Along with Rifat Atun, professor of Global Health Systems at Harvard TH Chan School of Public Health, and Julio Frenk, HSPH dean, FXB policy director Alicia Ely Yamin has contributed to a Special Series issue of The Lancet released October 16, 2014. The theme of the issue is universal health care in Latin America. Human Rights-based Approaches to Health in Latin America, co-authored with Ariel Frisancho of ForoSalud, in Peru, highlights the region’s success in applying human rights standards and principles to legislative frameworks, policies, and programs related to health care. While structural reforms in the legislative arena have enabled judicial enforcement of the right to health in several Latin American countries, evidence suggests that these measures constitute “a necessary but not sufficient condition for meaningful accountability,” particularly in the context of poorly functioning democracies. Human rights-based approaches (HRBA) are a more comprehensive way of ensuring that rights-holders (citizens) receive quality health care as an “asset of citizenship” – something to which they are entitled – rather than as an asset of the marketplace. HRBAs engage both government and citizens in an ongoing, dynamic negotiation, termed a “circle of accountability,” wherein citizens actively participate in the design, implementation, budgeting, and evaluation of health care services.
The piece features two brief case studies, one describing achievements in Colombia, the other, Peru. The Columbia case illustrates the role of legal reform in building public consciousness about its right to health, while the Peru example shows how citizens working together to monitor the work of duty bearers (governments) can increase the demand, access, and quality of health care services.