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The COVID-19 Pandemic And Its Impact On Economic, Social And Cultural Rights

The right to health in a post-COVID-19 context: learning hard lessons

The COVID-19 pandemic has put the spotlight on structural and longstanding problems that are undermining the right to health, including fragmentation and inequalities within the health system. Delivering on the Sustainable Development Goals (SDGs) and guaranteeing gender-sensitive health public services require a people-centred and feminist approach to development finance that takes account of hard lessons learned during the coronavirus crisis and beyond.   

In the 1980s and 1990s, national health systems in developing countries were transformed by structural adjustments programmes provided by the International Monetary Fund (IMF) and the World Bank. This resulted in the contraction and decentralisation of public healthcare services, as well as the opening of the health sector to private providers, the introduction of healthcare user fees and an increased precariousness of health professionals’ labour conditions. These policies aggravated the commodification and privatisation of healthcare, resulting in increased inequalities.

Even though these policies have proved to be highly problematic, they have not been completely reversed. IMF austerity policies continue to undermine public health systems, while the recent World Bank’s ‘Maximising Finance for Development’ approach is an indication of the priority role given to private finance, including in healthcare, as public finance is seen as a last resort.  

All this means that public health systems have been systematically underfunded, leaving them woefully unprepared to respond to a health crisis like the Covid-19 pandemic. It also means that access to healthcare today is often determined by income, gender and geographical location.

Privatisation of healthcare increases systems’ vulnerability

Recent research reveals that privatisation trends have resulted in greater vulnerability of the health system. It has led to reduced capacity in both equipment and staffing, less equitable coverage and lower adherence to medical standards. Moreover, where universal coverage is not granted, uninsured people with Covid-19 symptoms are more likely to avoid costly testing or treatment, which risks contributing to the spread of the virus.

To make matters worse, there is a clear overlap between vulnerable public healthcare systems and debt in developing countries. Eurodad research recently pointed out that many countries were already in debt distress and struggling to finance public services before the pandemic. The economic downturn has further increased debt vulnerabilities, making it even harder for governments to increase health budgets at a time when healthcare is needed more urgently than ever before.

Many are now looking at private sector actors and resources to meet the SDGs. In recent years the World Bank Group has actively encouraged governments to prepare the ground for private care providers through regulatory reforms that enable business opportunities, as well as supported companies and governments to engage in public-private partnerships (PPPs).

While PPPs are portrayed as a tool to leverage private finance, there is very little evidence that they are able to deliver on the universal realisation of the right to health. Civil society organisations and academics have repeatedly warned that health PPPs are emphasising commercial imperatives, which might undermine the right to health.

Three lessons can be learned from the experience of health PPPs. Firstly, hospital PPPs tend to be more expensive than publicly financed projects, due to the high cost of private finance, profit margins and the transaction costs associated with the negotiation of complex PPP contracts.

Secondly, health PPPs are usually risky businesses for the public sector. The delivery of healthcare is changing rapidly and the lack of flexibility in PPP contracts is a risk factor. COVID-19, in particular, could have a detrimental impact on the fiscal costs of hospital PPPs, through reduced revenue and increased costs, with a knock-on effect on already hard-pressed public finances.

The problematic experience of the Lesotho PPP hospital – supported by the World Bank – illustrates how risky PPPs can be for the public sector. It swallowed up almost a third of the nation’s health budget and the government’s bill to the private company is now reaching unaffordable levels.

Thirdly, the quest to maximise profits can have detrimental effects on women and the most marginalised people in society. There are concerns that PPPs could become a mechanism for securing revenue streams for private investors rather than contributing to high-quality and affordable healthcare, an essential condition to help secure the right to health for a large majority of women and the most vulnerable people.

What should be done?

A people-centred and feminist approach to development finance is key when it comes to rebuilding health systems in a post-COVID-19 era in order to deliver the right to health for all. Strong and accountable public health systems, with adequate financial and human resources, will allow for an efficient and equitable response that specifically deals with gender inequalities in health.

A crucial first step towards achieving such a system is to learn from past lessons. International financial institutions will need to commit to further debt cancellation and shift development finance agendas away from austerity measures and market-friendly reforms, which have contributed to countries’ vulnerability to exogenous economic shocks and risks increasing existing inequalities. Anything less will lead the world to ignore the lessons learned from the coronavirus crisis (and beyond) and to repeat past mistakes.  

Iolanda Fresnillo is Senior Policy and Advocacy Officer at Eurodad  – the European Network on Debt and Development – on Debt Justice. She is also involved in the spanish Citizens' Debt Audit Platform and other local and international social movements. She worked for more than 10 years as a researcher at Debt Observatory in Barcelona, and as a research consultant at MSF, Transnational Institute and several local authorities in Catalonia and Spain. She holds a MA in Development and Cooperation and a BA in Sociology, both from the University of Barcelona. Twitter: @ifresnillo

María José Romero is Policy and Advocacy Manager at Eurodad – the European Network on Debt and Development – on publicly-backed private finance and development finance institutions.  She is also a PhD candidate in Development Economics at SOAS, University of London. Before joining Eurodad, María José worked at the secretariat of the Latin American Network on Debt, Development and Rights (Latindadd), based in Peru, on tax justice and development finance. From 2005-2010 she coordinated the IFIs Latin American Monitor project at the Third World Institute (ITeM), based in Uruguay. Twitter: @ma_jose_romero

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Climate and Environmental Justice

We have advanced rights-based and gender-transformative transition frameworks through research that centres the lived experiences of women and marginalised communities on the frontlines of extractive energy policies, promoting climate and energy frameworks attentive to the social and care-related impacts of transition pathways. We have developed a clear vision for a gender-just transition, firmly rooted in gender and human rights norms, establishing both the legal basis and the direction for the transformative changes our planet and societies urgently need. In particular, the ‘Guiding Principles for Gender Equality and Human Rights in the Energy Transition’, a collective effort built through online consultations, an in-person workshop and multiple rounds of revision with activists, practitioners and experts from around the world, outline a transformative vision for reshaping global energy systems through a human rights and gender equality lens.

Our work recognises that the climate emergency is both an existential threat and an opportunity to reimagine societies built on social, gender, economic and environmental justice. We ground our advocacy in feminist and intersectional principles, prioritising the agency and perspectives of communities in the Global South who have contributed the least to the climate emergency yet face its most devastating consequences. Central to our approach is the understanding that energy is not merely a commodity but a fundamental human right; essential for dignity, health, education, work and the realisation of countless other rights. We challenge approaches to the energy transition that risk replicating the harmful patterns of fossil fuel extraction and, instead, advocate for transformative policies that ensure human rights and gender equality as central to building climate-resilient societies rooted in dignity, justice and planetary well-being.

What's next?

We will continue to challenge approaches that treat energy transition as merely a technical shift, instead positioning it as an opportunity to reimagine economies and societies rooted in dignity for all, with particular attention to communities in the Global South who have contributed least to the climate emergency yet are most exposed to its worst effects.

We will connect community-level evidence and the lived experiences of those on the frontlines of extractive policies to national reform and global norm-setting, breaking down silos between human rights, gender, and climate movements, and advancing a shared vision that recognises just transitions as not only fundamental to achieving climate-resilient and sustainable societies, but as transformative pathways that advance social and gender equality, redistribute power and resources equitably, and ensure that energy systems serve the public good rather than profit.

We will mainstream rights-based and genderjust transition priorities in key multilateral spaces (particularly, within the Just Transition Work Programme and the to-be-developed Just Transition Mechanism, within the UNFCCC) to guarantee that just transitions are advanced at all levels.

We will also translate our work, through strategic advocacy, into at least two concrete policy wins, whether promoted, adopted, implemented, or scaled, in priority countries (Argentina, Brazil, Chile, Mexico, Colombia, South Africa, or Kenya), ensuring these policies align with human rights standards, centre gender equality, and reflect the needs and views of affected communities.

We will build momentum for the progressive recognition of the right to sustainable energy to shift dominant narratives away from purely extractive solutions that sideline gendered impacts, community participation, and Global South perspectives.

Economic Justice and Climate Finance

Our work has transformed the global discussion on fiscal policy in a more just, emancipatory and sustainable direction. Our approach has combined both high-level, expert contributions within decisionmaking circles, with bold, impactful work on narrative change with the general public.

We have been instrumental in the inclusion of human rights as a guiding principle of the future United Nations Framework Convention on International Tax Cooperation, a multilateral instrument with the potential of raising approx. USD 492 billion per year in public revenues currently foregone to global tax abuse. In the process leading to the ‘Compromiso de Sevilla’ decided at FfD4, we proposed and succeeded in creating a specific human rights workstream within the Civil Society Financing for Development Mechanism, which was critical to ensure that explicit commitments on the matter were included in the negotiating outcome. In a context of cutbacks in multilateral institutions, we have amplified the capacities of technical experts, providing rigorous technical support and leveraging our influence to ensure the enactments of groundbreaking standard-setting instruments, such as the 2025 UN Committee on Economic, Social and Cultural Rights Statement on Fiscal Policy and Human Rights, and the first ex oficio hearing on the Inter-American Commission of Human Rights on Fiscal and Economic Policies to Address Poverty and Structural Inequality, leading to an upcoming thematic resolution on the matter. We have also bridged the silos between multilateral tax discussions and climate finance debates, promoting ambitious financing commitments to increase international and domestic resource mobilisation during COP 28, 29 and 30.

At the regional level, our engagement with fiscal cooperation platforms such as the Platform for Fiscal Cooperation of Latin America and the Caribbean (PTLAC), where we are member of its Civil Society Consultative Council, and the African Anti-IFFs Policy Tracker, for which we participated in the pilot mission in Ivory Coast together with Tax Justice Network Africa (TJNA), have been critical in cementing a growing engagement between tax administrations and ministries of finance with international legal experts, exploring actionable and transformative initiatives, such as the taxation of high-net-worth individuals, beneficial ownership registries and corporate countryby-country reports, to be implemented at the international level.

At the local level, our interventions in fiscal reform debates in Chile, Brazil, Colombia and Nigeria have contributed to shaping legislative outcomes in a more progressive, rights-compliant direction.

As for our leadership in narrative change, we have a measurable track record in delivering tailored, innovative campaigns which have decisively expanded economic justice constituencies by appealing to a broader tent. In Latin America and the Caribbean, we created the ‘Date Cuenta’ campaign, coordinating over 40 organisations across civil society to deliver plain language, innovative messaging connecting progressive fiscal reforms to the financing of health, education and social protection. ‘Date Cuenta’ generated over 55 original campaign messages that were tailored to the realities of seven priority countries (Argentina, Chile, Colombia, Mexico, Paraguay, Peru and Honduras) and disseminated in Spanish, Portuguese and English. In doing so, we convened more than 65 online co-creation workshops with partners, coordinating a unified communications strategy which combined digital outreach, press and media coverage, and collaboration with influencers. Ultimately, ‘Date Cuenta’ resulted in more than 60,000 interactions on social media, coverage in major regional and international media outlets, including El País, Deutsche Welle, Bloomberg and France 24, and the participation of at least 63 social media influencers through 58 dedicated publications. In collaboration with Fundación Gabo and the Friedrich Ebert Stiftung, we also organised a two-day workshop in Bogota with 20 journalists from 13 countries, building a regional network trained in a human rights-based approach to fiscal policy that has since generated published media coverage on outlets such as La Diaria, Ciper, El Diario Ar and Milenio. Through ‘Date Cuenta’ and our regional advocacy, we strengthened civil society engagement in key processes, including the Financing for Development track and FfD4, co-organised highlevel dialogues with states and civil society from Latin America and Africa.

What's next?

We will shape the UN Tax Convention and its Protocols so they embed human rights principles, and we will stay engaged through follow-up processes (including the expected Conference of the Parties) to support effective implementation. We will keep linking tax and climate finance so that new resources mobilised through fiscal cooperation are channelled to adaptation, mitigation, and loss and damage, in line with UNFCCC commitments.

Public Services for Care Societies

We have translated participatory research into accountability and policy outcomes.

In Ivory Coast, our work with Mouvement Ivoirien des Droits Humains and affected communities since 2023 exposed how privatisation and lack of accountability restrict access to quality healthcare. It contributed to the closure of 1,022 illegal private health centres, an executive instrument strengthening the regulation of private hospitals across the country, and the creation of a permanent complaints management committee in healthcare through a bylaw issued by the prefect of Gagnoa. Partners engaged through this process also advanced concrete improvements at facility level: members of the Gagnoa Midwives Association who took part in the participatory action research pooled resources to renovate the neonatal unit of the Regional Hospital, and the Director of the Gagnoa General Hospital launched an action plan to expand services and improve patient reception, with the facility receiving the award for best hospital in the country in 2025.

In Kenya, our research with the Mathare Education Taskforce documented the absence of public schools and the expansion of private provision, evidencing impacts on households and caregivers and strengthening demands for free, quality public education. This work contributed to stronger community agency and collective organisation, alongside ongoing strategies ranging from communications to litigation to secure a public school in the area, some involving GI-ESCR and others led independently.

Across Africa, this work is complemented by a multi-country study examining the human rights implications of austerity in education and health, including how regressive fiscal policies, rising debt burdens and persistent underinvestment undermine the financing and delivery of public services.

In Latin America, from 29 November to 2 December 2021, over a thousand representatives from over one hundred countries, from grassroots movements, advocacy, human rights, and development organisations, feminist movements, trade unions, and other civil society organisations, met in Santiago, Chile, and virtually, to discuss the critical role of public services for our future. Following the meeting, the Santiago Declaration on Public Services was adopted to demand universal access to quality, gender-transformative and equitable public services as the foundation of a fair and just society.

We are currently advancing work on care systems, linking public services and fiscal justice through integrated research, advocacy and communications, including a regional campaign framing care as a collective responsibility requiring sustained public investment.

What's next?

In Ivory Coast, we will evaluate and strengthen the complaints management committee and position it as a replicable model for other health facilities. In Kenya, we will support the Mathare community to co-design a model public school for Mabatini and Ngei wards, grounded in human rights standards. Building on our multi-country austerity study, we will drive national advocacy on financing for education and health: advancing reforms in Ghana; launching a fiscal policy and public services financing agenda in Kenya through the CESCR process and targeted coalition work; and, in Nigeria, using the new tax acts in force since 1 January 2026 to catalyse a national accountability campaign for adequately funded, quality public services. In Latin America, we will amplify locally led care pilots across 8 countries and turn lessons into influence—advancing care policies that strengthen care organisations, protect care workers’ rights, support unpaid caregivers, include disability and family networks, and redistribute care more equitably.