economic, social and cultural rights. In the words of the Court, both groups of rights must be “fully
understood as human rights, without any rank and enforceable in all the cases before the competent
authorities.”88
106.
In order to prevent violations of the right to life and humane treatment as a consequence of
provision of inadequate health care services, such services must fulfill the requirements of the principles of
availability, accessibility, acceptability and quality of the medical benefits, and it has been noted that those
obligations must be “oriented” toward the satisfaction of such principles,89 which were interpreted by the
Committee on Economic, Social and Cultural Rights in its General Comment No. 14 as “interrelated and
essential elements,” in the following terms:
a) Availability. Functioning public health and health-care facilities, goods and services, as
well as programs, have to be available in sufficient quantity within the State party. They
will include, however, the underlying determinants of health, such as safe and potable
drinking water and adequate sanitation facilities, hospitals, clinics and other healthrelated buildings, trained medical and professional personnel receiving domestically
competitive salaries, and essential drugs, as defined by the WHO Action Program on
Essential Drugs.
b) Accessibility. Health facilities, goods and services have to be accessible to everyone
without discrimination, within the jurisdiction of the State party. Accessibility has four
overlapping dimensions:
i)Non discrimination: health facilities, goods and services must be accessible to all,
especially the most vulnerable or marginalized sections of the population, in law and in
fact, without discrimination on any of the prohibited grounds.
ii)Physical accessibility: health facilities goods and services must be within safe physical
reach for all sections of the population, especially vulnerable or marginalized groups,
such as ethnic minorities and indigenous populations, women, children, adolescents,
older persons, persons with disabilities and persons with HIV/AIDS. […]
iii) Economic accessibility (affordability): health facilities, goods and services must be
affordable for all. Payment for health-care services, as well as services related to the
underlying determinants of health, has to be based on the principle of equity, ensuring
that these services, whether privately or public provided, are affordable for all, including
socially disadvantaged groups. Equity demands that poorer households should not be
disproportionately burdened with health expenses as compared to richer households.
iv) Information accessibility: accessibility includes the right to seek, receive and impart
information and ideas concerning health issues. However, accessibility of information
should not impair the right to have personal health treated with confidentiality.
c) Acceptability. All health facilities, goods and services must be respectful of medical ethics
and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples
and communities, sensitive to gender and life-cycle requirements, as well as being
designed to respect confidentiality and improve the health status of those concerned.
88 IA Court of HR, Case of Acevedo Buendía et al (“Discharged and Retired Employees of the Comptroller”) v. Peru. Preliminary
Objection, Merits, Reparations and Costs. Judgment of July 1, 2009. Series C No. 198, par. 101. Also see: UN. Committee on Economic,
Social and Cultural Rights. General Comment No. 9, par. 10.
89 IA Court of HR, Case of Suárez Peralta v. Ecuador. Preliminary Objections, Merits, Reparations and Costs. Judgment May 21,
2013. Series C No. 261,
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