How critical a role can taxation play in the debate on strengthening the right to health?
Laila Abdul Latif
Forum on strengthening the right to health: Shared Issues? Shared Analysis, Strategic Meeting on global health and governance for
health. Rome - Italy
THE RIGHT TO HEALTH AND ITS FINANCING
Article 2.1 ICESCR (Governments to take steps to progressively realise the right to health through maximum available resources by all appropriate means including adoption of laws)
The Kenyan approach under Article 43 of the Constitution (separated socio economic rights from human rights; financing through social security and insurance schemes)
Tax Justice Network Perspective: Linking tax to human rights
Missing factor in debates on the attainment of the right to health (MDGs context): is the issues of finance
Rights require resources!
The upholding of rights requires finance and without financial resources, then it would be a fallacy to talk of rights. To achieve all the components that are said to comprise the right to health, infrastructure is needed and for such infrastructure to be availed, then financing is vital.
– Dr. Attiya Waris, University of Nairobi, School of Law
Why Does Health Financing Matter?
Enormous mismatch between countries health financing needs and
their current health spending
Low income countries carry 90% of the world’s health burden yet
only 12% of global health spending occurs in these countries
Mere increase in resource and spending is not enough to fully
realise the right to health
WHAT CAN BE DONE?
There is a need to restructure and reform the health systems –
social insurance financing program as well as private insurance
financing: looking to Islamic taxation as an option in Kenya
Larger portions of national budget to be assigned to the health
sector
Implement legal domestic enforcement of health policy initiatives
and funding
SUGGESTED MODEL ON FINANCING HEALTH
Reference: Dr Attiya Waris, Tax and Development
SUGGESTED MODEL ON FINANCING HEALTH (2)
Reference: Dr Attiya Waris, Tax and MDGs
SUGGESTED MODEL ON FINANCING HEALTH (3)
Reference: Dr Attiya Waris, Tax and MDGs
SUGGESTED MODEL ON FINANCING HEALTH (4)
Reference: Dr Attiya Waris, Tax and MDGs
All Things Must Pass: October 2002
WHY IS IT IMPORTANT TO LINK TAXATION TO THE REALISATION OF
HUMAN RIGHTS?
Broad tax base ensures that all income and wealth is taxed
A narrow tax base is vulnerable to fiscal crisis, and narrow interest group
capture of the state
Tax per GDP ratio is a key measure of governance and welfare
Need to understand its dynamics of components, and not confuse with total
government revenue / expenditure.
Tax expenditure estimates are crucial, need much more research; See the tables
next…
All Things Must Pass: October 2002 11
Tax per GDP
<10% (n=16)
10%-15% (n=19)
15%-20%(n=9)
>20%(n=7)
Country
Algeria, Angola, Central African Republic, Chad, Comoros, Democratic Republic of Congo, Republic of Congo, Equatorial Guinea, Guinea-Bissau, Liberia, Libya, Madagascar, Niger, Nigeria, Sudan, Sao Tome and Principe
Botswana, Burkina Faso, Cameroon, Côte d’Ivoire, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Guinea, Malawi, Mali, Mozambique, Rwanda, Sierra Leone, Tanzania, Togo, Tunisia, Uganda
Benin, Burundi, Cape Verde, Ghana, Kenya, Mauritius,Morocco, Senegal, Zambia
Djibouti, Lesotho, Mauritania, Namibia, Seychelles, South Africa, Swaziland
All Things Must Pass: October 2002
Tax and
Development
Tax per GDP
includes:
Direct tax
Indirect tax
Trade tax
Resource revenues
are not included
Non-tax revenues
not studied
Tax revenue has
strongest
relationship
Tax and
Development
The lesser taxation
contributes to a
country’s GDP the
higher the rate of
mortality
The more taxation
contributes to a
country’s GDP the
lesser mortality
THE END