Malawi Country Assessment of the Cycle of Accountability for Sexual, Reproductive, Maternal, Child and Neonatal Health and Human Rights

Executive Summary

Chapter 1: Introduction, Background, Methodology and Approach

The Report presents the findings of the Malawi Country Assessment of the Sexual, Reproductive, Maternal, Neonatal and Child Health (SRMNCH) situation within a human rights perspective. The assessment was carried with the main objective of analysing the State’s efforts to improve sexual reproductive, maternal health and child health (new born and under 5), and the respect, protection and fulfillment of human rights around the cycle of accountability. The specific objectives were to: analyse the existing legal and policy framework and identify progress, gaps, and opportunities to the realization of sexual, reproductive, maternal and child health rights; assess the budgeting and financing mechanisms; assess the delivery of health services for MRSH and NCH; evaluate the availability of effective monitoring and review mechanisms for MSRH and NCH; and a mechanism for provision of remedies and redress.

The study was primarily carried out through literature review and used a qualitative methodology with the aid of predesigned tools. The assessment was undertaken through a multi stakeholder process led by a technical committee with members drawn from the Ministry of Health, (MoH), the Office of the High Commissioner for Human Rights, (OHCHR), the United Nations Population Fund, (UNFPA), World Health Organisation, (WHO), United Nations Children’s Fund (UNICEF), and UN Women. The methods employed were largely guided by the OHCHR predesigned tools, assessment and analysis guides.

The study built on a process that commenced in 2013 when a regional workshop on Rights Based Approaches to Maternal, Sexual, Reproductive, Newborn and Child Health was held in Malawi. The national stakeholders from South Africa, Uganda, Tanzania, and Malawi committed to undertake human rights assessments of State accountability for improving MSRH and NCH with a view to informing national multi-stakeholder dialogues for MSRHH and NCH, on-going review processes, and integration into on-going State efforts to strengthen accountability for MSRH and NCH and human rights.

The study was underpinned by the recognition that, maternal mortality and morbidity continue to be a serious human rights concern, justifying the increasing acceptance of application of human rights based approaches to SRMNCH, among a diverse range of stakeholders. The poor SRMNCH indicators are intricately linked with violence against women, poor health seeking, marginalization, women’s minimal participation in decision making, the under-prioritisation and under-funding of services and goods only women require and lack of accountability mechanisms to respond to maternal deaths and grievous injuries. Human rights violations are therefore both a cause and consequence of poor performance in SRMNCH.

This justifies the move away from traditional approaches in dealing with SRMNCH issues to integration of human rights-based approaches. To this end, the Office of the High Commissioner for Human Rights, at the request of the UN Human Rights Committee developed a technical guidance on human rights-based approaches to SRMNCH.

The study was premised on the understanding of the right to health as not the right to be healthy, but a right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health. Furthermore, the analysis takes cognizance of the fact that, due to the indivisibility and interdependence of human rights, various human rights also affect the realisation of SRMNCH, including the right to non-discrimination, the right to privacy, the right to human dignity, including personal autonomy, the right to education; the right to safe and clean water; the right to food, the right to housing, and the right to access to health-related information, among others. Most of these rights are guaranteed in the Malawi Constitution. In addition that, the right to health encompasses the underlying preconditions to health and the availability the right to, accessibility, acceptability, and quality of health goods and services.