PLANNING AND BUDGETING Guaranteeing the right to health obliges states to adopt a national public health strat-egy and plan of action that contains a sexual and reproductive health and rights strategy, encompassing maternal health, sexuality education and access to voluntary family planning. In addition to having a sectoral health strategy that incorporates sexual and reproductive health, multisectoral strategies, such as national development strategies and poverty reduction strategies are key in addressing underlying determinants of health and reproductive rights issues that usually fall outside the responsibility of the health sector but are essential for achieving more sustain-able and equitsustain-able health outcomes.
Obviously, the obligation of adopting a
national development strategy and a national public health strategy and plan of action goes beyond the capacity of a NHRI; none-theless, the NHRI can be a key player in
the development and monitoring of such strategies.
A comprehensive national public health strategy requires a situational analysis, where the most severely affected rights-holders are recognized and the duty-bearers with corre-sponding obligations towards those margin-alized and excluded rights-holders are iden-tified. This situational analysis then identifies the capacity gaps of rights-holders to claim their rights and of duty-bearers to meet their obligations. This analysis will translate into policies and plans that address the identified institutional and capacity gaps.
A HRBA to a situational analysis is guided by the following simple questions:
• What is happening to whom and where?
• Why is it happening? (What factors are e.g. preventing women, or certain women, from going safely through
preg-NHRIs can assist governments in conduct-ing rights-based analyses of sexual and reproductive health problems and in identi-fying the institutional and capacity gaps that need to be addressed.
In countries experiencing serious sexual and reproductive health challenges – such as for instance high levels of maternal mortality and high prevalence of new HIV infections –, governments, as the main duty-bearers, will typically be confronted by gaps in their abil-ity to ensure that sexual and reproductive health services are available, accessible, and acceptable and of good quality. According to WHO, the following are essential interven-tions to improve maternal health13 (and to the realization of reproductive rights):
• Family planning;
• Prevention and management of sexual transmitted infections, including HIV;
• Management of unintended pregnan-cies, including access to safe abortion services, wherever legal, and post-abor-tion care;
• Detection of domestic violence;
• Management of pre-labour rupture of membranes and preterm labour;
• Induction of labour for prolonged pregnancies;
• Caesarean sections; and
• Appropriate postpartum care.
The role of NHRIs is to make sure, through involvement in the policy making process or by reviewing the policy, that all these ele-ments are part of the national public health strategy.
From a rights-holders perspective, NHRIs can ensure that health strategies and plans and, more broadly, national development strategies also address the legal barriers as well as the institutional and capacity gaps that prevent marginalized and vulnerable groups from accessing sexual and repro-ductive health services, from claiming their rights and from participating actively in the formulation of the said strategies and plans.
To ensure effective implementation in furthering universal access to sexual and reproductive health, the national public health strategy has to be accompanied by deliberate steps in terms of financing, pop-ulation coverage and service expansion.
Ensuring a HRBA continuum in the interface between policy and budget formulation is another important step in the planning pro-cess for which the contribution of NHRIs is fundamental.
As part of a multi-sectoral response, the government has to match up the identified institutional and capacity gaps with rele-vant budgetary allocations across a range
of Education and will require adequate bud-gets for both health and education sectors.”14 Increasing budgetary allocations to NHRIs should also be considered in cases where the strengthening of national accountability systems for the protection of reproductive rights is one of the identified priorities.
NHRIs can play a special advocacy role in in making sure that policy and budgetary deci-sions do not place a disproportionate finan-cial burden on people, in particular women, living in poverty. Payment for certain health services should not impede accessibility to care. Furthermore, budgets should include provisions for ensuring accountability, including monitoring, access to justice for the poor, and both judicial and non-judicial mechanisms to facilitate timely redress.
IMPLEMENTATION
Depending on the issues identified as gaps in the provision of reproductive rights and the corresponding policy and budgetary decisions taken, NHRIs can be one of the duty-bearers in charge of taking action. For instance this will be the case where one of the main pri-ority areas identified concerns the strength-ening of national accountability systems and redress mechanisms for the protection of reproductive rights. As seen in the previous chapter, this can include the implementa-tion of intervenimplementa-tions to develop the internal capacities of the NHRI to engage with repro-ductive rights and the implementation of
judiciary, the police and the administration to promote and protect reproductive rights.
As seen in the previous chapter, NHRIs can also support governments in the implemen-tation of specific programmes aiming at the empowerment of rights holders to know and claim their reproductive rights. This can include the implementation of awareness raising campaigns or conducting trainings for civil society organizations, women’s groups, parents’ associations, journalists and profes-sional associations regarding the human rights implications of sexual and reproductive health.
In cases where the NHRI acts as a duty-bearer through the implementation of public policies public, programmes and funds, a HRBA calls to ensure that appropriate mech-anisms be put in place for the meaningful participation of concerned rights-holders, including marginalized and vulnerable groups, in the implementation process.
MONITORING
NHRIs can play a crucial role in monitoring as it has been shown above in Chapter 2.
When monitoring the implementation of public policies, programmes and budgets for the realization of reproductive rights, NHRIS should look into:
a. Changes in structural factors over time such as examining whether laws are adopted recognizing reproductive
c. Concrete results in terms of women’s sexual and reproductive health. This includes assessing the impact of sex-ual and reproductive health policies in reducing fertility rates, adolescent birth rates, maternal mortality ratios and the prevalence of sexually trans-mitted infections.
When dealing with quantitative factors, NHRIs need to assemble disaggregated data on sex, age, urban/rural residence, and ethnicity, level of education, wealth, disabil-ity and geographical location (if possible).
Additionally, these indicators should be:
a. Continuously or frequently measurable;
b. Objective so as to permit compar-ison across time, countries and/or sub-regions;
c. Programmatically relevant to enable priory setting and identification of accountability gaps; and
d. Where possible subject to local audit to promote accountability to the pop-ulations served.15
One distinct feature of HRBA to monitoring and evaluation is the principle of account-ability, ensuring independent review of governmental policy and budgetary efforts.
NHRIs in compliance with the Paris Prin-ciples are in a privileged position to
par-itoring and evaluation is to identify policy and systemic failures in order to recommend corrective actions and influence the formu-lation of the next policy cycle from a human rights perspective.
The ICPD Programme of Action affirms in its paragraph 7.3 that reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. The following chapter outlines the legal basis for the rights that collectively constitute reproductive rights. In addition to referring to binding international and regional human rights instruments, reference will be
made to decisions, comments and conclud-ing observations of the various international human rights bodies and mechanisms. An outline of these bodies and mechanisms can be found in Annex 1, which also con-tains extensive quotes of most of the United Nations comments, decisions and statements mentioned in this Chapter. Annex 1 also
includes information on the African, American and European human rights systems.