The role of human rights norms and principles in achieving developmental goals is now recognized in many influential international declarations and resolutions. With respect to women’s health, the 1994 International Conference on Population and Development (ICPD) and the 1995 Beijing Platform for Action were instrumental in shifting the traditional focus from a population-centric approach to one that envisioned an expansive developmental agenda that enshrined gender equality and sexual and reproductive health and rights (SRHR) as critical aspects. Many of the strides made in this direction were, however, undone when the Millennium Development Goals (MDGs) failed to adopt a broad reference to SRHR but limited the goal to reduction of maternal mortality (MDG 5).
Although the MDGs may be credited for mobilizing global resources and partnerships for health, available funding was mainly for disease-specific MDGs like HIV, tuberculosis and malaria. Moreover, many have questioned the failure of the MDGs to consider the larger social context of development in the goal-setting approach. For example, even where countries were reported to be on track to achieving MDG 5, wide and persistent inequities between SHRH services for women in rural and urban areas have been found. In considering a post-2015 development agenda, therefore, it is important to imbibe the lessons learnt from past experiences into achieving more holistic health outcomes.
Anchoring developmental priorities in human rights can go a long way in addressing the lapses of the current framework, particularly in identifying progress indicators, whatever the framework to be adopted. 17 UN Special Rapporteurs have identified three priority areas predicated on a human rights approach to development to inform the agenda, each of which is particularly relevant for the fulfillment of the right to health. These are: reducing inequalities, national social protection floors, and double accountability.Footnote*
Inequality
Non-discrimination lies at the heart of a rights-based approach to health. Women suffer a greater disadvantage in the enjoyment of health facilities, goods and services due to their socio-economic status. Inequality in women’s access to health services, including family planning and abortion services, including through legal restrictions, violates their right to the highest attainable standard of sexual and reproductive health.Footnote†
In drawing up the post-2015 development agenda, States must recognize that gender equality and women’s access to health services, including sexual and reproductive health services, are crucial to reducing inequalities in all spheres of socio-economic development, health programmes and policies.
National social protection floors
Social security, including health security, is key to reducing inequities in health access. Inadequate public expenditure on health and over-reliance on out-of-pocket payments such as user fees, impoverishes millions of families every year. A right to health approach requires that social and health insurance schemes reflect not only the health needs of the population, but also take into consideration the capacity of people to afford health care. Pooling of funds through pre-payment schemes that cross-subsidize financial risks across different groups protects the poor and vulnerable against catastrophic health expenses.
Within the context of sexual and reproductive health, States have an obligation to not restrict coverage to a certain group or groups to the exclusion of others. For example, insurance schemes which cover maternal and child health and not SRHR services for adolescents or screening services for older women are discriminatory and a violation of the right to health. States must ensure that health insurance schemes adopt a holistic approach to women’s health that covers all aspects of SRHR and all other aspects of health as well.
Accountability through participation
The health-related MDGs reflected a political will to tackle issues of global importance but were seen as ineffective in holding national and international actors accountable for failures in meeting their commitments towards achieving the targets. Strengthening accountability through formulating effective legal remedies at the national level and through periodic reviews at the international level are, therefore, critical to holding countries responsible for their commitment to promote health-related post-2015 development goals.
Effective community participation is also a critical aspect of ensuring accountability under the right to health approach. Community participation – especially of vulnerable groups – in all phases of decision-making processes to determine post-2015 development goals, targets and indicators and monitor their progress, both nationally and internationally, is necessary for their effective realisation and sustainability. Community participation will also ensure that States are ultimately responsible to the people, as they are in the best position to report instances of violations and failures by States. States must also establish stronger mechanisms to hold private businesses accountable, such as pharmaceutical companies and the food and beverage industry, which may limit access to essential medicines in the one case and directly or indirectly negatively affect health in the other.Footnote*
To ensure accountability and increase the visibility of the reasons behind limitations and/or failures in achieving existing development goals, it is necessary to look at the effect of the policies of inter-governmental and global institutions, all States, donors and private businesses on a global scale and not restrict this geographically. The whole system, as we presently know it, may have to be re-thought and overhauled in this regard.
Notes
† A/HRC/66/254. 3 August 2013. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/443/58/PDF/N1144358.pdf?OpenElement
* Statement by 17 Special Procedures mandate-holders of the Human Rights Council on the Post-2015 development agenda. United Nations Human Rights. Office of the High Commissioner for Human Rights. 21 May 2013. http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=13341&LangID=E
* A/HRC/23/42. 1 May 2013. http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session23/A-HRC-23-42_en.pdf