A/HRC/23/41 B. Participation 13. Participation of affected communities in decision-making processes is critical to the right to health framework. States should not discriminate on the basis of nationality or legal status19 and should pay special attention to vulnerable groups, such as low-skilled and irregular migrant workers, to protect them from rights violations by third parties, such as private recruitment agencies, intermediaries and employers. 14. Accordingly, States should ensure the participation of migrant workers, including irregular migrant workers, in the formulation, implementation, monitoring and enforcement of laws and policies, including in the negotiation of bilateral agreements. As trade unions are considered fundamental in promoting workers rights,20 including occupational health,21 regular and irregular migrant workers, should be encouraged to participate in or form unions. Effective participation, especially of irregular workers requires positive measures by States to create an environment in which these groups can participate without fear of sanctions. Access to timely and accurate information is a prerequisite to meaningful participation in health-related decision-making. 15. States, including receiving States, should ensure involvement of migrant workers in decision-making processes and awareness-raising strategies, particularly in relation to accessing health services. Participation will also raise awareness among potential migrant workers about issues such as migration stress factors, illegal recruiting practices, their rights in sending and receiving States and obligations of foreign employers. 22 Community participation will assist in making health services culturally and linguistically appropriate for migrant workers.23 In some States, civil society organizations have successfully involved migrant workers in outreach and referral programmes resulting in culturally and linguistically appropriate information for migrant workers,24 thus encouraging communityled initiatives. C. Accountability 16. The right to health mandates States to put in place effective and accessible mechanisms to hold all duty bearers to account. Non-citizens, such as migrant workers also have the right to access legal remedies to challenge violations against them. 25 Although States are the primary duty bearers under the right to health, they have a concurrent obligation to ensure that non-State actors, such as recruitment agencies and employers, are held accountable for violations of the right to health of migrant workers. 17. Accountability requires robust regulatory frameworks across all sectors of employment, with independent mechanisms, to enforce rights and monitor compliance. 19 20 21 22 23 24 25 6 CESCR, general comment No. 20, para. 36. CESCR, general comment No. 18 (2006) on the right to work, para. 54. A/HRC/20/15, para. 35. CARAM Asia, From Voices to Actions: Empowering Migrant Communities through Participatory Action Research (2009), p. 60. IOM, Thailand Mission, Healthy Migrants, Healthy Thailand: A migrant health program model (2009), p. 87, at http://publications.iom.int/bookstore/free/Healthy_Migrants_Healthy_Thailand.pdf Brahm Press (Raks Thai Foundation), Migrant’s Health and Vulnerability to HIV/AIDS in Thailand (n.d.), p. 28, available from http://ns4439.ukserverhosting.net/dmdocuments/Migrant_health_and_HIV_vulnerability_in_Thailand _phamit.pdf. CERD, general recommendation No. 30, para. 18.