Human Rights and Health Go Hand-in-Hand: Professor Savitri Goonesekere Recently Worked with the World Health Organization on a Human-Rights-Based Assessment of Sri Lanka's Laws, Regulations and Policies on Adolescents' Access to Reproductive and Sexual Health Information and Services. She Spoke to Sarah Cumberland about the Importance of Taking a Human Rights Approach to Health

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Q: On 20 November 2009, it was the 20th anniversary of the United Nations Convention on the Rights of the Child (CRC). Sri Lanka is often cited as a model for its work in reducing child and maternal mortality and in improving literacy. How has the CRC contributed to this?

A: Sri Lanka has a good record of achievement with regard to children. In my country, we have had visionary policies on health and education, meaning that every child has had the right to go to school and the right to basic health and that has been reflected in very good social indicators for children even before the CRC. In a sense, politicians had put rights in place through these policies but they weren't written into the 1978 Constitution's Bill of Rights.

Q: What changes followed the CRC in Sri Lanka?

A: Before the convention, we did not consider "rights" were necessary for all children, and child abuse was addressed only from the point of view that they are "children in difficult situations". The convention linked the concept of good governance and state accountability. Giving access to health and education for all children, recognizing gaps in coverage and the need to prevent disparities in health delivery are now state obligations. Protecting children from abuse and exploitation must also receive high priority. The CRC is a powerful accountability measure for ensuring an effective public health system.

Q: Is the CRC really necessary for a country with sound laws and policies?

A: Implementing all the standards on child rights in the CRC is not an easy task. An ideal situation does not prevail in any country, not even developed countries. Some argue that if "the health policies are in place, why do we need to put them in the constitution and other laws?" The reason is clear. Political systems are very fragile. All it takes is a change in a health minister. If someone comes in with a different attitude, everything can change. If a right is not in place in a law or constitution, it's very easy to pull it back.

Q: Is there cynicism about what human rights can achieve?

A: There is a cynicism about rights and what they can do, especially in developing countries. This just encourages states not to implement the treaties they have signed. Human rights laws create a culture of support for implementing health policies by helping the community to monitor the state's actions and programmes. They can't get away with saying "we can't help this situation". Even in a country such as ours, which has some fairly sound laws and policies on health systems and a fairly good administrative system for health delivery, there are gaps and weaknesses. Examples are the regional variations in health and education services and child abuse.

Q: You have completed an assessment of adolescents' rights of access to reproductive and sexual health information and services in Sri Lanka. What did you find?

A: We found that Sri Lanka's focus on child protection has benefited children in the younger age group, but has largely neglected young people. The problem is that we group adolescents as either children or young people but their needs are quite specific. Adolescents' health problems are becoming more complex. Health providers need to acknowledge adolescents have a right to basic health services in some neglected areas such as reproductive health based on access to information and the right of choice.

Over the years, problems have emerged including exploitation of children, particularly young girls who work in domestic service when they should be in school, sexual abuse of adolescents within the family and in the community. Teenage pregnancy is an emerging problem.

Q: Sri Lanka has an exceptionally good record in the region for its attempts to eliminate child marriages. Why do they still occur?

A: Our laws and policies on access to education helped in the implementation of minimum age laws. …