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The thesis investigates to what extent the international right to health can generate standards for Health Technology Assessment (HTA) implementation and policies. HTA has been used as a multidisciplinary process to determine the broad impact and cost-effectiveness of new healthcare technologies and interventions in health systems under multiple levels of resource constraints. By exploring the relation of this process with State measures to promote access to health, this thesis proposes a human rights-based approach (HRBA) to HTA focused on controlling economic relations and ensuring favourable conditions for access to healthcare. The central point of analysis is how the premise of scarcity, which inspired procedural approaches in bioethics and right to health litigation studies, is not rigid and can be mitigated by State continuous efforts during HTA. The normative focus is on Article 2.1 of the International Covenant on Economic, Social and Cultural Rights, concerning fundamental principles of progressive realisation and maximum available resources. In this doctrinal analysis, the notion of resources is expanded so as to include State regulatory power at large to contain scarcity through laws alongside HTA decisions. Resources, in this interpretation, involve enabling affordable healthcare, obligations of international cooperation and State support to evidence-making and knowledge production that enhance HTA criteria. A case study in Brazil indicates how the procedural justice model is insufficient to guide State responses to scarcity. A documentary analysis suggests that policies and law can be in practice applied as prescribed by the international economic and social rights principles concerning resource mobilisation, which cannot be divorced from resource allocation in political deliberations. Therefore, an HRBA to HTA should not be read as merely procedural justice but should also impose obligations to address the causes of scarcity where possible before overdependence on rationing deliberations.

This thesis considers the interdependence of the right to health and the right to just and favourable working conditions of healthcare workers in public hospitals in Kenya through the lens of the psychosocial factors affecting their health and wellbeing in the workplace. Drawing on the capabilities approach in chapter two, it argues that progressive realisation of the right to health requires securing safe and healthy working conditions for healthcare workers. An analysis in chapter three is conducted of the factors adversely affecting the psychosocial health and wellbeing of public sector healthcare workers. the normative content of the rights to health and just and favourable conditions are considered and how their violations affect the psychosocial health of healthcare workers. The shortcomings of the international and regional approaches to protection of the psychosocial health and wellbeing of healthcare workers are demonstrated in chapter four. A case is made for protection within the International Covenant of Economic, Social and Cultural Rights Framework which can be enforced in domestic courts. Chapter five then proposes the structural interdict as a strategic and effective remedy to be used by the courts for the protection of the psychosocial health and wellbeing of healthcare workers in public hospitals in Kenya. Its dialogic nature appeals to remedying violations attributable to systemic violations. It also promotes a distributive, rather than a corrective approach to justice for healthcare workers as victims of the violations. This thesis shows how the outcome of a labour law dispute between the employer and the employee can influence the progressive realization of the right to health through the resultant remedy's implications on health policy, regulation and resource allocation decisions in the public health sector.

Introduction: In 1978, the Alma Ata Declaration pledged global solidarity towards the progressive realisation of the right to health for all by the year 2000. The strategy was to be achieved using the principles of Primary Health Care, such as the promotion of equitable access to health, through an intersectoral lens with the active engagement of communities. This target was not achieved, due to the lack of political commitment. In 2015 seventeen new Sustainable Development Goals (SDGs) were established to reduce global inequities by 2030. We need to learn lessons from the past and focus on creating a more just global health system. The COVID 19 pandemic will have long term economic and social consequences, which could reduce health system resources and capacity. However, promoting the right to health could lead to a more equitable and peaceful global society. Ensuring timely access to essential effective health care services is a key priority for the third Sustainable Development Goal, with Universal Health Coverage as a specific target. Aim: The aim of this research was to present the significant contribution of original knowledge that the selected published works contributed to global health policy discourse, on the factors required for improving timely access to health services, especially in fragile contexts. There were three research questions answered: what are the factors needed to improve timely health service utilisation in fragile contexts? Is Universal Health Coverage the same as the right to health, as set out in the Alma Ata? Can Social Health Insurance alone achieve Universal Health Coverage to meet Sustainable Development Goal three? The literature: Nine peer reviewed published papers were selected, covering publications from 2008 to 2018. All papers were reviewed by academic and professional peers, along with organisational or journal editors. Six papers resulted from primary research, published by either the contracting organisation, or a peer reviewed journal. One paper was a scholarly comment published in a peer reviewed journal and one publication was the result of a scoping review, published by Save the Children. Methodology and theoretical framework: A mixed method participatory action approach was used for seven of the nine papers. These seven published research papers combined secondary data collection and analysis, with the collection of primary qualitative research. The former was analysed through excel files and the qualitative findings were analysed through thematic analysis and workshops with participants. One briefing report resulted from a scoping review or peer reviewed material and health financing grey papers. All research was carried out with a critical enquiry approach using evidence to reduce health inequities. An adapted theoretical framework approach was used to analyse the publications to support the overall commentary. The framework utilised merged the Primary Health Care principles of equity, voice and governance through an intersectoral lens with Gaventa's four expressions of power. This adapted framework captured the critical enquiry approach of the collective evidence, to support change in health policy and practice. Evidenced based health and nutrition advocacy can strengthen the power with and to those with unequal access to health. Each publication was published at key moments, to encourage change. Findings: The original research demonstrated that Universal Health Coverage is not the same as the right to health, as health requires concurrent investment in multiple sectors such as social protection, food security, nutrition, water and sanitation and quality education. However, it could be an effective stepping stone for the progressive realisation of the right to health. The research found no evidence to support Social Health Insurance alone could achieve Universal Health Coverage. Where it was implemented successfully it used public taxation funds to cover health for the poorest. Even in these situations the co-payments led to delays in timely health seeking. Overall, four factors were identified as essential to ensure timely health service utilisation, especially in fragile contexts: (i) Health services provided free at the point of access, through publicly funded taxation, were more equitable than social health insurance or user changes. (ii) Concurrent investment in social protection, food security, nutrition, water and sanitation and quality education with community health services, could prevent 2.5 million under five-year-old child deaths annually. (iii) Services are more effective when there is active engagement with communities. (iv) Good governance has resulted in reductions in under five morality rates, however, the lack of financial support for the World Health Organisation has resulted in fragmented global health governance, which must be urgently addressed.

The issue of access to medicines has been widely discussed under the international human rights law regarding patients without medicines. Through critical analysis of relevant documentary material of the international human rights law, this thesis examines the status of access to medicines as a human right. To explore the status of access to medicines as a human right, this study examines the available sources of international human rights law. Benefiting from the indivisibility of human rights, the study presents the scope of interpreting access to medicines as a human right under the right to life and health. The thesis argues for the status of access to medicines as a human right instead of considering it a mere ethical or moral demand. The recent outbreak of Coronavirus (COVID-19) pandemic is not only a test for human advancement in medical sciences but is also a reality-check for human rights in general and access to medicines in particular. The study systematically argues that treating the issue of access to medicines as an ethical or moral demand, instead of treating it as a human right, has affected the response to pandemics and epidemics. The Access to Medicines Index Report 2018 concludes that almost 2 billion people face several issues accessing the required medicines. The deprivation causes pain, fear, and violation of human right to life and health. To establish access to medicines as a human right, it is imperative to develop the human rights framework for access to medicines under the international human rights law. The arguments will progressively analyse the status of access to medicines as a human right. For developing the human rights framework, the study will analyse the norm-creation process of the international human rights law, the status of access to medicines as a legal norm, the obligations of state parties, limitations to recognise and enforce access to medicines as a legal norm, and the ways to elevate the standing of access to medicines as a human right.

The impact of influenza pandemics is felt most greatly in developing states, where the close proximity between humans and disease vectors, weak public health surveillance systems, and poor sanitation make these states particularly vulnerable to influenza pandemics. A vaccine is the most effective intervention to minimise the spread and impact of influenza, and yet, developing states are the least likely to have timely access to a vaccine during a pandemic. According to 'The Committee on Economic, Social and Cultural Rights General Comment No. 14: the Right to the Highest Attainable Standard of Health' there is a clear positive obligation for states to provide access to vaccines during an influenza pandemic, and this obligation is not waived or depleted merely because developing states have resource constraints. There has been a proliferation of literature recently which has considered access to medicines in developing states and the right-to-health. However, there has been little exploration of this issue in respect of pandemic influenza vaccines. This research explores the manner in which developing states procure influenza vaccines during a pandemic, and determines if the current international legal mechanisms which are available to developing states can be successfully used to enhance procurement, and increase the amount of vaccine developing states can access during a pandemic, to a point where they can discharge their right-to-health obligations. In doing so, I argue that the WHO Pandemic Influenza Preparedness Framework, and the flexibilities of the TRIPS Agreement are not able to enhance the procurement of pandemic influenza vaccines by developing states, to the point where states right-to-health obligations can be said to be discharged. From this, I propose an international 'Knowledge Clearing House as a solution to the problems in procurement which are identified in this research.

Healthcare services, traditionally provided by the government in a welfare state, have become a tradable commodity in the era of globalisation. Indeed, globalisation has led to the creation of a new international healthcare market with increased participation of the private sector, assisted with enhanced mobility of health professionals, service providers and patients across borders. Soon after its inception, the 1995 General Agreement on Trade in Services (GATS) has come under fire from critics, especially for its broad scope and inclusion of basic services like healthcare, water or education that fulfil social objectives. In establishing a multilateral legal framework, GATS mandates progressive liberalisation of trade in services among the WTO members through successive rounds of negotiations. Since GATS applies to the measures by WTO Members affecting trade in services (whether taken at central, regional or local government level), inclusion of health services therein has raised concern regarding a government's ability to regulate health-related services. Availability and accessibility of healthcare services is crucial from the right to health perspective. The International Convention on Economic Social and Cultural Rights (ICESCR) obligates its Member States to respect, protect and realise progressively and to the maximum of its available resources 'the right to the highest attainable standard of health.' When a WTO Member is also a signatory to the ICESCR, the question arises whether the legislative framework regulating healthcare services under GATS conflicts with the said Member's obligation to respect, protect and fulfil the right to health. The present thesis attempts to answer this question through an analysis of GATS and the right to health norms within the framework of conflict of norms in international law. Although norm conflicts are generally assessed in terms of a legal relationship between a given State with another State, the present thesis focuses on a single State bound by both sets of rules where compliance with both obligations may/does lead to a legal, social or factual conflict.

This thesis aims to provide a framework for analyzing the moral responsibilities of global agents in what I call the Global Health Crisis (GHC), with special attention devoted to the moral responsibilities of pharmaceutical companies. The main contribution of this thesis is to provide a general account of the moral responsibilities of different global players, mapping the different kinds of duties they have, their content and force, and their relation to the responsibilities of other relevant actors in the GHC. I also apply this account to current debates surrounding the need for reforms to the international legal rules addressing the GHC, notably the TRIPs regime. In doing so, this thesis will discuss the allocation of responsibilities for the GHC among different global players, such as state and non-state actors, the latter including pharmaceutical companies. In order to investigate the allocation of duties, I will first analyze the object of such allocation which constitutes the object of the current GHC (Part A); then the agents responsible for addressing this crisis (Part B); and finally, existing institutional alternatives to reform the international legal rules addressing the GHC, such as the TRIPs regime (Part C).

This chapter assesses how the law creates and sustains healthcare systems. It considers six paradigm concepts which are important in the structures of healthcare systems and how the law seeks to support and encourage the effective provision of healthcare to relevant populations. These concepts are quality/accessibility; health citizenship and a “right to health”; individual liberty; market competition; economic productivity; and “health justice” and integrated social services. The chapter then discusses five structures for health system regulation, starting with the simplest: public provision of health services, publicly funded but privately supplied health services, self-regulating health professions, public–private partnerships, and nonprofit and charitable organizations. Finally, it compares European and American approaches to the geographical dimensions of health system law and regulation, discussing paradigms of federalism and localism.

As the population of migrants continues to grow, ensuring migrant health needs are met is a global-public health priority. This dissertation examines health policies and programs that impact migrant health to improve upon them and mitigate disparities. The focus is on Mexican citizens, immigrants in California and elderly immigrant populations in the U.S., since they represent a large share of immigrants with increasing health needs in this country and the world. To do so, I draw from an interdisciplinary approach to health policy investigation at the intersection of ethics, health services research and implementation science. I use normative, quantitative and qualitative methods to analyze these policies. The work presented shows that justifying policies and their limits, measuring the effects of a policy to inform health reform and making adaptations to interventions in order to ensure successful implementation, are important ways to improve health policies that affect immigrants in the United States.