While calling for more accountability is certainly necessary for improving the realisation of the right to health, it is even more important to ensure that accessible, transparent and effective accountability mechanisms have been established for exerting accountability. Accountability mechanisms enable overseeing actors to hold State actors to account and to provide redress for violations of the right to health (or indeed any human right). The purpose of this chapter is to explore the nature and scope of accountability mechanisms that can hold State actors accountable for their right to health obligations at various levels.
Section 6.2 first clarifies the distinction between ‘accountability’ and an ‘accountability mechanism’. Subsequently, it proposes an analytical framework for analysing accountability mechanisms at different levels, within and outside health care systems. This framework is based on the three questions mentioned in chapter 5: who is accountable, for what are these actors accountable, and to whom are these actors accountable? Given that China is not a State party to any of the regional human rights treaties, the discussion in this chapter is confined to domestic and international accountability mechanisms. Paul Hunt, (one of the) former UN Special Rapporteurs on the Right to Health, has mentioned in several of his reports that the State undertakes a core obligation to establish a range of (domestic) accountability mechanisms so as to ensure the full enjoyment of the right to health. Section 6.3 offers an overview of judicial, quasi-judicial, political, administrative and social accountability mechanisms at the domestic level and illustrates how overseeing actors (i.e. right-holders and overseeing institutions) can hold State actors (with right to health obligations) to account through these mechanisms. Section 6.4 pays particular attention to the media, which function in this study as both an accountability mechanism and as an external overseeing institution. As will be discussed further in chapter 7, the media play a crucial role in exerting accountability in China. Nevertheless, the role of the media is perceived differently by scholars from different disciplines. The aim of section 6.4 is thus to synthesise existing studies across disciplines and to provide a comprehensive analysis of the role of the media in generating accountability. Section 6.5 provides a general discussion of international mechanisms for monitoring States parties’ compliance with their obligations under international human rights treaties.