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(b) Ensure that consumption taxes, such as excise taxes and VAT, are not
regressive. This may include setting appropriate thresholds below which small
enterprises are not subject to taxation and reducing or removing consumption
taxes on necessity goods;
(c) Consider earmarking portions of revenue from specific taxes, such as
sin taxes and VAT, for spending on health;
(d) Ensure tax liberalization policies resulting from international tax
competition, including tax abatements for foreign investors and low or non-existent
trade and capital gains taxes, do not result in reduced public funding for
health;
(e) Find ways to collect taxes from businesses in the informal sector,
contingent upon the provision of State services and other benefits associated
with being a taxable entity to such businesses.
57. The Special Rapporteur urges States to take the following steps in order to
cooperate internationally towards ensuring the availability of sustainable
international funding for health:
(a) Coordinate all donor activities in recipient States, incorporating the
participation of civil society and affected communities, towards meeting domestic
health needs and promoting the development of self-sustaining health systems;
(b) Develop a treaty-based global pooling mechanism, comprising
compulsory progressive contributions from States allocated based upon need
and driven by transparent, participatory processes, in order to shift from a
donor-based system towards an obligatory system of international funding.
58. The Special Rapporteur urges States to prioritize funding for national and
subnational health budgets in order to reduce overdependence on international
funding and ensure domestic resource self-sufficiency for health.
59. The Special Rapporteur urges States to take the following steps in order to
pool funds for health:
(a) Implement a pooling system comprising compulsory, progressive
prepayments, such as taxes and insurance contributions, in order to reduce or
eliminate out-of-pocket payments for health and ensure access to good quality
health facilities, goods and services for the poor;
(b) Develop social health insurance programmes funded through
compulsory, progressive contributions, supplemented by general tax revenue,
comprising a pool of contributors large enough to promote effective crosssubsidization, with absolute exemptions for the poor;
(c) Ensure that enrolment in social health insurance programmes
captures all necessary parts of the populations, particularly vulnerable or
marginalized populations, with special attention to informal workers;
(d) Ensure that benefits under social health insurance programmes
include a minimum set of health goods and services and are available and
universally accessible based on need. Benefits packages must:
(i)
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Be responsive to the disease burden and health needs of the population;
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