UNFPA at Work: Six Human Rights Case Studies

One role for User Committees has therefore been to negotiatewith service providers to see if they can modify theirpractices in ways that respect indigenous peoples’ concerns.In Orellana Province, for example, Committee membersproposed attaching a rope to a rafter in the healthfacility so that women could grasp the rope if they wishedto remain in an upright position during birth.Another component of acceptability is language. UserCommittees in some places have observed that indigenouspeoples would be more likely to read the information thatthe Government, whose official language is Spanish, hasdistributed about the Free Maternity Law if it were translatedinto their own indigenous languages.QualityAs well as being culturally acceptable, health facilities, goodsand services must also, according to General Comment 14, be“scientifically and medically appropriate and of good quality.This requires, inter alia, skilled medical personnel, scientificallyapproved and unexpired drugs and hospital equipment,safe and potable water, and adequate sanitation.”The quality of services provided under the Free MaternityLaw is of great concern to User Committees. This is reflectedin part by how they investigate complaints againsthealth-care providers. In addition to considering whetherproviders have violated other rights, as noted previously,the Committees also ask whether maltreatment might haveoccurred because providers lacked the skills and knowledgeto perform their jobs well.The community health surveys mentioned earlier are animportant tool for examining the quality of health facilities,goods and services. Survey results have led some UserCommittees to point out the need for corrective measures orfor re-prioritizing how local health-care budgets are spent.CONCLUSION: LESSONS LEARNEDFour major lessons can be highlighted from the ongoingwork of UNFPA to support the incorporation of the humanrights-based approach into the functioning of local UserCommittees in Ecuador.The first lesson is that the interdependence andinterrelatedness of rights must be understood if thoserights are to be exercised fully. Through its support,UNFPA encouraged the User Committees to take intoaccount far more than the health-related rights that theywere best known for protecting. The Committees recognizedthat their members could best fulfil their duties ifthey integrated an understanding of core human rightsprinciples into their work. This meant learning how attentionto participation, non-discrimination and accountabilitycould lead to better outcomes in the provision ofhealth services.The second lesson is that human rights cannot be exercisedif there are no mechanisms in place for doing so. The firststage in the existence of the Free Maternity Law – prior to theimplementation of the User Committee system – unequivocallydemonstrates how the absence of community mechanismscan render laws that promote rights ineffectual. Theestablishment of User Committees as a clearly defined systemfor enabling people to learn about and realize their rightswas what enabled the law to begin fulfilling its intended rolein improving the well-being of Ecuadorian people.The User Committees’ experience further demonstratesthat the mechanisms, like the law itself, are ineffectual inthe absence of concrete steps to set them in motion.Merely forming the Committees was not enough. The nextstep was to empower them through training to becomeproactive and self-sustaining forces in implementing theFree Maternity Law.The third lesson is that educating duty-bearers is an importantstrategy for bringing them into dialogue with rightsholders.The National Council on Women, the UserCommittees and UNFPA all worked in various ways to helpnational and local government officials and health-serviceproviders understand their role in implementing the FreeMaternity Law. Educational efforts helped both groups ofstakeholders understand that the Law bound them to morethan the independent fulfilment of health-related rights. Thenature of the User Committee system, as government representativesand providers learned, is to create a continuousdiscourse about how the enactment of the Law is being perceivedby those it is intended to benefit. Thus, over time,duty-bearing bodies (e.g., Municipal Health Councils) havebegun to work in a genuine partnership with the Committeesand with the community as a whole.And the fourth lesson is that for human rights to be acceptedand internalized in any community, attention should begiven to the cultural perspective and responding to those ofits components that would promote the principles ofhuman rights.ECUADOR17