La lutte contre les fléaux sanitaires enregistre un nombre pléthorique d’acteurs, opérant avec des instruments et des stratégies différents. Cette pluralité d’acteurs et d’instruments affecte la cohérence du cadre organico-fonctionel de protection du droit à la santé et pose un véritable défi de coordination. Notre étude axée sur le cas spécifique du Sénégal, interroge les mécanismes actuels de coordination qui ont montré leurs limites à l’épreuve de la pratique, tant au niveau national qu’international. Dans l’ordre interne sénégalais, l’impératif de coordination des actions sanitaires est plus affirmé que traduit dans la réalité. Au niveau international, les multiples dispositifs de coordination se caractérisent par une approche statique, largement dépassée par les réalités complexes du droit de la santé. Cette thèse se propose de dépasser l’approche statique pour une stratégie dynamique de la coordination, centrée sur le mécanisme de régulation. Plus adaptée aux déséquilibres qui caractérisent le cadre de protection du droit à la santé, la coordination-régulation que nous avons retenue, s’attachera à assurer une bonne articulation entre le principe de la responsabilité et la gouvernance sanitaire pour une plus grande efficacité des actions sanitaires dans les États en développement, à travers l’exemple du Sénégal.Mots clés : Coordination, Sénégal, OMS, fragmentation des actions sanitaires, droit à la santé, ONG, approche verticale, approche systémique, efficacité, efficience, gouvernance sanitaire, responsabilité sanitaire, régulation, déséquilibres, médecine traditionnelle, approche dynamique, fléaux sanitaires, politiques nationales, télémédecine. / Strategies. This plurality of actors and instruments affects the coherence of the organic-functional framework for the protection of the right to health and poses a real coordination challenge. Our study focuses on the specific case of Senegal, questions the current coordination mechanisms that have shown their limits to the test of practice, both nationally and internationally. In the Senegalese internal order, the imperative coordination of health actions, although present in speeches and texts, is insufficiently translated into reality. At the international level, the multiple coordination mechanisms are characterized by a static approach that has been largely overtaken by the new realities of health law. This thesis offers to go beyond a static approach for a dynamic strategy of coordination, centered on the regulation mechanism. More adapted to the imbalances that characterize the framework of protection of the right to health, the coordination -regulation will seek to ensure a good articulation between the principle of the responsibility and the sanitary governance for a greater effectiveness of the sanitary actions in the States in development, through the example of Senegal;

La thèse se propose d’analyser la nature des relations générées entre le pouvoir des sociétés multinationales et transnationales et les Etats, afin de rechercher l’ensemble des obligations internationales impliquées concernant les droits de l'homme et, plus spécifiquement, celles relatives au droit universel à la santé. En effet, il est de plus en plus évident que les sociétés transnationales sont en mesure de causer des risques considérables, susceptibles de provoquer des conséquences néfastes sur le droit à la santé des individus, ou bien encore, sur les « déterminants de la santé ». À la lumière de ces considérations et en constatant l’ampleur de la problématique, la thèse se focalise sur les obligations spécifiques liées aux secteurs de l’industrie pharmaceutique, des compagnies de tabac et des multinationales du secteur alimentaire. Le travail de recherche a été rédigé selon les critères académiques utilisés classiquement en Italie et est fondée sur un argumentaire articulé en trois chapitres principaux, une introduction et une conclusion finale. / The thesis aims to analyse the nature of the relationships generated between the power of multinational and transnational corporations and States, in order to identify all the international human rights obligations involved and more specifically, those relating to the universal right to health. According to the economic system established by the Western Countries and the globalization, transnational corporations are able to cause considerable risks, which may have adverse consequences on the Human Right to Health, or even “determinants of health”. In the light of these considerations and due to the extent of the issue, the thesis has been focused on the analysis of specific obligations related to the sectors of pharmaceutical industries, the tobacco corporations and the multinational food companies. The thesis was written according to the academic criteria traditionally used in Italy and is based on argumentation articulated in three main chapters, an introduction and a final conclusion. / Il proposito della tesi è quello di offrire un’indagine accurata concernente la natura delle relazioni che si generano tra il potere delle imprese transnazionali e le autorità statali, della trama degli obblighi internazionali implicati, in modo particolare alla luce di violazioni di diritti umani che potrebbero generarsi. Il liberalismo economico, la promozione degli scambi con relativo abbattimento delle barriere territoriali, il mercato globale hanno condotto al generarsi di formazioni industriali globalizzate con forze economiche tali da influenzare gli assetti politici di un Paese, andando dunque ben oltre le funzioni specifiche di mera produzione e immissione sul mercato dei propri prodotti. Preliminarmente, è interessante capire come la dottrina internazionalistica affronta e definisce le perplessità relative alla configurazione di una soggettività di diritto internazionale “eccezionalmente riconosciuta”, che poi costituirà la base per le riflessioni a venire. La prima riguarda la transnazionalità dell’impresa. Questa peculiarità costitutiva, figlia del mercato globalizzato, consente al meccanismo del sistema produttivo di sottrarre un’unità specifica dalla riconduzione territoriale della cd. Casa madre, pur restandone parte integrante.Lo stato dell’arte del diritto internazionale prevede, in capo all’autorità statale ospitante, un obbligo incombente di regolamentazione e controllo dell’attività svolta dalle imprese sul proprio territorio. Tuttavia, nella prassi si riscontrano circostanze di Stati deboli dal punto di vista legislativo, con carenti strumenti di tutela e scarse risorse, tali da renderli proprio per questo, mete ideali di soggetti investitori che intendono eludere le più rigide disposizioni vigenti nei propri Paesi di origine.Il ruolo delle società multinazionali oggi, di quelle transnazionali in particolare per alcuni, consente di poter ridiscutere dei capisaldi di un diritto internazionale definito stato-centrico e della propria capacità di riuscire a rispondere alle esigenze dei tempi correnti. Se è vero che il diritto internazionale nasce con il precipuo scopo di regolare i rapporti tra Stati, ai quali viene attribuita un’esclusiva personalità giuridica che li rende idonei ad essere titolari di diritti e obblighi giuridici, nella prassi delle relazioni emerge una realtà molto più complessa di questa.L’istituzione dell’Open Ended Intergovernmental Working Group che proseguono il lavoro del Relatore Speciale, il Professor Ruggie, lascia trasparire quanto il tema sia al centro dello sviluppo sui diritti umani della Nazioni Unite. Sulla stessa linea si sta sviluppando una legislazione anche in seno al Consiglio d’Europa con l’adozione della raccomandazione CM/Rec (2016)3 del novembre 2016, nonché in UE con la direttiva 2014/95/UE sull’obbligo di pubblicazione delle informazioni non finanziarie.Alla luce di tali circostanze, la tesi analizza il tema specifico della responsabilità delle imprese transnazionali in materia di rispetto e promozione del diritto alla salute e dei suoi determinanti, a fronte della diffusione epidemica delle malattie non trasmissibili. Per questo il lavoro di ricerca si concentra sugli obblighi specifici relativi ai settori delle imprese farmaceutiche, produzione e commercializzazione di tabacco, food corporations.

On observe des disparités importantes en matière de santé entre les Autochtones et les non-Autochtones au Canada. Ces inégalités démontrent l’importance d’agir afin de décoloniser les systèmes de santé canadiens et nous amène à nous demander si une approche fondée sur les droits pourrait constituer une solution efficace pour améliorer la situation. Ce mémoire vise donc à déterminer s’il existe, dans le contexte juridique canadien, un droit autochtone à la santé qui permettrait aux peuples autochtones de présenter leurs revendications et d’assurer l’imputabilité des gouvernements canadiens. Pour y répondre, nous analysons d’abord les disparités en matière de santé à partir des données épidémiologiques disponibles et de la théorie des déterminants fondamentaux de la santé. Nous procédons ensuite à une analyse du droit constitutionnel canadien et du droit international afin de déterminer la mesure dans laquelle ils pourraient servir à la revendication d’un droit à la santé par les peuples autochtones dans le contexte juridique national. Ce mémoire délimite quatre fondements juridiques potentiels rattachés à l’article 35 de la Loi constitutionnelle de 1982 qui pourraient fonder un droit autochtone à la santé : 1) le droit à l’autonomie gouvernementale; 2) les droits issus de traités; 3) les droits ancestraux spécifiques; et 4) les droits ancestraux génériques fondés sur la normativité internationale. Une approche fondée sur les développements jurisprudentiels récents en matière de droit de la personne favorise aussi une compréhension approfondie de l’étendue des obligations des gouvernements canadiens envers les peuples autochtones en matière de santé. Cela nous mène à conclure que le droit canadien ne permet pas d’établir l’existence d’un droit à la santé absolu pour les Autochtones, mais qu’un tel droit peut néanmoins exister sous certaines formes plus spécifiques qui répondent au besoin de prévisibilité du droit. / There are significant health disparities between Aboriginal and non-Aboriginal peoples in Canada. These inequalities highlight the importance of decolonizing Canadian health care systems and lead us to wonder whether a rights-based approach could constitute an effective solution to improve the situation. This thesis therefore aims to determine whether there exists, in the Canadian legal context, an Aboriginal right to health that would allow Aboriginal peoples to articulate their claims and ensure the accountability of Canadian governments. To answer this, we first analyze health disparities based on available epidemiological data and the theory of fundamental determinants of health. We then proceed to an analysis of Canadian constitutional law and international law to determine the extent to which they could be used for the assertion of a right to health by Indigenous peoples in the national legal context. This thesis delineates four potential legal bases flowing from section 35 of the Constitution Act, 1982, that could serve as a basis for argument in support of an existing Aboriginal right to health: 1) self-government rights; 2) treaty rights; 3) specific Aboriginal rights; and 4) generic Aboriginal rights based on international normativity. An approach grounded in recent human rights case law developments also serves to foster greater understanding of the extent of Canadian governments' obligations towards Indigenous peoples with respect to health. This analysis leads us to conclude that Canadian law do not support the existence of an unlimited right to health for Aboriginal peoples, but that such rights can nevertheless exist in more specific forms that respect the need for legal predictability.

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The aim of this dissertation is to examine and analyse the judicial framework pertaining to kidney transplants in South Africa. The examination is conducted within the framework of the South African Constitution and the National Health Act 61 of 2003. The specific focus of this dissertation is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable. A comparative study is undertaken, with Singapore and Iran as a background against which recommendations for the South African regulatory framework are made. The most important finding is that people should at least be granted the choice whether they would prefer to receive payment for their kidney donations or not. / Jurisprudence / LL.M.

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM

INTRODUÇÃO: Esta tese trata da discussão em torno às perguntas necessárias para compor uma agenda política estratégica da reforma hospitalar brasileira. Buscou-se construir argumentos sobre a relevância de abordar nessas perguntas a grande insuficiência da oferta de leitos hospitalares, como indicador da falta de resposta oportuna em volume e qualidade para materializar a resposta às necessidades da população e garantir os direitos humanos e sociais à saúde, conforme os preceitos constitucionais de 1988. MÉTODOS: O estudo adotou um enfoque desde a perspectiva de política de saúde, o que nos remete ao debate sobre processo e poder, destacando os ciclos de formulação e implementação de políticas, a hierarquização desses debates como de política estratégica (High Politics) ou setorial (Low Politics) e as condições requeridas em termos de atores e espaços de decisão a considerar. Realizou-se a revisão da experiência internacional para identificar as referências do número e perfil de leitos requeridos para atender populações nacionais em seus territórios e também foram resgatados os parâmetros adotados no Brasil desde o Estado Novo. Para a análise da oferta hospitalar entre 2005 e 2014, foram utilizados os dados secundários extraídos do Cadastro Nacional de Estabelecimentos em Saúde - CNES, do Sistema de Informações Ambulatoriais e Hospitalares - SIA / SIH, da Agencia Nacional de Saúde Suplementar - ANS e do Instituto Brasileiro de Geografia e Estatística - IBGE. RESULTADOS: 1. O número e tipo de leitos necessários e o número, porte, tipo e características sistêmicas dos serviços hospitalares que os abrigariam, são temas que se consideraram relevantes para compor as perguntas para a agenda estratégica em debate. 2. A análise da política do período 2004 a 2014 permite identificar a fragmentação e descontinuidade das ações mesmo obtendo resultados pontuais de melhora, mas afastando-se da promessa estratégica de algumas agendas ensaiadas no período. 3. Ganhou destaque a diminuição continuada do estoque geral de leitos e de leitos para o SUS, alcançando níveis muito inferiores a qualquer parâmetro comparativo de outros sistemas universais de saúde, particularmente quando adotou-se o critério de leitos efetivos para examinar a oferta de leitos e seu desempenho. Na Saúde Suplementar houve aumento de leitos, porém queda no número por mil assegurados dado o crescimento das coberturas hospitalares no período. CONCLUSÕES: A crise persistente de acesso hospitalar constitui razão para construir uma agenda estratégica para a reforma hospitalar brasileira. Ao buscar o caminho para elevar o tema da crise hospitalar a um tratamento de alta política, foram mapeados: o conteúdo de política hospitalar dos planos estaduais de saúde, documentos técnicos estaduais e organogramas de coordenação da atenção hospitalar estadual, examinando-se a possibilidade dos governos estaduais liderarem no processo de regionalização a construção de uma agenda política estratégica estadual e nacional, fortalecendo o diálogo entre os entes federados, incluindo seus próprios prestadores e os prestadores não estatais particularmente os filantrópicos, além de estender o diálogo com o corpo médico e os usuários entendidos como cidadãos sujeitos de direitos. Para alicerçar este caminho possível se apresenta o processo de elaboração participativa de planos diretores de redes e hospitais por estados e suas regiões, como forma de construção de comunidades epistêmicas e suas projeções para a sustentação de uma agenda para a alta política, orientada a alcançar 4 leitos por 1000 habitantes em 20 anos de esforço sustentado / INTRODUCTION: This thesis addresses the debate on the questions that should be part of a strategic political agenda of the Brazilian hospital reform. The purpose is to develop arguments on the relevance that such questions should approach the huge insufficient supply of hospital beds, as an indicator of the lack of timely answer, in number and quality, to materialize people\'s needs, and therefore to guarantee the human and social rights to health, according to the 1988 constitutional principles. METHODS: This study adopts the approach from the health policy perspective, referring us to debates on process and power, and outlining the cycles of policy formulation and implementation, as well as the classification of these debates as strategic policy (High Politics) or sectorial policy (Low Politics), and the required conditions in terms of actors and decision-making spaces. A review of international experience was carried out to identify data on number and types of hospital beds necessary to attend national populations in their territories; moreover a review of the parameters adopted in Brazil since President Vargas\' dictatorship, known as the New State (1937-1945), was also carried out. For the analysis of the hospital supply between 2005 and 2014, we used secondary data drawn from the National Health Facilities Register - CNES, both the Ambulatory and Hospital Information Systems - SIA / SIH, National Regulatory Agency for Private Health Insurance and Plans - ANS, and Brazilian Institute of Geography and Statistics - IBGE. RESULTS: 1. The topics considered relevant to set the issues for the strategic agenda are: number and type of necessary beds; and number, size, type and systemic characteristics of the hospital services that would provide the beds. 2. The political analysis of the period between 2004 and 2014 allows us to identify fragmentation and discontinuity of actions, limited improvement, and failure to fulfil the strategic promise of some agendas that were tried out during that time frame. 3. The on-going decrease in the total number of national hospital beds and at the Unified Health System (SUS) is outlined, showing much lower levels than any comparative parameter of other universal national health systems, particularly when considering effective beds in the analysis of beds\' supply and its performance. In Private Health, there has been an increase in beds, but also a decrease in the number per 1,000 insureds in view of the increase in the insurance coverings in that period. We refer the persistent crisis of the hospital access as the reason to build a strategic agenda for the Brazilian hospital reform. CONCLUSIONS: In our effort to find a path that could elevate the hospital crisis\' topic to be addressed as a high politics, we delineated the content of hospital policy in Brazilian States\' health plans, technical documents, and organization charts of their hospital care coordination; considering the possibility of States\' governments lead, in the regionalization process, the development of both state and national strategic political agenda; as well as strengthen dialogue among the federated entities and the non-state providers, especially the philanthropic ones; and also extend the dialogue with medical professionals and service users who should be regarded as citizens-subjects endowed with rights. To pave this possible path we indicate the process of participative development of director plans of hospitals networks for the States and their regions, as a mean of developing epistemic communities and their projections to the sustainability of an agenda for high politics aimed to achieve 4 beds for 1,000 inhabitants in 20 years of sustained effort

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM

INTRODUÇÃO: Esta tese trata da discussão em torno às perguntas necessárias para compor uma agenda política estratégica da reforma hospitalar brasileira. Buscou-se construir argumentos sobre a relevância de abordar nessas perguntas a grande insuficiência da oferta de leitos hospitalares, como indicador da falta de resposta oportuna em volume e qualidade para materializar a resposta às necessidades da população e garantir os direitos humanos e sociais à saúde, conforme os preceitos constitucionais de 1988. MÉTODOS: O estudo adotou um enfoque desde a perspectiva de política de saúde, o que nos remete ao debate sobre processo e poder, destacando os ciclos de formulação e implementação de políticas, a hierarquização desses debates como de política estratégica (High Politics) ou setorial (Low Politics) e as condições requeridas em termos de atores e espaços de decisão a considerar. Realizou-se a revisão da experiência internacional para identificar as referências do número e perfil de leitos requeridos para atender populações nacionais em seus territórios e também foram resgatados os parâmetros adotados no Brasil desde o Estado Novo. Para a análise da oferta hospitalar entre 2005 e 2014, foram utilizados os dados secundários extraídos do Cadastro Nacional de Estabelecimentos em Saúde - CNES, do Sistema de Informações Ambulatoriais e Hospitalares - SIA / SIH, da Agencia Nacional de Saúde Suplementar - ANS e do Instituto Brasileiro de Geografia e Estatística - IBGE. RESULTADOS: 1. O número e tipo de leitos necessários e o número, porte, tipo e características sistêmicas dos serviços hospitalares que os abrigariam, são temas que se consideraram relevantes para compor as perguntas para a agenda estratégica em debate. 2. A análise da política do período 2004 a 2014 permite identificar a fragmentação e descontinuidade das ações mesmo obtendo resultados pontuais de melhora, mas afastando-se da promessa estratégica de algumas agendas ensaiadas no período. 3. Ganhou destaque a diminuição continuada do estoque geral de leitos e de leitos para o SUS, alcançando níveis muito inferiores a qualquer parâmetro comparativo de outros sistemas universais de saúde, particularmente quando adotou-se o critério de leitos efetivos para examinar a oferta de leitos e seu desempenho. Na Saúde Suplementar houve aumento de leitos, porém queda no número por mil assegurados dado o crescimento das coberturas hospitalares no período. CONCLUSÕES: A crise persistente de acesso hospitalar constitui razão para construir uma agenda estratégica para a reforma hospitalar brasileira. Ao buscar o caminho para elevar o tema da crise hospitalar a um tratamento de alta política, foram mapeados: o conteúdo de política hospitalar dos planos estaduais de saúde, documentos técnicos estaduais e organogramas de coordenação da atenção hospitalar estadual, examinando-se a possibilidade dos governos estaduais liderarem no processo de regionalização a construção de uma agenda política estratégica estadual e nacional, fortalecendo o diálogo entre os entes federados, incluindo seus próprios prestadores e os prestadores não estatais particularmente os filantrópicos, além de estender o diálogo com o corpo médico e os usuários entendidos como cidadãos sujeitos de direitos. Para alicerçar este caminho possível se apresenta o processo de elaboração participativa de planos diretores de redes e hospitais por estados e suas regiões, como forma de construção de comunidades epistêmicas e suas projeções para a sustentação de uma agenda para a alta política, orientada a alcançar 4 leitos por 1000 habitantes em 20 anos de esforço sustentado / INTRODUCTION: This thesis addresses the debate on the questions that should be part of a strategic political agenda of the Brazilian hospital reform. The purpose is to develop arguments on the relevance that such questions should approach the huge insufficient supply of hospital beds, as an indicator of the lack of timely answer, in number and quality, to materialize people\'s needs, and therefore to guarantee the human and social rights to health, according to the 1988 constitutional principles. METHODS: This study adopts the approach from the health policy perspective, referring us to debates on process and power, and outlining the cycles of policy formulation and implementation, as well as the classification of these debates as strategic policy (High Politics) or sectorial policy (Low Politics), and the required conditions in terms of actors and decision-making spaces. A review of international experience was carried out to identify data on number and types of hospital beds necessary to attend national populations in their territories; moreover a review of the parameters adopted in Brazil since President Vargas\' dictatorship, known as the New State (1937-1945), was also carried out. For the analysis of the hospital supply between 2005 and 2014, we used secondary data drawn from the National Health Facilities Register - CNES, both the Ambulatory and Hospital Information Systems - SIA / SIH, National Regulatory Agency for Private Health Insurance and Plans - ANS, and Brazilian Institute of Geography and Statistics - IBGE. RESULTS: 1. The topics considered relevant to set the issues for the strategic agenda are: number and type of necessary beds; and number, size, type and systemic characteristics of the hospital services that would provide the beds. 2. The political analysis of the period between 2004 and 2014 allows us to identify fragmentation and discontinuity of actions, limited improvement, and failure to fulfil the strategic promise of some agendas that were tried out during that time frame. 3. The on-going decrease in the total number of national hospital beds and at the Unified Health System (SUS) is outlined, showing much lower levels than any comparative parameter of other universal national health systems, particularly when considering effective beds in the analysis of beds\' supply and its performance. In Private Health, there has been an increase in beds, but also a decrease in the number per 1,000 insureds in view of the increase in the insurance coverings in that period. We refer the persistent crisis of the hospital access as the reason to build a strategic agenda for the Brazilian hospital reform. CONCLUSIONS: In our effort to find a path that could elevate the hospital crisis\' topic to be addressed as a high politics, we delineated the content of hospital policy in Brazilian States\' health plans, technical documents, and organization charts of their hospital care coordination; considering the possibility of States\' governments lead, in the regionalization process, the development of both state and national strategic political agenda; as well as strengthen dialogue among the federated entities and the non-state providers, especially the philanthropic ones; and also extend the dialogue with medical professionals and service users who should be regarded as citizens-subjects endowed with rights. To pave this possible path we indicate the process of participative development of director plans of hospitals networks for the States and their regions, as a mean of developing epistemic communities and their projections to the sustainability of an agenda for high politics aimed to achieve 4 beds for 1,000 inhabitants in 20 years of sustained effort

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The aim of this dissertation is to examine and analyse the judicial framework pertaining to kidney transplants in South Africa. The examination is conducted within the framework of the South African Constitution and the National Health Act 61 of 2003. The specific focus of this dissertation is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable. A comparative study is undertaken, with Singapore and Iran as a background against which recommendations for the South African regulatory framework are made. The most important finding is that people should at least be granted the choice whether they would prefer to receive payment for their kidney donations or not. / Jurisprudence / LL.M.