A/HRC/4/10 page 18 by the obligation to make secondary and tertiary education accessible by every appropriate means, in particular by the progressive introduction of free education. This obligation should at least be described as a strategic objective of all PRSPs. 69. The facilitation of access to health and education through the abolition of user fees can be considered in both sectors as a key factor allowing the full enjoyment of the respective rights. Empirical findings confirm that the demand for education and health services is highly elastic and that user fees can often constitute an important impediment to access.29 States should therefore reduce the financial burden of health care and education, especially on the poor. Measures could include the introduction of other mechanisms instead of user fees (e.g. national insurance or general taxation) or by keeping user fees and introducing non-discretionary, equitable and non-stigmatizing interventions for the poor (e.g. exemption schemes, direct cash subsidies and vouchers).30 III. CONCLUSIONS AND RECOMMENDATIONS 70. Over the period covered by this report, the Bretton Woods institutions have meanwhile changed their concept of debt sustainability from a static indicator (debt to export ratio), essentially used for debt relief purposes, to a forward-looking analytical tool designed to avoid the accumulation of unsustainable debt. However, the key objective of the framework still remains the financial ability to service debt rather than the ability to achieve wider development objectives. The creation of country-owned and participatory peer review mechanisms could, and should, provide alternative and complementary views on debt sustainability by focusing on the achievement of the Millennium Development Goals (MDGs) and mainstreaming human rights as key thresholds for debt sustainability. 71. Creditors and borrowing countries have a shared responsibility for the current debt situation of poor developing countries. Therefore, forward-looking sustainability analysis tools should guide both parties in their decisions and in the choice of an adequate mix of concessional loans and grants. In this regard, the primary responsibility of borrowing countries to ensure that availed credits are invested in a productive and human rights promoting way cannot be over-emphasized; for a productive use of credits usually creates the capacity to service the corresponding debt. 72. The aggregate amount of debt to be ultimately cancelled through the Heavily Indebted Poor Countries (HIPC) and Multilateral Debt Relief (MDR) initiatives (US$ 100 billion) is modest compared to the overall magnitude of the debt burden of poor developing countries (US$ 426 billion) and middle-income countries (US$ 2.3 trillion). When weighted against the overall poverty and MDGs related expenditures, including donor-funded development projects, debt service savings through HIPC and MDR initiatives are probably too small to have a measurable impact on MDGs achievement or desired human rights improvement. Under the circumstances, there remains the need for comprehensive solutions to the debt problems of poor countries, including further debt relief by other multilateral institutions, and for permanent solutions to the problems of bilateral and commercial debts. Innovative relief mechanisms such as different forms of debt swaps merit careful consideration. Accordingly, future relief operations should,