Tag: Health rights

Power to the People: the Commonwealth Foundation at CHOGM 2022

After two years of delay and postponement, of anticipation and frustration, the Commonwealth Heads of Government meetings (CHOGM) finally took place in Kigali in late June.

For the Foundation, this was the culmination of years of preparation and planning, most especially for the People’s Forum—the largest gathering of civil society in the Commonwealth system that has been a fixture of the CHOGM calendar for almost two decades.

The Foundation also took the lead in convening a half-day of roundtable discussions between Foreign Ministers and members of Commonwealth civil society. An outcome video of the Forum, which was broadcast at the official CHOGM Foreign Ministers Meeting, and also played at the Roundtable itself, can be accessed here.

‘What role could—or should—the Commonwealth of Nations play in these vital steps towards a better world for all its people?’

The People’s Forum 2022: Our Health, Our Planet, Our Future

The People’s Forum 2022 set itself the ambitious task of asking—and trying to answer—the biggest and most important questions of our age: how do we harness the best of humanity—the forces of love, compassion, equality and justice­—to advance our common future and protect our planet? How do we work together to build or re-fashion our institutions so that they support a world that leaves no one behind? And what role could—or should—the Commonwealth of Nations play in these vital steps towards a better world for all its people?

Along with our partners at the Rwanda Governance Board, the Foundation took advantage of the two-year delay to shape a strong and streamlined programme that focused on what is front and centre for so many people of the Commonwealth: health, climate and freedom of expression. The Critical Conversations online event series, launched by the Foundation in 2020 after the first CHOGM postponement, proved to be a gamechanger: giving us experience and confidence in new formats and approaches and expanding our network of activists and leaders across all Commonwealth regions.

‘In a time of growing debt burdens, especially across low and middle-income countries, who should be paying for better primary health care and the other elements of UHC?’

In relation to developing the Forum sessions on climate for example, the Foundation was able to draw on several different events  organised as part of the Critical Conversations series, including one on small states and climate justice held in September 2021 just before COP26, and another on the difficult issue of reparations for climate damage, held in February of this year. Our main climate session at the People’s Forum was explicitly practical: looking ahead to COP27 in November and to what the Commonwealth could and should be doing to advance the interests of those most affected.  Leaders and advocates from the Commonwealth’s small island developing states left the Forum in no doubt about the urgency of the challenge and the moral duty of the Commonwealth, its member countries and its institutions, to demonstrate genuine solidarity through concrete commitments.

The Forum’s sessions on health also benefited from multiple Critical Conversations events the Foundation has convened since early 2020 which shed a bright light on the parlous state of so many national health systems and the apparent incapacity of international systems and institutions (including, disappointingly, the Commonwealth itself) to deliver practical support. At the Forum, the issue of universal health coverage (UHC)—the guarantee that people can access quality health services without facing financial hardship—was front and centre, with panellists interrogating the role that civil society might play in pushing for UHC and the strong, resilient, and equitable health systems that must be at its heart.

Any useful discussion around health and climate must address the thorny question of finance: how do we get the money needed to fund desperately overdue measures aimed at protecting countries and communities from the worst effects of climate change? In a time of growing debt burdens, especially across low and middle-income countries, who should be paying for better primary health care and the other elements of UHC? In the case of climate, Forum participants strongly took up the cause of the Commonwealth’s smaller and more vulnerable Member States, for whom the loss and damage caused by climate change is presenting unique—and in some cases existential—challenges. Across both issues participants were united in their conviction that the Commonwealth has a unique role to play in bringing together those who hold the power to deliver support, relieve debt burdens, and provide restitution. A failure to take up that role with determination would be, in the eyes of Commonwealth civil society, a clear rejection of the very ideas that the Commonwealth stands for.

‘a vibrant and principled Commonwealth is critical to the future of its citizens’

The Commonwealth Charter affirms that freedom of expression—including media freedom—is essential to the flourishing of democratic societies and a basic condition for development. Sadly, this is an area where too many Commonwealth countries are slipping behind. Building on a previous Critical Conversations event, the Forum engaged in a vigorous, at times tense discussion of freedom of expression: why does it matter and how can it be protected? What can the Commonwealth, its member states and institutions, do to support and advance free and responsible media? There was clear agreement that no country can afford to be complacent: direct threats to journalists and freedom of expression are real and growing. Civil society has an important role to play in championing the proposed Commonwealth Principles on Freedom of Expression that could help shore up freedom of expression and break the culture of silence that provides cover for its steady erosion.

The final session of the Forum, A Commonwealth for All’, set itself the ambitious goal of provoking deep discussion and personal reflection about where we are now, and how the Commonwealth—its Member States, its institutions, and its people—can help inspire real and meaningful change. It was aimed at all those who care about the Commonwealth; those who have a perspective on its past; and those who have a stake in its future. The Forum Chair participated in the event alongside the Commonwealth Secretary-General. Both were asked to comment on a provocative video of highlights from the Foundation’s three-part mini-series on the future of the Commonwealth. The passion and conviction of speakers at this final event—and of the many participants who contributed to the discussion—left no doubt that a vibrant and principled Commonwealth is critical to the future of its citizens. The ten-year anniversary of the Charter, which will be commemorated next year, was singled out by many as an opportunity to galvanise action for a reinvigorated Commonwealth.

Weaving together all Forum sessions was the idea of participatory governance: the idea that the involvement of people in their governance is critical to democracy and democratic legitimacy; the idea that citizens have a central role to play in helping to shape policies and decisions that affect their lives. Forum participants acknowledged that participatory governance is a work in progress right across the Commonwealth. We can learn from examples of innovation that have delivered tangible results. But we must be brave in pushing for more meaningful involvement of citizens across every area of public life.

‘How can we measure progress? And how can we push for meaningful action as global economic headwinds turn against us?’

Civil Society and the Foreign Ministers’ Roundtable

The roundtable between participants of the People’s Forum and Foreign Ministers is now an established fixture on the CHOGM calendar: a powerful embodiment of the Commonwealth identity as an organisation of people—and not just of states. For the Foundation, it is an unambiguous exercise in participatory governance—the unifying thread of the People’s Forum.

The 2022 Roundtable was widely proclaimed to be a huge success with the largest-ever number of Ministers in attendance, including a substantial contingent of Foreign Ministers and excellent representation from Commonwealth civil society and accredited organisations. The event was Chaired by the Rwanda Foreign Minister and moderated by me. The seating arrangement, large round tables where government and civil society sat together, and the moderator’s insistence that each take turns in contributing, guaranteed a lively and at times passionate debate. Among the wide range of matters discussed, gender equality and freedom of expression stood out as issues that everyone in the room—government and civil society alike—cared deeply about.

Towards the Future

On the current schedule, we now have less than two years to go until CHOGM 2024. While our future is uncertain, we must brace ourselves for the likelihood that many of the challenges discussed in Kigali will be unresolved. How can we measure progress? And how can we push for meaningful action as global economic headwinds turn against us?

The CHOGM communique—which sets out a bold and ambitious plan of action—should be front and centre. However, many participants in the Forum pointed out the danger of the Communique becoming irrelevant unless Member States commit to measuring their actions against the goals they have set before reporting to CHOGM 2024. Our analysis of the sentiment coming out from the Forum indicates that progress on climate could be usefully measured by the practical steps that Commonwealth countries and institutions take to protect small island developing countries. Progress on freedom of expression is even easier to measure: the Commonwealth must take the final step to adopt a robust set of principles on media freedom that comply with current international human rights standards and put in place mechanisms to monitor implementation. Progress on health requires concerted action to break the debt deadlock that is strangling efforts to deliver universal health care in so many of the Commonwealth’s low and middle-income countries.

So much more could and should be done. But we must start somewhere if the Commonwealth is to hold its head high. Let us decide to hold ourselves—and each other—to account. The people of the Commonwealth deserve no less.

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

Patently necessary: taking health into our own hands

At long last, the World Trade Organization is slated to open formal discussions on intellectual property waivers to help developing countries in the fight against Covid-19.

This pragmatic and humane idea was first proposed 18 months ago at the height of the pandemic. The proposals have since been woefully diluted: indeed—in their current form—it would seem the WTO has finally achieved the consensus it was looking for, since, apparently, everyone hates them. Hidden in the folds of this fiasco, however, is an important lesson for the developing world.

From the very beginning of the pandemic, monopolies on the production of tests and medicines were a part of the problem of surviving it. We went from a situation in 2020 during which tests and treatments were in short supply to a situation in 2021 in which vaccines were being made in far smaller quantities than was possible. This led to shamefully unequal access to these essential tools of survival. While vaccine access generally improved towards the end of 2021, there are still glaring disparities. To date, 93% of all contracted mRNA vaccines from Moderna, Pfizer and BioNtech have gone to rich countries, according to data from Airfinity, a health analytics company. Promising new treatments such as Pfizer’s Paxlovid which are now standard treatments in rich countries are almost completely unavailable in poor countries.

‘Promising new treatments such as Pfizer’s Paxlovid which are now standard treatments in rich countries are almost completely unavailable in poor countries.’

The TRIPs waiver—named after an obscure but powerful rule that obligates WTO member countries to uphold pharmaceutical monopolies—was meant to solve this problem. As the initial proposal was deflected, objected to, or just outright blocked by rich countries over a period of 18 months, people around the world suffered and died. The international community should be ashamed of this failure. Nevertheless, we find ourselves where we are, on the eve of discussions regarding proposals that have been dramatically watered down. What are we to make of this moment?

The first thing to understand is that critics of the current proposals are right: the ideas first put forward 18 months ago were more comprehensive and would have enabled us to turn the tide on the pandemic far sooner. The original proposals asked for intellectual property rights on all crucial aspects of our survival—namely tests, treatments and vaccines—to be waived for the whole course of the pandemic. These demands would have covered our immediate need to ramp up testing and would have delivered far greater quantities of treatments to those in need much faster. Consider the case of Bangladesh, where Pfizer’s patent on Paxlovid does not extend. Beximco—a pharmaceutical company based there—was able to manufacture and deliver the drug a mere ten days after the US Food and Drug Administration approved it, saving thousands of lives.

‘By limiting the waiving of patents to vaccines, rich countries have ensured the WTO plan will have a limited effect on the availability of treatments and tests that are so desperately needed.’

But, alas, the revised waiver proposal now under discussion at the WTO covers vaccines alone. This is perverse. By limiting the waiving of patents to vaccines, rich countries have ensured the WTO plan will have a limited effect on the availability of treatments and tests that are so desperately needed.

No matter how flawed the revised TRIPS wavier proposal is, the potential it holds to prompt a wider discussion among WTO member countries is probably a good thing. For the first time in eighteen long months, there has been a measure of agreement, however inadequate, between key WTO players to move forward: an essential prerequisite for the WTO to move the proposal into formal multilateral discussions. So far, discussions on potential waivers have been bilateral, or between groups of similarly-inclined countries, which is to say they have been unproductive and unaccountable to the international community.

The outcome at the WTO next week is almost certain to disappoint public health activists. Some rich countries are intent on further watering down the proposals and perhaps suppressing them altogether. A wide section of international civil society believes the proposal at the WTO has no value, even as a starting point. They argue that the WTO is in effect supporting a global protection racket: formal permission from the world’s richest countries to the rest of the world to allow them—without fear of reprisals—to do what they are in fact legally entitled to in order to survive an emergency.

‘But it’s also vital that we—those living in developing countries, the majority—begin to understand and use our own sovereignty to arrive at solutions.’

So, what if a decision could be taken at the level of the nation-state to simply roll back or even temporarily suspend patents, regardless of what’s decided at the international level? This would bring the immediate relief that developing countries need and arguably increase their bargaining power at the WTO. In September 2021, one country did exactly that: Brazil passed a law that went beyond even what the original TRIPs waiver proposal had asked for, and it did so with an overwhelming domestic majority and cross-party support. Even though the law was ultimately diluted by a Presidential veto, it remains in effect today and is perfectly permissible under the WTO’s own rules. This option, to create a legislative framework that supports increased supplies of tests, treatments and vaccines, and moreover, encourages their manufacture everywhere, is one that is open to all developing countries today.

Through this pandemic, we have heard much of the unfair way a majority of the world is being treated by a much smaller and wealthier minority. This situation deserves our outrage and attention. But it’s also vital that we—those living in developing countries, the majority—begin to understand and use our own sovereignty to arrive at solutions. The mRNA vaccine technology of today will define the future of global health. Many in the developing world understand that suspending pharmaceutical monopolies is an integral part of securing our present and future wellbeing. But what is less widely understood is that developing countries can do a lot to fix these problems on their own—or better still in concert with others—without having to wait endlessly for permission to do so.

Achal Prabhala is the coordinator of the AccessIBSA project which campaigns for access to medicines in India, Brazil and South Africa.

Women with disabilities advocate for their rights in Geneva

In February 2019, the Women with Disabilities India Network (WWDIN), coordinated by the Shanta Memorial Rehabilitation Centre, submitted an Alternative Report on Article 6 of the UNCRPD to the Committee on the Rights of Persons with Disabilities (CRPD). Our report was prepared in response to the Initial Report submitted by the Government of India on progress towards meeting its commitments to the UNCRPD. In April, a team of four women with disabilities from WWDIN travelled to Geneva to present the report’s findings. This was the first such engagement of its kind for women with disabilities in India.

The Alternative Report is the product of two years of data collection (2017 and 2018) from consultations with 441 women with disabilities in 23 states of India. Women with disabilities are one of the most vulnerable and invisible sections of society in India. Women with disabilities are marginalised in different ways related to education, livelihood and access to health and other services leading to different forms of gender and disability-based violence within families and communities.

‘…the distance of educational institutions from home also has a specific effect on girls’

The report appreciates the positive initiatives taken by the Government of India such as the passage of the Right to Persons with Disabilities Act 2016. The India Country Report has extensive listings of legal provisions, schemes and programmes for persons with disabilities in India. However, little data is provided about differential access women with disabilities have to these provisions. One of the reasons for this is that there is no coordination on issues of women with disabilities, who are relegated to the Disability Department by the Women and Child Development Department and often times overlooked. As a result, women with disabilities continue to remain far from achieving either de-facto or de-jure equality. The recognition of the legal capacity of women is partial, and this can be seen in old and even new legislation such as the newly introduced Mental Health Care Act (2017).

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

Our research revealed that women with disabilities are consistently marginalised in education and employment, with low enrolment and work force participation. An insufficient number of schools in rural areas, where the vast majority of disabled people live, affects access to education; in particular, there are low enrolment numbers for girls with disabilities.

‘In practice women with disabilities have effectively no access to the justice system.’

Education of disabled girls is also affected by factors like poverty, adolescence and puberty; the distance of educational institutions from home also has a specific effect on girls as they are thought to be more vulnerable during long commutes than their male counterparts. The distance between home and school along with poor commuting facilities is a crucial factor in determining dropout rates among disabled girls from educational institutions. This is compounded by lack of accessible infrastructural and residential facilities.

Persons with disabilities protest for their rights in India

Our findings show that women with disabilities are also particularly vulnerable to violence both in domestic and public spaces. Much of this violence is undocumented and unrecognised as policies and practices in India fail to address specific barriers faced by women with disabilities, particularly in response to gender-based violence and violations of sexual and reproductive rights. Gender-based violence against women with disabilities takes many unique forms and includes violence that is perpetuated by stereotypes that attempt to dehumanise or infantilise, exclude or isolate them, and target them for sexual and physical abuse. Many women with disabilities experience gender-based discrimination in the private sphere, ranging from harassment and emotional abuse to rape and physical violence. Women with disabilities in India also face violence at the hands of intimate partners, including husbands and their families.

The Women with Disabilities India Network sat opposite the United Nations Committee on Persons with Disabilities as they delivered their alternative report

Women with disabilities—particularly women with intellectual or psychosocial disabilities—are disproportionately subjected to practices such as forced or coerced sterilisation, contraception, and abortion. Frequently, when these women are minors or are deprived of legal capacity, guardians, parents, or doctors may make the decision on their behalf. Women with psychosocial and intellectual disabilities face discrimination in the form of continued institutionalisation in state- and privately-run care homes and hospitals. Indian Laws however do not take cognisance of the special types, intensity and magnitude of violence perpetuated against women with disabilities. While some laws address violence against women with disabilities in institutional settings, in practice women with disabilities have effectively no access to the justice system.

The most obvious barriers to equality before the law in terms of disabled women’s access to the justice system are physical access, communication barriers, and financial constraints. Current policies and practices in India addressing violence against women fail to address the unique causes and consequences of gender-based violence against women with disabilities. For instance, the Rights of Persons with Disabilities Act 2016 does not address violence against women with disabilities.

While in Geneva last month, the WWDIN team presented our findings during two interactions with the CRPD – one with the entire committee and a second meeting with committee member Mr. Jun Ishikawa. In both our engagements, we were able to impress on the CRPD committee members the violations of the rights of women with disabilities in India, the roots of these problems, and their varied nature. The committee members asked pertinent questions, asking for clarification on several points and duly noted that there is a need to engage more proactively on issues of violence against women with disabilities. The outcome of the pre-session has been favourable as the List of Issues mentions the violations of rights of women with disabilities and enjoins the Indian state to be more proactive in addressing the concerns of women with disabilities across the country.

This article was written collaboratively between Nandini Ghosh, Assistant Professor at the Institute of Development Studies, Kolkata, and Reena Mohanty, Programme Officer, Shanta Memorial Rehabilitation Centre, Odisha.

Strengthening the role of civil society for health-policy action in the Commonwealth: a blog journey

Blog entry one: the week ahead…

The coming week (May 15-19, 2019) promises to be an enriching and empowering experience for me with three back-to-back meetings facilitated by the Commonwealth Foundation: a Learning Exchange focussing on ‘Accountability in health policy and service provision’; a Civil Society Policy Forum on Universal Health Coverage (UHC) and; the Commonwealth Health Ministers Meeting. These meetings are innovative platforms to convene multi-sectoral stakeholders from Commonwealth countries to discuss and exchange our experiences in implementing projects that address critical health and developmental issues. What makes this a unique journey is the opportunity for us to be able to inform and cascade the insights and outcomes from one meeting to another, synthesising perspectives of civil society actors and policy-related stakeholders, with a potential to strategically position our priorities at the highest level of health-related policy making, at the ministerial meeting.

UHC is a common thread which strings together international, national and sub-national policy and programmatic responses to the entire spectrum of public health and developmental issues, including the focus of HRIDAY’s project in India on civil society engagement in the national response to Non-Communicable Diseases (NCDs). The meetings have been conceived in a participatory manner and are designed to garner multi-sectoral and multi-stakeholder insights on robust strategies to address these issues, within the available resource pool. The focus on holding key players accountable to their roles, is an important cross-cutting theme that we hope to deliberate on.

I look forward to hearing from fellow grant partners, about their successes and challenges, and identify opportunities for adapting effective strategies for our ongoing project on working with health and development civil society partners to track India’s NCD targets.

I am hopeful that this experience will help us to explore stronger pathways and mechanisms to participate in health policy-related decision making in our respective countries, regions, the Commonwealth and even globally.

Blog entry two: thoughts during the exchange:

A final, post-event blog entry is coming soon…

Building a healthy relationship

I suppose it’s inevitable that as the end of my term as Director-General nears, I reflect on the Commonwealth Foundation’s journey over the past seven years. I’ll always be grateful to our governments for backing a strategic change in direction in 2012. That focussed our work on people’s participation in governance but coming to that agreement wasn’t straight forward. Some took more convincing than others. A refrain I heard often at the time went ‘the Commonwealth Foundation’s proposed emphasis on governance is well and good but we want to see a focus on development.’

‘Intellectual property regimes are also being used to prevent the search for new drugs that protect public health as globally we face up to anti-microbial resistance.’

My response was and remains a rebuttal of a reductionist world view that posits development and governance as dichotomous. All those who share the Foundation’s outlook raised a cheer when SDG 16 made the explicit connection between inclusive governance and better development outcomes. It was a privilege to see how this works in practice while visiting a Commonwealth Foundation grant funded project in Malaysia this month.

Third World Network (TWN) is a well-respected independent, international, research and advocacy organisation, which since 1984 has been taking up issues of concern to the Global South. They recognise that trade agreements between countries include intellectual property clauses that run counter to the internationally ratified Trade Related Intellectual Property Rights (TRIPs) Agreement and a subsequent Declaration on TRIPs and public health. This affirms the right of countries to use the full flexibility of TRIPs to provide access to medicines to all. Intellectual property (IP) regimes are also being used to prevent the search for new drugs that protect public health as globally we face up to anti-microbial resistance.

TWN saw the need for engagement with governments in the global south on the provision of effective and affordable drugs. With funding from the Commonwealth Foundation they are helping the Ministry of Health (MoH) to navigate IP provisions to improve access to medicines and are providing a civil society perspective on the implementation and monitoring of a national action plan on anti-microbial resistance.

As we met with MoH colleagues, their genuine appreciation for the support they had received from TWN in the design, promotion and monitoring of the AMR national action plan was palpable. In 2012 the Ministry widened the focus of the AMR campaign from health professionals to the public at large and this called for considered and sustained civil society engagement. TWN acts as a champion, a trusted interlocutor and convenor. They raise awareness through events and publications and encourage civil society to participate and monitor progress. This is helping to take the AMR campaign to new audiences such as farmers who use antibiotics in their animal husbandry practices.

‘Getting the message across that [anti-microbial resistence] is an imminent threat that requires urgent action by all of us calls for new alliances and ways of working.’

We also met with colleagues from the remarkable Drugs for Neglected Diseases Initiative (DNDI). DNDI was established in recognition of the fact that the research and development of drugs doesn’t serve the interests of many on the global south. According to their research, of the 850 new drugs approved between 2000 and 2011 only 4% were for neglected diseases such as chagas, sleeping sickness and leishmaniasis (which with other neglected diseases accounted for 11% of the global disease burden over the same period). They develop new drugs to address these issues and patent them so they can be made available at an affordable price. In Malaysia they have targeted hepatitis c and have partnered with TWN as they have engaged with the Malaysian government so that one major drug is licensed and made available. In this instance TWN provided technical inputs on the TRIPS implications and opportunities to government policy makers.

I left Malaysia appreciating that the simple question ‘How can the most vulnerable people in society enjoy equitable access to health treatment?’ has a very complex answer. As Dr Ying-Ru Lo, the Head of Mission and WHO Representative to Brunei, Malaysia and Singapore said to us health issues are increasingly multi-sectoral and civil society is well suited to helping government agencies (often working in isolation) to make the connections and form the coalitions that are required to deliver public health.

This is inclusive governance in action and the Malaysian experience shows that it is not a luxury item. Getting the message across that AMR is an imminent threat that requires urgent action by all of us calls for new alliances and ways of working. The joined up approach of public health policy makers, DNDI and TWN on drugs for hepatitis c has contributed to the treatment of more than 1,000 people to date. Inclusive governance isn’t just about improving the decisions that shape people’s lives. It’s also about improving the decisions that save people’s lives. Seven years on from making the decision to change its strategic focus, the Commonwealth Foundation can make the connection between participatory governance and better development outcomes – but all that does is remind us of the amount of work that remains to be done.

Vijay Krishnarayan is Director-General of the Commonwealth Foundation.

Following the money: cash transfers

(Above) Helen Mudora presents project results at the Foundation’s annual grants workshop. The workshop shares monitoring and evaluation techniques with new grants partners and provides opportunities for networking and knowledge sharing.

Earlier this month, Helen Mudora, Programme Manager at Africa Platform for Social Protection (APSP), presented the results of her organisation’s project ‘Enhancing accountability for cash transfer programmes’ to our new cohort of grantees and our Board members at the annual Commonwealth Foundation grants workshop.

APSP’s project is being delivered in the counties of Busia, Kilifi and Kajiado in Kenya. In this interview, Helen discussed some results and lessons the project has generated with Gillian Cooper from the Knowledge, Learning and Communications team.

Gillian: What are social protection cash transfers?

Helen: The Africa Union defines social protection as: ‘responses by the state and society to protect citizens from risks, vulnerabilities and deprivations. It also includes strategies and programmes aimed at ensuring a minimum standard of livelihood for all people in a given country. This entails measures to secure education and health care, social welfare, livelihoods, access to a stable income, as well as employment’.

Social protection is largely seen to have three pillars: health insurance, social security, and social assistance.  In Kenya, the three most common social assistance programmes include the Orphans and Vulnerable Children cash transfer (OVC-CT), the Older Persons cash transfer (OPCT) and the Persons with Severe Disabilities cash transfer (PWSD-CT).

‘Cash transfers have transformed the lives of thousands of people who would ordinarily find it a challenge to meet even their basic needs.’

The orphans and vulnerable children cash transfer programme was started by UNICEF as a pilot, mainly as a response to the crisis of HIV orphans. It is now funded by the government and gradually over time has included all children who face poverty and vulnerability.

Cash transfer programmes for older persons respond to the unique challenges faced by older persons including low income levels and destitution.

The Persons with Severe Disabilities cash transfer programme was started to meet the basic needs of carer families who may not be in a position to find time to generate income because of caring responsiblities for a family member with a severe disability.

In many countries, the poorest of the poor are PwDs. They face multiple barriers – the system disadvantages PwDs from earning an income. They don’t have access to services and there’s no transport to take them to school. Without schooling there is a close correlation to poverty – only about 5% of PwDs in Kenya make it to university – and so the PwDs cash transfer helps to redress this imbalance. Cash transfers have transformed the lives of thousands of people who would ordinarily find it a challenge to meet even their basic needs.

Gillian: What did APSP’s community sensitisation and social audits uncover about the cash transfer programme?

Helen: APSP works with communities to promote citizen engagement in the delivery of cash transfer services through social audits. We identify community organisations to work with, who in turn identify community monitors who form the link between government programmes, citizens, and beneficiaries.

APSP trains the community monitors in social protection, rights-based approaches and advocacy.

Community sensitisation forums are held to increase awareness levels of the communities and citizens about existing social protection programmes. APSP, in collaboration with community groups, then conduct a social audit of government programmes.

The social audit is a deeper way of generating evidence to inform policy.

This entails collecting data on various parameters of the government service charter, including timeliness of payments, distance to collection points, dignity in service delivery, awareness of existing government programmes, as well as impact of the cash transfers.

‘APSP is conscious to strike a balance, making sure not to undermine the relationship with government and manage the politics so it does not become confrontational.’

Our audits have found that some people in rural areas have to walk more than 6km, sometimes 7km, to collect the cash.  In the urban areas this is not a problem as the service has been more decentralised and the road infrastructure is good. In rural areas beneficiaries walk longer distances to access the cash. We also found that the timeliness of payments varies. 50% say they get their payments on time. 33% have to wait about 6 months. For the rest, the time varies, some have delays more than six months.

We also looked at the length of time it takes to receive the cash at the bank. It was noted that because those who receive the cash are few in number, there is often a long line especially considering people have a short two week window within which to be paid.

Finally, the audit looked at the complaints and redress mechanism. We found that this has been poorly publicised as not many people know about the government toll free number, where they can report any challenges or issues. Currently the complaints process is still centralised at the headquarters in Nairobi, but the complaints might be made from 400km away! We are recommending that the complaints mechanism is decentralised so that people can lodge complaints and have it resolved at the community level.

Social accountability is about pushing for effective service delivery. What the government says it’s going to do should be done within the promised timeframe. That’s what it means to provide cash transfers as a right. APSP is trying to discourage tokenism and help community members realise that the cash transfer is a right. We’ve worked to build the confidence of the community so that if they find a problem, they have a right to complain and the government has an obligation to listen.

Gillian: What have been the most effective ways to track progress and ensure government accountability?

Helen: Evidence. You must generate evidence. For a long time, individuals would make complaints, but when you make a complaint as an individual, it’s not sufficient. But it becomes evidence when you bring in a bit of science, and present it as a research finding which shows that a particular phenomenon is a part of a bigger picture. And so, this project has helped us to move from individuals complaining, to a collective approach that generates evidence to inform policy.

‘Building capacity is about supporting marginalised groups to make their voice heard in a way that makes policy makers listen and respect them.’

Gillian: How has the project addressed gendered needs?

Helen: This is a work in progress. For starters, whenever we do community mobilisation, we always ask for a specific number of women and men. At the beginning, when you mobilise people to come together, you must make sure you get both men and women. You might not get a 50-50 ratio, but it’s important to set this as a target so that at least you will get a considerable number of women. For trainings we go the extra mile to get women to participate; we might need a sensitisation meeting to encourage participation.

We respect and are conscious of the triple roles of women. So for the community sensitisation forums, our starting time must take account of when women have completed their morning routine. We start at 9 or 10 and by 12:30 we must finish. If the timing is not right they will not come at all.  We have also built the capacity of women to articulate their issues in different fora. For APSP’s international meetings, we make sure women from project communities are on the programme to speak.

Gillian: How does APSP engage with government to make change?

Helen: We seek opportunities to sit with government and meet in their Boardroom. We always request meetings with the Permanent Secretary in her/his Boardroom so that we share these findings with them first before it goes public. APSP is conscious to strike a balance, making sure not to undermine the relationship with government and manage the politics so it does not become confrontational. APSP is part of the National Steering Committee for Social Protection, which is a government constituted committee. This shows they have faith in our work.

Our engagement has paid off; APSP’s research has influenced the process of cash disbursement. In 2018, the government started a universal cash transfer for older people. Previous cash transfers were provided at only two banks. Now there are five banks from which to choose from. In addition, clients are given an ATM card, so they can access the money at any time.

We also engage in the legislative process. Social protection is in the constitution but there is no subsidiary law to enshrine the cash transfer system. APSP has been working with both Parliament and the Executive arm. We try to balance our engagement so we are not leaning on one side. Parliament now invite us to the departmental committee meetings and we are working with them to pass that law.

Gillian: How should marginalised groups be included in decision-making about policies that affect their lives?

Helen: Capacity building is very important. Building capacity is about supporting marginalised groups to make their voice heard in a way that makes policy makers listen and respect them. The voice is there but how they voice it may mean nobody can listen to them. They may be voicing it through complaints or in anger or desperation.

Evidence generation is one way. People are less likely to doubt statistics – you don’t have to bang tables when you have data. The skills we’ve been able to build for the community has been intense but transformational.

We have developed an advocacy tool. It provides steps for engaging and how to make your message hard-hitting. The advocacy tool includes a monitoring guide to help track meetings and progress so you can attribute the impact of your work to a policy change.

Gillian: What are the next steps for your project?

Helen: We are hoping our experiences can be used to replicate the project in other counties in Kenya.  We can also replicate it in other countries – APSP works in 27. The project provides a very good basis for knowledge sharing. When we have our delegates meeting in August, grassroots representatives are part of the programme. We can show it as a model of citizen engagement in decision-making.

Beyond that our long term goal is for sustainability of social protection programmes. Our bigger advocacy agenda is around national budgets and processes. In many countries, social protection is funded by donors. In Kenya it is now 97% government funded but in other countries it is 100% donor funded. So where is the government commitment? We aim to push for social protection allocations from national budgets to meet the African Union  Social policy framework – which states that every government should use 2% of its budget on social protection so that it is sustainable and not dependent on external donors.

Helen Mudora is Programme Manager at Africa Platform for Social Protection

Grants roundup: helping civic voices to be heard

Five grants projects were approved by the Grants Committee on 13 June 2018.

In line with the Foundation’s strategic goals, these projects will help ensure that policy, law and government institutions are more effective contributors to development through the influence of civic voices.

This year’s cohort features two projects focussed on disability rights.

The first is to be implemented by the Access Bangladesh Foundation (ABF), a leading Disabled People’s Organisation (DPO) that has a strong track record of working to empower persons with disabilities through community based approaches. Bangladesh signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007 and passed the national Disabilities Act in 2013. This project aims to crystallise the government’s commitments by building on the advocacy capacities of people with disabilities.

This will be done by organising self-help groups in 20 union parishads (local constituencies) that are spread across three districts in Bangladesh. It is expected that by the end of the project, the self-help groups will be better integrated into planning processes and that government officials will have mainstreamed disability concerns into their programmes.

‘Carers often face a number of issues including deterioration in their own health, financial strain, isolation, and social stigma.’

In a project by ChildLink Inc, efforts are being made to support children with Disabilities in Jamaica and Guyana. In 2007, Jamaica became the first country to sign and ratify the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) which was followed by the adoption of the (national) Disability Act in 2014. ChildLink Inc. will focus on developing the skills of parents to engage the education system and hold it accountable to the act’s provisions.

In Guyana, ChildLink Inc will work with parents, teachers, children with autism and child-focussed Civil Society Organisations to support special education needs in Guyana. Guyana became a signatory to the UNCRPD in 2007. This was followed by the Persons with Disabilities Act in 2010 which involved a commitment to the special education needs policy (SEN). It is expected that by the end of the project SEN could be mainstreamed into government schools.

Two projects from this year’s cohort will be implemented in India.

The government of India has accorded high priority to building sustainable, smart cities that are resilient and able to meet the challenges posed by rapid urbanisation. A project implemented by Gujarat Mahila Housing Sew Trust (GMHST) will support government efforts by amplifying the voice of women in planning processes to bring about community participation in city-level development. The projects will take place in Ahmedabad and Surat: two of the cities covered by the Smart City Mission.

‘Occasionally the Commonwealth Foundation sees the value in building on the success of former projects.’

Occasionally the Commonwealth Foundation sees the value in building on the success of former projects. There are 26.8 million disabled people in India, many of whom need to be cared for by an unpaid family member. Carers often face a number of issues including deterioration in their own health, financial strain, isolation, and social stigma. From October 2014 to September 2017 Carer’s Worldwide UK sought to tackle this problem using funding from the Commonwealth Foundation.

They used the funds to: raise awareness of local authorities in Jharkand, Andra Pradesh and Karnataka to the needs and rights of carers; enable their inclusion into local authority welfare schemes; provide carers with greater access to medical care; and improve their ability to take up new or additional livelihood activities leading to increased income levels. In a new project starting in 2018, Carer’s Worldwide will build on results achieved at local government level, strengthen civic voice in advocating for the rights of family carers and support the passage of favourable policy and legislation.

Following an uptick in applications from the Pacific, amongst this year’s grants partners is The Pacific Islands Association of Non-Governmental Organisations (PIANGO), a regional coordinating body and network of umbrella NGO bodies in 24 Pacific Island countries and territories.

It is well understood that climate change represents the most serious challenge to the future of the Pacific Island countries. Low-lying atolls such as Kiribati are among the countries most vulnerable to its adverse impacts. PIANGO is proposing to work with one of its members, the Kiribati Association of Non-Governmental Organisations (KANGO), in order to collaborate and dialogue with the i-Kiribati government and the Pacific Islands Forum (PIF) to help shape policies that reflect the needs, priorities, and voices of local i-Kiribati communities on migration and climate change.

For information on our next grants 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 grants pages soon.

Right to Information: a success story from Vavuniya, Sri Lanka

Transparency International Sri Lanka made an Information Request of the Vavuniya Divisional Secretariat, querying the lack of updates to the Secretariat’s website.

The site in question had not been updated since 2015. Information was also requested about the steps the Divisional Secretariat had taken to help and facilitate members of the public who submit RTI Forms.

The Divisional Secretariat responded by updating their website in June 2018 . Furthermore, an information board was displayed in front of the Secretariat Office, containing details about the information officer of the Divisional Secretariat. This enabled easy access to the Secretariat’s RTI Unit for members of the public, and set a precedent for proactive disclosure.

The picture depicts the website last updated on 18 December 2014 and the update following the RTI request on 19 June 2018.

Sri Lanka marked a historic victory in August 2016 when the right to information act was passed. The law now enables all citizens to access information held by the State and was internationally acclaimed: ranking third in Centre for Law and Democracy’s RTI rating.

Even though the passage of the law was a result of 20 years of agitation by civil society, journalists, politicians and activists, beyond this circle, knowledge of the law and its significance was mostly non-existent. The grant provided by the Commonwealth Foundation enabled Transparency International Sri Lanka (TISL) to be one of the lead organisations in Sri Lanka demystifying the law for citizens – in Colombo, Matara, Ampara, Trincomalee and Jaffna, spanning the Northern, Western, Eastern and Southern provinces, and other districts as well.

Sri Lanka’s rank on Transparency International’s Corruption Perceptions Index (91 ) demonstrates the challenge set before the country and hopes and were fostered that the RTI law would open up the space for transparency, accountability, and an avenue for ordinary citizens to better understand government processes.

However, since the law’s enactment little effort has been made to educate people on RTI, and it is civil society that has filled that space. Through this grant, TISL has employed several techniques aimed at doing so.

Very early on, as RTI was operationalised, TISL used an ‘RTI Van’ with a large LED screen and loudspeakers, to drive through the districts, stopping in strategic locations. It ran audiovisual content on the RTI process, with staff members interacting with the public, and in certain cases, helped them to formulate RTI requests on the spot. Notably, in the Trincomalee districts, over 150 RTI requests were facilitated covering issues of corruption, access to education and health facilities. Street dramas around International Right to Know Day 2017 , newspaper advertisements, missed call campaigns and SMS shots are among the other techniques that were used.

A Manual and information leaflets were created and mirrored on a website which was regularly updated. These described case studies and the law in local languages in a simplified and accessible manner. TISL has continued to visit communities conducting small pocket meetings, listening to people’s needs and brainstorming as to how people can use RTI creatively and at times collectively to resolve problems. TISL also facilitates constructive discussions with government counterparts.

RTI has been working in unforeseen ways in Sri Lanka. While it has in many instances led to information disclosure, government actors have been known to remediate issues causing discontent without disclosing information.

For example, the residents of Akkaraipaththu in Ampara made a complaint to the Medical Officer of Health (MOH), about garbage accumulation affecting 10 families and a school in Akkaraipaththu in May 2017. The issue was communicated to the President via the ‘Tell the President’ campaign in July 2017, but no action was taken. In January 2018, a RTI was filed, requesting information on the actions taken by the MOH pursuant to the complaint. Within four days of making the request, the garbage was cleared and the MOH even asked the citizen if he could withdraw his RTI.. The citizen has refused.

Another manner in which RTI has assisted the average citizen is that it has given them access where formerly she might have been stonewalled. The stringent timelines for disclosure stipulated in the law has ensured that citizens with a good understanding of the RTI process could follow a few simple and non-confrontational steps to hold a public institution accountable.

RTI is both weapon and deterrent, enforcer and protector. Stories of the law’s success have now begun trickling in from many parts of the country. It is eminently important that these hard-won victories continue to be used for the benefit of all.

Sankhita Gunaratne is a project manager at Transparency International Sri Lanka.

Commonwealth Civil Society Forum on Health

The Commonwealth Health Ministers Meeting (CHMM), held on 20 May 2018, provided an opportunity for member countries to share their experiences and lessons learned, as well as build consensus around collaborating to enhance the global fight against non-communicable diseases (NCDs). It also addressed suggestions for effective funding models for universal healthcare (UHC).

Civil Society Forum

Working in collaboration with members of the Commonwealth Health Professions Alliance (CHPA), and in partnership with Oxfam GB, the Commonwealth Pharmacists Association (CPA) contributed to a successful Civil Society Forum (CSF) on the eve of the annual CHMM in Geneva.

The Forum entitled ‘Universal Health Coverage (UHC): holding countries to account’ followed on from discussions hosted by civil society on the same topic during the previous month at the Commonwealth People’s Forum (CPF). The afternoon saw seven speakers delivering thought-provoking presentations before engaging in lively discussions with delegates from all over the Commonwealth. The working descriptor for the session was:

‘everyone agrees UHC is a good thing, and governments have committed to UHC as part of the Sustainable Development Goals (SDGs). But UHC cannot be achieved without sustainable financing, a sufficient health workforce, and equitable access to safe, quality, and affordable medicines for every citizen’.

The CPA co-ordinated the health workforce section of the afternoon’s programme. Seven recommendations drafted after the CPF in London the previous month were further refined as a result of expert input and discussions. These were presented by the CHPA to the Commonwealth Health Ministers at CHMM the following day.

The CHPA also conducted a survey via their networks to request feedback on these recommendations from a wider audience. As a result of this, further refinement was achieved and the CPA was delighted that recommendation three (below) specifically referenced the need for governments to not only address ‘access to effective, quality and affordable essential medicines’ but also recognised the essential role pharmacy plays in this aspect of achieving UHC by specifically highlighting the need to invest in developing a ‘sufficient pharmacy workforce’:

 Recommendation 3: that Commonwealth governments include in their UHC plans strategies for:

  • Access to safe, effective, quality and affordable essential medicines and vaccines for their populations
  • Building capacity through education and training for a sufficient pharmacy workforce
  • Developing public procurement policies using public financing

Thank you to everyone that responded to our requests to answer the survey – your collective voice certainly made an impact and strengthened our advocacy efforts. We look forward to the next steps in these discussions. The full set of recommendations and presentations from the CPF are available on the CHPA website. ( www.chpa.co )

Commonwealth Health Ministers Meeting

The theme for the CHMM this year was, ‘Enhancing the global fight against NCDs; raising awareness, mobilising resources and ensuring accessibility to UHC’. The meeting began with opening remarks by the Chair, Hon. Rosy Sofia Akbar, Minister of Health, Fiji and the Rt Hon. Patricia Scotland QC, Commonwealth Secretary-General. Following this, Mrs Graça Machel DBE, co-founder of The Elders delivered the keynote, where she referred to the ‘fundamental right of health and well-being for all’, as an essential component for vibrant communities and the development of nations. After lunch Dr Tedros Adhanom Ghebreyesus, World Health Organisation Director-General continued these discussions in the same vein, focusing on the importance of Commonwealth collaboration in enhancing the global fight against NCDs in the context of UHC.

The Commonwealth Health Ministers engaged in discussion and debate throughout the day around challenges affecting their nations as they strive to make SDG3 and UHC a reality for their populations. There was particular emphasis on measures to encourage environments where healthy diets and exercise would promote wellness and help tackle the NCD epidemic through prevention.

The UK’s Secretary of Health and Social Care, Rt Hon Jeremy Hunt reiterated the British government’s commitment to health outlined in the 2018 CHOGM Communique, part of which was directly linked to and provided a basis for the programme of the CSF the previous day:

‘Commonwealth Heads agreed to achieve compliance with International Health Regulations, accelerate UHC, including through sustainable financing, strengthening health systems and integrated services which promote prevention, screening, diagnosis, treatment and palliative care. Heads also recognised the need to tackle antimicrobial resistance and noted with concern the proliferation of substandard and falsified medical products which contribute to antimicrobial resistant and drug resistant infections.’

The CPA were most encouraged that our advocacy efforts leading up to CHOGM were reflected in the commitment of CHOGM to tackle both AMR and the rise of substandard and falsified medicines.

The full CHOGM Communique can be viewed here. The full statement from CHMM will also be available on the Commonwealth’s website shortly.

Victoria Rutter is Executive Director at the Commonwealth Pharmacists Association. 

Citizen-generated data for a change

‘Citizen-generated and evidence-based data’ are terms we hear more and more about in the discourse around monitoring and accountability of the Sustainable Development Goals (SDGs).

I joined Mansuriah alongside other colleagues from the Foundation and EASSI on the learning visit to Gender Links earlier this month and thought the Gender Barometer they have developed was an excellent example of citizen-generated data. It was clear the barometer had become a powerful accountability tool in Southern Africa, influencing discourse and provoking change across the region around gender equality.

‘It was clear the barometer had become a powerful accountability tool in Southern Africa’

After South Africa, I continued to East Africa where I met with Foundation grant partners KELIN and the Africa Platform for Social Protection (APSP) who work with some of Kenya’s most marginalised communities. What approaches to citizen-generated data did they find effective?

Citizen-generated data is defined as ‘data that people or their organisations produce to directly monitor, demand or drive change on issues that affect them’ . Here are a few of the approaches to citizen-generated data that our partners are using to ensure inclusion of marginalised people in holding duty-bearers to account.

Mixed methods approaches that harness different knowledge sources

The SADC Gender Protocol barometer effectively pulls together and ‘houses’ data from a variety of monitoring and evidence measures. Referred to as an ‘omnibus’, it uses two main measures: An Index and the Citizen Score Card.

  • The Index draws on data from readily available statistics, an attitude survey and a media monitor tool.
  • The Index is complimented and compared with data collected from a Citizen Score Card – a perceptions measure administered to a representative sample of women and men in each of the 15 SADC countries.
  • Each of the organisations also use a variety of participatory methods to harness data and knowledge from communities to bring evidence and voice into decision-making spaces:
    Providing testimony on the lived experience and challenges faced by service-users and marginalised communities, if presented in a participatory decision-making space, such evidence can be a powerful stimulus for change and strengthens voices at the grassroots.
  • multistakeholder dialogues that bring together service-users with service providers and other governmental decision-making bodies into a participatory space where voices can be heard and progress towards change and solutions can be discussed.
  • case studies are used to capture more in-depth analysis of experiences.

Choosing indicators that really question the change

In March 2017, the Gender Protocol Alliance revamped its index so that it would result in ‘better data for better decisions’. Rather than using indicators that relied on data which was readily available, indicators were revised to really get at the nub of the issue and to ask difficult questions on gender equality. Gender Links’ Executive Director, Colleen Lowe, explained that indicators have been chosen for their potential to provide critical evidence; not simply about monitoring for the sake of data capture but about demonstrating the change that needs to happen.

‘Rather than using indicators that relied on data which was readily available, indicators were revised to really get at the nub of the issue’

Examples of indicators aimed at measuring some of the more hard-to-measure areas around women’s voice and gender-based violence, which have remained intractable and hidden issues for women, are:

• % who say if a woman works she should give her money to her husband
• % who say if a man beats a woman it shows that he loves her
• % who say a woman has a right to insist on a man using a condom
• % women sources on economic topics

Aligning with policy and validating data

The SADC gender barometer is aligned to an existing policy. It follows the nine sectors of the Gender Protocol: constitutional and legal rights, governance, education and training, the economy, gender violence, health HIV and AIDS, the media and climate change. Aligning the protocol to SDG 5 (Gender Equality) has given additional leverage for government to sign up to the protocol and meet the targets. Joan De Klerk, Head of Public Education and Information at South Africa’s Commission for Gender Equality confirmed that the Commission uses data from the barometer to cite in their own reports.

Validation of data with government has been critical for buy in and credibility of the evidence presented by civil society. APSP have validated data that showed that the people in need were not accessing the cash transfers, thus compromising its impact, by bringing government officers into the field to see the reality. Partnering with academic bodies to help in determining what is statistically acceptable is also another way to avoid data being discredited by government.

Popularizing the accountability tools, the results and building rights awareness

Each of the three organisations have gone to great lengths to popularise and breakdown technical policy documents and assessment criteria into simple language. This approach is critical to creating interest around the accountability process as it helps to build rights awareness and demonstrate how individual and community-based issues fit into a wider rights-based policy framework.

KELIN’s publication, Monitoring the Implementation of the Right to Health Under the Constitution of Kenya, outlines the constitutional provisions on Kenya’s right to health. As Allan Maleche, KELIN’s Executive Director noted, people living with HIV ‘must be able to know how to plug into questioning the broader rights to health issues. Unless they understand how the right to health and the health system works then the advocacy [and accountability measures] will be useless’.

The use of infographics and data visuals has also been a powerful way in which Gender Links has communicated the results of the barometer. These can be more easily shared via social media and to tell the story in accessible yet powerful ways that can build interest to engage.

Strong networks to capture perceptions in the margins and support advocacy

The Southern Africa Gender Protocol Alliance has been a critical vehicle for advocacy. Gender Links has sought to embed the protocol provisions in the work of each of its Alliance members. Gender Links’ networks also include working relationships with 430 local government councils who play a critical role in data capture.

‘[KELIN] is also building its network to include journalists who […] can also act as advocates to provide further evidence.’

KELIN is working to identify community champions and strong CSOs in each of the counties where its project operates. It is also building its network to include journalists who are passionate on community issues and who, with some additional training on health rights, can also act as advocates to provide further evidence.

Looking ahead

It’s not yet clear what strictly is or isn’t citizen-generated data but the visit and discussions showed that evidence and data used for accountability needs to have credible data and information that ask difficult questions, ideally using measures validated by duty-bearers but backed by a strong rights awareness among affected communities. Those affected need to see how their experiences fit into a wider policy and rights-based framework so that evidence collected is accountable to them.

A challenge that always exists is negotiating and judging how best to use the data and evidence in the accountability space. Describing the challenges of complimenting government interests while also advocating for change, Samuel Obara, of APSP said: ‘this [advocacy] space is fragile because [our work relies] on political will and this is a will that we are trying to protect’. Colleen Lowe from Gender Links described the relationship between government and civil society as ‘creative tension’. I would like to thank our partners in South Africa and Kenya for hosting rich discussions and sharing experiences.

Gillian Cooper is Programme Manager for Knowledge, Learning and Communications at the Commonwealth Foundation.