Investigation and Documentation as a Methodology in Monitoring Human Rights Violations

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Investigation and Documentation as a Methodology
in Monitoring Human Rights Violations

• Chandrima Chatterjee, Ph.D
• Centre For Enquiry Into Health and Allied Themes

IFHHRO Mumbai
Meeting Monitoring Right to Health in Asia
Towards a Sub-regional Network
1st December 2006
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Broad Categories of Denial

• General Emergencies
• Womens Health Care (maternal health care)
• Major Chronic illnesses
• Outbreak of immunisable or other preventable
  illnesses like measles, cholera, malaria or
  epidemic hepatitis-due top failure of the public
  health measures
• Mental illnesses

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MONITORING Health RIGHTS VIOLATIONS

• Two main methodologies in monitoring human rights
  violations
• Events (or acts-based) methodology
• Indicators-based methodology

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Events Methodology

• Has been used for decades now by human rights
  NGOs and other agencies
• Mainly for very visible types of violations
• Some weaknesses have been identified in its use
  (it is important to understand that structural
  deficiencies has to be documented rather than
  cases of negligence by individual doctors or
  staff)

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Documenting Denial

• ACT Of Denial
• Nonavailability of doctor
• Nonavailability of medicines
• Nonavailability of equipments/infrastructure
• No transport facility available for referring the
  patient
• Treatment not given or patient not attended on
  time
• Charges more than specified
• Insulting or discriminatory behaviour of staff
• Inadequate attention to patients resulting in
  poor quality of care
• Failure of healthcare facility to provide
  preventive health services, e.g. Inadequate
  coverage, outreach or inefficient surveillance,
  etc.

• EVENT of Denial
• Death of the patient
• Adverse health consequences or complications due
  to denial
• Mental agony due to discrimination
• Temporary or permanent physical damage or
  disability
• Financial loss to patient/family

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Methodological Requirements to document denial

• Documented cases of denial has to be
  representative of the cases and population
• Documentation must capture significant denial or
  loss to the patient
• All case papers/prescriptions or other relevant
  documents should be collected as supportive
  documents
• Oral consent of the person from information is
  sought is mandatory

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Format for Documentation of Events

• Nature of Complaint
• Type of facility where denial took place
• Type of service denied
• Consequence of denial (financial and personal)

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Public Hearing a Tool to report Events of Denial
Prepatory meetings and planning

• OBJECTIVES OF PH
• To mobilise communities around RTH
• To document and highlight specific instances of
  denial
• To present testimonies as evidence
• To create awareness amongst local communities
  about various health services which the Govt at
  different levels should provide

Collection of Testimonies and Data
Mobilising people, intellectuals, media from
Communities
Public Hearing to Report Denial
Follow-up of PHs
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Indicator- based Methodology

• a human rights indicator derives from,
  reflects and is designed to monitor realization
  or otherwise of a specific human rights norm,
  usually with a view to holding a duty-bearer to
• account
• Source WHO

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How it is different from any other standard
indicator

• A human rights indicator is different from any
  standard disaggregated indicator of
  socio-economic progress less in substance than
  (i) its explicit derivation from a human rights
  norm and (ii) the purpose to which it is put viz
  human rights monitoring with a view to holding
  duty-bearers to account.

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Tools of Indicator-based Monitoring

• 1) Indicators
• 2) Benchmarks
• Both benchmarks and comparative indicators can
  be used to monitor equity, namely the elimination
  of discrimination, which is an immediate state
  obligation.Indicators and benchmarks can be in
  the form of absolute numbers, proportions,
  averages, rates or ratios. States must formulate
  explicit, quantifiable and time-limited
  objectives for the purpose of meeting their
  obligations and must identify appropriate
  indicators and benchmarks with which they intend
  to measure progressive realization. The combined
  application of indicators and benchmarks enables
  results to be measured against targets.

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Tools for Monitoring

• What are Indicators ?
• Indicators are signals that make it possible to
  determine the extent to which a particular
  obligation or standard has been, or is being,
  attained. They are tools that can be used to
  indicate the present situation. They can show
  trends serve as signs reveal symptoms and mark
  progress towards targets. They are substitutes
  for capturing elements of the right to health
  that are otherwise difficult to measure directly.

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Important to Remember

• Indicators and benchmarks are powerful tools for
  monitoring state obligations subject to
  progressive realization
• Different methods are required for monitoring
  obligations of conduct and obligations of result,
  namely policy measurements and progress
  measurements
• While different indicators can help monitor
  different aspects of the right to health, all
  progress measurement indicators require
  disaggregation by categories such as gender and
  race, to reflect the situation of vulnerable and
  minority groups within the population and
• When working with indicators and benchmarks it
  is important to be aware of the limitations of
  the available data.

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Working with Indicators

• Indicators can be used to measure and monitor
• overall status of a particular situation
• changes or trends over a period of time
• achievements towards targets (benchmarks)
• differences between particular groups in the
  population and
• differences between geographic regions within a
  country.

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Kinds of Indicators

• Policy Measurement
• Progress measurement

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Policy Measurement

• Policy measurements (ie process or policy
  indicators) are used to monitor a governments
  compliance with its obligations of conduct.
  Sources of information for such measurements
  include national legislation, government policy
  documents and budgets.
• They focus on states and their behaviour (their
  commitment to, and compliance with, human rights
  obligations),

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Progress Measurement

• Progress measurements (ie outcome or impact
  indicators) are used to refer to the degree of a
  governments compliance with its obligations of
  result, and thus the extent to which its laws,
  policies and programmes are achieving an outcome
  consistent with enjoyment of the right to health.
  Sources of data for progress measurements include
  statistics based on disease-specific or
  population-specific indicators.
• Impact indicators focus on individuals and groups
  

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Example of Progress IndicatorStructural Barriers
(Class and Social Group) in Access to MCH
Services
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Developing a good indicator

• Indicators should be
• helpful
• simple and specific
• measurable
• able to be disaggregated (by categories such as
  gender, age, rural/urban, ethnic/linguistic
  minority, etc) and
• appropriate for measuring implementation of the
  right to health, (in other words, linked with
  specific government obligations).

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Tools for Monitoring

• What are Benchmarks ?
• Benchmarks are self-set goals or targets to be
  reached at some future date. National and
  international benchmarks set the framework for
  measuring progress in implementing the right to
  health and are used normally for assessing the
  effectiveness of policies.

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Benchmarks

• national benchmarks established by your
  government
• benchmarks established by both intergovernmental
  and non-governmental organizations
• goals and international targets set by MDGs and
  consensus agreements of UN world conferences
• (and their subsequent follow-up reviews) and
• global benchmarks established by UN agencies (eg
  WHO, UNICEF, UNFPA, UNDP)

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Selection and use of Indicators and Benchmarks

• The choice of indicators and benchmarks, together
  with the ways in which they will be used, depends
  on a number of factors, including
• particular aspect of the right to health that is
  being monitored
• aims of the NGO concerned
• resources and expertise that are available to
  assist in the exercise
• whether national-level indicators and benchmarks
  have been established and
• availability of accurate and reliable data.

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Working with Statistics as a tool for Monitoring

• Statistical evidence plays an essential role in
  measuring implementation of the right to health.
  This includes monitoring actual violations and
  the use of warning indicators to identify
  potential violations.
• In many developing countries improvement in the
  quality of vital statistics should be recognized
  as a priority for government.
• A human rights approach to health places
  particular focus on, and prioritizes, the needs
  of the most disadvantaged and vulnerable
  individuals and communities in a society. It is
  therefore essential that data used for monitoring
  the right to health be disaggregated so as to
  enable monitoring the status of, and changes
  within, these vulnerable groups.

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Sources of Statistical information

• Statistical data relevant to the right to health
  includes
• standard-based data, such as maternal mortality
  rates
• data based on services provided, such as
  percentage of births attended by qualified staff
  and
• health specifics, such as incidence vs.
  prevalence case fatality rates relative risk as
  opposed to absolute risk.

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Sources of Secondary Data

• National statistics and vital registration
  information published by governments, including
• institutional records, the census, surveys,
  and reports
• International or national statistics published
  by UN specialized agencies and international
  organizations, including World Health Statistics
  (published by WHO), UNFPA population health
  statistics, demographic and health surveys, and
  US State Department country reports
  information, including population-based surveys,
  collected by other NGOs, such as Amnesty
  International Human Rights Watch and the
  International Planned Parenthood Federation
• Country reports submitted by States parties to
  human rights treaty monitoring committees
• Shadow reports submitted by NGOs to treaty
  monitoring committees
• Research by academic institutions, including
  faculties of public health, environmental
  studies, medicine, and law
• Routine health services data health centre
  registers, and information made available by
  public or private health facilities, including
  anonymised statistics based on clients attending
  family planning clinics
• Clinical records, but only when strictest
  confidentiality is observed in their use and
• Information provided by the media, including
  press cuttings from national and local
  newspapers.

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Primary Sources of Data

• conducting in-depth interviews
• carrying out community, health service, or
  population-based surveys using tools such as
  simple questionnaires and focus group
  discussions
• conducting general interviews and focus group
  discussions as part of a community-based study
  and direct observation.

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Good Indicator

• Policy relevant
• Reliable
• Accessible
• Consistently measurable over time
• Disaggregation of data
• Impartiality

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• Thank You