A/HRC/41/34/Add.1 unintentionally, complicit in certain types of human rights abuses, for example when providing non-discriminatory services to all, including lesbian, gay, bisexual and transgender persons or migrants and refugees. 39. The capacity of well-trained health workers should be strengthened by, inter alia, integrating a human rights-based approach into the health-care education curriculum. A human rights-based health-care curriculum should encourage a change within the system, moving away from paternalistic, top-down medicine, compounded by an excessive focus on the tertiary level and biomedical technologies, towards increased partnership between health-care providers and users. 40. Medical education and research should also pay more attention to the role of the social determinants of health (such as poverty, violence and discrimination), to human rights in patient care, to the principles of medical ethics and to new approaches in providing services for persons with disabilities. 41. The Special Rapporteur learned that the salaries of physicians and other health-care personnel are unacceptably low, below the national average and below the average salaries in other sectors. According to data provided by the national statistics committee, in June 2018, the gross average salary of a health-care or social services worker was 10,566.90 som (approximately $150), while the national gross average salary was 15,994 som ($230). The gross average salaries of an education worker, a professional, scientific or technical worker, and a financial or insurance worker were 11,599.90 som ($166), 19,203.80 som ($275) and 33,227.10 som ($476) respectively. 18 42. The low salaries of health-care personnel have a negative impact on the quality of services and provide incentives for informal payments. They also contribute to the brain drain of medical personnel, not only to other countries but from the public to the private sector, including the pharmaceutical industry. 43. The State should make a greater effort to train, recruit and retain health-care personnel, and to protect their rights and guarantee decent living wages and working conditions, job security and rewards for good performance and conduct. It could also develop non-biased and evidence-based treatment guidelines in order to reduce the possibility of corruption. 44. It is equally important that the State strengthen the mechanisms of self-governance within the medical profession, to encourage health-care personnel to develop ownership over their profession and to adhere to ethical standards when providing health-care services. 2. Groups in vulnerable situations 45. Overall, any health-care system should address discrimination, which can undermine the full realization of the right to physical and mental health. The Special Rapporteur learned about many cases of stigmatization and discriminatory attitudes based on different grounds among society at large, and among health-care personnel in particular. One particular example of discrimination related to sexual orientation and gender identity. Lesbian, gay, bisexual and transgender persons are subjected to psychological violence, sexual abuse and physical harm by family members, law enforcement officials and healthcare personnel. This significantly affects their physical and mental integrity. 46. Such discriminatory practices are the result of a strongly patriarchal and conservative society, where issues that differ from the socially approved traditional norms, including those linked to sexual orientation and gender identity, are not accepted by social institutions, families or even government officials. This attitude is further reflected in the lack of national programmes specifically addressing the rights of lesbian, gay, bisexual, transgender and intersex persons and, in some cases, in the reluctance of public officials to cooperate with civil society organizations representing this community. 18 See www.ceicdata.com/en/kyrgyzstan/gross-average-salary/gross-average-salary-nace-2-health-careand-social-services. 9