Escopo e limite da judicialização do direito constitucional à saúde na África do Sul: avaliação de casos com referência específica à justiciabilidade da saúde
| Autor | Charles Ngwena |
| Páginas | 43-87 |
Artigos Originais / Original Articles
R. Dir. sanit., São Paulo, v. 14, n. 2, p. 43-87, jul./out. 2013
SCOPE AND LIMITS OF JUDICIALISATION
OF THE CONSTITUTIONAL RIGHT TO
HEALTH IN SOUTH AFRICA: AN APPRAISAL
OF KEY CASES WITH PARTICULAR
REFERENCE TO JUSTICIABILITY
Escopo e limite da judicialização do direito constitucional
à saúde na África do Sul: avaliação de casos com
Charles Ngwena*
ABSTRACT
Section 27 of the South African Constitution guarantees everyone a right of access to
healthcare services, including reproductive healthcare. This paper discusses how domestic
courts have interpreted and applied section 27. It explores the extent to which section
27 is justiciable in the sense of being amenable to judicial interpretation and application
in practice. The paper highlights the scope as well as the limits of the constitutional and
institutional competences of the courts to adjudicate a claim relating to the right to health
that is guaranteed by section 27. The justiciability of the right to health under the South
African Constitution is interrogated through a critical appraisal of three cases decided by
the South African Constitutional Court, namely, Soobramoney versus Minister of Health
KwaZulu-Natal, Minister of Health and Others versus Treatment Action Campaign and
Others, and Government of the Republic of South Africa and Others versus Grootboom
and Others against the backdrop of the transformation of the South African constitutional
landscape in the post-apartheid era.
Keywords: Constitutional Competence; Institutional Competence; Justiciability; Right to
Health; Socioeconomic Rights.
* LLM, University of Wales; LLD, Free State University. Professor, Centre for Human Rights, University
of Pretoria. Pretoria - South Africa. E-mail: charles.ngwena@up.ac.za
Received in: 13/03/2013. Approved in: 06/04/2013.
44 Charles Ngwena
R. Dir. sanit., São Paulo, v. 14, n. 2, p. 43-87, jul./out. 2013
RESUMO
Este trabalho discute como as cortes sul-africanas têm interpretado e aplicado o artigo
27 da Constituição da África do Sul, que garante a todos o direito de acesso aos serviços
de saúde, incluindo cuidados reprodutivos. A extensão da judicialização do artigo 27 é
analisada, considerando a possibilidade de interpretação judicial e aplicação prática.
Destaca-se a abrangência e os limites das competências constitucional e institucional dos
tribunais para julgar uma ação relacionada ao direito à saúde. A judicialização deste direito
na Constituição da África do Sul é investigada por meio de uma análise crítica de três
casos decididos na Corte Constitucional do país: (1) Soobramoney versus Secretaria de
Saúde de KwaZulu-Natal; (2) Ministro da Saúde e Outros versus Campanha de Tratamento
e Outros; e (3) Governo da República da África do Sul e Outros versus Grootboom e
Outros, tendo como pano de fundo a transformação do quadro constitucional sul-africano
na era pós-apartheid.
Palavras-chave: Competência Constitucional; Competência Institucional; Direito à Saúde;
Direitos Socioeconômicos; Justiciabilidade.
Introduction
The right to health is among the provisions of the Bill of Rights of the South African
Constitution. While the right to health manifests in a number of provisions of the
Constitution, section 27 is its most universal expression. Section 27, which bears
a close resemblance to article 2(1) of the International Covenant on Economic,
Social and Cultural Rights, (CESCR),(1) provides that:
1. Everyone has the right to have access to:
(a) health care services, including reproductive health care
(b) sufficient food and water; and
(c) social security, including, if they are unable to support themsel-
ves and their dependants, appropriate social assistance.
2. The state must take reasonable and other measures, within
its available resources, to achieve a progressive realisation
of each of these rights
3. No one may be refused emergency medical treatment.(2)
This paper seeks to interrogate how the right to health has been judicialised in
South Africa in the post-apartheid era. It critically appraises the manner in which
2200A (XXI), adopted 16 December 1966, entered into force 3 January 1976.
2 CONSTITUTION of the Republic of South Africa N. 108 of 1996 (hereinafter Constitution). Emphasis
added.
45
Judicialisation of the right to health in South Africa
R. Dir. sanit., São Paulo, v. 14, n. 2, p. 43-87, jul./out. 2013
courts have adjudicated and conceptualised constitutional claims revolving
around the right to health. The emphasis is on exploring the scope as well as
limits of justiciability of the right to health in the South African context. The paper
uses three leading cases as the main pivot for discussion. All the cases were
decided by the South African Constitutional Court, the country’s highest court
on constitutional matters.(3) Two of the cases, namely, Soobramoney v Minister
of Health KwaZulu-Natal (Soobramoney)(4) and Minister of Health and Others v
Treatment Action Campaign and Others (TAC),(5) concern claims directly relating
to a right to health. However, the third case, Government of the Republic of South
Africa and Others v Grootboom and Others (Grootboom),(6) concerns a right to
housing rather than health. Notwithstanding that the Grootboom case does not
directly relate to health, it is the Constitutional Court’s leading decision on the
interpretation and application of socioeconomic rights under the South African
Constitution. For this reason, the Grootboom decision is an important source of
interpretive guidance for lower courts when adjudicating socioeconomic rights
generally, including the right to health, under domestic law.
Because the concepts of the right to health and justiciability are central to this
paper, it serves well to begin by clarifying the context in which they are being used.
I. Right to health
At the domestic as well as the international level, the term “right to health” has
been used not so much as a legal term of art but rather as convenient shorthand.
When used in international human rights discourses, the term “right to health” can
be understood in a wider sense to cover not only a right of access to a range of
facilities, goods and services, including health services, but also a right to the under-
lying determinants of health such as food, housing, safe water, sanitation, healthy
working conditions, and an environment that is safe and free from hazards such as
pollutants.(7) In General Comment 14, for example, the Committee on Economic,
Social and Cultural Rights (Committee on ESCR), said that it interprets the “right
to health” in article 12 of the CESCR as an “inclusive” right that extends not only to
access to discrete healthcare services, but also to the underlying determinants of
health.(8) In this paper, however, right to health is used in a narrower sense to mean
a legally enforceable right of access to health services for the attainment of health.
3 Section 167(3)(a) of the Constitution.
4 1997 (6) BCLR 78 (Constitutional Court).
5 2002 (10) BCLR 1033 (Constitutional Court).
6 2000 (11) BCLR 1169 (Constitutional Court).
7 SHINN, Carolynne. The right to the highest attainable standard of health: public health’s opportunity to
reframe human rights debate in the United States. Health and Human Rights, v. 4, n. 1, p. 119, 1999.
8 COMMITTEE ON ESCR. General Comment No 14, The right to the highest attainable standard of
health (art 12 of the Covenant) (22n Session 2000), UN Doc E.C 12/2000/4.
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