Governance Area: Social inclusion

Health and disability rights: using legal frameworks

Posted on 01/09/202010/11/2020 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 04/08/202001/09/2020 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.

Tackling youth violence: inclusion for a change

Posted on 03/08/202030/12/2020 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.

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