A/61/338 57. Guided by the WHO Model List of Essential Medicines (2005), a State is required to prepare a national essential medicines list, by way of a participatory inclusive process. If a State declines to prepare its own national essential medicines list, the WHO model list will apply, subject to any obvious contextual revisions. A State has a core obligation of immediate effect — not subject to progressive realization — to make available and accessible throughout its jurisdiction the essential medicines on its national list.42 58. In summary, the right to health encompasses access to non-essential and essential medicines. While a State is required to progressively realise access to nonessential medicines, it has a core obligation of immediate effect to make essential medicines available and accessible throughout its jurisdiction. This chapter encompasses non-essential and essential medicines. Duties to respect, protect and fulfil 59. States have duties to respect, protect and fulfil the right to the highest attainable standard of health.43 For example, the duty to respect obliges a State to ensure that its medicines policy does not discriminate against women, ethnic minorities, or other disadvantaged groups. The duty to protect requires a State to ensure that third parties do not obstruct enjoyment of the right to health, for example, a State must ensure that privatization in the health sector advances, and does not hinder, the realization of the right to health. The duty to fulfil requires a State to provide those living in poverty with essential medicines if they would otherwise be unable to access them. 60. In other words, while a State may contract the delivery of health services to a private company, it does not contract out of its right-to-health obligations. A State always retains residual responsibility for the proper regulation of its health and medicines systems, as well as for the well-being of the most disadvantaged in its jurisdiction. Participation in health policymaking 61. The active and informed participation of individuals and communities in health policymaking that affects them is an important feature of the right to the highest attainable standard of health. In most cases, a local community will have a keen sense of its health priorities; it is entitled to participate in the identification of priorities and targets that guide the technical deliberations underlying the policy formulation that will affect its members. 62. When formulating its national medicine policy and programmes, a State is required to take steps to ensure the active and informed participation of all those affected, not only professional associations and universities, but also rural communities, non-governmental organizations, patients and consumer associations, and representatives of disadvantaged groups. International assistance and cooperation in health 63. The primary obligation for implementing the right to health falls upon the national authorities in the State in question. However, States have the obligation to take steps individually and through international assistance and cooperation towards the full realization of various rights, including the right to health. The Special 06-51997 15