A/HRC/39/25 She stressed the need for a concurrent focus on the wider enabling environment; for example, in WHO pilot programmes to implement quality of care tools in health systems in Georgia, the Republic of Moldova and Tajikistan, a broader goal was to support reporting on the implementation of health-related and other rights under the Convention. She provided examples of standards for assessing and improving children’s rights, for example by defining the best possible quality of care that could be delivered to all children, or developing plans to ensure equality and non-discrimination. The integration of child rights and quality of care standards into relevant undergraduate and graduate curricula was crucial. 22. Raul Mercer of the Program of Social Sciences and Health at the Latin American School of Social Sciences (FLACSO), Buenos Aires delivered a presentation on capacitybuilding and child rights training for health practitioners. He pointed out that the main determinants of health were only 10 per cent medical and 90 per cent due to social and environmental factors. In order to effect change, scientific evidence should be translated with a rights-based approach; a continuum of rights throughout life should be established through, inter alia, the promotion of human rights, the prevention of violations and the restitution of rights. With regard to training health professionals, epidemiological information could be used as the foundation of a national rights-based policy. Barriers in health systems and interventions, including bias, discrimination, omission, homophobia, prejudice and racism, ought to be addressed. 23. Armida Fernandez of the Society for Nutrition, Education and Health Action (SNEHA), Mumbai (India) discussed ways of tackling challenges to quality care in lowincome areas, such as ensuring sustainability. Her work focused on women and children, given that they were the most vulnerable groups in slums. The application of a life-cycle approach to the prevention of violence against women was essential. Almost half of the 16 million inhabitants of Mumbai lived in slums, where many women gave birth in their home. Gaining the trust of communities and changing health-seeking behaviour while accounting for diverse cultures and traditions had posed a real challenge. To bring about changes to behaviour, SNEHA had implemented a capacity-building and monitoring programme for community health workers. India had a mixed public and private health-care system, where partnerships had played a key role, including with private companies, public institutions and the global academic community. An appreciative approach to inquiry had been taken in order to share the strengths of successful approaches identified in workshops held with administrators, doctors, nurses and others. Access to the poorest had been improved by installing neonatal clinics at local health posts, where a referral system to peripheral and maternity hospitals had been developed. Improving the quality of care required partnerships, perseverance and a participatory approach. 24. Tarek Meguid of the Mnazi Mmoja Hospital and the State University of Zanzibar presented his perspective on the feasibility of high-quality maternal and child health care in hospitals in Zanzibar. He described a project designed to assess the readiness of local hospitals to integrate a human rights-based approach to quality of care on the basis of WHO standards. At the largest hospital in Zanzibar, which delivers 13,000 babies every year, infrastructure and services were scarce owing to problems with supplies, staffing and poor standards of care. Health workers were uninformed about rights; training and capacitybuilding were therefore needed to implement quality care standards. Men should be more involved during and after deliveries, but were prevented from doing so. Patients deserved dignity, and could play a key role if empowered to voice their needs. He emphasized the importance of addressing determinants to strengthen health-care systems, and of addressing the political context to bring about justice. 25. Sanjay Atreya of the Asha Health Care programme (Child Welfare Scheme Nepal) made a presentation on integrating children’s rights into the design and delivery of primary care services in western Nepal. He explained that primary care was a key opportunity to integrate human rights, and highlighted its shortfall among the urban poor, leading to, inter alia, violations of rights and hospital services that were unaffordable, and consequently little used or delayed. Many private providers were unregulated, their services just as unaffordable and associated with low quality care. A network had been created to improve primary health care and to make it more accessible, with a view to designing systems and 8