A/HRC/39/25 delivery based on human rights, and to increase the use of services by the poor, the socially excluded and disadvantaged castes. Efforts had led to major improvements in healthseeking behaviour, as confirmed by quality indicators. Care delivery was focused on values, behavioural change, training, protocols and monitoring. The approaches taken in this initiative had been adopted in the local municipal health-care systems in 2016. 26. During the discussion, participants considered how rights could be employed from the perspective of (a) legal frameworks and institutions that support the delivery of care through requirements enabling human rights input to health systems; and (b) accountability through the use of quality care benchmarks demonstrating the user’s perspective. They stressed that the issue of discrimination deserved greater attention, given that discriminatory barriers to health care were a central challenge that led to adverse health outcomes. They reiterated that the rights of health service providers should be addressed, and not only the rights of patients, given that, in many cases, the conditions of health-care workers amounted to a violation of human rights. “On the ground” mechanisms were imperative; changes should be accompanied by corresponding protocols. Education and training played a key role, also for health-care professionals on health-related laws. There was in addition a need for a greater focus on care and education provided to women, to ensure that mothers were empowered by relevant knowledge and information. 27. While some participants advocated for the expanded use of randomized controlled trials, others pointed out that they were costly and might not be an appropriate research methodology to gather evidence on the human rights dimension; they proposed that such funds could be used instead for alternative types of research, such as implementation research, including how to better implement effective measures that already existed, and how to develop additional tools and metrics to improve human rights-based approaches to child mortality. The right to privacy starts from the very outset; there was evidence that showed that the prognosis for newborns improved when the right to privacy was respected in intensive care units for newborns. B. Monitoring, evaluation and data to strengthen accountability and quality of care 28. Dinesh Poudyal of the Namuna Integrated Development Council (Nepal) discussed human rights in public health and social approaches for improving child health and accountability. He explained that gender and social discrimination were barriers to improving health in Nepal, exacerbated by lack of knowledge and information, poverty, difficulty in gaining access to health care and a lack of local accountability. In a three-year project encompassing caste-disadvantaged communities experiencing the highest rates of child mortality, progress had been made by addressing the infrequent use of maternal, newborn and child services by marginalized groups and negative gender norms and by promoting the empowerment of pregnant women. Positive change had been eventually made in the district health system, particularly by embedding local accountability systems and emphasizing a rights-based approach to health care. 29. Prasanta Tripathy of Ekjut India addressed the role of monitoring to strengthen community-based newborn health strategies. His organization implemented participatory learning and action through community mobilization and capacity-building workshops to improve maternal and newborn health, in accordance with WHO recommendations. After 10 to 12 group meetings, women felt confident to take on society and government officials in seeking support to improve outcomes. Although the change process had been difficult owing to established, hierarchical ways of working within the health system, the evidence gathered through a monitoring system reflected major reductions in mortality by the second year of implementation. Looking at the data from the perspective of inequality, participatory groups generated the greatest impact for the poorest, as they addressed social determinants and were conducted in local dialects. They had found that neonatal mortality could only be reduced if the poorest rural homes were reached by community health workers. The impact of participatory learning and action interventions had been sustained over time, even though the specific pathways to results had changed over time. 9