S/C/M/92/Add.1  
 
7 February 2020  
(20-1002) Page: 1/3 
Council for Trade in Services    
 
REPORT OF THE MEETIN G HELD ON 5 DECEMBER 2008  
NOTE BY THE SECRETAR IAT1 
Addendum  
As agreed at the meeting of the Council for Trade in Services held on 26 November 2004  (S/C/M/75), 
the statements relating to the modification or renegotiation of specific commitments pursuant to 
Article XXI of the GATS, which were contained in an informal document, are now circulated as an 
addendum to the meeting report.  
 
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Statements Made at the Meeting of the Council for Trade in Services 
on 5 December 2008 Under Item E of the Agenda  
 
 
 This document2 contains statements made by Members of the Council for Trade in Services 
under item E (Notification pursuant to GATS Articl e XXI) of the agenda contained in WTO/AIR/3290, 
relating to a notification made by Bolivia pursuant to Article  XXI of the GATS (document 
S/SECRET/12).  
 
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E. NOTIFICATION PURS UANT TO GATS ARTICLE  XXI 
1. The Chairperson  drew attention to a notification from Bolivia, made pursuant to GATS 
Article  XXI (Modification of schedules).  He recalled that, according to paragraph  1 of the Procedures 
for the Implementation of Article XXI of the General Agreement on Trade in Services , adopted by 
the Council on 19 July 1999 and contained in document S/L/80:  "A Member intending to modify or 
withdraw a scheduled commitment in accordance with Article  XXI (the "modifying Member") shall 
transmit a notification to that effect, no later than  three months before the intended date of 
implementation of such modification or withdrawal, to the Secretariat which will distribute the 
notification to all other Members in a secret document. The intention by a Member to modify or 
withdraw scheduled comm itments shall be included in the agenda of the next meeting of the Council 
for Trade in Services."  The notification by Bolivia was contained in document S/SECRET/12, dated 
11 November 2008.  He noted that each delegation had received a numbered copy and r ecalled that, 
as agreed by this Council at its meeting of 26  November 2004 (S/C/M/75) with respect to records 
of discussions relating to negotiations under GATS Article XXI, the record of the statements made 
under this agenda item would be circulated in an  informal document shortly after the meeting.  It 
would be re -issued as an unrestricted addendum to the minutes of the meeting, after the conclusion 
of the negotiations under Article XXI and the certification of any changes to the relevant schedule of 
comm itments.   
 
1 This document has been prepared under the Secretariat's own responsibility and without prejudice to 
the positions of Members and to their rights and obligations under the WTO.  
2 Previously circulated as JOB( 08)/131, dated 11 December 2008.  S/C/M/92/Add.1  
 
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  2. The representative of Bolivia  recalled that, on 6 November 2008, her delegation had notified 
to the CTS, in accordance with GATS Article XXI, the intention to withdraw its specific commitment 
on hospital services from the Health Services sect or of its schedule, GATS/SC/12.  Five reasons 
justified this notification:  (i) make Bolivia's GATS commitments compatible with the new political 
Constitution of the State;  (ii)  ensure that GATS commitments were compatible with Bolivia's 
national health objectives and new government policies;  (iii) ensure compatibility with international 
instruments on human rights;  (iv) the position of Bolivia to withdraw basic services, such as health, 
education, water, energy and communication, from the scope of the GATS on the ground that they 
were human rights;  (v) liberalization of health services had not translated into real benefits for the 
health of the people in Bolivia, especially for the poor and vulnerable.  She further explained that, 
pursuant to article 1 8, chapter 2, of the new political Constitution of Bolivia, which dealt with 
fundamental rights, everyone was entitled to health.  The State guaranteed the inclusion and access 
to health of all persons, without discrimination.  The unique health system put  in place by the new 
Constitution would be universal, free of charge, intra - and intercultural, participative, with all the 
necessary qualities and social values.  It would be based on solidarity, efficiency and co -responsibility 
and would be developed thr ough public policies at all levels of the government.  Furthermore, there 
was an entire chapter on the right to health and social security.  Article 35.1 of the new Constitution 
indicated that the State at all levels should protect the right to health, pro mote public policies 
directed to improving the quality of life and the general welfare, as well as free of charge access by 
the population to health services.  Article 12 said that the health system was a single one and 
included the traditional medicine, a s carried out by indigenous people.  In article 36.1, it was stated 
that the State should guarantee access to universal health insurance.  Article  37 referred quite 
clearly to the fact that the State had the absolute obligation of sustaining a right to hea lth as one of 
its primary financial responsibilities.  Secondly, the Bolivian State had adopted new health objectives 
in order to put an end to social exclusion, which had been deepened by neo -liberal policies, to the 
privatization of the sector, to the me rchandisation of services and to the establishment of an 
individualistic culture for health.  According to the new plan, health was a fundamental social and 
human right, not a merchandise, and it was the function of the State to protect it.  Social 
conside rations prevailed.  One of the objectives contained in the national development plan tried to 
eliminate the social exclusion which had been provoked through the liberalization of the health 
sector, in particular with the implementation of a single system, which would be intercultural and of 
a community nature, and which would include traditional medicine.  This system would be inclusive, 
equitable, based on solidarity, and of quality, which was potentially incompatible with Bolivia's GATS 
commitments.   
3. Concerning the third point, the representative of Bolivia noted that the entitlement to health 
was contained in many international and regional human rights treaties to which Bolivia was a party.  
Article  12 of the UN Covenant on Economic, Social and Cultu ral Rights (UNCESCR) spelt out "the 
right of everyone to the enjoyment of the highest attainable standard of physical and mental health".  
Among the measures to be adopted by the State in order to ensure the full effectiveness of this 
right, conditions had  to be created so as to ensure that everybody obtained the necessary medical 
healthcare.  According to General Comment No. 14 on Article 12 of the UNCESCR, the right to health 
in all its forms and at all levels included, among others, "availability" (each State needed to have a 
sufficient amount of health establishments, goods and services, as well as programmes), and 
"accessibility" (health establishments, goods and services should be accessible to everyone without 
any discrimination).  With respect to the  fourth point, she explained that, for Bolivia, basic services, 
such as water, health, energy, education and communication, among others, were human rights 
which could not be the object of private business and liberalization, because, inevitably, this woul d 
lead to privatization and create problems of accessibility for the population in general, and in 
particular for the poorest among them.  For this reason, her delegation had stated on numerous 
occasions, that it was fundamental to preserve these basic ser vices as human rights.  It was Bolivia's 
view that the WTO should initiate serious discussions so that these services be recognized as human 
rights and be totally excluded from the scope of the GATS.  Finally, in Bolivia's view, the liberalization 
of the h ealth sector had not translated into real benefits for the health of the population.  None of 
the possible opportunities offered by liberalization of trade in services had become reality in Bolivia, 
nor had it contributed to improving the quality and effic iency of the supply.  The study called "Social 
Exclusion in Health in Bolivia", carried out by the Pan -American Health Organization, had come to 
the conclusion that seventy -seven percent of the Bolivian population was excluded one way or 
another from healt h services.  Maintaining the liberalization of this sector could increase problems 
of access to the services, which would affect more particularly the poorest and most vulnerable, 
such as indigenous people.  Furthermore, the reduced size of the Bolivian ec onomy, the high level 
of poverty and unemployment did not make the market attractive for foreign investments.  Her S/C/M/92/Add.1  
 
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  delegation had not come across any data which showed that somehow, the current of investments 
had started thanks to the liberalization of thi s sector.  
4. The representative of the European Communities  said that her delegation had carefully 
assessed the notification made by Bolivia.  The EC did not intend to file a claim of interest in this 
case.  This was, however, without prejudice to other no tifications made under GATS Article XXI.  
5. A representative of the Secretariat  indicated that, due to the end -year closure of the WTO, 
and in accordance with the practice regarding legal deadlines, the deadline for filing claims of 
interests was postponed  until 5 January 2009.  
6. The Council took note  of the statements made.  
 
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