Creating A Circle of Accountability for the Prevention of Maternal Mortality and Morbidity: Recent Developments at the United Nations

Alicia Ely Yamin, JD MPH

Lecturer on Global Health, and

Director,Health Rights

of Women and Children Program

UN Technical Guidance General principles Planning and Budgeting Ensuring Implementation Accountability [International assistance and Cooperation]

Background

Thematic Report (A/HRC/14/39) Best Practices Report (A/HRC/18/27) 2012: “Technical Guidance on the Application

of a Human Rights Based Approach to the Implementation of Policies and Programmes for the Reduction of Preventable Maternal Mortality and Morbidity” (Technical Guidance). (A/HRC/21/22)

Technical Guidance: General Principles

HRBA to health, not MMM Social determinants of SRH Health Systems

Accountability Non-discrimination/equality Participation Transparency

Planning and Budgeting

National Plan of Action on SRH Multi-sectoral Based on situational analysis Transparent and participatory process Review of legal and policy framework Redressing historic patterns of discrimination;

special concern for marginalized and vulnerable groups

Budgeting

“Maximum available resources” Confers added protection

If budget increases… If budget decreases… Low-income populations

Ensuring Implementation

Bottom-up diagnostic exercise (what,? where?, to whom?, why?, who,? how?)

Two examples: Women arriving late or failing to seek EmOC Adolescent MMM

Example of identified problem: women arriving late or failing to seek emergency obstetric care

Lack of availability

Lack of accessibility (economic, physical, information, non-discriminatory basis)

Lack of acceptability

Lack of quality

• Delay in making the decision to

seek help

• Delay in arriving to health facilities

• Delay in receiving adequate treatment

In a HRBA…

Proximate and underlying factors Health workers Accountability requires follow-up

Accountability (1): Monitoring Laws, policy, and budgetary efforts, results (inputs,

outputs, outcomes) Quantitative indicators should facilitate drawing

conclusions with respect to international obligations: comparable, objective; programmatically relevant; subject to disaggregation, local audit; frequently or continuously measurable (Yamin and Falb, 2012)

Should facilitate strengthening the health system, including the health information system.

Monitoring encompasses private actors.

Accountability (2): Forms of Review/Levels of Accountability

Administrative, Social, Political, National legal accountability, International accountability

Professional, Institutional, Health system, Private actors, Donors

Accountability (3): Remedies

Ensuring Implementation of Laws and Policies

Reforming laws, policies and budgets Challenging discriminatory barriers Redress for violations of SRH rights in

practice

Concluding Reflections

Implementation report in 2 years

Post 2015