A Human Rights-Based Approach (HRBA) emphasises that every person has basic rights which should be respected and protected. Every person has a right to the enjoyment of the highest attainable standard of health. These rights are protected by international law.  

 

The problem: social-structural factors hinder health systems

At the 68th World Health Assembly in May 2015 in Genèva, Switzerland, non-State actors like civil society organizations, international non-governmental organizations (NGOs) and patients’ groups were concerned that social-structural factors in their countries were preventing health systems in delivering an adequate supply of affordable, acceptable and quality health services and public health programmes to their patients. 

Structural factors like inaccessible political power and decision-making structures in the economic, financial, social-welfare and health policy-making areas were resulting in inequalities, discriminatory practices and unjust power relationships within their health systems. This had a significant impact upon a patient’s health and the provision of patient-centred health systems, besides affecting the health enabling social-environmental factors like good employment opportunities, high quality education, efficient transport networks, safe work places, healthy cities and crime-free neighbourhoods.  

Existing technical guidance on HRBA: 'Give a bite to the bark'

The World Health Organization (WHO) and the Office of the High Commissioner for Human Rights (OHCHR) launched technical guidance in 2014 on how the State and non-State actors can use a HRBA to address social-structural bottlenecks preventing the delivery of maternal and paediatric health services in their countries.

The HRBA guidance came about because Member States were going to miss the Millennium Development Goal (MDG) targets to set-up universal access to reproductive health services and reduce maternal mortality by 75% and the under-five mortality by two thirds by 2015. Social-structural factors had prevented the delivery of the targets, prompting WHO to ask OHCHR to ‘give a bite to the bark’ of non-State actors’ advocacy by building capacity in NGOs to hold the State to account for breaches of maternal and child health rights. The MDGs are now being reassessed within a Post-2015 framework and will be set as the Sustainable Development Goals 2030.

The HRBA guidance came about because Member States were going to miss the Millennium Development Goal (MDG) targets to set-up universal access to reproductive health services and reduce maternal mortality by 75% and the under-five mortality by two thirds by 2015.

Opening up health systems to international scrutiny

Most patients’ organizations have been trying to end inequalities, discriminatory practices and unjust power relationships within their health systems by advocating patient-centred health systems. We have been calling for meaningful patient-engagement and patient-involvement in decision-making for over 15 years. Through our research, policy development and collective advocacy, we all hoped to give the patient-voice and patient-experience a central role in our health systems. Traditional advocacy approaches now need strengthening with HRBA. 

The HRBA is fairly similar to our traditional advocacy approaches. It echoes our aims to make all health policy and decision-making processes participatory, transparent, accountable and non-discriminatory, while respecting the rule of law. A HRBA adds more to our traditional advocacy because it is supported by the International Human Rights Framework, a body of international law monitored by UN agencies that most Member States have ratified in more than 10 international treaties.  

The cornerstone of HRBA

The cornerstone of HRBA and the International Human Rights Framework is the right-to-health. It has been defined as an economic, social and cultural right to a universal minimum standard of health to which all individuals are entitled. The WHO constitution defines it as: a right to the enjoyment of the highest attainable standard of health.

Patient advocates can now go beyond their national constitutions, statutory law (Acts of Parliament) and subsidiary legislation like orders, regulations, rules, by-laws and patient-charters/patient bill of rights to seek help from international law. They can invite global health governance scrutiny on the actions and inactions of their national governments and their health systems.

The cornerstone of HRBA and the International Human Rights Framework is the right-to-health. It has been defined as an economic, social and cultural right to a universal minimum standard of health to which all individuals are entitled. The WHO constitution defines it as: a right to the enjoyment of the highest attainable standard of health.

How does it work?

Under international law, the ratifying State as an obligation-bearer must respect, protect and fulfil a patient’s right-to-health by ensuring the availability, accessibility, affordability, acceptability and quality of health services within its health system, while making sure that it observes the wider principles and standards of human rights law as a right-to-health is universal, inalienable, indivisible, interdependent and interrelated with all other human rights.

If the State violates these rights, then the rights-holders (patients) or their representatives can seek redress locally from the obligation-bearers (the State and its health system) through a national human rights enforcement system, which may include the national human rights commission and human rights legislation. The human rights commission can investigate the claims and assess if the State has breached the Human Rights Standards. If there is a dispute, the patients’ organizations can then take any disputes to a judicial review adjudicated by a higher court like a Supreme Court or a special adjudicative body.

At the WHO’s World Health Assembly, many international NGOs were very pleased. Under the International Human Rights Framework, international organizations (like IAPO) that have a loci standi (capacity and connection with the matter and/or patients) can intervene on a local health right-to-health matter and refer the matter at an international level to UN treaty monitoring bodies. These bodies can then investigate and challenge the State on its violation of patients’ human rights if a national mechanism is not present. IAPO can act on behalf of its members on local issues.  

What this means for IAPO

We now have a golden opportunity to achieve patient-centred health systems by using human rights-based approaches to health. We need to form international partnerships with human rights organizations to reform social-structural factors in our countries that are preventing health systems in delivering an adequate supply of affordable, acceptable and quality health services and public health programmes. This is a big step in helping patients realize their right to the enjoyment of the highest attainable standard of health.

We have formed a partnership with Advocates for International Development to take this further,  

International Human Rights Framework Universal Declaration of Human Rights International Covenant on Economic, Social and Cultural Rights (ICESCR) Convention on the Rights of the Child (CRC) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) International Covenant on Civil and Political Rights (ICCPR) International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) International Convention on the Protection of the Rights of all Migrant Workers & Members of their Families (ICRMW) Convention on the Rights of Persons with Disabilities (CRPD)

Human Rights Bodies Human Rights Council Human Rights Committee (CCPR) Committee on Economic, Social and Cultural Rights (CESCR) Committee on the Rights of the Child (CRC) Committee on the Elimination of Discrimination against Women (CEDAW) Committee on the Elimination of Racial Discrimination (CERD) Committee against Torture (CAT)  Subcommittee on Prevention of Torture (SPT) Committee on Migrant Workers (CMW) Committee on the Rights of Persons with Disabilities (CRPD) Committee on Enforced Disappearances (CED)

 

Resources

• Office of the High Commissioner for Human Rights (OHCHR) – Human Rights-Based Approach to Health Information sheet
• World Health Organization (WHO) and the Office of the High Commissioner for Human Rights (OHCHR) - Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality
• World Health Organization (WHO) and the Office of the High Commissioner for Human Rights (OHCHR) - Technical Guidance on the application of a human rights-based approach to reduce and eliminate preventable under-5 child mortality and morbidity
• UN Special Rapporteur: Right to Health, Mr. Dainius Pūras
• International Human Rights Framework Standards