<br><div><p><span style="font-size:9.0pt;color:blue">From Human Rights Talk: </span><span class="apple-style-span"><span style="font-size:9.0pt;font-family:Arial;
color:#777777"><a href="mailto:multiple.contributors@undp.org">multiple.contributors@undp.org</a></span></span></p><p><span class="apple-style-span"><span style="font-size:9.0pt;font-family:Arial;
color:#777777"><a href="mailto:multiple.contributors@undp.org"></a></span></span><b><span lang="ES" style="font-size:11.0pt;color:black;
mso-ansi-language:ES">Ivan Mendoza; Abelardo Quezada; Thanalí Patruyo, UNDP </span></b><b><span lang="ES" style="font-size:11.0pt;color:red;mso-ansi-language:ES">Guatemala</span></b><b><span lang="ES" style="font-size:11.0pt;color:black;mso-ansi-language:ES"> :</span></b></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;
mso-ansi-language:EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;
mso-ansi-language:EN-GB">As way of introduction, the UNDP Guatemala is
supporting the Guatemalan Ministry for Public Health and Social Welfare in
incorporating the human rights-based approach (HRBA) into its initiatives to
extend the reach of basic health services (BHS), the ultimate aim being to
improve the conduct and performance of suppliers (DBs: duty bearers) throughout
the<span class="apple-converted-space"> </span><i>process</i><span class="apple-converted-space"> </span>of providing BHS to right-holders
(RHs)<b>.</b><span class="apple-converted-space"> </span>Although the right-holders
are essentially the entire population living in the areas covered by the
project, the initiative will in fact focus primarily on people facing
situations of vulnerability, such as children and women.</span><span style="color:black"></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;
mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Our aim is to
analyze the conduct of BHS suppliers and compare this with key standards and
principles of human rights: cultural belonging, non-discrimination,
accountability and participation. Our studies into causality, patterns and
capability gaps will unearth opportunities to enhance institutional performance
when providing the community with BHS.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify;text-indent:48.0pt"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p><span lang="EN-GB" style="font-size:11.0pt;font-family:Arial;color:#1F497D;
mso-ansi-language:EN-GB">Recommendations will be forwarded to the Ministry for
Health to overcome the capability gaps identified in the analyses. Furthermore,
training schemes will be planned for suppliers and operators alike, and good
practices will be highlighted and used to shape policies and train technical
officers at the Ministry.</span><span style="font-size:9.0pt;font-family:Arial;
color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">We would like to
make the following comments in response to the questions arising from the first
part of the debate:</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:8.0pt;
margin-left:.5in;text-align:justify"><i><span lang="EN-GB" style="font-size:11.0pt;
color:#1F497D;mso-ansi-language:EN-GB">1.
Could you share some recent experiences in which work on human rights proved to
be an essential element for accomplishing specific MDGs? If so, we would be
grateful if you could share any innovative aspects or key elements for
successfully reaching such goals, indicating how and why they worked.</span></i><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">One of the
underlying reasons for the project we are currently developing is precisely the
absence of projects in which the human rights-based approach played a role in
the local supply of basic health services. This project is being carried out in
four stages: as an initial stage,<span class="apple-converted-space"> </span><b>gaps
were studied</b><span class="apple-converted-space"> </span>in August 2009.
This revealed that in relation to the basic services that the Guatemalan
Ministry for Public Health and Social Welfare (MSPAS) provides through the
Coverage Extension Program (<i>Programa de Extensión de Cobertura</i>, or PEC),
there are significant limitations when it comes to respecting the principles of
non-discrimination, cultural belonging, participation and accountability, which
are the four principles through which the project is articulating the human
rights-based approach. To elaborate further, the analysis throughout the
different communities seeks to answer questions such as: what are the problems
associated with providing healthcare services in terms of the standards and
principles of chosen human rights (vulnerability analysis)? Who should act with
a view to remedying the problem? In other words, who are the DBs and the RHs
(analysis of roles/patterns)? What are the capability gaps of the DBs and RHs
preventing them from discharging their duties and claiming their rights,
respectively? As a result, there is a raft of problems that can be pooled into<i>seven
gaps</i>, which drag back the right of everyone to enjoy the highest possible
state of health in the process of providing local services – we are dealing
with capability gaps of suppliers (DBs) and marginalized people (RHs):</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">a)
Gap between needs and resources</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">b)
Gap in territorial distribution</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">c)
Gap in the labor conditions of Basic Health Teams (BHTs)</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">d)
Gap in citizen competences</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">e)
Gap in the introduction and training of the BHTs</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">f) Gap
in communication capacity</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:.65in;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">g)
Gap in accountability</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Following on
from the findings of the gap study, the second stage of the project involved
the development of a methodological approach currently being implemented
throughout the 9 communities taking part in the pilot scheme, this ahead of its
eventual validation and adoption by PEC management. The proposed methodology
consists of an<span class="apple-converted-space"> </span><b>awareness and
training stage</b><span class="apple-converted-space"> </span>on the right
to health and the human rights approach with the groups involved in providing
the services: DBs (both service providers and community and municipal
authorities) and RHs (encompassing both those belonging to community
organizations and users in general), before then taking the form of
participatory workshops to construct a mechanism for participation and
accountability, to which the various groups are committed.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify;text-indent:47.0pt"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">The training
sessions can also serve as an ideal opportunity to involve suppliers in the
task of unearthing solutions. The idea is to generate an installed capacity in
the program that we can continue to use with new groups and suppliers. In the
following stage of implementation, the agreed mechanisms are deployed and
workshops staged to reflect on the implementation experience in order to<span class="apple-converted-space"> </span><b>pinpoint and pass on good practices</b>.
Lastly, the plan is to<span class="apple-converted-space"> </span><b>train
the technical officers and politicians attached to the ministry<span class="apple-converted-space"> </span></b>in HRBAs and good practices, thus
helping the ministry to generate policies and define and shape the new
healthcare law currently on the table.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:47.0pt;text-align:justify"><i><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">2.
Bearing in mind the lessons and challenges raised by the Secretary
General in Keeping the Promise, could you provide further details of any
strategy/example that could help to meet specific MDGs? More specifically, in
relation to:</span></i><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:47.0pt"><i><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">·
The specific needs of the most vulnerable groups; and</span></i><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:47.0pt"><i><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">·
Inequality and social exclusion.</span></i><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:8.0pt;
margin-left:47.0pt"><i><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;
mso-ansi-language:EN-GB">What processes, instruments and tools have been used?
What results have been reported to date?</span></i><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">The study of
gaps in meeting the principles of non-discrimination, accountability,
participation and cultural belonging highlighted the need to work individually
with each and every one of the actors involved in providing basic health
services (DBs in their various guises at local level and RHs in their various
degrees of organization) so as to understand the information they possess and
the representations and meanings they entail in relation to the process of
providing the services, because it is precisely through these conceptions and
the expectations arising from them that we can create the spaces of
communication needed to gradually seal the gaps in terms of cultural belonging,
which is one of the most glaring gaps in the supply of basic services to rural
and indigenous communities in Guatemala.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">In this regard,
the process of incorporating the human rights-based approach into the supply of
basic health services, which is currently being implemented through a
small-scale pilot scheme, has pursued the following strategy:</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:42.0pt;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">-</span><span lang="EN-GB" style="font-size:7.0pt;color:#1F497D;mso-ansi-language:EN-GB"> <span class="apple-converted-space"> </span></span><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Mapping the
actors from each of the four groups</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:42.0pt;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">-</span><span lang="EN-GB" style="font-size:7.0pt;color:#1F497D;mso-ansi-language:EN-GB"> <span class="apple-converted-space"> </span></span><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Designing a
training plan with different activities for different groups, the aim being to
raise awareness of the right to health and to develop and hone skills in the
human rights-based approach.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-left:42.0pt;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">-</span><span lang="EN-GB" style="font-size:7.0pt;color:#1F497D;mso-ansi-language:EN-GB"> <span class="apple-converted-space"> </span></span><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Developing 14
workshops, which to date have boasted the participation of 287 participants
from 9 different communities.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Following this
ordering, the individual work carried out with each group at the workshops has
enabled us to identify practices and formulate proposals on mechanisms that
promote participation and accountability. Based on this inventory and the
compared experiences gleaned, we are currently commencing the stage of
generating agreements between groups through participatory workshops used to
establish the agreements governing the procedure for implementation. Lastly,
the process will be wrapped up with a support and follow-up stage geared
towards joint reflection.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p><span lang="EN-GB" style="font-size:11.0pt;font-family:Arial;color:#1F497D;
mso-ansi-language:EN-GB">3. What are the
real challenges and opportunities arising from the use of a human rights-based
approach for the purpose of attaining specific MDGs? Did any difficulties arise
during implementation, and if so provide details, and what steps were taken to
resolve them? What were the factors that enabled the different options to work?</span><span style="font-size:9.0pt;font-family:Arial;color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">The law-based
approach requires a change of attitude if it is to be implemented successfully.
This represents one of the greatest operational challenges facing the project,
a challenge affecting not only service providers and local authorities, but
also one that extends further up the chain of command.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-bottom:4.0pt;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">To
clear a path through these obstacles, we have developed a strategy based on
disclosing information and raising awareness of the importance and utility of
being committed to incorporating the approach.</span><span style="color:black"></span></p>
<p style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;
font-family:Arial;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="font-size:9.0pt;font-family:Arial;color:black"></span></p>
<p style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;
font-family:Arial;color:#1F497D;mso-ansi-language:EN-GB">In a similar fashion,
the deep roots left by the prolonged periods of exclusion and inequality to
which RHs have been exposed mean that bringing about a change in outlook, in
order for RHs to be recognized as citizens with the right to influence and have
their voice heard, is also going to be a lengthy task involving considerable
hands-on work.</span><span style="font-size:9.0pt;font-family:Arial;color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">Focusing on the
institutional realm, another important challenge will involve incorporating
rules and regulations that reflect the rights-based approach, focusing on the
subject and not on the services. Here, strategies target those hierarchical
levels that are vested with decision-making capacity in this regard.</span><span style="color:black"></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB"> </span><span style="color:black"></span></p>
<p class="MsoNormal" style="margin-bottom:4.0pt;text-align:justify"><span lang="EN-GB" style="font-size:11.0pt;color:#1F497D;mso-ansi-language:EN-GB">As
the greatest challenge facing the project naturally relates to its
sustainability, negotiations are currently being staged with PEC management to
incorporate it gradually into other jurisdictions where the program works,
although undoubtedly its sustainability will depend on the changes in the
indicators through which performance of the service providers is currently
assessed.<br>
<br>
On a very positive note, please note that there has been definite interest from
the Coverage Extension Program, or PEC, attached to the Guatemalan Ministry for
Public Health and Social Welfare, to extend the activities gradually to other
areas of health. This expansion requires three aspects: a) ensuring that
complete documentation and records are left so that it can be reapplied in
other health-related areas. In this regard, the project is duly
documenting the entire process through an Operations Manual and training
manuals for suppliers (DBs) and users (RHs) of health services; b)
training ministry of health staff to pave the way for a subsequent expansion
process. With this in mind, the project has involved technical experts and PEC
supervisors at different stages thereof, and; c) managing financing for the
purposes of reproducing materials and funding training processes in new areas
and local activities associated with the initiatives to be undertaken.</span><span style="color:black"></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Please</span><span class="apple-converted-space"><span style="font-size:11.0pt;color:black"> </span></span><b><span style="font-size:11.0pt;color:black"><a href="http://www.uepnud.org/thanali/" target="_blank"><span style="color:#2A5DB0">click here</span></a></span></b><span class="apple-converted-space"><span style="font-size:11.0pt;color:black"> </span></span><span style="font-size:11.0pt;color:#1F497D">to access key documents from the first
two phases of the project, e.g. a general presentation of the project, capacity
gap study and materials from the capacity development workshops (such as a
methodological guide, facilitation guides, work guides and support material)
for four groups of participants (namely duty bearers of the</span><span class="apple-converted-space"><span style="font-size:11.0pt;color:black"> </span></span><span style="font-size:11.0pt;color:red">basic service teams</span><span style="font-size:11.0pt;color:#1F497D">, institutional duty bearers, organized
and non-organized rights holders). All materials are in Spanish, one work guide
is in<span class="apple-converted-space"> </span>Q'eqchi'.</span><span style="color:black"></span></p>
<p class="MsoNormal"> </p></div>