A/HRC/44/48/Add.1 B. Normative and institutional framework 12. Ecuador is a founding member of the United Nations and has played a leading role in the international forums on the right to health. It has ratified the core international human rights treaties that determine the country’s important commitments in different areas, including the right to health, sexual and reproductive rights, and the rights of children and adolescents, among others. Ecuador issued a standing invitation to the special procedures mandate holders in 2003 and in the last two years has received five country visits. 13. The country was reviewed in the context of the universal periodic review in 2008, 2012 and 2017. During the most recent review in May 2017, Ecuador accepted a number of recommendations, inter alia those relating to efforts to promote health-care facilities, particularly in rural areas, with a focus on tackling malnutrition; to continue to develop, implement, monitor and strengthen policies to reduce rates of obesity and the incidence of non-communicable diseases; and to continue to strengthen measures to deal with teenage pregnancies by promoting access to reproductive health services for all, including sexual and reproductive health education, as well as counselling services and health care adapted to young people (see A/HRC/36/4). 14. The 2008 Constitution enshrines the concept of “good living” (buen vivir or sumak kawsay) in its preamble, “We … hereby decide to build a new form of public coexistence, in diversity and in harmony with nature, to achieve the good way of living.” The “good living” concept has been the basis of several national development plans, in which the Government has sought to integrate its international commitments, including on the right to health, into national development planning. The national development plans from 2007, 2009 and 2013 were articulated in line with the Millennium Development Goals. The current national development plan for the period 2017–2020 (the National Plan for Good Living) is articulated in line with the 2030 Agenda for Sustainable Development and the Sustainable Development Goals, and includes a policy for the health sector and several health objectives that Ecuador has committed to achieving. 11 15. The Constitution recognizes health as a human right for both Ecuadorians and foreigners without discrimination. It provides the legal framework for the health system, guaranteeing the right to health and primary health care, along with an integrated public network of free health-care services. Several of its provisions are relevant to the right to health and its underlying determinants. In particular, article 32 provides that: “Health is a right guaranteed by the State and whose fulfilment is linked to the exercise of other rights, among which the right to water, food, education, sports, work, social security, healthy environments and others that support the good way of living.” The same article states that the State guarantees the right to health “by means of economic, social, cultural, educational, and environmental policies; and the permanent, timely and non-exclusive access to programs, actions and services promoting and providing integral health care, sexual health, and reproductive health”. 16. The Constitution further provides that public health-care services shall be universal and free at all levels and include the necessary diagnostic procedures, treatment, medication and rehabilitation (art. 362). It also provides that the State shall be responsible for the universalization of health care, permanently improve quality and expand coverage (art. 363). 17. The Special Rapporteur notes that article 11 (3) of the Constitution establishes that the rights and guarantees set forth in the Constitution and in international instruments are to be directly and immediately enforceable by and before any public servant, whether administrative or judicial, ex officio or at the request of a party. In addition, article 426 of the Constitution establishes that judges, administrative authorities and public servants are to directly apply the provisions of the Constitution and those of international human rights instruments when they are more favourable than those set forth in the Constitution, even when they are not expressly invoked by the parties. 18. The right to health is considered justiciable in Ecuador. According to information provided by the Constitutional Court during the Special Rapporteur’s visit, of the 3,847 actions that have obtained a sentence from the Constitutional Court, in only 19 cases have 11 See http://repositorio.dpe.gob.ec/bitstream/39000/2184/1/DEOI-DPE-005-2018.pdf. 5