Between Insurrectional Discourse and Operational Guidance: Challenges and Dilemmas in Implementing Human Rights-Based Approaches to Health

Whether the future ‘sustainable development’ framework advances the rights of the immiserated around the globe will depend not just on the language in the global documents. It will crucially depend upon how meaningfully human rights-based approaches (HRBAs) are implemented in practice. We argue here that dilemmas arise from two principal contradictions inherent in HRBAs: HRBAs to health require subversion of power relations which lead systematically to patterns of ill-health among certain populations, yet also require working with and buy-in from those who have power—in governments, donor institutions and agencies. Second, human rights are set out as universal, deontological principles; yet in operationalizing them through HRBAs, trade-offs and deeply contextualized political realities necessarily enter the equation. In the context of sexual and reproductive health (SRH), we explore how these contradictions lead to challenges and dilemmas that arise in relation to: (1) conceptually defining HRBAs; (2) addressing gaps in legal and policy frameworks; (3) meaningfully engaging in priority-setting in health, and sexual and reproductive health in particular; (4) devising transformative approaches to monitoring and accountability; and, finally, (5) dilemmas faced in situating HRBAs beyond the state, both by donors and in relation to holding donors and other non-state actors accountable. We argue throughout that if they are to live up to their transformative potential, HRBAs must not be reduced to technical formulas, but rather must ensure that in their conceptualization, strategy, implementation and measurement they foster meaningful voice and accountability for the people they purport to benefit.

Read more here.