A/HRC/44/48/Add.1 ministerial agreements. Continuing to exercise its functions without a legal framework provided by the Constitution could eventually jeopardize the progress the country has made, for example in the area of food labelling. The Special Rapporteur stresses that an updated and comprehensive human rights-compliant legal framework is essential for the formulation of corresponding health regulations and policies. Without clear public health policies and regulations, the national health-care system risks being influenced by powerful interest groups that often lobby for investment that may not be in the interests of the public. C. National health-care system 26. The national health-care system is a mixed system, consisting of both the public and private sectors. The public sector comprises the Ministry of Health, the health services of some municipalities and the entities of the social security system aimed at the labour market, which consist of (a) the Ecuadorian Social Security Institute, which includes peasant social security; (b) the Social Security Institute of the Armed Forces under the Ministry of National Defence; and (c) the Social Security Institute of the National Police under the Ministry of the Interior. The private system consists of health insurance companies and prepaid medicine providers. The health system is characterized by some degree of fragmentation, to the extent that it is composed of different institutions, each with its own management and financing, which may make coordination challenging. The Special Rapporteur is concerned that this fragmentation is not efficient and recommends it be addressed in an effective manner, following a human rights-based approach, with a view to ensuring better coordination and integration of all the existing elements. 27. The Constitution describes the principles and characteristics of the national health system (in particular, articles 358, 359, 360 and 361). According to these provisions, the national health system shall be guided by the general principles of social inclusion and equity, and by those of bioethics, sufficiency and interculturalism, with a gender and generational focus. 28. The comprehensive health-care model (modelo de atención integral de salud) is defined in accordance with the principles of primary health care. The model sets forth a set of strategies, norms, procedures, tools and resources that guarantee the provision of health services, with a focus on community, family, pluriculturalism and gender by taking health services beyond health centres into homes and the community. The model is oriented to the provision of health services in all its dimensions: biological, mental, spiritual, psychological and social.13 29. While the Ministry of Health has developed the definition of the model and the tools for its implementation, the Special Rapporteur regrets that putting it into practice remains a challenge and that no national implementation strategy has been designed. Although there have been heterogeneous improvements, these have depended on capacity at the local and provincial levels. In the proposed health code, the model is recognized as one that should be implemented in the national health system. The Special Rapporteur recommends the adoption of a national health policy that promotes the implementation of the model and a strategy that includes the human and financial resources required for its effective implementation. 30. During his visit, the Special Rapporteur was informed about the inter-institutional agreement of July 2019, which provides for the reorganization of the State presence in the territory and the organic restructuring of the central public administration. 14 Although its scope and state of progress are not yet known, the Special Rapporteur received information that such restructuring might affect the implementation of the comprehensive health-care model and decrease the capacity of the Ministry of Health to exercise its function of steering and governance of the national health system. The Special Rapporteur recommends that any territorial planning should be promoted in line with the requirements of the health sector and the comprehensive health-care model and should enable the Ministry to exercise its public health functions. 13 14 See http://instituciones.msp.gob.ec/somossalud/images/documentos/guia/Manual_MAISMSP12.12.12.pdf. Agreement No. SENPLADES-MEF-MDT-001-2019. 7