Accountability and the Right to Health
The right to health has received widespread recognition in international law. Most notably, the International Covenant on Social, Economic and Cultural Rights (ICSECR) recognizes the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (Art. 12.1). Despite a clear legal obligation on the part of governments to protect, promote, and fulfill this, they often fail to meet the health needs of marginalized groups such as indigenous women, those with mental health problems, and migrants. In this blog post, I will provide an overview of the different accountability mechanisms that exist to hold governments accountable to their right to health obligations, while noting the importance of social accountability mechanisms at the local level.
Types of Accountability Mechanisms
An accountability mechanism is the “procedure through which government is answerable for its acts or omissions in relation to right to health obligations” (http://repository.essex.ac.uk/9717/1/accountability-right-highest-attainable-standard-health.pdf). Different types of accountability mechanisms exist: judicial (courts); quasi-judicial (human rights institutions); administrative (human rights commission); political (elections); and social (civil society). Each has its strengths and weaknesses. Judicial mechanisms arguably receive the most attention due to high-profile cases where litigants have secured access to life-saving medical treatment through judicial decisions (see e.g. Minister of Health v Treatment Action Campaign). The legal process is undeniably a powerful accountability mechanism in allowing rights-holders to challenge government legislation and policy through the courts. However, marginalized populations often encounter barriers in accessing justice through the courts; the justice system is often too complex, expensive, or culturally insensitive for these groups to navigate.
Social Accountability Mechanisms
Social accountability mechanisms are becoming increasingly important in keeping governments accountable to marginalized people’s right to health and, in my view, deserve greater attention. This type of accountability generally involves the use of citizen action to keep government conduct in check. For instance, the Treatment Action Campaign (TAC) engaged in massive public mobilization and extensive media campaigns to draw attention to the South African government’s restrictions on access to antiretrovirals.
Social accountability mechanisms at the local level have become more prominent among NGOs seeking to foster citizen participation. On this point, various techniques that allow marginalized populations to assess the performance of government health services have been developed and implemented. CARE Malawi, for example, has developed the “community score card” as a technique for citizens to systematically address local-level barriers to health services and facilitate good governance. The underlying principles of the community score card include participation, inclusion of voice, accountability and transparency, equity, and shared responsibility and obligation. There is evidence that these social accountability mechanisms have a positive effect on health outcomes (https://coregroup.org/wp-content/uploads/media-backup/documents/Resources/Tools/Social_Accountability_Final_online.pdf).
Conclusion
Human rights, including the right to health, are no more than window-dressing without adequate accountability mechanisms. Accountability provides governments and public officials with the opportunity to explain their actions. Where there are mistakes, accountability demands some form of redress. While human rights actors have traditionally put much effort in using the courts and the electoral process to keep governments accountable, social accountability mechanisms at the local level such as community scorecards deserve attention for their beneficial effects on health outcomes, participation, and empowerment.
Benny Chan (LLM ’20) is a Global Health Law Scholar at Georgetown University Law Center and a student fellow with the Global Health Initiative.