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InWEnt Forum

Social services: Promoting a human right

Development Policy Forum: "We take our partners seriously"


12/2006		  

[ Social services ]

Promoting a human right

Governments and their institutions need to ensure that everyone has access to adequate health services – including the poorest members of society. This notion is still insufficiently embedded in many people’s minds.


[ By Claudia Kornahrens ]

The Uganda National Health Consumers Organisation (UNHCO) is an unusual human-rights group. Its focus is on health services. The UNHCO effectively lobbies the government and, at the local level, runs training programmes to empower people to stand up for their rights. It has already happened that the organisation rallied people to occupy a local health station in order to get incompetent personnel – a persistently drunken health officer, for example – removed from their posts.

Conditions for UNHCO’s campaigns are good in Uganda. The national Human Rights Commission is also going to look more closely at the health sector in future, after Paul Hunt, special rapporteur on the right to health at the UN, identified this body as a relevant actor last year.

The country’s Ministry of Health also sees access to care as a fundamental right. One thing it has done is set up Village Health Teams, in which each member is responsible for 25 to 30 households, and has the task of monitoring that scarce resources are efficiently made use of at the local level.

All these steps show that Uganda is making progress towards realising the human right to health – a right stipulated not only by the United Nations but also called for by international civil society. In 2000, independent groups from all over the world established the “People’s Health Movement” in Bangladesh, adopting a “People’s Charter for Health” to assert the right to health in the wake of globalisation. The charter is based on the principle of universal, comprehensive primary health care.

The right to health has been enshrined in international conventions for 60 years, but it is not realised everywhere and still being debated by legal experts. In 1946, the World Health Organisation (WHO) stated in the preamble to its constitution that the enjoyment of the highest attainable standard of health was one of the fundamental rights of every human being. This was underlined in both the Universal Declaration of Human Rights of 1948 and the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR). The latter has so far been ratified by 155 countries.

Of course, the right to health should not be misunderstood as the right to be healthy, as that is not something any government or society could possibly guarantee. The right to health tackles other issues: access to health care along with a variety of socio-economic, environmental and other factors – from freedom from torture to the prohibition of harmful traditional practices such as female genital mutilation.


Legal dimensions

Traditional human rights like freedom of speech or freedom of assembly protect individuals from assault by the state. Economic, social and cultural rights, on the other hand, define a claim (to housing, food, health, water and education). Some experts object that, because of lack of resources, it may be beyond the power of a given country to guarantee these rights. The response to that argument is that where there is a political will, there is a way of fulfilling fundamental obligations – even with limited funds.

A second widespread objection concerns the legal quality of the ICESCR guarantees. In principle, human rights should be judicially enforceable. As far as the prohibition of inhuman action by state authorities is concerned, that is comparatively easy to regulate in law. But the rights set out in the ICESCR require the state to perform certain services. It is much more difficult to identify the institution responsible when such rights are not met. UN bodies are working on getting a better legal grip on such issues.

It is now consensus that the right to health is defined by four core elements. Among professionals, they are known as the “triple A and one Q”:
– Availability of an adequate number of medical facilities, goods and services,
– accessibility, in the sense of supply being within reach,
– acceptability in the given socio-cultural context and, finally, the
– quality necessary to ensuring appropriate standards.

There is also consensus on the fact that states and their institutions need to fulfil three obligations. They need to respect the right to health and may thus neither hinder nor obstruct the enjoyment of existing rights. They have an obligation to protect, safeguarding rights from interference by third parties. And finally they have an obligation to fulfil, in the sense of taking appropriate legislative, administrative and other measures to facilitate the realisation of the right to health.

Accordingly, governments which discriminate in the provision of health care or even use it to apply political pressures are guilty of violating human rights. Furthermore, it has been clearly established that states have a duty to protect their citizens from health hazards, such as industrial emissions. A third conclusion is that governments need to ensure adequate care for the poorer sections of society.

For the obligation to fulfil, human-rights scholarship acknowledges the principle of “progressive realisation”, which was already stipulated in the ICESCR. The principle means that not all requirements need to be met immediately. Nevertheless, the approach is not arbitrary. Signatories are required to
– take concrete and targeted action,
– use available resources on an appropriate scale (with a distinction made between inability and unwillingness of governments),
– implement the provisions at various levels (legislative, administrative or other) and
– establish effective mechanisms for monitoring progress towards the realisation of the right to health. After all, specific indicators and benchmarks are important for doing so.

In 2003, the United Nations Development Group (UNDG) adopted a “Common Understanding of the Human Rights Based Approach to Development”. It provides a standardised reference framework for the UN’s entire developmental activities. This approach sees people primarily as rights holders, not as needy of charity. This line has also been adopted by Germany’s Federal Ministry of Economic Cooperation and Development, which regards poverty reduction and the promotion of human rights as two mutually reinforcing principles. Core principles to be taken into account in all development cooperation are therefore participation, equal opportunity, non-discrimination and accountability.


Reaching minds

However, this way of thinking needs to be embedded in more minds – and not only in poor countries. Even experts sometimes fail to realise that people who are sick are not simply victims in need of benevolent support, but rather have a fundamental right to state-of-the-art care.

Implementing the law-based UN approach depends crucially on capacity building. Not only those in charge in government and public services need training and education, rights holders – individuals, self-help organisations and other civil-society groups – also deserve to be addressed. InWEnt takes account of this facts and tailors programmes accordingly:
– Fora for international dialogue provide platforms for exchanging experiences, networking governments and civil society as well as raising awareness of standards of good practice.
– An innovative months-long e-learning course developed in cooperation with the WHO provides upgrade training for UN staff as well as target groups in developing countries.
– Training courses on “Measuring Democracy, Governance and Human Rights” methodically strengthen monitoring capacities in target countries.

This summer, InWEnt cooperated with the WHO and KfW Entwicklungsbank on hosting a regional workshop in Nairobi. The programme addressed all health-related human rights, the UN Millennium Development Goals and the Poverty Reduction Strategies (PRS), which many developing countries need to come up with in return for multilateral debt relief. The workshop was the first major international exchange of its kind in Africa.

One gratifying aspect was that participants did not split along government and civil-society lines, as often happens in the context of human rights. Instead, there was a closing of ranks. Moreover, representatives of various human rights commissions were present. While the role and significance of such bodies certainly differ from one nation to another, their members’ elaborations in Nairobi clearly showed that experts from different countries have no problem extending their attention from civil and political human rights to include those of the ESC catalogue.


Claudia Kornahrens
heads InWEnt’s Health Division. Before taking this job, she worked as a staff member for the Social Democrats in the Bundestag, specialising in human rights and humanitarian aid.
claudia.kornahrens@inwent.org