A/HRC/21/22 40. The national plan should set out deliberate steps to realize universal access to sexual and reproductive health services, in terms of financing, population coverage and service expansion. 41. The national plan should address disparities in the substantive enjoyment of sexual and reproductive health rights based on prohibited grounds of discrimination, as well as inequalities in wealth, level of education or area of residence.33 42. Remedying de facto discrimination in access to sexual and reproductive health services may require special measures to ensure equitable spending and distribution of health facilities, goods and services, including where absolute population numbers or cost effectiveness data would not ordinarily warrant such action. Such special measures are not construed as discrimination under human rights law.34 43. The national plan should be devised and its implementation reviewed in consultation with the populations affected. The criteria and evidence for prioritizing must be transparent and subject to public scrutiny. Power differentials based on literacy, language, social status or other factors, which may exclude the women and girls most affected by the decisions taken, should be redressed to promote their meaningful participation. B. Budgeting 44. The identification of budgetary needs requires the involvement of a range of ministries and departments; for example, adolescent pregnancy must be addressed in conjunction with the Ministry of Education and will require adequate budgets for both health and education sectors. 45. The State must devote the maximum available resources to sexual and reproductive health. The establishment and sustainability of an adequate fiscal envelope to afford the maximum available resources is critical to a rights-based approach; where structural imbalances exist between expenditures and revenues, strengthened and rationalized revenue collection should be undertaken before cuts are made to critical health areas, including sexual and reproductive health. 46. The budget should ensure that financing is not borne disproportionately by the poor. Out-of-pocket costs cannot impede accessibility of care, irrespective of whether services are provided by public or private facilities. 35 47. Addressing maternal health as a human rights issue in budget formulation confers added protection for resources allocated to related programmes at both the national and subnational levels: (a) If the overall available budget increases, resources for maternal health should increase accordingly insofar as significant need in that area remains. In particular in the case of high-burden countries, the principle of progressive realization under human rights law means that the budget for maternal health programmes would be expected to increase unless there is public justification to the contrary; 33 34 35 10 E/CN.4/2000/4, para. 19. Convention on the Elimination of All Forms of Discrimination against Women, art. 4; International Convention on the Elimination of All Forms of Racial Discrimination, art. 1; Convention on the Rights of Persons with Disabilities, art. 5. E/CN.4/2000/4, para. 12; WHO, World Health Report 2010: Health Systems Financing: the Path to Universal Coverage (Geneva, 2010).