human rights based approach essay

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3 Human Rights-Based Approaches to Development: Towards Accountability

• Published: April 2007
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This chapter outlines the core concepts of human rights-based approaches (HRBAs) and explores the evolution of human rights-based approaches to development including the United Nations (UN) commitment to integrate human rights into all its work, national development plans, the role of socio-economic rights in development problem analysis, impact assessment, and key challenges to undertaking human rights-based development. The chapter also highlights the issue of measurement of human rights change as a critical factor in development planning, implementation, and evaluation towards ensuring accountability for both process and impact.

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• How we work

The Human Rights-Based Approach

• Human rights-based approaches
• Culturally sensitive approaches
• Results Based Management approach
• Diversity, Equity and Inclusion
• Centre of Excellence on Civil Registration and Vital Statistics Systems
• South-South and Triangular Cooperation
• Generation Equality Forum: Action Coalition on Bodily Autonomy and SRHR
• Strategic plan 2022 – 2025
• UNFPA in the UN system
• UNFPA HQ Optimization
• Strategic partnerships
• Transparency
• Internal Audit and Investigation
• Fraud Alert
• Policies & Procedures Manual
• Corporate Environmental Responsibility in UNFPA
• Protection from Sexual Exploitation, Sexual Abuse and Sexual Harassment
• Disability Inclusion
• Donor Contributions
• Programme Expenses

The equal and inalienable rights of all human beings provide the foundation for freedom, justice and peace in the world, according to the Universal Declaration of Human Rights, adopted by the UN General Assembly in 1948.

Achieving equality and dignity of all also underpins the Programme of Action of the International Conference on Population and Development (ICPD ), which guides our work.

Prioritizing the application of human rights principles became a cornerstone of UN reform efforts initiated in 1997. UNFPA was one of the agencies that in 2003 adopted the UN Common Understanding on a Human-Rights-Based Approach (HRBA) to Development Cooperation , which clarifies how human rights standards and principles should be put into practice in programming .

Elements of good practices under a human rights-based approach

• Programmes identify the realization of human rights as ultimate goals of development
• People are recognized as key actors in their own development, rather than passive recipients of commodities and services.
• Participation is both a means and a goal.
• Strategies are empowering, not disempowering.
• Both outcomes and processes are monitored and evaluated.
• Programmes focus on marginalizedand excluded groups.
• The development process is locally owned.
• Programmes aim to reduce disparities and empower those left behind.
• Situation analysis is used to identify immediate, underlying and root causes of development problems.
• Analysis includes all stakeholders, including the capacities of the state as the main duty-bearer and the role of other non-state actors.
• Human Rights standards guide the formulation of measurable goals,targets and indicators in programming.
• National accountability systems need to be strengthened with a view to ensure independent review of government performance and access to remedies for aggrieved individuals.
• Strategic partnerships are developed and sustained.

Source: The Human Rights-based Approach to Development Cooperation

Rights vs. needs

Before 1997, most UN development agencies pursued a ‘basic needs’ approach: They identified basic requirements of ben eficiaries and either supported initiatives to improve service delivery or advocated for their fulfilment.

UNFPA and its partners now work to fulfil the rights of people, rather than the needs of beneficiaries. It’s an important distinction, because an unfulfilled need leads to dissatisfaction, while a right that is not respected leads to a violation. Redress or reparation can be legally and legitimately claimed.

A human rights-based approach also seeks to reinforce the capacities of duty bearers (usually governments) to respect, protect and guarantee these rights. It aims to address development complexities holistically, taking into consideration the connections between individuals and the systems of power or influence. And it endeavours to create dynamics of accountability.

Rights holders and duty bearers

This is a two-way street: Individuals and communities need to be fully informed about their rights and to participate in decisions that affect them. Governments and other duty bearers often need assistance to develop the capacity, the resources and the political will to fulfil their commitments to human rights.

The rights-based approach deals not just with outcomes but also with how those outcomes are achieved. It recognizes that people are actors in their own development, rather than passive recipients of services. Informing, educating and empowering them is essential. Their participation is central, not only to ensure they have ownership over the programme, but also to sustain progress.

A rights-based approach develops the capacity of duty-bearers to meet their obligations and encourages rights holders to claim their rights. Governments have three levels of obligation: to respect, protect and fulfil every right. To respect a right means refraining from interfering with the enjoyment of the right. To protect a right means to prevent other parties from interfering with the enjoyment of rights. To fulfil a right means to take active steps to put in place, laws, policies, institutions and procedures, including the allocation of resources, to enable people to enjoy their rights.

Mechanisms for protecting human rights

A number of UN treaty bodies mechanisms help UNFPA advance human rights, including

• Committee on the Elimination of all forms of Discrimination against Women
• Committee on Economic, Social and Cultural Rights
• Special Procedure mandate-holders the Commission on Human Rights (human rights experts with mandates to report and advise on human rights from a thematic or country-specific perspective)

Recently the Universal Periodic Review has emerged as a powerful mechanism. This state-driven process reviews the fulfillment of the human rights obligations and commitments of all 193 UN Member States once every four and a half years. The UPR is giving considerable attention to sexual and reproductive health and rights, which comprised  27 per cent of all recommendations issued during the first cycle of the mechanism (2008 to 2012).   

UNFPA also provides technical support to national human rights institutions – including human rights commissions and ombudsman offices to monitor sexual and reproductive health and rights and to pay particular attention to the situation faced by certain population groups, such as indigenous peoples, persons with disabilities, and migrants, who are often subject to human rights violations.

Updated 24 November 2014

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Introduction to a rights-based approach

A human rights-based approach (HRBA) is a conceptual framework that is normatively based on international human rights standards and operationally directed to promoting and protecting human rights. It seeks to analyse obligations, inequalities and vulnerabilities, and to tackle discriminatory practices and unjust distributions of power that impede and undercut human rights.

Under a human rights-based approach, plans, policies and programmes are anchored in a system of rights and corresponding obligations established by international law. This helps to promote sustainability, empowering people themselves (rights holders)—especially the most marginalized—to participate in policy formulation and hold accountable those who have a duty to act (duty bearers). UN agencies have agreed (see below) that a human rights-based approach consists of a number of essential attributes:

• As policies and programmes are formulated, the main objective should be to fulfil human rights.
• A human rights-based approach identifies rights holders and their entitlements and corresponding duty bearers and their obligations, and works towards strengthening the capacities of rights holders to make their claims and of duty bearers to meet their obligations.
• Principles and standards derived from international human rights treaties should guide all policies and programming in all sectors and in all phases of the process.

In practical terms, a human rights-based approach can be used to guide policies and measures of poverty. It can inform assessments and strengthen processes; it can be a mechanism for ensuring access to essential information, effective participation, and the provision of access to justice.

Here are some selected resource to help you understand a rights-based approach to social protection.

Last updated: 13/7/2015

• Selected resources

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The ‘Rights-Based Approach’ to Development: A Critical Reflection

Since 1990s, there has been an increasing realization in the field of development that the traditional need-based approach to development is not enough to meet the need of this field. This field, both in theory and practice, requires a paradigm shift from the so-called need-based approach to the rights-based approach. The rights-based approach to development is meant as catalyst to enable individuals (right-holders) to demand and exercise rights and also the state and non-state actors (duty-bearers) to deliver those rights (Cornwall & Nyamu-Musembi, 2004). This capacity development notion of the approach empowers individuals to demand justice as a right rather than a charity (Sen, 2005). However, right-based approaches are practically facing challenges to be pro-poor. Recently, this issue has been addressed by many development scholars. This essay argues that rights-based approaches are not automatically pro-poor, rather they require consciously and systematically paying attention to the marginalized groups, processes and outcomes, and the integration of human rights principles into development initiatives. For these issues, the essay first highlights the welcomed turn to the rights-based approach. Then it discusses how rights-based approaches are not automatically pro-poor while offering suggestions to make it pro-poor. Finally, it presents a case study from Latin America to strengthen the argument that rights-based approaches are not pro-poor by-default.

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A rights-based approach to development has increased in prominence in recent development discourse and practice. The approach is characterised by the empowerment of marginalised people through the realisation of human rights; human rights which have been defined and legally represented in the international instruments of the United Nations system. The inherent participatory nature of a rights-based approach to development therefore brings together the work of non-governmental human rights and development organisations. While a rights-based approach to development is an emerging field in development studies, this dissertation questions its assumptions by detailing through a case study the efforts of state-led development initiatives to realise rights. It also seeks to understand how nongovernmental actors can partner with the state, especially in authoritarian contexts, to operationalise a rights-based approach to development. A legal framework and an operational framework are drawn from development literature to assess the rights successes of state-led development initiatives and the opportunities for encouraging a rights-based approach to development in marginalised communities. The case study of the dissertation is the experience of the Uyghur ethnic minority in the Xinjiang Uyghur Autonomous Region of The People‘s Republic of China in the Great Western Development Drive era. The Great Western Development Drive, which is the Chinese government‘s attempt to realise rights and developmental equality in its western regions, offers the prospect of assessing the effects of a state-led development initiative on a marginalised people. In turn the shortfalls of the Great Western Development Drive present the chance to understand how marginalised people can partner with the state to offset state failure to bring developmental equality and realise rights. The work mainly draws upon secondary sources; however, the author‘s experience of education projects in Xinjiang and some original research are also presented. The dissertation concludes that partnership of the state, through consultative interventions sensitive to international human rights instruments, and the non-governmental sector, by means of a rights-based approach to development, offers a comprehensive and multistakeholder method to poverty alleviation.

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Towards a Human Rights-Based Approach to New and Emerging Technologies: A Framework

Framework document of policy paper series on "A Human Rights-Based Approach to New and Emerging Technologies" (Updated in 2024)

60 Pages Posted: 27 Oct 2023 Last revised: 29 Jun 2024

Stephan Sonnenberg

Seoul National University - College of Law

Louis Mason

Universal Rights Group

Seoul National University School of Law

Tejaswi Reddi

Independent.

Date Written: December 10, 2022

The HRBA@Tech model integrates three different perspectives, each of which brings unique insights to the questions posed above. First, it explores the principles that are most relevant in the development of new and emerging technologies (“the What” of the HRBA@Tech model). Drawing from both human rights standards as well as classical technological ethics literature, the paper articulates seven interlocking principles, organised into two pillars. The first (the ‘do no harm’ pillar) postulates that new and emerging technologies should be accountable, secure, non-discriminatory, and grounded in international human rights law. The second (the ‘make the world a better place’ pillar) additionally specifies that new and emerging technologies should also be based on proactive representation of, transparency towards, and the empowerment of those who would likely be impacted by new and emerging technologies. Each of these principles is associated with a list of discrete processes, for example ‘consultation,’ ‘human rights by design,’ or ‘capacity building.’ The articulation and study of these discrete processes – of which we argue there are a total of 24 – is the true added value of this HRBA@Tech model, since it suggests actionable ways to make real the lofty principles of the HRBA@Tech model in an applied, real- world setting. Second, the paper describes how these principles and corresponding processes apply to new and emerging technologies along the course of a classical technology lifecycle, starting from the initial days of innovation all the way to a technology’s eventual irrelevance. We call this ‘the How’ of the HRBA@Tech model. The report shows that certain processes tend to be far more relevant at certain stages of the technology’s lifecycle than others. The third and final perspective is that of the stakeholders (‘the Who’ of the HRBA@Tech model). Here we ask what stakeholders are relevant, working in which coalitions, to drive the HRBA@Tech model. While these descriptions remain somewhat abstract, the discussion highlights how various stakeholders must learn to work not only in opposition to one another, but also join hands in collaborative problem solving to make headway on this issue. The paper concludes by illustrating how the HRBA@Tech model would apply to artificial intelligence, highlighting how aspects of this approach are already being utilised by ethically-minded technologists, academics, government officials and corporate managers to nudge technologies in the direction of the promotion and protection of human rights. The final Chapter of the paper distills those findings into a succinct list of recommendations. Our intention in these pages is to bring together the various strands of technological ethics underneath the umbrella of a human rights- based approach, using accessible language to do so and highlighting specific processes that will be essential in any such efforts. We especially hope that this paper will contribute to efforts at the United Nations and elsewhere at the international level to use human rights mechanisms to systematically and progressively advance the issue of technology and human rights. Such a concerted effort is sorely needed, and we believe the diplomatic common ground exists to gradually develop implementable standards that can provide tangible guidance for all those who are involved in the process of designing and developing New and Emerging Technologies (NETs).

Keywords: Human rights based approach, new and emerging technologies, artificial intelligence, global governance

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Human rights

Key facts 

• Human rights are universal rights of all human beings, regardless of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.
• The right to health and other health-related human rights are legally binding commitments enshrined in international human rights instruments. WHO’s Constitution also recognizes the right to health.
• Every human being has the right to the highest attainable standard of physical and mental health. Countries have a legal obligation to develop and implement legislation and policies that guarantee universal access to quality health services and address the root causes of health disparities, including poverty, stigma and discrimination.
• The right to health is indivisible from other human rights, including the rights to education, participation, food, housing, work and information.
• Universal health coverage (UHC) grounded in primary health care helps countries realize the right to health by ensuring all people have affordable, equitable access to health services. 

Human rights are enshrined in human rights instruments. All WHO Member States have ratified at least one international human rights treaty that includes the right to the highest attainable standard of health.    After ratifying a treaty, a country has a legal obligation to protect and fulfil the rights recognized in the treaty. To deliver on binding human rights commitments countries need to adopt a human rights-based approach to health.

Health and human rights

The right to the highest attainable standard of physical and mental health is enshrined in several international legal instruments including the International Covenant on Economic, Social and Cultural Rights. It includes freedoms and entitlements. Freedoms include the right to control one’s health and body (for example, sexual and reproductive rights) and to be free from interference (for example, free from torture and non-consensual medical treatment and experimentation, particularly relevant for persons with disabilities ). Entitlements include the right to access quality health services without any discrimination. 

A human rights-based approach to health commits countries to develop rights-compliant, effective, gender transformative, integrated, accountable health systems and implement other public health measures that improve the underlying determinants of health, like access to water and sanitation. 

This means countries must ensure legislation and health policies and programmes respect and advance the realization of human rights. Research shows that proactive measures to comply with human rights obligations help countries improve substantive equality and build resilience to shocks . For example, applying a human rights framework to reproductive health can help us identify how preventable maternal mortality and morbidity results from a variety of human rights violations including discrimination and lack of access to quality health services.

Fundamental human rights principles

A human rights-based approach (HRBA) requires mainstreaming fundamental human rights principles and standards across health services and health system policies, including public health emergency preparation and responses. They include:

Non-discrimination and equality : This requires prioritizing the needs of those furthest behind to achieve equity. Equity is used as a framework in public health to identify and address unfair and

remediable health disparities among different sub-populations. HRBA provides legal standards and obligations to put legal protections for equality and non-discrimination into action.

Addressing discrimination requires attention to overlapping and intersecting factors of discrimination notably gender, race, ethnicity, disability, sexual orientation, gender identity and socioeconomic status. An intersectional lens allows for the examination of health inequalities driven by multiple grounds of exclusion and for health interventions to be designed in a way that responds to intersecting factors. This would include, for example, ensuring that health information is provided in formats that allow people to access the information they need. 

Participation : Participation requires empowering health service users, communities and civil society to engage in planning, decision-making and implementation processes for health across the programme cycle and at all levels of the system. To be meaningful, participation must include explicit strategies to address power imbalances, value experiential evidence, and manage conflicts of interest so that the needs and expectations of people are met. Participatory planning techniques can be used to engage beneficiary populations in designing health services or public spending prioritization.

Accountability : Countries must establish accessible and effective accountability mechanisms. These may include administrative and judicial remedies and oversight by other institutions, such as national human rights institutions and health and social care regulators. The United Nations human rights mechanisms, including the Committee on Economic Social and Cultural Rights, play a crucial accountability role by regularly reviewing countries’ compliance with their health-related human rights obligations.

There is a growing recognition of the importance of regulation of non-State actors, such as the private sector and non-governmental organizations, to ensure they respect and protect human rights. For example, by enacting bans on tobacco advertising, promotion and sponsorship (TAPS), countries are implementing their commitments to manage tobacco control under the WHO Framework Convention on Tobacco Control. One third of countries (66), representing a quarter of the world’s population, have completely banned all forms of TAPS.

Progressive realization and international cooperation 

Some human rights obligations are of immediate effect, such as the guarantee of non-discrimination. Other components of the right to health, like access to cutting edge health technology, are subject to the principle of progressive realization. Countries are legally obliged to use the maximum available resources to develop and implement rights-based legislation, policies and programmes. Countries in a position to assist have an obligation to cooperate with those with fewer resources.

Core components of the right to health

The right to health includes 4 essential, interrelated elements: availability, accessibility, acceptability and quality.

Availability refers to the need for a sufficient quantity of functioning health facilities, goods and services for all. Availability can be measured through the analysis of disaggregated data to different stratifiers including by age, sex, location and socio-economic status and qualitative surveys to understand coverage gaps. 

Accessibility requires that health facilities, goods, and services must be accessible to everyone. Accessibility has four dimensions: non-discrimination, physical accessibility, economic accessibility (affordability) and information accessibility. This is particularly important for persons with disabilities who often encounter significant barriers to health related to the inaccessibility of services, facilities and health information.

Assessing accessibility requires analysis of physical, geographical, financial and other barriers to health systems and services, and how they may affect people who are marginalized. It requires the establishment or application of clear norms and standards in both law and policy to address these barriers.

Acceptability relates to respect for medical ethics, culturally appropriate, and sensitivity to gender. Acceptability requires that health facilities, goods, services and programmes are people-centred and cater to the specific needs of diverse population groups and in accordance with international standards of medical ethics for confidentiality and informed consent. 

Quality extends to the underlying determinants of health, for example safe and potable water and sanitation as well as requiring that health facilities, goods, and services are scientifically and medically approved.

Quality is a key component of universal health coverage (UHC). Quality health services should be: 

• safe: avoiding injuries to people for whom the care is intended;
• effective: providing evidence-based services to those who need them; 
• people-centred: providing care that responds to individual needs; 
• timely: reducing waiting times and harmful delays; 
• equitable: providing care that does not vary in quality on account of age, gender, ethnicity, disability, geographic location, and socio-economic status; 
• integrated: providing a full range of health services throughout the life course; and
• efficient: maximizing the benefit of available resources and avoiding waste.

Human rights treaties which include the right to health

• International Covenant on Economic, Social and Cultural Rights  (Article 12) 
• Elimination of All Forms of Racial Discrimination  (Article 5(e) iv)
• International Convention on the Elimination of All Forms of Discrimination Against Women  (Articles 11(1) (f), 12 and 14(2)(b))
• Convention on the Rights of the Child  (Article 24)
• International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families  (Articles 28, 43 (e) and 45 (c)
• Convention on the Rights of Persons with Disabilities  (Article 25)

WHO response 

WHO supports countries to deliver on their human rights commitment to ensure non-discriminatory access to effective, quality health services and the underlying determinants of health. To achieve this goal WHO:

• advocates for the right to health and other health-related human rights, including through communication campaigns ;
• raises awareness of health-related human rights, for example on the right to safe healthcare;
• supports countries to integrate human rights standards into laws, health programmes and policies, for example through development of tools and guidelines such as guidance on human rights in the context of mental health and sexual or reproductive health ;
• builds capacity on a rights-based approach to health among policymakers; 
• provides evidence, analysis and recommendations related to health and human rights; and
• collaborates with other UN entities, to ensure human rights are recognized as a fundamental foundation to effective health service delivery, for example through implementation of the United Nations Disability Inclusion Strategy across all 3 levels of WHO. 
• WHO's work on human rights

Related health topics

• Health equity  
• Health systems governance
• Patient safety 
• Universal health coverage  

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• v.18(1); 2016 Jun

Human Rights-Based Approaches to Mental Health

Sebastian porsdam mann.

Student in the Department of Psychiatry, University of Cambridge, UK.

Valerie J. Bradley

President of the Human Services Research Institute, Cambridge, MA, USA.

Barbara J. Sahakian

Professor of Clinical Neuropsychology at the Department of Psychiatry and Medical Research Council/Wellcome Trust Behavioral and Clinical Neuroscience Institute, University of Cambridge, UK.

The incidence of human rights violations in mental health care across nations has been described as a “global emergency” and an “unresolved global crisis.” The relationship between mental health and human rights is complex and bidirectional. Human rights violations can negatively impact mental health. Conversely, respecting human rights can improve mental health. This article reviews cases where an explicitly human rights-based approach was used in mental health care settings. Although the included studies did not exhibit a high level of methodological rigor, the qualitative information obtained was considered useful and informative for future studies. All studies reviewed suggest that human-rights based approaches can lead to clinical improvements at relatively low costs. Human rights-based approaches should be utilized for legal and moral reasons, since human rights are fundamental pillars of justice and civilization. The fact that such approaches can contribute to positive therapeutic outcomes and, potentially, cost savings, is additional reason for their implementation. However, the small sample size and lack of controlled, quantitative measures limit the strength of conclusions drawn from included studies. More objective, high quality research is needed to ascertain the true extent of benefits to service users and providers.

Introduction

The historical and current incidence of human rights violations in mental health care across nations has been variously described as a “global emergency” and an “unresolved global crisis,” evidenced by reports of physical and sexual abuse; discrimination and stigma; arbitrary detention; inability to access health care, vocational and residential resources; and denial of self-determination in financial and marital matters, among other rights deprivations. 1 Mental illness affects nearly one in three individuals globally during their lifetime and nearly one in five in the past 12 months. 2 Mental and substance abuse disorders were leading causes of disability and were responsible for 8.6 million years lost to premature death worldwide in 2010. 3 The burden of these disorders increased by 37.6% from 1990 to 2010. 4 The annual economic cost of mental illness globally has been estimated to be $2.5 trillion, with a projected increase to $6 trillion by 2030, more than half of the total costs for all non-communicable diseases. 5 The World Health Organization defines mental health as a “state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” 6 This definition implies that mental health is reliant on the wide array of supports and resources that facilitate individual engagement at the highest level of gainful employment and in other community roles. 7 These factors include, among others, health, the availability of adequate housing, just and favorable conditions for work, and freedom from discrimination, all of which are enshrined in international human rights law. 8 There are thus significant connections between mental health and human rights. 9

The relationship between mental health and human rights has at least three parts. 10 First, human rights violations such as torture and displacement negatively affect mental health. 11 Second, mental health practices, programs, and laws, such as coercive treatment practices, can impact human rights. 12 Finally, the advancement of human rights benefits mental health synergistically. 13 These benefits extend beyond mental health to the close connection between physical and mental health. 14 There are thus clinical and economic reasons, as well as moral and legal obligations, to advance human rights in mental health care.

A human rights-based approach (HRBA) to mental health care capitalizes on these rich interconnections. An HRBA “is a conceptual framework…that is normatively based on international human rights standards and operationally directed to promoting and protecting human rights.” 15 HRBAs have been successfully implemented in a variety of fields, including international development and HIV treatment. 16 In the context of mental health care, an HRBA means placing emphasis not only on avoiding human rights violations but making sure that human rights principles are at the center of a service-providing organization. 17

Human rights frameworks are increasingly being recognized as important contributors to health care. Recently, leaders in the fields of neuro science and global mental health have called for:

a multilayered and multisectoral approach to prevention and treatment… including... provision of living and working conditions that enable healthy psychosocial development, promotion of positive interactions within and between social groups, social protection for the poor, anti-discrimination laws and campaigns, and promotion of the rights of those with mental disorders. 18

Similarly, the Grand Challenges in Global Mental Health initiative has noted that:

[e]fforts to build mental capital—the cognitive and emotional resources that influence how well an individual is able to contribute to society and experience a high quality of life—could also mitigate the risk of disorders such as depression, substance-use disorders, bipolar disorder and dementia…. Thus, health-system-wide changes are crucial, together with attention to social exclusion and discrimination. 19

However, “all care and treatment interventions—psychosocial or pharmacological, simple or complex—should have an evidence base to provide programme planners, clinicians and policy-makers with effective care packages.” 20 HRBAs have the potential to fulfill these demands at relatively low costs. Their potential should be examined in order to provide the evidence called for above.

These frameworks have both normative and legal backing and have substantial overlap with medical ethics. Human rights set out universal, non-negotiable standards for all people, and can thus act as powerful catalysts for change in areas such as mental health care that have historically been marred by discrimination and, in some cases, disregard for the inherent worth and dignity of patients. Though there is little doubt that infringement of human rights has negative effects on mental welfare, few papers have sought to explore the converse part of this reciprocal relationship.

This paper aims to review instances where an explicitly HRBA to mental health care, including intellectual disability and dementia care, has been carried out by service providers. It does not aim to review the impact of rights-based litigation on mental health care.

Literature search

An initial search of PubMed on March 22, 2015, with the search phrases “human rights based approach” and “mental” yielded 274 results, of which only one record met inclusion criteria. It was therefore decided to aggressively expand search criteria in the hopes of locating more records that would meet inclusion criteria.

A systematic search of PubMed (Medline), PsycInfo, PsycArticles, British Library, Library of Congress and Web of Science was carried out on March 22 and 23, 2015. Combinations of the phrases “human rights,” “mental health,” “mental,” “mental illness,” “mental disorder,” “human rights based approach,” “human rights-based approach,” “rights-based approach,” “rights based approach,” “human rights approach,” “intellectual disability,” “intellectual difficulty,” “intellectual difficulties,” “learning disorder,” “learning difficulty,” “learning difficulties,” “learning disability,” and “UNCRPD” constituted the search terms.

The publications and reports of the human rights commissions, health departments (where applicable), and mental health commissions (where applicable) of the United Kingdom, United States of America (Inter-American Commission), New Zealand, Australia, Scotland, Ireland, Canada, South Africa, Ontario, Germany, Denmark, European Union, United Nations, African Union, and Islamic Human Rights Council were hand searched.

The reports and publications of the organizations Amnesty International, Mind UK, National Disability Authority Ireland, BasicNeeds, Federation Global Initiative on Psychiatry, World Federation for Mental Health, Disability Rights International, International Disability Alliance, American Association of Community Psychiatrists, American College of Psychiatrists, National Institute of Mental Health, Samaritan Institute, Centre for Mental Health UK, Rethink Mental Illness, Royal College of Psychiatrists, SANE, United Response, Mental Health Europe, MindFreedom International, Mental Health Foundation UK, and Mental Health America were also hand searched.

In addition, 13 researchers as well as the above-mentioned human rights commissions and organizations were contacted in the hopes of locating additional sources.

The selection of organizations and commissions was based on size and the language competencies of the first author.

The first author performed the literature search and data abstraction.

Inclusion criteria

Studies were selected according to the following criteria:

• there was use of an explicitly HRBA to improve mental health outcomes;
• information was reported on the mental health outcomes or on measures immediately relevant to mental health outcomes;
• the report was in English; and
• the report was published.

Exclusion criteria

Studies were excluded according to the following criteria:

• the report referred to work that was reported more fully elsewhere;
• the report was in a language other than English; or
• the report was not published.

Studies that fulfilled all inclusion criteria and none of the exclusion criteria were included in the analysis. As a consequence, only studies that explicitly identified themselves as HRBA were included.

The database searches resulted in 8,889 hits. 2,757 records were identified through other sources, for a total of 11,646 records. 7,056 records remained after duplicates were removed. Of these, 615 were reviewed on the basis of their abstracts, and 60 were reviewed on the basis of the full text. Ten articles met inclusion criteria.

Studies that met inclusion criteria ranged from a single case study to nationwide initiatives. Three studies were carried out by national human rights commissions and one by a national health department. Four studies reported on work performed by state hospitals. Of the remaining two studies, one reported a case study of an incarcerated mental health service user and the other reported on work done by a service user advocacy group. Five of the studies were evaluations of national or organizational policy initiatives and the remaining five reported case studies. The studies span across six countries. All 10 included studies reported positive outcomes.

The State Hospital, Carstairs, Scotland

The Scottish Human Rights Commission undertook an independent evaluation of an HRBA at The State Hospital (TSH) in Carstairs, Scotland. 31 TSH is a high-security forensic hospital for compulsorily detained mental health patients. Following a critical report by the Mental Welfare Commission in 2000, the hospital decided to adopt an HRBA into its culture. A human rights working group was established and underwent extensive training under the purview of a human rights expert. In conjunction with the expert, the group interviewed approximately 100 staff and patients to identify human rights concerns. The working group proceeded to examine all hospital policies using a three-tiered “traffic light” assessment tool. Although no policies were given a “red light” (indicating that a policy was not compliant with human rights standards), several policies, such as those concerning the use of restraint and seclusion, were given an “amber light” rating. Amber light ratings were used to identify policies in need of development and consideration.

In addition, human rights training was provided for staff not involved in the working group and a patient and staff forum for involvement in the decision-making process was established. The human rights training was provided in the form of a series of workshops over two years, examining the reasons behind the implementation of the HRBA and using case studies to educate staff. Roughly 200 staff took part in these efforts. A “best practice guide” was developed to help staff make appropriate decisions in cases where human rights might be infringed. The guide included an index of hospital practices and policies where human rights problems might occur, with instructions on how to avoid breaches.

The Scottish Human Rights Commission’s evaluation included the review of internal documents as well as focus groups and interviews with management, staff, and patients. The Commission found that “the majority [of patients, caregivers, management, and external commentators] whole heartedly agree that a positive rights respecting culture, where the rights of staff, patients and carers are respected, was created at TSH as a result of the human rights-based approach.” The Commission found improvements in the care and treatment conditions of patients as well as a reduction in the use and severity of restraint. Staff reported improved working conditions and a reduction in anxiety. Both patients and caregivers reported a shift from blanket policies to more individualized, patient-centered approaches. These changes combined to effect improved working relations between caregivers and patients. Negative comments were limited to concerns about communications and involvement in discussions on working practices related to hospital rebuilding works among staff and patient concerns regarding proposed restrictions on diet choices and smoking.

Indian National Human Rights Commission

In a 1997 Indian Supreme Court decision, the National Human Rights Commission was given the mandate to monitor and supervise performance at the mental health institutions at Agra, Gwalior, and Ranchi “to ensure that [they function] in the manner as is expected for achieving the object for which [they were] set up.” 32 Since then, this mandate has extended to all similar institutions in India. The Commission’s first steps were to analyze the existing status and shortcomings of 37 mental health institutions. The Commission then published a list of recommendations including abolition of cell admissions; restructuring of closed into open wards; construction of smaller capacity wards; ensuring adequate supply of potable water and access to sanitation; provision of nutritious food at 3,000 calories per day; ensuring compatibility of policies with the Mental Health Act (1987); provision of individual cots and mattresses; in-house training of staff; and occupational therapy for patients. A later set of recommendations included expanding patient access to public goods such as late-age pensions. In addition, the Commission established an advisory group with representatives from the Department of Health, the national legislature, and the Ministries for Social Justice and Women and Child Development; expanded data reporting requirements; engaged with the Indian Medical Council and Department of Health to expand mental health training and recruitment; and carried out regular site visits to monitor compliance.

PRISMA 2009 Flow Diagram. *

Characteristics of studies included.

A report of site visits at 13 institutions was prepared by the Commission’s Special Rapporteur, L. D. Mishra, in 2012. 33 The rapporteur found improvements in hospital infrastructure, including the construction and improvement of outpatient departments and delivery of potable water, as well as improved use of technology, including electronic data collection. The inspections found improvements in integration of primary care and provision of nutritious food. In addition, patients were now able to access improved dining and recreational facilities and had better access to sanitation. Hygiene standards were improved, and some patients were offered occupational therapy as well as yoga and meditation opportunities. However, the report also highlighted the continuing dearth of mental health resources in the country, with an estimated shortfall of roughly 8,500 psychiatrists, 16,750 clinical psychologists and 22,600 psychiatric social workers. The report also noted the chronic lack of psychiatric beds as well as the dilapidated and archaic facilities, overcrowding of institutions, lack of modern tools, and persistence of practices such as unnecessary restraint and inadequate investigative facilities.

Mersey Care National Health Service Trust, England

The United Kingdom’s Equality and Human Rights Commission published a report on five organizations that had incorporated an HRBA into their culture. 34 The five organizations were the Welsh Assembly Government, the National Policing Improvement Agency, Southwark Council, Mersey Care Trust, and Age Concern. Mersey Care Trust is of primary interest as it provides the full range of specialist mental health services as well as medium- and high-security forensic mental health services. Mersey Care adopted an HRBA to its service delivery in 2001. One of the first steps taken was the appointment of a director for user and caregiver involvement to the Trust board. Another was implementing performance monitoring of senior staff by caregivers and patients as well as caregiver and patient involvement in the recruitment and induction of new staff. In addition, each document passed to the board is required to feature a cover sheet identifying relevant human rights concerns. The trust worked with the British Institute of Human Rights to deliver human rights training to staff and caregivers as well as the board. The Institute’s training was tailored to the needs of the Trust and focused on the basic concepts involved. The training included case studies and highlighted the human rights issues most relevant for each group of participants. This resulted in the development of human rights benchmarks, assessment tools, and questionnaires for patients.

Eighty-nine percent of patients felt that involvement stemming from the HRBA had resulted in increased recovery and well-being. Patients reported increased access to skills training and vocational opportunities. In addition, the report found that newly hired staff were more likely to be empathetic and understanding due to patient and caregiver involvement in new hire screenings. Staff and management also reported positive effects on their work. The Trust reported that these benefits were achieved with an annual investment of less than £400,000.

United Kingdom Department of Health: Valuing People Now

In 2009, the United Kingdom’s Department of Health launched a nationwide initiative designed to improve care and services for people with intellectual disability. The initiative, Valuing People Now, was based on four key principles of rights, independence, choice, and inclusion. 35 The initiative consisted of several recommendations and the establishment of funds for their implementation. The key priorities of the initiative were the modernization of day care facilities; provision of support for the transition to supported community accommodation; establishment of supported living arrangements for service users with older caregivers; development of local specialized services; provision of direct payments; and increased use of person-centered planning approaches.

The Department commissioned a self-evaluation of the project 18 months after roll-out. 36 The report was based on progress reports from all 152 local institutions involved in the project. The report found that as a result of the initiative, more acute liaison nurses had been recruited and more annual health checks were being performed, though half of service users still failed to receive annual checks. The report also found increased access to employment opportunities and community accommodation. Institutions reported higher levels of service user involvement in health planning and greater access to person-centered planning approaches and health facilitators.

However, an independent review of Valuing People Now identified several areas of concern. 37 The review found that although Valuing People Now had enhanced some areas of choice, participation, and quality of life for people with intellectual disabilities, it had only affected a minority of service users and may have disproportionately excluded people with the most severe disabilities. In addition, the review found little evidence that Valuing People Now had increased choice of public services for service users.

The Scottish Government’s National Dementia Strategy

The Scottish Government launched its first human-rights based nationwide dementia strategy in 2010. 38 Three sites were chosen as demonstration sites. The North Lanarkshire site has published a report detailing the steps taken to ensure compliance with the human rights and outcome goals of the project. 39 As part of this initiative, and in recognition of the terminal nature of dementia, the North Lanarkshire site placed a particular emphasis on reshaping institutional infrastructure and the local environment to become more dementia-friendly. A community outreach program was established, informing local business owners and community service providers of steps they could take to make their services more amenable to dementia patients. Several training programs for the demonstration site staff were conducted, including dementia awareness; post-diagnosis training; the use of assistive technology; best practice workshops; dealing with stress and distress; and palliative care. The training courses focused on improving awareness and understanding of the condition and the effects it can have on patients’ understanding of the world they live in. A post-diagnosis support program was developed and provision of day services was increased. Lastly, peer to peer support was encouraged through the establishment of “dementia cafes” for service users and caregivers.

The evaluation reported several beneficial outcomes. These included a 40% reduction in falls and a 60% reduction in near-falls resulting from dementia-friendly restructuring. The need for anti-psychotic and mood elevating pharmacotherapy was reduced and access to assistive technology was improved. In addition, fewer hospital admissions were reported. Both staff and patients reported lower levels of distress as a result of the program. Service providers received higher grades on their Care Inspectorate reports. Communication between caregivers and staff improved, resulting in greater treatment and work satisfaction.

The Public Initiative for the Prevention of Suicide—Greater Shankill Bereaved Families Rights Group

The Participation and Practice of Rights Project (PPR) is a service-user-led advocacy group based in Northern Ireland. As a result of political turmoil, Northern Ireland is facing much higher rates of mental health issues and suicide attempts than previously. 40 In conjunction with another local organization, the Public Initiative for the Prevention of Suicide-Greater Shankill Bereaved Families (PIPS-GSBF) Rights Group, a human rights-based project with the aim of instituting a mandatory one-week follow-up system for patients with severe mental illness and a history of self-harm was conceived. The impetus behind this project was the fact that the majority of suicides happen within one week of discharge from services, yet only a minority of patients are assigned a follow-up appointment within one week. 41 The group’s first steps were service-user-led research and identification and development of human rights issues, indicators, and benchmarks.

The group identified areas of local service provision which they considered problematic and compared them to international human rights standards. They then conducted focus group sessions and surveys of local service users to assess the extent to which these issues were pervasive in nearby communities. Next, the group presented their findings to an international panel of human rights and mental health experts. With the encouragement and support of the panel, the group conducted further research and an extensive campaign resulting in a meeting with the Minister of Health. As a consequence of the group’s campaign and meetings, the Minister of Health agreed to implement a nationwide policy of mandatory follow-up appointments within one week for service users with a history of self-harm.

Luthando HIV Clinic, Soweto, South Africa

In Soweto, South Africa, an HRBA was used to set up an integrated mental health, tuberculosis and HIV treatment clinic. 42 Nearly two-thirds of all cases of HIV are located in southern Africa. An estimated 26.5% of all mental health service users in South Africa are thought to have co-morbid HIV. 43 Though it is not an official policy, it is very difficult for mental health service users to access HIV or tuberculosis treatment due to limited resources and a widespread belief that they will not adhere to treatment. Using an HRBA, three local psychiatrists successfully argued that this constituted discrimination and were granted a small amount of resources to set up an integrated mental health and HIV clinic with tuberculosis care added subsequently. As a result of this program, integrated service has been provided to more than 600 individuals who would otherwise have faced severe obstacles to accessing care. In addition, the program delivers vocational and skills training.

New York City’s Bureau of Correctional Health Services

New York City’s Department of Health and Mental Hygiene’s Bureau of Correctional Health Services is responsible for the health care of jail and prison inmates. This setting can engender conflict between the medical and security missions, a situation known as “dual loyalty.” As a consequence of this, the Bureau adopted a health care policy in 2012 based on the three aims of patient safety, population health, and human rights. 44 As part of the human rights element, a human rights forum and subcommittee were established and mandatory human rights and dual loyalty training for staff was implemented. This training focused on introducing and clarifying the basic concepts behind human rights. Case studies and examples of dual loyalty situations in correctional health were used in the training, which is mandatory for all health staff. In addition, the electronic health record system in use was modified with the aim of improving the monitoring and care of vulnerable inmates’ health. 45 These modifications allowed the Bureau to track and analyze incidents of harm and self-harm among inmates who were also mental health service users. The analysis revealed that mental health problems and solitary confinement were very significant risk factors for self-harm. 46 Due to concerns arising from the human rights viewpoint, these data were used to end solitary confinement practices for adolescents with serious mental illness. 47

Individual patient case studies

The final two studies presented case studies of individual patients. Chan et al. applied the framework of the Convention on the Rights of Persons with Disabilities to the case of “Ned,” a man with co-morbid intellectual disability and mental health issues detained for most of his life in a high-security prison setting where he received little treatment beyond antipsychotic medication. 48 Ned was being detained in prison despite having no records of violence, excepting verbal threats which were not followed through, during his roughly 40 years of detention. As a result, a number of Ned’s rights under the Convention were breached. Using an HRBA, a transfer to a community treatment setting was planned and executed over an extended period.

Whitehead, Carney, and Greenhill presented several case studies of an HRBA to positive risk assessment and support of people with a learning disability. 49 The HRBA emphasized the use of proactive (preventive) instead of reactive strategies; the importance of using the least restrictive strategy; finding an appropriate balance between rights and risks; and service user involvement in health planning and advance directives. In addition, human rights risk screening and joint risk and human rights management tools were created. The team describes seven cases where complex treatment solutions have been reached as a result of the HRBA. The authors conclude that their approach “respects human rights, creates opportunities for growth and meaningful community participation, and empowers people with a learning disability and complex needs to access ‘a life like any other.’” 50

All 10 included studies reported beneficial effects of adopting an HRBA. Benefits ranged from subjective reports of a better work environment to the provision of previously unavailable services. The reports were consistently positive across the spectrum of studies included, from single-person case studies to national initiatives. Negative reports were much less frequent and generally concerned issues related to communication or inclusion.

The methodology used to assess impacts of the HRBAs was in many cases limited to interviews with patients, caregivers, and/or staff. Only three studies reported quantitative data related to the impact of their approaches on patients’ access to treatment, well-being, or mental health outcomes. Roughly half of the studies involved self-assessment rather than external evaluation. In addition, two external evaluations were carried out by national human rights bodies that may have had an interest in positive evaluations of HRBAs. None of the studies used experimental design and few used structured interview techniques for their evaluations. There is thus significant risk of bias.

The potential for bias can be seen in the contrast between the self-evaluation of the UK Department of Health’s Valuing People Now initiative and the independent review of the same project. 51 Whereas the self-evaluation correctly identified several areas of improvements, it failed to mention that these were often limited and did not reach all of the intended recipients, as highlighted in the independent review. Nonetheless, it was clear that all projects were considered to have yielded significant benefits.

The cost of implementation was mentioned in one study only. 52 Mersey Care Trust reported having spent roughly £400,000 on their HRBA, less than a quarter of 1% of their annual resources. Due to the nature of the interventions most frequently used, such as workshops, training, service user inclusion, and policy development, costs are likely to be modest compared to potential system-wide benefits. Administrators at Mersey Care argued that they had spent “less than a quarter of 1 per cent of their income to ensure they spend the other 99.75 per cent more effectively.” 53

All studies were completed in 2009 to 2014. This may reflect the increased awareness of human rights issues in disability and mental health care due to the lead up to and ratification of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which came into effect in 2009. 54 The CRPD places significant emphasis on the equality of persons with disability before the law and with respect to all other rights. 55 One of the strengths of HRBAs is their grounding in international and some domestic law. This gives such approaches ethical and legal weight, with recourse to legal mechanisms should this be necessary.

Our survey is important in that it constitutes an early step towards the realization that human rights principles, beyond being ethically and legally obligatory, can also lead to beneficial outcomes in mental health. Furthermore, the experience of Mersey Care Trust indicates that HRBAs can be implemented at low cost and are likely to be cost-effective. We hope that calling attention to these features will galvanize stakeholders to pay more attention to human rights and their connection with mental health. Training mental health staff, advocacy groups, and other stakeholders in human rights has the potential to benefit all involved at little cost. This aspect of human rights has received little attention thus far, and may help as a practical incentive towards improved programs for vulnerable members of society with mental health problems.

The studies reviewed here can be seen as an indication that an HRBA can be successfully and beneficially applied in mental health contexts. However, the methodological shortcomings of the studies reviewed strongly suggest that more research is needed to confirm these benefits and to explore which types or features of HRBAs are most suitable. There were other limitations to our review. The literature and data extraction was performed by one author only. Only published studies in English utilizing an explicitly HRBA were included, and the grey literature was not searched. Consequently, our focus is restricted to an HRBA to mental health and does not cover other vulnerable populations, such as refugees, who are not represented in the included studies. The quantity of relevant articles and the extent of methodological rigor of the included studies limit the scope and strength of our analysis.

Objective, quantitative studies with appropriate control groups will be necessary in order to place HRBAs on a firm evidence base. Future studies ought to include clearly defined outcome measures such as effects on quality of life, use of medications, and use of mental health services. In addition, more cost-benefit analyses are required. Evidence of costs and benefits derived from well-conducted, controlled quantitative studies could be used to promote the wider introduction of HRBAs in mental health.

This paper aimed to review instances where explicit HRBAs were used to promote the mental well-being of service users. Although few such studies have been conducted or were available for analysis, and the quality of experimental design and data collection were generally not of a high standard, all noted widespread benefits of adopting human rights standards into service delivery. This was the case across both scale and nature of services, from single-case studies to nationwide initiatives, and from severe and persistent mental illness to dementia and intellectual disability services.

HRBAs ought to be in place for moral reasons, since human rights are fundamental pillars of justice and civilization. 56 The fact that such approaches contribute to positive therapeutic outcomes and, potentially, cost savings, is an additional reason for their implementation. The HRBA thus offers a moral, political, legal, and empirical rationale for inclusion in mental health systems—at the national, state, and provider levels. Although more well-designed research is required to validate the extent of benefits to service users and providers, the information already available provides a strong argument for the adoption of HRBAs.

Acknowledgments

Barbara J. Sahakian receives funding from the Human Brain Project. She is President of the International Neuroethics Society and a Distinguished Research fellow at the University of Oxford Uehiro Centre for Practical Ethics.

Sebastian Porsdam Mann wishes to acknowledge the International Neuroethics Society and the Carnegie Council for Ethics in International Affairs, where he is a Global Ethics Fellow for the Future.

* D. Moher, A. Liberati, J. Tetzlaff, and D.G. Altman, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed100009

A Human Rights-Based Approach (HRBA) in Practice: Evaluating NGO Development Efforts

• Symposium Article
• Published: 10 September 2012
• Volume 44 , pages 523–541, ( 2012 )

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• Hans Peter Schmitz 1  

Human rights-based approaches (HRBAs) promise greater alignment of development efforts with universal norms, as well as a focus on the root causes of poverty. While HRBAs have been widely adopted across the development sector, there is little systematic evidence about the actual impact of this strategic shift. Evaluating the effectiveness of HRBAs is challenging because various non-governmental and other organizations have developed very different understandings of how to apply a rights-based framework in the development context. This essay takes a step toward the rigorous evaluation of HRBAs by offering a comprehensive review of rights-based programming implemented by Plan International, a child-centered organization. It shows that Plan's adoption of HRBA-inspired strategies has transformed its interactions with local communities and added an explicit focus on the state as the primary duty bearer. There is evidence for a systematic increase in individual rights awareness, greater ownership exercised by community organizations, and the application of evidence-based advocacy aimed at scaling up proven program activities. But Plan's peculiar brand of HRBA neglects collaboration with domestic social movements and civil society, largely avoids a more confrontational approach towards the state, and has yet to produce evidence for regular successful rights claims by disadvantaged communities against governmental representatives at local, regional, or national levels. The study also reveals a limited ability of Plan to address disparities and discrimination within local communities, as well as a need to define clearly the organization's own accountability and duties deriving from its presence in local communities across more than fifty developing nations.

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William R. Easterly, The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good (New York: Penguin Press, 2006).

Sam Hickey and Diana Mitlin, eds., Rights-Based Approaches to Development: Exploring the Potential and Pitfalls (Sterling, VA: Kumarian Press, 2009).

Peter Uvin, Human Rights and Development (Bloomfield, CT: Kumarian Press, 2004).

Paul J. Nelson and Ellen Dorsey, New Rights Advocacy: Changing Strategies of Development and Human Rights NGOs (Washington, DC: Georgetown University Press, 2008).

The United Nations established the HRBA portal to offer resources on the mainstreaming of the human rights-based approach as well as the facilitation of inter-agency collaboration focused on HRBAs ( http://hrbaportal.org/ ).

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The practice of rating NGOs only based on financial health has been widely criticized by practitioners and scholars alike; see George E. Mitchell, Watchdog Study: Reframing the Discussion about Nonprofit Effectiveness (Washington, DC: DMA Nonprofit Federation, 2010), and Ann Goggins Gregory and Don Howard, “The Nonprofit Starvation Cycle,” Stanford Social Innovation Review 7 (2009): 48–53. In response, Charity Navigator, one of the main NGO watchdogs operating in the United States, has begun to expand its rating system to also include information about levels of accountability and transparency as well as actual results of program activities; for an update on the methodology, see Charity Navigator's methodology section at www.charitynavigator.org and Ken Berger's blog at www.kenscommentary.org/ .

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Three exceptions include Shannon Kindornay, James Ron, and Charli Carpenter, “Rights-Based Approaches to Development: Implications for NGOs,” Human Rights Quarterly 34 (2012): 472–506; Sheena Crawford, The Impact of Rights-Based Approaches to Development: Bangladesh, Malawi and Peru (London: UK Interagency Group on Human Rights Based Approaches, 2007); and Gready, “Reasons to Be Cautious.”

Tosca Bruno-van Vijfeijken, Uwe Gneiting, Hans Peter Schmitz, and Otto Valle, Rights-Based Approach to Development: Learning from Guatemala (Syracuse, NY: Moynihan Institute of Global Affairs, 2009); Tosca Bruno-van Vijfeijken, Uwe Gneiting, and Hans Peter Schmitz, How does CCCD Affect Program Effectiveness and Sustainability? A Meta Review of Plan's Evaluations (Syracuse, NY: Moynihan Institute of Global Affairs, 2011).

Craig Johnson and Timothy Forsyth, “In the Eyes of the State: Negotiating a ‘Rights-Based Approach’ to Forest Conservation in Thailand,” World Development 30 (2002): 1591–1605.

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Ibid., 179.

Jennifer Chapman. Rights-based Development: The Challenge of Change and Power (London: ActionAid International, 2005).

Paul Gready, “Rights-Based Approaches to Development: What is the Value-Added?” Development in Practice 18 (2008): 735–47.

Srirak Plipat, Developmentizing Human Rights: How Development NGOs Interpret and Implement a Human Rights-based Approach to Development Policy (University of Pittsburgh, Doctoral Thesis, 2005).

Jonathan Menkos, Ignacio Saiz, and Maria Jose Eva, Rights or Privileges? Fiscal Commitment to the Rights to Health, Education and Food in Guatemala (Madrid/Guatemala City: Instituto Centroamericano de Estudios Fiscales and The Center for Economic and Social Rights, 2009).

Irko Zuurmond, ed., Promoting Child Rights to End Child Poverty (Woking, UK: Plan International, 2010).

Bruno-van Vijfeijken, Gneiting, and Schmitz, Meta Review , 6.

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Hickey and Mitlin, Rights-Based Approaches to Development , 225.

Bruno-van Vijfeijken, Gneiting, and Schmitz, Meta Review , 11.

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Emily B. Rodio and Hans Peter Schmitz, “Beyond Norms and Interests: Understanding the Evolution of Transnational Human Rights Activism,” International Journal of Human Rights 14 (2010): 442–59.

Bruno-van Vijfeijken, Gneiting, Schmitz, and Valle, Learning from Guatemala.

Tosca Bruno-van Vijfeijken and Hans Peter Schmitz, “A Gap between Ambition and Effectiveness,” Journal of Civil Society 7 (2011): 287–92.

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Bruno-van Vijfeijken, Gneiting, and Schmitz, Meta Review , 23.

Anthony Bebbington, “Donor-NGO Relations and Representations of Livelihood in Nongovernmental Aid Chains,” World Development 33 (2005): 937–50.

Bruno-van Vijfeijken, Gneiting, and Schmitz, Meta Review , 40.

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The findings reported here are partly based on two evaluations commissioned by Plan Guatemala in 2009 and Plan U.S.A. in 2011. During the research process, Plan U.S.A.'s Senior Program Manager Justin Fugle and CEO Tessie San Martin, as well as Plan Guatemala's country director Ricardo Gomez-Agnoli, provided unrestricted access to archives and other sources. The research team based at the TNGO Initiative included Uwe Gneiting and Tosca Bruno-van Vijfeijken. The author also thanks Joannie Tremblay-Boire, the members of the APSA task force, and its chair, Michael Goodhart, for their important feedback on earlier versions of this article.

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Schmitz, H. A Human Rights-Based Approach (HRBA) in Practice: Evaluating NGO Development Efforts. Polity 44 , 523–541 (2012). https://doi.org/10.1057/pol.2012.18

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Published : 10 September 2012

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Human Rights and Biomedicine

Back Promoting human rights-based approaches in clinical practice

As part of its significant initiative to promote the human rights and ethical standards in healthcare, the Council of Europe, in close collaboration with the Yerevan State Medical University, conducted a comprehensive   training on the key human rights principles enshrined in the Council of Europe Convention on Human Rights and Biomedicine (Oviedo Convention) for 35 physicians clinical specialists from university clinics. The programme was designed to equip healthcare professionals with the skills and knowledge necessary to manage complex human rights and ethical challenges in clinical practice. Meri Katvalyan, Senior Project Officer of the Project “Protection of Human Rights in Biomedicine” and Mary Ter- Stepanyan, the Head of the National Scientific Research Centre of Health Programs of YSMU made the opening remarks emphasizing the importance of human rights and ethical guidelines in clinical practice. 

The participants had an opportunity to learn from the expertise of international and national  consultants who covered a wide range of topics,  such as national and European standards on right to health protection and access to healthcare services, the reproductive health rights, human rights-based approaches to healthcare, issues of informed consent, medical secret and confidentiality, as well as human rights challenges in emergency situations.  

As a result, medical practitioners from university clinics upgraded their knowledge and skills that would help them to further promote and practice the standards outlined in the Oviedo Convention as part of their profession. 

Additionally, participants earned 10 continuous professional development credits and expanded their professional networks, enhancing collaboration and expertise in the field.

The capacity-building training was organised by the Council of Europe Project on “ Protection of Human Rights in Biomedicine II ” implemented within the Council of Europe Action Plan for Armenia 2023-2026 .

Background note: The Council of Europe Convention on Human Rights and Biomedicine (known as the “Oviedo Convention“) is the first and the only international legally binding instrument addressing human rights issues in the biomedical field. The Convention provides a framework for the protection of human rights and human dignity by establishing fundamental principles applicable to daily medical practice as well as clinical research, transplantation, and genomics.  

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