CEDAW/C/49/D/17/2008 4.5 The State party further explains its duty to regulate, enforce and control health actions and services. The Ministry of Health establishes the national audit system (Sistema Nacional de Auditoria) and coordinates the technical and financial evaluation of the health system throughout the national territory with the technical cooperation of the states, municipalities and the Federal District. The national audit system undertakes technical and scientific evaluation, accounting, financial and asset audits of the health system through a decentralized process. Decentralization is ensured through state and municipal bodies and branch offices of the Ministry of Health in each Brazilian state and the Federal District. 4.6 Private institutions may legally be incorporated into the health system only in the event that service availability is insufficient to guarantee coverage to the population of a given geographical area. The role of private institutions within the health system, therefore, is to provide health assistance, not to perform enforcement, control or regulatory actions or to implement public policies under the system. These institutions are subject to the principles of the health system and the national audit system in respect of evaluation of service quality. 4.7 With regard to the allegations that the State party violated articles 2 and 12 because of its failure to adopt measures aimed at eliminating discrimination against women in the field of health care, directly leading to the substandard medical attention provided to Ms. da Silva Pimentel Teixeira, the State party notes that a number of public policies are under development that address the specific needs of women, particularly those in situations of vulnerability, which affect the equality of men and women. It involves, in fact, a complaint about lack of access to medical care, insofar as the communication does not offer a single link between Ms. da Silva Pimentel Teixeira’s gender and the possible medical errors committed. The State party refers to the finding of the technical visit report of the Rio de Janeiro Audit Department which concluded that the failures in the medical assistance provided to Ms. da Silva Pimentel Teixeira did not fall under discriminati on against women, but rather deficient and low-quality service provision to the population, resulting in the facts described. The State party admits that Ms. da Silva Pimentel Teixeira ’s vulnerable condition required individualized medical treatment, which was not forthcoming, but claims that the alleged lack of specific medical care was not denied because of an absence of public policies and measures encompassed within the obligation of the State party to combat discrimination against women in all fields. The case describes a potential failure in the medical assistance provided by a private health institution, indicating errors in the mechanisms used to contract private health services and, by extension, the inspection and control thereof, not a lack of commitment on the part of the State to combat discrimination against women. 4.8 The State party argues that this line of reasoning has been confirmed by the State Committee on Maternal Mortality, which concluded in the investigative report on maternal death issued by the State Health Secretariat of Rio de Janeiro that Ms. da Silva Pimentel Teixeira’s death was non-maternal and that the probable cause of death was digestive haemorrhage. Further, the report contains a summary of information on her death, including the initial medical care provided, her admission to hospital and her ultimate death, with reference, in addition, to the cause of death and the critical junctures in her treatment, as well as comments and recommendations. The summary investigative report is the document that the State Committee on Maternal Mortality analyses and uses, in conjunction with other 10 11-51699