[Facilitator’s Note: Part 1 of the e-Discussion : Practical examples and policies in furthering human rights and the MDGs

(see below En, Fr, Sp). We welcome contributions in English, French and Spanish. Thank you]
HuriTALK and MDG-net Facilitation Team (sarah.rattray@undp.org; hideko.hadzialic@undp.org; and Kayla.Keenan@undp.org) for this Annual e-Discussion.

Contributions to date (06 July 2010):             Alfonso Barragués Fernández, OHCHR Geneva; Luz Angela Melo, Human Rights Advisor, UNFPA New York; Malcolm Langford, Guest Moderator*; Heather Bryant, UNDP Nepal; Lucinda O'Hanlon, OHCHR Geneva;
Milena Leivi, UNDP Argentina.

Ibrahim Wani and Malcolm Langford, Guest Moderators* Jasmina Papa, UNDP Croatia; Christian Hainzl, UNDP BiH Urban Jonsson, International Consultant Fadi El Halabi, President of the Ecumenical Disability Advocates Network (EDAN) Mandeep Dhaliwal, Susana Fried, Brianna Harrison and Nada Ali, UNDP New York.

Themes of contributions:        Added value of human rights approach to achieve the MDGs: Human rights principles complementary and must be pursued together – Non-discrimination, Accountability and Participation Human rights-based approach is the most effective and sustainable way to reduce maternal mortality and morbidity: MDG 5 A human rights-based approach requires equal attention to the outcome of the MDGs but also to the process of achieving the goals themselves. Practical dilemma: Prioritize the MDGs or ‘Non-discrimination’ MDG 7: Ensure Environmental Sustainability. Political will and empowered communities will improve access to quality services – the work of the Independent Expert on the issue of human rights obligations related to access to safe drinking water and sanitation MDG 7: Ensure Environmental Sustainability. Operationalizing Human Rights Based Approaches to Poverty Reduction through localizing the MDGs – Experience from Argentina and lessons learned E-Discussion Part 1 extension for 1 week.

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Processes of social inclusion / exclusion are relational in nature, just like the achievement of one particular MDG depends on the achievement of others – at the core of both, social inclusion and MDG achievement is a rights-based approach. Promoting rights-based approaches and practices through capacity development of local governments: Experiences and methodology Stop ‘MDG Reductionism’ and replace it with the full implementation of the Millennium Declaration, with equal commitment, emphasis and monitoring of both Outcome and Process. Adopting and applying inclusive policies and strategies especially towards people with disabilities is needed for MDG achievement and greater awareness and action by partners including the UN on the issues of Persons with Disabilities (PWD) is required. Human rights violations are one of the common links between all of the MDGs, and protecting, promoting and fulfilling human rights are the means by which HIV, health and development responses can deliver cross-MDG benefits. Examples refer to MDGs 3, 5 and 6.
HuriTALK and MDG-net Facilitation Team (Sarah Rattray, Hideko Hadzialic and Kayla Keenan)

To access all contributions thus far to the e-Discussion click here.

Alfonso Barragués Fernández, OHCHR Geneva wrote: Dear colleagues, Thank you for hosting this very timely and important discussion. In the lead-up to the MDG review summit in September, the Office of the High Commissioner for Human Rights has developed a few key messages that emphasize the linkages between human rights and development and the added value of applying a human rights approach in national and international efforts to achieve the MDGs (see below Information Note). We think that these messages could provide a good framework for this discussion. Therefore, we would welcome the views of others as well as any good examples of country experiences demonstrating the instrumental value of human rights, in particular the application of human rights principles of equality and non-discrimination. Having said this, we would also like to emphasize that in many country contexts human rights should be seen as development priorities in themselves, thus requiring a state response in national strategies and development policies. For example, countries facing alarming situations of gender-based violence should make this issue central to their national development strategies. Failure to do that will limit the country's ability to achieve MDGs 3 and 5 by the target date of 2015. A recent study by OHCHR on preventable maternal mortality and morbidity is making clear this need for policy coherence in addressing both human rights and development challenges for a more equitable and sustainable development. Best regards

Governments that pursue development hand-in-hand with human rights stand a better chance of reaching the Millennium Development Goals (MDGs). By incorporating human rights principles into national development strategies and fulfilling their human rights obligations, governments are more likely to be successful in meeting the MDGs (to reduce poverty, hunger and disease and promote gender equality, education, environmental sustainability and global partnerships) and in realizing the UN Charter’s vision of a more equal and just world. Human rights and development policies are mutually reinforcing. They use different yet complementary tools and strategies for achieving the same objective: improving human wellbeing. But while development strategies prioritize economic growth, human rights establish universally accepted legal guarantees to protect the freedom and equality of all individuals. Human rights standards and obligations put the State at the service of the people to ensure that everyone benefits from growth and enjoys a life with dignity. At a UN Summit meeting of world leaders, to be in held New York in September 2010, States will be asked to make a renewed commitment to reach these Goals in the next 5 years. The “action agenda” they agree on at this meeting will be crucial in determining whether or not the MDGs become reality by the 2015 target date. The UN Secretary-General points out in his report for the September meeting, “Keeping the Promise”, that accelerated progress towards achieving the MDGs can be accomplished by adhering to the standards contained in international human rights instruments. These norms and values “provide the foundation for engagement, in particular the key human rights principles of non-discrimination, meaningful participation and accountability.” These principles should drive national and international development efforts. But just as the MDGs cannot be successfully attained in isolation from each other, so too these human rights principles are complementary and must be pursued together. Applying just one principle will not do the job. Development is more likely to be successful if everyone affected is included in the process. The involvement of individuals and communities enables them to have a say and allows the government to better understand their real needs. As a result, policies will be more responsive to the people and thus governments will be more accountable. In order to ensure that everyone benefits from development, governments must combat discrimination that marginalizes some groups and ensure their active and meaningful participation. Non-discrimination Development typically fails when its benefits do not reach groups of people who are systematically disempowered, discriminated against, excluded and/or suffer multiple human rights deprivation. Even in countries where economic growth has lifted some people out of poverty, large inequalities still persist,

with millions of people left behind in the process towards achieving the MDGs. § Governments must take proactive measures to counter discrimination and remove obstacles that prevent the poorest and most marginalized people from accessing basic services, information and remedies. § Disaggregating global average MDG targets and indicators can help better identify the situation of such groups and enable governments to design appropriate national policies and target budgets accordingly. Without suitable data, such groups remain invisible without priority attention and resources, thus widening the inequality gap. Participation The human rights principle of participation can ensure that the people for whom the MDGs are designed become agents of change and not merely recipients to enable them to take ownership for their development. While having the formal ‘space’ for participation is a fundamental pre-requisite, it is not enough. § Governments must remove laws and regulations and change discriminatory attitudes that prevent people from participating. § Pertinent information should be made available and easily accessible. § To enable participation, public polices should promote education, access to justice as well as freedom of association and expression. Accountability The current MDG accountability system will need to be further strengthened to achieve the MDGs by 2015. Human rights offer a framework for strengthened accountability by clarifying the duties and responsibilities of developing states, donor states and non-state actors. This would also ensure more transparency and commitment in national and international efforts. Development strategies should link human rights and MDG accountability systems: § At the national level, for example, human rights institutions and non-governmental stakeholders could be involved in monitoring and evaluating strategies to reach the MDG targets. § At the international level, the Universal Periodic Review and Special Procedures of the Human Rights Council, as well as treaty monitoring bodies, can review national efforts to achieve the MDGs. This can help governments translate their commitments and obligations into concrete action through more operational guidance and better documentation of “best practices” in integrating human rights in development work. Meeting the MDGs will also require strengthened international cooperation, which is a human rights obligation of all States as clearly spelled out in the UN Charter, the Universal Declaration of Human Rights and other international human rights instruments.

*************** Alfonso Barragués Fernández Human Rights Officer Millennium Development Goals Section

Development and Economic and Social Issues Branch Research and Right to Development Division UN/OHCHR - Palais des Nations Office 1-10 Motta 8-14 Avenue de la Paix CH-1211 GENEVE 10 Switzerland Tel: +41 (0)22 928 9626 Fax: +41 (0)22 928 9010 Email: abarragues@ohchr.org

Luz Angela Melo, Human Rights Advisor, UNFPA New York wrote: Based on our experience at the country level, at UNFPA we have some ideas on what should be done to reduce maternal mortality and morbidity. A human rights-based approach is, in our view, the most effective and sustainable way to reduce maternal mortality and morbidity. Key aspects of a human rights-based approach include:  Reducing gender inequalities: Maternal mortality and morbidity are, at their core, a consequence of gender inequalities and health inequities and hence a failure to guarantee women’s human rights. The lack of progress in reducing maternal mortality in many countries highlights the low value placed on the lives of women and testifies to their limited voice in setting public priorities. Women, and particularly women living in poverty, are often unable to access care because they lack the decision-making power, the financial resources, or the empowerment to obtain the full range of quality reproductive health services and information. For adolescents, in particular, high levels of maternal mortality and morbidity stem from gender norms that force them into child marriage, school drop-out and lack of basic knowledge and decision-making power about reproductive health; Ensuring that human rights standards guide laws, policies and programmes: including national Constitutions, recommendations and concluding comments of treaty bodies and resolutions of the Human Rights Council; Availability, Accessibility, Acceptability, Good quality: As the Committee on Economic, Social and Cultural Rights has indicated in its General Comment 14, the right to health in all its forms and at all levels contains the following interrelated and essential elements: availability, accessibility, acceptability and good quality. This is applicable to maternal health. Availability: States should do all they can to ensure that maternal health care services are available to everyone within their jurisdiction. According to the UN Guidelines for Monitoring the Availability and Use of Obstetric Services, for a population of 500,000 there should be a minimum of four facilities offering basic emergency obstetric and neonatal care (EmONC) and one facility offering comprehensive EmONC. There is clear evidence that if obstetric services as suggested by the UN Guidelines are equitably distributed across the population, it leads to a better capacity to address problems of maternal mortality. Accessibility: In addition to being available, maternal

health services should also be accessible to everyone without discrimination. In the context of maternal health services, access has four dimensions: safe physical accessibility, economic accessibility (i.e. affordability), including to women living in poverty, accessibility without discrimination and information accessibility. Acceptability: As well as being available and accessible, maternal health facilities should be respectful of the culture of individuals, minorities, indigenous peoples, women with disabilities, and communities and sensitive to gender and life-cycle requirements. This also implies that sexual and reproductive health services should respect the needs of adolescents and young people. Too often services are centered in traditional ‘adult’ clinical settings and are often viewed as unfriendly and inappropriate sources of care by adolescents and youth. Good quality: Reproductive health services and facilities must be of good quality; and health workers must be polite and respectful. According to the Committee on Economic, Social and Cultural Rights, ‘health facilities, goods and services must also be scientifically and medically appropriate and of good quality’.  Applying the principles of accountability and the rule of law, participation and nondiscrimination into policies and programmes: this means to ensure that all cases of maternal mortality are recorded and explained, showing what works and what does not work; that participatory mechanisms are in place to ensure that women, including indigenous women, women with disabilities, and women living in poverty, participate in health planning at the local and national level; that national human rights institutions integrate reproductive rights into their work; that judges understand that preventable maternal mortality is a human rights issue; that there are mechanisms for redress and reparation for victims and survivors of preventable maternal mortality and morbidity. It is also important to guarantee: Access to family planning and skilled birth attendance with backup emergency and new born obstetric care are another element of the puzzle. These interventions have proven to be effective in countries such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia. Many of these countries appear to have decreased their maternal deaths by half in the space of a decade; Community participation and community driven interventions: are an integral component of public health strategies. The Government of India launched, in 2005, the National Rural Health Mission, to improve access to rural women and children to health services. It focuses on marginalized and excluded women. It established village based health committees composed by elected representatives of women living in poverty and marginalized women, who articulate their needs and demands for quality maternal health services. A cadre of villages based- change agents, who are women from the same communities, help women and girls living in poverty negotiate health care with the health centers and hospitals. Conditional cash transfers are in place to enable women to deliver safely in health facilities. The Programme also aims to conduct maternal death audits to reveal the determinants of maternal deaths, and to initiate community action to prevent such deaths in future. According to reports, India has seen a substantial decrease in maternal mortality and it appears that this Programme is well poised to accelerate pace of decline to achieve MDG5; The focus on the disadvantaged and marginalized is essential: As we know, improvements in national health indicators can mask a deteriorating situation for the poor and disadvantaged groups. In particular, indigenous women and women with disabilities face multiple layers of discrimination. For instance, in our experience, providing effective health services to indigenous peoples often depends on the ability of medical and social services to accommodate cultural understandings, perceptions and practices. But it is more than that. It acknowledges that the

ways in which indigenous peoples understand the world are essential to their identity, and development policies should therefore reflect and reinforce them. In that regard, cultural sensitivity may include the need to offer privacy or preserve modesty when accessing information and services, the use of traditional herbs or teas during labour, or familiarity with alternate birthing positions such as vertical delivery (see case study below). Many indigenous women are more comfortable with traditional medical knowledge, and feel misunderstood or poorly treated by health personnel, who may not speak their language or approve of their medicinal practices. Women with disabilities are not only less likely to receive general information on sexual and reproductive health and are less likely to have access to family planning services, but should they become pregnant, are also less likely, than their non-disabled peers, to have access to prenatal, labour and delivery and post-natal services. Physical, attitudinal and information barriers frequently exist. In many places, women with disabilities are routinely turned away from health services should they seek help, often being told that they should not be pregnant, or scolded because they have decided to have a child. Along with WHO, UNFPA has released internal guidance to its country offices in order to support programmes that are aimed at finding solutions to ensure that women with disabilities enjoy their right to a family, and to appropriate health services;  The cultural factor: We know that in many countries with high prevalence of maternal mortality, cultural and community beliefs coupled with women’s low decision-making power prevent pregnant women from seeking health care during birth and having their babies delivered in health-care facilities. Poor road, transport and water access contribute greatly to maternal and infant deaths and disability. In many of those countries, women suffer from obstetric fistula; Fees are a strong barrier: Poverty in general and significant out of pocket expenditure is a challenge for women in need of services. Families and women have to pay for drugs, medical tests, food and lodging for their relatives. They also have to pay for transportation. But even when services are free there are other barriers. For instance, in some countries where services are free, human resources inadequacies remain a major obstacle to quality service delivery. The main problems are: shortage of medical and para-medical personnel, inappropriate skill-mix, concentration of personnel in urban areas and inadequate presence in rural areas. In addition, in many cases, there are continuous shortages of drug supplies, and health centers are affected by poor management issues. This why it is so important to increase expenditure for health and have functioning health systems: Basic functioning national health systems are a condition /sine qua non /to any effort of reducing maternal health. And also, investments in maternal health will also contribute to the building of health systems more able to respond to all medical needs and emergencies, not just those faced in pregnancy and childbirth.

Please also refer to the UNFPA publication ‘A Human Rights-Based Approach to Programming: Practical Information and Training Materials’, UNFPA and the Harvard School of Public Health, 2010. A short summary of the Ecuador case study (included in the above publication) as it relates to the human rights-based approach in implementing the Free Maternity Law directly relevant to MDG 5 is also included below. Best regards,

Luz Angela Melo, Human Rights Technical Advisor UNFPA New York

(Short Version) UNFPA Case Study Ecuador: The Importance of Human Rights Standards and Redress Mechanisms for Implementing Laws Name of Project: UNFPA Ecuador, Supporting the Implementation of the Free Maternity Law Information provided by Silvia Vega, UNFPA Consultant, and the 2009 UNFPA publication “UNFPA at Work: Six Case Studies”. Context In 1998 Ecuador passed the Free Maternity Law. This guarantees the right to free, high-quality care for pregnant women during pregnancy, birth and the post-partum period. It applies to all women in the country and children between 0-5 years. Despite the existence of the law, many women were not benefiting from the maternity services that they were entitled to; indigenous and rural women in particular. Strategy and Impact The law establishes the creation of User Committees. These committees, whose members are elected by their communities, monitor public health facilities’ compliance with the Law. They also educate providers and community members about what the Law encompasses. With the help of UNFPA, the government decided to support these User Committees. The committees were trained on human rights principles and standards and the methodology of HRBA. The Committees were then able to start educating and encouraging women to claim their rights under the law. They also acted as a mechanism to which citizens could bring cases of abuse, discrimination and negligence of service. Through the forums they organised, they helped identify the priorities and needs of the community. As results of their actions, the Committees helped ensure that the law was implemented. They obtained the provision of free maternity health services in the regions where they worked; the good treatment of women in hospitals; and better awareness among women of their rights under the law. Moreover one major issue that was preventing women from seeking health services was cultural practices. For indigenous women (one third of the Ecuadorian population), the medical system’s child birth practices clashed with their traditional customs. They felt that hospital practices violated their

privacy. And did not allow them to give birth in their traditional way- kneeling. Hospital staff also do not speak their language. General Comment 14 on the right to health calls for all health facilitates to be “respectful of medical ethics and culturally appropriate”. Guided by this General Comment, the User Committees and other actors advocated for more culturally sensitive pregnancy services. After negotiation with the service providers, ‘vertical pregnancy rooms’ that allow women to remain upright during birth have been built. Information about the Free Maternity Law is also being distributed in indigenous language. Lessons Learned 1. UNFPA’s experience further demonstrated that the mechanisms, like the law itself, are ineffectual without concrete steps to set them in motion. That is, merely forming the User Committees was not enough. The next step was to empower them through training to become proactive and self-sustaining forces in implementing the Law. 2. Human rights will not be exercised without mechanisms in place to implement the laws in which they are enshrined. The User Committees helped render the Free Maternity Law effectual. 3. Bringing right-holders and duty-bearers together can develop a better understanding among both groups on how the law is perceived. It can also help identify the obstacles that prevent it from being implemented. 4. Abiding by human rights standards can help ensure that social and economic services are appropriate to different cultures.

Malcolm Langford, Guest Moderator* wrote: The OHCHR Information Note shared by Alfonso emphasizes the linkages between human rights and development and the potential added value of applying a human rights approach in national and international efforts to achieve the MDGs. The challenge to discuss is: how to mainstream a human rights approach into policies, programmes and politics? What are some of the strategies and good practices that have made a difference? Particularly to address women’s rights and social exclusion and inequality? The MDG targets <http://www.unmillenniumproject.org/goals/gti.htm> are problematic for their focus on average outcomes and a lack of attention to reducing inequality. Studies are beginning to show there has been little MDG progress for the poorest of the poor for instance. However, this is where human rights approaches can assist in practice, in particularly principles such as equality, nondiscrimination, participation and inclusion. Moreover, human rights standards such as affordability and physical accessibility can help focus attention on the key obstacles in the way of realizing the rights of women and marginalized groups. A human rights-based approach requires attention to the outcome of the MDGs but also to the process of achieving the goals themselves. Can we share examples of how human rights approaches have led to changes in development processes or policies that would have had negative effects? I look forward to your contributions, Best regards, Malcolm Langford.

*Guest Moderator Mr. Malcolm Langford is a Research Fellow at the Norwegian Centre for Human Rights and Director of the Socio-Economic Rights Programme. Prior positions also include: Director of the Human Rights and Development Research Group, Faculty of Law, Advisor to multiple UN bodies (OHCHR, UN-Habitat, WHO and UN CESCR), Senior Legal Officer at the Centre on Housing Rights and Evications (COHRE), Visiting Fellow at the University of Mannheim, University of NSW and University of Stellenbosch. Primary author of the publication ‘Claiming the Millennium Development Goals: a human rights approach’ and co-organizer of multi-stakeholder events on the topic in Africa, Asia, Europe and North America).

Heather Bryant, UNDP Nepal wrote: Dear colleagues, I can share a practical example from Nepal involving access to water which illustrates the point underlined in Malcolm Langford’s message (“A human rights-based approach requires attention to the outcome of the MDGs but also to the process of achieving the goals themselves”). A few years ago, UNDP was supporting a project called the “Rural Urban Partnership Programme” (RUPP). The objectives of the project included empowering local communities in rural and urban areas through social mobilization and social development activities ranging from leadership training and awareness creation to the provision of grants for improvements to community infrastructure. RUPP was working, among others, in a municipality in a district in the western part of the country; this district is considered to be one of the districts where traditional forms of caste and gender discrimination are most widely practiced. In one of the neighborhoods in the municipality, there were separate, side-by-side wells for Dalits (socalled ‘untouchables’) and non-Dalits. The non-Dalit well was relatively large, and well protected by a stone structure with covered stairs leading to the water point. The Dalit well was smaller, had less water in it, and was less protected from pollution by animals, dust or leaves. In January 2004, the Municipality had provided 10,000 rupees to the non-Dalit community to improve their water source. The Dalit community also requested support to improve their water source, but received nothing. After the UNDP project began working in the area, the Dalit community applied for a grant under the projects’ community infrastructure component to improve their water source. This request posed a dilemma: the Dalits’ well was clearly inferior to that of the non-Dalits, and provision of a grant would have resulted in improved access to clean water. However, investing in the structure would have perpetuated segregated taps and reinforced the physical symbol of discrimination in the urban landscape. We asked ourselves, and many other partners, in simple terms, should the project prioritize ‘the MDGs’ or prioritize ‘non-discrimination’? In search of answers, we looked to some of our “guiding documents”. Looking at the question from the perspective of the MDGs – one of the targets of which relates to access to safe drinking water – and the Millennium Declaration which only mentions “discrimination” once – a development worker might well opt for improving the segregated water source. However, the Millennium Declaration also refers to protecting and promoting civil, political, economic, social and

cultural rights, and human rights instruments offer different perspectives. For example, CESCR General Comment 15 (2002) recognizes water as an independent human right and mentions the “right to a system of water supply and management that provides equality of opportunity for people to enjoy the right to water.” The General Comment also states that, “the elements of the right to water must be adequate for human dignity, life and health.” In the settlement described, the Dalits clearly did not enjoy a system of water supply that provided equality of opportunity, nor could they access water in dignity. The General Comment further states, “water…must be accessible to all including the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds.” Add to this a reading of CERD General Recommendation No. 29 on descentbased discrimination, which includes “discrimination against members of communities based on forms of social stratification such as caste…”, and which refers specifically to “access to public spaces, places of worship and public sources of food and water…”, and simply renovating the segregated tap no longer appears an appropriate solution. An alternate solution in cases such as this might initially delay Dalits’ improved access to water. Instead of immediately renovating the segregated well, development partners could support the Government (in our case, the Municipality) to “take steps to remove de facto discrimination” and allocate resources in such as way as to “facilitate access to water for all members of society”, as recommended in General Comment 15. They could support the Municipality to “encourage dialogue between members of descent-based communities and members of other social groups” (CERD Gen Rec No 29) – in the case at hand, between Dalits and non-Dalits. Additional funds might be required to redesign the settlement water system so that a single, improved water source could be accessed by all. Such an approach might take a little longer, and require a little additional investment, but in the longer run, reducing practices of discrimination around the water tap might also lead to reduced discrimination in other areas of social and public life, in turn leading to reduced inequalities in overall human development. Two different responses to the dilemma – (i) renovating the water source without further attention to social practices or (ii) investing in social advocacy, encouraging dialogue, building awareness of State and community actors of their rights and obligations, and redesigning the water system for the wider community – would have resulted in the same immediate development outcome: improved physical access to water. However, the latter solution, with greater focus on process and on human rights, might ultimately lead to greater human development, social justice and equality. In short, and as already stated, process is as important as the outcome. This case has led the Country Office to be much more attentive to questions of discrimination, even in seemingly straightforward project components such as support to community infrastructure. I am attaching a paper I wrote on this topic, which explains the case in greater detail. Access here. With best regards, Heather Heather Bryant (Ms.) Programme Analyst, Monitoring & Evaluation United Nations Development Programme Kathmandu, Nepal heather.bryant@undp.org

Lucinda O’Hanlon, OHCHR Geneva wrote:

Dear friends, My name is Lucinda O'Hanlon and I work at the Office of the High Commissioner for Human Rights on the mandate of the Independent Expert on the issue of human rights obligations related to access to safe drinking water and sanitation, Ms. Catarina de Albuquerque. Our team working on this mandate noted Heather's post with great interest. In fact, we had read about this example before and think that it illustrates very well the difference that human rights can make. Increasing access to water while perpetuating discrimination is unacceptable from a human rights perspective. We were considering this situation in work we are doing concerning good practices - in this effort, the Independent Expert has made it clear that practices which might be good from one perspective, but which contribute to human rights violations in other dimensions could not be considered good from a human rights perspective. For more information on the work of the Independent Expert on good practices, please see http://www2.ohchr.org/english/issues/water/iexpert/good_practices.htm In her work, the independent expert has come across several examples where reliance on the MDGs falls short of human rights standards. In one country, she was shown water coming out of a tap which was black. That tap counts towards the MDGs in that slum, even though the water is unfit for human consumption. In another country, she was questioned "Why are you here, we have already met the MDGs," even though access to safe drinking water and sanitation in that country was not universally guaranteed, in particular not for indigenous populations. In these cases, the MDGs had been achieved, and the momentum to continually improve access, to reach the hardest to reach, seemed lost afterwards. Those who were left behind are those who are excluded and discriminated against more broadly. On positive note, on another country visit, the Independent Expert was pleased to observe that the country went beyond the 50% MDG targets to set themselves goals of universal access to safe drinking water and sanitation, within a certain time frame. In that same context, she saw that especially the interventions to improve access to sanitation were based on awareness raising of communities which contributed to a bottom-up approach to empower communities to demand quality services. Collection of disaggregated data, and more refined indicators, are necessary measures to gain a more holistic picture of who has access to safe drinking water and sanitation in a particular context. More than anything though, addressing these issues requires political will to change these patterns of exclusion and discrimination. It requires motivation to move beyond the MDGs, which are an important first step, but still only a first step. In the above positive example, the combination of political will and empowerment of communities has resulted in incredible progress in improving access to sanitation, especially when compared with higher income countries in the region. In October, the Independent Expert will present her annual report to the General Assembly which will outline a human rights analysis of the MDGs on water and sanitation. An advanced version of this report should be ready later in the summer, and I look forward to sharing it with you. Looking forward to more interesting contributions in this online discussion. Best regards

Lucinda O'Hanlon Special Procedures Division / OHCHR Palais Wilson, Office 3-080 tel: +41 22 917 9679 email: lohanlon@ohchr.org website: http://www2.ohchr.org/english/issues/water/iexpert/index.htm

Milena Leivi, UNDP Argentina wrote:

In 2005, we took part in the global pilot project ‘Operationalizing Human Rights Based Approaches to Poverty Reduction’ with a local project on targeting MDGs at a local level with a HRBA. The project aimed to develop an analysis and an action plan to achieve MDGs at local level adopting a HRBA, with an in-depth understanding of the concepts and implications related to poverty alleviation, MDGs and HRBA from a local, people-centered perspective. It worked in two municipalities of two different provinces of Argentina and even though it did not address one specific MDG, it intended to operationalize the HRBA in the local plan containing the 8 MDGs, which were aligned to the national adaptation made in 2000. The main impact of the project has been at the local government level, since the pilot Project has provided them with a tool for the development of a local action plan for poverty reduction with a precise methodology. This last one allows integrating all actions and plans – generally scattered through different sectoral areas of municipal and / or provincial and national administration (health, education, social action, etc) – that generally endure serious coordination problems. Moreover, the MDGs local plan allows integrating a clear timeframe and the determination on indicators that enables both the government and the citizenship to evaluate its degree of compliance. Besides, the HRBA favors the fact that citizen participation is a central axle in all stages of the plan: diagnostic, formulation, planning, monitoring and evaluation. It demands the generation of structures and norms that formalize citizen participation in municipal actions, obliging local authorities to pass from declaration to action. Another important impact was the exhaustive analysis of mechanisms and dynamic of social participation in the communities that were part of the pilot project. Given the fact that the participating municipalities value their communities’ participation and counts with structures and mechanisms for it, those structures and mechanisms were the basis for the call to participate in the diagnosis workshops and the participative elaboration of the action plans. Nevertheless, in all the cases, before the call, the participative dynamic had to be reviewed in order to analyze the need to include the territorial and / or specific stakeholders that might not have been previously considered, to assure the widest representation as possible. The pilot project took into account the principles for the development of its strategy’s approach:  People are recognized as key actors in their own development rather than passive recipients of products and services;

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Participation is a means and a goal at the same time; The outcomes and processes must be evaluated; The analysis includes all actors and participants; The programs focus on marginalized groups, disadvantaged and excluded groups; The goals of the programs are to reduce the disparity; The programs require the identification of responsibilities of all actors and participants.

A central point of the strategy adopted by the Project was to articulate the elaboration of the local action plan with the participation of technical experts, municipal and political officers, and CSOs in the already existing participation structures. These last ones were already institutionalized within municipal structures, thus counting with legitimacy and approved management mechanisms. The strategy adopted allowed not only that the elaboration of the action plans efficiently articulates with other executing municipal managerial processes, but also – and most important – that it could be supported by a basic structure that could assure its execution, evaluation and sustainability in the future. One of the project outputs is a methodological guideline for the replication of the experience in other municipalities. UNDP Argentina is signing MoUs with two cities, in order to start working with them in the localization of MDGs to design a local poverty reduction strategy with a HRBA. Most of the challenges faced during the process were related to the available statistical information: from the quantitative point of view neither the government nor the CSOs count with basic statistical information and that in many cases they ignore the available programs that may attend their needs or interests. The problem of providing adequate information is central in order to make effective the citizen participation. The knowledge of the population about mechanisms and criteria by which they can benefit from a program is essential for the access of the whole potential beneficiaries. Moreover, the municipal teams had required technical assistance in:  Elaboration of qualitative and quantitative information, and statistics at a local level;  Design of indicators from a HRBA;  Participatory planning techniques and methodologies;  Institutional communication. CSOs also needed capacity development for institutional strengthening in the areas of:  Institutional communication  Network building  Quantitative information analysis and interpretation  Participatory planning techniques and methodologies. You can find more information on the project, lessons learned and tools developed at http://hurilink.org/argentina.php Best regards, Milena Leivi (Ms.) Democratic Governance PO & Human Rights Focal Point UNDP Argentina Milena.leivi@undp.org

Ibrahim Wani and Malcolm Langford wrote: Dear colleagues, Based on your feedback and interest, we are extending Part I of the e-Discussion: Practical examples and policies in furthering human rights and the MDGs for another week until 03 July to allow for more exchange of opinions on human rights work and utilizing a human rights-based approach toward achievement of the MDGs. We have received thoughtful and inspiring contributions on the subject. Let’s reflect this week on what has been discussed so far and use the questions below (extracted from the eDiscussion thread). We also invite you to share country and / or personal experience in your work with a particular focus on addressing the special needs of the most vulnerable, social exclusion and inequality. PART I Questions / Topics for discussion (14 June to 03 July) [FRENCH I SPANISH] : 1. Can you share recent experiences where human rights work was instrumental in the achievement of specific MDGs? If so, please also provide us with any innovative aspects and key elements of success, highlighting how and why the particular case worked. 2. Could you elaborate specifically on any strategies / examples in working toward the achievement of specific MDGs in:  Addressing the special needs of the most vulnerable  Addressing social exclusion and inequality. What processes, instruments and tools were used? What are the results to date? 3. What are the challenges and practical opportunities in utilizing a human rights-based approach toward achievement of specific MDGs? What have been the implementation bottlenecks, what has been done to resolve them and what were the factors that enabled different options to work? Examples could include: National or local adaptation of MDGs; Human Rights-Based Approaches to programming; Integration of MDG achievement plans in wider development planning processes such as National Human Rights Action Plans (NHRAPs), Poverty Reduction Strategies (PRS) / National Development Strategies; Justiciability of economic, social and cultural rights; Social and human rights impact assessments. After week 3, the e-Discussion Team will summarize all contributions and the e-Discussion Moderators will introduce Part II with a new set of questions. In Part II, which will run from 04 July to 18 July, we will discuss monitoring and accountability and reflections on how the MDG framework can be utilized beneficially toward the realization of human rights. We look forward to your contributions, Your Guest Moderators,

Ibrahim Wani, Chief, Development and Economic and Social Issues Branch, Office of the High Commissioner for Human Rights.

Malcolm Langford, Research Fellow and Director of the SocioEconomic Rights Programme, Norwegian Centre for Human Rights.

Jasmina Papa, UNDP Croatia, wrote: Dear friends, As the discussion on achievement of MDG's intensifies, I would like to share an experience of Croatia on preparation of 2006 National Human Development Report (NHDR) on the topic of social exclusion/inclusion and relevance for programming and questions related to MDG 's that evolved based on this work. In 2006 Croatian Government was preparing one of the crucial documents (Joint Inclusion Memorandum) in the area of social policy which was part of EU pre-accession process. Realizing that there is a lack of reliable, disaggregated data on poverty and quality of life UNDP Croatia has undertaken comprehensive research project to serve as a background for NHDR devoted to social exclusion/inclusion. The findings were then used by line ministry in preparation of a document required as a part of EU pre-accession process. The research project consisted of three aspects: 1. Quantiative survey on Quality of Life which provided insights about the extent and scope of social exclusion among the regions and broad socio-demographic groups in Croatia; 2. Survey among social service providers which fleshed out the institutional and legal framework within which the processes of inclusion/exclusion are being addressed; and, 3. Qualitative research (focus groups) in order to figure out the types and experiences that comprise social exclusion itself. I would like to concentrate here on the qualitative part of the research as it was focused on the at-risk social groups that are not only too small or too hidden to be reached by the population survey, but their critical issues are way too specific to be subsumed under the general notion of exclusion from material resources, labour market or social networks. So, the effort was made to determine not prevalence but pathways of social exclusion as it affects 18 social groups deemed at greatest risk of social exclusion. That is: not seeking answers to 'how many' or to 'which extent' are those people excluded, but to 'what specific form' and 'in which way' they face exclusion and marginalization. Combination of all three aspects clearly showed that processes contributing to quality of life, institutional response and lived experiences of exclusion are mutually interwoven and in many cases influenced by discriminatory practices. These insights were used for preparation of the NHDR Croatia 2006 Faces of Social Exlusion http://www.undp.hr/upload/file/130/65078/FILENAME/WEB_engleska_verzija.pdf and for the programming.

The whole process pointed to certain challenges faced by middle income countries (and UNDP present in those countries) that are approaching EU integrations whilst simultaneously reporting on MDG's: 1. EU pre-accession process is cumbersome for the national institutions and requires, to an extent different technology of preparation. With regard to MDG 1 (nationalized indicator) relative poverty in terms of median income becomes more important than other poverty lines more commonly associated with MDGs. As country progresses, it becomes clearer that even relative poverty concepts and / or concept of income poverty is insufficient to point out to pockets of deep poverty, inequalities and discrimination. 2. The question that then can be asked is should countries that are on the path or are aspiring to join EU, further align their MDG national indicators with the EU agenda. And if they choose to do so, what this means in terms of MDG's - are they then becoming more of social inclusion indicators; and what it means in terms of country needing to invest limited resources in bringing closer two approaches, while they might have only one priority. 3. The data, and in particular data on hard to reach, minority / marginalized groups are too scarce, so they can very rarely make quantitative evidence based arguments that would get ‘heard’ by majority. 4. The processes of social inclusion / exclusion are relational in its nature, just like the achievement of one particular MDG depends on the achievement of others. It seems that at the core of both, social inclusion and MDG achievement is a rights-based approach. But then if there are limited resources within the country, in the times of crisis, policy decisions are even harder to be made. Did other countries in RBEC region that have joined EU faced similar issues and how they have dealt with MDG reporting? Thank you Jasmina Papa Programme Officer Social Inclusion Programme United Nations Development Programme Croatia E-mail: jasmina.papa@undp.org

Christian Hainzl, UNDP BiH wrote: With reference to the request for practical examples within this global discussion, I would like to share a knowledge product from UNDP Bosnia and Herzegovina, capturing the experiences and methodology used by the Rights-Based Municipal Development Programme (RMAP) of UNDP Bosnia and Herzegovina (BiH) in the form of a “Primer on Rights Based Local Development Planning”. Please download at: http://www.rmap.undp.ba/upload/sc/PRIMER_RMAP-Protected.doc In a nutshell, RMAP was designed to strengthen the capacities of local governments in BiH for more inclusive and participatory planning and service delivery, as a way to accelerate development and achievement of the MDGs. To achieve this goal, RMAP applied a HRBA to local policy design and development planning. Specific emphasis was given to a thorough think through and application of the core principles of a HRBA.

RMAP was rolled out in two programmatic phases, with the initial phase lasting from 2002 to 2004 and working with 21 BiH municipalities. In the second phase (2006-2009) RMAP engaged 16 BiH municipalities under its planning, implementation and capacity development component. The RMAP Primer mainly builds on the practices and experience of the second phase. Written by the project staff, it intends to make available a series of best practices, methods and lessons learned. The focus is on presenting the specific value-added of integrating a HRBA with local development planning. This Primer has three principle sections. The first section critically examines conventional concepts of local development and presents standard practices in the field. It further presents in short the conceptual role of human rights in (local) development, as well as addresses the essential features of an HRBA. The second section presents the RMAP project and its components in the context of BiH. It starts with some key issues and challenges related to local development in BiH, followed by principle considerations related to the design of RMAP and the tailored application of a HRBA to local development in BiH. It also provides an overview of the planning and implementation methodology and processes as applied within RMAP. The last section seeks to provide in detail entry points and value added of the application of a HRBA in local development planning and management processes as facilitated by RMAP. The approach chosen is to show how the application of a so called “human rights lens” changes and adapts the various steps of a local development planning and management processes, with a view to take guidance from human rights normative contents as well as to in particular give concrete meaning to the leading principles of a HRBA - participation, accountability and non-discrimination and empowerment. Finally, this section also provides key lessons learned during the RMAP design and implementation. In the annex some of the typical municipal projects supported and co-financed by UNDP RMAP are presented in more details and the full listing of all local projects implemented is provided. Why do we think that this is a relevant example? First, it highlights the transformative potential of a HRBA and a way to strengthen cohesion within diverse and inter-ethnic communities. Along such thought, the 2009 Assessment of Development Results (ADR) for Bosnia highlighted RMAP for its efforts to introduce a participatory approach to local planning based on human rights. The ADR further recognized that UNDP’s activities provided special attention to transforming the municipal management from a purely administrative function inherited from the past socialist regimes to a more participatory, inclusive decision-making process, by ensuring that minorities and the vulnerable and socially excluded groups have a say in shaping the development of their communities. Second, it underlines the specific value of human rights principles for a practical and pragmatic implementation of a HRBA. HRBA projects regularly run into the issue how to properly tailor the application of a HRBA to the overall program aim and the country context. A key challenge is to avoid analytical/ conceptual deadlock, while at the same time offering concrete and effective results for local partners. In the framework of RMAP, a HRBA was used as a discrete but complementary framework, building on the premise that human rights

principles and approaches contribute best to development programming when they complement existing best practices. Pragmatically, RMAP has found that human rights principles and approaches are legitimised and operationalised to a greater degree by their complementary integration into existing best practices, than when they attempt to provide the entire solution to development problems, and to thereby aim to “reinvent development.” In other words, RMAP tried to put on a “human rights lens” and analyse the objectives, structures, processes and results of a LED (local economic development) planning process, with a view to deepen, amend, change and widen the approach, as well as, at the same time to keep and adopt what already worked well or where a human rights perspective simply had nothing to add. In this regard a structured application of HRBA principles, as described in the Primer, proved to be particularly helpful. Third, it flags an approach and a methodology that was applied and tested throughout the full cycle of a project, and which offer itself to partial or full replication. RMAP not only devised and applied a methodology to local development planning, resulting in concrete, well founded multi sectoral planning frameworks, but also gave concrete and effective technical assistance and financial support for the implementation of priority projects from the municipal development strategies in its partner municipalities resulting in more than 40 small to mid-size municipal projects identified and implemented reaching some 90,000 of beneficiaries in the partner municipalities. In this regard roughly USD 600,000 of seed funding was provided by UNDP RMAP in total, while notably, local project co-financing doubled or tripled the seed funding provided by the program, amounting to more than USD 1,410,000 spent on local projects. By this way we also succeeded in bridging the often existing gap between planning and implementation targeting concrete change on the ground. (References to individual projects are attached to the Primer.) While the RMAP project was finally closed in 2009, its approach and its hands-on experiences have served as a model and resource at regional and global workshops with the methodology and tools being reviewed and used across the Western Balkans region. We thus hope that colleagues in this wider global discussion will find the experiences and lessons captured in the Primer useful; and we are looking forward to hearing back from you. For more detailed info on or references to RMAP pls visit: www.rmap.undp.ba www.hurilink.org/bosnia_detail.php UNDP Primer on “HR & MDGs – making the link”. Christian Hainzl, UNDP BiH (for the former RMAP team)

Urban Jonsson, International Consultant on Human Rights, Development and Democracy wrote: In order to understand the relationship between the MDGs and human rights, both concepts need to be contextualized historically and programmatically.

During the last decade two competing development approaches have emerged. First, the Aid Effectiveness Agenda, with demands for increased effectiveness in development cooperation, originally initiated and promoted by the World Bank and articulated in the Aid Effectiveness Agenda at the High Level Forums in Paris (2005) and Accra (2008) and by several OECD / DAC meetings. Second, the Human Rights Agenda, with its origin in the United Nations Charter and the Univeral Declaration on Human Rights articulated at the Millennium Summit (2000), the United Nations Summit (2005) and in several reports by the Secretary-General to the UN General Assembly. There is a need to reconcile these two international agendas and many recent efforts have also been made to do that, for example the OECD / DAC concluded in their Action Plan that ‘there is an urgent need to close the gap between the aid effectiveness agenda and the human rights agenda (OECD/DAC (2007), Action-Oriented Policy Paper on Human Rights and Development). It is important to note that not a single word about human rights is said in the Paris Declaration. However, very soon after the Paris Declaration several NGOs protested against this lack of attention to human rights in the Paris Declaration. The Canadian Council on International Cooperation (CCIC) and Eurodad made a very distinct difference between aid effectiveness and development effectiveness (CCIC (2006), The Paris Declaration on Aid Effectiveness: Donor Commitments and Civil Society, Critiques, CCIC, Backgrounder, May 2006; and CCIC (2008), Accra Agenda for Action: Moving from Aid Effectiveness to Development Effectiveness, CCIC). These can be mutually reinforcing, but they may also be contradictory. Aid effectiveness, for example, does not necessarily result in development effectiveness. OECD / DAC has tried very hard to reconcile the two Agendas (OECD Working Group on Aid Effectiveness (2008), Aid Effectiveness. A Progress Report on Implementing the Paris Declaration). In a report they concluded that all parties have made commitments to results on key issues such as gender equality, human rights and environmental sustainability (including the MDGs, the Beijing Platform for Action, the Rio Conventions and the Vienna Declaration and Programme of Action) and these can be used to improve the results-focus of development activities. It is very clear that human rights principles and standards can be used to define the results to be achieved and the strategies needed to achieve them. This requires equal attention to outcome and process. There is not inherent conflict between resultsbased management and a focus on human rights. The conclusion must be that the relationship between the RBM and HRBA depends on how ‘result’ is defined. If result includes both outcome result and process result, there is no contradiction between RBM and HRBA. RBM then becomes an obligatory part of HRBA. The recognition of the construction of development as an outcome and process is important and provides the basis for the construction of a human rights-based approach (HRBA) to development by identifying desirable outcomes with human rights standards (e.g. the first seven MDGs) and the legitimacy of the process with human rights principles (e.g. equality, participation etc.). The case from Nepal, described so eloquently by Heather Bryant, represents a wonderful example of the outcome / process construct, or that the ‘aim does not legitimize the means’. In September 2009, the OECD / DAC issued Draft Guiding Principles for Human Rights and Aid Effectiveness (OECD/DAC (2009), Draft Guiding Principles for human Rights and Aid Effectiveness, September 2009). The Guidelines suggests three human rights-based opportunities for strengthening

aid effectiveness: (1) ensure that human rights are central to the objectives of development; (2) use human rights as a basis for building more effective and inclusive partnerships for development at international, national and local levels; and (3) ensure that development policies and programmes are designed and implemented in ways that are consistent with agreed international commitments on human rights, gender equality, disability and environmental sustainability. This consensus suggests a strong commitment by donor agencies to address the achievement of the MDGs within the context of the Millennium Declaration, which stipulates human rights criteria for the process to achieve the desirable MDGs. But what happened with all this new insight, consensus and commitment to address and monitor both outcome and process? In 2004, Philip Alston was asked by Geoffrey Sachs to review the annual country MDG reports (Alston, P. (2004) “A Human Rights Perspective on the MDGs”, Paper prepared as a contribution to the work of the Millennium Project Task Force on Poverty and Economic Development). His critical report was not accepted by the Millennium Project and he then published an edited version of it in Human Rights Quarterly (Alston, P. (2005), Ships Passing in the Night: The Current State of the Human Rights and Development Debate seen through the Lens of the Millennium Development Goals Human Rights Quarterly - Volume 27, Number 3, August 2005, pp. 755-829) . He found in his review that almost no annual MDG report contained anything on human rights, or any other aspects of the process, and strongly recommended that people working in development and people working with human rights should start talking to each other to find a way to better work together in achieving the MDGs. How could this MDG Reductionism happen? Why does it continue to happen? Let us look at a few common misunderstandings of the Millennium Declaration. First, very few people in development seem to be aware of the fact that only 8 out of the 43 Goals were included in the list of MDGs. Seven of the eight MDGs reflect outcomes, and very few are talking about MDG 8. In conclusion, all MDGs that most agencies and governments are trying to achieve represent desirable outcomes. The Millennium Declaration (MD) is simply not appreciated as the major human rights document since the Vienna Conference 1993. In the Millennium Declaration it is stated that world leaders have a ‘collective responsibility to uphold the principles of human dignity, equality and equity at the global level’ (para.2); ‘…respect human rights and fundamental freedoms for the equal rights of all’ (para. 4); and, ‘We are committed to making the right to development a reality for everyone and freeing the entire human race from want’ (para. 11). All reflecting a strong demand for human rights-based processes to achieve the MDGs. This uncritical focus on outcomes only was criticized by the former Secretary – General, Kofi Annan, who in an email to Mark Malloch Brown, then Administrator of UNDP had said ‘Kofi Annan had recently chided me and others for concentrating so much on the eight MDGs that we forget that they are part of the Millennium Declaration which calls for very strongly for democracy and human rights as the route to achieving the goals’. The risk of a blind focus on the MDGs out of context of the Millennium Declaration was recognized already at the Stamford meeting in 2003 (which issued the UN Common Understanding on a Human Rights-Based Approach to Development Cooperation) which was summarized in the report as ‘there is a concern that, taken in isolation, the MDGs might lead us back into a technocratic (input / output) approach to development’. The real issue is therefore whether the achievement of a desirable outcome as a genuine human rights realization OR just a privilege (i.e. there is no mechanism for the right-holder to enforce the right).

There is an urgent need to stop the ‘MDG Reductionism’ and replace it with the full implementation of the Millennium Declaration, with equal commitment, emphasis and monitoring of both Outcome and Process. A second serious mistake, or maybe even a deliberate effort to confuse, is the fact that although from the very beginning it was clear that the MDGs are referring to global averages, the World Bank and all UN agencies promoted the acceptance of the global MDGs as national goals. The global MDGs were calculated as the predicted result of 25 years from the base-year 1990 if the trends continued to be the same as the previous 25 years. This of course means that different countries would continue to develop at different speed. It is therefore nonsense to talk about “how can Mozambique achieve the (global) MDGs” or ranking countries according to percentage achievement of the (global) MDGs”. The fact is that the (global) MDGs can very well be achieved with some countries getting worse off than 15 years ago. This is why many statements do not make much sense, like “We do understand that most African countries will not meet the 2015 targets. We still have a long way to go until the MDGs are met in Africa” (Bob McMullan, MP, Australia); or “Africa is the only region in the world where not even a single country is on the track. We must help those countries so that they can join on the track” (Ban Ki moon, May 2009). Finally, from a human rights perspective there is a very important difference between ‘promise’ and ‘obligation’. A ‘promise’ can be broken at any time without any repercussions, so often seen with the use of basic needs approaches. After the 1990 World Summit for Children, where the majority of world leaders committed themselves and their countries to improve the situation of children, UNICEF launched the journal “Keeping the Promise”. The publication of this journal ceased when it was clear that most leaders would not ‘keep their promises’. Ratification of international human rights treaties, however, does not mean ‘promises’, but entails an obligation according to international law. With this well known distinction, it was quite surprising to read the title of the recently issued General Assembly report, referred to in this discussion, “Keeping the Promise: A Forward-looking review to promote an agreed action agenda to achieve the MDGs by 2015”. We are back to a world in which the leaders of the world only need to ‘promise’, not to be held accountable for the non-realization of human rights. And by avoiding any talk about the process, unpleasant ideological and political aspects of the process, including equality, non-discrimination and participation, can continue to be avoided. Urban Jonsson International Consultant on Human Rights, Development and Democracy Executive Director, The Owls

Fadi El Halabi, President of the Ecumenical Disability Advocates Network (EDAN), wrote: Before talking with you about our experience as an NGO in the field of disability and what was our contribution on that level, allow me to first share some real concerns about the MDGs regarding adopting and applying inclusive policies and strategies especially towards people with disabilities, my experience with UN agencies till now is not very promising on that level, despite all the calls of the UN Secretary-General to include people with disabilities in their respective agenda, until now the answer has been very limited and it seems we need to do a lot of work to reach a point where Persons with Disabilities (PWD) are as respected as other vulnerable groups.

I will share first of all with you two documents: 1. Report of the Secretary-General on the Implementation of the World Programme of Action concerning Disabled Persons: the Millennium [A/62/157]. http://www.un.org/disabilities/default.asp?id=711 In this report there is a call to include the disability agenda in each of the goals of the MDGs. 2. Mainstreaming disability in the development agenda. Report of the Secretary-General http://www.un.org/disabilities/documents/reports/csocd48.pdf In this report the Secretary-General mentioned what was achieved regarding disability cause to be included in the UN agencies agenda and he recognizes that it is still a new process to integrate in the mindset of the UN. Regarding the report: ‘Keeping the promise: a forward-looking review to promote an agreed action agenda to achieve the Millennium Development Goals by 2015’. Disability was highlighted only regarding education and it was ignored in all the other dimensions, which proves one more time that this group who represents 10% of the population (650 million persons) do not get enough attention. I would like to share another personal examples that ‘shocked’ me on that level: I was asked to prepare a seminar about human security, peace and disability, to be able to write a concept note I was supposed to read most of the UN reports about this concept, I have to admit that I was concerned that the disability cause was not mentioned at all in all of the documents that I read even the most recent ones although all the other categories of people are mentioned. In two subsequent reports by UN agencies: the Arab Human Development Report 2009: Challenges to Human Security in the Arab Countries which was a report gathered by highly esteemed researchers disability was not mentioned in a region where we have 30 million PWD, the most marginalized groups and in Human Security: Human Security Approaches and Challenges 2008 disability is only mentioned in one of the recommendations briefly but ignored as a concept and as one of the criteria to be taken into consideration. These facts make me feel that before advocating and lobbying with governments and the private sector and society in general, I need to do the same thing to make the UN agencies start including in a serious way the disability cause in its agenda knowing that without those efforts we can never make a real change in life of PWD who are supposed to be treated in an equal way as any citizen. This is my first contribution to this e-Discussion and I hope that you will take it as a positive call to start resonating in another way with the disability cause to reach a better understanding and action on that level so that the MDGs will be achieved in a more inclusive way in 2015. Regards, Fadi EL Halabi, President of the Ecumenical Disability Advocates Network (EDAN) Lebanon.

Mandeep Dhaliwal, Susana Fried, Brianna Harrison and Nada Ali, UNDP HIV Practice New York, wrote:

Building on the contribution of Luz Angela Melo at UNFPA in relation to MDG 5, UNDP would like to share some lessons learned regarding the role of human rights in our response to the MDGs from the last three decades of the HIV response. The Millennium Declaration is grounded in human rights and is the foundation of States’ commitment to achieve the Millennium Development Goals. Echoing the contribution from UNFPA, UNDP’s efforts to accelerate sustainable progress on all of the MDGs in underpinned by human rights. An example to illustrate this point is drawn from efforts combating the spread of HIV (MDG6), addressing maternal mortality and morbidity (MDG5), and reducing gender inequality (MDG3). Human rights-including women’s rights and gender equality – constitute common denominators in relation to maternal mortality and morbidity and HIV. Moreover, safeguarding women’s rights and promoting gender equality is central to achieving all the MDGs. This contribution focuses on three main points: i. The importance of devising strategies that simultaneously address HIV and maternal mortality and morbidity, with explicit attention to gender equality; ii. How a human rights-based approach helps address the structural drivers and consequences of HIV and maternal mortality and morbidity; and, iii. How this relates to collective efforts to realize the Millennium Declaration and achieve the MDGs. According to the most recent evidence, 18% of maternal mortality globally is attributable to HIV (Hogan M. et al. Maternal Mortality for 181 Countries, 1980-2008: A Systematic Analysis of Progress Towards Millennium Development Goal 5. The Lancet. 12 April 2010). At the same time, globally, about 50% of people living with HIV are women, though in sub-Saharan Africa the rate is over 60% (WHO/UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008, Geneva. Available at: http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008). The importance of concrete action on gender equality cannot be overstated: while gender equality is a human right and MDG in and of itself, it is also essential to achieving all the MDGs. Sustainable, rights-based HIV, health and development results depend on addressing structural drivers such as laws, policies, practices that fail to recognize the different conditions in which women and men live and which impact on their differential ability to claim rights and access HIV and health services. Gender inequality, HIV and maternal mortality and morbidity are inter-related; they flourish when human rights are not enjoyed and discrimination prevails. And while they require health sector responses, they also require complementary responses in other sectors to address structural and social inequalities. Structural interventions work to effect positive health outcomes in many ways:  First, they alter the context in which health is produced: for example, addressing economic marginalization and food insecurity among women can help prevent risky sexual behavior and thereby help prevent HIV, while this can improve women’s decision making power, including in relation to the use of health services. It also has a significant impact on maternal health since inadequate nutrition can increase complications with pregnancy (For more information, see The Partnership for Maternal, Newborn and Child Health at http://www.who.int/pmnch/en/). Second, structural interventions address socioeconomic conditions, the legal and policy context and cultural norms (including ideas about appropriate feminine and masculine roles); and stress

linkages between sexual and reproductive health and HIV policies, programmes and services. For example, where women have the right and capacity to travel to clinics, they are better able to access the health services they need. Indeed, women’s ability to access contraception and decide on its use, including male and female condoms, can help prevent unintended pregnancy (which has been identified as a risk factor for maternal ill-health) and unsafe abortion as well as HIV. Third, structural interventions can lead to sustained progress, particularly where those who were disempowered by the existing structures are directly involved in determining the changes needed for equal enjoyment of rights- this is embodied in the hallmark of the AIDS response – the principle and practice of the greater involvement of people living with HIV (See, for example, The World Bank, Public Health at a Glance).

A sustainable response calls for strategies that address inequality. An example of such an approach is an initiative in Malawi which provided cash incentives to school girls to stay in school and for recent dropouts to return to school. This project resulted in significant declines in early marriage, teenage pregnancy and self-reported sexual activity within 12 months – which reduces gender inequality and has positive flow-on effects including reducing vulnerability to HIV and unplanned pregnancy (Baird et al, The Short Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behaviour of Young Women, The World Bank: Impact Evaluation Series No 40 , October 2009). The likelihood of maternal mortality and morbidity increases by 1.5-2% if a women is living with HIV (J McIntyre. Mothers Infected with HIV: Reducing Maternal Death and Disability During Pregnancy. BR Med Bull 2003; 67: 127-135). Women living with HIV face persistent threats or acts of violence and other human rights abuses – whether in the form of dispossession of their rightful property or battery at the hands of partners and other family members. And, women living with HIV face discriminatory treatment by health workers and law enforcement which can increase their vulnerability to the negative impact of HIV on their health and discourages them from seeking health services (Global Coalition on Women and AIDS, Keeping the Promise: An Agenda for Action on Women and AIDS; Centre for Reproductive Rights, At Risk: Rights Violations of HIV Positive Women in Kenyan Health Facilities, 2009. Available here; Nyblade et al, “Combating HIV Stigma in Health Settings: What Works?” Journal of the International AIDS Society 2009, 12:15; Odgen, J and Nyblade, L. Common at its Core: HIV-Related Stigma Across Contexts, International Centre for Research on Women, 2005). For example, recently there have been numerous reports of coerced sterilization of HIV-positive women. In view of these interconnections, rights-based maternal mortality and morbidity programmes can have a broader impact on HIV and other development goals. Multi-pronged strategies that address the need to scale up health and community systems can have an impact across health and non-health MDGs, to empower women to secure their sexual and reproductive health, and to address root causes of vulnerability to maternal mortality and morbidity and HIV through fostering gender equality and securing human rights. For example, in India, knowledge of and access to sexual and reproductive health services in rural areas is low, and HIV-related stigma and discrimination lead to low levels of demand. UNDP is supporting a public-private partnership to establish small hospitals providing low-income clients with access to maternal and child healthcare services –such services can help make societies more crisis-resilient over the longer term, and contribute to more sustainable and equitable development (UNDP Press Release 8 April 2010. Available here). And efforts can have even greater impact on HIV and other MDGs when combined with programming that strengthens women’s legal and economic empowerment, such as microfinance projects combined with

HIV and gender-based violence prevention or community mobilization and challenges to traditional gender norms. By the same token, rights-based HIV programmes contribute to progress on maternal mortality and morbidity and other MDGs. For example, Kenyan NGO Liverpool VCT (UNDP, “Women, girls and HIV: Delivering Results. Update on Universal Access for Women and Girls Now!”, March 2010; http://www.liverpoolvct.org) has been working with the government to scale up comprehensive post rape care services in health facilities, as well as providing services to some of the most vulnerable communities, such as sex workers and men who have sex with men. It has been recognized that violence is linked both to HIV vulnerability and to increased maternal mortality and morbidity. UNDP is currently supporting LVCT to share its research and good practice to further influence policy and strategy in Kenya, including the third National HIV Strategic Plan III and its first National Plan of Operations. In terms of human rights programming, the Joint United Nations Programme on HIV / AIDS (UNAIDS) response is calling for governments to scale up programmatic responses to HIV-related human rights issues through implementing a package of programmes to reduce stigma and discrimination and increase access to justice for key populations (See, for example: Decision of the UNAIDS Programme Coordinating Board, June 24 2010. Available at: http://data.unaids.org/pub/Agenda/2010/20100603_26pcb_decision_points_en.pdf). These programmes – legal audits and law reform; legal services; ‘know your rights’ campaigns; stigma and discrimination reduction; training and sensitization of law enforcement agent, lawyers and / or judges; and training of health care providers on HIV-related human rights issues – build the capacity of key sectors such as law-makers, health and law enforcement. They also, importantly, empower those most marginalized and vulnerable to know and claim their rights, and to demand a social and legal environment that enables them to achieve and reach beyond the MDGs. UNDP’s MDG Breakthrough Strategy specifically highlights the need to tackle structural drivers as one of the key strategies for accelerating progress on all the MDGs. As with achieving success in halting and reversing the spread (and impact) of HIV and AIDS, making progress on other MDGs (including health and non-health MDGs) requires action that goes beyond isolated interventions. UNDP’s support – in terms of its work on governance, human rights, capacity development, aid co-ordination, integration of maternal health into Poverty Reduction Strategies and National AIDS plans and strategies, improving delivery of services and leveraging of resources – is crucial if goals relating to reducing maternal mortality and morbidity, gender equality and HIV are to be met.

Mandeep Dhaliwal, Cluster Leader: Human Rights, Gender and Sexual Diversities; Susana Fried, Senior Gender Advisor, Brianna Harrison and Nada Ali, Consultants, UNDP HIV / AIDS Practice, New York.

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