Tag: Health rights

Advocacy is not complaining: Jamaicans for clean air and water

Posted on 20/12/201702/07/2019 by Suzanne Stanley

Jamaican communities living near to mining and quarrying operations often experience adverse impacts to air and water and to their quality of life.

At the same time, these commercial operations are also a source of jobs and economic development which restrains residents from taking action. The Jamaica Environment Trust (JET) has been working with mining communities on the island since 2013. Our objectives have been to ensure community members know why good air and water quality is important to their health and about their rights under the law. JET has also worked on empowering communities to advocate on their own behalf, rather than simply filing complaints with JET and/or government regulators.

‘Community members knew what their problems were – dust, noise, impacts to water – but did not know how to address them and did not know who to talk to’

With funding from the Commonwealth Foundation, JET has been implementing a project entitled Jamaicans for Clean Air and Water since October 2016. The target communities are: Hayes/New Town in Clarendon, affected by a large alumina processing company and its Residue Disposal Area (RDA), Ten Miles at Bull Bay, St. Andrew, affected by quarrying by a cement company, Pleasant Farm in Ewarton, St. Catherine, also affected by bauxite mining, processing and waste and Port Morant, St Thomas, affected by sugar cane production and processing.

Site visit to Port Morant with community group and sugar factory representatives (2017)

Community members knew what their problems were – dust, noise, impacts to water – but did not know how to address them and did not know who to talk to. JET conducted advocacy training, with a focus on developing familiarity with the legal framework for mining and quarrying, especially regarding the environmental permits issued for these activities. Residents learned, for example, that the companies were required to keep a complaints register at a location that was easily accessible to them. The registers did exist, but were held inside the companies, where local people did not have easy access. Because they were not used, the companies were able to argue to regulators that there were no complaints. We also taught communities how to do logs of pollution events, so that they would be able to provide evidence of these impacts. Work continues to encourage communities to use these unaccustomed avenues.

Participants in the training also learned how to use the Access to Information (ATI) Act. They knew they were affected by dust, and they knew air quality was being tested by the company, but they did not know how to get the information, or how to interpret it. During workshops, community members learned how to do a simple ATI request and were excited to receive the information from government agencies after their requests were submitted. Because the information was often highly technical, however, they still needed expert input from JET and its consultants to understand what was sent to them.

‘Community members also benefit from meetings with regulators through the project’

JET continues to push the regulatory authorities to proactively disclose information about air and water quality to the public, especially nearby communities, in a form that is understandable by a lay person. A major output of this first year of the project was the release of a Review of the Legal and Policy Framework for Air and Water Quality in the island of Jamaica. This was launched at an Editor’s Forum at Jamaica’s main daily newspaper, the Gleaner, and received broad media coverage. In 2018, we will engage with the main environmental regulator, the National Environment and Planning Agency (NEPA), regarding the recommendations of this study.

Community members also benefit from meetings with regulators through the project. Stakeholder meetings have given them the opportunity to meet the responsible officers and tell them in their own words of their experiences. The regulators had to grapple with their first-hand accounts and contact information was exchanged.

Meeting between JET, community members and government stakeholders (2017)

However, despite improved knowledge and networking facilitated by JET amongst the communities, participants still remain somewhat unwilling to contact government officials, as they fear victimization. JET set up a WhatsApp group to receive updates and this is being lightly used to exchange information, but the communities would much rather complain to JET and have us liaise with regulators on their behalf. Over time, through public education and training JET hopes to build the confidence of the communities and the wider Jamaican public, and inspire community-led advocacy on air and water quality, and other environmental issues.

Suzanne Stanley is CEO of Jamaica Environment Trust.

Mental health policy reform: time to decolonise our minds

Posted on 20/11/201705/10/2018 by Vijay Krishnarayan

Mental health legislation in 20 per cent of Commonwealth countries was passed before 1960.

The term “idiot” remains on the statutes of 10 Commonwealth countries. The law in many Commonwealth countries is in conflict with contemporary international human rights obligations towards people with mental illness. The roots of mental health legislation can often be traced to a bygone era. It’s time we de-colonised our minds.

‘The roots of mental health legislation can often be traced to a bygone era.’

The Commonwealth Foundation is not a mental health focussed organisation but we are committed to strengthening civic voice in policy reform. We funded a review of mental health laws across the Commonwealth five years ago. The final report – produced by the Commonwealth Health Professions Alliance (CHPA) and written by Dr Soumitra Pathare and Dr Jaya Sagade of the Indian Centre for Mental Health Law and Policy highlighted the dichotomy between existing laws and human rights. The CMNF identified two countries where policy reform was being considered. They applied to the Commonwealth Foundation for a grant to help make change happen and were successful.

One of the project’s countries is Seychelles and I was privileged to see for myself the way they are going about the process of reform. Seychelles was identified because of the willingness of lawmakers, and civil society (mental health and allied professionals and people with mental illness) to work together to address the policy challenge. The inclusion of people with mental illness in the process speaks to the Foundation’s core purpose of strengthening less heard voices.

Civil society has provided the impetus for reform but it has drawn strength from the support of the Minister for Health who impressed upon me the need for civic-state dialogue to make health services responsive to contemporary demands. The need for change is evident. The existing law is the Mental Health Act of 2006. Although relatively recent the legislation was passed before Seychelles signed the UN Convention on the Rights of Persons with Disabilities. I heard from mental health professionals that the law emphasises retaining people with mental illness in institutions rather than the treatment and rehabilitation of patients. As one mental health professional critiqued it’s about protecting “us” from “them.”

‘the law can help to either re-inforce or deconstruct social attitudes.’

A Mental Health Advisory Committee was established to steer the project in-country. It is chaired by the Chief Medical Officer and it brings together health professionals, policy specialists and service consumers. The Committee is supported by the CMNF and Dr Pathare and during my stay I sat in on their discussions. I heard how hard it is for people with mental illness to enjoy rights that we take for granted – to gain employment or to get insurance. I also heard how easy it is for people with mental illness to be incarcerated or restrained. The particular challenge of the stigma associated with mental illness in a small state was never far from the surface and it was recognised that the law can help to either re-inforce or deconstruct social attitudes.

Essential to the process of reform was the engagement of the Attorney-General’s office. I had the chance to meet with the newly appointed Attorney General and I was struck by his recognition of the importance of bringing his office nearer to people. His representative sat with the Committee as they pored over the new draft Act, line by line. The draft Act was then presented at an open meeting at the Seychelles Hospital. About forty people from all walks of life gathered: patients, politicians, police and practitioners. They attested to the need for change, called for more and targeted dialogue with particularly affected parts of society like young people. They want to see the Act passed and fully implemented. They want to see the new law make a difference and all were optimistic about the chances of the Act going before Parliament by next April.

Our colleagues on the Advisory Committee – public officials and civil society alike are committed to change. They agreed that there was no point in trying to change elements of the existing 2006 Act and are developing a national policy that will provide a framework for the new Act. They recognised that the spirit of the existing law was a ghost from a time long past. This was a time when administrators wrote laws to suit themselves and when it was presumed that people with mental illness were objects of charity rather than agents of their own destiny.

Colonial institutions are not just fine buildings that are well preserved but they are laws and practices that have also endured. While I’ve been here, discussions with Ministers, senior officials and civil society have all touched on the continuing relevance of the Commonwealth. In Seychelles they’ve taken a problem left behind by empire and addressed it using the empathy and solidarity that are the hallmark of the People’s Commonwealth.

Image credit: Flickr CC darkday

Realising rights to health care

Posted on 30/10/201702/07/2019 by Timothy Wafula

Article 43(1)a of the Constitution of Kenya guarantees the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.

The realization of this right is fundamental to the physical and mental wellbeing of all individuals and is a necessary condition for the exercise of other human rights. In the implementation of the right to health care, State officers are bound by Article 10’s constitutional principles of transparency and accountability.

The Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) is a human rights non-government organization that advocates for the full enjoyment of the right to health by all, including vulnerable, marginalized, and excluded populations.

‘The project adopts a capacity building approach for communities and the media to demand increased transparency and accountability in service delivery and health-budgetary spending’

Starting this October KELIN, with support from the Commonwealth Foundation, will commence implementation of a project titled: Protection of right to health of the vulnerable through transparency and accountability. This project, which will be implemented in the regions of Mombasa, Nairobi, Kakamega and Kisumu, seeks to ensure that resources allocated to the health sector are utilized in an accountable and transparent manner. KELIN will work with community based organisations (CBOs), civil society organisations (CSOs), the media and communities of persons living with and affected by HIV and TB to monitor implementation of the right to health.

The project adopts a capacity building approach for communities and the media to demand increased transparency and accountability in service delivery and health-budgetary spending:

“The Constitution of Kenya provides for public participation in governance, health-governance included. Public participation is a powerful accountability tool that citizens can use to monitor formulation and implementation of laws, policies and guidelines by governments. This project will provide communities and the media with information, knowledge, and platforms to demand for accountability and transparency in the health sector.” – Allan Maleche, KELIN Executive Director.

An estimated 26% of the total health expenditure in Kenya is derived from development assistance. Relatedly, 72% of the total expenditure for HIV is from development partners or aid. Lack of transparency and accountability can have dire consequences, and impact negatively on realization of health rights. For instance, the United States Agency for International Development (USAID) recently suspended direct assistance to the Ministry of Health. Among the reasons cited for the suspension included lack of accountability.

‘An estimated 26% of the total health expenditure in Kenya is derived from development assistance’

This new project builds on a previous one named “Enhanced Protection of PLHIV Rights through Participatory Governance” which was implemented from 2013 to 2016, with support from the Commonwealth Foundation. The project enhanced and strengthened the knowledge and capacity of CSOs, PLHIV, and CBOs on participatory approaches in governance; and promoted active participation in the legislation process.

In preparation for the project, as KELIN’s Program Officer I joined the Commonwealth Foundation and other grantees, from 3-6 October 2017 at a workshop on monitoring, assessment and learning. The Workshop, held in London, brought together 14 organizations receiving support from the Commonwealth Foundation to implement projects in Commonwealth countries including Papua New Guinea, Tonga, Sri Lanka, India, Pakistan, Nigeria, Mauritius, and Kenya. The workshop equipped us with knowledge on developing, monitoring and assessment plans that would ensure projects achieve their intended purposes.

KELIN will use the current project to give communities the knowledge and voice to demand for transparent and accountable implementation of the right to health.

To contribute to the discussion and for live updates you can find KELIN on Twitter @KELINkenya and Facebook: http://www.facebook.com/kelinkenya. Image Credit: KELIN Kenya

Grants roundup: steps to a fairer future

Posted on 31/08/201722/07/2020 by Commonwealth Foundation

The Commonwealth Foundation’s Grants Committee recently approved 14 projects. This new cohort of initiatives complements the Foundation’s key 2017-2021 strategic objective: to strengthen people’s voices so they can engage with governance.

Following a rigorous, multi-stage selection process, the newly endorsed projects are as ambitious as they are regionally varied, with initiatives being implemented from the Pacific islands to East Africa.

Here’s a snapshot of a few:

Find Your Feet are working towards the realisation of the rights of India’s 104 million indigenous people. The Indian government has introduced a number of laws and policies that are specifically designed to promote the rights of tribal communities. Find Your Feet have focussed on the need to adequately monitor the implementation of legislation and policy at the central and state levels of government. The Tribal Rights Fora (TRF) was established by civil society to do just this—but as new entities, they need support if they are to engage policymakers and make recommendations to the institutions responsible for implementing legislative changes.

Find Your Feet of India are going to design and implement a tailored programme of capacity development with TRF members in leadership, advocacy skills and engagement with governance and the media. Its key utility will be to focus on assisting, influencing and engaging with the government’s implementing bodies, particularly the National Human Rights Institutions (NHRIs).

AbleChildAfrica are paying close attention to the parliamentary cycle as they form alliances between Disabled People’s Organisations (DPOs) and government officials. The Government of Kenya has demonstrated its commitment to the right of Children with Disabilities (CWDs) by ratifying both the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the United Nations Convention on the Rights of the Child (UNCRC). With the Children’s Act due for review in the Kenyan parliament, AbleChildAfrica will facilitate meetings, the attendance of national parliamentary review sessions and develop the coalition’s ability to advocate using awareness-building campaigns. A series of evidence-based reports and the involvement of policymakers throughout will help to better inform the Children’s Act review process.

In Mauritius, Prevention Information Lutte contre le SIDA (PILS) are taking action on HIV. Despite the success of recent harm reduction programmes in reducing the occurrences of the virus among adults, progress has rolled back with a recent spike in cases among people who use drugs (PWUDs), a community with limited awareness of health care options. By facilitating their access to services and raising awareness of prevention techniques, PILS hopes to tackle the spread of the virus while at the same time demonstrating the value of the harm reduction approach to national drug policy.

A welcome upsurge in the number of grant applications to the Foundation from the Pacific region has led to the endorsement of some important new initiatives. The Tonga Strategic Development Framework 2015-2025 provides a roadmap for the localisation of commitments made in international treaties, particularly on the environment. The Civil Society Forum of Tonga (CSFT) plans to work towards a constructive working relationship with the Tongan Government so they can jointly monitor the progress of the Tonga Strategic Development Framework. Crucially, the CSFT will begin the process mapping the alignment of civil society and government priorities. These form solid foundations that make a partnership between civil society and government more likely to work.

In Papua New Guinea, the Centre for Environment Law and Community Rights (CELCOR) have linked the issues of environmental legislation and indigenous rights. They will engage government agencies to deliver changes to legislation and policies that govern the use and management of natural resources to benefit indigenous customary landowners. This will involve conducting a detailed review and analysis of existing policies and legislation, and working with government agencies directly to present and propose changes to the First Legislative Counsel and advocate with Parliamentarians for these changes to be adopted.

In this latest round of grants projects, there is a discernible sense of civil society cooperating with governments and building on their work. Constructive engagement and adding value to development lie at the core of the Commonwealth Foundation’s strategic objectives. Many of the new projects do this by broadening and deepening participation to make national legislation effective. They are aimed at achievable, sustainable and institutionalised change and highlight the importance of including marginalised voices that offer a worldview from which there is much to learn.

Grant calls for the 2017/18 period will open in December 2017. 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.

Explainer video: what is the Commonwealth Civil Society Forum?

Posted on 21/06/201704/06/2020 by Commonwealth Foundation

The Civil Society Forum, supported by the Commonwealth Foundation, takes place annually in Geneva prior to the Commonwealth Health Ministers Meeting and gives Commonwealth civil society a chance to discuss policy issues raised at the Commonwealth Health Ministerial Meeting (CHMM). This video provides a summary of the process and its potential value to participants.

Find out more
www.chpa.co
www.commonwealthfoundation.com/project/ccsf

With thanks to our contributors
Hon. John Boyce, Minister of Health, Barbados
Maisha Hutton, Executive Director, Health Caribbean Coalition
Prof. Tony Nelson, Commonwealth Health Professions Alliance

Healthy discussion: but will Ministers listen?

Posted on 22/05/201729/07/2019 by Vijay Krishnarayan

Anton Kerr, former Director of HIV/AIDS alliance and chairman of Commonwealth Health Professions Alliance, makes the case for increased spending on health. Photo credit: Leo Kiss

But will Ministers listen? That was the thought that nagged away throughout the short flight from London to Geneva as I travelled to attend this year’s Commonwealth Heath Minister’s meeting. They meet in the wings of the World Health Assembly and we work to bring civic voices to that Commonwealth ministerial gathering. Naturally civil society organisations across the Commonwealth have an interest in trying to influence the outcomes of the ministerial meeting. To do this we convened a policy dialogue at the Commonwealth Civil Society Forum that addressed the themes that would come up in the Commonwealth Health Ministers Meeting, which met under the banner “Sustainable Financing of Universal Health Coverage as an Essential Component for Global Security Including the Reduction of All Forms of Violence. But would they listen?

I came away from Geneva understanding that I had been asking the wrong question. It’s not a question of getting ministers to listen – rather the challenge is getting ministers, officials and civil society to talk with each other in order to find workable solutions to the health challenges we face. The approach we took this year was two-fold.

Firstly, we broadened the debate so that a wider cross section of civil society was able to participate in the discussion. Not only did this bring a Commonwealth agenda to a new audience – it also provided an opportunity for voices less heard to be given a platform. We convened a working group comprising the Commonwealth Health Professionals Alliance, Third World Network and the International Community of Women Living with HIV in Eastern Africa so that civil society organisations were designing and steering the process. They also delivered the three policy papers that formed the basis of the discussions at the civil society forum. Those papers included policy asks of Commonwealth Ministers. Those policy asks drew on the inputs of more than 100 other civic voices from across the Commonwealth through a survey. The process also drew in new stakeholders.

Secondly we deepened the discussion so that Ministers were provided with perspectives from civil society that they might not have considered or previously been exposed to. The three papers explored each of the strands on the Ministerial agenda: adding a gender equality dimension; exploring the utility of the concept of well-being; and provoking a discussion on the financing of universal healthcare.

The papers stimulated discussion in different ways. The paper by Saamah Abdallah on the Politics of Wellbeing challenged conventional metrics of development. It posited wellbeing as a sustainable condition that enables the individual to develop and thrive. Its holistic approach encourages ministries and agencies to collaborate. In data collected to date it seems there is a correlation between high levels of wellbeing in a population and “good” governance. The paper on structural violence and its impact on women’s health was powerfully delivered by Lillian Mworeko. She cited instances of forced sterilisation of women living with HIV. She made the point that when institutions visit this violence on women they foster discrimination and stigma and this despite progressive laws and policies. Tony Nelson presented on financing Universal Health Care. The provocative thesis suggested that spending more on health care doesn’t always result in better health outcomes and that greater accountability is needed on way that resources are allocated and spent.

But would Ministers listen? The chances of giving the issues raised by civic voices a proper airing is constrained by the format of the Ministerial Meeting so we invited policy makers to sit with civil society at the Forum and respond to the policy changes being suggested. The Minister of Health for Barbados, Hon. John Boyce provided new insights on the potential of alliances between civil society and Ministries of Health. He described moves to address sugar in soft drinks in Barbados, where collaboration had worked well. Dr Jabbin Mulwanda, the Permanent Secretary for Health Services in Zambia affirmed how helpful civic inputs were for civil servants charged with finding solutions to public health challenges. Their willingness to engage at the Forum helped to achieve our objective of dialogue. Without them the Forum would have been one more civic gathering and there are plenty of spaces where civil society can talk to itself. I know colleagues from governments valued the exposure and I dare say we enhanced their Commonwealth Health Ministerial Meeting experience.

We provided a Commonwealth space that encouraged the co-creation of new policy thinking in a collegial and informal setting. We went some way to making room for less heard voices and south-south exchange. The process worked well and everyone got a boost from the attendance and participation of the Commonwealth Secretary-General, Hon. Patricia Scotland QC. It was the first time that an SG had actively listened to what civil society had to say about the Health Ministers’ agenda and her assurance that the policy asks made would be given proper consideration was widely appreciated.

But did Ministers listen? The crude indicator in these matters is the final statement that Ministers issue at the end of their meeting. These statements are brief and summarise the main points. In the Commonwealth system they generally serve to signal intent rather than bind governments to specific commitments. Last year the Ministers’ statement included the line: “we note the civil society participation and contribution to discussions on sustainable financing and encourage their ongoing participation in health policy.” This was a disappointing result and perhaps responsible for that nagging refrain that wouldn’t go away – “Will Ministers listen?”

I looked at this year’s statement with hope restored. In paragraph 12: “Ministers noted the report from the Civil Society Forum Policy Dialogue which highlighted the need for a universal health system that provides basic minimum package of services to all as a key priority; emphasised well-being as core to health policy and being more than just absence of disease; and, raised the issue of structural inequalities and violence and their impact on the utilisation of healthcare.” This year it seems, at least the substance provided by civil society at its Forum had been registered.

Yes, Ministers of Health did listen to what civil society organisations had to say but now I was left with a new concern. If the priorities in the Ministers’ statement are going to be implemented – the position of Health Ministers in national administrations needs to be strengthened. My new question was “Does anyone listen to what Ministers of Health have to say?” Surely dialogue and alliances between health ministries and civil society for a common cause can only improve the chances.

Commonwealth Health Ministers Meeting: Civil Society Forum 2017

Posted on 10/05/201729/07/2019 by Commonwealth Foundation

With support from the Commonwealth Foundation, the Civil Society Forum was jointly hosted by the Commonwealth Health Professionals Alliance, International Community of Women Living with HIV Eastern Africa (ICWEA) and Third World Network, and took place on 20 May 2017 prior to the World Health Assembly and in conjunction with the Commonwealth Health Ministers’ Meeting (CHMM).

Objectives: to present the Commonwealth civil society position on issues discussed at the Commonwealth Health Ministerial Meeting 2017, and produce a policy statement that will be heard by Ministers attending the CHMM 2017.

Methodology: The forum followed the format of a policy dialogue bringing together civil society representatives and policy makers. It included a presentation of policy briefs that are the result of a consultation process in which civil society voices throughout the Commonwealth were reflected.

The policy briefs presented to ministers can be downloaded below: