Modelo VERA: Tecnologías para la orientación al aprendizaje y movilidad en personas con discapacidad visual

A human rights-based approach (HRBA) is a framework which integrates human rights standards and principles into development processes. It has been promoted since the late 1990s by the United Nations (UN), some bilateral aid agencies and international non-governmental organisations (NGOs) as an alternative discourse to needs-based and economy-centred discourses. The potential values and problems of a HRBA have largely been debated theoretically, with little attention to how it is understood and implemented in practice. With regard to human rights-based practices in development NGOs, the literature views local and organisational contexts as a constraint and local practitioners as lacking the knowledge and skills needed to implement a HRBA. This suggests a HRBA is viewed as a normative discourse, which should be applied by local practitioners as predetermined. Questioning this view, the thesis pays attention to changes in a HRBA influenced by the contexts and the roles of development practitioners. This research explores the particular understanding and practicing of a HRBA in ActionAid Bangladesh (AAB). AAB was selected because it belongs to the federation of ActionAid international (AAI) which adopted a HRBA in 1998, and because it operates in a country characterised as challenging due to its hostility to human rights advocacy. The research has drawn on interviews with 15 AAB staff and 13 staff of its local partner organisations. The interviews were conducted in Bangladesh in 2012. The information obtained was supplemented by documents produced by AAI and AAB. The interview transcriptions and the documents were thematically analysed. The findings of this research indicate that AAB has developed its own way of understanding and practicing a HRBA attuned to its contexts. For example, AAB’s differentiation between a HRBA and a rights-based approach (RBA) is related to the laws of Bangladesh. Combining a HRBA with a needs-based approach (NBA) is justified by AAI’s coinage of human rights and basic needs as ‘basic rights’ and by the fact that the needs of Bangladeshi residents are largely left unmet. AAB shapes its own HRBA influenced by the context of both AAI and Bangladesh This research suggests AAB’s HRBA is the product of contextualisation of a HRBA. In this thesis, the term ‘contextualisation’ means the process of shaping the HRBA to fit organisational and national contexts. This thesis argues that NGO practitioners play an important role in contextualising a HRBA, encouraged or moderated by their contexts. The research participants displayed their agency in challenging and recreating a HRBA. Exploration of the contextualisation process reveals that the exercise of agency requires some understanding of and commitment to a HRBA, which is conceptualised as ‘internalisation’ in this thesis. Noting the varied degrees of internalisation, this research provides a plausible explanation in terms of two factors: the extent of their exposure to a discourse and their involvement in field practices. Those who strongly internalised a HRBA tend to contribute toward shaping a HRBA to be relevant and applicable to their contexts. The discussion draws attention to context-related knowledge, which enables contextualisation of a HRBA. This research shows that individual workers’ knowledge about contexts is mostly implicit and informally transferred to colleagues. Organisational support is needed for amplification and legitimisation of individuals’ contextualised knowledge. Heightened understanding of the contextualisation process can contribute to both new knowledge and development practice. Building on theories about discourse and agency, the thesis adds knowledge of internalisation and contextualisation of a discourse. As a result of examination of contextual influences and the agency of local practitioners, it suggests a HRBA is an interactive process rather than a predetermined normative framework; and development practitioners are proactive discourse creators rather than passive discourse users. This study also provides development NGOs with practical insights into how to incorporate contextual consideration into a HRBA for relevant and appropriate practices. It emphasises the importance of organisational supports for the generation and circulation of context-related knowledge. In doing so, this thesis contributes to the field of development practices involving human rights principles and NGOs.

Over the last decade, there have been increasing calls for respecting and integrating human rights into health, including into mental health policies, plans, and programmes. The convergence of mental health and the right to health has implications for health workers, as they are the key translators of policy- and programme-related decisions into practice. This thesis is a qualitative research study which follows a case-study approach situated in the Programme for Improving Mental Health Care in Nepal. It aims to explore the perceptions and perspectives of health workers in the Chitwan district in Nepal on the use of a human rights-based approach (HRBA) to mental health. The specific objectives are to (1) examine existing evidence on the use of an HRBA to advance health; (2) explore perspectives on the right to health among mental health workers in Nepal; (3) explore health workers’ perceptions of the application of an HRBA to mental health in planning and service provision; and (4) develop a conceptual framework regarding the use of an HRBA to mental health. The literature review identified some plausible positive evidence on the use of an HRBA to advance health, but also highlighted the very limited quantity and quality of the evidence and the difficulty in determining with certainty the direct influence of an HRBA to health. No studies were identified that explored an HRBA to mental health in low- or middle-income countries. The qualitative research highlighted that participants were aware of human rights, but faced difficulty in understanding their meaning and application, including an HRBA. An HRBA to health and related plans requires an understanding of both the health system context and involvement of health workers. A conceptual framework was developed of an HRBA to mental health to help guide the application of an HRBA in mental health planning and service provision. Recommendations are provided.

The Millennium Development Goals (MDGs) have become the international community's shared framework for development. Since the Goals focus on national averages and do not refer explicitly to human rights, a long debate has ensued since the adoption of the MDGs in 2001 on whether the Goals are consistent with the progressive realisation of human rights. This paper reviews the history of the MDGs and outlines how developing countries can achieve the Goals. It shows that the MDGs are consistent with Human Rights Based Approaches. Yet, efforts aimed at integrating Human Rights Based Approaches into strategies to achieve the MDGs have primarily focused on normative questions. Too little progress has been made in applying Human Rights Based approached to inform the day-to-day decisions that development practitioners and Governments need to make. In response, the paper outlines a practical approach for how Human Rights Based Approaches could be systematically integrated into five common stages involved in the design and implementation of national development strategies to achieve the MDGs. The five stages cover: (i) the choice of interventions to meet the MDGs; (ii) establishment of corresponding coverage targets and an explicit monitoring framework; (iii) the programming of public expenditures; (iv) the prioritisation and sequencing of interventions over time; and (v) the design of supporting policy frameworks. For each stage, the paper outlines how Human Rights-Based Approaches can inform the choices and decisions that policymakers need to make.

Background: Health and Social Care Alliance Scotland (the ALLIANCE) is a strategic partner with the National Collaborative in Scotland, and our key role was to facilitate the work of a group of 15 people affected by substance use (rights holders), duty bearers and rights defenders, known as the Change Team, to integrate a human rights based approach into drug and alcohol policy to assure better outcomes for people affected by substance use in Scotland. Approach: The Change Team were recruited in 2022 to co-design an action plan for the National Collaborative. This saw their development and launch of a Charter of Rights for people affected by substance use in December 2024. Development of the charter was led by the Change Team, facilitated by the ALLIANCE. Their workplan and decision-making was informed by a Call for Evidence which took place over several months in 2023 to better understand the experiences of people affected by substance use. A draft charter was then published in December 2023, followed by a six-month public consultation. In summer 2024, the ALLIANCE led the design and delivery of a robust co-analysis process to support the Change Team to thematically analyse all consultation feedback, and agree the necessary actions to improve and finalise the charter itself, as well as develop an implementation toolkit to help support Duty Bearers and Rights Holders to utilise the Charter to best effect. Results: The finalised Charter and Toolkit was launched on 11 December 2024. The National Collaborative are now working in partnership with Scottish Government to assure effective implementation of the Charter across Alcohol and Drugs Services in Scotland throughout 2025 and beyond. Implications: People affected by substance use will have greater awareness of their human rights, with increased support to claim and assert their rights. Policy changes and service improvements across Drugs and Alcohol Services in Scotland will be driven via adoption of a humans rights based approach – wholly designed around the experiences, views and feedback of a historically stigmatised and discriminated community of people impacted by substance use across Scotland. The ALLIANCE will share our key learning as a strategic partner working with people with lived and living experience to co-produce and embed a human rights based approach across a multi-sector collaborative network of Drug and Alcohol Services.

The application of human rights norms at the national policy level is largely codified, but rigorous research on the field-level application of a human rights based approach (HRBA) to health programs is still in its infancy. The paper identifies human rights norms from international law and standards that are relevant to maternal, newborn and child health (MNCH) programs, and presents an example of how a HRBA has been previously applied in an MNCH project. It introduces a HRBA framework recently developed by Concern Worldwide and partners, and conducts a document analysis of a previous Concern Worldwide project in Malawi. Discussion focuses on where and how the project could have benefited from incorporation of a HRBA in project design, implementation and evaluation. The authors conclude by discussing how such inclusion could have impacted project outcomes, and how such analysis can help inform future efforts to implement a HRBA to health.

A human rights based approach to Public Health and to Public Mental health offers an opportunity to realize the right to health for all. However, a human rights-based approach to Public Health will require new inter-disciplinary approaches and an innovative frame. This frame should include the use of international human rights standards as a framework for research, policy and practice; the participation of target groups; and the enhancement of inclusion and respect for all. This workshop follows up from the Ljubljana 2018 workshop on human rights and public (mental) health and aims to test the requirements needed to ensure a human rights based approach to public health. For this, a panel of a researcher, ethicist, lawyer and a patient is set up to evaluate three practical cases. What are they advising in these specific cases and what does this mean for the international human rights framework. The outcomes of the panel discussion will be presented by the chair of the workshop. Case 1 Coerced sterilization in the UK The parents of a 21-year old woman with Down’s syndrome in the UK contacted a doctor to have their daughter sterlised our of fear that she may become pregnant. The woman did not have a bodyfriend nor expressed an interest in starting a sexual relationship. The parents stated that - as she had grown up - she had become more aware of the opposite sex and could be “overfamiliar” with people. Therefore sterilisation was needed to protect her in the future. A specialist supported the parents, but a second doctor suggested various methods of contraception as an alternative. Case 2 Euthanasia in the Netherlands A 74-year old incapacitated women with dementia stated several times that she does not want to live anymore. But she has also been heard saying that she likes her life. Under Dutch law, euthanasia is possible if the patient clearly indicates this, the so-called living-will. In this case, the doctor performed euthanasia based on her living will, which was given years earlier, before she was struck by dementia. Case 3 Rape in Northern Ireland A 12-year-old girl from Northern Ireland is raped. Abortion is not possible in this case due to the strict laws prohibiting abortion unless the woman’s life is in danger or there is a permanent or serious risk to her mental or physical health. The girl has to travel to England under police escort to have an abortion, so that a police officer could seize the ‘samples’ from the procedure for evidence. Key messages A human rights based approach to Public Health and to Public Mental health offers an opportunity to realize the right to health for all. It is critical that we do not risk losing the right to health in the rhetoric of the SDGs and ensure that we respond to the need of improving research methods on the promise of leaving no one behind. Mauro Giovanni Carta Contact: mgcarta@tiscali.it Dineke Zeegers Paget Contact: d.zeegers@euphaoffice.org Els Maeckelberghe Contact: e.l.m.maeckelberghe@umcg.nl

The chapter explores the potential of a human rights–based approach in enhancing autonomy and connection in the lives of older persons, particularly in relation to their right to take part in cultural life. As matters currently stand, many older persons cannot fully take part in the cultural and social life of the communities of which they are part because of physical, social, and systemic barriers. The chapter discusses how an approach focused on human rights could have a positive impact on these barriers and challenges. After describing the human rights–based approach's conceptual framework and outlining key international law instruments dealing with the right to take part in cultural life, the chapter considers the notions of autonomy, participation, ageism, and the role of local and international actors in furthering the objective of connected autonomy for older persons. Finally, the need to pursue efforts to adopt a dedicated convention on the rights of older persons is emphasized as this would be a key step in grounding a human rights–based approach in States’ social and political fabric, and thus create a stronger framework for older persons’ connected autonomy via participation in cultural and social life.

Background: Health and Social Care Alliance Scotland (the ALLIANCE) is a strategic partner with the National Collaborative in Scotland, and our key role was to facilitate the work of a group of 15 people affected by substance use (rights holders), duty bearers and rights defenders, known as the Change Team, to integrate a human rights based approach into drug and alcohol policy to assure better outcomes for people affected by substance use in Scotland. Approach: The Change Team were recruited in 2022 to co-design an action plan for the National Collaborative. This saw their development and launch of a Charter of Rights for people affected by substance use in December 2024. Development of the charter was led by the Change Team, facilitated by the ALLIANCE. Their workplan and decision-making was informed by a Call for Evidence which took place over several months in 2023 to better understand the experiences of people affected by substance use. A draft charter was then published in December 2023, followed by a six-month public consultation. In summer 2024, the ALLIANCE led the design and delivery of a robust co-analysis process to support the Change Team to thematically analyse all consultation feedback, and agree the necessary actions to improve and finalise the charter itself, as well as develop an implementation toolkit to help support Duty Bearers and Rights Holders to utilise the Charter to best effect. Results: The finalised Charter and Toolkit was launched on 11 December 2024. The National Collaborative are now working in partnership with Scottish Government to assure effective implementation of the Charter across Alcohol and Drugs Services in Scotland throughout 2025 and beyond. Implications: People affected by substance use in Scotland will have greater awareness of their human rights, with increased support to claim and assert their rights. Policy changes and service improvements across Drugs and Alcohol Services in Scotland will be driven via adoption of a humans rights based approach – wholly designed around the experiences, views and feedback of a historically stigmatised and discriminated community of people impacted by substance use across Scotland.

Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015). Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results: This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i) the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii) the lack of information for complaining and the fear of consequences of complaining; iii) the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv) the high level of burden of proof in court cases and lack of good practices; v) the lack of a patient (human) rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions: This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care; encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the rights of patients and compensation for the damage to their health’, clearly stating where to complain in case of discrimination; create a webpage and brochures with readable and understandable information for elderly persons and their families and caregivers; establish legal consultation and mediation cabinets in health care facilities; establish an older persons’ rights protection service under the Ministry of Social Security and Labour in close cooperation with the Ministry of Health; promote sustainable results by incorporating a human rights-based approach regarding elderly persons in all policies.

Negative and stigmatising attitudes towards human rights and mental health exist worldwide. The Ghanaian government has attempted to tackle such discriminatory attitudes and practices to align with a human rights-based approach in mental healthcare through the implementation of the World Health Organisation QualityRights Initiative in Ghana. As part of the initiative, the World Health Organisation has developed a range of capacity building tools on mental health, disability, human rights and recovery. National stakeholders in Ghana completed the WHO QualityRights e-training to build capacity and change attitudes to promote recovery and respect for human rights for people with mental health conditions, psychosocial and intellectual disabilities. Participants completed pre- and post-training questionnaires assessing perceived attitude and practice change. Thematic analysis was conducted on the open-ended questions on the post e-training questionnaires to discover how attitudes were impacted by the e-training. Three themes emerged: "legal capacity and the right to decide", "coercion, violence and abuse" and "equality and community inclusion." Attitudes on the right to make decisions, treatment of individuals with mental health conditions, psychosocial and intellectual disabilities, equality, social inclusion and non-discrimination had improved to be more in line with a human rights-based and recovery-oriented approach to mental health. The QualityRights training shows promise as a scalable intervention to reduce stigma, promote rights, and improve care for individuals with mental health conditions, psychosocial and intellectual disabilities.

Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015). Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results: This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i) the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii) the lack of information for complaining and the fear of consequences of complaining; iii) the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv) the high level of burden of proof in court cases and lack of good practices; v) the lack of a patient (human) rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions: This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care; encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the rights of patients and compensation for the damage to their health’, clearly stating where to complain in case of discrimination; create a webpage and brochures with readable and understandable information for elderly persons and their families and caregivers; establish legal consultation and mediation cabinets in health care facilities; establish an older persons’ rights protection service under the Ministry of Social Security and Labour in close cooperation with the Ministry of Health; promote sustainable results by incorporating a human rights-based approach regarding elderly persons in all policies.

Background: Shared decision making (SDM) is a mainstream component of cardiovascular disease care in the US. This is particularly true in light of support for SDM from the IOM, the ACA, the FDA 1-3, several professional societies, and Cochrane Review findings of improved patient-centered outcomes4. Given the complex nature of advanced CV therapies - characterized by the IOM as having “more to do, more to manage, and more people involved than ever before”5 - SDM programs are critical to patient-centered assessment of quality of care in CV. Human rights-based approaches (HRBAs)6-7 are common in evaluations of programs targeting communicable disease in developing countries, but are underutilized in CVD care in the US. HRBAs ground assessment in international human rights law, and provide a normative framework for the design, implementation, monitoring and evaluation of interventions, policy, and programs. An HRBA to health aims to realize the right to the “highest attainable standard of health”—including the availability, accessibility, acceptability, and quality of health facilities, information, goods, and services—and other health-related human rights (including autonomy and full and informed decisionmaking, the right to participation, and accountability).8-12 Approach: Using decision support regarding ICDs as a model, we created a conceptual framework highlighting synergies between HRBAs and SDM. This model of HRBA assessment of SDM programs covers four stages of design/deployment of decision aids (design of tools; implementation; use of PtDAs with patients; monitoring, evaluation and accountability), with accompanying rights-based considerations for each. The model is replicable across decision support related to other complex therapies with preference-sensitive trade-offs. Results & Implications: There is considerable synergy between HRBAs and SDM. Both empower patients, emphasize autonomy, and have potential to improve processes and outcomes. This model offers legal grounding and a normative framework through which one can evaluate SDM programming, improving decisionmaking processes and better aligning outcomes with patients’ values and goals. Research into the use of HRBA assessment of SDM is warranted; the goal being to respect, protect, and fulfill human rights obligations.

This study analyzes the need for the human rights-based approach (HRBA) to strengthen the efficiency and sustainability of KOICA’s operations in international development cooperation. It reviews KOICA’s human rights policies and explores the limits of need-based development. Policy inputs are provided by studying HRBA policies of UN and donor agencies. The study recommends an implementation framework for HRBA programming as the first step toward establishing KOICA’s human rights based development cooperation model. The framework is built around the triple pillar of root-cause analysis, rights-holders / duty-bearers analysis, and the application of PANEL principle. A practical example for practitioners is provided by applying the HRBA framework to the KOICA medium term strategy for education and health. Difference between previous KOICA projects with human rights elements and HRBA projects might look minimal. However, closer examination reveals the essential and fundamental difference of human rights-based approach as follows 1) HRBA clearly identifies rights and responsibilities of stakeholders by differentiating rights-holders from duty-bearers 2) HRBA puts human rights and empowerment of rights-holders in the center of development. 3) HRBA promotes the principles of participation, accountability, non-discrimination, empowerment, and linkage to human rights standards across all stages of a development programme.

The term ‘human rights-based approach’ is common in rights and international development literature. Yet there is no single, universally agreed definition of a human rights-based approach, let alone its application to the right to health. This article uses a PRISMA-informed systematic literature review to address the question, ‘What is the current status of the human rights-based approach to health in international law?’ Previous reviews have described how international organizations and development donors have tackled human rights-based approaches to development generally and discussed prominent works on human rights-based approaches to health. However, this is the first review to sample the peer-reviewed literature systematically. The study revealed that authors use the terms ‘human rights’, ‘human rights-based approach’ and ‘right to health’ to import a raft of legal implications, or none at all. Similarly, readers may assign legal meanings to these terms, or none at all. Confusion arises because although these terms often have different meanings for authors and readers from different disciplines, this is not commonly acknowledged, and authors rarely clarify their perspectives. The author concludes that scholars should seek co-authors with human rights law or public health qualifications, as relevant. Most academic institutions research and teach health and law separately; interdisciplinary centres of excellence in health, law and human rights offer an opportunity to overcome these historical obstacles to interdisciplinary dialogue and understanding. The study and its conclusions will be of interest to legal researchers, human rights advocates, public health scholars, and advocates from other disciplines.

Whether the future ‘sustainable development’ framework advances the rights of the immiserated around the globe will depend not just on the language in the global documents. It will crucially depend upon how meaningfully human rights-based approaches (HRBAs) are implemented in practice. We argue here that dilemmas arise from two principal contradictions inherent in HRBAs: HRBAs to health require subversion of power relations which lead systematically to patterns of ill-health among certain populations, yet also require working with and buy-in from those who have power—in governments, donor institutions and agencies. Second, human rights are set out as universal, deontological principles; yet in operationalizing them through HRBAs, trade-offs and deeply contextualized political realities necessarily enter the equation. In the context of sexual and reproductive health (SRH), we explore how these contradictions lead to challenges and dilemmas that arise in relation to: (1) conceptually defining HRBAs; (2) addressing gaps in legal and policy frameworks; (3) meaningfully engaging in priority-setting in health, and sexual and reproductive health in particular; (4) devising transformative approaches to monitoring and accountability; and, finally, (5) dilemmas faced in situating HRBAs beyond the state, both by donors and in relation to holding donors and other non-state actors accountable. We argue throughout that if they are to live up to their transformative potential, HRBAs must not be reduced to technical formulas, but rather must ensure that in their conceptualization, strategy, implementation and measurement they foster meaningful voice and accountability for the people they purport to benefit.