Resources Topic 5: Human rights and health services

A useful summary of the issue can be seen in Strengthening health systems in developing countries:

"As stated by the WHO, today more than one billion people cannot obtain the health services they need, because those services are either inaccessible, unavailable, unaffordable or of poor quality.

The WHO World Health Statistics 2014 (Part III Global health indicators, Chapter 6, Health systems, p. 128-140) address the "density of health workforce (persons currently participating in the health labour market), infrastructures and technologies – including the density of hospital beds, which is regarded as an indicator for the availability of inpatient services. Data are derived from multiple sources, including national population censuses, labour-force and employment surveys, health-facility assessments, and routine administrative information systems."

The figures below come from the paper Health workforce metrics pre- and post-2015: a stimulus to public policy and planning.

We see large geographical variations in the health workforce, and that maternal mortality is strongly associated with the health workforce density.

You can explore you own situation through the WHO Global Health Observatory.

Health and human rights from WHO again, suggests:

A human rights-based approach to health provides strategies and solutions to address and rectify inequalities, discriminatory practices and unjust power relations, which are often at the heart of inequitable health outcomes.

The goal of a human rights-based approach is that all health policies, strategies and programmes are designed with the objective of progressively improving the enjoyment of all people to the right to health. Interventions to reach this objective adhere to rigorous principles and standards, including:

• Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’.

• Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.

• Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:

  • non-discrimination;

  • physical accessibility;

  • economical accessibility (affordability);

  • information accessibility.

• Acceptability: All health facilities, goods and services must be respectful of medical ethics and culturally appropriate as well as sensitive to gender and life-cycle requirements.

• Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality.

• Accountability: States and other duty-bearers are answerable for the observance of human rights.

• Universality: Human rights are universal and inalienable. All people everywhere in the world are entitled to them.

Indicators:

If we think about how to measure the problem and any attempts at intervention to improve the provision of health services with a human rights perspective, it will be important to identify indicators of success. Gruskin & Ferguson, in: Using indicators to determine the contribution of human rights to public health efforts say that these issues should be taken into account:

• Considering the legal and policy context within which interventions occur.
• Supporting the participation of affected groups, especially vulnerable groups, in all efforts that concern them.
• Working to ensure discrimination does not occur in the delivery of services nor in the health outcomes experienced among different population groups.
• Using human rights standards to deliver services in particular with respect to ensuring their availability, accessibility, acceptability and quality.
• Ensuring transparency and accountability both for how relevant decisions are made and their ultimate impact.

The paper goes on to discuss the importance of indicators to measure if health services are meeting these criteria. "There is a need to identify existing approaches that link human rights and health concerns and then to determine the best ways to assess their impact on the effectiveness and outcomes of health policies and programmes. As basic as it sounds, this approach requires clarity, not only in defining human rights, but also in recognizing what incorporation of identified norms and standards should look like in practice...In the interests of validity and comparability, from a public health perspective, assessment requires appropriate quantitative indicators. Implicit in the use of such indicators is a sense that they are both impartial and objective."