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DiStefano MJ, Abdool Karim S, Krubiner CB. Integrating health technology assessment and the right to health: a qualitative content analysis of procedural values in South African judicial decisions. Health Policy Plan 2022; 37:644-654. [PMID: 34792599 PMCID: PMC9113169 DOI: 10.1093/heapol/czab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
South Africa's move towards implementing National Health Insurance includes a commitment to establish a health technology assessment (HTA) body to inform health priority-setting decisions. This study sought to analyse health rights cases in South Africa to inform the identification of country-specific procedural values related to health priority-setting and their implementation in a South African HTA body. The focus on health rights cases is motivated in part by the fact that case law can be an important source of insight into the values of a particular country. This focus is further motivated by a desire to mitigate the potential tension between a rights-based approach to healthcare access and national efforts to set health priorities. A qualitative content analysis of eight South African court cases related to the right to health was conducted. Cases were identified through a LexisNexis search and supplemented with expert judgement. Procedural values identified from the health priority-setting literature, including those comprising Accountability for Reasonableness (A4R), structured the thematic analysis. The importance of transparency and revision-two elements of A4R-is evident in our findings, suggesting that the courts can help to enforce elements of A4R. Yet our findings also indicate that A4R is likely to be insufficient for ensuring that HTA in South Africa meets the procedural demands of a constitutional rights-based approach to healthcare access. Accordingly, we also suggest that a South African HTA body ought to consider more demanding considerations related to transparency and revisions as well as explicit considerations related to inclusivity.
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Affiliation(s)
- Michael J DiStefano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Safura Abdool Karim
- SAMRC/WITS Centre for Health Economics and Decision Science (PRICELESS SA), Office 233, 2nd floor, Wits Education Campus, 27 St Andrews Road, Parktown, Johannesburg 2193, South Africa
| | - Carleigh B Krubiner
- Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
- Center for Global Development, 2055 L St., Washington, DC 20036, USA
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Bowser DM, Agarwal-Harding P, Sombrio AG, Shepard DS, Harker Roa A. Integrating Venezuelan Migrants into the Colombian Health System during COVID-19. Health Syst Reform 2022; 8:2079448. [PMID: 35675560 DOI: 10.1080/23288604.2022.2079448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Colombia provides a unique setting to understand the complicated interaction between health systems, health insurance, migrant populations, and COVID-19 due to its system of Universal Health Coverage and its hosting of the second-largest population of displaced persons globally, including approximately 1.8 million Venezuelan migrants. We surveyed 8,130 Venezuelan migrants and Colombian nationals across 60 municipalities using a telephone survey during the first wave of the pandemic (September through November 2020). Using self-reported enrollment in one of the several Colombian health insurance schemes, we analyzed the access to and disparities in the use of health-care services for both Colombians and Venezuelan migrants by insurance status, including access to formal health services, virtual visits, and COVID-19 testing for both groups. We found that compared with 3.6% of Colombians, 73.6% of Venezuelan telephone survey respondents remain uninsured, despite existing policies that allow legally present migrants to enroll in national health insurance schemes. Enrolling migrants in either the subsidized or contributory regime increases their access to health-care services, and equality between Colombians and Venezuelans within the same insurance schemes can be achieved for some services. Colombia's experience integrating Venezuelan migrants into their current health system through various insurance schemes during the first wave of their COVID-19 pandemic shows that access and equality can be achieved, although there continue to be challenges.
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Affiliation(s)
- Diana M Bowser
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Priya Agarwal-Harding
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Anna G Sombrio
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Donald S Shepard
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Arturo Harker Roa
- School of Government Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
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Wang D, Vasconcelos NPD, Poirier MJ, Chieffi A, Mônaco C, Sritharan L, Van Katwyk SR, Hoffman SJ. Health technology assessment and judicial deference to priority-setting decisions in healthcare: Quasi-experimental analysis of right-to-health litigation in Brazil. Soc Sci Med 2020; 265:113401. [PMID: 33250316 PMCID: PMC7769796 DOI: 10.1016/j.socscimed.2020.113401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
The constitutional right to health in Brazil has entitled patients to litigate against the government-funded national health system (SUS), claiming access to various health treatments including those excluded from the health system's benefits package. Courts have tended to rely on a single medical prescription to judge these cases in favor of individual patients and against the health system. The large volume of cases has had a substantial financial impact on the government's health budget and has created unfairness in accessing healthcare. To change courts' behavior, a new health technology assessment (HTA) body - CONITEC - was created in 2011. Its creation was accompanied by an administrative procedure that made decisions about the health system's benefits package more transparent, accountable, participative and evidence-informed. It was expected that this HTA system would bring more legitimacy to the government's priority-setting decisions and promote deference from the courts. This study tests whether Brazil's new HTA system succeeded in encouraging judicial deference by analyzing a stratified random sample of 13,263 court decisions for whether the existence of a CONITEC report resulted in less frequent court orders to provide treatment for individual litigants. The results show that the creation of CONITEC did not change courts' behavior; courts still decide in favor of patients in most cases. Indeed, even when there was a CONITEC report recommending against government funding for a particular healthcare treatment, the vast majority of the relatively few patients who were unsuccessful in obtaining a health benefit at their first court hearing later obtained a favorable decision after appealing to a higher court. This finding was confirmed through an interrupted time-series analysis that did not find an impact of having a CONITEC report on courts' willingness to override a government priority-setting decision. In fact, CONITEC was rarely cited in court decisions, even when litigants mentioned the existence of a CONITEC report.
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Affiliation(s)
- Daniel Wang
- Fundação Getulio Vargas (FGV), Law School in São Paulo, Brazil.
| | | | - Mathieu Jp Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada
| | - Ana Chieffi
- Deapartment of Health of the State of São Paulo, São Paulo, Brazil
| | - Cauê Mônaco
- Centro Universitário São Camilo, School of Medicine, São Paulo, Brazil
| | - Lathika Sritharan
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster Health Forum, McMaster University, Hamilton, Canada
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O'Brien N, Li R, Isaranuwatchai W, Dabak SV, Glassman A, Culyer AJ, Chalkidou K. How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2 nd May 2019 London, UK. Gates Open Res 2019; 3:1543. [PMID: 31633086 PMCID: PMC6784300 DOI: 10.12688/gatesopenres.13063.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) requires them to prioritize health spending. Prioritizing is even more important as low- and middle-income countries transition from external aid. Countries will have difficult decisions to make on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are efficient and equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best to spend public money on healthcare. In May 2019, iDSI convened a roundtable entitled
Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation, and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community: • to develop a new publication package on premium estimation and budgeting, actuarial calculations and risk adjustment, provider payment modalities and monitoring of quality in service delivery • to call on the WHO to redouble its efforts in accordance with the 2014 Health Intervention and Technology Assessment (HITA) World Health Assembly resolution to support countries in developing priority setting and HTA institutionalization, and to lead by example through introducing robust HTA processes in its own workings • to develop a single Theory of Change (ToC) for evidence-informed priority setting, to be agreed by the major organizations working in the areas of priority setting and HTA.
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Affiliation(s)
- Niki O'Brien
- Global Health and Development Group, Imperial College London, London, UK
| | - Ryan Li
- Global Health and Development Group, Imperial College London, London, UK
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, UK.,Center For Global Development, London, UK
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O'Brien N, Li R, Isaranuwatchai W, Dabak SV, Glassman A, Culyer AJ, Chalkidou K. How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2 nd May 2019 London, UK. Gates Open Res 2019; 3:1543. [PMID: 31633086 PMCID: PMC6784300 DOI: 10.12688/gatesopenres.13063.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 06/07/2024] Open
Abstract
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) has increased the need for prioritizing health spending. Such need will soon accelerate as low- and middle-income countries transition from external aid. Countries will have to make difficult decisions on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best and how much to spend public money on healthcare. iDSI core partners include Center For Global Development, China National Health Development Research Center, Clinton Health Access Initiative, Health Intervention and Technology Assessment Program, Thailand / National Health Foundation, Imperial College London, Kenya Medical Research Institute, and the Norwegian Institute of Public Health. In May 2019, iDSI convened a roundtable entitled Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community to further country-led capacity building, as well to foster deeper collaboration between the community itself. HTA is a tool which can assist governments and development partners with evaluating alternative investment options in a defensible and accountable fashion. The definition and scope of HTA, and what it can achieve and support, can be presented more clearly and cohesively to stakeholders. Organizations engaging in HTA must develop deeper collaboration, and integrate existing collaborations, to ensure progress in developing HTA institutionalization globally is well organized and sustainable.
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Affiliation(s)
- Niki O'Brien
- Global Health and Development Group, Imperial College London, London, UK
| | - Ryan Li
- Global Health and Development Group, Imperial College London, London, UK
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, UK
- Center For Global Development, London, UK
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Biehl J, Socal MP, Gauri V, Diniz D, Medeiros M, Rondon G, Amon JJ. Judicialization 2.0: Understanding right-to-health litigation in real time. Glob Public Health 2018; 14:190-199. [DOI: 10.1080/17441692.2018.1474483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- João Biehl
- Department of Anthropology, Princeton University, Princeton, USA
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA
| | - Mariana P. Socal
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Varun Gauri
- Development Research Group and Mind, Behavior, and Development Unit, World Bank, Washington DC, USA
| | - Debora Diniz
- Law School, University of Brasília, Brasília, Brazil
- ANIS – Institute of Bioethics, Human Rights and Gender, Brasília, Brazil
| | - Marcelo Medeiros
- Department of Sociology, University of Brasília, Brasília, Brazil
- IPEA – Institute for Applied Economic Research, Brasília, Brazil
| | - Gabriela Rondon
- Law School, University of Brasília, Brasília, Brazil
- ANIS – Institute of Bioethics, Human Rights and Gender, Brasília, Brazil
| | - Joseph J. Amon
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA
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Rumbold B, Baker R, Ferraz O, Hawkes S, Krubiner C, Littlejohns P, Norheim OF, Pegram T, Rid A, Venkatapuram S, Voorhoeve A, Wang D, Weale A, Wilson J, Yamin AE, Hunt P. Universal health coverage, priority setting, and the human right to health. Lancet 2017; 390:712-714. [PMID: 28456508 PMCID: PMC6728156 DOI: 10.1016/s0140-6736(17)30931-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/09/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Benedict Rumbold
- Department of Philosophy, University College London, London, UK.
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Octavio Ferraz
- The Dickson Poon School of Law, Kings College London, London, UK
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK
| | - Carleigh Krubiner
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas Pegram
- Department of Political Science, University College London, London, UK
| | - Annette Rid
- Department of Global Health and Social Medicine, Kings College London, London, UK
| | - Sridhar Venkatapuram
- Department of Global Health and Social Medicine, Kings College London, London, UK; Department of Philosophy, University of Johannesburg, Johannesburg, South Africa
| | - Alex Voorhoeve
- Department of Philosophy, Logic and Scientific Method, London School of Economics, London, UK; Department of Bioethics, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Daniel Wang
- School of Law, Queen Mary University of London, London, UK
| | - Albert Weale
- Department of Political Science, University College London, London, UK
| | - James Wilson
- Department of Philosophy, University College London, London, UK
| | - Alicia Ely Yamin
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Georgetown University Law Center, Washington, DC, USA
| | - Paul Hunt
- School of Law, University of Essex, Colchester, Essex, UK
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Chalkidou K, Li R, Culyer AJ, Glassman A, Hofman KJ, Teerawattananon Y. Health Technology Assessment: Global Advocacy and Local Realities Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness". Int J Health Policy Manag 2017; 6:233-236. [PMID: 28812807 PMCID: PMC5384986 DOI: 10.15171/ijhpm.2016.118] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022] Open
Abstract
Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities.
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Affiliation(s)
- Kalipso Chalkidou
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ryan Li
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anthony J. Culyer
- Department of Economics & Related Studies and Centre for Health Economics, University of York, York, UK
| | | | - Karen J. Hofman
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
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Slutsky J, Tumilty E, Max C, Lu L, Tantivess S, Hauegen RC, Whitty JA, Weale A, Pearson SD, Tugendhaft A, Wang H, Staniszewska S, Weerasuriya K, Ahn J, Cubillos L. Patterns of public participation. J Health Organ Manag 2016; 30:751-68. [DOI: 10.1108/jhom-03-2016-0037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The paper summarizes data from 12 countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. The purpose of this paper is to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned.
Design/methodology/approach
– The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country.
Findings
– Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation.
Originality/value
– The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies.
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Hawkes S, Buse K. Searching for the Right to Health in the Sustainable Development Agenda Comment on "Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?". Int J Health Policy Manag 2016; 5:337-9. [PMID: 27239885 PMCID: PMC4852005 DOI: 10.15171/ijhpm.2016.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/19/2016] [Indexed: 11/09/2022] Open
Abstract
The United Nations (UN) Sustainable Development Agenda offers an opportunity to realise the right to health for all. The Agenda's "interlinked and integrated" Sustainable Development Goals (SDGs) provide the prospect of focusing attention and mobilising resources not just for the provision of health services through universal health coverage (UHC), but also for addressing the underlying social, structural, and political determinants of illness and health inequity. However, achieving the goals' promises will require new mechanisms for inter-sectoral coordination and action, enhanced instruments for rational priority-setting that involve affected population groups, and new approaches to ensuring accountability. Rights-based approaches can inform developments in each of these areas. In this commentary, we build upon a paper by Forman et al and propose that the significance of the SDGs lies in their ability to move beyond a biomedical approach to health and healthcare, and to seize the opportunity for the realization of the right to health in its fullest, widest, most fundamental sense: the right to a health-promoting and health protecting environment for each and every one of us. We argue that realizing the right to health inherent in the SDG Agenda is possible but demands that we seize on a range of commitments, not least those outlined in other goals, and pursue complementary openings in the Agenda - from inclusive policy-making, to novel partnerships, to monitoring and review. It is critical that we do not risk losing the right to health in the rhetoric of the SDGs and ensure that we make good on the promise of leaving no one behind.
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Affiliation(s)
- Sarah Hawkes
- Faculty of Pop Health Sciences, Institute for Global Health (IGH), University College London, London, UK
| | - Kent Buse
- United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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