areas showing considerable progress include child health protection, child and maternal health, and the fight against HIV/AIDS and other diseases. Progress was weak in poverty and hunger reduction, education, gender equality and governance, all of which contribute to the effective protection of human rights and to sustainable development. Overall, the principles of the Sustainable Development Goals are well reflected in national strategic documents. The Special Rapporteur was informed that one major challenge linked to the insufficiency of indicators to measure the attainment of policy goals and targets, was being addressed. An integrated website containing official statistics and metadata, publicly available and with access for user feedback, is reportedly expected to fill existing data gaps. The availability of relevant and timely data is critical for the formulation, monitoring, evaluation and review of public policy. 11. In 2015, the human development index value for Armenia was 0.743, placing the country in the high human development category, positioned at 84 out of the 188 countries and territories included in the index. Between 1990 and 2015, the human development index in Armenia increased by 17.2 per cent, life expectancy at birth increased by seven years and expected years of schooling by two years, while the gross national income per capita increased by approximately 122 per cent. The human development index is below average for both the totality of countries in the high human development group and the countries of Europe and Central Asia. Armenia is ahead of its neighbours when it comes to gender-based inequalities in reproductive health, empowerment and economic activity, with a gender inequality index value of 0.293, ranking sixty-first out of 159 countries reviewed.4 12. Over the last decade, maternal mortality has declined in Armenia (18.5 per 100,000 live births in 2014), however, progress has been slower than projected. Achievements have been made in addressing the factors behind maternal morbidity and mortality, including through the introduction of the “state maternity certificate”