Condensed: States have the obligation to ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care.States must take necessary stepts to ensure that quality primary health care, which includes, functional hospitals and health centres providing antenatal and maternal healthcare services, emergency obstetric care, and essential medicines for the prevention and treatment of child diseases and injuries are not only (a) available in sufficient quantity but also (b) physically and economically accessible (c) for all children without discrimination.
Denial of primary healthcare to children exists in all situations where functional primary health centres are insufficiently available; where health centres or medical professionals are concentrated in urban areas; and where there is limited availability or relatively prohibitively high cost of essential children drugs. Furthermore, incidences of low coverage of vaccinations, low breastfeeding rates, and high incidences of malnutrition and micro-nutrition deficiencies, high prevalence of malaria are evidence of denial of access to primary healthcare to children. States are obliged to ensure that adolescents have access to appropriate education and information that is essential for their health and development, have opportunities to participate in decisions affecting their health as well as to freely make appropriate health behaviour choices.
Comprehensive: In order to realize the health rights of children, article 24(2)(b) of the CRC obliges States to to ensure the provision of necessary medical assistance and health care to all children with emphasis on ‚the development of primary health care‘.[1] Both the ICESCR and the CRC require States to take effective steps to reduce infant and child mortality.[2]
According to the Declaration of Alma Ata primary health care is essential health care that is universally accessible to individuals and families in the community through their full participation at an affordable cost, and constitutes the first element of the healthcare process.[3] Primary health care includes at least education concerning prevailing health problems and the methods of preventing them, promotion of food supply and proper nutrition, and adequate supply of safe water and basic sanitation, maternal and child healthcare, including family planning, immunization against the major infectious diseases (which are essential for the reduction of child mortality), prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries and provision of drugs.[4]
The provision of primary heathcare for children is part of the minimum core obligations of States under the ICESCR.[5] Thus, States must ensure that quality primary health care, which includes, functional hospitals and health centres providing antenatal and maternal healthcare services, emergency obstetric care, and essential medicines for the prevention and treatment of child diseases and injuries are (a) available in sufficient quantity and (b) physically and economically accessible for all children without discrimination.[6]
While physical accessibility means that primary healthcare must be within the physical reach of all children, including children living in rural areas, economic accessibility entails that primary healthcare must be affordable for all children or their parents including those living in poverty.[7] The CRC specifically enjoins states to strive to ensure that children with disability have full and equal access to primary health care services which shall be free of charge whenever possible[8]. Primary healthcare for adolescents should be sensitive to their needs providing special attention to sexual and reproductive health and mental health.[9] Adolescents should have access to appropriate education and information that is essential for their health and development, have opportunities to participate in decisions affecting their health as well as to freely make appropriate health behaviour choices.[10] To this end, available primary healthcare for adolescents must be sensitive to their needs with special attention to sexual and reproductive health and mental health.[11] Thus failure of the State to develop effective measures to remove barriers hindering adolescents’ access to appropriate education, information, treatment, care[12] as well as prevention measures for sexually transmitted diseases (STDs) including HIV/AIDS,[13] or to adopt legislation to combat practices that either increase adolescents’ risk of infection or contribute to the marginalization of adolescents who are already infected with STDs or HIV/AIDS[14] constitute violations of their right to health.
The obligation to provide primary healthcare requires States to carry out regular immunization exercises on all children against the prevailing major infectious diseases and also ensure that all children and their mothers have access to adequate food and nutritious diets, clean drinking water, proper sanitation and sanitary facilities.[15] Also, breastfeeding strengthens the immunity of the child against diseases and is therefore important to child health, growth and development. Accordingly, the CRC requires States to promote the advantages of breastfeeding and ensure that parents have access to adequate information on the proper use of breastmilk substitutes when necessary.[16]
Denial of primary healthcare to children exists in all situations where functional primary health centres are insufficiently available; where health centres or medical professionals are concentrated in urban areas; and where there is limited availability or relatively prohibitively high cost of essential children drugs. Furthermore, incidences of low coverage of vaccinations, low breastfeeding rates, and high incidences of malnutrition and micro-nutrition deficiencies, high prevalence of malaria are evidence of denial of access to primary healthcare to children.
[1] See also ICESCR art 12(1); CRC art 24. [2] Article 12(2)(a) of ICESCR; Article 24(2)(b) CRC; African Children’s Charter art 14(2)(a) [3] Declaration of Alma Ata, International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, para VI. [4] Declaration of Alma Ata, para VII [5] CESCR General Comment 14 para 43. [6]Article 24(2) of CRC. There must also be no discrimination in access irrespective of the child or his or her parents legal guardians’ race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. [7]The CESCR Committee has stated that payment for health-care services whether privately or publicly provided, should be affordable for all without discrimination, including socially disadvantaged groups. See also CRC Committee Concluding Observations: Kenya (2001) para 44 recommending the abolition or rationalisation of cost sharing in primary healthcare in order to facilitate greater access to services and reduce the burden on poor families. [8] Article 23(3) of CRC [9] CRC Committee, General Comment 4 para 41(a). [10] CRC Committee General Comment 4 para 39(b) [11] CRC Committee General Comment 4 para 41(a). [12] CRC Committee General Comment 3 para 20 [13] CRC Committee General Comment 3 para 16 [14] CRC Committee General Comment 4 para 30 [15] Article 24(2)(c) [16] Article 24(2)(d) of CRC; The Global Strategy for infant and young child feeding endorsed in 2002 by the World Health Assembly (WHA55/2002/REC/1, Annex 2)
States have the obligation to ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care.States must take necessary stepts to ensure that quality primary health care, which includes, functional hospitals and health centres providing antenatal and maternal healthcare services, emergency obstetric care, and essential medicines for the prevention and treatment of child diseases and injuries are not only (a) available in sufficient quantity but also (b) physically and economically accessible (c) for all children without discrimination.
Denial of primary healthcare to children exists in all situations where functional primary health centres are insufficiently available; where health centres or medical professionals are concentrated in urban areas; and where there is limited availability or relatively prohibitively high cost of essential children drugs. Furthermore, incidences of low coverage of vaccinations, low breastfeeding rates, and high incidences of malnutrition and micro-nutrition deficiencies, high prevalence of malaria are evidence of denial of access to primary healthcare to children. States are obliged to ensure that adolescents have access to appropriate education and information that is essential for their health and development, have opportunities to participate in decisions affecting their health as well as to freely make appropriate health behaviour choices.
Comprehensive:
In order to realize the health rights of children, article 24(2)(b) of the CRC obliges States to to ensure the provision of necessary medical assistance and health care to all children with emphasis on ‚the development of primary health care‘.[1] Both the ICESCR and the CRC require States to take effective steps to reduce infant and child mortality.[2]
According to the Declaration of Alma Ata primary health care is essential health care that is universally accessible to individuals and families in the community through their full participation at an affordable cost, and constitutes the first element of the healthcare process.[3] Primary health care includes
at least education concerning prevailing health problems and the methods of preventing them, promotion of food supply and proper nutrition, and adequate supply of safe water and basic sanitation, maternal and child healthcare, including family planning, immunization against the major infectious diseases (which are essential for the reduction of child mortality), prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries and provision of drugs.[4]
The provision of primary heathcare for children is part of the minimum core obligations of States under the ICESCR.[5] Thus, States must ensure that quality primary health care, which includes, functional hospitals and health centres providing antenatal and maternal healthcare services, emergency obstetric care, and essential medicines for the prevention and treatment of child diseases and injuries are
(a) available in sufficient quantity and
(b) physically and economically accessible for all children without discrimination.[6]
While physical accessibility means that primary healthcare must be within the physical reach of all children, including children living in rural areas, economic accessibility entails that primary healthcare must be affordable for all children or their parents including those living in poverty.[7]
The CRC specifically enjoins states to strive to ensure that children with disability have full and equal access to primary health care services which shall be free of charge whenever possible[8]. Primary healthcare for adolescents should be sensitive to their needs providing special attention to sexual and reproductive health and mental health.[9] Adolescents should have access to appropriate education and information that is essential for their health and development, have opportunities to participate in decisions affecting their health as well as to freely make appropriate health behaviour choices.[10] To this end, available primary healthcare for adolescents must be sensitive to their needs with special attention to sexual and reproductive health and mental health.[11] Thus failure of the State to develop effective measures to remove barriers hindering adolescents’ access to appropriate education, information, treatment, care[12] as well as prevention measures for sexually transmitted diseases (STDs) including HIV/AIDS,[13] or to adopt legislation to combat practices that either increase adolescents’ risk of infection or contribute to the marginalization of adolescents who are already infected with STDs or HIV/AIDS[14] constitute violations of their right to health.
The obligation to provide primary healthcare requires States to carry out regular immunization exercises on all children against the prevailing major infectious diseases and also ensure that all children and their mothers have access to adequate food and nutritious diets, clean drinking water, proper sanitation and sanitary facilities.[15] Also, breastfeeding strengthens the immunity of the child against diseases and is therefore important to child health, growth and development. Accordingly, the CRC requires States to promote the advantages of breastfeeding and ensure that parents have access to adequate information on the proper use of breastmilk substitutes when necessary.[16]
Denial of primary healthcare to children exists in all situations where functional primary health centres are insufficiently available; where health centres or medical professionals are concentrated in urban areas; and where there is limited availability or relatively prohibitively high cost of essential children drugs. Furthermore, incidences of low coverage of vaccinations, low breastfeeding rates, and high incidences of malnutrition and micro-nutrition deficiencies, high prevalence of malaria are evidence of denial of access to primary healthcare to children.
[1] See also ICESCR art 12(1); CRC art 24.
[2] Article 12(2)(a) of ICESCR; Article 24(2)(b) CRC; African Children’s Charter art 14(2)(a)
[3] Declaration of Alma Ata, International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, para VI.
[4] Declaration of Alma Ata, para VII
[5] CESCR General Comment 14 para 43.
[6]Article 24(2) of CRC. There must also be no discrimination in access irrespective of the child or his or her parents legal guardians’ race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status.
[7]The CESCR Committee has stated that payment for health-care services whether privately or publicly provided, should be affordable for all without discrimination, including socially disadvantaged groups. See also CRC Committee Concluding Observations: Kenya (2001) para 44 recommending the abolition or rationalisation of cost sharing in primary healthcare in order to facilitate greater access to services and reduce the burden on poor families.
[8] Article 23(3) of CRC
[9] CRC Committee, General Comment 4 para 41(a).
[10] CRC Committee General Comment 4 para 39(b)
[11] CRC Committee General Comment 4 para 41(a).
[12] CRC Committee General Comment 3 para 20
[13] CRC Committee General Comment 3 para 16
[14] CRC Committee General Comment 4 para 30
[15] Article 24(2)(c)
[16] Article 24(2)(d) of CRC; The Global Strategy for infant and young child feeding endorsed in 2002 by the World Health Assembly (WHA55/2002/REC/1, Annex 2)