INTRODUCTION

In 2018 the Astana Declaration was endorsed by all World Health Organization (WHO) member states, 40 years after the Alma Ata Declaration, which committed governments to provide “health for all”. Although this was ostensibly a celebration of four decades of work promoting primary healthcare (PHC) and universal health provision, critics used it as a moment to reflect on how far the global health agenda has moved away from the commitment to social justice and the right to health that is at the core of the Alma Ata Declaration.

The debate around a universal provision in health is highly contested and open to diverse interpretations of universalism and the best way to implement and finance the universal health coverage (UHC) agenda (Yi, Koechlein & de Negri Filho 2017). Nevertheless, critics argue that UHC typically encourages systems with state-purchased services, provided either entirely by the private sector or by a mix of private and public providers. Such configurations encourage the participation of private, for-profit insurance corporations. Benefits packages purchased in these configurations generally utilize tiers for the poor and non-poor (Smithers & Waitzkin 2022: 1). For the People's Health Movement (PHM), a global movement of health activists, academics and civil society organizations, the Astana Declaration clearly articulated this shift. It became the “de facto international strategy for financing health services” (PHM 2022: 86).

Within this vision, governments are relegated to a regulatory and governing role. Thus, if states are no longer tasked with financing healthcare services, what does this mean for the right to health? As of 2022 171 state parties have signed up to the International Covenant on Economic, Social and Cultural Rights (ICESCR), which recognizes the right to health (UNGA 1966: art. 12). The right to the highest attainable standard of health is codified in numerous legally binding international and regional human rights treaties, and over 100 constitutions worldwide (Khosla, Allotey & Gruskin 2022). Furthermore, there is also a consensus on the importance of a holistic view of this right. Paul Hunt (2006: 604), former special rapporteur on the right to health, contends: