Report on a human rights-based approach to health workforce education


Published:
16 July 2019
Author:
Special Rapporteur on the right to health
Presented:
At the UN General Assembly’s 74th session
Link:

Background

The Special Rapporteur promotes the uptake of health-care worker education based on human rights principles. From the selection of students to the curricula taught to the location of training and subsequent employment within health systems, he promotes the impact that human rights-based approaches to medical education can have on the health-care workforce. Integration of human rights into health education can help health-care workers overcome their own inherent discriminatory behaviours and attitudes.

Summary

In this report, the Special Rapporteur focuses on the impact that human rights-based approaches to medical and other health education can make. He identifies features of current health education that limit the capacity of the health-care workforce to function effectively. He notes hurdles that prevent the health-care workers from carrying out their crucial role in promoting, respecting and fulfilling the right to physical and mental health.

The expert stresses that we need to learn lessons from the past, when science and the practice of medicine was exercised without a human rights imperative. This resulted in an unbalanced workforce that is failing many, especially those in most vulnerable and marginalized situations.

He presents some structural elements that shape the capacity of the health-care workforce to fulfil States’ right-to-health obligations to make health care available, accessible, acceptable and of good quality. He stresses the importance of applying a right-to-health framework to health-care workers themselves in order to identify issues that can enhance or restrict their ability to perform well.

A rights-based medical and health training curricula should provide a balance among different competencies, including human rights, public health, community and social medicine, mental health promotion and care, palliative care, medical ethics, medical law, and managerial and communication skills.

Recommendations

The Special Rapporteur urges schools of medicine and those who train health-care workers to ground health curricula in a right to health framework, and to pay attention to the conditions in which people are born, grow and live. He also recommends that graduates be encouraged to work in primary health care and in rural or remote settings so as to strengthen primary health care for people in those settings.

He explains that conventional medical education has been, and too often remains, based on an outdated medical hierarchy, the predominance of a biomedical paradigm and a reliance on tertiary care hospitals. Empowering all health-care workers with rights-based competencies and skills prevents human rights violations in the care of patients and corruption. It also promotes and protects the rights of health-care workers, reduces power asymmetries, and contributes to decent working conditions and a climate of mutual trust and respect within and beyond health-care systems.

Methodology

In addition to an in-country consultation, the Special Rapporteur sought written inputs from stakeholders (member States, civil society actors, medical professionals, academia, and others) to inform this report.

The Special Rapporteur asked for input regarding the following:

1) Examples of medical education undergoing change from more hierarchical to more democratic, rights-based and community-based models.

2) Examples of medical training which includes human rights. 

3) Successful methods to encourage doctors and nurses or other mid-level health workers to live and work in remote or rural areas and reduce inequitable access to health care.

4) Examples of medical education curricula or other health workforce training that focuses on the social determinants of health and on training professionals with a broad spectrum of competencies and skills.

5) Examples of how concerns such as the mismatch of competencies to patient and population needs; poor teamwork; gender stratification; narrow technical focus; predominant hospital orientation; imbalances in the professional labour market, and weak leadership, have been addressed to produce stronger health workforce and stronger health systems.

6) Examples of national health workforce strategies that contain either explicit or implicit recognition of the right to health? 

7) Feedback on ways in which human rights-based medical education could make a positive contribution to resolving these and other global health crises such as opioid dependency, mental health, palliative care, the influence of the pharmaceutical sector and the tensions between social medicine and biomedicine, amongst others.

8) Other challenges or opportunities health workers are experiencing in their daily work in relation to strengthening the health workforce, and ways to fortify human rights responses to these challenges or opportunities

9) Suggestions for rights-based indicators that can effectively assess and monitor progress in relation to rights-based approaches to medical education, both within specific fields and broadly.

For more details see the questionnaire.