State invests enough in health, education, or housing, on the level of investments in these respective sectors as a percentage of the country's GDP, combining private and public investment, or should they focus instead on the level of governmental expenditure, as indicated for instance by the share of the public budget that goes to such sectors? In low-income countries, where a large part of the population has a very low purchasing power -- and one, certainly, too low for them to be an attractive market for private service providers, except at the expense of quality --, it does seem sensible to require from governments that they make up for this massive market failure: however efficient (indeed, precisely because they are efficiency-driven), markets shall not, and could not, compensate for widespread poverty. In such contexts, setting as a benchmark a minimum level of intervention of the government in meeting the costs of healthcare, education, electricity or transport, appears as the only reasonable option. In order to ensure that the basic needs of the population are met in all countries, but that the availability, accessibility and adequacy of the services gradually increase as the ability for the government to deliver such services improves, two separate indicators may be designed, referring respectively to the minimum public expenditure per capita and to the expected public expenditure in the sector concerned as a percentage of the country's wealth. Thus, when experts convened in Chatham House to define the appropriate level of governmental spending in healthcare, they settled on two targets, one representing the absolute governmental spending per capita per year that should go to healthcare (86 USD), and the other representing the percentage of the total GDP of the country that should go to healthcare (5 per cent): this latter indicator, the experts noted, is important to include, since "[w]hile $86 may ensure priority services for everyone, it is clearly insufficient to meet all important health needs, and GHE [governmental health expenditure] therefore needs to be progressively increased [in line with the overall growth of the country's economy]"; the former indicator however is equally important to maintain, since "GHE/GDP of 5 per cent may be insufficient to ensure priority services in poor countries", and therefore it is justified, in these poor countries, to set a minimum benchmark corresponding to what would seem to cover at least basic health needs. As to the 5 per cent figure itself as a measure of the government health expenditure to the GDP, it is seen as the percentage that is "generally required for limiting the proportion of [out-of-pocket payments] to 20 per cent of [Total Health Expenditure (THE)], which in turn is generally needed for achieving low rates of catastrophic and impoverishing health expenditure".86 It is noteworthy that these targets express a minimum level of public expenditure in healthcare : unless governments invest enough in healthcare, poor families risk having to pay beyond their means, leading to a spiral of indebtedness and poverty from which many may be unable to escape. Therefore, setting targets of governmental spending, rather than targets of total health expenditures (including both public and private spending), seemed the most appropriate route. c) Positional goods That is not all, however. Indeed, privatization also poses a third challenge, that cannot be answered simply by the strengthening of the regulatory framework applicable to the private sector. Even in situations where even low-income groups have access to the good or service concerned and where appropriate supervision ensures that compliance with essential quality standards, can there be a risk that, while the needs of the poor are met, the rich still have access to much better services thanks to the coexistence of different channels through which one can have access to healthcare, housing or education ? If there is such a risk, should this be a concern ? A distinction should be made in this regard between rights that, to be effectively enjoyed, should be distributed in conditions of relative equality, and rights to some amount of a good or some level of provision of a service, however much better the situation of others. For instance, education is a positional good in ways in which housing is not : for the right to housing to be satisfied, it matters whether each household has access to adequate 86 Shared Responsibilities for Health: A Coherent Global Framework for Health Financing. Final Report of the Centre on Global Health Security Working Group on Health Financing (London, Chatham House, Royal Institute for International Affairs, 2014), at 12. 18