Alicia Ely Yamin , JD MPH Lecturer on Global Health, and Director, Health Rights

1. Creating A Circle of Accountability for the Prevention of Maternal Mortality and Morbidity: Recent Developments at the United Nations Alicia Ely Yamin, JD MPH Lecturer on Global Health, and Director, Health Rights of Women and Children Program

2. UN Technical Guidance • General principles • Planning and Budgeting • Ensuring Implementation • Accountability • [International assistance and Cooperation]

3. Background • Thematic Report (A/HRC/14/39) • Best Practices Report (A/HRC/18/27) • 2012: “Technical Guidance on the Application of a Human Rights Based Approach to the Implementation of Policies and Programmes for the Reduction of Preventable Maternal Mortality and Morbidity” (Technical Guidance). (A/HRC/21/22)

4. Technical Guidance: General Principles • HRBA to health, not MMM • Social determinants of SRH • Health Systems • Accountability • Non-discrimination/equality • Participation • Transparency

5. Planning and Budgeting • National Plan of Action on SRH • Multi-sectoral • Based on situational analysis • Transparent and participatory process • Review of legal and policy framework • Redressing historic patterns of discrimination; special concern for marginalized and vulnerable groups

6. Budgeting • “Maximum available resources” • Confers added protection • If budget increases… • If budget decreases… • Low-income populations

7. Ensuring Implementation • Bottom-up diagnostic exercise (what,? where?, to whom?, why?, who,? how?) • Two examples: • Women arriving late or failing to seek EmOC • Adolescent MMM

8. Example of identified problem: women arriving late or failing to seek emergency obstetric care • Lack of availability • Lack of accessibility (economic, physical, information, non- discriminatory basis) • Lack of acceptability • Lack of quality • Delay in making the decision to seek help • Delay in arriving to health facilities • Delay in receiving adequate treatment

9. In a HRBA… • Proximate and underlying factors • Health workers • Accountability requires follow-up

10. Accountability (1): Monitoring • Laws, policy, and budgetary efforts, results (inputs, outputs, outcomes) • Quantitative indicators should facilitate drawing conclusions with respect to international obligations: comparable, objective; programmatically relevant; subject to disaggregation, local audit; frequently or continuously measurable (Yamin and Falb, 2012) • Should facilitate strengthening the health system, including the health information system. • Monitoring encompasses private actors.

11. Accountability (2): Forms of Review/Levels of Accountability • Administrative, Social, Political, National legal accountability, International accountability • Professional, Institutional, Health system, Private actors, Donors

12. Accountability (3): Remedies • Ensuring Implementation of Laws and Policies • Reforming laws, policies and budgets • Challenging discriminatory barriers • Redress for violations of SRH rights in practice

13. Concluding Reflections • Implementation report in 2 years • Post 2015