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Us, and them: time for a paradigm shift in African mental health policy

Posted on by Susan Fock-Tave

My name is Susan Fock Tave and I am from the Seychelles. Though a surgeon by trade, I had to give up clinical practice in 2014 on medical grounds, soon adopting the post of Principal Medical Officer in the Seychelles Hospital, the only referral hospital in the country. I was still finding my feet in this new position when I was asked to act as the Chairperson of the newly established National Mental Health Advisory Committee at a time when the national approach to mental health would be utterly transformed.

The Republic of Seychelles consists of 115 islands in the Western Indian Ocean with a population of just under 100,000. The right of every citizen to the enjoyment of the highest attainable standard of physical and mental health is proudly enshrined in Article 29 of our Constitution.

Seychelles, as is the case in many other countries, has its fair share of mental illness and mental ill-health. Discrimination and stigmatisation of people suffering from mental illness, though not rampant or institutionalised, is still a cause for concern. Until recently, persons with mental disabilities did not benefit from the social and financial protections reserved for those suffering physical disabilities. In 2006, the Mental Health Act marked a significant improvement on the Mental Treatment Act of 1906: disparaging language such as ‘Commissioner of Lunacy’ were ditched, and more decision-making powers were reserved for mental health professionals. But the 2006 Act still served to ‘protect’ society from mentally ill patients, and so did little to preserve their basic rights to dignity, privacy and autonomy. These contradictions meant that the act could never be fully implemented, which ultimately derailed progress.

‘disparaging language such as “Commissioner of Lunacy” were ditched, and more decision-making powers were reserved for mental health professionals’

A proposal to include Seychelles in a Pan-African project to review mental health legislation was welcomed with open arms. The project, led by the Commonwealth Nurses and Midwives Federation and funded by the Commonwealth Foundation, employed a multi-stakeholder approach–which meant that everyone who needed to play a part was included from the outset. The first step of the process was to establish a national advocacy group to pool experience and resources and agree on a piece of legislation, and so the National Mental Health Advisory Committee was born. Membership comprised mental health professionals, policymakers, a user of mental health services and a caregiver. This local working group was given technical support from Dr Soumitra Pathare, the Director of Centre for Mental Health Law and Policy at the India Law Society, and Ms Jill Iliffe from the Commonwealth Nurses and Midwives Federation.

Step two consisted of an assessment, not only of the 2006 Act but also of the legislative environment. This meant reviewing relevant legislation, policy documents and international conventions to which Seychelles is party. Most importantly, the 2006 Act was assessed for compliance with the Convention of the Rights of Persons with Disabilities, widely considered the gold standard for mental health legislation. The assessment was not favourable. In a presentation of review findings in October 2015, Dr Pathare summarised: ‘If you are a person with mental illness, you really don’t have a choice but to consent.’

‘No amount of tweaking could shift this paradigm. The recommendation, therefore, was to repeal and replace.’

Indeed, the 2006 Act appeared to be premised on the assumption that persons with mental disabilities have no capacity. Even when a person was determined to have capacity; their consent could be overridden by relatives or health professionals. And the consequences could be harshly punitive: unlimited ‘detention’ in a mental hospital–without the recourse of appeal. The only escape? Discharge at the discretion of a psychiatrist for ‘good behaviour’. Furthermore, the Act did not make provision for participation of persons with mental disabilities or their representative organisations in any of the regulatory bodies created under the Act. Ultimately, the Committee concluded that amendments to the 2006 Legislation could not change the fundamental spirit of the Act, which was designed to protect ‘us’ from ‘them’. No amount of tweaking could shift this paradigm. The recommendation, therefore, was to repeal and replace.

The result is the Mental Health Care Act of 2020, recently approved by the Seychelles National Assembly. It’s an exemplary piece of legislation that meets the high standards laid out in the Convention on the Rights of Persons with Disabilities, and in the words of that convention ‘it takes to a new height the movement from viewing persons with disabilities as “objects” of charity, medical treatment and social protection towards viewing [them] as “subjects” with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent’. I urge other African nations to build a collective will for change, draw on their own national mental health expertise, and enact reform. It’s my hope that the story of the Seychelles can inspire this cause.

Dr Susan Fock-Tave is Chief Medical Officer in the Seychelles Department of Health.

Space for change?

Posted on by Phyll Opoku-Gyimah

Often, when I talk about striving to make human rights progress within the Commonwealth, I’m met with raised eyebrows. The Commonwealth? I’ll hear, is that really the right place to be pushing for progress?

It’s a healthy scepticism I come across time and time again, especially from those who are well-versed in the long-lasting impact of the British Empire on its former colonial subjects. The Commonwealth, for many, feels like a vestige of a foregone time, a time in which certain countries were under the thumb of others, a time where the imposition of British law and values upon a litany of diverse and distinct cultures went largely unscrutinised by the global community. And so, the Commonwealth’s origin story, and the fact that its existence cannot be uncoupled from the legacy of empire, continues to ring loud in the ears of many. Especially those who are still dealing with inherited colonial laws that expressly discriminate against certain communities.

‘For the Commonwealth to be seen as a space for change, it must continue to adapt to the wants and needs of its most marginalised citizens’

It was in this light that the Commonwealth Foundation held the first of its Critical Conversations series, bringing together a diverse array of thinkers and doers to examine the Commonwealth’s past and reimagine its future. It was a chance to have an honest conversation about the legacy of the Commonwealth while also discussing its potential as a space for progress, where decision-makers and activists can come together and challenge each other to create a fairer and more positive future.

Although it may seem counterintuitive to some, the Commonwealth has proven itself as a useful space for civil society organisations to come together and advocate for positive change. This wasn’t necessarily a view shared by all panellists, but it is a truth I have seen in action. As Executive Director of Kaleidoscope Trust, the United Kingdom’s leading international lesbian, gay, bisexual and transgender (LGBT+) human rights organisation, I have found that the organising done to create awareness and advocate on LGBT+ human rights issues at Commonwealth-specific fora, such as the Commonwealth Heads of Government Meeting (CHOGM), has often had a resounding impact.

The work of The Commonwealth Equality Network (TCEN), a network of 62 LGBT+ organisations across the Commonwealth, for which Kaleidoscope Trust acts as Secretariat, is a testament to this. TCEN aims to create a positive and more equal future for LGBT+ citizens in the Commonwealth, in a context where 34 of 54 Member States criminalise homosexuality as a direct result of inherited colonial-era laws. For LGBT+ activists in the Commonwealth, an acknowledgement of the past was the first step toward envisioning a more equal future. And so TCEN went about advocating for this exact thing—a statement of acknowledgement and regret from the UK government.

The network achieved this primarily by centring the voices of young grassroots activists in our advocacy both before and during CHOGM 2018, which was held in London. This simple act, of creating opportunities for the lived realities of LGBT+ people to be heard in high-level diplomatic spaces, was enormously impactful.

It included creating a platform for Melusi Simelane, a young gay man from eSwatini, to talk about the safety and security of LGBT+ people in his country at the Committee of the Whole, during an event for Commonwealth accredited civil society organisations to present priorities relating to CHOGM to high-level Commonwealth officials. It also included working with the Commonwealth Foundation to ensure Zeleca Julien, a lesbian activist from Trinidad and Tobago, was able to speak about her experiences fighting for equality at the opening plenary of the Women’s Forum at CHOGM 2018, the first time an LGBT+ person was granted the opportunity to do so.

Beyond these specific examples, we also aimed for as much LGBT+ civil society representation as possible at Commonwealth events. CHOGM, for example, is a unique opportunity for LGBT+ organisations to come face to face with diplomatic or parliamentary representatives from their countries or regions, an opportunity that few other diplomatic spaces provide. Where they might not be able to safely do so in their own countries, representatives of TCEN organisations were able to hold their national-level parliamentary representatives to account within a Commonwealth space.

TCEN is one of many examples of how the Commonwealth can be used as a force for good, particularly for the LGBT+ community. But TCEN is only the beginning. As our work has continued, we have sought to ensure we are building a more intersectional human rights movement in the Commonwealth, working with youth organisations and those fighting for women and girls rights to make sure that the progress we achieve can also support the aims of other marginalised groups.

For the Commonwealth to be seen as a space for change, it must continue to adapt to the wants and needs of its most marginalised citizens—and that includes examining the mistakes of the past, mistakes that have led to staggering inequalities, and aiming to rectify them accordingly. So long as the Commonwealth can continue to create spaces for the likes of TCEN to make their voices heard, it deserves to be championed as a promising avenue for real progress.

Phyllis Akua Opoku-Gyimah (Lady Phyll) is Executive Director of Kaleidoscope Trust.

Statement on the International Day to End Impunity for Crimes against Journalists

Posted on by Anne Therese Gallagher

The United Nations has declared 2 November as the International Day to End Impunity for Crimes against Journalists, recognising those whose lives have been cut short or destroyed because of their commitment to truth, justice and accountability.

Over the past 14 years, close to 1,200 journalists have been killed for reporting the news and bringing information to the public. Many, many more have disappeared or been subject to torture, intimidation or harassment. Even more worrying is the fact that crimes against journalists and media workers are rarely investigated, prosecuted or punished. That shocking level of impunity sends out a clear and chilling message: journalists will not be protected; their killers will not be brought to justice.

Member States of the Commonwealth have proclaimed, loudly and clearly, their commitment to human rights, to the rule of law, and to ‘peaceful, open dialogue and the free flow of information, including through a free and responsible media’. The 2.4 billion citizens of the Commonwealth have a right to demand that these commitments be implemented in a meaningful way: that their governments take decisive action to prevent violence against journalists and bring perpetrators to justice.

The battle for media freedom must be fought on many fronts. Across the Commonwealth assaults on media freedom are becoming more commonplace and more severe. They include not just attacks on journalists but also repressive legislation, unjustifiable censorship, misinformation and other forms of information control. This trend is contributing to an erosion of democratic culture and diminished government accountability at a time when such accountability has never been more important—or more urgent.

While civil society will inevitably be at the forefront of the battle for media freedom, it cannot act alone. The Commonwealth: its member States and its institutions must step forward to protect those values which are fundamental to the Commonwealth’s existence; its legitimacy and its credibility.

#TruthNeverDies

Dr Anne T. Gallagher AO is Director-General of the Commonwealth Foundation.

The Commonwealth Foundation is running a series of online events: People of the Commonwealth: Critical Conversations. A conversation on media freedom in the Commonwealth is planned for January 2021. Register to participate in the series here.

Message from the Director-General on the planned closure of the Institute of Commonwealth Studies

Posted on by Anne Therese Gallagher

The Commonwealth Foundation, one of the three intergovernmental pillars of the Commonwealth, has a specific mandate to amplify the voice of the Commonwealth’s 2.4 billion citizens.

The Foundation was dismayed to learn of the planned closure of the Institute of Commonwealth Studies—and we are convinced that this decision was made without a full appreciation of what is being lost. I speak particularly of the rich contribution that the Institute has made, over many years, to cultivating a critical understanding of the Commonwealth; its complicated legacy; and its potential to contribute to a future based on justice and equality.

It is well understood that these difficult times require hard decisions. However, the proposal to close the Institute certainly appears to lack strategic foresight, most especially for a University which has built its reputation on innovation and excellence in teaching, outreach and research. The Institute embodies all of those qualities and its continued existence would, I believe, contribute to the University’s own longer-term flourishing.

I urge the University to reconsider this decision, reflecting fully on the place that the Institute for Commonwealth Studies occupies within a living, breathing network of people and ideas. And I encourage the many individuals and groups that have drawn inspiration and strength from the work of the Institute to make their voices heard.

Dr Anne T. Gallagher AO is Director-General of the Commonwealth Foundation. 

Health and disability rights: multi-stakeholder approaches

Posted on by Commonwealth Foundation

The Foundation recently convened learning exchanges with civil society leaders working on health and disability rights—particularly the rights of vulnerable populations who have been ‘left behind’. The participants, who hailed from 11 Commonwealth countries and had each received support from our grants programme, shared strategies and approaches to realise these rights by making governments more accountable.  

This is the fourth in a series of blogs profiling the case studies our partners shared. Previous blogs in the series have examined how our partners gather citizen data and present it to decision-makers to improve health outcomes. This month’s blog looks at how our partners engage a range of stakeholders—from government agencies to think tanks and families—so they can advance health outcomes. This is known as a multi-stakeholder approach; it involves identifying and understanding the varied institutions and actors that can create change and considering how each can be persuaded to think and act differently to fulfil health rights.

Community Tours in Guyana

ChildLinK aims to improve the protection of children with disabilities at home, within families, and in education—particularly children with autism and those experiencing abuse. Their approach is based on building relationships between children and their families and communities, as well as government agencies and decision-makers. One innovative method they use is known as a ‘Community Tour’.

With guidance from the Ministry of Social Protection and ChildLinK’s caseworkers, ChildLinK identifies communities seeking more information on child protection or communities where there are high numbers of reported child rights violations. These communities are then contacted to assess whether they would participate in a Community Tour; if the community agrees, a small delegation of officials from, for example, the Ministry of Social Protection, local schools, and the police spends half a day in the neighbourhood, meeting and speaking with each household as well as families in the streets and in local shops. They carefully uncover a picture of the issues faced by children in the community and instances of child abuse. They explain what support is on offer and distribute information (posters and brochures) in shops, schools, and health centres.

‘They have helped build relationships between government agencies so they can work more effectively together.’

Quarterly, multi-agency meetings are organised at which information from the tour is processed. Regional teams are sensitised to the needs of children and children with disabilities, and a comprehensive inter-agency action plan is formulated. ChildLinK and local partners implement and monitor the action plan while regularly feeding back to the communities in question.

Community Tours have made governance institutions better informed about the situation of children, including children with disabilities. They have helped build relationships between government agencies so they can work more effectively together. Children and families say these tours leave them feeling more supported and help build their trust in government agencies with whom they can directly engage. Insights gained from the tours are currently being considered by the government as they develop new guidelines for schools to improve the educational outcomes of children with autism. ChildLinK plans to use future tours to identify community advocates who will be trained to sustain community monitoring and awareness. 

Preventing and controlling non-communicable diseases in India

HRIDAY’s Non-Communicable Disease (NCD) Taskforce programme is another example of a multi-stakeholder approach. The Taskforce aims to improve cross-sector collaboration to achieve health targets that reduce non-communicable diseases (diseases that are not directly transmissible between people). It brings together government, health service providers, international agencies such as the World Health Organization, research institutions, and civil society organisations.

At the start of their project, HRIDAY reviewed the available literature and consulted with experts on the Taskforce to track India’s progress against national and international targets on NCDs. Using the findings, HRIDAY established an accountability framework: a document that recommends additional action that the government and other stakeholders should commit to in order to meet the country’s targets. Crucially, the document provides a framework for civil society to monitor the government’s progress and hold decision-makers accountable to their promises to fulfil health rights.

The Taskforce keeps HRIDAY abreast of emerging trends, identifies which actors have the power to contribute to greater NCD control, and helps prioritise areas where action is urgently needed. Due to growing recognition of the greater risk that people living with NCDs have to COVID-19, the Taskforce is accelerating action on risk factors for NCDs such as tobacco and alcohol use, unhealthy diets and physical inactivity.

The work of the Taskforce also feeds into that of the Healthy India Alliance (HIA) which is part of the Global NCD Alliance. The HIA connects global developments with national civil society action on NCDs. Additionality, as HRIDAY functions as the Secretariat of Healthy India Alliance, they can facilitate information sharing between the Taskforce and global partners.

Dr Shobha Das is a former Director of Programmes at Minority Rights Group International and Gillian Cooper is the Programme Manager of Knowledge, Learning, and Communications at the Commonwealth Foundation.

Health and disability rights: using legal frameworks

Posted on by Commonwealth Foundation

The Foundation recently convened learning exchanges with civil society leaders working on health and disability rights—particularly the rights of vulnerable populations who have been ‘left behind’. The participants, who hailed from 11 Commonwealth countries and had each received support from our grants programme, shared strategies and approaches to realise these rights by making governments more accountable; this is the third in a series of blogs profiling the case studies our partners shared.

The evidence is unambiguous: vulnerable and marginalised groups—including women and girls, the poor, and persons with disabilities (PwDs)—are very far from achieving the promise of universal health coverage. And much remains to be done before we come close to realising the globally agreed Sustainable Development Goal of ensuring healthy lives and wellbeing for all. It is significant that the estimated one billion PwDs in the world continue to be denied equitable participation in society due to prevailing material and attitudinal barriers. They face higher rates of multidimensional poverty, lower educational attainment and rates of employment, and poorer health outcomes. The COVID-19 pandemic has exacerbated these inequalities.

Civil society plays a critical role in promoting and protecting health and disability rights. Civil society groups can, for example, hold their governments to account in respect of rights enshrined in national legislation and the constitution. International treaties can also provide a valuable framework for advocating for improved protection of rights including through changes to domestic law and policy.

Alternative reports to the international treaty bodies

The Shanta Memorial Rehabilitation Centre (SMRC) has been gathering grassroots data on disability for years in partnership with civil society organisations throughout India. Their data is consistent with the UN’s findings: women with disabilities face more obstacles than their male counterparts and struggle to access ‘adequate housing, health, education, vocational training and employment’.

In 2019, SMRC and its partners submitted an alternative report to the UN Committee on the Rights of Persons with Disabilities (CRPD). This is a process which enables civil society to provide an alternative point of view to the official reports submitted by governments under international treaties. The report, which was presented by a group of women with disabilities, contained 33 recommendations. It detailed what they were seeing on the ground in relation to Article 6 of the Convention on Persons with Disabilities, which relates specifically to women. They also included data on 15 other articles that intersect with Article 6, on the Right to Life, Access to Justice, Education, Health and Employment, and Freedom from Violence.

The Women with Disabilities India Network deliver the alternative report in La Salle des Emirates in the Palace of Nations, Geneva

Their data identified nine major barriers faced by women with disabilities including discriminatory attitudes and low standards in service provision, challenging the Indian Government’s data on this point. Many of the report’s findings and recommendations were cited when the CRPD reported back to the Indian Government at the conclusion of the review process.

The report, along with the remarks of the committee, were later disseminated to communities and disabled persons organisations in India. SMRC provided training on how to use the documents for advocacy purposes, thereby helping to create a groundswell of grassroots campaigning. Hundreds of people with disabilities are now reaching out to officials in their own states and pressing for change. Some trainees have even approached the courts where they feel government action is either not forthcoming or too slow.

Review and reform

Research that took place in 2012-13 found that mental health legislation in the Seychelles and Botswana was outdated and ignored advances in care and treatment, denying those living with mental health problems their basic rights. The Commonwealth Nurses and Midwives Federation and its partners established a National Mental Health Advisory Committee (NMHAC) in each country that involved civil society representatives and government officials. The job of these committees was to review existing legislation, prepare guidelines for law reform, and educate stakeholders and the public on mental health issues.

‘the central mental health law was focussed on keeping the mentally ill in custody and excluding them from society’

In the Seychelles, the government had ratified the Convention on Persons with Disabilities (CRPD). The job of the newly-formed Committee was, therefore, to help ensure domestic legislation was up to the new standard agreed to by the government through its ratification of the treaty. The Committee’s review revealed substantial gaps and weaknesses and it confirmed that new domestic legislation was required. A new mental health act went before Parliament in 2018 and was enacted into law in the National Assembly in May 2020.

Unlike the Seychelles, Botswana has not become party to the CRPD. However, Botswana’s constitution affirms the right to life, to personal liberty and freedom, as well as freedom from inhumane treatment and discrimination. The National Mental Health Advisory Committee’s analysis identified numerous violations of these fundamental rights. Because the central mental health law was focussed on keeping the mentally ill in custody and excluding them from society, the Committee decided that it could not be reconciled with a rights-based approach. In response, and using drafting instructions provided by the Committee, the Attorney General drafted a new mental health bill that will soon go before Parliament.

Strategic litigation

Where collaboration and dialogue do not work, civil society may use litigation to ensure governments implement their legal commitments. In 2015, the Kenyan government issued a Presidential directive for district education departments to collect the names of HIV positive school children and their guardians. Although the Directive was aimed at delivering more effective care, it exposed children to potential discrimination that could cause real hardship and adversely affect educational outcomes.

‘it exposed children to potential discrimination that could cause real hardship and adversely affect educational outcomes’

Community representatives wanted safeguards to be put in place to protect individuals from having their HIV status known in this way. Efforts to lobby the government to change the Directive were unsuccessful. The Kenya Ethical Legal Issues Network on HIV and AIDS (KELIN), alongside a child rights agency and the families of two children living with HIV, brought a case against the government arguing that the Directive violated fundamental rights and freedoms in contravention of the Kenyan constitution.

The High Court of Kenya ruled that the Directive did indeed breach the right to privacy and was in violation of the overarching guiding principle of the ‘best interests of the child’. It ordered all data to be anonymised so a person’s name could not be linked to their HIV status. In partnership with community leadership, KELIN continues to advocate for legal compliance with the court ruling, providing awareness-raising for schools and supporting schools’ efforts to help children living with HIV.

Next month in our blog series on health and disability rights accountability, we look at how our partners build multi-stakeholder coalitions to achieve their advocacy goals. 

Dr Shobha Das is a former Director of Programmes at Minority Rights Group International and Gillian Cooper is the Programme Manager of Knowledge, Learning, and Communications at the Commonwealth Foundation. 

Health and disability rights: building coalitions

Posted on by Commonwealth Foundation

The Foundation recently convened learning exchanges with civil society leaders working on health and disability rights—particularly the rights of vulnerable populations who have been ‘left behind’. The participants, who hailed from 11 Commonwealth countries and had each received support from our grants programme, shared strategies and approaches to realise these rights by making governments more accountable; this is the second in a series of blogs profiling the case studies our partners shared.

The evidence is unambiguous: vulnerable and marginalised groups—including women and girls, the poor, and persons with disabilities (PwDs)—are very far from achieving the promise of universal health coverage or the Sustainable Development Goal of ensuring healthy lives and wellbeing for all. Further, the estimated one billion PwDs in the world are denied equitable participation in society due to prevailing material and attitudinal barriers. They face higher rates of multidimensional poverty, lower educational attainment and rates of employment, and poorer health outcomes. The COVID-19 pandemic has made these inequalities starker.

Coalition building can be a powerful force for change, not least because coalitions of like-minded organisations working towards a common purpose provide greater visibility for a cause by engaging groups across society. As the following case studies demonstrate, those within a coalition also share information and pool their skills, vastly increasing their potential to create and sustain change.

Two case studies from Kenya

Action Network for the Disabled (ANDY) is a Disabled Persons Organisation (DPO) in Kenya. They are working in partnership with Able Child Africa to realise the rights of children and young people with disabilities.

ANDY builds coalitions at both the national and community levels in Kenya.

The National Disability Coalition brings together disability rights activists with other civil society groups working on related issues such as education, health, and employment. The coalition builds relationships with decision-makers. It also establishes nationwide policy priorities, key messages, and raises awareness of disability rights issues.

At the community level, ANDY identifies informal groups that are organising around an issue. For instance, the Sagana Disabled Self-Help Group in Kirinyaga county is an informal collection of businesspeople with disabilities who are looking for ways to make the business environment more disability-friendly, including through seeking exemptions from business fees. Such groups, which ANDY calls disabled people’s groups, have a detailed understanding of the local needs of people with disabilities but often lack the capacity to engage government on matters of policy. ANDY and other civil society organisations in the network build their partners’ skills in advocacy, fundraising, and collecting evidence. They then connect the disabled people’s groups with the relevant decision-makers in the network.

This strategy has proven effective. For example, a disabled people’s group in Machakos county worked with a number of formal organisations in the network to improve the accessibility of local buildings and, together, they managed to successfully lobby the county government to pass the necessary legislation. In another example, in Kirinyaga county, ANDY connected a disabled persons group working to protect children with disabilities from abuse to the government’s local children’s officer. They now work regularly together to resolve cases.

Using Community Champions

KELIN’s mission is to improve the quality of life for people living with HIV by making sure the government meets its commitment to protect their health and wellbeing. A fundamental part of their strategy is to build the capacity of people living with HIV to collaborate.

KELIN use a two-step process. First, they identify all relevant non-government stakeholders in an area—this includes people living with HIV, communities affected by HIV, health providers, civil society organisations, community-based organisations, and media with an interest in health issues. They then bring the groups together for a two-day training and networking session. Those involved are provided with information on the rights of people living with HIV and how decisions are made by government. They then develop work plans based on the priorities they agree on, as well as the most appropriate methods for engaging relevant decision-makers.

At the end of the event, the group selects a sub-group of Community Champions who meet on a quarterly basis. Community Champions continue to identify and prioritise the most important issues throughout the year to ensure the coalitions’ advocacy strategy is responsive to evolving needs. For example, Community Champions in Mombasa noticed that women with HIV or TB were being detained in a health facility after giving birth, due to non-payment of hospital charges. The coalition met formally with officials at the facility to point out that the practice of detainment was not in line with the government’s stated commitment to free maternal services. This led to the head of the health facility working with their team to eliminate the practice.

KELIN has found that building coalitions in this way leads to sustainable change. For example, involving journalists in the coalition results in coverage and raised public awareness. Community Champions gradually develop the confidence and know-how for independent advocacy. And the government also begins to see the value in regular community feedback. This is well illustrated in Mombasa, where local officials now invite Community Champions to join regular working groups so they can provide input on policy and practice. 

Dr Shobha Das is a former Director of Programmes at Minority Rights Group International and Gillian Cooper is the Programme Manager of Knowledge, Learning, and Communications at the Commonwealth Foundation. 

Civil society responses in the wake of COVID-19

Posted on by Shem Ochola

Without doubt, the coronavirus pandemic has exposed the lack of preparedness among states across the global north and south for a disaster of this magnitude. Decades of underinvestment in health and education has been laid bare. The unravelling of the institutions that underpin these sectors has been spectacular, exposing fundamental deficiencies in their capacity to deliver. It is no exaggeration to say that vast sections of the global population face further exclusion unless governments affect far-reaching reforms. An assertive and engaged civil society can help governments find solutions to these challenges by drawing from the experience of their grassroots constituencies.

Civil society organisations have so far been involved in a range of interventions, from direct service provision to engaging lawmakers to reform the policies and guidelines that govern responses to the pandemic. Within the Commonwealth, there has been enhanced engagement in Commonwealth Ministerial Forums by civil society. At a recent Health Ministers meeting, the Commonwealth Civil Society Policy Forum made a presentation on how digital diagnostic technologies can be used to achieve universal health coverage (UHC). Members are advocating the One Health approach, which looks at finding ways for the civic, private and government sectors to better communicate and work together to achieve UHC.

‘in poor rural areas and especially in the global south, the infrastructure for digital learning is not in place.’

As a leading member of the Forum, the Commonwealth Health Professions and Partners Alliance has been at the forefront of advocating for the implementation of UHC. In the wake of the pandemic, the Alliance has scaled up its advocacy, making proposals for mapping the use of digital technologies in health service and medicines delivery; using technology for better deployment of human resources; and development of model regulation, policy and standards for the use of digital technology, including addressing privacy and other human rights concerns. Articulation of these priorities has been an important first step. The next is to ensure their systematic implementation.

The wide application of digital learning in place of face-to-face learning is clearly a vital innovation that, in our post-pandemic world, is here to stay. But the effects of these changes can only be understood by first acknowledging the fact that, in poor rural areas and especially in the global south, the infrastructure for digital learning is not in place. We do not yet know who–or how many—are currently excluded from these new digital technologies. But a ‘one size fits all’ approach is undoubtedly a recipe for entrenching that exclusion. During this time of systemic change, it is thus vital that the Incheon Declaration and Framework for Action is adhered to. This commitment recognises the role of education as a key driver of development and provides guidance for implementing Education 2030—an essential prerequisite for achieving the promise of Sustainable Development Goal Four: equitable learning for all.

‘Civil society must be—and must be seen to be—a partner and ally to governments: working together to forge a path towards a more positive future.’

Tackling the challenges ahead will require substantial policy and institutional reforms. Without change, there is a real risk that the Covid-induced health crisis will become something much more serious and enduring: that it will lead to even greater inequality and instability; that it will stall our progress towards the realisation of truly peaceful and inclusive societies. Civil society must be—and must be seen to be—a partner and ally to governments: working together to forge a path towards a more positive future. The Foundation is seeking to pivot its own programmes to ensure that it is able to make a meaningful contribution to Commonwealth civil society as communities and countries work to repair and recover from the global pandemic.

Shem Ochola is Deputy Director-General of the Commonwealth Foundation.

Civil society organisations engaged in responses to COVID-19 in Commonwealth countries are encouraged to subscribe to our mailing list for updates on our forthcoming grants call.

Tackling youth violence: inclusion for a change

Posted on by Leo Kiss

At the 1998 World Conference on Youth, the origin of International Youth Day, the late Kofi Annan made his famous opening remarks: ‘No one is born a good citizen; no nation is born a democracy. Rather, both are processes that continue to evolve over a lifetime. Young people must be included from birth. A society that cuts itself off from its youth severs its lifeline; it is condemned to bleed to death.’

There is a fact that gives Annan’s sanguineous metaphor grim new meaning: violence is now the fourth leading cause of death in young people worldwide. Perhaps no other community of nations should seek to understand this fact more urgently than the Commonwealth; sixty per cent of our more than 2.4 billion citizens are under the age of 30. Here we explore three of our recently approved grants projects that are empowering youth so they can overcome this scourge.

‘Too often, discussions on violence in these communities are one-off events, occurring after policy decisions have been taken and without sufficient youth representation.’

In data released in 2017 by the UN, the murder rate in Jamaica stood at 57 per 100,000 of the population, the second-highest recorded rate in the world. Despite significant efforts to address this problem on the part of the Government of Jamaica, the young continue to be severely affected by violent crime as both victims and perpetrators. In a project that will last two years, Fight for Peace International will work in two of Kingston’s worst-affected neighbourhoods: Denham Town and Parade Gardens.

In designing this project, Fight for Peace focussed on how affected communities were being cut off from policy development and decision-making. Too often, discussions on violence in these communities are one-off events occurring after policy decisions have been taken and without sufficient youth representation. To counter this tendency, they will train 1000 youth and civil society leaders to formulate evidence-based recommendations during regular, specially organised meetings. This will provide youth groups with an opportunity to share their perspectives on security policies so, ultimately, these can be tabled at Jamaica’s Commission on Violence Prevention. Youth leaders will also be trained to deliver traditional and social media campaigns, giving them the tools to influence public discourse on the issue.

‘[In South Africa] an estimated 23 people are shot and killed every day, with the highest rates of death by homicide found among 15-29-year-olds.’

The same UN data that put Jamaica’s murder rate among the highest in the world ranked South Africa’s as eighth. Firearms play a significant role in the perpetration of violence in South Africa. The 2000 Firearms Control Act, which introduced measures such as stricter licensing, led to a significant decline in recorded shootings. Still, an estimated 23 people are shot and killed every day with the highest rates of death by homicide found among 15-29-year-olds. With a grant from the Commonwealth Foundation, Gun Free South Africa will support youth groups to deliver their input during the Control Act’s review in 2020. Young people with experience of gun violence will give oral presentations at public hearings to increase the impact of their recommendations. The organisation will also train youth groups to develop and implement safety initiatives in their communities, including the establishment of gun-free zones in schools and other public places. These initiatives will be coupled with awareness campaigns to mobilise support in favour of greater safety.

While young men are more likely to be the victims and perpetrators of violent crime both in Jamaica and South Africa, these projects will develop analyses and policy proposals that address the differing ways in which women and girls are affected, while ensuring they are fully represented at each stage.

Survey data collected in 2013 in Nigeria provides just a glimpse of the burden of violence shouldered by women: 28 per cent of women aged 15-49 have experienced some form of sexual violence. Of the woman surveyed, one in ten had experienced physical and/or sexual violence in the last 12 months alone. The Government of Nigeria has a clear policy framework in place to address the sexual abuse, violence and exploitation suffered by women and girls, including The Child Rights Act and the Violence Against Persons Prohibition Act. But neither has been ratified in all Nigerian states and serious problems persist throughout the country. For example, there has been an alarming rise in reports of so-called ‘baby factories’, in which women are forced to give birth to children who are then taken from them and sold into illegal adoption and potentially also for exploitation. Other reports suggest a worrying rise in the normalisation of abuse in educational settings.

Nationwide ratification of the key laws and their effective application would go a long way in confronting this trend. Grants partner Youth Alive Foundation have identified what they believe to be the principal obstacles to the first step of ratification: a lack of coordinated advocacy, low public awareness, and prevailing cultural beliefs. Their project will create an alliance working across five target states made up of parliamentarians, students, and civil society and media organisations. The alliance will start by carefully mapping existing laws and policies to identify gaps, and, by gathering data in tandem, they will produce authoritative guidelines on how to bring nationwide ratification closer.

Constructive engagement between civil society and government lies at the core of the Foundation’s strategy, and in this new cohort of projects, there is a discernible sense of civil society cooperating with governments and building on their work. These projects do this by broadening and deepening participation of youth groups to strengthen national legislation. They are aimed at achievable and institutionalised change and highlight the importance of including the voices of the young from which there is much to learn.

Leo Kiss is Communications Officer at the Commonwealth Foundation.

For information on our next grant call and all other updates on our grants programme please sign up here. Profiles for each newly endorsed project will be available on the Commonwealth Foundation’s project pages soon.

Health and disability rights: gathering citizens’ voices

Posted on by Commonwealth Foundation

The Foundation recently convened learning exchanges with civil society leaders working on health and disability rights—particularly the rights of vulnerable populations who have been ‘left behind’. The participants, who hailed from 11 Commonwealth countries and had each received support from our grants programme, shared ways to realise these rights by making governments more accountable. This is the first in a series of blogs profiling the approaches our partners have taken.

Existing research is unambiguous: vulnerable and marginalised groups—including women and girls, the poor, and persons with disabilities (PwDs)—are very far from achieving the promise of Universal Health Coverage (UHC) or the Sustainable Development Goal of ensuring healthy lives and wellbeing for all. Further, the estimated one billion PwDs in the world are denied equitable participation in society due to prevailing material and attitudinal barriers, facing higher rates of multidimensional poverty, lower educational attainment, lower rates of employment, and poorer health outcomes. The COVID-19 pandemic has made these inequalities starker.

If you want to ensure a government remains accountable to a community, gathering data directly from that community is a vital first step. Decision makers rarely seek citizen data automatically and voluntarily, and disadvantaged communities may not readily have the capacity to know when, how, and where to provide it in order to influence decisions. The media, civil society organisations (CSOs), and research groups play a key role in the collection, synthesis, and communication of citizen data. Many Commonwealth Foundation partners fulfil this intermediary role. The key to their success has been to fully involve the communities they are trying to help in the process—ensuring it is both credible and sustainable.

Here are two examples of how this has been done effectively:

Community scorecards, Jadabpur Union Council, Bangladesh

Beneficiaries under the Bangladesh government’s Vulnerable Group Development (VGD) scheme are entitled to 30kgs of rice each month—this is a safety net to provide food security for the poorest and most vulnerable citizens. Government officials believed that the scheme was satisfactorily reaching all those in need, but Access Bangladesh Foundation found that many persons with disabilities (PwDs) living in poverty were not accessing the scheme due to lack of awareness, gender discrimination, and nepotistic and non-transparent beneficiary selection.

‘The scores revealed a gulf between the perceptions of PwDs and government officials.’

In order to hold the government accountable to its promises, Access Bangladesh first needed to find an effective way to demonstrate the gulf between PwD’s and the government’s perceptions of the scheme. For this, they designed a community scorecard for the Jadabpur Union council. Through focus groups and individual meetings with PwDs and government officials, they identified the most relevant performance criteria on VGD schemes including the beneficiary selection process, the attitudes of staff providing the service which affected how PwDs felt, and the quality and quantity of items. The scores revealed a gulf between the perceptions of PwDs and government officials. For instance, government officials scored themselves highly on the quality of information provided to PwDs before beneficiary selection, as well as on beneficiary selection itself—PwDs gave the government low marks for both.

Access Bangladesh then facilitated discussions between the two parties during which the scores were revealed. PwDs explained how the government could improve the scheme’s uptake, while government representatives explained their constraints. Through dialogue, both parties agreed on how to improve access to the support schemes. This exercise produced reliable citizen data, initiated a sustained dialogue among service users and providers, increased the trust PwDs held in government because they were listened to, and led to more-inclusive service delivery. For example, women with disabilities were given priority in future beneficiary selection because their additional vulnerability was recognised. In addition, PwDs became more aware of the scheme and the numbers of users increased. In particular, the vulnerability of women with disabilities was recognised and they were given priority in future beneficiary selection. The success of the project was driven by each party working together before, during, and after the meeting in a manner that ensured equal participation. The exercise also improved the confidence and problem-solving skills of the PwDs involved, who are currently following through on the scorecard exercise to ensure that promises are being delivered on.

Social audits, India

During their work in India, Carers Worldwide (CW) found anecdotal evidence that many PwDs in remote, rural and tribal areas were not counted in government disability data, or were miscategorised as having low-level disability and were not in receipt of adequate support. Upon investigation, the assessment process was found to be deeply flawed: camps were only held once per year at locations in each district shown to have poor accessibility. PwDs who couldn’t attend these camps did not get disability certificates and received no government support as a result.

‘They entered the discussion armed with a powerful combination of clear data, a call to action, and the presence of PwDs and their families’

CW brought this to the attention of government officials and other decision makers with the help of a local organisation called SPREAD. A year passed without progress and so CW, alongside local partners and PwDs, decided a new strategy was required. They conducted a large-scale social audit to ascertain data on disabilities and government support. The audit was implemented by PwDs and carers in two villages as pilots before it was scaled up to 34 villages. The data showed the extent of the problem: hundreds of PwDs in this small area were not registered and not claiming government support. Poor community knowledge on accessing support and an inadequate understanding of what counted as a disability had profound impacts with mental illness, stroke, and accident-acquired disabilities too often going undeclared. Perhaps the most striking finding was that 80% of persons with severe disabilities had been wrongly categorised as having ‘minor disabilities’—leading them to claim far less government support than they were entitled to.

A coalition of CW, local partners, PwDs, and carers presented these results to local government officials during a face-to-face meeting. They entered the discussion armed with a powerful combination of clear data, a call to action, and the presence of PwDs and their families. This combination attracted the attention and empathy of government officials who took swift action. As a result, assessment camps are now held three times a year in several locations and involve increased numbers of staff and attendant PwDs. Additionally, hundreds of PwDs have been registered as disabled or re-categorised to reflect their actual level of disability and are now in receipt of the government support they are entitled to.

Next month in our blog series on health and disability rights accountability, we will share case studies that demonstrate the importance of coalition building and leveraging networks.

Dr Shobha Das is a former Director of Programmes at Minority Rights Group International and Gillian Cooper is the Programme Manager of Knowledge, Learning, and Communications at the Commonwealth Foundation.