Message from the Chair: Accountability for Every Woman and Every Child's Right to Health: Seeking a new normal
On the occasion of the International Human Rights Day 2013
Consultation on Applying Human Rights to Women’s and Children’s Health, 5-6 December 2013, Oslo, Sweden
It is our belief as the iERG that this should be underpinned by an accountability mechanism governed by the principles of availability, accessibility, acceptability, and quality of services; participation; equality and non-discrimination.
Including the underlying determinants of health, this human rights approach places as much emphasis on the process of shaping the laws, policies, and programs; delivering the service, as well as the health outcomes for women and children. The costs of not adopting this approach over the past decade and a half are clear. To achieve universal coverage with comprehensive quality, efficient, and effective services, the strengthening of the systems that deliver these services is critical. It is disconcerting that vital registration continues to be very poor; data on RMNCH resource allocations and expenditures at country level is more often than not incomplete or inaccurate; data is still not fully disaggregated, with critical areas like violence, mental health and young people not being monitored at all. The iERG 2013 report identifies failure by countries and partners in the systems area as the key reason why MDG 5 is off track. Another glaring failure has been the inattention to reproductive health which we believe is symptomatic of a larger inattention to women more generally.
A human rights approach will expand country and partner commitment, at the same time that it will enhance iERG capacity to evaluate programs for women's and children's health. It is clear to us that the iERG was born out of human-rights-based approach to health. Our independent accountability framework of monitor-review-remedy is taken explicitly from the human rights community within the UN system.
We therefore call for the reproductive, maternal, newborn, and child health community and the human rights community, to bridge the gap between their work by integrating into the RMNCH programs effective human rights tools that will accelerate and improve service delivery, results and impact for women's and children’s health.
In this regard, 2013 marked two important advances in the field of human rights and RMNCH:
- adoption by the Human Rights Council of a resolution on the child’s right to health, calling for a study of child mortality as a human rights concern;
- a two-year process concluded in 2013 with the adoption of General Comment 15 on the Child’s Right to Health. A Group of Partners—comprising WHO, UNICEF, World Vision, and Save the Children—now have the opportunity to develop the tools to apply this resolution at country level, including defining the roles of civil society, and participation of communities in accountability structures and mechanisms.
As the iERG, we have adopted five principles that guide our evaluation of evidence and thinking based on the rights based approach that is informed by the work of the Humans rights community. First, we want to assess the extent to which our countries and partners strengthen not only health but also the dignity of and equity between women and children in communities. Second, we are looking for a person-centered, not an intervention-centered, approach to health and human dignity. Third, we seek the extent to which a life-course approach to adolescents', women's, and children's health has been applied. Fourth, work on behalf of women and children must be assessed for the extent to which it is set in the context of equitable and sustainable development. We emphasize that no human rights principles can be fully realized without a commitment to independent accountability, based on the tripartite model of monitor, review, and action or remedy.
In this way, we believe that we will be in a position to monitor the effective application of the tools developed by the RMNCH and human rights communities. The cross that we must all bear is that there is a substantial gap between these human rights principles and evidence about the reality of care for woman and children in countries. The way care is currently delivered frequently violates human right principles. To bridge this gap, we need stronger integration and coordination of care services for women and children, including interventions that give women space to find their own voice and empower themselves, rather than make them the objects of healthcare delivery. This human rights approach is without a doubt a core element of sustainability.
Last year, the iERG report called for the strengthening of human rights tools and frameworks to achieve better health and accountability for women and children. The 2013 accountability workplan now includes a human rights component where partners will support a series of rights-based reviews in Malawi, Tanzania, Uganda, and Nepal to analyse laws and policies relating to maternal and child health.
The iERG 2013 report clearly recommends first that countries and partners demonstrably prioritize and evaluate country-led, inclusive, transparent, and participatory national oversight mechanisms to advance women’s and children’s health to lock in accountability, as part of the rights based approach.
Secondly, we call for a Global demand for global accountability post 2015. We urge both the RMNCH and the Human rights communities to advocate for and win an independent accountability mechanism to monitor, review, and continuously improve actions towards delivering the post-2015 sustainable development agenda with a focus on the right to health.
Our fourth recommendation calls for the prioritization of quality to reinforce the value of a human-rights-based approach to women’s and children’s health: Making the quality of care the route to equity and dignity for women and children.
We seek a new normal, where the right of every woman and every child to health is prioritized by all.