ZADHR NEWSLETTER: Volume 7, Issue 1 - April 2009

Contents

* Rights-Based Approaches to Health: Lessons for Zimbabwe
* The MoHCW’s 100 Day Health Action Plan
* Monitoring the Right to Health: Training Report
* Prison Health in Zimbabwe: The Case for Reform

Rights-Based Approaches to Health: Possibilities for Zimbabwe

‘A human rights-based approach differs from the basic needs approach in that it recognizes the existence of rights… A need not fulfilled leads to dissatisfaction. In contrast, a right that is not respected leads to a violation’ UNFPA

Defining the Right to Health

The right to health includes the entitlement to timely and appropriate health care and also encompasses underlying determinants of health, such as access to safe and potable water, adequate sanitation, an adequate supply of safe food, nutrition, housing and access to health-related education and information. Participation by the population in all health-related decision making is also important.

The right to health has the following characteristics which are true of all human rights:

- it is inherent

- it focuses on the dignity and integrity of every human being

- it is universal, interdependent, indivisible and interrelated with all other rights

- it applies to all individuals on the basis of equality and non-discrimination

- it must be guaranteed by law

- it cannot be arbitrarily taken away or waived

- it can and should be claimed.

Health care and the underlying determinants of health are measured by:

- Availability of functioning public health facilities and health care and of the underlying determinants: safe and potable water, sanitation, food etc

- Acceptability which requires respect for medical ethics and cultural appropriateness

- Accessibility including non-discrimination, physical accessibility, economic accessibility (affordability) and access to information

- Quality which requires all health facilities, good and services to be of good quality.

 

What is the Rights-Based Approach?

A rights-based approach to health means integrating human rights norms and principles in the design, implementation, monitoring, and evaluation of health-related policies and programmes. As the premise of all human rights is the inherent dignity of every human being, a rights-based approach to health focuses on human dignity. The principles of equality and non-discrimination, also central to human rights, are key elements of this approach and in this vein, attention is paid to vulnerable and marginalized groups and efforts are made to ensure that the health system is equitably accessible to all.

The rights-based approach empowers communities by ensuring their participation in decision-making processes which affect them and allowing them to set their own priorities both at community and national level.

Human rights require legal protections and similarly a rights-based approach to health must have legal protections for health. It is important that the government operates in a transparent manner that allows it to be held accountable for its actions pertaining to health.

Implementation of the rights-based approach requires fulfillment by the government of its obligations and participation and claiming of rights by communities—the rights holders.
 

Government’s Obligations

The Government has 3 types of obligations with regards to human rights. These are to respect, protect and fulfil.
 

Respecting the Right to Health

The State should refrain from interfering with or blocking people’s ability to enjoy the right to health such as introducing policies or programmes that are likely to result in unnecessary morbidity and preventable mortality or undertaking actions that cause physical or mental harm.

Protecting the Right to Health

This requires the government to make effort to minimize risks to health and to take measures that safeguard the population from infringements of the right to health. The government should thus ensure that private enterprises refrain from violating the right of individuals and communities.

Fulfilling the Right to Health

The government is obliged to take legal, administrative and other measures to ensure the progressive provision of health care and development of infrastructure to support this.
 

What Can the Rights-Based Approach Contribute?

The rights-based approach re-frames basic health needs as health rights. Establishing the conditions that enable one to become healthy and to remain so is not regarded merely as a medical, technical or economic problem, but as a question of concrete government obligations and entitlements of the population.

For example child immunization within the health rights framework is not just a medical requirement for children and a responsible public health measure; it becomes a right of all children, with corresponding government obligations that cannot be reasoned away because of financial constraints or other priorities as to how money should be spent in the health or other sectors.

The right to health helps answer the question ‘how can we best allocate scarce resources?’. A rights-based approach ensures that the available resources are allocated to those who have the greatest needs or have been excluded the most. It exposes situations where public funds are being used to refurbish hospitals in a capital city, or where expensive equipment is being purchased for elective procedures that only benefit a few while, at the same time, rural populations or vulnerable groups are failing to access minimum standards of health care. It subsequently requires that immediate action be taken to remedy the situation.
 

Outcomes of a Rights-Based Approach to Health

· Increased accountability for health by the government;

· Increased attention to the health needs of the poor and other vulnerable and disadvantaged groups;

· The correction of imbalances between the health status of different population groups;

· More participatory approaches to the provision of health services and the determinants of health;

· Cessation in imposition of retrogressive measures (take-backs) in health-related legislation and budgetary and administrative practices;

· Honouring of concrete obligations by government to immediately provide the minimum standards that are essential for enjoyment of the right to health; and

· Setting of goals, targets and indicators that will allow for monitoring of progress.
 

Possibilities for Zimbabwe

- The rights-based approach can and should be applied to all planning that is currently taking place around resuscitation and rebuilding of the health system. There needs to be community participation in setting of priorities and making of decisions.

- The Ministry of Health and Child Welfare should endeavour to increase transparency and accountability by informing the population of its targets and allowing monitoring of progress by health workers and other members of the community so that violations of the right to health do not go unnoticed and without being put right.

- There is a general lack of perception that health as a human right in Zimbabwe. The right to health must be enshrined in the new Zimbabwean constitution that is to be drafted under Global Political Agreement. There should also be a review of all health related legislation to ensure that it is in line with human rights principles.