Kaja Jurczynska l Palladium - Oct 29 2021
Walking The Talk: Embedding Human Rights into Routine Healthcare Practices

Credit: Joshua Jacobs

Now more than ever before, ideals like equity, equality, and non-discrimination have taken centre-stage, from our talks on climate change and the wage gap, to universal health coverage. These discussions are fundamentally about our rights as human beings, or the entitlements and protections we all share based on hard-fought consensus enshrined in international treaties and declarations.

But how do we go beyond the rhetoric to make respecting, protecting, and fulfilling human rights an everyday reality?

When it comes to health, one simple but essential ingredient is to train providers on human rights literacy and the essential elements that should be in place to deliver services in a rights-based way.

The benefit of doing so has recently been demonstrated in family planning, or programs that provide the information and services needed for individuals to make decisions about the number, timing, and spacing of their children. Because they deal with sexuality and fertility, these programs often carry religious and cultural sensitivities, making them especially prone to human rights challenges.

Training that leads to attitudinal and behaviour change among providers: the “aha” moment

Consider a health facility with too little funding to create a separate room for individual counselling of family planning clients and inadequate staff training to realise that’s an essential practice. Not only does this compromise clients’ rights to auditory and visual privacy, but this simple reality can also dissuade young or unmarried women from seeking services, leading to unplanned pregnancies, increased unsafe abortions, and maternal death and disability.

Can training help overcome this challenge?

In 2016-2017 with funding from the Bill and Melinda Gates Foundation, Palladium implemented one of two first-of-their-kind interventions to test the human rights-based approach to family planning services. Across health facilities in Kaduna State, Nigeria, the team trained family planning providers on the rights-based approach, which included:

• Exploring their values and how that shapes the way in which they provide family planning services;

• Reviewing the practical—rather than purely conceptual—definitions of human rights and their related principles and standards;

• Exploring the common yet underappreciated subtle ways in which individuals’ rights can be compromised unintentionally;

• Examining what the “ideal state” of human rights in family planning service delivery looks like, from facility set-up, the supply of equipment, the storage of commodities, to the nature of client counselling.

The team also supported clinic staff in systematically reviewing the status of human rights in their facilities and practices, producing plans for how to strengthen human rights over the course of a year.

The effect? A mindset shift among providers during which every day, often normalised occurrences like turning certain clients away, limited contraceptive method options, a lack of accurate or full information for clients, or no auditory or visual privacy were successfully elevated to the level of rights issues – the “aha” moment.

For one Community Health Extension Worker, the ‘aha’ moment was all about providing choice, “Before this training, there were certain things we do, for example how we decline teenagers and unmarried adults counseling or access to any method because they are not married, or we say she is not old enough to use them. But now we let them in and counsel them and let them make their choice.”

Many of these issues can be traced back to inadequate domestic financing of the health sector, and therefore the solution lies in advocating to local or federal governments to bolster program funding. In other cases, the fixes can be simple and inexpensive—like hanging a suggestion box to solicit feedback on the quality of services—or free—like providers acknowledging and agreeing to eliminate their biases from clinical practice.

Not only did the team observe statistically significant improvements across the service environment for family planning, they also detected higher contraceptive uptake across facilities with rights trained staff.

A new training curriculum on the human rights-based approach to voluntary family planning

Building on the success of this project and a new framework that helps visualise the essential elements that need to be in place to protect and fulfil individuals’ human rights in family planning programs, Palladium and What Works Association have developed and launched a new, five-module training curriculum.

The Human Rights-Based Approach to Voluntary Family Planning Training Package provides all of the guidance and materials needed to conduct training for family planning providers, facility managers, supervisors, and local health committees—all human rights duty-bearers—on what they need to know and do to ensure that individuals’ human rights are respected, protected, and fulfilled in their programs.

While this new resource focusses on family planning, it shows us how to make the principles of human rights concrete, and what actions different healthcare workers can take to routinely embed human rights into service delivery. These are important lessons for health care services writ large, where both subtle and overt rights issues exist across high-, middle-, and low-income countries alike.

Kaja Jurczynska is a Senior Technical Advisor for Health at Palladium. She led the implementation of the Voluntary, Rights-Based Family Planning Project in Kaduna, Nigeria, and brings five years of experience in human rights-based programming. For more information, contact info@thepalladiumgroup.com.