AAAQ Framework

All health related facilities, goods and services must be available, accessible, acceptable, appropriate and of good quality (AAAQ). For more information on AAAQ and the importance of participation in a human rights framework, please refer to Helen Pott’s Participation and the right to the highest attainable standard of health. [1] (PDF).

Availability

Health facilities, goods and services must be available in sufficient quantity within the country. This includes, for example, hospitals, clinics, trained health workers, essential medicines, preventive public health strategies and health promotion as well as underlying determinants, such as safe drinking water and adequate sanitation facilities.  For example, in Zimbabwe, there is limited access to essential medicine and supplies, as well as failed sewage and sanitation systems. The government has disastrous policies for improving the state of health, and it has intentionally suppressed information regarding increasing malnutrition. The government has not made available the physical presence of health services. Click here to see PHR’s report. [2]

Accessibility

Health services must be accessible to everyone without discrimination, especially the most vulnerable people. They must be physically and economically accessible. Health services must be designed in a way that is responsive to local people’s needs. Accessibility also includes the right to seek, receive and impart information on health.

For example, in Peru, more than 1200 women die, most of them unnecessarily during childbirth each year. The interventions needed to treat obstetric emergencies and prevent deaths are well-known and readily available to women with economic means and to most living in urban areas. But because of vast disparities in the healthcare system, policy decisions, and cultural factors, poor and disenfranchised women are dying unnecessarily. Due to the lack of economic resources, these poor women do not have access to the obstetric care that would prevent maternal mortality.

Click here to see PHR’s 2007 report. [3]

Acceptability

Health services must be respectful of medical ethics, culturally appropriate and gender sensitive. Medical treatment must be explained in an understandable manner and health workers need to be aware of cultural sensitivities.

For example, gender discrimination and inequality fuel the AIDS epidemic, particularly women and teenage girls in Botswana and Swaziland. These females are at a much higher risk of HIV transmission than their male counterparts. Findings strongly indicate that women’s lack of control over sexual relationships, gender and HIV-related discrimination, poverty, food insufficiency, inadequacy of health care infrastructure and lack of political will to address these issues all contribute to women’s and men’s risk of HIV infection. In order for health care to be acceptable, women need to be empowered and protected and necessary health services need to be tailored to women in addition to men.

Click here to see PHR’s 2007 epidemic on inequality report. [4]

Quality

Health services must also be scientifically and medically appropriate and of good quality. Quality also extends to the manner in which people are treated, and the underlying determinants of health must be appropriate and of good quality.

For example, the US government had authorized a widespread and systemic regime of abusive methods that meet the legal definition of torture at Abu Ghraib and Guantanamo Bay. Medical personnel have been compliant in activities that implement the psychological and physical torture, which contravene US and international law, human rights standards, and the core principles of medical ethics. This is clearly a violation of human rights, and health workers must treat all people humanely with an appropriate quality of care. Click here to see PHR’s 2007 annual report [5].