A/HRC/44/46
minimum essential food, which is nutritionally adequate and safe, to ensure freedom from
hunger; access to basic shelter, housing and sanitation and an adequate supply of safe and
potable water; provision of essential drugs; equitable distribution of all health-care
facilities, goods and services; adoption of a national public health strategy and plan of
action seated on epidemiological evidence that is to be devised and periodically reviewed
on the basis of a participatory and transparent process; provision of education and access to
information; and appropriate training for health-care personnel, including education on
human rights.
22.
The Special Rapporteur emphasizes the importance of non-discrimination and
preventative interventions on the social determinants of health, health education,
rehabilitation and the human rights education of the health-care workforce, as well as the
provision of health-care at the community level, which is essential for people living in
remote areas or peripheral areas, together with outreach services. Focus on primary care
must not lead to the loss of medical expertise in diagnosing and properly treating a highly
complex disease, nor to the absence of secondary and tertiary services able to address the
multiple medical challenges posed by leprosy. The provision of health care to children
affected should ensure, in cooperation with social, child protection, education and other
relevant services, a continuum of care for children that effectively uses psychoeducational
and psychosocial methods for interventions that enhance emotional health and social
development. The Special Rapporteur also emphasizes the importance of health-care
systems empowering community engagement and participation, including social support,
increased patient-provider communication that should fully acknowledge the experience of
affected persons as valid knowledge, psychosocial individual and family counselling, selfcare and self-help groups, peer support and peer health promoters and outreach activities
within partnerships between health services and persons affected as integral parts of healthcare services.
23.
A rights-based strategy for leprosy within health-care systems must be peoplecentred, having as its priority the well-being of persons, communities and populations, and
must ensure: availability, as well as physical and economic accessibility of health-care
services; quality of health-care facilities, goods and services; active and informed
participation of users; gender-sensitive and culturally sensitive strategies, as well as childfriendly services; accountability of the health-care workforce, with indicators that facilitate
monitoring; non-discriminatory treatment; and provision of high-quality medical care. The
strategy must take a holistic approach that includes a rights-based approach to mental
health, which should be ethically respectful, culturally appropriate, gender-sensitive and
empowering to individuals, making use of peer support as an integral part of recoverybased services.
D.
In practice
24.
In Brazil, the conditional cash transfer programme Family Allowance and the
benefit of continuous instalments for older persons and persons with disabilities have been
guaranteeing financial aid to persons affected who are eligible under the established criteria
for both benefits, even though difficulties in access have been reported. Private-public
partnerships between the Ministry of Health and the Movement of Reintegration of Persons
Affected by Hansen’s Disease (MORHAN), Novartis Brazil, DAHW Brazil, the Sasakawa
Health Foundation and the Pan American Health Organization are examples of
groundbreaking initiatives in the fields of health care and active case detection, awarenessraising, the training of health-care workers, outreach activities and community engagement.
In India, the pension for persons with disabilities has been benefiting persons affected by
leprosy that fit into the established criteria of disability, but difficulties in access have been
reported, as well as the insufficiency of the pension amount to meet basic needs. Civil
society has been taking the lead in the training of affected persons for inclusion in the
labour market and the creation of job opportunities, an important example being the
vocational training centres in India. Microcredit loans, training through partnerships with
non-governmental organizations, including initiatives in areas such agriculture and/or
livestock rearing, have been reported in Mozambique, the Niger and Nigeria. The existence
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