A/HRC/21/22 dimensions of review and oversight, and remedies are also critical elements of the circle of accountability, as is establishing donor accountability.37 A. Monitoring 69. Monitoring in a human rights framework requires the use of indicators, not all of which are quantitative or relate to the health sector.38 A rights-based approach requires systematically tracking and evaluating: (a) Changes in structural factors over time; this includes, but is not limited to, examining whether adopted laws explicitly recognize sexual and reproductive health rights; adopting a national plan; and modifying laws that discriminate against women, as well as institutions, such as creating a national human rights institution; (b) Policy and budgetary efforts within and beyond the health sector. Policy efforts include, for example, costing, resourcing and implementation measures with regard to the national plan. Resources and expenditures relating to sexual and reproductive health should also be tracked, as should the capacity to relate spending to human rights goals and commitments, such as the elimination of financial barriers to care; (c) Concrete results in terms of women’s sexual and reproductive health, and maternal mortality and morbidity in particular; this includes outputs, outcomes and impact in health system categories, ranging from availability, accessibility, acceptability and quality (both through objective indicators, such as case fatality rates, and subjective measures of women’s satisfaction) of health facilities, goods and services to ultimate effects, such as fertility and adolescent birth rates and maternal mortality ratios. 39 70. Effective monitoring requires functioning health information systems, civil registration systems and disaggregated data. The disaggregation of information on the basis of sex, age, urban/rural residence and ethnicity, as well as of education, wealth quintile and geographic region insofar as possible, is essential for ensuring nondiscrimination and equity, and affording due protection to vulnerable and marginalized groups.40 71. Quantitative indicators should facilitate the drawing of conclusions with regard to compliance with international obligations relating to sexual and reproductive health rights.41 In addition to disaggregation, as stated above, quantitative indicators should be (a) continuously or frequently measurable in order that the actions taken by an administration may be measured in a timely manner; (b) objective, to permit comparison across time and countries and/or subregions; (c) programmatically relevant, to enable priority setting and identification of accountability gaps; and, ideally, (d) subject to local audit to promote accountability to populations served. Not all maternal health indicators currently used at the national and international levels comply with such criteria; however, both Governments and development partners should foster accountability by ensuring that 37 38 39 40 41 WHO, Keeping Promises, Measuring Results (see footnote 5), p. 8. See HRI/MC/2008/3. The Accountability Commission endorsed 11 indicators to promote enhanced accountability for maternal and child mortality and morbidity. WHO, Keeping Promises, Measuring Results (see footnote 5), p. 13. Ibid., pp.12-13. Alicia Ely Yamin and Kathryn L Falb. “Counting what we know; knowing what to count: Sexual and reproductive rights, maternal health, and the Millennium Development Goals”, Nordic Journal of Human Rights (on file with the secretariat). 15