A/63/263 and human rights movement needs human rights advisers, implementers and enablers, as well as those whose job it is to hold duty-bearers to account. All those functions will rarely reside in one organization or individual. For example, while specialized agencies should be human rights advisers, implementers and enablers, it is not their primary task to hold States to account. The accountability function must be provided by some organization or person, but probably not by a specialized agency, unless the agency decides to establish a discreet independent procedure and body for this purpose. 1 11. In the context of the right to the highest attainable standard of health, there are many different types of accountability mechanisms, including national human rights institutions, health commissioners, democratically elected local health councils, public hearings, patients’ committees, impact assessments, judicial proceedings, and others. An institution as complex and important as a health system — and a human right as complex and extensive as the right to the highest attainable standard of health — require a range of effective, transparent, accessible, independent accountability mechanisms. The media and civil society organizations have a crucial role to play. 12. Accountability in respect of health systems is often extremely weak. Sometimes the same body that provides health services also deals with regulating and holding to account. In some cases, accountability is little more than a device to check that health funds were spent as they should have been. Of course, that is important. But human rights accountability is much broader. It is also concerned with ensuring that health systems are improving, and the right to the highest attainable standard of health is being progressively realized, for all, including disadvantaged individuals, communities and populations. 13. In some States, the private health sector, while playing a very important role, is largely unregulated. Crucially, the requirement of human rights accountability extends to both the public and private health sectors. Additionally, it is not confined to national bodies; it also extends to international actors working on health-related issues. Accountability mechanisms are urgently needed for all those — public, private, national and international — working on health-related issues. 14. The design of appropriate, independent accountability mechanisms demands creativity and imagination. Often associated with accountability, lawyers must be willing to understand the distinctive characteristics and challenges of the right to the highest attainable standard of health, and learn from the rich experience of medicine and public health. 15. Since 2002, the Special Rapporteur has emphasized the critical importance of accountability in relation to the right to the highest attainable standard of health. Building on the work of others, he has developed an analytical framework for “unpacking” the right to health and making this fundamental human right easier to grasp. This analytical framework is used in most of his reports. Crucially, monitoring and accountability are an integral part of this framework. 2 16. Judicial accountability is one form of accountability. While this form of accountability is considered in many of the Special Rapporteur’s reports, the most __________________ 1 2 08-45647 As the International Labour Organization has chosen to do. One of the fullest elaborations of the analytical framework is in the report on people with mental disabilities (E/CN.4/2005/51); on monitoring and accountability, see paras. 67-75. 5