**2.2 National health plans and health workers**

The realization of women and children's right to health may be pursued through numerous approaches of which the adoption of national health plans that embraces health workers is one. General Comment 14 requires States parties to the International Covenant on Economic, Social and Cultural Rights (ICESCR) to develop a comprehensive home health plan encompassing human resources with a sentiment to assist them to realize their obligation of access to quality of health care to their population [18]. Adoption of national public health plan is a core obligation. But, what must a comprehensive national health plan, which incorporates health workers, exhibit?

First, health workers in preventive, curative, and rehabilitative health, encompassing physical and mental health must be available. Second, health workers must have appropriate preparation. Third, incentives must be in place to encourage the appointment, and retention, of health workers in underserved areas to better access, especially of marginal communities and populations. Fourth, human rights, including respect for cultural diversity and treating patients with courtesy, should

be a compulsory part of the training for all health workers. Fifth, health workers must receive domestically competitive salaries and other reasonable terms and conditions of employment.

#### **2.3 Availability, accessibility, acceptability, and quality (AAAQ ) of health-care**

General Comment 14 provides an in-depth articulation of the four interrelated and essential AAAQ elements, which can equally be applied to women's or children's right to health. *Availability* implies that structures, goods and services necessary for women and children's health are made available for the whole of the population within a state (this includes hospitals, clinics and other health-related buildings, medical and professional personnel, drugs and other equipment). Nevertheless, the handiness of such commodities and services depends on the physical and financial accessibility to those women and kids in need of them. Structures, goods and services have to be accessible to all women and children without discrimination —addressing discriminatory laws, policies, practices and gender inequalities in health care and in society that prevent children from accessing good quality services [18]. Accessibility has four dimensions: nondiscrimination, physical, economic, and information accessibility. *Acceptability* implies that structures, goods, and services are to be respectful of medical ethics and culturally appropriate [18]. Q*uality* signifies structures, goods, and services must be scientifically and medically appropriate and of good quality [18].

#### **2.4 Accountability**

Accountability is fundamental to a HRBA. Paul Hunt notes "human rights can become no more than window-dressing without accountability" [19]. When accountability operates in a system, duty-bearers are answerable for their human actions or omissions in relation to their responsibilities. As a procedure, "accountability provides right-holders with an opportunity to understand how duty-bearers have discharged, or failed to discharge, their obligations, and it also provides dutybearers with an opportunity to explain their conduct" [20]. Accountability does not necessarily imply punishment or blaming but constitutes elements of responsiveness, monitoring, independent review, answerability, and remedial action.

Different international and national accountability mechanisms can be envisaged within and outside the health systems that aim to hold all actors responsible, identify gaps and failures of institutions and programs, and provide remedy and redress for those (such as children) whose rights have been violated. According to the UN Office of High Commissioner for Human Rights (UNOHCHR), four broad categories of accountability mechanisms are identified: judicial, quasi-judicial, administrative, and political [21]. Helen Potts identifies a fifth case of accountability mechanism, social [19].

This chapter will only concentrate on the part of judicial accountability. This is mainly because litigation is increasingly used to seek accountability and redress for violation of constitutional and international human rights law dealing with the right to maternal and child health [22]. Yet, for litigation to be in force, certain conditions must exist.

First, there must be a direct entrenchment of the justiciable right to health in the national law/s of a given country that presents a specific right to health accountability mechanisms, which in turn can provide access to the courts to enable rightsholders to challenge government legislation and policy through litigation. Fitting in with Leslie London's view, constitutional recognition of "human rights standards can and do inform more powerful methods to establish accountability for realizing

**101**

*A Human Rights-Based Approach to Maternal and Child Health in Ethiopia: Does it Matter…*

basic human needs" [23]. Furthermore, the stipulation of the international human right to maternal and child health has significantly contributed as an interpretive role to establish state obligations to ensure access to health care towards their population. Today each country is a state party to at least one of the international human rights instruments incorporating the right to health care [24]. Clearly, subscribing to these instruments raises an obligation upon state parties to guarantee accessibil-

Second, due to their incapacity and vulnerability caused by biases and inequalities, women and children need an efficient legal representation to seek remedy before judicial bodies for systemic violation of their right to health [25]. Civil society organizations (CSOs) or human rights non-governmental organizations (NGOs) play a substantial role in this regard as discussed in the subsection below. Despite the recent evolutions in the judicialization of maternal and children's rights which has increased access to health-care services in nations such as India, South Africa, and Columbia, accountability in many health systems remains extremely light. In some states, the same body provides and regulates health

Civil society organizations' contribution in litigating constitutional matters concerning health rights is of paramount importance. London underscores that active agency by those vulnerable to human rights violations is an aspect of health as a right relevant to shaping a HRBA to health [23]. Civil society action has an emancipatory or transformative potential to challenge state neglect or omission of health rights of children and women. A good example is post-apartheid South Africa, where CSOs have litigated most, if not all, major constitutional human rights cases,

The extent of the actual significance of CSOs in women and children's rights advocacy and representation depends on the sociopolitical and legal environment in which they function. In emerging democracies, such as South Africa and Brazil, CSOs tend to sustain a relatively relaxed operational environment, and there is room for a mushrooming of vibrant human rights NGOs, whereas in restrictive settings—as in many African countries where laws are promulgated that constrain the natural processes and operational space of CSOs—they are regarded as obstructive by their governments [26]. In the latter case, the restriction on CSOs is manifested, for instance, in the content and implementation of legal instruments that are meant to govern their formation and operation. The next section analyzes the challenges presented to civil society in engaging human rights advocacy concerning women's

ity of a detailed implementation program and comply with the AAAQ.

inclusive of the right to health care affecting women and children [25].

and children's health care rights in Ethiopia.

**3. Access to maternal and child health care in Ethiopia**

**3.1 The legal framework of maternal and child health in Ethiopia**

With a population of above 100 million people, Ethiopia is the second most inhabited country in Africa and is one of the few countries in the globe with a high population of maternal and child deaths [27, 28]. There are legal, policy, and institutional mechanisms that respond to this challenge. The Federal Democratic Republic of Ethiopia (FDRE) Constitution (1995) along with the nine regional states constitutions dedicate a specific provision entirely dealing with the rights of women due to their vulnerability [29]. It states that women have the right "to prevent harm arising

services, as well as having those responsible to account [3].

**2.5 Social mobilization**

*DOI: http://dx.doi.org/10.5772/intechopen.83513*

#### *A Human Rights-Based Approach to Maternal and Child Health in Ethiopia: Does it Matter… DOI: http://dx.doi.org/10.5772/intechopen.83513*

basic human needs" [23]. Furthermore, the stipulation of the international human right to maternal and child health has significantly contributed as an interpretive role to establish state obligations to ensure access to health care towards their population. Today each country is a state party to at least one of the international human rights instruments incorporating the right to health care [24]. Clearly, subscribing to these instruments raises an obligation upon state parties to guarantee accessibility of a detailed implementation program and comply with the AAAQ.

Second, due to their incapacity and vulnerability caused by biases and inequalities, women and children need an efficient legal representation to seek remedy before judicial bodies for systemic violation of their right to health [25]. Civil society organizations (CSOs) or human rights non-governmental organizations (NGOs) play a substantial role in this regard as discussed in the subsection below.

Despite the recent evolutions in the judicialization of maternal and children's rights which has increased access to health-care services in nations such as India, South Africa, and Columbia, accountability in many health systems remains extremely light. In some states, the same body provides and regulates health services, as well as having those responsible to account [3].

### **2.5 Social mobilization**

*Education, Human Rights and Peace in Sustainable Development*

conditions of employment.

and of good quality [18].

ity mechanism, social [19].

conditions must exist.

**2.4 Accountability**

be a compulsory part of the training for all health workers. Fifth, health workers must receive domestically competitive salaries and other reasonable terms and

**2.3 Availability, accessibility, acceptability, and quality (AAAQ ) of health-care**

Accountability is fundamental to a HRBA. Paul Hunt notes "human rights can become no more than window-dressing without accountability" [19]. When accountability operates in a system, duty-bearers are answerable for their human actions or omissions in relation to their responsibilities. As a procedure, "accountability provides right-holders with an opportunity to understand how duty-bearers have discharged, or failed to discharge, their obligations, and it also provides dutybearers with an opportunity to explain their conduct" [20]. Accountability does not necessarily imply punishment or blaming but constitutes elements of responsiveness, monitoring, independent review, answerability, and remedial action.

Different international and national accountability mechanisms can be envisaged within and outside the health systems that aim to hold all actors responsible, identify gaps and failures of institutions and programs, and provide remedy and redress for those (such as children) whose rights have been violated. According to the UN Office of High Commissioner for Human Rights (UNOHCHR), four broad categories of accountability mechanisms are identified: judicial, quasi-judicial, administrative, and political [21]. Helen Potts identifies a fifth case of accountabil-

This chapter will only concentrate on the part of judicial accountability. This is mainly because litigation is increasingly used to seek accountability and redress for violation of constitutional and international human rights law dealing with the right to maternal and child health [22]. Yet, for litigation to be in force, certain

First, there must be a direct entrenchment of the justiciable right to health in the national law/s of a given country that presents a specific right to health accountability mechanisms, which in turn can provide access to the courts to enable rightsholders to challenge government legislation and policy through litigation. Fitting in with Leslie London's view, constitutional recognition of "human rights standards can and do inform more powerful methods to establish accountability for realizing

General Comment 14 provides an in-depth articulation of the four interrelated and essential AAAQ elements, which can equally be applied to women's or children's right to health. *Availability* implies that structures, goods and services necessary for women and children's health are made available for the whole of the population within a state (this includes hospitals, clinics and other health-related buildings, medical and professional personnel, drugs and other equipment). Nevertheless, the handiness of such commodities and services depends on the physical and financial accessibility to those women and kids in need of them. Structures, goods and services have to be accessible to all women and children without discrimination —addressing discriminatory laws, policies, practices and gender inequalities in health care and in society that prevent children from accessing good quality services [18]. Accessibility has four dimensions: nondiscrimination, physical, economic, and information accessibility. *Acceptability* implies that structures, goods, and services are to be respectful of medical ethics and culturally appropriate [18]. Q*uality* signifies structures, goods, and services must be scientifically and medically appropriate

**100**

Civil society organizations' contribution in litigating constitutional matters concerning health rights is of paramount importance. London underscores that active agency by those vulnerable to human rights violations is an aspect of health as a right relevant to shaping a HRBA to health [23]. Civil society action has an emancipatory or transformative potential to challenge state neglect or omission of health rights of children and women. A good example is post-apartheid South Africa, where CSOs have litigated most, if not all, major constitutional human rights cases, inclusive of the right to health care affecting women and children [25].

The extent of the actual significance of CSOs in women and children's rights advocacy and representation depends on the sociopolitical and legal environment in which they function. In emerging democracies, such as South Africa and Brazil, CSOs tend to sustain a relatively relaxed operational environment, and there is room for a mushrooming of vibrant human rights NGOs, whereas in restrictive settings—as in many African countries where laws are promulgated that constrain the natural processes and operational space of CSOs—they are regarded as obstructive by their governments [26]. In the latter case, the restriction on CSOs is manifested, for instance, in the content and implementation of legal instruments that are meant to govern their formation and operation. The next section analyzes the challenges presented to civil society in engaging human rights advocacy concerning women's and children's health care rights in Ethiopia.
