A/HRC/44/48/Add.1 VI. Conclusions and recommendations 74. Ecuador is in a good position to reach universal health coverage and other health-related goals. However, for that to happen, key elements need to be in place. In the first place, investment in primary care, modern mental health-care services and palliative care must be substantial and sustainable, even in times of financial constraint. Investment in health-care infrastructures must be complemented by good care, devoting special attention to the coverage and accessibility of health-care services in rural areas and zones inhabited by indigenous peoples and AfroEcuadorians. The Government’s proposed austerity measures and budget cuts risk being detrimental to the effectiveness and sustainability of the national health-care system. The Special Rapporteur reiterates that it is essential to ensure the sustainability, as well as the necessary human and financial resources, of the health sector to guarantee the right to physical and mental health of all persons. 75. Secondly, efforts to invest in the biomedical elements of health care to provide health-care services are not enough. As set out in the Constitution, the determinants of health are crucial to the health and well-being of all persons. Non-discrimination in the health-care system and beyond must become a reality. Violence, in particular against women and girls, is detrimental to health and must be addressed with determination and courage by all actors. Respectful relationships with nature are also crucial to building a healthy and inclusive society (see A/HRC/41/34). 76. The right to health should be promoted and protected, not only through access to health-care services, supplies and facilities, which should be available, affordable, appropriate and of good quality, but should also be realized through the design and implementation of cross-sectoral programmes that address socioeconomic, cultural and environmental factors. Such policies or programmes should be guided by a human rights-based approach with a strong emphasis on the principles of equality and non-discrimination, participation and empowerment, and accountability. 77. The Special Rapporteur recommends that the State: (a) Ensure the necessary financial and human resources to maintain sufficient levels of access to health-care services and reach at least the 4 per cent of GDP provided under the Constitution. In that regard, the Special Rapporteur recommends that the economic measures taken and those under consideration be reviewed and transparency and dialogue ensured, in order to guarantee the right to physical and mental health of all persons. In particular, he recommends substantial investment in primary health care, mental health services and measures to combat violence against girls and women as the highest priority, and that the effective and sustainable implementation of public policies in that regard be facilitated; (b) Adopt without delay an updated health code in compliance with international human rights standards. The Special Rapporteur recommends that conscientious objection exemptions be well-defined in scope and well-regulated in use and that referrals and alternative services be available in cases where the objection is raised by a service provider. He also recommends the inclusion of a specific section for special and specialized care of rare diseases in the new health code; (c) Address the fragmentation of the health-care system, with a view to integrating existing elements in an effective manner and following a human rightsbased approach, with a view to ensuring better coordination and integration of all the existing elements; (d) Adopt a national health policy that promotes the implementation of the comprehensive health-care model and establish a strategy that includes the necessary human and financial resources required for the effective implementation of the model; (e) Ensure that any territorial planning is promoted in line with the requirements of the health sector and the comprehensive health-care model, enabling the Ministry of Health to exercise its public health functions; (f) Ensure transparency and equal access to expensive medicines; 17