A/HRC/7/11 page 15 organizations have also tried to identify a minimum “basket” of health services. This is a difficult exercise, not least because health challenges vary widely from one State to another, which means that in practice, the minimum “basket” may vary between countries. In some countries, the challenge is undernutrition, elsewhere it is obesity. 53. Much more work has to be done to help States identify the minimum “basket” of health-related services and facilities required by the right to the highest attainable standard of health. However, that vital task is not the purpose of this report. This report is not attempting to provide a list of essential services and facilities that are needed for a well-functioning health system. Rather, the report is seeking to identify a number of additional, and frequently neglected, features arising from the right to the highest attainable standard of health, and informed by health good practices, that are required of all health systems. These include, for example, access on the basis of equality and non-discrimination, an up-to-date health plan, effective accountability for the public and private health sector, and so on. 10. Quality 54. Health services and facilities must be of good quality. For example, a health system must be able to ensure access to good quality essential medicines. If medicines are rejected in the North because they are beyond their expiry date and unsafe, they must not be recycled to the South. Because medicines may be counterfeit or tampered with, a State must establish a regulatory system to check medicine safety and quality. The requirement of good quality also extends to the manner in which patients and others are treated. Health workers must treat patients and others politely and with respect. 11. A continuum of prevention and care with effective referrals 55. A health system should have an appropriate mix of primary (community-based), secondary (district-based) and tertiary (specialized) facilities and services, providing a continuum of prevention and care. The system also needs an effective process when a health worker assesses that a client may benefit from additional services and the client is referred from one facility to another. Referrals are also needed, in both directions, between an alternative health system (e.g. traditional practitioners) and “mainstream” health system. The absence of an effective referral system is inconsistent with the right to the highest attainable standard of health. 12. Vertical or integrated? 56. There is a long-standing debate about the merits of vertical (or selective) health interventions, which focus on one or more diseases or health conditions, and a comprehensive, integrated approach. By drawing off resources, vertical interventions can jeopardize progress towards the long-term goal of an effective health system. They have other potential disadvantages, such as duplication and fragmentation. However, in some circumstances, such as during a public health emergency, there may be a place for a vertical intervention. When these circumstances arise, the intervention must be carefully designed, so far as possible, to strengthen and not undermine a comprehensive, integrated health system.