1. Rights based approach to health
Renu Khanna
July
MPS Short Course, Trivandrum

2. What are Human Rights?
Those rights that every human being possesses and is entitled to by virtue of being human irrespective of citizenship, nationality, race, ethnicity, language, sex, sexuality or abilities
Are the birth right of all human beings based on the fundamental principle that all persons possess an inherent human dignity
A powerful tool for promoting social justice and dignity of all people

3. Principles and Values underlying Human Rights
Equality
Nondiscrimination
Dignity
Bodily integrity
Self determination
Compassion
Interdependence
Right to life and development

4. History of Human Rights
Universal Declaration of Human Rights (1948)
International Covenant of Civil and Political rights
International Covenant of Social, Cultural and Economic Rights
Third generation of rights: CEDAW, CRC, Racial Discrimination etc.

5. Another definition…. What does one mean by a ‘right’?
a right is an entitlement that locates the particular concerns, needs and interests of certain class(es) of individuals against a set of objective standards such that such needs and interests can be claimed and asserted irrespective of an individual’s, a community’s or a government’s views on the issues around them

6. Sources of Rights Constitution of countries National law
International human rights conventions, covenants, treaties
Regional human rights conventions, charters
Declarations, programmes of action of various international and UN conferences
Committees e.g. CEDAW
These sources of rights often define – or lead to – the objective standards

7. Obligations of the State
To respect: no obstacles in enjoyment of rights
To protect: to protect against violations by third parties
To fulfill: to create enabling conditions so that rights can be met – legislations, policies, budgets

8. Right to Health in International Documents
Universal Declaration of Human Rights, Article 25
International Covenant on Economic, Social and Cultural Rights, Article 7, 11 and 12
Convention on the Elimination of All Forms of Discrimination Against Women, Article 10, 12 and 14
Convention on the Elimination of all forms of Racial Discrimination, Article 5
Convention on the Rights of the Child, Article 24

9. Constitutional Provisions Relating to Health
Unfortunately, in the Constitution of India, health is not a fundamental right of the citizens.
BUT……
Fundamental Rights, Article 21(No person shall be deprived of his life or personal liberty )
Directive Principles of State Policy Articles 41, 42, 47,

10. Article 41(…make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, )
Article 42 (…make provision for securing just and humane conditions of work and for maternity relief)
Article 47 (…regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medical purposes of intoxicating drinks and of drugs which are injurious to health.)

11. The Right to the Highest Attainable Standard of Health
Article 12, International Convention on
Economic, Social and Cultural Rights:
Ratified by 145+ countries
1. The States Parties to the present Covenant
recognize the right of everyone to the enjoymen of
the highest attainable standard of physical and
mental health.

12. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;
The improvement of all aspects of environmental and industrial hygiene;
The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

13. Health as a Human Right Right to HEALTH Right to HEALTH CARE
Right to food, Right to a healthy environment, Right to adequate housing, Right to education, Right to work and rights at work, Right to life, Right to information, Right to safety and bodily integrity
Right to HEALTH CARE
CESCR Article 12, General Comment 14 on health…highest attainable standard of health, availability, accessibility, acceptability, quality

14. Highest attainable standard of health…..
Availability
Services, facilities, goods, programmes in sufficient quantities
Trained personnel
Essential drugs
Determinants of health e.g. water, sanitation etc.
Accessibility
Non-discrimination
Physical accessibility including for vulnerable groups (old, dalits, disabled...)
Economic accessibility
Information (along with confidentiality)

15. Acceptability
Culturally appropriate (Life –cycle, gender, minorities)
Medical ethics
Quality
Scientifically, medically appropriate
Skilled personnel
Rational, unexpired, quality drugs
Aseptic procedures
Safe blood

16. Reproductive Rights
the right to attain the highest standard of sexual and reproductive health.
the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so,
the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.
promoting mutually respectful and equitable gender relations.
meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality.

17. Sexual Rights
The concept of sexual rights, like that of human rights, provides a framework to ensure non-discrimination, and therefore cannot be used to privilege one individual or group over another.
Sexual rights affirms entitlements, such as the right to bodily integrity, as well as rights that protect against violations, such as the right not to be coerced into sexual activity.

18. Sexual Rights include the right to
Bodily integrity and right to choose if, when, how and with whom to be sexually active and engage in sexual relations with full consent
Sexual pleasure without fear of infection, unwanted pregnancy
Sexual expression and to make sexual decisions that are consistent with one’s personal, ethical and social values.
Sexual and Reproductive health care, information, education and services.
Enter relationships, including marriage, with full and free consent and without coercion.
Express one’s sexuality without discrimination, and independent of reproduction
Privacy and confidentiality in seeking sexual and reproductive health care services.
(Source: HERA, 1999)

20. citizen. other stakeholders government voice. respective roles
citizen other stakeholders government voice respective roles respect participation protect fulfill laws, policies, information, services, resources, accountability AVAILABLE, ACCESSIBLE, ACCEPTABLE, QUALITY

21. Savita, Kusuma, Renuka, Jyoti
Case Studies
Savita, Kusuma, Renuka, Jyoti

22. Violation of Right to life
Right to self determination – control over one’s body
Right to equality – lower wages for same work for women, unequal food
Right to quality health care – poor quality ANC, appropriate referral care, no followup

23. Violation of
Right to acceptable health care – informal providers, deposit money first only then service will be provided
Right to timely and safe abortion services
Right to affordable health care
Widespread denial of services – ambulance, deposit money

24. The separate human rights that contribute to SRHR can be clustered as, Right to:
Life, survival, , sexuality
Reproductive self determination and free choice of maternity
Health and benefits of scientific progress
Non-discrimination and due respect for differences
Information, education, decision making

25. Right against discrimination
Gender/ sex
Health status (e.g.HIV +ve)
Age (e.g. adolescents)
Economic status (poor)
Rural
SC/ ST/ religious minorities
Marital status, sexual orientation

26. Right to information, education
- empowerment through education - sensitization and enablement of all the stake-holders - information on rights, laws, policies, services, staff, infrastructure, redressal mechanism - special groups addressed - special concerns addressed