Parliaments can play a key role in promoting the right to health in the region, particularly in helping to oversee and realise state commitment to health rights. To better understand and support the practical implementation of this role, EQUINET, through the University of Cape Town (UCT), the secretariat at the Training and Research Support Centre (TARSC) and the Southern and East African Parliamentary Alliance of Committees on Health (SEAPACOH) implemented a questionnaire survey in September 2008 to explore and document the work and experiences of parliamentary committees on health and their understanding and engagement with human rights. This report presents the findings of the section of the questionnaire on parliament processes and work on health rights.

Parliamentary committees’ legislative work has rarely been framed in terms of the right to health, even though much of its review of new and revised legislation and policy affected and spoke to the right to health directly. Knowledge of the purview and application of international human rights and related laws pertaining to the right to health was found to be limited. Parliamentarians were more likely to be familiar with Trade-related Aspects of Intellectual Property Rights (TRIPS) applications and with the provisions of the Abuja Declaration than with the substantive content of the right to health, as contained in the International Covenant on Economic, Social and Cultural Rights (ICESCR), its General Comment 14 or the African Charter on Peoples and Human Rights. All of these conventions, when ratified by states, impose substantial regulatory and programmatic obligations on governments. Therefore, important gains could be made if parliamentarians were able to analyse, interpret and integrate international human rights agreements into their parliamentary work.

Nonetheless, parliamentary debates on health were frequently able to draw on human rights claims to increase the effectiveness of arguments for the adoption of health policies and to influence resource allocation in favour of health and towards meeting the needs of vulnerable groups. Many of these successes are related to areas considered essential components of the right to health in terms of international benchmarks. Despite this, parliamentarians expressed diverse opinions as to how effective their interventions were in the budget process, highlighting the potential benefits of a rights analysis to strengthen claims for health in the budgetary process.

Public engagement with parliamentary committees took many forms, and in many cases, civil society submissions invoked rights arguments that were important in positively influencing the decision-making process. Typically, these claims related to resourcing decisions and were uncommonly directed at other rights issues, such as anti-discrimination measures. Engagement with media was also dominated by high-profile issues attracting public disquiet, although some parliamentarians reported use of media to raise awareness of rights issues and promote better uptake of available services. In general, public participation was regarding as very valuable for parliamentary processes.

Parliamentarians were, in general, acute aware of the constraints placed on the realisation of the right to health, by resource limitations. This applied not only to limitations on the provision of services, but also on the capacity of parliament to support public participation processes needed to effect health rights. However, despite this high awareness of resource limitations as a barrier to health rights, there was relatively little familiarity with the concept of progressive realisation as a mechanism to make rationing and priority-setting decision more transparent and defensible within a rights framework. Important gains could be made if work around progressive realisation was able to integrate resource allocation decisions within a rights framework.

Furthermore, although not the main finding in the analysis, parliamentarians were also generally aware that beneficiaries of human rights claims can include individuals and groups who have less need and lower vulnerability, such as higher-income individuals, companies or groups with sectoral interests. Ensuring that parliamentary processes are able to preferentially provide access to decision-making processes for the most vulnerable and poor is an essential component of a human rights approach to health. In addition, parliamentarians’ experiences confirm that rights are not just about individual claims but also about socio-economic entitlements for groups and for the community at large.

Parliamentarians were generally positive about the role of rights claims in improving communication between communities and health service providers. This was notwithstanding the potential for rights claims to be perceived by providers as a threat, at least initially, because they generate criticism and demands that may not be realistic. Nonetheless, all respondents were of the view that rights are good tools to mobilise community members to take action to promote health. Information is key to enabling communities to be informed and to understand how to take up health rights issues.

Many of the annual goals set by the committees relate to core obligations of governments toward the right to health. Casting health goals in a rights paradigm would add a greater urgency and level of accountability for delivery, once agreed on. Needs for support expressed by committees were generally related to finances, technical inputs, forums for dialogue, but particularly related to capacity building to use and engage with human rights frameworks for advancing parliamentary work on health.

The survey highlights the importance of building capacity amongst parliamentarians in the region to interpret and use rights-based analyses in their parliamentary roles and to build the scope and reach of parliamentarians’ work to advance the right to health in the region. Inasmuch as respondents identified the need for further inputs, work on health rights should be a priority for engagement with parliamentary committees on health in SEAPACOH by EQUINET and other organisations seeking to promote health in east and southern Africa.