Human Rights Education for Health Workers

8/12/2019 Human Rights Education for Health Workers

1/66


2/66


3/66

Published by the OSCE

Office or Democratic Institutions and Human Rights (ODIHR)

Ul. Miodowa

Warsaw

Poland

www.osce.org/odihr

OSCE/ODIHR

All rights reserved. The contents o this publication may be reely used and

copied or educational and other non-commercial purposes, provided that

any such reproduction is accompanied by an acknowledgement o the OSCE/

ODIHR as the source.

ISBN ----

Designed by Homework, Warsaw, Poland

Cover photograph by iStockphoto

Printed in Poland by Sungra


4/66

Contents

................................................................................

...................................................................................................

............................................................................................

Rationale or human rights education or health workers.............................

Key definitions or the guidelines .............................................................................

Process or elaborating the guidelines ...................................................................

Anticipated users o the guidelines ..........................................................................

Purposes o the guidelines ...........................................................................................

Application o the guidelines ......................................................................................

Structure o the guidelines..........................................................................................

. .....................................................

Human rights-based approach in programming ..............................................

Human rights-based approach in educational institutions ..........................

. ...........................................................................

Knowledge and Understanding ..................................................................................

Attitudes and Values .......................................................................................................

Skills ........................................................................................................................................

. .............................................................................................

Organization o Curricula ............................................................................................

Textbooks and support materials ..............................................................................


5/66

. ...........................................

Methodologies ...................................................................................................................

. ..........................................................................................

Learner assessment ......................................................................................................... Trainer assessment ...........................................................................................................

Programme evaluation ...................................................................................................

Impact assessment ............................................................................................................

. ,

.............................................................................................

Competencies o trainers and other education personnel .............................

Training institutions .......................................................................................................

Quality o training ............................................................................................................

..................................................................................................


6/66

ACKNOWLEDGEMENTS

The OSCE Office or Democratic Institutions and Human Rights (ODIHR)

would like to thank Dr. Peter G. Kirchschlaeger, Co-Director, Centre

o Human Rights Education, University o Teacher Education Central

Switzerland Lucerne, who put his knowledge, skills and commitment into

the development o the Guidelines on Human Rights Education for Health

Workers.

ODIHR extends its thanks to the Office o the United Nations High

Commissioner or Human Rights (OHCHR) or its participation and input

in the development process or these guidelines. ODIHR would also like to

thank the ollowing experts or their and eedback in the process o drafing

the guidelines:

Kamiar AlaeiInternational Health and Human Rights Expert, University at Albany, State

University o New York (United States);

Sneh AuroraInternational Human Rights Education Manager, Amnesty International

International Secretariat (United Kingdom);

Britta BaerWorld Health Organization (WHO);

Ludovica BanfiEuropean Union Agency or Fundamental Rights (FRA), Freedoms & Justice

(Austria);

Brock Chisholm

Forced Migration Trauma Service (United Kingdom)


7/66

Guidelines on Human Rights Education for Health Workers

Dragana iri MilovanoviDisability Rights International, Serbia Office (Serbia)

Victor De Currea-Lugo

Proessor, Universidad Javeriana, (Colombia/Spain)Sandra del PinoHuman Rights Specialist, Pan American Health Organization (PAHO)/WHO

(United States)

Alicia DibbetsInternational Federation o Health and Human Rights Organisations (IFHHRO)

Enver DjulimanHead o the Human Rights Education Department, Norwegian Helsinki

Committee (Norway)

Gulara EfendiyevaHealth Financing Coordinator, Ministry o Health, The World Bank, HealthSector Reorm Project (Azerbaijan)

Elena G. EwertDenver Health Residency in Emergency Medicine (United States)

Tamar EzerSenior Program Officer, Law and Health Initiative o the Open Society

Public Health Programme (United States)

Gregory FabianInternational Human Rights Consultant (United States/Slovakia)

Kazunari FujiiSoka Gakkai International (Switzerland)

Arlan FullerExecutive Director, Francois-Xavier Bagnoud Center or Health and Human

Rights, Harvard University (United States)

Jamshid GaziyevHuman Rights Officer, Economic, Social and Cultural Rights Section

Section, Special Procedures Branch, Office o the UN High Commissioner

or Human Rights (Switzerland)

Susana GomezAmerican University, Washington College o Law (United States)

Dmytro GroysmanVinnitsa Human Rights Group (Ukraine)

Mette HartlevLegal Department, Copenhagen University (Denmark)

Vincent IacopinoSenior Medical Advisor, Physicians or Human Rights, Adjunct Proessor o

Medicine, University o Minnesota Medical School, Senior Research Fellow,

Human Rights Center, University o Caliornia, Berkeley (USA)


8/66

Acknowledgements

Kaisa Immonen-CharalambousEuropean Patients Forum (Belgium)

Elena Ippoliti

Methodology, Education and Training Section, OHCHR (Switzerland)Aydan IyigngrEuropean Union Agency or Fundamental Rights (FRA), Freedoms & Justice

(Austria)

Lily LynchIndependent consultant (United States)

Helena Nygren-KrugHealth and Human Rights Adviser, WHO

Stefanie Rinaldi

Research Fellow, Centre o Human Rights Education, University o TeacherEducation Central Switzerland Lucerne (Switzerland)

Viktor RolikDoctor, Vice Coordinator, Vinnytsa Human Rights Group (Ukraine)

Cristina SgangaHuman Rights Trainer and Advisor (United Kingdom/Italy)

Astrid StuckelbergerPublic Health School, Faculty o Medicine, University o Geneva, Instructional

Co-ordinator and Co-conceptor o the WHO International Health Regulation

course and the WHO Ethics Research Committee (Switzerland)

Daniel TarantolaVisiting Proessorial Fellow, School o Public Health and Community Medicine,

Faculty o Medicine, The University o New South Wales (Australia/France)

Felisa TibbittsHuman Rights Education Associates and the Carr Center or Human Rights

Policy o the Harvard Kennedy School o Government (United States)

Javier VasquezHuman Rights Advisor, PAHO/WHO (United States)

Olena VolochaiNGO Proessional Assistance (Ukraine)

James WelshResearcher/Advisor, Special Thematic Projects, Amnesty International

(United Kingdom)

Karolina WickiewiczPolish Federation or Women and Family Planning (Poland)

Nazmi ZenginNEU Meram Faculty o Medicine Konya (Turkey)


9/66


10/66

FOREWORD

In the Moscow Document the OSCE participating States agreed that

they will encourage their competent authorities responsible or education

programmes to design effective human rights related curricula and courses

or students at all levels, particularly () students () attending public ser-

vice schools. These guidelines aim to support systemic and effective hu-

man rights education or health workers, and especially those who study to

become health proessionals or already carry out that important work.

Given the central role health workers play in saeguarding human rights,

and the right to health in particular, human rights should be a key compo-

nent o their proessional development. In reality, however, there is very

little, or in many cases no human rights education available or doctors,

nurses, medical students, medical policymakers and all others whose pri-

mary responsibility is to enhance health. The guidelines aim to change that

situation by helping to transer human rights skills, knowledge and atti-

tudes, and make them appropriate and applicable in the daily work o health

workers, through human rights education.

The guidelines were prepared on the basis o broad consultations involving

health workers, academics, NGO specialists and representatives rom inter-

governmental agencies. The guidelines promote the objectives o the United

Nations World Programme or Human Rights Education and its Second

Phase ( to ), which ocuses on implementing human rights train-

ing programmes or teachers and educators, civil servants, law enorcement

officials and military personnel.


11/66


The document presents approaches to be adopted when planning or imple-

menting human rights education or health workers related to six key struc-

tural areas: the human rights-based approach to human rights education;

core competencies; curricula; training and learning processes; evaluation;and proessional development and support o trainers. The guidelines also

offer a list o key resources to assist in planning and implementing human

rights education or health workers.

These guidelines may prove useul in a variety o contexts. For example,

they can help educational personnel to plan, conduct and evaluate courses,

lectures and seminars. They can also be used or advocacy purposes, such

as in initiating changes in the system o proessional development o health

workers, in drafing o charters on rights and responsibilities or healthworkers or, additionally, in serving as a point o reerence or expertise to

anyone who may be interested in health-related human rights issues.

ODIHR is pleased to present these Guidelines on Human Rights Education for

Health Workersand welcomes eedback on them, which will be used or u-

ture editions. It is our hope that the guidelines will contribute to the better

implementation o OSCE human dimension commitments.

Ambassador Janez Lenari

Director, OSCE Office or Democratic Institutions and Human Rights


12/66

INTRODUCTION

The enjoyment o human rights represents an essential condition or the

protection and promotion o human health defined as a state o complete

physical, mental, and social well-being and not merely the absence o dis-

ease or infirmity.Beyond that, health itsel is a undamental human right

indispensable or the exercise o other human rights as confirmed by inter-

national human rights law.The right o everyone to the enjoyment o the

highest attainable standard o physical and mental health comprises both

health care and pre-conditions to health, such as clean water, sanitation,

Declaration o Alma-Ata, World Health Organization, , ; The Constitution o the WorldHealth Organisation, , (Declaration o Alma-Ata).

International Covenant on Economic, Social and Cultural Rights, United NationsOffice o the High Commissioner or Human Rights, January , article , para. ,. For an analysis othis article see General Comment No. , The Right to the Highest Attainable Standardo Health, UN Committee on Economic, Social and Cultural Rights, August ,U.N. Doc. E/C.// (General Comment ), . The right to health is also guaranteed in the Charter oFundamental Rights o the European Union, December , /C/, Article: Everyone has the right o access to preventive health care and the right to benefit

rom medical treatment.
http://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdfhttp://www.who.int/governance/eb/who_constitution_en.pdfhttp://www.who.int/governance/eb/who_constitution_en.pdfhttp://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspxhttp://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.Enhttp://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.Enhttp://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.Enhttp://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.Enhttp://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspxhttp://www.who.int/governance/eb/who_constitution_en.pdfhttp://www.who.int/governance/eb/who_constitution_en.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdf


13/66


nutrition and adequate housing.This underlines the interconnection be-

tween health and human rights. Health policies and health services can

serve to protect human rights and undamental reedoms, but may also hin-

der the exercise o these rights. At the same time, respect or the humanrights and undamental reedoms o every individual is crucial or genuine

health, and violations o human rights can have a direct impact on physical,

mental and social well-being.

Within this synergistic relationship between health and human rights,

health workers, whose main goal is to enhance health,are key actors in

protecting, respecting and promoting the health-related human rights o

every individual. Human rights can support health workers in their pro-

essional practice by improving their interaction with patients, by givingdirection in situations where their decisions and situational judgement a-

ect human rights and by helping health workers recognize human rights

violations, which must be documented and redressed.In order to be able

to develop these specific human rights competencies to strengthen health

workers proessional perormance, health workers should become aware o

human rights standards, principles and values and integrate them into their

work. Thereore, human rights should be a part o any training or educa-

tional programme or all categories o health workers.

OSCE commitments affirm the undamental character o human rights

education and encourage human rights education in all educational in-

stitutions or all types o students and proessional groups, including

General Comment , op. cit., note , para. . Report o the Special Rapporteur on the Right o Everyone to the Enjoyment o the

Highest Attainable Standard o Physical and Mental Health, United Nations Office othe High Commissioner or Human Rights, September , UN Doc. A//,. (Report o

the Special Rapporteur on Health)
http://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspxhttp://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspx


14/66

Introduction

medical personnel.The United Nations (UN) Declaration on Human Rights

Education and Training reaffirms that everyone should have access to hu-

man rights education.

The necessity o human rights education or health workers has been rec-

ognized in the UN Convention against Torture and Other Cruel, Inhuman

or Degrading Treatment or Punishment, the Vienna Declaration and

Programme o Action, and the Plan o Action o the Second Phase o the

UN World Programme or Human Rights Education.The importance o

human rights education or health workers has been emphasized also by

the UN Special Rapporteur on the right o everyone to the enjoyment o

the highest attainable standard o physical and mental health, by the

Committee on the Elimination o Discrimination against Women,

bythe UNESCO Recommendations on Human Rights Teaching, Inormation

Document o the Copenhagen Meeting o the Conerence on the Human Dimensiono the CSCE, Conerence on Security and Co-operation in Europe, Copenhagen, to June , para. ., , (CopenhagenDocument); Concluding Document o the Vienna Meeting, Conerence on Securityand Co-operation in Europe, Vienna, January , paras. . ., < http://www.osce.org/mc/>, (Vienna Document); Document o the Moscow Meeting o theConerence on the Human Dimension o the CSCE, Conerence on Security and Co-operation in Europe, Moscow, October , paras. . ., , (Moscow Document); OSCE Ministerial Council, DecisionNo. /, Enhancing Efforts to Combat Trafficking in Human Beings, including orLabour Exploitation, through a Comprehensive and Proactive Approach, Brussels, December , .

United Nations Declaration on Human Rights Education and Training, UN GeneralAssembly, December , UN Doc. A/RES//, Art. , , (UNDeclaration on Human Rights Education and Training).

World Programme or Human Rights Education, Plan o Action, nd Phase, UN HighCommissioner or Human Rights, July , UN Doc. A/HRC//, , (WPHRE, Plan oAction). The Plan o Action or the Second Phase o the World Programme or HumanRights Education ocuses on human rights education and training or different groupso civil servants.

Report o the Special Rapporteur on Health, op. cit., note . CEDAW, general recommendation () on women and health, para. (). .
http://www.osce.org/odihr/elections/14304http://www.osce.org/mc/16262http://www.osce.org/mc/16262http://www.osce.org/odihr/elections/14310http://www.osce.org/odihr/elections/14310http://www.osce.org/mc/23048http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/467/04/PDF/N1146704.pdf?OpenElementhttp://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/467/04/PDF/N1146704.pdf?OpenElementhttp://www.ohchr.org/Documents/Publications/WPHRE_Phase_2_en.pdfhttp://www.ohchr.org/Documents/Publications/WPHRE_Phase_2_en.pdfhttp://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htmhttp://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htmhttp://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htmhttp://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htmhttp://www.ohchr.org/Documents/Publications/WPHRE_Phase_2_en.pdfhttp://www.ohchr.org/Documents/Publications/WPHRE_Phase_2_en.pdfhttp://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/467/04/PDF/N1146704.pdf?OpenElementhttp://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/467/04/PDF/N1146704.pdf?OpenElementhttp://www.osce.org/mc/23048http://www.osce.org/odihr/elections/14310http://www.osce.org/odihr/elections/14310http://www.osce.org/mc/16262http://www.osce.org/mc/16262http://www.osce.org/odihr/elections/14304


15/66


and Documentationand by civil society bodies.Moreover, health pro-

essional organizations, such as the World Medical Associationand the

International Council o Nurses, advocate or the inclusion o human rights-

related topics in the training o health workers.

These guidelines have been designed to support effective human rights edu-

cation or health workers.

The term health worker includes all people whose primary role is to en-

hance health. This includes public health workers, health care staff, healthpolicy workers, health service management, community health workers,

health educators and private health workers.

The United Nations Declaration on Human Rights Education and Training

states that:

Human rights education and training comprises all educational, train-

ing, inormation, awareness-raising and learning activities aimed at pro-

moting universal respect or and observance o all human rights and

undamental reedoms. Human rights education contributesto the pre-

vention o human rights violations and abuses by providing persons with

knowledge, skills and understanding, and by developing their attitudes

Malta Recommendations on Human Rights Teaching, Inormation andDocumentation, UNESCO, , reproduced in: The United Nations Decade orHuman Rights Education. No. The Right to Human Rights Education, UnitedNations, Geneva, , p. , .

Amnesty International Urges a Stronger Human Rights Role or Nurses and Midwives,Amnesty International, Nursing Ethics, May , Vol. , No. , , pp. ,.

Resolution on the Inclusion o Medical Ethics and Human Rights in the Curriculumo Medical Schools Worldwide, World Medical Association, st Annual GeneralAssembly, October , .

Position Statement: Nurses and Human Rights, International Council o Nurses(ICN), adopted in , reviewed and revised in , .
http://www.ohchr.org/Documents/Publications/RightHReducationen.pdfhttp://www.ohchr.org/Documents/Publications/RightHReducationen.pdfhttp://www.amnesty.org/en/library/asset/ACT75/002/2005/en/4ec594ad-d4ea-11dd-8a23-d58a49c0d652/act750022005en.htmlhttp://www.amnesty.org/en/library/asset/ACT75/002/2005/en/4ec594ad-d4ea-11dd-8a23-d58a49c0d652/act750022005en.htmlhttp://www.wma.net/en/30publications/10policies/e8/http://www.wma.net/en/30publications/10policies/e8/http://www.amnesty.org/en/library/asset/ACT75/002/2005/en/4ec594ad-d4ea-11dd-8a23-d58a49c0d652/act750022005en.htmlhttp://www.amnesty.org/en/library/asset/ACT75/002/2005/en/4ec594ad-d4ea-11dd-8a23-d58a49c0d652/act750022005en.htmlhttp://www.ohchr.org/Documents/Publications/RightHReducationen.pdfhttp://www.ohchr.org/Documents/Publications/RightHReducationen.pdf


16/66

Introduction

and behaviours to empower them to contribute to the building and pro-

motion o a universal culture o human rights.

The Declaration also asserts that:

[H]uman rights education encompasses:

a) Education about human rights, which includes providing knowledge

and understanding o human rights norms and principles, the values

that underpin them and the mechanisms or their protection;

b) Education through human rights, which includes learning and teach-

ing in a way that respects the rights o both educators and learners;

c) Education or human rights, which includes empowering persons in-dividuals to enjoy and exercise their rights and to respect and uphold

the rights o others.

Human rights education is complementary to training in medical law, medi-

cal ethics and bioethics in the ollowing ways and or the ollowing reasons:

human rights serve as the oundation or medical law;

human rights are a point o reerence or policy development on health

issues;

human rights provide a ramework or health workers to make ethical

decisions and situational judgements; and

unlike medical ethics and bioethics, human rights are binding on all

states and those acting on their behal, including non-state actors, as

part o international legal obligations.

Thereore, courses in medical ethics, bioethics or medical law cannot be

a substitute or human rights education in the training o health workers.

ODIHR initiated the development o this series o guidelines on human

rights education as ollow-up to consultative workshops that took place in

Istanbul on and September , in Geneva on and August ,

UN Declaration on Human Rights Education and Training, op. cit., note . Ibid.


17/66


and in Warsaw on and November and July and . These

guidelines will continue to evolve to reflect ongoing discussions aimed at

developing quality human rights education programmes or health workers.

The Guidelines on Human Rights Education for Health Workers have been

elaborated in close consultation with practitioners with long-standing ex-

perience in this field, including health workers, academics, NGO specialists

and representatives rom inter-governmental agencies. An initial document

was drafed in collaboration with a working group organized ollowing the

Istanbul workshop. The final version o the guidelines was developed on the

basis o input provided by an additional group o practitioners represent-

ing all OSCE geographical regions. These individuals are presented in the

Acknowledgements section o these guidelines.

The guidelines have been developed with reerence to existing key policy

and resource documents promulgated by the UN, including the WHO, as

well as regional human rights bodies and other agencies, such as the Pan

American Health Organization (PAHO).

The Guidelines on Human Rights Education for Health Workers are based

on the normative ramework o the OSCE human dimension commit-

ments, other regional human rights standards and mechanisms, such as

those existing within the Council o Europe, and on core international

human rights instruments, as well as decisions o their respective moni-

toring bodies:the International Covenant on Civil and Political Rights

(ICCPR), the International Covenant on Economic, Social and Cultural

Rights (ICESCR), the International Convention on the Elimination o

All Forms o Racial Discrimination (ICERD), the Convention on the

Elimination o All Forms o Discrimination against Women(CEDAW),

the Convention against Torture and Other Cruel, Inhuman or Degrading

Treatment or Punishment (CAT), the Convention on the Rights o the

Child(CRC), the International Convention on the Protection o the Rightso All Migrant Workers and Members o Their Families(ICRMW), the

Convention on the Rights o Persons with Disabilities (CRPD), and the

International Convention or the Protection o All Persons rom Enorced

Disappearances(CPED).
http://www.osce.org/odihr/76894?download=truehttp://www.osce.org/odihr/76894?download=truehttp://www2.ohchr.org/english/law/ccpr.htmhttp://www2.ohchr.org/english/law/cescr.htmhttp://www2.ohchr.org/english/law/cescr.htmhttp://www2.ohchr.org/english/law/cerd.htmhttp://www2.ohchr.org/english/law/cerd.htmhttp://www2.ohchr.org/english/law/cedaw.htmhttp://www2.ohchr.org/english/law/cedaw.htmhttp://www2.ohchr.org/english/law/cat.htmhttp://www2.ohchr.org/english/law/cat.htmhttp://www2.ohchr.org/english/law/crc.htmhttp://www2.ohchr.org/english/law/crc.htmhttp://www2.ohchr.org/english/law/cmw.htmhttp://www2.ohchr.org/english/law/cmw.htmhttp://www2.ohchr.org/english/law/disabilities-convention.htmhttp://www2.ohchr.org/english/law/disappearance-convention.htmhttp://www2.ohchr.org/english/law/disappearance-convention.htmhttp://www2.ohchr.org/english/law/disappearance-convention.htmhttp://www2.ohchr.org/english/law/disappearance-convention.htmhttp://www2.ohchr.org/english/law/disabilities-convention.htmhttp://www2.ohchr.org/english/law/cmw.htmhttp://www2.ohchr.org/english/law/cmw.htmhttp://www2.ohchr.org/english/law/crc.htmhttp://www2.ohchr.org/english/law/crc.htmhttp://www2.ohchr.org/english/law/cat.htmhttp://www2.ohchr.org/english/law/cat.htmhttp://www2.ohchr.org/english/law/cedaw.htmhttp://www2.ohchr.org/english/law/cedaw.htmhttp://www2.ohchr.org/english/law/cerd.htmhttp://www2.ohchr.org/english/law/cerd.htmhttp://www2.ohchr.org/english/law/cescr.htmhttp://www2.ohchr.org/english/law/cescr.htmhttp://www2.ohchr.org/english/law/ccpr.htmhttp://www.osce.org/odihr/76894?download=truehttp://www.osce.org/odihr/76894?download=true


18/66

Introduction

These guidelines are intended or health workers who want to enhance

their human rights competencies; policymakers in the area o education,health care and public health; health workers trainers; university and other

medical school lecturers; and educational programme designers; as well as

all other stakeholders involved in the planning, delivery and evaluation o

educational curricula or health workers. As governments are responsible

or the delivery o human rights education, it is presumed that the imple-

mentation o such programmes will take place within a legislative or policy

ramework ensuring sustainable human rights education or health workers.

These guidelines apply equally to private individuals and companies whoprovide any health service or products, and to private medical and related

colleges that train health workers. They also serve civil society organiza-

tions working with or monitoring the perormance o health workers.

The Guidelines on Human Rights Education for Health Workersserve to:

support the realization o the right to the highest attainable standard o

health o every human being;

illustrate the basic elements o human rights and, in particular, the right

to the highest attainable standard o health, and their meaning in the

context o health practice;

acilitate human rights education processes and awareness-building o

human rights issues in the daily practice o health workers;

be a point o reerence or and articulate quality human rights education

to those who develop educational programmes;

articulate human rights education learner outcomes (specifically in the

categories o knowledge and understanding, values and attitudes, and

skills);

assist in the elaboration o effective programmes or training educators

to deliver human rights education or health workers;

become a point o reerence or assessing progress in promoting and

adhering to human rights; and

promote ongoing improvements in the quality o human rights educa-

tion or health workers.


19/66


The guidelines propose principles that can be used in the design o human

rights education or health workers, as well as criteria to evaluate the e-

ectiveness o such efforts. They are deliberately generic and have not been

designed as a resource with examples.

Health workers ace human rights challenges throughout their daily prac-

tice, even though they may not always be able to properly recognize such

issues in their proessional activity. In order to avoid human rights-based

training becoming dissociated rom practice, it is advantageous to embed

human rights as a cross-curricular topic, rather than teaching it as a sepa-rate subject. These guidelines support the introduction o human rights

education complementing educational processes in law and ethics as

an integral part o subjects taught to health workers at all levels, including

pre and in-service training, as well as training or career advancement or

proessional development. Training institutions are key actors in providing

quality and sustainable human rights education or health workers. It is

essential that human rights values inuse the culture and practices o the

learning environment so that human rights are a lived experience in the

training system. The dignity o learners, educators and other members o

the community should be ully respected, so as to motivate learners to re-

spect and apply human rights in their proessional and private lives.

The guidelines aim to strengthen the incorporation o human rights stand-

ards in all areas o work o academic and proessional health communities,

or example in:

Research and Teaching:

working with students at the undergraduate and graduate level;

planning, conducting and evaluating courses, lectures and seminars;

carrying out field work; and

developing internship programmes.

Advocacy:

promoting awareness o health and human rights topics;

initiating changes in health legislation and practice, as well as in the

system o proessional development o health workers; and

reviewing or drafing codes o conduct and proessional ethics, codes

o practice or employers, and charters on rights and responsibilities

or health workers;


20/66

Expertise:

strengthening the capacity o organizations that want to work on

health-related human rights issues, and have little or no competen-

cies to do so; promoting the creation and implementation o equitable and effective

public health policies and programmes;

enhancing accountability in the incorporation o human rights

norms, principles and standards in health work;

enhancing the investigation and documentation o human rights vio-

lations by health workers;

inorming consultation services and technical support; and

sharing knowledge through conerences, workshops and training

sessions.

These guidelines cannot take into account all the specific contexts in which

health workers operate, or example, the cultural context, personal experi-

ences with human rights, and other political and historical eatures o the

learning environment within which human rights education will take place.

Nor can these guidelines address the special needs or vulnerabilities o

learners, such as those learning in conflict, post-conflict and post-disaster

situations. Trainers and those designing human rights education will need

to take such needs, conditions and sensitivities into account so that human

rights education is carried out in a way that is the most effective and em-

powering or learners.

Finally, these guidelines are not ormulaic. Rather, they are intended to

serve as a measure or gauging the quality o educational programmes or

health workers and as a support tool or those who initiate and conduct

educational programmes compliant with human rights good practice or

health workers.

Introduction


21/66

Guidelines on Human Rights Education or Health Workers

The guidelines are organized into six main areas:

. Overall Processes and Goals, ensuring that the overall processesand goals o human rights education reflect the human rights-based

approach;

. Core Competencies, identiying the key learner outcomes that illus-

trate the essential capabilities or learner development;

. Curricula, developing educational and training programmes or all

learning activities, ormal and non-ormal;

. Training and Learning Processes, ensuring these are learner-cen-

tered (relating human rights to learners real-lie experiences), participa-

tory and inclusive, and take place in a human rights-respecting learningenvironment;

. Evaluation,ensuring that educational programme results are regularly

evaluated, using appropriate methods; and

. Training, Professional Development and Support for Educators,

ensuring that educational personnel receive pre-service and regular in-

service training and support.

These guidelines also include a resources section that lists reerence ma-

terials to assist the user o the guidelines in planning, implementing and

evaluating human rights education or health workers. Resources are organ-

ized according to the ollowing categories:

Human rights education and training resources or health workers;

Resources on health and human rights;

E-learning courses on human rights and health, and training in human

rights education or health workers; and

Human rights education policy documents with relevance or health

workers.


22/66

. OVERALL PROCESSES AND GOALS

Main aim: Ensuring that the overall processes and goals o human rights

education reflect the human rights-based approach

The human rights-based approachto human rights education involves the

integration o human rights principles within policy ormulation, as well as

the planning, design, implementation, monitoring and evaluation o edu-

cational events or programmes. This approach works with the expectation

that outcomes are explicitly linked with an improvement in the enjoyment

o the right to health. Moreover, the human rights-based approach implies

that training institutions reflect these principles in their organizational and

managerial practices.

The human rights principlesare:

universality and inalienability;

indivisibility;

inter-dependence and inter-relatedness;

equality and non-discrimination;

participation and inclusion; and

accountability and the rule o law.

Vienna Document, op. cit., note , paras. ; United Nations, The UN Statement

o Common Understanding on Human Rights-Based Approaches to DevelopmentCooperation and Programming, , .
http://hrbaportal.org/?page_id=2127http://hrbaportal.org/?page_id=2127


23/66


-

All training courses or health workers integrate human rights principles,values and norms in order to enable proessional perormance based on re-

spect or human rights and dignity.

Training programmes are designed and implemented in consultation with

a wide range o stakeholders at the national, regional and local levels and

take due account o governmental, legal, educational and civil society bod-

ies interests and experiences. The meaningul involvement o different civil

society actors and consultation with them are core elements o designing

and implementing training programmes based on the human rights-basedapproach.

Human rights education programme planning involves the identification o

key human rights challenges aced by health workers and by society.

The objectiveo the programme is the improved realization o human rights,

with links made to relevant human rights standards and instruments.

As a result, human rights training programmes developed using the hu-

man rights-based approach strengthen the capacity o health workers to

meet their human rights obligations through improvements in policies,

legislation, plans, programmes, resource allocation and practice, as well as

empowering health workers to bring about change in their own proession-

al and private lives. Human rights training programmes also strengthen

the understanding and capacity to respect, protect and ulfill the rights o

others, especially those who are excluded or discriminated against on the

basis o race, colour, gender, language, political or other opinion, religion,

national or social origin, property, birth, age or other status, and empowers

them to claim their own rights.

OSCE Vienna Document, op. cit., note , para. .; General Comment No. , Non-Discrimination in Economic, Social and Cultural Rights (art. , para. ), UN Committeeon Economic, Social and Cultural Rights, June , UN Doc. E/C./GC/. Seealso Human Rights Guide or the Civil and Public Service, Irish Human RightsCommission, , p. , .


24/66

. Overall processes and goals

Educational programme objectives are outcome-based and measurable, en-

couraging action to ulfill the human rights o all members o the society.

To succeed, sufficient and sustained resources(time, financial and humanresources) are allocated by governments or human rights education.

-

The human rights-based approach applies to the ways o working o train-

ing institutions. These institutions promote rights-based principles within

their organizational structure, processes and procedures, including non-dis-

crimination and inclusion, dignity and respect, accountability, participationand empowerment o all health workers who undergo training, as well as o

all educational personnel.

The training delivered by relevant institutions osters participation, sel-ex-

pression, communication, co-operation and teamwork, and discipline in pro-

cesses that affirm the human dignity o learners and educational personnel.

WPHRE, Plan o Action, op. cit., note , p. .


25/66


26/66

. CORE COMPETENCIES

Main aim: Ensuring that clearly established learner outcomes includ-

ing dimensions o knowledge and understanding, attitudes and values and

skills guide the development o curricula, training, learning and evalua-

tion processes, and preparation o educational personnel.

The desired core competencies, or learner outcomes, presented here are in-

tended to be used in designing human rights education or health workers.

The competencies are grouped under three headings:

knowledge and understanding;

attitudes and values; and

skills.

Although the competencies are presented separately, they are ofen inter-

linked, and when delivering and assessing an education programme they

will be blended together. The competencies are not presented in any par-

ticular order or priority. The selection o relevant competencies to acquire

(as an objective o a training course or a curriculum) is carried out by edu-

cational staff based on the concrete context and needs o participants.

Particular attention is paid to the transormation o theoretical knowledge

into practice-related skills through relevant, human rights-related exercises.


27/66


The learner is aware of and understands:

Legal and philosophical foundations of human rights

The history and philosophy o human rights; the unction o human

rights, the ethical, legal and political justification o human rights;

the evolving nature o the human rights ramework; the Universal

Declaration o Human Rights;

Human rights principles and human rights standards as defined in the

international and regional human rights treaties and relevant case law,including but not limited to: the International Covenant on Civil and

Political Rights; the International Covenant on Economic, Social and

Cultural Rights; the International Convention on the Elimination o All

Forms o Racial Discrimination; the Convention against Torture and Other

Cruel, Inhuman or Degrading Treatment or Punishment; the Convention

on the Elimination o All Forms o Discrimination against Women; the

Convention on the Rights o the Child; the International Convention on

the Protection o the Rights o All Migrant Workers and Members o

Their Families; the International Convention or the Protection o All

Persons rom Enorced Disappearance; the International Convention

on the Rights o Persons with Disabilities; the Geneva Conventions;

the Convention or the Protection o Human Rights and Fundamental

Freedoms (ECHR); the EU Charter on Fundamental Rights; the European

Social Charter; the Council o Europe Convention on Human Rights and

Biomedicine; the American Convention on Human Rights; and the World

Health Organization Declaration on the Rights o Patients in Europe;

The status o ratification o international and regional treaties, including

existing reservations;

National legislation reerencing human rights (e.g., constitutions, na-

tional health care laws, etc.);

The nature o the states obligations under human rights law;

Responsibility o the private sector, or example, pharmaceutical compa-

nies or health insurance companies, or the realization o human rights,


28/66

. Core competencies

in particular o the right o everyone to the enjoyment o the highest

attainable standard o physical and mental health ;

The role o human rights mechanisms, international (e.g., UN Treaty Bodies,UN Special procedures mandates, with a clear impact on health, particu-

larly the Special Rapporteur on the right o everyone to the enjoyment o

the highest attainable standard o physical and mental health, Universal

Periodic Review), regional (e.g., OSCE, European Union, Organization o

American States, Council o Europe and the European Court o Human

Rights), and national (e.g., national human rights institutions);

The role o civil society, media and other organizations with mandates

or thematic ocus related to health issues, such as associations o healthworkers or organizations advocating or patients rights, in addressing

human rights;

The definition o a human rights violation; the root causes o human

rights violations including the role o stereotypes and prejudices lead-

ing to human rights abuses, as well as the physical and psychological

consequences o human rights violations on individuals, their amilies

and society, especially in the health context;

The linkages between health and human rights

The inherent dignity o all human beings and the necessity to protect

this dignity under all circumstances, regardless o race, colour, gender,

language, political or other opinion, religion, national or social origin,

property, birth, age or other status;

The concept o progressive realization o the right to health and relevant

obligations o the state;

See Report o the Special Representative o the Secretary-General on the Issue o HumanRights and Transnational Corporations and other Business Enterprises, Guiding Principleson Business and Human Rights: Implementing the United Nations Protect, Respect andRemedy Framework, United Nations, March , UN Doc. A/HRC//; Report o theSpecial Rapporteur on the Right o Everyone to the Enjoyment o the Highest AttainableStandard o Physical and Mental Health, Annex Human Rights Guidelines or Pharmaceu-tical Companies in relation to Access to Medicines, August , UN Doc. A//.

Final Act o the Conerence on Security and Co-operation in Europe, Helsinki, ,

VII, .
http://www.osce.org/mc/39501http://www.osce.org/mc/39501


29/66


The obligation o the state to provide appropriate training or health

personnel, including education on health and human rights, the right to

access to health care, distributive justice, standards o care and quality

o lie or the person;

The connection between human rights instruments and specific docu-

ments related to the duties o health workers, e.g., national medical-

treatment legislation or the relevant codes o ethics or health workers;

Human rights as legal and ethical reerence points or health workers

or their day-to-day work and perormance o their statutory duties with

the public, notably regarding the treatment o children and adolescents,

older persons, detainees, minorities, indigenous peoples, asylum-seekersand other migrants, people with physical or mental disabilities, victims

o human rights violations, in particular victims o torture, and all other

persons unable to express or ormulate their rights;

The impact o the health sector on human rights, including the role o

health workers in preventing and reacting to human rights violations

that affect health,as well as the impact o impaired health on human

rights, including participation in the cultural, civic and political lie o

the community, and in education, employment or housing;

The impact on health o environmental degradation resulting rom cli-

mate change, natural disasters, warare and industrial and agricultural

pollution;

See WHO, Casebook on Ethical Issues in International Health Research (WHO, ),; rd GeneralAssembly, International Code o Medical Ethics, World Medical Association, London,, ; and Code o Ethics orNurses, International Council o Nurses, adopted in , revised in , .

See Pat Mayers, Introducing Human Rights and Health into a Nursing Curriculum,Curationis, Vol. No. , , pp. , ; The World Medical Association Declaration oTokyo. Guidelines or Physicians Concerning Torture and other Cruel, Inhuman orDegrading Treatment or Punishment in Relation to Detention and Imprisonment,WMA, October , .

OSCE Ministerial Council, Document o the Eleventh Meeting, OSCE Strategy toAddress Threats to Security and Stability in the Twenty-First Century, Maastricht,

, para. , .
http://www.wma.net/en/30publications/10policies/c8/http://curationis.org.za/index.php/curationis/article/view/1117/1052http://curationis.org.za/index.php/curationis/article/view/1117/1052http://www.wma.net/en/30publications/10policies/c18/http://www.osce.org/mc/17504http://www.osce.org/mc/17504http://www.wma.net/en/30publications/10policies/c18/http://curationis.org.za/index.php/curationis/article/view/1117/1052http://curationis.org.za/index.php/curationis/article/view/1117/1052http://www.wma.net/en/30publications/10policies/c8/


30/66

. Core competencies

The impact o human rights violations on health (or example the impact

o violence against women on the health o women and children, or the

impact o trafficking in human beings on the health o the victims);

The legal and ethical duties o health workers, taking into account the

interests o the patients, in documenting and reporting alleged human

rights violations or seeking to prevent human rights violations;

Human rights issues related to lie sciences and associated

bio-technologies;

The accountability o governments or health-related human rights vio-

lations and the emerging statutory and case law regarding health re-lated human rights issues;

The legitimate derogations on rights (Siracusa Principles and limitation

clauses, especially in relation to public health emergencies, in interna-

tional human rights instruments in general), which are applicable in

cases o perceived conflict between individual rights and rights o others

(e.g., cases o inectious pandemic);

OSCE Ministerial Council, Annex to Decision No. /, OSCE Action Plan to CombatTrafficking in Human Beings, Maastricht, July , para. ., .

Universal Declaration on Bioethics and Human Rights, UNESCO, Paris, ,; International Health Regulations, WHO, , (WHO); International Ethical Guidelines or Biomedical Research InvolvingHuman Subjects, Council or International Organizations o Medical Sciences, Geneva,, (CIOMS);Convention or the Protection o Human Rights and Dignity o the Human Being withregard to the Application o Biology and Medicine: Convention on Human Rights andBiomedicine, Council o Europe, April , (Council o Europe).

Moscow Document, op. cit., note , para .; International Health Regulations, WHO,, ; The Siracusa Principles on the Limitation andDerogation Provisions in the International Covenant on Civil and Political Rights, UNCommission on Human Rights, September , U.N. Doc. E/CN.//, . For analysis o the Siracusa Principles,see Sara Abiola, The Siracusa Principles on the Limitation and Derogation Provisionsin the International Covenant or Civil and Political Rights (ICCPR): history andInterpretation in Public Health Context, Research Memorandum Prepared or the Open

Society Institutes Public Health Program Law and Health Initiative, Harvard, .
http://www.osce.org/pc/42708http://www.osce.org/pc/42708http://www.who.int/ihr/enhttp://www.who.int/ihr/enhttp://www.cioms.ch/publications/frame_available_publications.htmhttp://conventions.coe.int/Treaty/en/Treaties/html/164.htmhttp://conventions.coe.int/Treaty/en/Treaties/html/164.htmhttp://www.who.int/ihr/enhttp://www.who.int/ihr/enhttp://conventions.coe.int/Treaty/en/Treaties/html/164.htmhttp://conventions.coe.int/Treaty/en/Treaties/html/164.htmhttp://www.cioms.ch/publications/frame_available_publications.htmhttp://www.who.int/ihr/enhttp://www.who.int/ihr/enhttp://www.osce.org/pc/42708http://www.osce.org/pc/42708


31/66


The protection o the overall health o the population, or public health in

cases o international spread o diseases;

The coherence o health policy with human rights;

The right to health and other health-related rights;

The right to the highest attainable standard o health;

The right to health extending to underlying determinants o health,

such as ood, nutrition, housing, access to sae and potable water and

adequate sanitation, sae and healthy working conditions, and a healthy

environment;

Elements o the right to health (in relation to all health acilities, goods and

services): availability (o health acilities, goods, and services), accessibility

(non-discrimination, physical accessibility, economic accessibility [afforda-

bility], inormation accessibility), acceptability (respectul o medical ethics

and culturally appropriate, sensitive to gender and lie-cycle requirements),

quality (scientifically and medically appropriate and o good quality);

Inter-relatedness and inter-dependence between the right to health and

other rights;

The rights o patients and other individuals, as well as their amily

members and members o their communities;

The right to sel-determination and autonomy, including the right to in-

ormed consent (the right to choose or decline care or nourishment, the

See WHO,op. cit., note . General Comment , op. cit, note , para. . Ibid. Ibid., para. . Declaration o Alma-Ata, op. cit., note ; European Charter o Patients Rights, Active

Citizenship Network, Rome, , ; WHO, European Consultation on theRights o Patients, A Declaration on the Promotion o Patients Rights in Europe,Amsterdam, June , ; see a list o a number o national patients rights documents on the WHO website:

.
http://ec.europa.eu/health/ph_overview/co_operation/mobility/docs/health_services_co108_en.pdfhttp://ec.europa.eu/health/ph_overview/co_operation/mobility/docs/health_services_co108_en.pdfhttp://www.who.int/genomics/public/eu_declaration1994.pdfhttp://www.who.int/genomics/public/eu_declaration1994.pdfhttp://www.who.int/genomics/public/patientrights/en/http://www.who.int/genomics/public/patientrights/en/http://www.who.int/genomics/public/eu_declaration1994.pdfhttp://www.who.int/genomics/public/eu_declaration1994.pdfhttp://ec.europa.eu/health/ph_overview/co_operation/mobility/docs/health_services_co108_en.pdfhttp://ec.europa.eu/health/ph_overview/co_operation/mobility/docs/health_services_co108_en.pdf


32/66

. Core competencies

right to participate in decision-making processes regarding ones health,

the right to complain about health services);

Rights with regard to human research and genetic engineering, includ-

ing the limitation or prohibition o clinical research, particularly on vul-nerable and disadvantaged groups;

The right to inormation (including access to ones own clinical records);

The right to be treated with dignity and respect;

Sexual and reproductive rights,such as access to amily planning, con-

traception, pregnancy, etc.;

The right to bodily integrity, including the absolute prohibition on the

use o torture, or other cruel, inhuman and degrading treatment, o the

participation o health workers in torture and executions or other cor-

poral punishment,prohibition o the perormance o, or participation

See International Ethical Guidelines or Epidemiological Studies, Council or

International Organizations o Medical Sciences, , ; Council o Europe Committee oMinisters, Recommendation No. R () , Ethical and Organisational Aspects oHealth Care in Prison ( April ); World Medical Association, Declaration oHelsinki, adopted in , revised in , , , , , , ; UNESCO, Council o EuropeParliamentary Assembly, Resolution (), Female Genital Mutilation, May, ; and Position Statement, Nurses Role in the Care o Detainees and Prisoners,International Council o Nurses (ICN), adopted in , reviewed and revised in ,.

UN General Comment , op. cit., note , paras. . See also Sexual rights: an IPPFDeclaration, International Planned Parenthood Federation, ; and Report o theInternational Conerence on Population and Development, United Nations PopulationInormation Network, October , U.N. Doc. CONF./.

Report o the Special Rapporteur on Health, op. cit., note .. OSCE Copenhagen Document, op. cit., note , para. .; OSCE Vienna Document, op.

cit., note , para .; Convention (IV) relative to the Protection o Civilian Personsin Time o War, UN, August ; UN General Assembly, Res. /, Principleso Medical Ethics, December , UN Doc. A/RES//, ; and Position Statement: Torture, Death Penalty andParticipation by Nurses in Executions, International Council o Nurses (ICN), adopted in, reviewed and revised in and , ; and Duncan Forrest, Doctors and Torture (Hoolet: Freedom rom Torture,

), .
http://www.cioms.ch/publications/frame_available_publications.htmhttp://www.cioms.ch/publications/frame_available_publications.htmhttp://www.wma.net/en/20activities/10ethics/10helsinki/index.htmlhttp://www.wma.net/en/20activities/10ethics/10helsinki/index.htmlhttp://www.un.org/documents/ga/res/37/a37r194.htmhttp://www.un.org/documents/ga/res/37/a37r194.htmhttp://www.freedomfromtorture.org/document/publication/5570http://www.freedomfromtorture.org/document/publication/5570http://www.un.org/documents/ga/res/37/a37r194.htmhttp://www.un.org/documents/ga/res/37/a37r194.htmhttp://www.wma.net/en/20activities/10ethics/10helsinki/index.htmlhttp://www.wma.net/en/20activities/10ethics/10helsinki/index.htmlhttp://www.cioms.ch/publications/frame_available_publications.htmhttp://www.cioms.ch/publications/frame_available_publications.htm


33/66


in harmul traditional practices, prohibition on the use o medical

techniques that cause unnecessary pain or suffering, both physical or

mental;

The right to privacy (including confidentiality o medical inormation);

The right to liberty (related to procedures governing institutionalization

o patients);

The right to care with adequate access to pain treatment;

The health rights o persons with disabilities;

The right to participate in health-policy-making processes;

A human rights approach to health planning, implementation and

monitoring;and

Principles o the human rights-based approach in health planning, im-

plementation, monitoring and in other health interventions.

Equality and non-discrimination

Equality, non-discrimination, participation and inclusion as undamen-

tal human rights principles, including the prohibition o discrimination

based on race, colour, gender, language, political or other opinion, reli-

gion, national or social origin, property, birth, age or other status (such

See OHCHR, UNAIS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM,WHO, Eliminating Female Genital Mutilation, An Interagency Statement, World HealthOrganization, , ; UNAIDS, UNDP, UNFPA, UNHCR, UNICEF, UNIFEM, WHO,FIGO, ICN, IOM,MWIA, WCPT, WMA, Global Strategy to Stop Health-Care Providers rom PerormingFemale Genital Mutilation, World Health Organization, , ; and Position Statement, Elimination o FemaleGenital Mutilation, International Council o Nurses (ICN), adopted in , reviewedand revised in and , .

A human rights based approach to health, WHO, ; WHO, UNOHCHR, SIDA, Human rights and gender equality in healthsector strategies: how to assess policy coherence, WHO, , .
http://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdfhttp://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdfhttp://whqlibdoc.who.int/hq/2010/WHO_RHR_10.9_eng.pdfhttp://whqlibdoc.who.int/hq/2010/WHO_RHR_10.9_eng.pdfhttp://www.who.int/hhr/news/hrba_to_health2.pdfhttp://www.who.int/hhr/news/hrba_to_health2.pdfhttp://www.ohchr.org/Documents/Publications/HRandGenderEqualityinHealthSectorStrategies.pdfhttp://www.ohchr.org/Documents/Publications/HRandGenderEqualityinHealthSectorStrategies.pdfhttp://www.ohchr.org/Documents/Publications/HRandGenderEqualityinHealthSectorStrategies.pdfhttp://www.ohchr.org/Documents/Publications/HRandGenderEqualityinHealthSectorStrategies.pdfhttp://www.who.int/hhr/news/hrba_to_health2.pdfhttp://www.who.int/hhr/news/hrba_to_health2.pdfhttp://whqlibdoc.who.int/hq/2010/WHO_RHR_10.9_eng.pdfhttp://whqlibdoc.who.int/hq/2010/WHO_RHR_10.9_eng.pdfhttp://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdfhttp://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdf


34/66

. Core competencies

as individuals suffering rom chronic or inectious diseases such as HIV/

AIDS);

The treatment o vulnerable people, such as children and adolescents,older persons, detainees, minorities, asylum-seekers and other migrants,

people with physical or mental disabilities, victims o human rights vio-

lations (in particular victims o torture), and the protection o persons

unable to express or ormulate their rights due to temporary or chronic

severe illness;

The right o migrants in irregular situations, at a minimum, to access

necessary healthcare, the right o migrant women in irregular situations

to access primary and secondary pre and post-natal care, the right omigrant children to the same health care services as nationals;

The limitation o the qualiying conditions or health care to only what

is necessary to guarantee continuity o care, such as proo o identity;

The provision o inormation concerning medical treatment to health

clients in languages they understand; and

The importance o integrating a gender perspective in any activity or

plan as a means to ensure equality.

OSCE Ministerial Council Decision No. / Tolerance and Non-Discrimination, Porto,; OSCE Ministerial Council Decision No. / Preventing and Combating Violenceagainst Women, Ljubljana, ; UN CESCR, op. cit., note , para. ; InternationalCouncil o Nurses (ICN), Position Statement, HIV inection and AIDS (adopted in ,reviewed and revised in , and ) ; and UNAIDS, th Meeting o the UNAIDS Programme Coordinating Board,Non-discrimination in HIV Responses, to June , .

Migrants in an irregular situation: access to healthcare in European Union MemberStates, European Union Fundamental Rights Agency (FRA), , .

Ibid. OSCE Ministerial Council, Decision No. / OSCE Action Plan or the Promotion o

Gender Equality, Sofia, December , .
http://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdfhttp://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdfhttp://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdfhttp://www.osce.org/mc/23295http://www.osce.org/mc/23295http://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdfhttp://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdfhttp://fra.europa.eu/sites/default/files/fra_uploads/1771-FRA-2011-fundamental-rights-for-irregular-migrants-healthcare_EN.pdf


35/66


The rights of health workers, related to the exercise of their duties

Work-related rights, such as the right to just, avourable and sae condi-

tions o work, the right to orm and to join trade unions and other as-sociations, etc.;

The right to care, including the management o vicarious traumatization

or compassion atigue arising rom work duties;

The learner, through actions and conduct, demonstrates:

Respect or onesel and respect or others, namely patients and other

individuals within the sphere o influence o health workers, based on

the dignity o all people and their human rights;

A non-judgmental and non-discriminatory approach to patients, col-

leagues and other individuals;

Respect or diversity, including the prohibition o discrimination based

on race, colour, gender, language, political or other opinion, religion,

national or social origin, property, birth, age or other status;

A supportive attitude towards womens human right to health through-

out their lie span;

A child and age sensitive attitude;

Awareness o ones own inherent prejudices or biases, and effort and de-

termination to overcome these;

OSCE Copenhagen Document, op. cit., note , para. .; rd World Health Assembly,Global Code o Practice on the International Recruitment o Health Personnel, WHO, May , .

See General recommendation Women and Health, UN Office o the HighCommissioner or Human Rights, CEDAW,, May , , ; General Comment , op. cit., note .
http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/77bae3190a903f8d80256785005599ffhttp://www.unhchr.ch/tbs/doc.nsf/(Symbol)/77bae3190a903f8d80256785005599ffhttp://www.unhchr.ch/tbs/doc.nsf/(Symbol)/77bae3190a903f8d80256785005599ffhttp://www.unhchr.ch/tbs/doc.nsf/(Symbol)/77bae3190a903f8d80256785005599ff


36/66

. Core competencies

Openness to understanding the cultural and other contexts o ones own

proessional perormance as a health worker;

A supportive and appreciative attitude towards other individuals;

Compassionand attention to marginalized, disadvantaged groups and

persons with particular vulnerabilities;

Compassion or those suffering human rights violations, and sel-assur-

ance in supporting all victims o crime and human rights violations;

Integrity, independence and honesty;

Confidence in protecting human rights, in ulfilling the obligation o

duty bearers to respect, protect, promote and ulfill human rights, and

in perorming ones duty in an accountable, transparent, efficient and

effective manner;

Leadership, personal and proessional engagement in building a culture

o human rights, and especially in the realization o the right to health,

via a commitment to sustaining and saeguarding human rights and to

not be a bystander when rights are violated;

Readiness to reflect and openness to receive eedback to improve per-

sonal and team perormance in ways reflective o human rights values

and principles;

Interest to work collaboratively with others to protect and promote hu-

man rights in and beyond ones own environment; and

Willingness to work in an open and transparent manner so as to pro-

mote public accountability and patients trust .

The principles o compassion include sympathy, empathy, non-judgment, warmth.See Paul Gilbert, Compassion and Cruelty: A Biopsychosocial Approach, in: PaulGilbert (ed.), Compassion: Conceptualisations, Research and Use in Psychotherapy(London:Routledge, ).

OSCE Ministerial Council Decision, Decision No. / Action Plan on Improving theSituation o Roma and Sinti within the OSCE Area, para. (b), , , .
http://www.osce.org/odihr/17554http://www.osce.org/odihr/17554http://www.osce.org/odihr/17554http://www.osce.org/odihr/17554


37/66


The learner demonstrates an ability to:

Respect and protect human rights in everyday work, and especially the

right to health o all persons;

Use the methodology o a human rights-based approach in health plan-

ning, implementation and monitoring o policies and strategies and

other health interventions;

Communicate respectully with patients and other individuals;

Critically evaluate ones own personal contribution to enhancing heath

while respecting human rights;

Promote and advocate on a daily basis or human rights in ones own

proessional environment and in the public domain, thereby contributing

to the improvement o the state o health in general;

Recognize and analyze human rights issues in ones own proessional

context and take the appropriate steps to address these issues by apply-

ing human rights principles, (e.g., by reusing to participate in practices

that violate patients human rights despite institutional or societal pres-

sure, or otherwise preventing and reacting to human rights violations,

including through documentation and reporting);

Provide necessary access to health care or all persons, regardless o le-

gal status, including migrants, and promote such access among decision-

makers at all levels, (e.g., by calling or respect or the applicable medical

code o ethics in debates on entitlement to health care, and or respect or

the confidentiality principle to discourage reporting o personal data to

authorities, such as the legal status o migrants);

Use or advice on the use o the complaint procedures or right to health

violations in the national context, including redress mechanisms at health

See, or instance, Mark Costanzo, Ellen Gerrity, and M. Brinton Lykes, The Use oTorture and Other Cruel, Inhumane, or Degrading Treatment as InterrogationDevices, SPSSI Policy Statement, .


38/66

. Core competencies

acilities, national human rights institutions, courts o law, health proes-

sion regulatory authorities, health practitioners councils and civil society;

Recognize and analyze health issues in a societal context rom a humanrights perspective and initiate appropriate steps to address them, also

collectively where necessary;

Evaluate a policy decision;

Educate and empower other health workers to recognize potential hu-

man rights issues and to take appropriate action;

Provide support to victims o human rights violations and treat themwith humanity and respect or their dignity and human rights, in par-

ticular ensuring their saety, and physical and psychological well-being

and privacy;

Provide a healthy and sae environment or patients and other individuals;

Address the interests o those who require care when acing situations

o dual loyalty;

Take into account the rights o individuals and communities within

medical research projects, including during the stages o selecting,

designing and implementing research projects;

Locate and disseminate inormation on human rights relevant to ones

own personal and proessional needs and interests;

See Human Rights: Human Lives A Handbook for Public Authorities (UK Ministry oJustice, ), .

Basic Principles and Guidelines on the Right to a Remedy and Reparation or Victims oGross Violations o International Human Rights Law and Serious Violations o InternationalHumanitarian Law, United Nations General Assembly resolution /, December, .

Dual loyalty can be defined as simultaneous obligations, express or implied, to a patientand to a third party, ofen the state. See Dual Loyalty & Human Rights In HealthProessional Practice: Proposed Guidelines & Institutional Mechanisms, InternationalDual Loyalty Working Group, a Collaborative Initiative o Physicians or Human Rightsand the School o Public Health and Primary Health Care University o Cape Town, HealthSciences Faculty, .

UNESCO, WHO, CIOMS, Council o Europe, op. cit., note ; and WHO, op. cit., note .
http://www.justice.gov.uk/downloads/human-rights/human-rights-handbook-for-public-authorities.pdfhttp://www.justice.gov.uk/downloads/human-rights/human-rights-handbook-for-public-authorities.pdfhttp://www.ohchr.org/EN/ProfessionalInterest/Pages/RemedyAndReparation.aspxhttp://www.ohchr.org/EN/ProfessionalInterest/Pages/RemedyAndReparation.aspxhttp://www.justice.gov.uk/downloads/human-rights/human-rights-handbook-for-public-authorities.pdfhttp://www.justice.gov.uk/downloads/human-rights/human-rights-handbook-for-public-authorities.pdf


39/66


Use human rights, gender-, age and child-sensitive and non-discrimi-

nation approaches in the exercise o daily duties;

Support patients and other individuals whose rights are violated and

who seek advice, by educating and empowering them to claim their hu-

man rights, assisting them to complain about rights violations using the

appropriate mechanisms and reerring them to appropriate institutions;

Claim human rights on ones own behal and on behal o others;

Identiy human rights violations;

Contribute to the establishment o consultative mechanisms to address

human rights violations (e.g., a committee or the right to health in

a hospital or a complaint office in a ministry o health); and

Establish a sae working environment guaranteeing patients access to

confidential advice, counsel, support and assistance, including in situa-

tions with a risk o human rights violations.

In addition to all the above, training or health workers in management

positions covers all aspects o responsibility, supervision and control where

human rights come into question. Furthermore, training guarantees a high

level o knowledge, commitment and skills enabling mangers to integrate

human rights in perormance appraisal o health workers at all levels.

Supervision training should aim to develop skills, behaviors and knowledge

enabling those in supervisory positions to deal with requirements to or-

mulate human rights-compliant health care procedures and to achieve the

highest attainable standard o health.

See Special Rapporteur on Health, op. cit.note ; London, Leslie and Baldwin-Ragaven,Laurel, Human Rights and Health: Challenges or Training Nurses in South Arica,

Curationis Vol. , No. , , pp. .


40/66

. CURRICULA

Main aim: Ensuring that education-programme design and curricula are

used in ormal and non-ormal learning environments in ways that are ap-

propriate to the particular context, proessional responsibilities and needs

o participants, and are culturally, socially and linguistically relevant.

Curricula can be used in both ormal and non-ormal teaching and training,

taking into account classroom teaching, practical skill-oriented training

and extra-curricular opportunities. Training programmes need to combine

theory and practice, and all health workers should have regular access to re-

resher courses. Any curriculum includes lesson plans that include practical

exercises, as well as theory-based learning activities, handouts, moments

or revision and clear means o testing and evaluating the achievement o

learning outcomes.

OSCE Moscow Document, op. cit., note , para. ., stipulates that the OSCE participatingStates encourage their competent authorities responsible or education programmes todesign effective human rights related curricula (...) or students () attending () publicservice schools.

For syllabi rom institutions and organizations providing health and human rightseducation in academic settings see the online database on health and human rightseducation in academic settings at:.
http://www.hsph.harvard.edu/pihhr/resources_hhrdatabaseintro.html#healthandhumanrightsdatabasehttp://www.hsph.harvard.edu/pihhr/resources_hhrdatabaseintro.html#healthandhumanrightsdatabasehttp://www.hsph.harvard.edu/pihhr/resources_hhrdatabaseintro.html#healthandhumanrightsdatabasehttp://www.hsph.harvard.edu/pihhr/resources_hhrdatabaseintro.html#healthandhumanrightsdatabase


41/66


The curriculum or health workers is built upon the key duties o health

workers as defined in the national health care legislation and relevant in-ternational ethical codes, taking into account human rights standards and

obligations o the state related to the right to health, including specific rec-

ommendations derived rom the United Nations treaty bodies and special

procedures, as well as other relevant human rights mechanisms.

The curriculum is outcomes-based and reflects key human rights education

competencies or each o the categories o knowledge and understanding, atti-

tudes and values, and skills required by health workers and listed in the Core

Competencies section o the guidelines. The curriculum is comprehensiveand includes learning objectives, learning content, assessments, methods and

accompanying materials or use in class or or uture reerence by the learn-

ers. It is suitable or all stages o the health workers proessional lie.

The curriculum takes into account the diversity o all health workers, and is

accessible to all learners, especially women and persons who belong to mi-

nority groups or who have disabilities. The curriculum uses locally available

examples that reflect the daily reality o learners, and when necessary, it is

adapted to specific contexts. Thereore, education programmes range rom

short, highly ocused, simple, on-the-job induction or reresher training to

longer-term courses, or example or medical school students, care providers

and decision makers, requiring a deeper amiliarity with the subject matter.

Curriculum development and review are carried out regularly, to ensure

that curriculum addresses matters o immediate relevance in an inclusive

manner, and involves different stakeholders, such as educational proession-

als, university aculties, learners, educational institutions, patient advocates

and patients representative organizations, as well as other members o

community.

On-site and online courses on health and human rights are accessible or

all audiences.

See Resources section or a list o suggested courses.


42/66

. Curricula

The availability o specific textbooks and other learning resources reflects

the needs and conditions o learners and considers their common concernor human rights.

All learning resources reflect human rights principles and values and in-

tercultural dialogue, the valuing o diversity and equality, and opposition

to discrimination on the basis o race, colour, gender, language, political

or other opinion, religion, national or social origin, property, birth, age or

other status.

In order to ensure their conormity with human rights principles, existingand new textbooks and support materials across all subjects are reviewed

and revised rom a human rights perspective. Practical criteria and stand-

ards are developed or selecting, reviewing and preparing textbooks, case

studies and other learning resources. Materials are reviewed both rom

medical and human rights perspectives to make sure that all relevant ele-

ments are considered.

Textbooks and support materials show health workers practical ways in

which they can promote, protect and monitor the right to health in their

workplace and communities. They also explain the obligations o the state

in relation to individuals in a health care setting, as well as the human

rights responsibilities o the patients and their amilies, and include an in-

troduction to the human rights-based approach explaining the principles

o the human rights-based approach and how to integrate a human rights-

based approach in health sector programming.

Learning resources encourage active participation o learners, or example

through discussion and debate. They also support the use o simulation

techniques and audio-visual materials, and reflect real-lie situations aced

by health workers.

Human rights education materials are disseminated in sufficient numbers

and in appropriate languages.

WPHRE, Plan o Action, op. cit., note , p. .


43/66


Due to the possible complexity o human rights issues or health workers,

working materials contain guidance on how specific matters should be un-

derstood and dealt with. Any support necessary in this regard is sought

rom human rights experts.


44/66

. TRAINING AND LEARNINGPROCESSES

Main aim: Ensuring that training and learning processes are learner-cen-

tered, practical (relating human rights to participants real lie experiences),

participatory, inclusive, promote critical thinking and take place in a learn-

ing environment that respects the human rights o all participants.

Human rights education takes place in an environment that is trusting, re-

spectul, secure and democratic. Educators and trainers demonstrate a mo-

tivation or and an understanding o lesson content and teaching skills in

their interaction with learners, and make sure that health and human rights

notions are in synergy. Likewise, instruction and learning processes are

motivational to students and encourage their engagement with and com-

mitment to human rights.

Co-operation is acilitated between training institutions and other actors

with relevant expertise involved in human rights education or health work-

ers, such as national human rights institutions (NHRIs) and NGOs that are

encouraged to provide training to health workers. Specific human rights

expertise is sourced rom NHRIs, civil society organizations or academia

where necessary.


45/66


Learner-centered methods and approaches are used to empower health

workers to learn, and to encourage their active participation in co-operativelearning and a sense o solidarity, creativity and sel-esteem. These meth-

ods put learners at the centre o the learning experience.

The training sessions aim to:

enhance skills, knowledge and attitudes or successul integration o hu-

man rights into health workers activities;

be action-oriented and ofen combine with the development o advocacy;

oster strategies or collaborative proessional development;

develop reflective practice; strengthen planning, implementation and evaluation skills and knowl-

edge; and

oster partnership between participants by creating ormal and inormal

networks or the promotion o the right to health.

Representatives rom various vulnerable and marginalized groups, as well

as patients are invited to training sessions. This allows them to present

their concerns, needs and cultural traditions. It also acilitates an exchange

o views between these groups and health workers about the responsibilities

and benefits o co-operation.

Analysis o case law, legal opinions and international instruments, and the

elaboration o case studies using an inductive method, acilitate the learn-

ing o general rules and standards, and the active participation o health

workers through interactive problem solving.

Instruction and learning processes acilitate the inclusion o all partici-

pants, and encourage diversity among participants. Methodologies are ap-

propriate to the needs o learners, enabling them to achieve the desired

competencies.

Ibid., p. . For methodological tips regarding human rights training or health providers, see

publications developed by the Health Programme o the Open Society Foundations at:.
http://www.opensocietyfoundations.org/publications/expert-consultation-how-can-training-health-providers-be-effectively-used-promote-humanhttp://www.opensocietyfoundations.org/publications/expert-consultation-how-can-training-health-providers-be-effectively-used-promote-humanhttp://www.opensocietyfoundations.org/publications/expert-consultation-how-can-training-health-providers-be-effectively-used-promote-humanhttp://www.opensocietyfoundations.org/publications/expert-consultation-how-can-training-health-providers-be-effectively-used-promote-human


46/66

Teaching methods are varied and aim at acilitating the adoption o skills

and attitudes that promote and protect human rights (methods may include

discussion groups, ormal lectures, role-playing, simulations, c