A/HRC/43/41/Add.3 should be redirected to investing in family and community-based support and services, such as day care, respite care, therapeutic services, foster and kinship care. I. Health 61. The right to health is referred to in several pieces of legislation, including the Patients’ and Users’ Rights Act, the Health and Care Services Act, the Specialist Health Service Act, and the Dental Health Services Act. Norway spends 10 per cent of its gross national product on health care, resulting in very good health-care infrastructures, distributed among primary health-care services at the municipal level and specialist healthcare services provided by the State through four regional health authorities. 62. The Government endeavours to provide universal access to quality health care to the general public, including persons with disabilities, most of which is free of charge. It is also making efforts to improve the competence and professional development of the municipal health-care sector, for instance through the strategy entitled “A society for all”, the care plan 2020, the dementia plan 2020 and the quality reform for older persons. According to 2018 data from the Ministry of Health, municipalities provided 24-hour health and care services to 209,369 persons through home care services. 63. Despite those efforts, persons with disabilities continue to face challenges in accessing the right to health on an equal basis with others, including physical, mental and dental health. A survey conducted by the Norwegian Board of Health Supervision in 2016 in 57 municipalities revealed serious failures in the provision of municipal health and care services for persons with intellectual disabilities in 45 of them. 15 The Special Rapporteur received similarly worrying reports about persons with intellectual disabilities receiving poor quality health care and support in residential homes and from home-care services, ranging from staff who were poorly informed about the health condition of the users they should assist, to lack of competence and training, language barriers that impeded communication, high staff turnover (up to 40–50 different people in a month) and negligence (for example, staff not informing families when their relatives were injured and the circumstances of the injury, or about poor diet and undernourishment). 64. Culturally safe practices at the institutional, group and individual levels are essential to the well-being of Sámi peoples. Sámi with disabilities reported concerns regarding health-care services that are not culturally sensitive and health professionals lacking cultural knowledge and language skills in encounters with patients, which had led to misunderstandings and wrong diagnoses in some cases. Furthermore, autistic and other persons with disabilities reported being reluctant to disclose sensitive information about their health condition to doctors and nurses in the presence of a Sámi interpreter, feeling uncomfortable that members of their community would know about such personal matters. 65. In the area of sexual and reproductive health and rights, the Special Rapporteur was informed that sexual education programmes are not tailored to the needs of youth with disabilities, including autistic girls, and they are often taken out of class when sexuality is discussed, owing to the assumption that it is not relevant for them. Information about pregnancy and motherhood is not available in an accessible manner to the diversity of persons with disabilities. Campaigns to prevent sexual violence against children and youth are also not inclusive, thus boys and girls with disabilities, including the deaf, do not know what to do if they are subjected to such abuse. J. Coercion in mental health and social care 66. Norwegian mental health and social care legislation permits the use of coercive measures against persons with psychosocial disabilities, intellectual disabilities and dementia. The Mental Health Care Act (ch. 4) allows for the involuntary admission and 15 See www.helsetilsynet.no/upload/Publikasjoner/rapporter2017/helsetilsynetrapport4_2017.pdf (in Norwegian). 13