2. What is a “Rights-Based Approach”?
“Rights-
• Health and development initiatives often speak
of a “Rights-Based Approach”
• Seldom well understood or explained
• No single way of applying a RBA
• Simply new jargon to some
• Completely new approach to others
• Needs to be carefully considered and
meaningfully applied
• This presentation describes current thinking on
the right to health and PRIDE’s approach…
4. Key human rights concepts
Universal
• All have rights
• Recognized in international standards and conventions
Indivisible, interdependent & interrelated
• “Health rights” cannot be separated from other rights
Right holders
• All entitled and have responsibilities to claim
• Emphasis on most vulnerable and marginalized
Duty bearers
• Obligation of the state to respect, protect and fulfill rights
• All responsible for influencing enjoyment of rights
Addressing root causes
• Cycles of poverty and social disadvantage
• Underlying determinants of poor health
5. Health “is a fundamental human
right that that is indispensable for
the exercise of other human rights.
Every human being is entitled to the
enjoyment of the highest attainable
standard of health conducive to
living a life in dignity.”
Committee on Economic, Social and Cultural Rights, General Comment No. 14 (2000), par. 1
http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument
6. Sphere Standards for Protection in
Health
1. Health programs provide disaster-affected
populations with safe and equitable access
to health facilities and services
2. Health staff respond appropriately to
individuals or groups that are victims of
physical and/or sexual violence, torture or
other human rights abuses
3. Health services respect the cultural and
religious context to the extent that this does
not undermine other fundamental human rights
7. Although there is no prescribed way
of making health rights real…
“At the heart of the right to the highest
attainable standard of health lies an
effective and integrated health system,
system,
encompassing medical care and the
underlying determinants of health, which is
responsive to national and local priorities
and accessible to all.”
Hunt & Backman 2008
8. Minimum health related obligations
include the right to…
• Access to health facilities, goods and services
on a non-discriminatory basis, especially for
vulnerable or marginalized groups
• Access the minimum essential food which is
nutritionally adequate and safe
• Access shelter, housing and sanitation and an
adequate supply of safe drinking water
• The provision of essential drugs
• Equitable distribution of all health facilities,
goods and services
9. This is also linked to ideas of…
Accountability
Accessibility
Acceptability
Availability
Respect
Equity
Representation
Protection
Information
Participation
Involvement Sustainability
Transparency Quality
10. Putting ideas into action…
“The concept of a right to health
can be used to formulate policies,
organize systems and services,
and develop actions that promote
better health outcomes
outcomes.”
De Negri Filho 2008
11. What actions might a RBA include?
• Critical analysis and monitoring
• Right holder / civil society mobilization
• Duty bearer / government capacity
building
• Awareness raising
• Advocacy and lobbying
• Policy / legal reform
• Intersectoral partnerships
12. Continuums of rights orientations
Purpose of Activity
Demand Duty
Generation Fulfillment
Methodological Orientation
Promotional & Protection &
Educational Enforcement
Style of Programming
Consensus Escalating
Building Opposition
Prioritization within Programming
Implicit Explicit &
& Indirect Integral
13. Which rights orientations and
actions are appropriate and feasible?
Determined by…
– Country context
– Orientation of
organization
– Position of project
– Individual interpretation
15. Our challenge…
How can the concept of rights be
translated into health realities?
16. Pakistan’s challenging rights context
Pakistan subscribes to: Pakistan is not party to:
• Convention on the • Economic, Social and
Elimination of All Cultural Rights
Forms of Covenant
Discrimination • Civil and Political
Against Women (with Rights Covenant
some reservations) • Convention against
Torture
• Children’s Rights • Convention Relating
Convention (with to the Status of
some reservations) Refugees
Limited respect for human rights and lagging health indicators
17. PRIDE’s rights orientation
PRIDE focuses on:
• A rights lens for planning and programming
• Longer term perspectives for sustainable solutions
• System support above direct delivery of
commodities and services (except in response to
emergencies)
• Equity of access (e.g. gender, geographic location,
ethnicity, language, literacy), particularly for most
vulnerable and marginalized
• Improving attitudes, skills, behaviors of duty bearers
and right holders
• Participatory approaches to building constructive
partnerships between duty bearers and right holders
18. PRIDE activities addressing rights
• Building institutions and communications
enabling communities to increase demand for
and involvement in health and health services
• Developing support for setting and achieving
standards for quality services
• Increasing access to essential services and
commodities
• Contributing to improved management systems
• Monitoring equity of intervention coverage
• Advocating for policy and program reform
20. Health rights concepts
• Basic primer, Center for Economic and Social
Rights
http://www.cesr.org/health
• Health and human rights, WHO
http://www.who.int/hhr/en/
• Health and human rights, Human Rights Watch
http://www.hrw.org/doc/?t=health
• Health rights web links, American Medical
Student Association
http://www.amsa.org/global/hhr.cfm
21. Health rights in reality
• The right to health, WHO & OHCHR
http://www.ohchr.org/Documents/Publications/Factsheet31.pdf
• The right to health: a resource manual for NGOs, Asher
http://shr.aaas.org/pubs/rt_health/rt_health_manual.pdf
• Applying a rights-based approach: an inspirational guide
for civil society, Boesen & Martin
http://humanrights.dk/files/pdf/Publikationer/applying%20a%20rights%20ba
sed%20approach.pdf
• Health systems and health rights, Hunt & Backman
http://www.hhrjournal.org/index.php/hhr/article/view/22/106
• Human rights applications to public health programming,
De Negri Filho
http://www.hhrjournal.org/index.php/hhr/article/view/29/107
22. Health rights advocacy resources
• Alma Ata Declaration on Primary Health Care
http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
• People’s Charter for Health (Urdu)
http://www.phmovement.org/files/phm-pch-urdu.pdf
• People’s Health Movement
http://www.phmovement.org
• Human Rights Impact Resource Centre
http://www.humanrightsimpact.org
• Women’s Global Network for Reproductive
Rights
http://www.wgnrr.org
23. Rights in Pakistan
• State of Human Rights in Pakistan 2007, Human
Rights Commission of Pakistan
http://www.hrcp-web.org/hrcpDetail_pub3.cfm?proId=528&catid=173
• Know your rights, Sustainable Development
Policy Institute
http://www.sdpi.org/know_your_rights/know%20you%20rights/
• Pakistan’s human rights record, NY Times
http://query.nytimes.com/gst/fullpage.html?res=9C01EEDD1F3BF93
AA15750C0A9649C8B63
• Literacy, health and rights, IRIN
http://www.irinnews.org/Report.aspx?ReportId=78097
