[e-farmacos] Acceso a los medicamentos esenciales como derecho humano

["Hogerzeil, Hans V" <hogerzeilh@who.int>]

[En este mensaje de Hans Hogerzeil resumen dos articulos publicados por su departamento y, al final, propone unos elementos de reflexion y discusion. Os animo a iniciar un debate al respecto en e-farmacos, AF]

Estimados,

Me gustaria anunciaros dos articulos que nuestro departamento ha escrito recientemente. Uno se titula: "Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts?" y aparecerá en la revista The Lancet del proximo 22 de Julio. A continuación anexamos el resumen:

Hogerzeil HV, Samson M, Casanovas J, Rahmani-Ocora L. Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts? 
Lancet 2006; 368: 305-311.  

Background
Most countries in the world have become States parties to one or more international human right treaties, thus creating an obligation by the State to its people towards the realization of the right to health, which includes access to essential medicines. But whether such access is enforceable in practice is unknown.

Methods
We did a systematic search to identify completed court cases in low and middle-income countries in which individuals or groups had claimed access to essential medicines with reference to the right to health in general, or to specific human rights treaties ratified by the government. We identified and analysed 71 court cases from 12 countries in which access to essential medicines was claimed with reference to the right to health.

Findings
In 59 cases, access to essential medicines as part of the fulfilment of the right to health could indeed be enforced through the courts, with most coming from Central and Latin America. Success was mainly linked to constitutional provisions on the right to health, supported by the human rights treaties. Other success factors were a link between the right to health and the right to life, and support by public-interest non-governmental organizations. Individual cases have generated entitlements across a population group, the right to health was not restricted by limitations in social security coverage, and government policies have successfully been challenged in court. 

Interpretation
Skilful litigation can help to ensure that governments fulfil their constitutional and international treaty obligations. Such assurances are especially valuable in countries in which social security systems are still being developed. However, redress mechanisms through the courts should be used as a last resort. Rather, policy-makers should ensure that human rights standards guide their health policies and programmes from the outset. 

Personal comment:
As far as we know this the first systematic analysis of the effect and impact of such court cases in developing countries. Besides identifying these cases for further legal study, the analysis shows that some of these cases are legal landmarks which have changed government policies with great impact on many patients. As far as I am concerned, the main conclusion of this study is therefore that such court cases can indeed make a difference. The fact that most successful cases so far have taken place in Central and Latin America may encourage individuals and patient groups in other continents.
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El otro articulo aparecio en el WHO Bulletin de mayo de 2006 y describe la manera como los responsables de politicas de medicamentos podrian incorporar los derechos humanos a sus programas nacionales de medicamentos. Sigue el resumen:

Hogerzeil HV. Essential medicines and human rights: what can they learn from each other? WHO Bull 2006; 84: 371-375

Abstract
Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health. After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments. A practical example may be of help to those governments who aim to translate their international treaty obligations into practice. WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved. This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to essential medicines. This paper provides a brief overview of what the international human rights instruments mention about access to essential medicines, and proposes five assessment questions and practical recommendations for governments. These recommendations cover the selection of essential medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms.

Personal comment: The key question in this paper is what the rights-based approach can add to a good public health programme. The key answer is that most essential medicines programmes do not do badly, but could still do better. Here are the five assessment questions, for reflection:
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Cinco preguntas (del articulo del WHO Bulletin) 
1) Que medicamentos esenciales estan cubiertos mediante el derecho a la salud? La constitucion nacional o alguna otra ley nacional, reconocen el derecho de todos a acceder al mejor estandar de salud disponible? Existen leyes que especifiquen la responsabilidad del gobierno para asegurar el aceso equitativo a los medicamentos esenciales? El listado nacional de medicamentos esenciales se ha actualizado en los ultimos dos anhos?

2) Se han consultado todos los beneficiarios del programa? La politica nacional de medicamentos, se ha actualizado en los ultimos 10 anhos? Se consultaron las organizaciones de pacientes y las comunidades rurales al desarrollar este programa?

3) Existen mecanismos para asegurar la transparencia? La politica nacional de medicamentos, detalla las obligaciones de los distintos financiadores? Existen datos de base sobre el acceso a los medicamentos esenciales, para poder comparar si se logran los objetivos?

4) Todos los grupos vulnerables, tienen el mismo acceso a los medicamentos esenciales? Como es posible saberlo? Existten estadisticas con datos separados para ninhas, ninhos, mujeres, hombres, poblacion rural y poblacion urbana? En las carceles, hay acceso a los medicamentos esenciales? Existen materiales educativos y desplegables con informacion sobre medicamentos en todas las lenguas que hablan las minorias etnicas de cada pais?

5) Existen mecanismos que se puedan activar en caso de que se violen los derechos humanos? Existen mecanismos legales disponibles, y se han utilizado en algun caso en relacion a los medicamentos esenciales? 

Me gustaria iniciar una discussion sobre la manera como estas ideas se podrian llevar a la practica.

Cordialmente,

Dr Hans V. Hogerzeil
Director 
Medicines Policy and Standards
World Health Organization
CH-1211 Geneva 27
Switzerland
Tel: +41-22-791-3528
Fax: +41-22-791-4730
email: hogerzeilh@who.int