ARC’s work on health rights and accountability focuses on learning from and with people that we call frontline health rights defenders. These diverse actors seek to hold authorities and providers accountable from the point of service delivery. They include health care workers committed to public service, grassroots advocates for public accountability, community paralegals, community health workers, and human rights defenders.
Frontline health rights defenders address power imbalances that perpetuate unequal access to health rights and take action to improve service quality for excluded populations. Their activities include monitoring local service delivery, mediating between service users and providers to solve problems and address complaints, accompanying patients during referrals, and implementing health rights literacy campaigns.
Frontline health rights defenders also go further, working to address underlying causes of system failures with multi-level monitoring and advocacy strategies that address policy-making and budget decisions throughout the health system.
Guatemalan Health Defenders Rosa Sojven, Paulina Culum, Glora Ujpán and Benilda Batzin. 2017. Credit: Sandra Sebastián
Frontline health rights defenders and related resources
ARC and its partners have engaged in action learning to reflect with and document the activities of two different sets of frontline health rights defenders: community-based monitors of services and policies, and those organizing for health worker rights.
1. Community-based monitoring
Community-based monitoring involves networks of advocates that collect evidence on healthcare policy implementation and service performance. Advocates representing organized communities meet with authorities, presenting evidence and discussing and agreeing action plans to resolve problems. To ensure that authorities respond, advocates often combine diverse tactics, and build coalitions with frontline workers, the media, and public oversight institutions. Some of these networks are completely non-governmental, while others participate in official participatory oversight institutions, such as health facility committees.
Rural public health systems and accountability politics: insights from grassroots health rights defenders in Guatemala (Julia Fischer-Mackey, Benilda Batzin, Paulina Culum & Jonathan Fox, 2020)
In this journal article Guatemalan activists Paulina Culum and Benilda Batzin describe how ‘health rights defenders’ seek justice for rural indigenous communities.
Defensor/a: A Term to Refer to Indigenous Health Rights Defenders in Guatemala (Benilda Batzin, 2021) (Spanish version)
This Accountability Keywords blog discusses the concept of “defender” (“defensor/a” in Spanish) and how it is being used to describe community defenders of health rights in Guatemala.
Indigenous Groups, Languages, and Challenges in the Construction of Concepts such as the Right to Health and Governance (Ariel Frisancho, with the collaboration of Luz Estrada, 2021) (Spanish version)
This Accountability Keywords blog discusses the challenges of translating key words in accountability and governance during a participatory process with Quechua women leaders to construct a model of citizen oversight of health service delivery.
Bottom-up Accountability in Uganda: Learning from People-centered, Multi-level Health Advocacy Campaigns (Angela Bailey and Vincent Mujune, 2021)
This Brief analyzes how the Accountability Can Transform Health (ACT Health) program’s approach to “people-centered advocacy” supported almost 400 community advocates representing 98 health facilities to organize, identify joint advocacy priorities, directly monitor health services, and collaborate on health advocacy campaigns in 18 districts of Uganda.
In this Accountability Note, two health rights defenders from Guatemala describe how they have worked together to make government health systems more accountable to all citizens, by mobilizing established community leaders to engage on health access issues at multiple levels of government and forming alliances with national groups.
This Accountability Note reflects on the lessons learned by the Center for the Study of Equity and Governance in Health Systems from a decade of experience working with health rights defenders to use evidence to influence authorities and promote participation by users of public health services in rural indigenous municipalities of Guatemala.
Transparency and Accountability Strategies & Reproductive Health Delivery Systems (Victoria Boydell, Jonathan Fox, Sarah Shaw, 2016)
This Learning Exchange Report documents a discussion between 40 practitioners and researchers which focused on how strategic citizen oversight initiatives can facilitate monitoring of reproductive health systems and promote accountability.
2. Health workers and accountability
In many countries, frontline health workers link communities and the health system. This makes them well placed to potentially act as agents of accountability to communities, or to facilitate conditions for inclusion and participation of marginalized populations. However, health workers are often at the bottom of hierarchical public structures such as ministries of health, and need to organize to defend their own rights.
To learn from experience of organizing for health worker rights as a change strategy, ARC and partners have documented the actions of health workers to organize and demand better working conditions, including through crowdsourcing reports of health worker protests during the Covid-19 pandemic. We are learning about the tensions they encounter if they try to work both to foster accountability within the health system, and between the health system and the community.
Workers not Warriors: 4 Lessons from Health Worker Protests During Covid-19 That Could Help Avert a Looming Workforce Crisis (Veena Sriram and Sorcha A. Brophy, 2022)
This blog summarizes findings on the frequency and geographic distribution of health worker protests during the first year of the Covid-19 pandemic, and explains what issues lead health workers to protest.
Heroes on Strike: Trends in Global Health Worker Protests During Covid-19 (Sorcha A. Brophy, Veena Sriram, Haotian Zong, Chloei Andres, Maria Paz Mawyin, and Narayanan GL, 2022)
This Accountability Note describes global trends in health worker protests between March 2020 and March 2021, and argues that the frequent characterization of health workers as heroes of the pandemic obscures the fact that health workers themselves describe the challenges they faced during this time as violations of their rights as workers.
Health Worker Protests and Proposals (2020-21)
The Covid-19 pandemic led to frontline health workers facing great risks to ensure access to healthcare and protect the lives of others; it also gave rise to a new wave of protests and proposals from health workers. For one year, this pilot learning project monitored, collected, and shared media reports of health worker protests and proposals, helping to raise awareness of accountability challenges in the health sector, and highlight the needs and proposals of health workers.
Voices from the pandemic frontlines: Health worker protests and proposals from 84 countries (Jennifer Johnson 2020)
This blog reports on the common themes emerging from analysis of health work protests at the height of the Covid-19 pandemic, documenting both the risks faced by health workers, and their innovative approaches to protest.
Learning to Sustain Change: Mitanin Community Health Workers Promote Public Accountability in India (Samir Garg and Suchi Pande, 2018) (Hindi version)
This Accountability Note analyses the community health worker program of the Chhattisgarh state government in central India—known as Mitanin—and asks whether community health workers can act as agents of change in enhancing the public accountability of government, despite being state-funded actors themselves.
Report on the Think-in on Community Health Worker Voice, Power, and Citizens’ Right to Health (Marta Schaaf, Caitlin Warthin, Amy Manning, and Stephanie Topp, 2016)
This Learning Exchange Report discusses experiences of Community Health Workers facilitating—or demanding—greater health system accountability in Brazil, India, South Africa and the USA.