- How to strengthen the HR-approach in our work in health
13.The more specific challenge we face is to incorporate the HR-based approach into the Health For All Now agenda. The popularization of what the human (people’s) rights discourse means, as characterized in a very simplified way in Part 1, is step one. We need to do this first with our strategic allies in bilateral, multilateral and non-governmental organizations. Several of them have already started: UNICEF has taken the lead among UN agencies to set the course of what needs to be done to apply the HR-based approach in development planning; CARE has made substantial advances in adopting a HR-based approach in its operations worldwide. The fact not withstanding that most government and non-governmental development agencies have not yet re-visioned and re-missioned themselves to adopt a HR-based approach, there is much we can learn from the two experiences cited here (See U. Jonsson’s book, ‘ The HR Approach to Development Programming’, UNICEF, Nairobi, 2003 and CARE’s ‘Promoting Rights and Responsibilities’ Newsletter, aswani@care.co.ke )
14.In step two, it will be for these allies to then bring the new concepts to their colleagues and peers, as well as to a host of different health workers in their respective workplaces and then to community leaders in the areas where they work.
15.The incorporation of capacity analyses to identify and characterize duty bearers that are not doing what needs to be done will, from now on, be key to our work. This process is in itself empowering for us and for the claim holders we work with.
16.Both in steps one and two, it has to be emphasized that there is no hierarchy of HR; there are no ‘competing rights’. All rights are universal and inclusive, so we have to work for their fulfillment in all areas; that is why looking at ‘Health for All Now’ as a key element of our struggle for the drastic reduction of poverty is crucial.
17.The neoliberal development paradigm tries to fragment the social reality into sectors allowing partial small victories to be hailed as successes alas with absolutely no sustainability. If the system that causes all the symptoms and signs that come with poverty is not fixed, small victories in health, in education or any other sector are just deceiving us. For example, the emphasis on trade that globalization fosters is not going to benefit the poor unless we specifically build-in fair trade rules AND mechanisms of distribution of the benefits of trade to the lowest income quintile. Or, an example from the health sector would be: We have seen Herculean efforts and resources being poured into the Expanded Program of Immunization; who could fault that when it saves lives? But saves lives for how long? Until the child saved from dying from one of the six immunizable diseases, because s/he is malnourished and lives in a poor and contaminated environment, falls prey to a pneumonia or a diarrheal episode for which we do not have a vaccine yet? Who are we fooling here?
18.What is highlighted here is that we cannot let the forces of status-quo hijack the concept of HR in health. Any partial/sectoral interpretation of this concept is ultimately dishonest. HR is about a more equitable distribution of resources in society and health is one of many entry points to achieve this goal.
19.Human beings are born with a right to health and society has to proactively make the investments to prevent ill-health and malnutrition and to treat those affected by the diseases of poverty. Focusing our efforts in anything short of this is a job half done, more so if we do not arrive at such a situation through the empowerment of claim holders themselves to relentlessly demand that the needed changes are implemented. This is not a task for an avant-garde only: it is a mass mobilization task.
20.I am not saying that all this is easy, or fast, or that there are no small victories on the road to achieving our main objectives. But the focus has to remain on the big picture….do not miss the forest!
Claudio Schuftan, Ho Chi Minh City