A/HRC/27/31 policy/programme design, implementation, monitoring and evaluation, and in accountability mechanisms. This includes ensuring that institutional mechanisms exist that enable people to participate; ensuring that all segments of the population, including the most marginalized, can participate; and making available functional independent accountability mechanisms in relation to participation. 29. Participation requires that States create an enabling environment for citizen engagement and develop capacity to ensure that duty-bearers can fulfil their obligations and that rights-holders have the knowledge that allows them to claim their rights. Participation should be viewed as fostering critical awareness, and decision-making as the basis for active citizenship.17 In the case of young children, such capacity-building may be targeted towards their caregivers. 30. Participation in the context of under-5 mortality and morbidity means ensuring that children’s parents, or other representatives, can access all relevant and necessary information to ensure an informed opinion about the child’s health status and potential interventions, and participate meaningfully in the decision-making processes which affect their children’s survival and health. 31. The best interests of the child should be assessed and taken as a primary consideration in all actions affecting children, including actions concerning their health, and should guide decisions on issues ranging from individual treatment options to policy and regulatory frameworks. This requires that States place children’s interests at the centre of all decisions affecting their health and survival, including decisions on the allocation of resources and on the development and implementation of policies and interventions that affect the underlying determinants of health. 32. Ensuring accountability is at the core of actions to address under-5 mortality and morbidity. Accountability requires multiple forms of monitoring, review, oversight and redress – administrative, social, political and legal. States have the obligation to ensure that relevant government authorities and service providers are accountable for maintaining the highest possible standards of children’s health and health care. This means, for instance, ensuring that health service users are able to report essential medicine stock-outs in addition to ensuring that there procedures for investigating preventable deaths. States have an obligation to ensure that functional, accessible accountability mechanisms exist such that all duty-bearers can be held to account and that both the individual and the structural nature of any children’s rights violations and harm caused by discrimination in regard to children’s health-related rights can be addressed.18 33. A human rights-based approach to health requires States to ensure the availability, accessibility, affordability, acceptability and quality of facilities, goods and services related to health, as well as to address its underlying determinants, such as poverty, poor education and lack of access to other social services.19 A well-developed and accessible health system characterized by attention to all the principles of a human rights-based approach, through which children and caregivers have access to health information, services and commodities, is critical. Similarly, collaboration across government sectors is required to address the underlying determinants of health. 34. The State bears the primary human rights obligation in relation to child health and survival and also has an obligation to ensure that non-State actors, including individuals, do 17 18 19 United Nations Population Fund and Harvard School of Public Health, A Human Rights-based Approach to Programming: Practical Implementation Manual and Training Materials, 2010. E/C.12/GC/20, para. 40. E/C.12/2000/4. 7