APPLICATION
OF
HUMAN
RIGHTS BASED APPROACH IN
MATERNAL
HEALTH
PROGRAMMES IN MALAWI
GRACE TIKAMBENJI MALERA
MALAWI HUMAN RIGHTS COMMISSION
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.
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 rightsbased approach
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
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
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
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
Why HRBA
• Need for greater accountability
• Need for increased participation and
empowerment
• Non-discrimination and attention to
vulnerabilities and marginalization
• Express linkage to rights
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
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
Why Public Inquiry
• To address issues of systemic human
rights violations with respect to
maternal health
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.
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
Findings of the Public Inquiry
• With an intensified level of community engaged which
is crucial in HRBA, the inquiry brought out evidencebased 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
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
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
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
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
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
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
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
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
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
Conclusion
• The Technical Guidance offers valueaddition 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