Egalité homme-femme et développement

Case study: A rights-based approach to promoting ownership and accountability within the health sector in Peru


The humanitarian organisation CARE conducts a health programme in Peru aimed at improving the health of the poor by implementing a rights-based approach. It focuses on increasing the voice of the poor as a key strategy for improving relations between the state and society. This is based on two assumptions: significant and sustainable improvements can only be made if the poor are involved in shaping health policies, practices and programmes; and, if there are strong, participatory mechanisms that ensure what is agreed is translated into action.


Photo credit: Eugenie Itme, Citizen Monitor of Ayaviri, Puno, biking to health post (CARE/USA)


To promote public debate and accountability for health policy, CARE has:

  • Supported reporting processes, such as a civil society shadow report to the UN Special Rapporteur on the Right to Health, as well as reports on sexual and reproductive rights and access to HIV/AIDS treatment.
  • Collaborated with ForoSalud – a nation-wide civil society health network – to build civil society capacity (with a particular focus on women), and to participate in decisions and advocate for health rights.
  • Worked with key government agencies, in particular the Ministry of Health, to develop its capacity to deliver citizens’ health rights and strengthen its accountability mechanisms, and the Peruvian Ombudsman office, to propel oversight of state fulfilment of its responsibilities.


This work resulted in the development of national legislation on health rights and citizen participation, the implementation of specific programmes and strategies on neglected health issues such as neonatal health, and the implementation of local mechanisms for citizen surveillance of health services’ quality. It also produced a strengthened basis for holding the Government to account for service delivery, including the approval of a National Law on Health Services Users’ Rights and Responsibilities in September 2009.


Photo credit: Primitiva Ccoharity, Ayaviri's Citizen Monitor of Health Services (CARE/Peru)


Lessons learned:

  • It is important to raise awareness of health rights with culturally appropriate social communication strategies.
  •  It is possible to develop local mechanisms of surveillance of health services, together with establishing partnerships with key actors to strengthen voice and improve effectiveness.
  • It is necessary to secure funds and political will to implement new laws and agreed health commitments.


Main messages:

  • Citizens’ participation, including through civil society networks, is vital for ensuring more inclusive and sustainable social policies.
  • Mutual accountability should ensure a process that promotes local and democratic ownership.


The original version of this case study was used in the 2009 OECD Development Co-operation Report.


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