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\title{Realization of Health Right in Nigeria: A Case for Judicial Activism}
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             \author[1]{Oyeniyi  Ajigboye}

             \affil[1]{  Afe Babalola University, Ado Ekiti, Ekiti, Nigeria}

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\date{\small \em Received: 8 December 2013 Accepted: 4 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Nigeria adopts the dualist approach to international human right laws and it remains one of the countries with the highest medical-related death rates in the world. The nonenforceability of member state?s minimum core obligation and, the non-justiciability of ECSRs in Nigeria remains seemingly, a major impediment to the realization of health right in Nigeria thus; Nigeria ranks 158 out of 177 countries on the Human Development Index. Eleanor D. Kinney suggested approaches that can advance recognition and implementation of human right to health in the US however, Kinney wittingly excluded justiciability approach to the implementation and realization of right to health given that once a legislation is enacted and full recognition is given to this class of right, policies and programs will be established and adequate funding will become essential. The present position in Nigeria is different. There are laws â??" international and regional treaties already domesticated. These laws are focused on the realization of health rights in Nigeria. The paper therefore, contends that given the judicial activism evidences from India, South Africa and its effects on the implementation and accessibility of health care right in these countries, the setbacks in realizing health right in Nigeria is a challenge to the Nigerian Judiciary. The paper suggests that the judicial activism experienced in India and South Africa, offers an instrument for realizing health right also in Nigeria while accountability on budget allocation and the appropriate interpretation of the existing corpus for realization of health right is a required tool which would guarantee realizing the right to health in Nigeria and not justiciability of health right per se.

\end{abstract}


\keywords{health care, health rights and judicial activism.}

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\section[{Introduction}]{Introduction}\par
he right to health is the right to the highest attainable standard of health and it is recognized in at least 115 constitutions.  {\ref 2} Therefore the adequate access to health care, such as the primary health care, sexual health care, medical and pharmaceutical technologies, and healthy environment are complimentary to any other efforts put in place by the government to ensure that its citizenry is virile and healthy. The right was first reflected in the World Health Organization constitution in 1946  {\ref 3} and was later reiterated in the 1978 Declaration of Alma Ata. Right to health was also adopted by the World Health Assembly in 1998.  {\ref 4} According to International Convention on Economic and Social Cultural Rights,  {\ref 5} and the General Comment No. 14, 6 every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity as health is a fundamental human right. Health is indispensable for the exercise of other human rights and the realization of the right to health may be pursued through various complementary approaches. These approaches include formulation of health policies, the implementation of health programs as developed by the World Health Organisation (WHO), or the adoption of specific legal instruments for instance the domestication of international treaties which provides for the health rights. In Nigeria, the legal authority for human right to health and health care are international and regional treaties.\par
Office of the U.N. High Comm'n for Human Rights, The Right to Health: Fact Sheet No. 31 10 (2008), accessed online on 24 th May, 2013 at http://www.ohchr.org/Documents/Publications/Fact sheet31 .pdf. The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. See for example, CESCR General Comment No. 14, (E/C. 12/2000/4), para. 8., ICJ, Rights to Health Database, Preliminary Proposal, 2002, quoted by the Special Rapporteur on the Right to Health of the Commission on Human Rights in his first report, par.20: E/CN. 4/2003/58: http://www. unhchr. ch/Huridocda/Huridoca.nsf/0/9854302995c2c86fc1256cec005a18d7/\$ FILE/G0310979.pdf.  {\ref 3} See generally the Basic Document, 43 rd Edition, Geneva, World Health Organization, 2001.  {\ref 4} See Article 25(1) of UDHR, Article 12(1) and (2) of the icescr, cerd of 1963, the cedan of 1979 and the crc of 1989. 5 (Article12).  {\ref 6} (11/08/00)(E/C.12/200/4) (Paragraph 1) T These International and Regional treaties define the content of the international human right to health in Nigeria and, also impose on Nigerian government as signatory of the international and regional treaties, the duties to assure health care services, promote and protect the health of its population.  {\ref 7}  
\section[{Health Right in Nigeria}]{Health Right in Nigeria}\par
The source of human rights generally can be traced back to the Magna Carta of 1215, and the Bill of Rights 1689,  {\ref 8} and the right to health is a relatively new legal concept, borrowed from the aspirational terms of international human rights instruments and of evolving philosophies of distributive justice.  {\ref 9} In Nigeria, the health rights can be said to date back to the acceptance of Sir Henry Willink's Commission's recommendations on human constitutional conference which formed the basis for the Chapter III of the Independence Constitution of 1960 and the Republican Constitution of 1963.  {\ref 10} According to Babalola, the beginning of health schemes in Nigeria is traceable to the emergence of the National Development Plan in the 60's through the 70's which made provisions geared towards integrating health with other social services.  {\ref 11} In 1988, the government introduced National Health Policy and Strategic Framework which was aimed at achieving Health for all Nigerians. In overall, the policy seeks to improve the health of all Nigerians through devising a sustainable Health System based on focusing emphasis on Primary Health Care (PHC) that promotes, protective, preventive, restores and rehabilitates, as well as ensure a socially and productive society for all individuals  {\ref 12} This policy  {\ref 7} See generally Eleanor D. K. Recognition of the International Human Right to Health and Health Care in the United States accessed online on 12 th February, 2013 at ???????.According to Lawson-Dada, F., on financing healthcare in Nigeria, the right to health care in Nigeria is derived primarily from regional and international laws and instruments ratified by Nigerian Government which foists on the government as a state, the responsibility to ensure the implementation of access to health care particularly in view of the objectives of various international instruments which serve as the platform for protecting health care rights in Nigeria. See generally Lawson-Dada, F., "Healthcare financing in Nigeria: A legal discourse" (2009) 3 University of Ado-Ekiti Law Journal 81 -110 at 85, was subsequently revised in 2004.  {\ref 13} Under the extant Constitution of the Federal Republic of Nigeria, 1999 (As Amended by the Third Alteration) all Socio-economic Rights are classified under the Fundamental Objectives and Directive Principles of State Policy and enshrined in Chapter II of the Constitution.  {\ref 14} The right to health has long been treated as a "second generation right," under International Human Rights Treaties and Conventions, and this implies that it is not enforceable at the national level except ratified and domesticated at the national level.  {\ref 15} Nigeria is a party to major international human rights treaties such as the International Covenant on Civil and Political Rights (the "ICCPR"),  {\ref 16} the International Covenant on Economic, Social and Cultural Rights (the "ICESCR"),  {\ref 17} the International Convention on the Elimination of All Forms of Racial Discrimination (the "ICERD"),  {\ref 18} the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (the "CAT"),  {\ref 19} the Convention on the Elimination of All Forms of Discrimination Against Women (the "CEDAW")  {\ref 20} and the Convention on the Rights of the Child (the "CRC"). 21 At the regional level, the goal of Africa Health Strategy is to contribute to Africa's socioeconomic development by improving the health of its people and by ensuring access to essential health care for all Africans, especially the poorest and most marginalized, by 2015.  {\ref 22} Therefore, the African Union  
\section[{II.}]{II.}\par
has an ample provision for health rights in the African Charter on Human and Peoples' Rights (Ratification and Enforcement) Act (the "African Charter Act").  {\ref 23} The effect of this however remains impugned as there continues to be a decline in the implementation and realization of health rights in Nigeria although Nigeria is a signatory to several international and regional treaties. 
\section[{a) Approaches to realization of health rights internationally}]{a) Approaches to realization of health rights internationally}\par
The promotion of human rights and the fight against poverty and other socio-economic rights is now a major concern for the United Nations. This reflects in the organization's mandate and the approaches in place for the realization of these rights particularly health rights. One of the widely accepted approach to realize health right is the rights-based approach commonly referred to as the "traditional" or "generational" approach. A rights-based approach to development is based on the framework of rights and obligations. Human rights-based approach determines the relationship between individuals, groups with valid claims (rights-holders) and, State and non-state actors with correlative obligations. It works towards strengthening the capacities of rights-holders to make their claims, and of the states to meet their obligations."  {\ref 24} This approach is now generally accepted as the capacity of citizenry to claim for ESCRs is curtailed as this category of rights are generally treated as nonjusticiable.  {\ref 25} Human Right is a basic principle that is accepted with wide consensus. It is also applicable to all democracies across the globe. Indeed some scholars see the entrenchment of these rights as a means of protecting the minorities from the majorities thus forming the core basis for a democratic society while others are of the view that by the Social Contract theory. In recent times, other scholars see it from the perspective of welfare entitlement to the citizenry.  {\ref 26} Thus, each of these scholars holds different view on the approach to realizing human rights. Human Rights approach is the philosophical perception and theory of how to ensure the achievement of human rights goals. Primarily, the human right based approach is concerned with the realization of rights through the promotion, protection, of rights. This approach essentially seeks to address violations after they have occurred or address  {\ref 23} Now contained in Chapter 10, Laws of the Federation 1990.  {\ref 24}  human rights issues before they occur. It is a reactive and proactive measure to ensure that human rights goals are achieved.  {\ref 27} Simply put, rights approach to realization of rights means making sure that citizens can hold governments to accountable for their human rights obligations.  {\ref 28} Another approach is the Essential Approach. This approach to realizing human rights is based on the essence of the right sought to be protected and proponents of this approach set up a normative investigation into why we value economic and social rights and which of their aspects should be most important. Thus it raises the need for a minimum standard particularly on states obligation towards achieving the set human right goals. This approach is helpful in ensuring that advocates are able to articulate the minimum core of rights through vocabularies that draw attention to the important ethical justifications for economic and social rights. This approach is consistent with the insight that rights belong to a category of legal entitlement that is, for special reasons, immune to the vagaries of short-term politics or cost-benefit decision making.  {\ref 29} Young argued that the strongest example of the Essence Approach views the right's core content as an embodiment of "the intrinsic value of each human right which is essential for the very existence of that right as a human right." 30 Oliyide on the other hand however argued that rights impose positive obligations on the government to provide conducive and decent living condition without which the negative rights i.e. the civil and political rights cannot be enjoyed. The nonjusticiable class however are also fundamental to human existence and survival. He concluded by suggesting that the judiciary should, in the future improve on its gesture by making even more progressive and encouraging pronouncements appertaining to Human Rights than it has done in the past.  {\ref 31}  
\section[{III. The Judiciary and Escrs in Nigeria}]{III. The Judiciary and Escrs in Nigeria}\par
Judicial systems vary from one country to another depending on the constitutional and political  {\ref 27}  context in such country, the substantive content of the applicable legislations, the capacity of enforcing institutions and the solidity of the foundation of the rule of law. 32 Therefore, it is paramount that governments in ensuring realization of human rights particularly the ESCRs must consider putting an independent judicial system put in place within their polity. The judiciary should in turn ensure that there are no large backlogs of cases which can erode individual's and property rights, and in return stifle the ultimate goals of the constitution.  {\ref 33} Judicial systems should discourage further obstacles capable of possibly ensuring the violation of human rights of the citizens which is now argued favourably as violation of fundamental human right on its own.  {\ref 34} It is imperative to infer that such judicial systems must not only be independent, but also be practically positive in ensuring the fulfillment of such rights which the entire system must protect. By virtue of the provisions of Section 6 of the constitution, the Courts have the powers to adjudicate on matters before it. The Constitution as the grundnorm also provides for the powers of the courts to interprete the provisions of the laws thus the courts wields the powers which enables it to state the position of the extant laws. One of the legal disputes that stare at the courts therefore, is the extent of realization and implementation of the ESCRs on one hand and the enforcement of this class of rights b the 32 Bank, W. \& Paper, T., 1999. WTP430 Court Performance around the World, Accessed online on 12 th January, 2013 at http://sitere sources.worldbank.org/brazilinporextn/Resources/3817166-11858956 45304/40441681186404259243/14pub\textunderscore br176.pdf  {\ref 33} According to Armando Castelar Pinheiro, in Brazil, for example, it has been estimated that inefficient courts reduce investment by 10 percent, and employment by 9 percent. See Armando Castelar Pinheiro, The Hidden Costs of Judicial Inefficiency: General Concepts and Estimates for Brazil, Address at the seminar "Reformuas Judiciales en Amnerica Latina: Avances y Obstaculos para el Nuevo Siglo," Confederaci6n Excelencia en la Justicia, Santafe de Bogota, Columbia (July 29, 1998) (transcript on file with author).  {\ref 34} The absence of independent and impartial tribunals is considered a violation of human rights. See, e. g., International Covenant on Civil and Political Rights, Art. 14, adopted Dec. 16, 1966, entered into force citizenry. Mubangizi having carried out a comparative evaluation of the constitutional protection of Socioeconomic Rights in South Africa, Ghana, Uganda, and Namibia, concluded that though many African constitutions tend to recognize civil and political rights, these constitutions generally disregard the socioeconomic rights while some include these rights as "Directive Principles of States Policy". The necessary legal issue is therefore the justiciability of this class of rights in such countries.  {\ref 35} Chapter II of the Constitution of the Federal Republic of Nigeria provides for the Fundamental Objectives and Directives Principles of State Policy.  {\ref 36} Section 14 and 17 provides as follows:\par
The legal effect of these Sections is different from the legal implications of the provisions of chapter four of the same constitution as the latter is cloth with a different status -justiciability by which the citizenry can approach the courts for a remedy. This is not so in respect of the former. This is because according to Oluduro, there is "no trigger mechanism" in which case there is no clause conferring jurisdiction on any courts to hear and determine claims of infringement of these rights.  {\ref 37} Incidentally, at the regional level, Nigeria became a party to the African Charter on Human and People's Rights (Africa Charter), which was domesticated and now forms part of the laws in Nigeria.  {\ref 38} Advocate of judicial activism therefore had urged that extrinsic meanings be used, even when the intrinsic meanings of the provision of the laws are known.  {\ref 39} At the core of the concept of judicial activism at any rate is the notion that in deciding a case judges (particularly those of the appellate court) may, or some advocate must, reform the law if the existing rules or  {\ref 35} John Cantius Mubangizi 2Afr.J.Legal Stud. 1 (2006) 1 -19 36 See sections 14 and 17 of the Constitution of the Federal Republic of Nigeria, 1999 (As amended).  {\ref 37} See Olubayo Oluduro, (February, 2004) The Right to health in Nigeria; How justiciable? International Law, Human Rights and Development, Essays in Honour of Professor Akindele Babatunde-Oyebode Edited by Akin-Ibidapo Obe \& T.F. Yerima citing Olisa Agbakoba, SAN, "Advancing Human Rights in the Fourth Republic: Prospects and Challenges" published by the Human Rights Law Service (HURI LAWS) June, 1999 p.9. 38 See CAP A.9 Laws of Federation of Nigeria, 2004 39 See the argument of Ronald Dworkin in Dworkin, Taking Rights Seriously, 134 -35; where he argued that it would be wrong in interpreting the constitutional phrase, "cruel and unusual punishment" for the Supreme Court "to be much influenced by the fact that when the clause was adopted capital punishment was standard and unquestioned." He concluded that one justification for a statute is better than another and provides the direction for coherent development of the statute if it provides a more accurate or more sensitive or sounder analysis of the underlying moral principles. This he based on the argument that there must be a fusion of constitutional and morality, and so judges should decide which one of the two competing justification is superior as a matter of political morality and apply the statute so as to further that justification; See the review of Ronald Dworkin's work in Jesse, B. \& John, B., 1986. Three Contemporary Theories of Judicial Review : A Critical Review.\par
principles appear defective.  {\ref 40} The judicial powers in Nigeria are clearly provided for in Section 6 of the Constitution.\par
"Honourable Justice Kayode Eso, JSC, underscores judicial activism in the following words:\par
"It would be tragic to reduce judges to a sterile role and make an automaton of them. I believe it is the function of judges to keep the law alive, in motion, and to make it progressive for the purpose of arriving at the end of justice, without being inhibited by technicalities, to find every conceivable, but acceptable way of avoiding narrowness that spells injustice. Short of being a legislator, a judge, to my mind, must possess an aggressive stance in interpreting the law." 41 a) Justiciability of Health Rights under the Nigerian Constitution\par
The term "justiciability" is generally understood to refer to right's faculty to be subjected to the scrutiny of a court of law and another quasi-judicial entity. A right is said to be justiciable when a judge can consider this right in a concrete set of circumstances and when this consideration can result in the further determination of this right's significance.  {\ref 42} According to Kaase, arguments on the debate of the non-justiciability and justiciability raised in opposition and for judicial enforcement of social rights are manifold. One of the argument is that the separation of powers in a democratic government require the Judiciary in performing its functions, to restrain itself from intruding on the governmental functions assigned to other branches of government and this has been argued for and against by several authors.  {\ref 43} The implementation of  {\ref 40}  Economic, Social and Cultural Rights, is viewed to be costly since this class of right were understood as obliging the state to provide welfare to the individuals.  {\ref 44} The consequence is that Nigerian public hospitals are grossly underfunded and health services are not properly managed, which has resulted in a comatose state of health infrastructure.  {\ref 45} This is the live situation found in Nigeria whereas, the World Health Organization recommends that government should spend a minimum of \$34 per capita on health annually for low income countries, Nigeria has been spending between \$2 -\$5 per capita on health, which is grossly below the minimum recommended.  {\ref 46} Adekoya rightly captured the situation thus: "Nigeria with a population of over 140 million and a major producer of oil in the world have majority of her citizens living in extreme poverty. Nigeria also ranked among the 20 poorest countries in the world. As at 1996, 13 years ago, about 67\% of Nigerians have been living in poverty and one can then imagine the figure would reached an alarming rate in 2009; judging from the fact that nothing tangible has been done to reverse the poverty trend in the country in spite of the much touted poverty alleviation programme of government. With the said poverty rate, over 70\% of Nigerians can be regarded as desperately poor"  {\ref 47} Therefore, the non-justiciability of Economic and Socio-Cultural Rights in Nigeria remains an admitted aberration considering the huge deposit of natural resources in Nigeria. The major problem with regard to the implementation and enforcement of economic and social rights as enshrined in the ICESCR is that such implementation is dependent upon the resources available within a state party; thus, these rights themselves are limited by a lack of resources.  {\ref 48} International law requires a State to carry out its made justiciable and are vindicated by the Courts, the result will tend to distort the traditional balance of the separation of powers between the Judiciary and other branches of government in that more power will flow to the judiciary"  {\ref 44}  international obligations undertaken by it by ratifying international treaties, but it does not govern the process of incorporating international law into municipal law. The principle of sovereign equality as embodied in the UN Charter is the cornerstone of the international relations between the States.  {\ref 49} Each State has different processes of incorporating international law into their domestic legal system, depending on their constitutional provisions in this respect. Thus, the process of implementation of international law at national level varies in different countries and the divergent State practices pertaining to incorporation of international law into municipal law depends on the provisions of the constitution.\par
b) The implications of the "African Charter Act" on health rights in Nigeria\par
The preamble to the African Charter on Human and People's Rights, states that ...therefore it is settled that this regional instrument is an Act with important provisions in relation to the realization of health rights in Nigeria. The relevant Section of the Regional Act states as follows: Article 1 of the Charter The Member States of the African Unity parties to the present Charter shall recognize the rights, duties and freedoms enshrined in this Charter and shall undertake to adopt legislative or other measures to give effect to them. improvement of appropriate national institutions entrusted with the promotion and protection of the rights and freedoms guaranteed by the present Charter.\par
Although given the arguments on justiciability and non-justiciability of rights it is settled beyond doubt that the constitution is the core propelling force for the implementation of health rights which is categorized under the non-justiciable rights, however, the African Charter represents a significantly new and challenging framework for the implementation of Economic Social and Cultural Rights in Nigeria. The Charter is a treaty and it therefore has the force of law. According to Article 26, Vienna Convention on the Law of Treaties, a treaty is defined as follows:\par
""treaty " means an international agreement concluded between States in written form and governed by international law, whether embodied in a single instrument or in two or more related instruments and whatever its particular designation"\par
The Constitution of the Federal Republic of Nigeria 1999 provides that no treaty between the Federation and any other country shall have the force of law except if the treaty has been incorporated into domestic law by the National Assembly.  {\ref 50} The Supreme Court of Nigeria per Achike, JSC had this to say:\par
"I cannot agree more with learned crossappeallant's counsel that Ogugu v. State (supra) is a good authority that the African Charter, having been duly incorporated into our municipal laws, it would follow that the procedural provisions set out in the Fundamental Rights (Enforcement Procedure) Rules under Chapter 4 of the 1979 Constitution for enforcing fundamental rights enshrined in the Constitution, are applicable, by extension, to the provisions of the African Charter. As I have highlighted earlier in this judgement, the process of incorporating the African Charter into the body of our domestic laws simply places the Charter at par with all our domestic legislations and in turn brings the African Charter within the judicial powers of the courts established under the Constitution" Consequently, the African Charter on Human and Peoples' Rights (Ratification and Enforcement) Act is enforceable in Nigeria.  {\ref 51} Sections 88 and 89 of the Constitution also empower the Parliament with oversight function on all activities of government, which in this case includes ensuring the implementation of the relevant legal instruments and policy frameworks which Nigeria is a signatory thereto. On the one hand, it can be argued that it is the duty of the Parliament to ensure that  {\ref 50} Section 12(1) of the Nigerian Constitution (1999) grants the Parliament sacrosanct autonomy with regard to responsibility of ratifying all international agreements and instruments before they can assume the force of law. 51 Adopted on June 27, 1981, OAU Doc. CAB/LEG/67/3 rev.5 reproduced in 21 I.LM 58 and came into force on October 21, 1986. these international instruments are complied with given the nation's commitment and obligations under these instruments. According to Brand, courts can protect socio-economic rights in two ways. Firstly, through their law-making powers of interpreting legislation and developing the rules of the common law, and secondly, by adjudicating constitutional and other challenges to state measures that are intended to advance those rights.  {\ref 52} On the other hand however, considering the provisions of Section 6(6) of the Constitution of the Federal Republic of Nigeria, one may argue that the Judiciary is empowered to determine any dispute arising from the purported implementation of the provisions of the Constitution. In the case of Abacha v. also the duty of the court to adjudicate on such complaint before it in this regard. The goal of the ESCRs therefore is to ensure that citizens enjoy the highest attainable standard of health. Again, it is important to consider the unequivocal declaration of the Committee on Economic, Social and Cultural Rights:\par
"Any person or group victim of a violation of the right to health should have access to effective judicial or other appropriate remedies at both the national and international level. All victims of such violations should be entitled to adequate reparation, which may take the form of restitution, compensation, satisfaction or guarantees of non-repetition."  {\ref 56} It should be noted that the fundamental rights contained in the Constitution will be meaningless if its breaches cannot be enforced. It is often said that a right, which cannot be enforced, is no right at all.  {\ref 57} The African Charter places the duty and obligation on implementing institutions of the Charter and human rights advocates working in Africa to pioneer an imaginative approach to the realization of this right. According to Kinne \& Clark there are different constitutions which have different patterns and provisions for health rights of their citizenries. For instance, some constitutions only make statements of aspiration, stating a goal in relation to the health of its citizens.  {\ref 58} The Mozambique Constitution provides for health right and health care or public health services as an entitlement 59 and there are other constitutions which make it the duty of the state to provide health care and public health services to its citizenry. This posits that it is a state obligation which is very positive in nature.  {\ref 60}  imposes a duty to provide health care or public health services on the State; consequently, it can be enforced against the State. In some other countries, there are provisions of the constitution which are either pragmatic or referential. The former type of constitution states a pragmatic approach on financing health care, model of health care system in the country, and the mandate for the delivery of health care in the country, 61 however, this is not a commitment or guaranty for the citizenry's enjoyment of the highest attainable health. The referential type of constitution makes provisions for health care and health right by way of incorporating specific reference to any international or regional human rights treaties recognizing a human right to health or health care.  {\ref 62} Again, this is limited in that each State has the powers to limit all International treaties' application through the provisions of the constitution. For instance in Nigeria, any treaty that is not domesticated cannot be enforced against the State. Unfortunately, international treaties do not automatically become part of national law in Nigeria just like it is in India. Consequently, the interpretation, application and implementation of international treaties at the domestic level continue to be an issue of concern to the realization of health rights in Nigeria.  {\ref 63} International laws require a State to carry out its international obligations undertaken by it by ratifying international treaties, but it does not govern the process of incorporating international law into municipal law. In fact, the States follow different processes of incorporating international law into their domestic legal system, depending on their constitutional provisions in this respect. For instance, the United States Senate in the early 1950s considered a constitutional amendment that would have required a treaty to be implemented only by separate federal legislation in an effort to ensure 61 23. The following is an example of a programmatic statement:\par
(1) Citizens have the right to health insurance that guarantees them accessible medical care and to free medical care under conditions and according to the procedure determined by law.\par
(2) The citizens' healthcare is financed from the state budget, by employers, by personal and collective insurance payments, and from other sources under conditions and according to a procedure determined by law.\par
(3) The state protects the health of the citizens and encourages the development of sports and tourism. (4) No one may be subjected to forced medical treatment or sanitary measures except in cases provided by law. (5) The state exercises control over all health institutions as well as over the production of pharmaceuticals, biologic [al] substances and medical equipment and over their trade. BULG. CONST. ch. II, art.52, translated \& reprinted in 3 Constitutions of the Countries of the World: Bulgaria 11 (Gisbert H. Flanz ed., 2004).  {\ref 62} The following is an example of a referential statement: "International treaties, to whose ratification Parliament has consented and by which the Czech Republic is obligated, are part of the legal order; if the international treaty provides for something other than the law, the international treaty shall be used." ´USTAVA CR. that international human rights treaties could not be used to promote civil rights for African Americans or otherwise supersede states' rights. \hyperref[b0]{64} Orentlicher in considering the case of Wideman v. Shallowford \hyperref[b3]{65} asserts that rights to healthcare in the United States have been weak because courts have rejected the possibility of "positive" rights under the Constitution. \hyperref[b4]{66} There are however other writers who are of the view that where the provisions of a national law is in conflict with the provisions of a treaty which the nation is a signatory thereto, the provisions of the State law will bow for the treaty as it is the case in the United States of America.\par
Again, Quincy Wright stated that the terms of Article 6, paragraph 2, of the Constitution are unambiguous, "?all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every State shall be bound thereby, anything in the Constitution or laws of any State to the contrary notwithstanding" therefore he concluded that "whatever may be the causes, the hesitancy of courts to refer directly to international law tends to emphasize national sovereignty and the political, as distinct from the legal, aspects of international relations. On the other hand, recognition of wide judicial authority to apply treaties and international law tends to emphasize the authority of the international community and the objectivity of international law" 67 This divergent State practice pertaining to incorporation of international law into municipal law has been explained by two schools of law monist and dualist.  {\ref 68} The ICESCR stipulates the obligations of the States Parties to ensure full realization of the rights recognized under the Covenant.  {\ref 69} According to the Limburg Principles on Implementation of the International Covenant on Economic, Social and Cultural Rights, "a failure by a State Party to comply with an obligation contained in the International Covenant on Economic, Social and Cultural Rights is, under international law, a violation of the International Covenant on Economic, Social and Cultural Rights." 70 This is also similar to Article 19 of the Vienna Convention on the Law of Treaties, 1969, which states that "a state is at liberty to enter reservations to a treaty where such reservations are not prohibited, provided for by the treaty, or such reservations are not incompatible with the object and purpose of the treaty itself." c) Judicial Activism Generally, there is little consensus on the meaning of the term 'judicial activism'.  {\ref 71} According to Craig Green, a Westlaw search revealed that the terms "judicial activist" and "judicial activism" appeared in 3,815 law review articles during the 1990s and in 1,817 more articles between 2000 and 2004.  {\ref 72} It is a philosophy of decision-making whereby judges follow their personal views about public policy among other factors, to guide their decisions, usually with the suggestion that adherents of this philosophy tend to find constitutional violation and are willing to ignore precedent.  {\ref 73} It is a paradigm of philosophical liberalism based on a legal concept that courts should endeavour to expound the horizon of law by utilitarian approach to adjudication.  {\ref 74} Judicial activism is a necessary tool for growing the law and nurturing justice as it serves as an instrument for the effective social and economic engineer.  {\ref 75} There is also no better definition of judicial activism than the judges interpreting laws to meet the demands of substantive justice, irrespective of the bare letters of the law and the Constitution. It implies the judges bringing its head out of and demonstrating that it hears the cry of the oppressed see the oppressive bravado of the oppressor and interprets the law to show that oppression and arbitrariness do not pay the oppressed and the society.  {\ref 76} Judges also exhibits judicial activism when they modify the law from what was previously stated to be the existing law by substituting their own decision from that of the elected representatives of the people.  {\ref 77} In the case of Yaundoo v. Attorney General of Guyana, 78 the Court stated as follows "the question of procedure and access to court are imperative, while civil and criminal justice are very important to the people, every citizen's right has to be recognized and translated into actual judicial remedies. Denying this right would lead to erosion and denuding the real value of our society?" Charles Evans Hughes puts it succinctly as follows:\par
"a poor judge is perhaps the most wasteful indulgence of the community. You can refuse to patronize a merchant who does not carry good stock, but you have no recourse if you are haled before Judge whose (sic) mental or moral goods are inferior. An honest, high minded, able and fearless Judge is the most valuable servant of democracy for he (sic) illuminates justice as he interprets and applies the law, as he makes clear the benefits and the short coming of the standards of individual community right among a free people" 79 Oputa, JSC (as he then was) has once noted:\par
"In a progressing world, the law and the administration of justice cannot afford to be static and regressive. The only option open to our jurisprudence is intelligent, mature and progressive activism. We are not to fold our hands and do nothing. No. Our judges have to so interpret the law such that it makes sense to our citizens in distress and assures them of equal protection of the law, equal freedom under the law, and equal justice. A careful perusal of the founding provisions of the Republic of South Africa's constitution reveals that human dignity, achievement of equality and advancement of a democratic society based on rights and freedoms, and supremacy of the constitution is a unique distinction which serves as the basis for justiciability of ESCRs in South Africa.  {\ref 81}  rights. There is no doubt that the 1996 South African Constitution includes the Bill of Rights in addition to traditional civil and political rights, and makes these rights enforceable by the courts, by virtue of Section 38 of the Constitution. In India, the Indian Constitution has similar provisions for the protection of health rights of its citizenry, howbeit, as a Directive of State on Fundamental Principle. Section 37 of the Indian Constitution provides as follows:\par
Application of the principles contained in this Part.-\par
The provisions contained in this Part shall not be enforceable by any court, but the principles therein laid down are nevertheless fundamental in the governance of the country and it shall be the duty of the State to apply these principles in making laws.\par
The Indian Constitution envisages a welfare State at the Federal level as well as the State level. This is also in tandem with the provisions of several international treaties on socio-cultural rights which India is a signatory thereto. In India, the Fundamental Rights and Directive Principles are interpreted harmoniously with the Fundamental Human Rights as the Supreme Court is of the position that these principles supplement each other.  {\ref 83} According to Vijayashri, India's leaders had a unified vision on human rights. Although, there seem to be a distinction between judicially enforceable rights otherwise known as Fundamental Rights and the socio-economic obligations on the State known as Directive Principles of State Policy in the Indian Constitution, 84 Maneka Gandhi case formed the basis for a rethink of the position of the court on the distinction between Fundamental Human Rights and Directive Principles of State Policy. In Maneka Gandhi's case,  {\ref 85} Maneka having being issued a passport on 1 st June, 1976 under the Passport Act 1967, was requested by a letter originating from the regional passport officer, New Delhi on the 2 nd July, 1977 to surrender her passport under section 10(3) (c) of the Act in public interest, within 7 days from the date of receipt of the letter. Maneka Gandhi demanded by a letter from the Regional passport officer, New Delhi a copy of the statement of reasons for such order. However the government of India, Ministry of External Affairs refused to produce any such reason in the interest of general public. Maneka Gandhi consequently, filed a writ petition under Article 32 of the Constitution in the Supreme Court challenging the order of the government of India as violating her  {\ref 83} In Unni Krishnan, J.P. v. State of Andhra Pradesh, (1993) 1 SCC 645 , Justice Jeevan Reddy declared as follows "The provisions of Parts III and IV are supplementary and complementary to each other and not exclusionary of each other and that the fundamental rights are but a means to achieve the goal indicated in Part IV".  {\ref 84}  "'a fundamental right is not an island in itself'. The expression "persoal liberty" in Article 21 was interpreted broadly to engulf a variety of rights within itself. The court further observed that the fundamental rights should be interpreted in such a manner so as to expand its reach and ambit rather than to concentrate its meaning and content by judicial construction. Article 21 provides that no person shall be deprived of his life or personal liberty except in accordance with procedure established by law but that does not mean that a mere semblance of procedure provided by law will satisfy the Article , the procedure should be just , fair and reasonable. The principles of natural justice are implicit in Article 21 and hence the statutory law must not condemn anyone unheard. A reasonable opportunity of defense or hearing should be given to the person before affecting him, and in the absence of which the law will be an arbitrary one"\par
This was the origin of the activism that led to blurring of the line of distinction and the arguments on justiciability of rights that are termed non-enforceable in India.  {\ref 86} The Indian judiciary has a unique position under the Constitution as an independent organ of state designed to provide a countervailing check on the functioning of the other two organs in their respective spheres. Armed with the power to strike down executive, quasi-judicial and legislative actions as unconstitutional, the judiciary has, as the ultimate interpreter of constitutional provisions, expounded the basic features of the Constitution.  {\ref 87} The judiciary in exercising its  {\ref 86} See the cases of Sunil Batra v. Delhi Administration, A.I.R. 1980 S.C. 1565, Charles Sobraj v. Delhi Administration, A.I.R 1978 S.C. 1590 among others cases on the prisoner's rights to include freedom from mental and physical torture, and prohibition of the use of chains and fetters on prisoners.  {\ref 87} Se the case of State of Rajasthan v. Union of India (1977) 3 S.C.C 592 at 662, See S. Muralidhar, An Overview of the Experience of the Indian Judiciary First South Asian Regional Judicial Colloquium on Access ti Justice, New Delhi, 1-3 November, 2002. Available online at http://www.ielrc.org /content /w0202.pdf constitutional powers in India had declared that there is no division of fundamental human rights on one hand and the Directive Principle of State Policies on the other hand as the Directive Principle of State Policies are subordinate to the fundamental rights.  {\ref 88} Nigeria has one of the worst statistics in the world in maternal health because only about 3,000 registered gynecologists operate in Nigeria with a population of over 170 Million.  {\ref 89} Nigeria has one of the highest rates of maternal mortality in the world. One Nigerian woman dies in childbirth every ten minutes.  {\ref 90} There is a need for a national approach to health education, promotion, and behavior change. Currently, the unit within the primary health care responsible for health promotion needs to be supported and strengthened to discharge her responsibilities effectively.  {\ref 91} It is humbly submitted that the judiciary in a way, has a major role to play in realizing health rights today. In terms of the actual number of maternal deaths, Nigeria is ranked second in the world behind India and Nigeria is part of a group of six countries in 2008 that collectively accounted for over 50\% of all maternal deaths globally. In terms of the maternal mortality ratio, Nigeria is ranked eighth in Sub-Saharan Africa behind, Angola, Chad, Liberia, Niger, Rwanda, Sierra Leone and Somalia.  {\ref 92} Health indices in Nigeria are pathetic. Nearly a quarter of a million newborn babies die each year. There has been no significant reduction in the average national neonatal mortality rate over the past decade. There is wide variation in mortality between states, between urban and rural areas and among the poorest families compared to the richest.  {\ref 93} V. 
\section[{Conclusion}]{Conclusion}\par
In Nigeria just as applicable in other developing countries, the human right to health is recognized in numerous international instruments which these countries are signatories thereto, but the realization of economic, social and cultural rights generally, depends \begin{figure}[htbp]
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in Nigeria" 1(2013) ABUAD Law Journal, Afe Babalola University Press,\\
pp.\\
16 Ratified October, 29 1993.\\
17 Ratified October 29, 1993.\\
18 Ratified January 4, 1969.\\
19 Ratified July 28, 2001.\\
20 Ratified July 13, 1985.\end{longtable} \par
  {\small\itshape [Note: 21 22 See generally, the Africa Health Strategy: 2007 -2015, at the THIRD SESSION OF THE AFRICAN UNION CONFERENCE OF MINISTERS OF HEALTH, JOHANNESBURG, SOUTH AFRICA on "Strengthening of Health Systems for Equity and Development in Africa" 9-13 APRIL 2007 CAMH/MIN/5(III).]} 
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Cooperation And Programming: A UNDP Capacity Development\\
Resource, Capacity Development Group Bureau for Development\\
Policy UNDP, September 2006 accessed on 25 th May, 2013 at\\
http://www.hurilink.org/tools/Applying\textunderscore a\textunderscore HR\textunderscore approach\textunderscore to\textunderscore UNDP\textunderscore Tec\\
hnical\textunderscore Cooperation--unr\textunderscore revision.pdf\\
28 "Realising Human Rights for Poor People." DFID, October 2000, pg.\\
7)\\
29 Katharine G. Young, 'The Minimum Core of Economic and Social\\
Rights: A Concept in Search of Content' The Yale Journal Of\\
International Law [Vol. 33: 113] p.138\\
30 Fons Coomans, In Search of the Core Content of the Right to\\
Education, in EXPLORING THE CORE CONTENT OF ECONOMIC\\
AND SOCIAL RIGHTS: SOUTH AFRICAN AND INTERNATIONAL\\
PERSPECTIVES 159, 167 (Danie Brand \& Sage Russell eds., 2002)\\
31 Oliyide O. \& Awolowo O. Meaning, Nature and Evolution of Rights in\\
Nigeria (2006) Rights (Thorne-of-Grace Limited Publishers, Lagos) 1-\\
9, 8.\end{longtable} \par
 
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\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
280.\\
43 See Kaase T.F., The Justiciability of Social Rights Myth or Reality?\\
1(1) October, 2010 Human Rights Review (Department of Public Law,\\
Ahmadu Bello University, Zaria). For arguments on non-justiciability of\\
Socio-Economic Rights, see generally Christiansen C.E., Columbia\\
Human Rights Law Review, 38 Col. Hum. Rts. L. Rev. (2007), 321, Vile\\
M., Constitutionalism and the Separation of Powers (Oxford;\\
Clarendon Press, 1967), 13, Hogan G., "Directive Principles, Social\\
Rights and the Constitution", Irish Jurist, Vol. 36 (2001), 174 at 189,\\
Villiers B.D., "Social Rights" in Van Wyk, J. Dugard B. de Villiers and D.\\
Davis (eds).\end{longtable} \par
 
\caption{\label{tab_3}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_4}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
By virtue of International Convention of Socio-\\
cultural Rights, States Parties to the Covenant on ESCRs\\
are to recognize the right of everyone to the enjoyment\\
of the highest attainable standard of physical and\\
mental health and such steps to be taken by the States\\
Parties to the present Covenant to achieve the full\\
realization of this right includes those necessary for:\\
a. The provision for the reduction of the stillbirth-rate\\
and of infant mortality and for the healthy\\
development of the child;\\
b. The improvement of all aspects of environmental\\
and industrial hygiene;\\
c. The prevention, treatment and control of\\
epidemic, endemic, occupational and other\\
diseases;\\
d. The creation of conditions which would assure to\\
all medical service and medical attention in the\\
event of sickness 55\\
A careful appraisal of these provisions reveal\\
that it is the duty of States Parties to ensure that its\\
citizenry are protected from any condition which would\\
not guaranteed health care delivery system, or lead to a\\
deteriorating condition which can foster ill health. It is\\
Ordinary\\
session of the Commission held in The Gambia. For text, see\\
University of Minnesota Human Rights Library website, online:\\
<http://www1.umn.edu/humanrts/africa/comcases/155-96b.html>\\
(last accessed: May 30, 2005) ["Communication 155/96"].\\
53 [2000]6 N.W.L.R Part. 660 at p.249\\
54 (1994) 9 NWLR (Pt. 366) 1 at 26 -27, (1998) 1 HRLRA 167 at 189\\
55 International Covenant on Economic, Social and Cultural Rights,\\
Article 12\end{longtable} \par
 
\caption{\label{tab_5}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
  {\small\itshape [Note: translated \& reprinted in 20 CONSTITUTIONS OF THE COUNTRIES OF THE WORLD: URUGUAY (Booklet 1) 5 (Gisbert H. Flanz ed., Reka Koerner trans., 1998).]} 
\caption{\label{tab_6}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
Section 1\\
provides as follows:\\
1. Republic of South Africa.-The Republic of South\\
Africa is one, sovereign, democratic state founded\\
on the following values:\\
a. Human dignity, the achievement of equality and\\
the advancement of human rights and\\
freedoms.\\
b. Non-racialism and non-sexism.\\
c. Supremacy of the constitution and the rule of\\
law.\\
d. Universal adult suffrage, a national common\\
voters roll, regular elections and a multi-party\\
system of democratic government, to ensure\\
accountability, responsiveness and openness.\\
Section 27 and 27 of the South African Constitution\\
provides as follows:\\
26. Housing\\
1) Everyone has the right to have access to\\
adequate housing\\
2) The state must take reasonable legislative and\\
other measures, within its available resources, to\\
achieve the progressive realization of this right.\\
3) No one may be evicted from their home, or have\\
their home demolished, without an order of court\\
made after considering all relevant circumstances.\\
No legislation may permit arbitrary evictions.\\
27. Health care, food, water and social security\\
1) Everyone has the right to have access to-\\
a. health care services, including reproductive\\
health care;. . .\\
2) The state must take reasonable legislative and\\
other measures, within its available resources, to\\
achieve the progressive realization of each of\\
these rights.\\
3) No one may be refused emergency medical\\
treatment. 82\end{longtable} \par
 
\caption{\label{tab_8}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
constitution. The main issues before the court in this\\
case were as follows:\\
1. Whether right to go abroad is a part of right to\\
personal liberty under Article 21.\\
2. Whether the Passport Act prescribes a\\
'procedure' as required by Article 21 before\\
depriving a person from the right guaranteed\\
under the said Article.\\
3. Whether section 10(3) (c) of the Passport Act is\\
violative of Article 14, 19(1) (a) and 21 of the\\
constitution.\\
4. Whether the impugned order of the regional\\
passport officer is in contravention of the\\
principles of natural justice.\\
The Supreme Court of India, per Justice K. Iyer,\\
held as follows:\\
fundamental rights guaranteed under Article 21 of the\\
85 Maneka Gandhi v. Union of Indian and Another 1978-(001)-SCC-\\
0248-SC, 1978-(002)-SCR-0621-SC, 1978-AIR-0597-SC\end{longtable} \par
 
\caption{\label{tab_9}}\end{figure}
 			\footnote{Oputa, C.A., Human Rights in the Political and Legal Culture of Nigeria, 2 nd Ndigbe Memorial Lectures, Nigerian Law Publications Ltd., Lagos (1998) 38 -39. 9 Katharine G. Young \& Julieta Lemaitre, Vol. 26 (2013) The Comparative Fortunes of the Right to Health: Two Tales of Justiciability in Colombia and South Africa Harvard Human Rights Journal pp. 180 10 See generally the provision of the Constitution of the Federal Republic of Nigeria, 1960, 1963 etc. 11 Afe Babalola, 2011 Health Scheme Development, being a paper presented on 3 rd February, 2011 at the University Teaching Hospital, Ibadan at the SIDCAIN Diabetes and Hypertension Conference. 12 Hodo B. Riman, \& Emmanuel S. Akpan, (2010) Causality between Poverty, Health Expenditure and Health Status: Evidence from Nigeria using VECM European Journal of Economics, Finance and Administrative Sciences -Issue 27 (2010) 121} 			\footnote{Communication 155/96; Decision handed down at the 30 th} 			\footnote{Quincy W. National Court and Human Rights -The Fujii Case, The American Journal of International Law, Vol. 45, No. 1 (Jan., 1951), pp. 62-82. 68 Agarwal S.K. IMPLEMENTATION OF INTERNATIONAL LAW IN INDIA: ROLE OF JUDICIARY, accessed online on 1th January, 2013 at http://oppenheimer.mcgill.ca/IMG/pdf/SK\textunderscore Agarwal.pdf.69  See art 2(1) of the ICESCR 1966 which provides as follows: "Each State Party to the present Covenant undertakes to take steps, individually and through international assistance and co-operation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the present Covenant by all appropriate means, including particularly the adoption of legislative measures."} 			\footnote{Keenan D. Kmiec, Comment, The Origin and Current Meanings of "Judicial Activism," 92 CAL. L. REV. 1441, 1442 (2004); see also Bradley C. Canon, A Framework for the Analysis of Judicial Activism, in SUPREME COURT ACTIVISM AND RESTRAINT 385, 386 (Stephen C.Halpern \& Charles M. Lamb eds., 1982) (describing prevalent activism debates as "little more than a babel of loosely connected discussion").73  Bryan A. Garner, Black's Law Dictionary, Eighth Edition, (USA: West} 		 		\backmatter   			  			  			 \par
significantly on action of the state, notwithstanding party states obligations under the international treaty which they are parties thereto.  {\ref 94} It is therefore obvious that in advocating for the realization of health rights in Nigeria, Ladan's comment on the implementation of international treaty is right. According to Ladan, "implementing an international treaty means putting the treaty into effect. It goes a bit further than mere observance of the law. It implies that its general aim, the result that was desired by those who adopted the treaty is achieved or will be achieved, so that the treaty-rules can be said to have been given full effect."  {\ref 95} In the absence of such judicial activism, a constitution would become stultified and devoid of the inner strength necessary to survive and provide normative order for the changing times.  {\ref 96} It is generally accepted that domestic laws should be interpreted as far as possible in a way which conforms to a State's international legal obligations.  {\ref 97} Given the legal framework put in place in Nigeria on health rights and the powers of the judiciary, one cannot but wonder the basis for sustaining such arguments which holds the plank of "non-justiciability" of health rights in Nigeria. It is submitted that the coast is clear for a sail into a new dispensation of health care system administration in Nigeria, and realization of this right in Nigeria today as the legal circumstances in Nigeria are stronger than the chances and opportunities converted through activism in India and South Africa. The judiciary therefore is protected by the domestication of the provisions of the African Charter on Human Rights on health rights in Nigeria. The judiciary is the last hope of a common man in Nigeria where there are frightening statistics on maternal mortality ratio, infant mortality rate, life expectancy even at birth, equipment and facilities available for the larger portion of the population, judges are challenged to give life to the wordings of the constitution, and apply the appropriate laws irrespective of the political consequences of such decisions particularly in the interest of the citizenry. This will also enable the State to comply with its obligations as required by the international law. Some have suggested that legal remedies might be restricted to violations emanating from failures to meet these minimum core requirements, but the concept of the "minimum core content" needs to be clearly distinguished from the idea of justiciability which had been the major impediment to the realization of health rights in Nigeria. The Nigerian health system is in comatose, few hospitals with few drugs, inadequate and substandard technology and a lack of infrastructural support, including electricity, water and diagnostic laboratories resulting in misdiagnosis. Medical record keeping is rudimentary and diseases surveillance is very poor. Delivery of health care becomes a personal affair and dependent on ability to pay for basic laboratory and physician services.  {\ref 98} The rather pathetic downturn of the state of the health care sector in Nigeria can only be upturned by an approach which aligns with ensuring accountability on the part of the government for it compliance with fulfillment, respect and protection obligations under the African Charter. This cannot be achieved with an element of judicial activism in Nigeria today given the past experiences and the judicial attitude demonstrated by the judges. It is also to be noted that with the current state of the law in Nigeria on health rights, the issue of justiciability has lost its relevance as the incorporation of the African Charter has provided a basis for a finding of a prima facie case of violation of health rights, and thereby placing a greater onus on the governments in particular circumstances to demonstrate that all available resources have been allocated as a matter of priority to meeting the most critical needs. There is a need for a fundamental change in policy, regulation, financing, provision of health services, reorganization, management and institutional arrangements, with a practical effort by the government to improve the access to health care and health system in Nigeria in a bid to improve the health status of Nigerian citizens. This can only be achieved with the aid of an effective interpretation and application of the corpus in place in Nigeria by the judiciary.  
\subsection[{2013.v4n1p221}]{2013.v4n1p221}			 			  				\begin{bibitemlist}{1}
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\end{document}
