Table 3: TB and the Right to the Highest Attainable Standard of Health
Examples of Human Rights Violations
- Persons with TB are denied access to quality TB treatment and care in prison.
- Persons with MRD-TB are denied tailored therapies of second-line drugs.
- Government failed to utilize donor resources to construct isolation wards.
|Human Rights Standards||Treaty Body Interpretation|
|ICESCR 12(1) The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.||CESCR: Expressing concern to Estonia about the high rate of cases of tuberculosis and recommending that “the State party intensify its efforts to combat the spread of tuberculosis.” E/C.12/1/ADD.85 (2002).
CESCR: Expressing concern to Moldova about the “rising incidence of tuberculosis in the State party and notes with particular concern the acuteness of this problem in prisons where the infection rate is more than 40 times higher than the national average” and recommending that “the State party intensify its efforts under the National Programme on Tuberculosis Prophylaxis and Control to combat the spread of tuberculosis, including by ensuring the availability of medicines and adequate sanitary conditions in prisons.” E/C.12/1/ADD.91 (2003).
CESCR: Expressing concern to Kyrgyzstan that new health threats such as the “reemergence of communicable and vaccine-preventable diseases such as tuberculosis” and urging “the State party to continue its efforts to address the prevailing health threats, and to target progressively resources to health services.” E/C.12/1/ADD.49 (2000).
CESCR: Expressing concern to Russian Federation “about the spread of drug addiction, including by way of injection, which is the main factor for the growing epidemic of HIV/AIDS, hepatitis C and tuberculosis in the Russian Federation” and urging “the State party to apply a human rights-based approach to drug users so that they do not forfeit their basic right to health.” E/C.12/RUS/CO/5 (CESCR, 2011).
CESCR: Expressing concern to Russian Federation about “the high incidence of tuberculosis in the State party, particularly in prisons, in the Republic of Chechnya and in the regions of the Far North, in particular among indigenous communities” and recommending that “the State party intensify its efforts to combat tuberculosis, under the special federal programme ‘Urgent measures to tackle tuberculosis in Russia for the period 1998-2004’, including by ensuring the availability of medicines and adequate sanitary conditions in prisons, and by taking special measures to combat the epidemic in the worst affected regions.” E/C.12/1/Add.94 (2003).
|Human Rights Standards||Treaty Body Interpretation|
|12(2) The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: . . . (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases.||CESCR: Expressing concern to the Ukraine that “information from the State party that in 2006, 70 persons out of 100,000 (80 out of 100,000 in rural areas) were suffering from tuberculosis, which has become the leading cause of death among persons with HIV/AIDS and is particularly prevalent among the prison population” and recommending that “the State party take urgent measures to improve tuberculosis prevention and accessibility of specialized tuberculosis treatment and medication, in particular in prisons, detention centres and police stations, and reduce delays in screening detainees for tuberculosis.” E/C.12/UKR/CO/5 (CESCR, 2008).
CESCR: Expressing concern to Azerbaijan “about overcrowding and sub-standard conditions in prisons in Azerbaijan which have given rise to a disproportionately high rate of tuberculosis and other health problems among prisoners” and recommending “that the State party continue to take measures to improve the sanitary and hygienic conditions in prisons and to ensure that the right to mental and physical health of all prisoners in Azerbaijan is respected.” E/C.12/1/Add.104 (2004).
CESCR: Expressing concern to India at the “high incidences of tuberculosis” and recommending that “the State party significantly increase its health-care expenditure, giving the highest priority to … treating serious communicable diseases, including HIV/AIDS.” E/C.12/IND/CO/5 (2008).
CESCR: Expressing concern to India about the “overcrowding and sub-standard conditions in prisons which are operating at 200-300 per cent of their maximum capacity, which have given rise to a disproportionately high rate of tuberculosis and other health problems affecting the prisoners” and recommending that “the State party strengthen its measures to improve the sanitary and hygienic conditions in prisons and to ensure that the right to mental and physical health of all prisoners is respected” E/C.12/IND/CO/5 (2008).
CESCR: Expressing concern to Uzbekistan “about the absence of adequate health care and the poor hygienic conditions in prisons that lead to frequent tuberculosis infections of detainees” and recommending that the “State party to take measures to improve the hygienic conditions in prisons and to ensure that the right to health of all detainees in the State party is respected” E/C.12/UZB/CO/1 (2006).
|CRC 24(1) States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.||CRC: Expressing concern that malaria and TB were re-emerging in Malaysia and recommended that the government “[p]revent and reduce the spread of tuberculosis and malaria.” CRC/C/MYS/CO/1 (2007).
CRC: Expressing concern in Latvia at increasing rates of TB and recommended that the government “[offer] HIV-related care and treatment… including for the prevention and treatment of health problems related to HIV/AIDS, such as tuberculosis and opportunistic infections.” CRC/C/LVA/CO/2 (2006).
CRC: Recommending that Turkmenistan “[a]ddress the issue of underreporting of communicable and infectious diseases, particularly HIV/AIDS and tuberculosis.” CRC/C/TKM/CO/1 (2006).
CRC: Recommending that Lithuania “[strengthen] its efforts to implement the National Tuberculosis Prevention and Control Programme for 2003–2006.” CRC/C/LTU/CO/2 (2006).
CRC: Expressing concern in Russia “that the number of tuberculosis cases remains high” and recommending that the government “continue efforts to reduce morbidity due to tuberculosis.” CRC/C/RUS/CO/3 23 (2005).
CRC: Recommending that the Central African Republic “strengthen its efforts to combat HIV/AIDS infection, including through efforts to combat tuberculosis.” CRC/C/15/Add.138 (2000).
Policy on Collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders (WHO, 2012). Extensive discussion of TB prevention, treatment and care options.
WHO Guidelines for the programmatic management of drug-resistant tuberculosis (WHO, 2011):
Recommendation 6. Patients with MDR-TB should be treated using mainly ambulatory care rather than models of care based principally on hospitalization….
WHO Guidance on ethics of tuberculosis prevention, care and control (WHO, 2010):
The obligation to provide access to TB Services. Governments’ ethical obligation to provide universal access to TB care is grounded in their duty to fulfil the human right to health…. The obligation to provide universal access to TB care implies a duty to ensure the quality of that care.
All aspects of TB care should be provided free of charge…. It is also important to remove non-TB-specific financial barriers to accessing the health-care system, such as user fees that prevent poor people from receiving health-care services, or charges imposed on TB patients for the care of related conditions (e.g. HIV)….
As WHO has recognized, “community-based care provided by trained lay and community health workers can achieve comparable results [to hospitalization] and, in theory, may result in decreased nosocomial spread of the disease”. In addition, community-based care reduces burdens on health-care facilities and is more cost effective than facility-based treatment, thereby enabling governments with limited resources to serve the greatest proportion of those in need.
Resolution WHA 62.15, Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis (WHO, 2009):
Para. 1. Achieve “universal access to diagnosis and treatment of multidrug-resistant and extensively drug-resistant tuberculosis as part of the transition to universal health coverage”.
Para. 1(a). Develop “a comprehensive framework for management and care of [MDR- and XDR-TB] that includes directly-observed treatment, community-based and patient-centred care, and which identifies and addresses the needs of persons living with HIV, the poor and other vulnerable groups, such as prisoners, mineworkers, migrants, drug users, and those dependent on alcohol, as well as the underlying social determinants of tuberculosis”.
Para. 1(b). Strengthen “health information and surveillance systems to ensure detection and monitoring of the epidemiological profile of [MDR- and XDR-TB] and monitor achievement in its prevention and control”.
Para. 1(d). Make “available sufficiently trained and motivated staff in order to enable diagnosis, treatment and care of tuberculosis”.
Para. 1(e). Strengthen “laboratory systems, through increasing capacity and adequate human resources, and accelerating access to faster and quality-assured diagnostic tests”.
Para. 1(f). Engage “all relevant public and private health-care providers in managing tuberculosis… and tuberculosis-HIV coinfection according to national policies, and strengthening primary health care in early detection, effective treatment and support to patients”.
Para. 1(g). Ensure “that national airborne infection-control policies are developed… and implemented in every health-care facility and other high-risk settings…”.
Para. 1(h). Ensure “an uninterrupted supply of first- and second-line medicines for tuberculosis treatment… and that quality-assured fixed-dose combination medicines of proven bioavailability are prioritized within a system that promotes treatment adherence”.
Para. 1(i). Strengthen “mechanisms to ensure that tuberculosis medicines are sold on prescription only and that they are prescribed and dispensed by accredited public and private providers”.
Para. 1(k). Establish “national targets in order to accelerate access to treatment, according to WHO guidelines, for [MDR- and XDR-TB] patients”. Resolution WHA 62.15.
Beijing Call for Action on Tuberculosis control and patient care: together addressing the global MDR-TB and XDR-TB
epidemic (WHO, 2009):
Para. 1(l). Identifying and addressing the underlying social determinants of TB and M/XDR-TB. This needs action both within and outside the health system, and should be linked to broader national initiatives to ensure “health in all policies”.
Para. 1(b). Ensuring the removal of financial barriers to allow all TB patients equitable access to TB care, that their rights are protected, and that they are treated with respect and dignity.
WHO Policy Guidelines for Collaborative TB and HIV Services for Injecting and Other Drug Users (WHO, 2008):
Recommendation 10. All services dealing with drug users should collaborate locally with key partners to ensure universal access to comprehensive TB and HIV prevention, treatment and care as well as drug treatment services for drug users in a holistic person-centred way that maximizes access and adherence: in one setting, if possible.
SR Health (2006): Commenting that the “socio-economic consequences of stigmatization and discrimination can have devastating consequences” for marginalized individuals in Uganda: “stigma related to tuberculosis can be greater for women: it may lead, inter alia, to ostracism, rejection and abandonment by family and friends, as well as loss of social and economic support” and recommending that all relevant actors “urgently consider whether or not the national and international programmes in relation to HIV/AIDS, tuberculosis and malaria could also enhance interventions for other diseases”. E/CN.4/2006/48/Add.2 (2006)
Patients’ Charter for Tuberculosis Care (World Care Council, 2006):
Care. The right to free and equitable access to tuberculosis care, from diagnosis through treatment completion, regardless of resources, race, gender, age, language, legal status, religious beliefs, sexual orientation, culture, or having another illness. The right to receive medical advice and treatment… centering on patient needs, including those with multidrug-resistant tuberculosis (MDR-TB) or tuberculosis-human immunodeﬁciency virus (HIV) coinfections and preventative treatment for young children and others considered to be at high risk. The right to benefit from proactive health sector community outreach, education, and prevention campaigns as part of comprehensive care programs.
Security. The right to nutritional security or food supplements if needed to meet treatment requirements.
International Standards for Tuberculosis Care (Tuberculosis Coalition for Technical Assistance, 2006):
Standard 9. To foster and assess adherence, a patient-centered approach to administration of drug treatment, based on the patient’s needs and mutual respect between the patient and the provider, should be developed for all patients. Supervision and support should be gender-sensitive and age-specific and should draw on the full range of recommended interventions and available support services, including patient counseling and education.
Political Declaration on HIV/AIDS (UN General Assembly, 2006):
Para. 33. Emphasize the need for accelerated scale-up of collaborative activities on tuberculosis and HIV, in line with the Global Plan to Stop TB 2006–2015, and for investment in new drugs, diagnostics and vaccines that are appropriate for people with TB-HIV co-infection.
Para. 34. Commit ourselves to expanding…our capacity to deliver comprehensive HIV/AIDS programmes in ways that strengthen existing national health and social systems, including by integrating HIV/AIDS intervention into [programmes for tuberculosis].
Abuja Call for Accelerated Action Towards Universal Access to HIV/AIDS, Tuberculosis and Malaria Services in Africa (African Union, 2006):
Protection of Human Rights. To continue promoting an enabling policy, legal and social environment that promotes human rights particularly for women, youth and children and ensure the protection of people infected and affected by HIV and AIDS, TB and Malaria and to reduce vulnerability and marginalization including conflict-affected and displaced persons, refugees and returnees.
Access to Affordable Medicines and Technologies. To… ensure the availability of medicines and commodities at affordable prices as well as technologies for the treatment, care and prevention of HIV and AIDS, TB and malaria including vaccines, medicines and Anti-retrovirus Therapy (ART). Sp/Assembly/ATM/2 (I) Rev.3 (2006).
Cairo Programme of Action of the United Nations International Conference on Population and Development (UN, 1994):
HIV/AIDS. 8.31. The links between the prevention of HIV infection and the prevention and treatment of tuberculosis should be assured.