Accountability and the Right to the Highest Attainable Standard of Health

This study analyses the concept of accountability as a feature of human rights in the context of the right to the highest attainable standard of health. According to the author, accountability is the process that provides individuals and communities with the opportunity to understand how governments and others have discharged their right to health obligations, including the right to redress where mistakes are made. This monograph is intended as a starting point for health policy makers seeking to develop greater understanding of the area of accountability.

The premise of the document is that the State remains ultimately accountable for guaranteeing the realisation of the right to health. Thus, the focus of accountability is the relationship of the State (the government and its agents, for example, health policy makers) and rights-holders. Section I briefly reviews the sources and content of the right to the highest attainable standard of health, particularly the contents of treaties that describe the right to health. Section II explores the concept of accountability beginning with governments ensuring the incorporation and implementation of accountability processes into all health policy. "This involves continuous monitoring by government and civil society to find out what is working, what is not, what has been omitted and what needs to change. Just as rights-holders have the right to receive information on whether government is fulfilling their right to health obligations, government has an obligation to make public, in an understandable form (that is, transparently), all available information about the implementation of the right to health. In addition, mechanisms are required to assess the data; allow explanation and justification of deficiencies; encourage better performance; and provide remedies if required."

There are five broad types of accountability mechanisms described in the document:

• judicial - for example, judicial review of executive acts and omissions, constitutional redress, statutory interpretation, public interest litigation;
• quasi-judicial - for example, national human rights institutions, regional and international human rights treaty bodies;
• administrative - for example, human rights impact assessment;
• political - for example, parliamentary committee review of budgetary allocations and the use of public funds, democratically elected health councils, healthcare commissions; and
• social - for example, the involvement of civil society (independently or in collaboration with government) in budget monitoring, health centre monitoring, public hearings, and social audits, and the use of media to engage citizen awareness in the issues.

The role of media in accountability is to influence community attitudes, beliefs, and behaviour; play a vital role in politics, economics and social practice; and influence political popularity. "Civil society movements frequently engage the media and hence rely on the presence of a free media that is willing to engage in critical journalism. The effectiveness of social accountability mechanisms is weakened in the absence of the protection and enforcement of the human rights of expression, association, and information."

The remedies for redress of errors that focus on the rights holder and are concerned with redressing the impact of the violation on the individual or group rights-holder include restitution, rehabilitation, and compensation. Satisfaction and guarantees of non-repetition are focused on ensuring the introduction of systematic accountability processes in the long term and are focused on redress through systems changes, including health worker training, among others.


Though the author notes that a checklist for accountability is not possible, there are "pre-conditions for effective accountability, such as a strong commitment and long-term vision on the part of government to the incorporation of the right to health into the day-to-day work of health policy makers; the presence of a national health plan that incorporates the right to health; the establishment of effective institutional arrangements for civil society and the government to work together; the establishment of effective monitoring systems; access to, and implementation of, the decisions of accountability mechanisms that are relevant to health policy; and the development of ongoing right to health training for health policy makers at all levels."