137. This Court also takes note of the Ecuadorian regulations in this area that have been approved subsequently, such as the Ecuadorian Constitution of October 20, 2008; 186 its article 32 establishes the guarantees of the right to health pursuant to the principles of universality, solidarity, interculturalism, quality, efficiency and effectiveness, and its article 363 envisions the formulation of public policies that guarantee integral health care and prevention, as well as the Organic Health Act of December 22, 2006, amended on January 24, 2012. 187 In addition, the Court also takes note of the recent efforts of public entities such as the Ombudsman in this area. 188 138. Therefore, this Court observes that, at the time of the facts, the above-mentioned norms established a regulatory framework for the provision of medical services, granting the corresponding State authorities the necessary competence to control these, with regard to both the supervision and control of the functioning of public and private facilities, and the supervision of the exercise of the medical profession. Consequently, the Court finds that the national health authority was endowed with certain administrative attributes, through the Health Code, to inspect the provision of services and, if necessary, sanction any adverse effects of the irregular practice of medicine, which will be verified below. 2. The State’s obligation to supervise and control as regards health services and the protection of the personal integrity of Melba Suárez Peralta 139. In order to determine whether, in this case, there have been any violations of the right to personal integrity and, consequently, the international responsibility of the State as regards its obligation to guarantee rights, the Court finds it necessary to distinguish between two separate moments in the medical care provided to Melba Suárez Peralta: on 186 Article 32 of the 2008 Constitution of the Republic of Ecuador establishes that: “Health is a right guaranteed by the State […]. The State shall ensure this right by economic, social, cultural, educational and environmental policies, and permanent, timely and inclusive access to programs, actions and services for integral health care and promotion […]. The provision of health services shall be governed by the principles of equity, universality, solidarity, interculturalism, quality, efficiency [and] efficacy, […].” In addition, article 363 establishes that “[t]he State [is] responsible for formulating public policies that ensure promotion, prevention, treatment, rehabilitation and integral care for health” (file of annexes to the answering brief, folios 2060 and 2154). 187 Organic Health Act (file of annexes to the answering brief, folio 2342). The act establishes the following, among other matters: i. Regarding the control of medical services, in its article 4: “[t]he national health authority is the Ministry of Public Health, entity responsible for exercising leadership functions in the area of health, together with the responsibility of the application, control and monitoring of compliance with [this] act.” In addition, article 6 stipulates that: “[i]t is the responsibility of the Ministry of Public Health: […] to regulate, to supervise, to control and to authorize the functioning of the public and private, profit and non-profit, health care establishments, and others subject to health inspection”; these obligations are also established in articles 180 and 181; iii. Regarding users’ rights, article 7 recognizes and regulates different patients’ rights. In addition, article 9 establishes that: “[t]he State must guarantee the right to health of the individual and, to this end, it has the following responsibilities: [… t]o encourage the participation of society in the care of individual and collective health, and to establish oversight and accountability mechanisms in the public and private institutions concerned”; vi. Regarding the regulation of the exercise of the medical profession, article 194 establishes that: “[i]n order to practice as a health professional, it is necessary to have obtained a postgraduate university degree from one of the universities legally established and recognized in the country, or a degree from a foreign university that has been authenticated and revalidated. In either case, registration is necessary with the National Council of Higher Education (CONESUP) and with the national health authority. In addition, article 199 grants the national health authority competence to investigate and sanction the illegal practice of medicine. 188 Cf. 2009 Annual Report of the Ombudsman’s Office, and the First report on the situation of the area of neonatology in public hospitals of Ecuador, March 22, 2011. Likewise, Cf. Information provided by the Ombudsman’s Office (file of annexes to the final arguments, folios 3207 to 3216); and final arguments of the representatives (merits file, folios 800 to 810). 41