A/HRC/21/22 providers, insurance and pharmaceutical companies, and manufacturers of health-related goods and equipment, as well as community and family members, comply with certain standards.19 States may be held responsible for private acts if they fail to act with due diligence to prevent, investigate and punish violations of rights. 20 23. Where the health system is decentralized, the national Government remains accountable for complying with human rights obligations, including those relating to sexual and reproductive health. III. Planning and budgeting 24. Public health planning traditionally begins with the acknowledgement of a maternal mortality and morbidity problem, and then goes on to propose how to address it within the current societal framework. Rights-based planning goes further by also examining the dominant assumptions underlying the structural determinants of women’s health, and then includes strategies to address those factors, to reshape the possibility frontier for advancing maternal health. A human rights-based approach therefore changes decision-making processes, and the issues and actors included in those processes, as well as outcomes. 25. A human rights-based approach requires a multi-sectoral approach to economic and social planning and budgeting, including, at a minimum, coordination among a variety of Government ministries and departments, as well as with other key actors, such as the private sector, development partners and civil society. Moreover, planning and budgeting processes cannot leave all decision-making to technical experts; full transparency and meaningful participation by the people affected are required for devising effective, democratically legitimate and sustainable solutions to the inevitable policy trade-offs. A. Planning 26. Guaranteeing the right to health requires the State, as a core obligation, to adopt a national public health strategy and plan of action (national plan). The national plan, coordinated with subnational plans, must comprehensively cover the health needs of the entire population, clearly identifying responsible actors in various contexts and establishing accountability mechanisms. 27. The national plan must contain a sexual and reproductive health strategy, encompassing maternal health. It should reflect the pivotal importance of sexual and reproductive health, including maternal health, and follow best practices, including those set out by WHO.21 Linkages between sexual and reproductive health and related policies, including education and nutritional policy, should be drawn explicitly. 28. The national plan, and policies linked to it, must be based on an up-to-date situational analysis of women’s sexual and reproductive health and rights, informed by suitably disaggregated data and trends, as well as vital registration. Human rights require an understanding of which population groups are deprived of access, and determining the reasons behind that deprivation at both the national and subnational levels. 19 20 21 Committee on the Elimination of Discrimination against Women, general recommendation No. 28, para. 13. Ibid. See also Committee on the Elimination of Discrimination against Women, general recommendation No. 19, para. 9, and CEDAW/C/49/D/17/2008, paras 7.5 and 8. WHO, Reproductive health strategy to accelerate progress towards the attainment of international development goals and targets, Geneva, 2004, p. 59. 7