Arnott Grady, Otema Charles, Obalim Godfrey, Odallo Beatrice, Nakubulwa Teddy, Okello Sam B T
Center for Reproductive Rights, Global Legal Program, New York, New York, United States of America.
CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda.
PLOS Glob Public Health. 2022 Aug 22;2(8):e0000836. doi: 10.1371/journal.pgph.0000836. eCollection 2022.
Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.
确保性健康和生殖健康及权利的实现可追究责任，这是一项人权义务，也是改善人道主义环境中卫生系统及成果的战略的核心宗旨。这项试点研究探讨了采用人权战略的可行性和可接受性，具体而言是通过社区主导的参与式投诉机制，促使道主义卫生系统对乌干达北部难民及当地社区妇女和女孩的性健康和生殖健康及权利负责。在15个月的时间里，我们对难民和当地社区的权利持有者及责任承担者开展了一项多方法探索性研究，采用纵向深入访谈、焦点小组讨论和二手数据文件审查的方式。运用演绎和归纳编码技术对数据进行反复分析，以确定内容和主题。通过社区投诉机制收集了107项与性健康和生殖健康及权利相关的投诉和反馈。投诉涉及医护人员的不尊重和虐待行为；青少年无法获得性健康和生殖健康服务及信息；性暴力和基于性别的暴力；以及无法获得可接受的优质卫生用品和服务。参与者报告称，通过该干预措施，他们对人权的理解和主张有所增加，人道主义卫生系统行为体对基于权利的问责战略表示接受，并且在性健康和生殖健康权利未得到尊重时，获得补救的机会有所改善。研究结果表明，在人道主义应对层面整合基于权利的社会问责机制，是加强人道主义卫生系统并使其对受人道主义局势影响的妇女和女孩的性健康和生殖健康及权利负责的一种有前景的方法。
