The Right to Health: A Resource Manual for NGOs Written by: Judith Asher The Right to Health: A Resource Manual for NGOs Written by: Judith Asher The printing and dissemination of this manual was facilitated and financially supported by the International Federation of Health and Human Rights Organisations (IFHHRO). IFHHRO promotes health related human rights, the right to health and the mobilisation of medical expertise in the investigation of human rights violations. www.ifhhro.org Published by the Commonwealth Medical Trust in August 2004 c/o BMA House Tavistock Square London WC1H 9JP tel: +44 20 7272 8492 fax: +44 20 7272 8569 email:[email protected] www.commat.org Co-published by the AAAS Science and Human Rights Program 1200 New York Ave., NW Washington D.C. 20005 USA tel: +1 202 326 6790 fax: +1 202 289 4950 email: [email protected] http://shr.aaas.org The American Association for the Advancement of Science, ”Triple A-S” (AAAS), is an international non-profit organization dedicated to advancing science around the world by serving as an educator, leader, spokesperson and professional association. In addition to organizing membership activities, AAAS publishes the journal Science, as well as many scientific newsletters, books and reports, and spearheads programs that raise the bar of understanding for science worldwide. Co-published by HURIDOCS 48, chemin du Grand-Montfleury CH-1290 Versoix, Switzerland tel. 41.22.7555252 fax 41.22.7555260 e-mail : [email protected] http://www.huridocs.org/ HURIDOCS (Human Rights Information and Documentation Systems, International), established in 1982, is a global network of human rights organisations concerned with human rights information. HURIDOCS champions effective documentation and information handling, including the use of information and communication technologies, as a force to defend, assert and promote human rights. Cover photo credits: Boy receiving polio vaccination, Ethiopia: WHO/P Virot Nurse helping patient undergoing tuberculosis treatment, India: WHO/P Virot AIDS awareness rally, Thailand: Arjen van de Merwe/World Population Foundation Surgeons, Mexico: Rick Maiman/David and Lucile Packard Foundation Printed by Printing B.V., Bergstraat 21, Amersfoort, The Netherlands, [email protected] TABLE OF CONTENTS List of Abbreviations . .i Acknowledgments . .ii Foreword . .iii Objectives of the manual . .v Introduction: Understanding a health and human rights approach . .1 0.1 Who will find this Resource Manual useful? . 1 0.2 Why would an NGO choose to use a human rights framework to promote health?. 2 0.3 How should the Resource Manual be used? . 4 0.4 Organization of the Resource Manual. 5 PART I: Gaining Knowledge: Understanding the Legal Framework Chapter 1 What are human rights? The legal framework . .7 1.1 Concept of human rights. 7 1.2 International human rights laws and norms . 8 1.3 What is the relationship between international human rights law and international humanitarian law? . 12 1.4 Human rights and state obligations . 13 1.5 Human rights monitoring and enforcement mechanisms of the UN system. 14 1.6 Human rights monitoring and enforcement mechanisms of regional systems . 14 1.7 Human rights in domestic law. 15 Chapter 2 What is meant by the right to health? . .17 2.1 Health as a human right . 17 2.2 What does a shift to a human rights approach to health involve?. 21 2.3 How do universal obligations apply to all states, despite their social and economic differences? . 22 2.4 Are there obligations that are of immediate effect to all states? . 23 2.5 Where has the right to health been affirmed and codified? . 25 Part II Moving towards action: Focussing on obligations arising from the right to health Introduction to Part 2 . .29 Chapter 3 The nature of state obligations . .31 3.1 Basic components of government obligations . 31 3.2 Obligations to respect, protect and fulfil the right to health . 35 3.3 Availability, accessibility, acceptability and quality: the four essential standards for evaluating the implementation of state obligations . 37 3.4 What constitutes violations? A quick guide to violations of the right to health . 39 3 3.5 Catalogue of examples of state obligations to respect, protect and fulfil the right to health . 42 Chapter 4 Focus on core obligations . .50 Chapter 5 Focus on non-discrimination and vulnerable and otherwise disadvantaged groups . .53 5.1 Ensuring non-discrimination . 53 5.2 How does discrimination against vulnerable groups occur? . 56 5.3 Obligations and special measures for ensuring that women are able to enjoy the right to health . 58 5.4 Special measures to ensure non-discrimination for other vulnerable groups . 60 Chapter 6 Globalization, obligations of non-state actors, and international obligations arising from the right to health . .64 6.1 Some notes on globalization and the right to health . 64 6.2 Obligations of non-state actors. 67 6.3 International obligations arising from the right to health . 68 6.4 NGO advocacy related to non-state actors and international obligations . 70 PART III Taking Action: Working with the right to health Introduction to Part 3 . .75 Chapter 7 Monitoring the right to health . .77 7.1 A basic introduction . 77 7.2 Developing a strategy . 80 7.3 Key questions for monitoring the right to health . 83 Chapter 8 Tools for monitoring I: Working with indicators, benchmarks and statistical data . .86 8.1 Measurements of policy and progress. 86 8.2 Working with indicators, benchmarks and statistical data . 88 8.3 Important considerations to inform the selection and development of indicators for monitoring the right to health . 95 8.4 Undertaking budget analysis . 97 Chapter 9 Tools for monitoring II: Identifying violations . .100 9.1 Introduction. 100 9.2 Different types of violations . 101 9.3 Examples of the most common ways that governments violate their immediate obligations to respect, to protect and to fulfil the right to health . 102 Chapter 10 Promoting the right to health: Activities to promote and protect the right to health at community, national and international levels . .108 10.1 Introduction. 108 10.2 The importance of promoting cooperation among NGOs and government in the development and implementation of human rights based health policies and programmes . 110 10.3 Engaging in research and documentation . 111 4 10.4 Increasing public awareness of the right to health and engaging in community education and mobilization. ..