Blockchain Papers

Hemasree Akula

No abstract is available for this record.

Paul Turowski, Simon Hutchinson, Takuto Fukuda

No abstract is available for this record.

Mark Fenwick, Stefan Wrbka

This chapter examines the potential of non-fungible tokens (NFTs) as an instrument to enhance access to justice, highlighting the necessity for judicial and legislative innovation to accommodate them into existing legal frameworks. We analyze two instances of such innovations: judicial adaptations in the Anglo-American legal systems that recognize NFTs as a tool to improve access to justice from both a procedural and substantive perspective and legislative measures in the European Union that incorporate NFTs into regulatory schemes, potentially improving substantive justice access to justice. Our findings suggest that while judicial creativity has played a crucial role in advancing justice in the discussed cases, it is insufficient on its own. Comprehensive legislative reforms are essential, and this requires regulators to be more attendant to market developments, specifically in the field of legal tech, and mechanisms need to be developed to reduce information asymmetries. In designing any new legislative scheme for crypto-assets, access to justice should be a key consideration in mitigating the risks of this new technology.

Matthew M. Kavanagh, Luis Gil Abinader, Fatima Hassan, Eli A. Friedman

Scientific advances to fight infectious diseases have been remarkable. International law and global governance have sought, and often failed, to keep pace, secure equity, and stop outbreaks. We trace the law and governance model emerging from early failure in the AIDS response and identify four elements: use of law by national governments to compel sharing; decentralized generic manufacturing; mechanisms for voluntary sharing of patents and technology transfer; international funding. In combination, these created a remarkable new ecosystem. We find that when COVID-19 hit and mRNA vaccines were rapidly developed, global North governments opposed mobilizing this synergistic model. Instead, equity efforts focused on financing purchase of vaccines from originator companies with little use of law. Amidst monopolies and scarcity of doses, vaccine nationalism fatally undermined this effort. Whether more synergistic law and governance emerges from rapidly changing global health law will likely dictate the efficacy of future global infectious disease response.

Luke D. Graham

Internet access is a prerequisite for access to Web3. Consequently, Web3 and the benefits thereof are rendered inaccessible for those individuals who lack Internet access. Presently, rich discussion exists on the topic of a right to Internet access. The central purpose of this contribution is not to argue for the recognition of such a right. Rather, the central purpose of this contribution is to suggest that if a right to Internet access is to be recognised, then it can be grounded in Article 11 (1) of the International Covenant on Economic, Social and Cultural Rights (ICESCR). Examining the potential of a right to internet access to be derived from this provision facilitates an examination of the parameters of the right to an adequate standard of living. It is suggested that the right to an adequate standard of living is not fixed or static but is instead capable of capturing technological and societal advancements. The advantages of this approach are two-fold. First, grounding a right to internet access within the right to an adequate standard of living recognises a right to internet access both as a constituent part of the right to an adequate standard of living and as an independent right. After all, independent rights have been interpreted as deriving from Article 11 (1) ICESCR. Second, anchoring a right to Internet access in Article 11 (1) ICESCR allows the established legal framework of the ICESCR to be applied to delimiting the content of a right to internet access so understood.

Matthias Helble, Zulfiqar Ali, Jera Lego

To what extent do the World Health Organization, the World Trade Organization, and the World Bank remain central today and how much influence do they still wield in shaping the global agenda? While several studies have traced the development of various intergovernmental organizations (IGOs), charting their growth and influence in international affairs, and assessing their prospects, few if any have compared IGOs across various fields. This paper aims to fill this gap by taking a closer look at three different policy fields to better understand the current architecture of global governance, the centrality of IGOs, the role of new and other actors, as well as the strengths and weaknesses of this "new" architecture. The authors find that, first, the emergence of new private players has significantly eroded the centrality of IGOs such that the course of global governance in health, trade, and development finance has changed irreversibly. Second, regional arrangements have overtaken global ones and nonstate actors have assumed more prominent roles. Third, this multiplicity of powerful players has led to some positive outcomes but also greater inefficiencies and redundancies. Fourth, developed countries have been pivotal in eroding the centrality of IGOs, but developing countries are taking on a greater role in global governance. Fifth, the new architecture can be described as one of diversification in global health governance, fragmentation in global trade, and variation in multilateral development finance. Global governance in the 21st century is thus characterized by a proliferation of actors and a decentralization of authority, an erosion of IGO centrality accompanied by a greater role for nonstate actors, developing countries, and by increased regionalism. Depending on the sector of governance, its inherent aims, and the nature of the actors involved, the new architecture may be one of variation, fragmentation, or diversification. While this new architecture is complex and might possibly lead to inefficiencies and redundancies, it allows a greater number of actors to participate, making it more representative of the current world order and making it possible to mobilize more resources to promote development.

Authors unavailable

Financing Agreement (National Decentralized Planning and Finance Project) between the Republic of Mozambique and the International Development Association (with schedules, appendix and International Development Association General Conditions for Credits and Grants, dated 1 July 2005, as amended through 15 October 2006). Maputo, 11 May 2010

Henriques, Henriques José

The study analyzes the "International Law and the constitution of Mozambique: Consensus and dissent in the light of the Global Legal pluralism". This reflective analysis will converge in the problem of the internationalization of law in contemporary society, i.e., the interaction between International Law and the Constitutional Law in the light of the global legal pluralism. After reflecting on past political, economic and social changes, it is concluded that, on the one hand, constitutionalism is neither limited nor satisfied only with the structure of the state legal space (national) and its legal order. On the other hand, International Law is no longer limited to issues related to global international policy. The phenomenon of emerging globalization has created a challenge to the international law as to the idea of a pluralist synchronization and polycentric notion of Law that could respect the legal diversity or legal specificity, within the global Legal Pluralism. The older idea of International Law entered into crisis for not having achieved the unity and cohesion within the global legal system. This crisis driven by the polycentric force of globalization dictated the diversification and the expansion of international law. This diversification has imposed the constitution and strengthening of various autonomous international legal regimes, the multiplication of organs of international conflicts resolution and the emergence of a new normative configuration. With the emergence of new instances of international and global legal production, the debate on the internationalization of Law imposes itself as an urgent need, in the framework of the globalization process and the global legal pluralism. The great debate today, on this theme, departed from general International Law and is set in the context of the new global international legal order. The debate on the internationalization of law took two aspects: one on the protagonism of new instances of autonomous global and international legal production and its influence in the construction of the global international legal order. Another aspect is that of regional economic and political blocks and of organizations and institutions of humanitarian aid and development, under the same prism. This debate brings back the old or new problem of interaction between International Law and the Constitutional Law in the new global international legal order, i.e., the problem of internationalization of national law. In fact, some international rules emanating from autonomous international legal production organs, within the framework of hegemonic globalization, are imposed directly to citizens and States, sometimes without knowledge of such rules, or of its existence. The action of these organs or agents can be considered as a latching and destructive phenomenon within the national legal orders? These rules are imposed on citizens and States not only as strategies or means of operationalization of flows, for the success of the process of globalization and economic development, but also, sometimes, for unclear purposes and within wide range economic interests. With the introduction of the new international legal regimes, the relationship with National Law has decentralized, thus creating a polycentrism, where each regime seeks to draw to itself the protagonism. This phenomenon has created conflicts within National Law and between the various legal systems. It is noted that each legal regime has its specific rules of internationalization of law. The National Law, in the face of this diversity, must meet several distinct rules and sometimes contradictory. There are times when the same matter is subject to various internationalizations by different legal regimes and through distinct rules to that effect. The proliferation of various regimes and agents in the internationalization of Law has weakened the policies and measures of protection and rule production in peripheral States because of the overlap and complexity of the phenomenon. In this new global legal order, unfortunately, we are witnessing the phenomenon of international legislative hegemony led by the major powers with regard to the demands of globalisation. This unusual phenomenon, lived in the global society, is translated into anti-constitutional and anti-democratic practices in the creation and internationalization of law in peripheral countries. The study starts from the analysis of the relationship between international law and the constitution of Mozambique and returns to the debate on the problem of the relationship between International and National Law, in the framework of the new global international legal order.

Lauren Paremoer

In recent years, global governance institutions have operationalized their commitment to the right to health by advocating for universal health coverage (UHC) – particularly in the Global South. UHC aims to develop health systems that are efficient, well staffed, and capable of providing affordable and appropriate medical care and essential medicines to rich and poor alike (World Health Organisation, 2014). The political priority afforded to this goal is driven by an acknowledgement that people in wealthy and poor countries alike are priced out of the “market” for health care. This has caused concern because of the negative economic effects associated with inadequate access to care. Academic research and scholarly rhetoric often justifies UHC on the grounds that it will strengthen the economic position of households (particularly households living below or just above the poverty line) and contributes to the growth prospects of national economies (World Health Organisation Commission on Macroeconomics and Health, n.d.). UHC is thus framed as an investment in human capital: Healthier citizens are more productive citizens. They are more capable of investing in their own well-being, and that of their dependents, through participation in the labor market rather than relying on public assistance. Why is it problematic to justify UHC, and health promotion more generally, on the basis of its economic value, that is, on the basis of the contributions it makes to growing markets and improving economic productivity? Research on the reconfiguration of welfare regimes in the Global North suggests that globalization is undermining their social, political, and economic foundations. These countries – much like their counterparts in the Global South – are experiencing a rise in unemployment, coupled with an increase in flexible and precarious work. Globalization has also been associated with an increase in human migration from the Global South to the Global North and within the Global South. As a result, states are simultaneously faced with increased demands for welfare from the unemployed and the working poor, an erosion of their tax base, and increasingly heterogeneous societies. States are responding to these changes by adopting welfare policies that expand the influence of market actors and market logics on social welfare. Consequently, decisions about how to define and promote the public good are increasingly made in a decentralized fashion by private actors operating in households or markets rather than in democratic political institutions. For example, in many countries, access to public assistance is now contingent on welfare recipients' efforts to find employment (i.e., the shift from welfare to “workfare”) and pay for basic services, on private and public sector providers' ability to provide social services efficiently and cost effectively, and on the state's ability to efficiently coordinate interactions between citizen consumers and social services providers (Roche, 2002). Advocacy for UHC reflects these political and normative shifts. It de-emphasizes the importance of collective democratic decision-making about how the health needs of populations should be addressed. Instead, public institutions are primarily responsible for solving a “technical” problem: financing health consumption for all. As public institutions become more focused on policing health financing, they reduce the services they provide and, in so doing, strengthen the market power of private players (Global Health Watch, 2014). Private actors – philanthropic foundations and for-profit providers of medical services, health insurance, and medicines – now routinely constrain the ability of governments to decide the terms on which the right to health should be advanced. Their influence is legitimated by the World Bank and IMF austerity policies that frame debt repayment and economic growth as the direct and primary responsibilities of democratic governments. Although governments in the Global South are particularly vulnerable to these pressures, similar pressures are present in the Global North – as demonstrated by private sector opposition to Obamacare (Kirsch, 2013) and patent law reform in South Africa (De Wet, 2014). In contrast, these institutions frame the obligation to promote the social dimension of citizenship as something that can be outsourced to private actors and/or achieved through market logics. Additionally, the value of social policies is often justified in economic terms, for example, in terms of their ability to improve the productivity of worker citizens and the revenues of public and private sector service providers. This discourse de-emphasizes the intrinsic value of formal and substantive equality and meaningful participation in collective decision-making about the public good. Political institutions feature in it primarily as mechanisms that mediate the efficacy of investments in health care. Their significance is determined by their ability to maximize returns on investments in health (Jack and Lewis, 2009). What are some of the consequences of advancing the right to health in this manner? Research shows that the shift from universalistic welfare regimes to regimes that target “especially vulnerable” or “especially deserving” populations undermines social solidarity by stigmatizing welfare recipients as people who violate the liberal ethos of contemporary welfare states. Vulnerable populations (e.g., non-citizens, people of color, indigenous peoples, working class women, and able-bodied unemployed people) are stigmatized as being reluctant to (or incapable of) succeeding in market societies on their own “merit” and as unfairly benefiting from welfare policies that advance their particularistic group interests rather than overall well-being (Brown, 2003). The low social status of these groups obstructs their ability to access appropriate and effective medical care, even when it is available at no or little cost to patients (Bassett, 2015). Globalization is a politically and socially mediated process. The harmful effects of globalization on social inclusion, and the limits of the policy responses to these dynamics, point to the urgent need for collective action and research aimed at addressing the dimensions of globalization that undermine the social determinants of health by privatizing, stigmatizing, and instrumentalizing the management of health – and in some cases, life itself. Collective action is needed to democratize decision-making about health care at the local, national, and global levels in a meaningful way to foster social solidarity and address status inequalities that lead to disproportionate rates of illness and death among stigmatized social groups and to politicize the priority placed on economic growth, given its sometimes harmful effects on human and planetary health. Global Challenges is a journal that welcomes scholarly contributions on these tough issues and insightful commentary that points toward strategies for addressing them.

Limelight Networks, Inc. v. Akamai Technologies, Inc., et al. 35 U.S.C. §271(b)

No abstract is available for this record.

Authors unavailable

Financing Agreement (Additional Financing for the Second Decentralized City Management Project) between the Republic of Benin and the International Development Association (with schedules, appendix and International Development Association General Conditions for Credits and Grants, dated 1 July 2005, as amended through 15 October 2006). Cotonou, 12 September 2008

Charles B. Holmes, Yogan Pillay, Albert Mwango, Jos Perriëns · 9 authors

Introduction To successfully implement the 2013 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at country level, the implications for national and regional health systems need to be considered and addressed. The guidelines target the entire continuum of care for the HIV-infected individual, and in some cases, their partners, and those with unknown status. The guidelines include not only a more inclusive treatment initiation threshold of CD4+ T-cell count of 500 cells/μl or less for adults and adolescents, treatment for life for pregnant and breastfeeding women (or treatment for the duration of pregnancy and breastfeeding regardless of CD4+ T-cell count), treatment regardless of CD4+ T-cell count for children under 5 years of age, discordant couples, those co-infected with either tuberculosis (TB) or severe hepatitis B virus (HBV), and diversification of effective strategies to reach those with unknown status through couples testing and community-based testing. These changes, if fully enacted, will lead to an increase in treatment eligibility of over 60%, from 17.6 million globally, to 28.6 million globally, with variation in that increase by epidemic type and other epidemiologic factors [1]. However, within these increases in volume, health systems will be serving a healthier mix of patients starting antiretroviral therapy (ART), and greater proportions of pregnant women and children, and sexual partners seeking care together. The increased patient volumes and changes in the composition of those seeking care will require rapid attention to existing care delivery strategies in order to ensure that newly diagnosed individuals are served with the maximum efficiency and effectiveness, and others entering or already within the system under existing guidelines are not harmed. Additionally, to be successful over the long term, health systems and HIV programs will need strengthened adherence-support strategies. Systems of care that may already be stressed need to be further augmented through innovations, and in many cases provided with additional resources in order to become more efficient, resilient, robust and effective. The ‘Operations’ and ‘Service delivery’ sections (Chapter 9) of the guidelines address these challenges through recommendations for innovations in the models of service delivery, laboratory diagnostics and treatment delivery in the form of fixed-dose combinations (FDCs) to improve the efficiency, reach and quality of the prevention, care and treatment cascade. There are also potential gains from implementing the guidelines that could accrue to and strengthen health systems and communities, such as a healthier and more productive workforce and fewer new HIV infections, especially in newborns, and HIV-related hospitalizations, and these benefits must also be factored into HIV program and country-level decision-making surrounding adoption and adaptation of the new guidelines [2]. Our objective was to examine the implications of the new guidelines across the continuum of care for each of the elements of national health systems, starting with governance and the role of strategic planning and policy, and including diversification of service delivery models, generation and use of data, healthcare financing, human resource capacity, and supply chains for therapeutic and diagnostic commodities. Governance, strategic planning and policy The progress of discovery and change in the HIV epidemic have demanded a high degree of engagement with evolving evidence, as reflected in part by the 10 guidance documents on antiretroviral drug use issued by WHO since 2000. To date, national governments, with the support of civil society and cooperative partners, have employed a variety of approaches to new guideline adoption. Whereas earlier approaches often focused largely on clinical issues, there is now a need for much broader adoption processes to consider the complex interplay between clinical objectives, operational feasibility, issues related to equity, affordability and health systems capacity. In order to consider, adopt and implement new national guidelines with a broad coalition of support, Ministries of Health must take a strong leadership and governance role. When performed well, the key elements of the process at national level include the following: An inclusive and transparent consultative process that draws upon the best available resources, including program experts and managers, healthcare providers, civil society including people living with HIV, community and faith-based groups, key populations, technical specialists, other relevant government Ministries (e.g. Finance), budget experts and economists, researchers, academics, and health-related professional associations. Assembly, analysis and presentation of relevant clinical, programmatic and financial information. Consideration of guidelines changes in light of broader strategic policy frameworks cross-cutting a broader array of health, human rights and development issues. Clear decision-making mechanisms that allow consideration of competing demands. Clear articulation of roles and responsibility of various partners, in order to ensure accountability and oversight of the processes of change. Ensuring that the case for health in national development, including the potential benefits and risks of potential guidelines changes, is clearly communicated early and often to political leadership and external development partners. The recent process of developing and adopting new guidelines for antiretroviral drug use in pregnant and breastfeeding women in Zambia provides an instructive example of the range of activities needed to ensure that guidelines changes are made with broad stakeholder and health systems support (Fig. 1) [3,4]. National governments and civil society are encouraged to learn lessons from peers, and to participate in WHO's regional guidelines dissemination workshops that are designed to support strong national processes of guidelines change.Fig. 1: The process of changing prevention of mother-to-child transmission (PMTCT) guidelines in Zambia.Diversification and integration of service delivery models to manage patient volumes and improve retention and quality The expansion of HIV testing, care and eligibility for ART will require national governments and partners to consider how best to augment or modify their current health systems to accommodate increased volumes and new categories of patients, and to ensure retention across the care and treatment cascade. There is currently an over-reliance on a limited number service delivery models in many countries. Maximum expansion capacity and quality can be achieved by ensuring that a carefully selected variety of models are put in place and adapted strategically to take account of geography, epidemiology and local needs. Thus, it is an opportune time for governments and funders to focus on previously piloted models that are appropriate for scale-up, and to ensure that the most effective models are scaled up systematically in order to provide substantial complementary capacity to absorb new patients and provide ongoing care. Within the new guidelines, there is an increased emphasis on the importance of expanded national HIV testing and counseling strategies in order to identify ‘as many people living with HIV as early as possible after acquiring HIV infection, and link them appropriately and in a timely manner to prevention, care and treatment services’. The reality of most HIV-testing programs in most generalized epidemics is that they have been largely dominated by provider-initiated testing (most typically healthcare provider-initiated), which has been favored because of the ease of linkage to services and for its high yield and cost-effectiveness. However, it often identifies people living with HIV late in the course of HIV disease, in particular, men and adolescents, as well as key populations, who have low utilization of healthcare services. With the guidelines’ strong recommendation for community-based HIV testing and counseling with linkage to prevention, care and treatment services, governments should consider systematically expanding a number of approaches tailored for their settings, including mobile, door-to-door, index, campaign, workplace and school-based HIV testing and counseling approaches, and other strategies that ensure the inclusion of underserved groups such as children, adolescents and men. It is also important to recognize that the yield of nonclinic-based testing can be lower and more expensive from a human resource perspective, requiring a careful balance to be struck. For concentrated and low-level epidemics, governments are urged to consider guidelines that reflect WHO's strong recommendation to increase the number and diversity of the facilities in which provider-initiated testing and counseling are available, including sexually transmitted infection clinics, hepatitis and TB sites, antenatal care settings and services for key populations, notably MSM, transgender people, sex workers and people who inject drugs (Fig. 2) [5].Fig. 2: Innovative service delivery models to increase diagnosis and early antiretroviral therapy (ART) initiation among key populations in Indonesia.The capacity of national health systems to absorb the greater numbers of healthier, pregnant and individuals accompanied by partners eligible for treatment will be directly related to the extent to which ART sites are diversified, decentralized (and in some cases integrated into primary care services) and generally expanded. Extending care through different models will also relieve traditional ART sites and higher-level facilities and allow a greater focus on the sickest patients, especially in high-burden generalized epidemics. Models for consideration and rapid scale-up include ART initiation and maintenance for mothers and children in high HIV-prevalence settings integrated into antenatal care, and maternal and child health clinics, and for HIV/TB co-infected individuals into TB clinics, and other approaches that reduce the need of patients to come to clinics through community-based treatment clubs with rotating antiretroviral drug pick-up and home delivery, especially in remote rural areas. A systematic review on the impact of decentralization of ART delivery identified evidence from both randomized controlled trials and observational studies, and found that patients initiated at a hospital and maintained at a health center were more likely to be retained [6]. No difference in attrition was observed between those initiated and maintained on ART at a hospital compared to at a health center. Comparable attrition was observed after 12 months in the two trials in which ART maintenance was in the community [6]. Regions with measurable injection drug use may also consider the new strong recommendation for ART initiation integrated into clinics and sites in which opioid substitution therapy (OST) is provided. In areas with strong general outpatient services, integration of HIV services may yield greater equity with other health services, and may more directly enable HIV's chronic care models to benefit care and management responses to other chronic diseases such as diabetes and hypertension. These integrated sites must also be capacitated with on-site laboratories and referrals with a rapid turnaround for results reporting, especially for viral load, CD4+ T-cell count testing, TB testing and safety laboratories. Tiered laboratory systems must work closely with program leadership to ensure strategic investments in the best technologies for sites providing ART. Intentional analyses should be conducted to balance the convenience of point-of-care (e.g. CD4+ T-cell testing) technologies with the use of centralized high-throughput instruments. With anticipated rapid expansion of demand for viral load testing, it is essential to use internationally acceptable methods to locally validate the use of dry blood spots, as a means of viral load testing, which will allow expansion of this capacity without phlebotomy and cold chain capacity – the imminent availability of point-of-care viral load testing will also strengthen the health system's ability to provide good quality care. It is also critical to close the loop with results reporting via short message service or other secure electronic communication. Existing and new models also need to be chosen in order to intentionally retain patients in care and treatment, and ensure adherence to ART. Structural interventions such as increasing access points and decentralization through community-based models can address some of the most commonly cited reasons for disengagement with care (e.g. transport expenses, overcrowding of vertical sites). At an individual level, substantial evidence has demonstrated the benefits of two-way mobile phone text message systems, and WHO has made a strong recommendation for consideration of this approach [7]. As with numerous other proven methodologies, very few countries have systematically evaluated the needs of various vulnerable groups such as pregnant women, adolescents, key populations and healthy individuals starting ART and systematically taken appropriate packages of cost-effective adherence and retention interventions from the pilot phase, to scale. Generation and use of data for monitoring, evaluation, efficiency and quality improvement National and regional health systems of program monitoring and evaluation are fundamental to public health approaches to HIV prevention, care and treatment, and other chronic illnesses. When they work well, systems of measurement serve to provide actionable data for decision-making, starting with the clinician and service delivery sites, to regional and national program managers, related sectors (e.g. Ministries of Finance), and development partners [8]. Although the HIV response has focused substantial investments on monitoring and evaluation, the nature of the emergency response combined with weak health systems and the sheer volume of chronically ill patients have resulted in greater than expected challenges for many national systems. These challenges have been highlighted in recent studies demonstrating serious gaps in the ability of these systems to report on indicators that meaningfully measure program quality, and a lack of consistent data use at the site and regional levels to improve program quality [9]. With the influx of individuals seeking testing and care, and through sites and models not traditionally reporting on ART use (e.g. community-based antiretroviral drug pick-up and antenatal care sites), there are actions that must be taken coincident with guidelines adoption to ensure effective monitoring and evaluation of program quality. National governments and supportive cooperative partners must redouble efforts to harmonize and strengthen platforms for the use of data at levels of the health system to ensure that guidelines changes are as expected and that quality of care and patient are not models include or by the of health and development partners their implementing to review care and treatment at the and local These processes should be to and quality improvement processes that ensure clinical sites review their on critical elements of the care and treatment and have to to to quality and access to technical as on data use also to attention on the volume and of indicators and the systems that data A of potential indicators over the years has in some cases attention from those indicators considered at regional and national and countries are encouraged to their most critical indicators with the and ensure in the WHO's early indicators for HIV drug system of key indicators designed to quality improvement of ART services at level, with for and of the results for program management National governments and development partners also need to ensure systems are to allow reporting and use of the There are numerous and systems in few are fully integrated across the of care and treatment and at a national WHO is with numerous countries to improve integration of systems the Systems for HIV a of and guidelines to countries and implement a system that patient and and the impact in an integrated across maternal and child health of mother-to-child transmission and In WHO will consolidated strategic guidance that will a of indicators across the continuum of prevention, treatment and these will the key of quality HIV With this HIV program will have access to the critical indicators within with other When data are not to and important areas of the other methods may be including use of to more on critical issues that can with program quality, and traditional indicators and studies to the of critical program changes (e.g. studies of pregnant women starting ART CD4+ T-cell count of models and efficiency The HIV response ongoing and attention to to ensure the availability of for effective and with the Although the new guidelines will have much greater impact on health and of new and have the potential to reduce the of their are [1]. Ministries of Health and have critical challenges with new guideline to the and financial of potential guidelines changes in order to with local planning and to secure to support ongoing and changes to and to ensure the use of available of the of potential guidelines changes can be a variety of models, and some countries have been these of for As in of the guidelines, the of models is of the most commonly and its and resource needs models can be to the impact of guidelines changes on number of number of infections, and the of changing guidelines or approaches in a variety of epidemic models include the Health and models by the Health and for each with various and potential are encouraged to consider that is only as good as its ease of level of support, and attention must be in to ensuring the of local programmatic and Although has the of for the HIV response over the 10 years of the response in many low and some national governments have to increase their The ability of the in low and countries to further support the HIV and broader health response will be especially if traditional to These new guidelines a case for changing the course of the HIV and further resource may be by the of (e.g. more in antiretroviral drugs in the may reduce HIV that are less at for These may also be in the of such as the for Health and as for development of national that have the potential to provide a more for the HIV response and general health The has a to with to increase for methods for the efficiency by which the healthcare system resources to key and will also to and further resource For to the range of to provide ART to an individual, or provide an HIV testing and counseling by or of and for activities partners have made investments in developing these methods over recent and national governments are encouraged to to and resource use as the new guidelines are Ensuring human resource capacity to support evolving service delivery models of to the range of services to quality healthcare are a chronic in many countries. in many low and with of patients, are in some cases by only clinical and to long and for patients and a lack of attention to quality the new guidelines have many of the HIV interventions (e.g. a available in for HIV-infected and a focus on ensuring patients ART they HIV-related illnesses. These will further allow national programs to care delivery to who require less and to service delivery models and community delivery of The new guidelines also include recommendations for ART initiation to and for and community health workers to ART between has been a in the evidence for these recommendations and has successfully as a means of increasing the number of sites and to serve HIV-infected individuals (Fig. The effective use of in as a means of and expanding access to HIV care and as countries and scale-up new models of delivery, the guidelines changes provide a good to the current of various levels of and to use rapid evaluation to For the has that allow national governments to the need for additional healthcare workers on various guidelines These can also countries to approaches to and healthcare including laboratory These can form the for with professional of laboratory and and programs for other including community health workers and In order to the potential of the health including substantial numbers of new of health governments must to monitoring of program and ongoing support for the development of healthcare It is also important to frameworks to enable support and for new of health workers that have proven essential to the HIV including and community health These with the to have often been considered now are upon for delivery of services and must or and for Ensuring national supply chains are for the increase in volumes and changes in the mix of of the critical interventions in the new guidelines are on a consistent supply of essential commodities. Although national supply chains have in the 10 years of the HIV especially for antiretroviral drug there serious challenges in ensuring that clinics have For of rapid at the site level the efficiency and of and testing and prevention programs With more and expanded testing capacity for individuals their CD4+ T-cell count 500 cells/μl the case of and rapid expansion of viral load capacity, countries will to ensure that and related are with the of as antiretroviral activities for the of new guidelines include of the capacity of the and human resource capacity for transport and data management of the national supply for and need to include on antiretroviral drug that the use of fixed-dose in order to ensure adherence and supply the potential for viral load testing to up demand for and for additional HIV rapid (and other of care diagnostic such as point-of-care CD4+ T-cell and TB testing and and antiretroviral drug of of the of supply and of available technical and national of of with accountability at the levels of government and will likely have the with ensuring of key such as HIV rapid antiretroviral drugs and critical laboratory if their demand are communicated to their or supply and into The is important because the them and the to TB and work with to the demand for various of which the to the demand for their In the this and financial to of by of health services as well as civil society should be encouraged by national governments to ensure that are as early as possible that may be In the new WHO consolidated guidelines reflect not only evolving clinical also in the and of service delivery and program The most effective processes of guidelines change are by and reflect consultative processes in which and can be by partners with a in the It is expected that most countries will that there is a need to investments in the diversification of service delivery models, use and of data, development of human resources, and supply chains in order to accommodate increased patient volumes and to quality across the care and treatment cascade. and with careful for the essential elements of national health systems, the new guidelines could yield substantial for individuals living with HIV and public of There are of

Martin Oulu

No abstract is available for this record.

Peter Roderick, Allyson M Pollock

No abstract is available for this record.

Mark J. Cherry

The United Nations Educational, Scientific, and Cultural Organization's (UNESCO) Universal Declaration on Bioethics and Human Rights announces a significant array of welfare entitlements--to personal health and health care, medicine, nutrition, water, improved living conditions, environmental protection, and so forth--as well as corresponding governmental duties to provide for such public health measures, though the simple expedient of announcing that such entitlements are "basic human rights." The Universal Declaration provides no argument for the legitimacy of the sweeping governmental authority, taxation, and regulation to create and impose such "rights." As this paper explores that some action promotes a purported good, such as "health," does not thereby make the action morally permissible. Just as there are moral limits on legitimate personal actions, there are also moral limits on legitimate governmental actions to promote purported goods, including health. A core question of any governmental regulation, therefore, is whether it is a legitimate application of moral political authority or an unauthorized act of state coercion. Pace UNESCO's wide-ranging assertions, this paper argues that promoting health only falls within the legitimate authority of governments in very narrowly defined circumstances. As the paper critically explores, at stake are foundational moral and political questions concerning the limits of governmental authority to intervene in the consensual interaction of persons. Imposing such duties on others, including citizens of a state through regulatory activity and taxation, must be justified, nonarbitrary, and demonstrably within the limits of moral political authority. UNESCO's assertions do not meet this burden of proof.

Sam Halabi

The right to participation is the "the right of rights"--the basic right of people to have a say in how decisions that affect their lives are made. All legally binding international human rights treaties explicitly recognize the essential role of participation in realizing fundamental human rights. While the substance of the human right to health has been extensively developed, the right to participation as one of its components has remained largely unexplored. Should rights-based health advocacy focus on participation because there is a relationship between an individual's or a community's active involvement in health care decision-making and the highest attainable standard of health? In the context of the human right to health, does participation mean primarily political participation, or should we take the right to participation to mean more specifically the right of persons, individually and as a group, to shape health care policy for society and for themselves as patients? Decentralization of health care decision-making promises greater participation through citizen involvement in setting priorities, monitoring service provision, and finding new and creative ways to finance public health programs. Between 1999 and 2008, Indonesia decentralized health care funding and delivery to regional governments, resulting in substantial exclusion of its poor and uneducated citizens from the health care system while simultaneously expanding the opportunities for political participation for educated elites. This article explores the tension between the right to participation as an underlying determinant of health and as a political right by reviewing the experience of Indonesia ten years after its decision to decentralize health care provision. It is ultimately argued that rights-based advocates must be vigilant in retaining a unified perspective on human rights, resisting the persistent tendency to separate and prioritize the civil and political aspects of participation over its social component.

Ranjani K. Murthy

This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health (SRH) services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to programme management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes. Setting up of community health structures, decentralization and community financing are three important strategies used for promoting participation and accountability within reforms. The scant evidence on the impact of these strategies suggests that marginalized groups and sexual and reproductive rights based groups are poorly represented in the forums for participation, and that hierarchies of power between and amongst health personnel and the public play out in these forums. Community financing has not lead to enhanced service accountability. As a result of the above limitations, community participation in health sector reforms has rarely strengthened accountability with respect to provision of comprehensive SRH services. In this context, rights (including sexual and reproductive) based groups and researchers need to engage with design, monitoring and evaluation of health sector reforms, both from inside as participants and outside as pressure groups. Participation contracts enhancing powers of civil society representatives, quotas for participation (for women, other marginalized groups and rights-based organizations), and investment in capacity building of these stakeholders on leadership and sexual reproductive rights and health are pre-requisites if participation is to lead to health and SRH service accountability. Community participation and service accountability hence requires more and not less investment of resources by the state.