(d) To provide essential drugs, as from time to time defined
under the WHO Action Programme on Essential Drugs;
(e) To ensure equitable distribution of all health facilities,
goods and services;
(f) To adopt and implement a national public health strategy
and plan of action, on the basis of epidemiological
evidence, addressing the health concerns of the whole
Aside from these, the Committee stipulates a number of other obligations
which it posits as “obligations of comparable priority” including—and this is
very important to the discourse on fistula—an obligation to ensure
reproductive, maternal (pre-natal as well as post-natal) and child health
These specifications are the minimum or basic thresholds, which States
Parties to the ICESCR are under obligation to meet regardless of prevailing
economic circumstances in their respective jurisdictions.166 This strict
interpretation represents a striking departure from General Comment No. 3,
which excuses non-compliance with core obligations on the basis of resource
constraints.167 This more recent interpretation was emphatic that core
obligations are non-derogable regardless of the circumstances.168 The
Maastricht Guidelines holds these obligations applicable “irrespective of the
availability of resources of the country concerned or any other factors and
difficulties.”169 Non-derogability is premised on the understanding that
“compliance with such obligations may be undertaken by most States with
relative ease, and without significant resource implications.”170 The idea is
that no country is so resource challenged as to be incapable of responding to
basic health care needs of its people, particularly considering that “both the
resources within a State and those available from the international
community through international co-operation and assistance” are taken into
consideration in calculating the quantum of resources available for health.171
Non-derogable character of core obligations has very significant
synergistic relationship with the MDGs. In what seems like a preemption of
the Millennium Declaration, the Committee on ESCR interprets Art. 2( 1) of
164. Id. ¶ 43.
165. Id. ¶ 44.
166. Id. ¶ 43.
167. See General Comment No. 3, supra note 157, ¶ 10 (noting that “any assessment as
to whether a State has discharged its minimum core obligation must also take account of
resource constraints applying within the country concerned.”).
168. General Comment No. 14, supra note 143, ¶ 47.
169. Maastricht Guidelines, supra note 120, ¶ 9.
170. Id. ¶ 10.
171. General Comment No. 3, supra note 157,, ¶ 13; see also Limburg Principles, supra
note 120, ¶ 26.