1. APPLICATION OF HUMAN RIGHTS BASED APPROACH IN MATERNAL HEALTH PROGRAMMES IN MALAWI GRACE TIKAMBENJI MALERA MALAWI HUMAN RIGHTS COMMISSION

2. Introduction HRBA concept relatively new compared to other traditional approaches. HRBA has gained ground in Malawi Duty bearers, including the government, the Human Rights Commission and NGOs have been applying HRBA Developmental programmes and projects, including in the area of maternal health.

3. Introduction This is evident from: The Constitution which recognises health as a developmental and rights issue The recognition of women’s rights in the Constitution Ratification of Maputo Protocol and other instruments The implication of this is that health issues, including maternal health are given the status of “rights”, which can be claimed This gives a good basis for the application of a rights- based approach

4. Introduction The National Sexual and Reproductive Health Policy of 2009 expressly refers to: human rights-based approach, equity, gender sensitivity, accountability, and community participation as some of the policies guiding principles. These are some of the key components of HRBA

5. Introduction Even before the Technical Guidance was adopted, there have been efforts to integrate HRBA in maternal health programmes To concretise these efforts, in 2013, a team of the country team UN Agencies, OHCHR, the NHRI and CSOs held a conference on HRBA and maternal health

6. Introduction Against this background, the presentation illustrates some of the programmes in Malawi that have integrated a HRBA The added value of the technical guidance Lessons learnt, including challenges and suggestions for the future

7. Why HRBA Human rights denials and discrimination against women are significant contributing factors to preventable maternal and child mortality Malawi has one of the highest maternal mortality rate Notwithstanding the significance improvement recorded in last years, 675/100,000, Low access to SRH and MNH services, especially in hard to reach areas, low coverage, high unmet family planning needs, high rate of unsafe abortions

8. Why HRBA Need for greater accountability Need for increased participation and empowerment Non-discrimination and attention to vulnerabilities and marginalization Express linkage to rights

9. Activities by the Malawi Human Rights Commission In 2009/10 a National survey on the right to health from an HRBA perspective was carried out The Survey aimed at assessing Government’s fulfillment on its obligations on the right to health using an HRBA lens: It assessed the following components: Availability, Accessibility, Affordability and quality of services Participation of claim holders Empowerment of communities and Accountability of duty bearers The Results were used to engage Government in order to influence greater integration of rights based approaches to health programming

10. Activities by the Malawi Human Rights Commission In 2010 – 11, HRC implemented a programme called “Promote Human Rights: Improve Maternal Health” funded by UNFPA Activities included a community Based Public Inquiry, Training on Human Rights and Maternal Health a National Conference on Human Rights Based Approach to Maternal health

11. Why Public Inquiry To address issues of systemic human rights violations with respect to maternal health

12. Activities by the Malawi Human Rights Commission The public inquiry aimed at: identifying and assessing the accessibility, availability, acceptability and quality of maternal health care in TA Kachere community in Dedza District, strengthening the accountability of duty-bearers by increasing knowledge and understanding of women’s human rights, more especially maternal health rights for the poor and rural women. Strengthening capacities of local health workers and community leaders to implement effective strategies and mechanisms for improving maternal health Engaging Government and its partners on implementation of Government polices and guidelines on sexual and reproductive health.

13. Public Inquiry: Participants Members of the community – Claim holders Safe motherhood committees Traditional birth attendants Health Personnel HIV and AIDS Support Groups Members of CBOs Youth Organisations Traditional Leaders Members of Parliament

14. Findings of the Public Inquiry With an intensified level of community engaged which is crucial in HRBA, the inquiry brought out evidence- based findings on barriers relating to accessing maternal health services such as: Limited availability of services, Shortage of personnel Infrastructural constraints, roads, medical facilities (e.g. lack of adequate waiting rooms) Shortage of drugs, supplies and equipment Limited awareness on maternal health issues Low education attainment levels Harmful social and cultural beliefs, traditions, attitudes and practices

15. Barriers Negative attitudes of health personnel Family responsibilities Limited food supplies at household level Lack of or limited youth friendly services Common theme of disempowerment of women and gender imbalance

16. Findings - Recommendations Government – formulate laws and policies furthering the rights guaranteed in the Constitution – Enact a Reproductive health law Prioritize maternal health issues and human rights mainstreaming in policy Institutional capacity issues: provision of adequate equipment to rural health centers, harness and consolidate capacity of safe motherhood committees; Intensify capacity building of duty bearers on the topic of HRBA Develop and implement grievance and complaints handling protocols

17. Capacity Building: Regional HRBA Conference Malawi hosted the regional conference on applying HRBA to maternal, Newborn, Child Health and Sexual and Reproductive Health Issues Organised jointly by OHCHR, UNFPA, WHO and other stakeholders Tanzania, Malawi, Uganda and South Africa

18. Expected outcomes Long term programming which will lead to strengthening of legal and policy environments that support improving women’s and children’s rights, including health outcomes Interrogation of implications of planning, budgeting, implementation and monitoring and review and remedies Consolidating multi-stakeholder platforms Strengthening national linkages between human rights and health practitioners Effecting institutional changes that address the intersection between human rights and public health

19. Current Activities Capacity Building National level analysis of the legal and policy environment for MCNSRH National dialogue Action plan Additional – Public inquiry Submission to the Public Health Act Review Capacity Building

20. Challenges in integrating HRBA Different levels- community, district, national, structural Capacity gaps Limited awareness of human rights – claim holders and duty bearers Politicizations of developmental programmes Financial constraints Conceptual – nature of Economic, Social and Cultural Rights as progressive – prioritisation

21. Lessons Learnt – Best practices Constitutional provisions – rights Law review – Public health Act, Gender Equality Act Express provisions of HRBA in Policies Patients charters Service delivery charters Community empowerment Accountability forums Bridging the gap between health and human rights practitioners Evidence-based engagement through inquiries

22. Way Forward Establish a multi-stakeholder technical working group Develop tailor made manual on HRBA Foster capacity building efforts Focus on budget monitoring and tracking Greater community mobilisation Push for establishment of a Parliamentary Committee on Human Rights Work through the decentralised structure – district assemblies HRBA to integrated in post 2015 dev agenda

23. Conclusion: Added Value of the Technical Guidance Critical tool in integration of HRBA – instructive on a structured and systematic application of HRBA Contributes to challenging the status quo in power dynamics - the central inquiry is: how can Government and other stakeholders be made to deal with these very concrete problems that thousands of women in the country face? Most importantly allows for a systematic application of human rights standards and principles in designing, implementing and monitoring development interventions Allows us to look at both process and outcome for sustainable development

24. Conclusion The Technical Guidance offers value- addition to work of NHRIs, NGOs and Health practitioners Good for bridging the defacto public health and human rights gap Fundamental shift in thinking – Robust accountability mechanism THANK YOU