Adolescent & Youth Sexual & Reproductive Health Toolkit: Advocacy
Accountability is the cornerstone of the human rights framework. It encompasses the obligations of those in authority: to take responsibility for their actions; to answer for them by explaining and justifying them to those affected; and to be subject to some form of enforceable sanction if their conduct or explanation for it is insufficient.
In short, accountability is about responsibility, answerability and enforceability (United Nations, 2013). If those in authority fail to respect, protect and/or fulfill young people’s sexual and reproductive rights, young people have the right to hold them to account. There are many mechanisms for doing so, both formally and informally.
What Are the Benefits?
- Accountability is the vital connection between policy on paper and policy in practice; it ensures that human rights are translated into the betterment of young people’s health and well-being.
- Accountability—particularly social accountability—can be empowering for young people, as they are able to seek justice for themselves and their peers.
- Accountability can ensure that programs for young people residing in urban environments are responsive to their needs and realities and that services remain of a high quality.
How to Implement?
There are many different types of accountability – from legal and judiciary to social, political and administrative. Accountability also happens at various levels, from individual service providers and hospitals to national health systems and legal frameworks. Citizen participation is not just the purview of social accountability; rather, the active engagement of young people is vital for any and all accountability mechanisms to function properly.
- Social Accountability
- Judicial Accountability
- Independent Oversight Accountability
- Global and Regional Human Rights Accountability
“Social accountability” refers to a variety of activities that citizens – including young people – and civil society organizations (CSOs) can use to highlight rights violations and hold those in authority to account. In the context of sexual and reproductive health (SRH), social accountability has also been referred to as a “set of tools citizens can use to influence the quality of service delivery by holding providers to account” (Evidence Project, 2014).
Social accountability tools or mechanisms include:
- Complaint mechanisms are formal channels for young people to express dissatisfaction with a service and demand redress.
- Citizen charters articulate guidelines on the young client and provider relationship, providing standards a client can expect and demand.
- Citizen report cards are participatory surveys that solicit young users’ feedback on the performance of public services.
- Social audits engage young citizens, users of services, or civil society organizations in collecting and publicly sharing information on available resources for service delivery and public works.
- Community scorecards combine social audits and citizen report cards, compiling information from users and service providers about a particular service. Data are reviewed to allow for immediate feedback and development of an action plan.
Legal accountability refers to the use of courts or other legal systems for redress and sanction when human rights are violated or duty-bearers fail to fulfill their legally mandated obligations. The advantages of this approach are the enforceability of court decisions and the broad range of remedies available through the courts.
Litigation can not only address individual grievances but, also, prompt larger debates in society about issue including sexual and reproductive health (United Nations, 2013).
Many countries have independent bodies that oversee the implementation of human rights obligations; these are often referred to collectively as “national human rights institutions” (NHRIs), although in reality they differ greatly in mandate and power.
Example: Public Inquiry for SRHR
In 2012, the Kenya National Commission on Human Rights partnered with the Federation of Women Lawyers – Kenya and the Center for Reproductive Rights to conduct a public inquiry into violations of sexual and reproductive health and rights (SRHR). The inquiry used interviews, desk reviews and public hearings to gather data and develop recommendations. The inquiry’s report aimed to document the extent of violations within the public health sector, and to suggest appropriate redress and remedies. Amongst the findings were that young women faced financial barriers in accessing contraception; that young women face social ostracization when pregnant outside of marriage; and that young mothers are victims of discrimination during delivery.
Global and regional human rights bodies are another avenue for pursuing justice for violations of sexual and reproductive rights.
- Treaty monitoring bodies (TMBs) are bodies that monitor the implementation of international human rights treaties; examples include the Committee on the Rights of the Child (CRC) and the Committee on the Elimination of Discrimination against Women (CEDAW). In addition to the review of government reports on implementation, civil society organizations may also comment on implementation from their unique perspectives.
- Universal Periodic Review (UPR) is a procedure of the Human Rights Council that reviews the fulfilment by each of the 193 United Nations Member States of their human rights obligations and commitments.
- Individual complaint procedures exist for just eight human rights treaty bodies under specific, limited circumstances. CEDAW, for example, may consider individual complaints alleging violations of the CEDAW Optional Protocol.
Determine avenues for accountability within the urban context
The first step is for program implementers to understand what exists currently for young people who may experience violations of their sexual and reproductive rights, or wish to hold those in authority to account for respecting, protecting and fulfilling those rights. This step may include speaking to young people; officials from the executive, legislative and judicial branches of government; representatives of human rights institutions (NHRIs); and any non-governmental organizations involved in the transparency, accountability and participation (TAP) sector. In undertaking this landscaping, programmers should also be mindful of the barriers that young people face in accessing accountability mechanisms.
Forge partnerships with organizations working with SRH accountability mechanisms
Working with accountability mechanisms may require partnerships that are outside of the typical scope of SRH-providing organizations. In order to access some of the accountability mechanisms (particularly at the global level), it may be worth forging new partnerships with those who are already familiar with processes and procedures.
Integrate accountability into AYSRH programs
All SRH programs should have accountability mechanisms in place that provide a continuous feedback loop on quality, access and human rights. At the very least, service providing institutions can ensure that they have charters of clients’ rights and accompanying complaints mechanisms for individual clients whose rights are violated. On a larger scale, programs may wish to work with young people to organize citizen hearings or conduct inquiries into rights violations.
Link accountability mechanisms with program improvement and advocacy
Accountability mechanisms – whether at the service provision or policy level – should serve to improve programs. Evidence generated through accountability processes should be fed back into programs and/or advocacy for continual improvement, ensuring that young people’s voices remain central at all times.
What Is the Evidence?
There is a lack of evidence on the impact of social accountability in relation to family planning and SRH. However, there are five important elements of social accountability initiatives evident from the existing literature (Evidence Project, 2014):
- A clearly articulated theory of change
- Recognition that context matters
- Awareness of power relationships and values
- Linkages to redress and remedy mechanisms
- Presence of core enabling factors, such as citizens’ access to information
Accountability is one of the the World Health Organization’s nine standards for implementing a human rights-based approach to contraceptive service provision. Recommendations falling under this standard are:
- Recommend that effective accountability mechanisms are in place and are accessible in the delivery of contraceptive information and services, including monitoring and evaluation, and remedies and redress, at the individual and systems levels;
- Recommend evaluation and monitoring of all programs to ensure the highest quality of services and respect for human rights must occur; and
- Recommend that, in settings where performance-based financing (PBF) occurs, a system of checks and balances should be in place, including assurance of non-coercion and protection of human rights.
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One of the benefits of accountability is that it can be empowering for young people, as they are able to seek justice for themselves and their peers.CorrectIncorrect
Accountability happens only at the national level with legal frameworks and ministry of health strategies and guidelines.CorrectIncorrect
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Accountability is one of WHO’s nine standards for implementing a human-rights based approach to contraceptive service provision.CorrectIncorrect
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- Information alone is not always power; evidence shows that accountability mechanisms must have “teeth,” too. In other words, accountability is not accountability unless young people’s voices have the ability to effect change.
- Incentives and sanctions for providers and government officials working on family planning programs have, in the past, been associated with coercion and violations of rights. These must be thought out very carefully if employed as a part of accountability initiatives.
- Feedback from the community should also be considered and incorporated as appropriate into the project to foster community support and buy-in and reduce chances the chances of backlash
- Design social accountability initiatives that place a priority on young people’s lived experiences of services.
- Ensure the collection of high quality, disaggregated data to aid accountability efforts.
- Collect qualitative data on young people’s experiences of SRH services and programs, ensuring that their voices are heard.
- Partner with Transparency, Accountability and Participation (TAP) organizations to learn from their experiences in using different accountability mechanisms to hold those in authority to account.
- Legal redress can be expensive and time-consuming—barriers that are compounded for those who are young and/or poor.
- Corruption in systems can act as a barrier to justice for people who have experienced violations of their sexual and reproductive rights.
- Power relationships and hierarchies may prevent the free flow of information; health providers and policy-makers, for example, may feel uncomfortable accepting suggestions for quality improvement from young clients. These power dynamics must be addressed—rather than ignored—within accountability systems.
Tools Related to This Approach
- Social Accountability EGuide, World Bank
- Community Scorecard Toolkit, CARE
- The Role of Social Accountability in Improving Health Outcomes, USAID
- Old Challenges, New Hopes: Accountability for the Global Strategy for Women’s, Children’s and Adolescents’ Health, Independent Accountability Panel
- Who will be accountable?, OHCHR
- The role of NHRIs in Promoting and Protecting the Rights, including Health, of LGBTI People in Asia and Pacific, UNDP
- Reproductive Rights are Human Rights: A Handbook for NHRIs, UNFPA
- Universal Periodic Review – A practical guide for civil society, OHCHR
- The Civil Society Compendium A comprehensive guide for Civil Society Organisations engaging in the Universal Periodic Review, UPR Info