UNFPA at Work: Six Human Rights Case Studies

Encouraged by the Committees, some health units postannouncements about their different services on the wallsof the centres, and some municipalities use their localhealth councils to broadcast radio commercials. In someplaces, User Committees have enlisted women’s organizationsto help raise awareness of the Law.The availability of services often depends on providersunderstanding the Law. Community members in someplaces have called the User Committees’ attention toproviders’ apparent ignorance of some of its details, and theCommittees have determined that the resulting servicelapses occurred in part because of a lack of provider training.The problem is compounded in rural areas, whereproviders rotate annually. The Committees are working toget the government agencies responsible for training tostructure training requirements differently in order toencourage the preservation of institutional knowledgeabout the Law at community health facilities.The intervention of User Committees is also seen as usefulfor raising awareness about the availability of services. InOrellana, for example, 500 women had Pap smear tests in2002. After the Committees helped in creating awarenessand training, the number increased to 2,000.AccessibilityAccording to General Comment 14, health facilities, goodsand services have to be accessible to everyone without discrimination.Accessibility has four overlapping dimensions:non-discrimination, physical accessibility, economic accessibilityand information accessibility. The User Committeessupported by UNFPA have found this principle guiding theirresponses to many different issues. For example, it led themto recognize women’s concerns about clinic hours as a priorityissue. Some women explained to the Committees thatit was difficult for them to attend clinics that only hadmorning hours, because that was the time when they neededto organize their housework and family tasks for the day.Another problem in some places was the two-to-five-hourwait to see health-care providers. At the encouragement ofUser Committees, some clinics are changing their hours ofoperation and intake procedures in order to better accommodateclinic users.Geographical accessibility is another concern. UserCommittees have called attention to the fact that insome rural areas, pregnant women need to walk severalhours to reach health centres. This issue, like many otheraccessibility issues, relates back to the principle of nondiscrimination:the Committees have learned to askwhether people who find services to be inaccessible aremembers of consistently marginalized groups, such aspoor rural residents.User Committees have also championed the cause of economicaccessibility, which is a primary intention of the FreeMaternity Law. They have found that a major problem isproviders’ failure to fulfil the Law’s mandate to provide awide range of services at no charge to women and to thenseek reimbursement from the State. In some cases, thismay be because of a lack of awareness of the Law. In othercases, the providers may have administrative reasons fornot wanting to give up the opportunity to collect fees.Regardless, the Committees recognize the practice ofcharging patients for health services covered under the Lawas a violation of these patients’ right to access health care.User Committees are particularly attuned to the danger ofpoor and indigenous community members being turnedaway from clinics because they cannot pay fees that arebeing charged in violation of the Law.User Committees are also aware of how the accessibility ofinformation can affect health outcomes. In Orellana, theCommittees took responsibility for a campaign to preventcervical cancer, first receiving training and then sharing thattraining with women in the community. This made it possiblefor the Committees to carry out prevention activities foran entire group – the first time they were able to do so.AcceptabilityGeneral Comment 14 calls for all health facilities, goods andservices to be “respectful of medical ethics and culturallyappropriate, i.e., respectful of the culture of individuals,minorities, peoples and communities, sensitive to genderand life-cycle requirements, as well as being designed torespect confidentiality and improve the health status ofthose concerned”.User Committees have found that the issue of acceptabilityfrequently relates to cultural traditions. For example, indigenousperspectives on the medical system’s practicesaround childbirth are very well described by a provider fromArchidona, who says, “They were afraid to show their intimateparts. When it was time to deliver, they feared how itwould be in a hospital, because they like to kneel. Manywomen feel that the husband and the grandmother shoulddeliver the baby.”16SIX HUMAN RIGHTS CASE STUDIES