A/HRC/21/22 marginalized and vulnerable groups and health workers, in efforts to identify problems, causes and duty-bearers, and in prioritizing remedial actions and solutions. 64. Evaluating factors that may constitute obstacles in practice requires examining sequencing and coordination within and between systems, including the appropriate alignment of: (a) Laws and policies (for example, ensuring appropriate protocols are issued and disseminated by the Ministry of Health to provide for abortion where it is legal); (b) Policies and budgets (for example, shifting budget allocations toward the needs of the poorest quintiles and/or marginalized groups); (c) Budgets and programmes (for example, ensuring that costs do not raise barriers to access to essential sexual and reproductive health care); (d) Policies and programmes (for example, ensuring that all levels of providers are actually performing functions set out in national and regional policies); (e) Training and programmes (for example, ensuring that sufficient numbers of mid-level providers are recruited and trained to meet the sexual and reproductive health needs of the population). 65. A rights-based approach requires simultaneous attention to immediate health interventions and the longer-term social transformation required to reduce maternal mortality and morbidity. Overcoming identified obstacles to all essential interventions, supplies and medicines within the context of health system strengthening must be prioritized. At the same time, however, efforts are also required to address any broader patterns of discrimination against women and/or particular groups of women that affect maternal mortality and morbidity. 66. Full respect for the rights of both health system users and health workers is fundamental to a rights-based approach. Any form of abuse, neglect or disrespect of health system users undermines their rights. Institutions need to be organized and managed to facilitate respect for women’s sexual and reproductive health rights, such as provision for privacy and confidentiality. Systematic education is required for policymakers, planners, health system administrators and providers to ensure that women’s access to care is treated as a right and that all duty-bearers understand their corresponding obligations of conduct. Moreover, in a health system, health workers are rights-holders as much as duty-bearers. Ensuring adequate working conditions and treatment of health workers, including salary and benefits, disciplinary processes and voice, is necessary to respect their rights and, in turn, to promote health system effectiveness in addressing maternal mortality and morbidity. V. Accountability 67. As has been stressed throughout the present report, accountability is central to every stage of a human rights-based approach. It requires not just transparency but meaningful participation by affected populations and civil society groups. Effective accountability also requires individuals, families and groups, including women from vulnerable or marginalized populations, to be aware of their entitlements with regard to sexual and reproductive health and are empowered to make claims grounded in them. 68. In the sections above, emphasis was put on the importance of assessing accountability gaps within and beyond the health sector in the situational analysis and addressing them through planning and budgeting, as well as regular, ground-up diagnostic exercises and follow-up, in order to ensure implementation in practice. Monitoring, the 14