It is better to light a light than to complain about darkness. (Confucius)
[I will illustrate the implications of this by using the example of the practical application of the human right to health in communities in Cape Town].
1. The human right to health (RTH) has wrongly been contested for many reasons. These include i) attacks from neoliberal ideologues for its lack of practicability, ii) its focusing on individuals’ rights over the public good, and iii) the more general criticism that human rights reflect a ‘Western’ construct based on norms that are not universally accepted –not withstanding the close to universal political adoption of the respective international UN covenant on the matter. Of course, these arguments have been overruled by i) examples of the practical application of the RTH like the one that follows here below, ii) a better understanding of individual and collective notions of human rights that have helped to understand and explore what kinds of strategies are most effective in promoting health equality; and, of course, as this Reader has proven, iii) an emphatic assertion about the universality of human rights.
2. Furthermore, as also said many times before, the analysis of the right to health inescapably falls within the realm of power analyses, i.e., an assessment of who makes decisions, within what institutional framework and with what consequences for equality in health.
3. As I hope you have already internalized, using the human rights-based approach to advance health equality is essentially about confronting conditions of vulnerability through strengthening the means by which those who are powerless are empowered to actively demand their rights.
4. Not to be forgotten though is the fact that the human rights-based approach is not only about demanding state accountability, but also about the active participation in that demanding of those most affected by government policies and by gaps in the delivery of public services. Instrumental to this capacity to act, is the people’s right to information. Access to information underlies both the components of accountability and of active participation essential to the human rights-based approach, in this case applied to health. For these reasons, human rights learning (HRL) is deemed key to turning awareness into action even if HRL has had little evaluation so far.
Human Rights Learning
5. At the stage we are now, we urgently need to establish such a HRL space in which civil society organizations (CSOs) can also share experiences, both positive and negative, so as to learn from each other what strategies work best to realize the human right to health.
6. How do we know HRL is taking place? One method is through using questionnaires to explore the knowledge, attitudes and the practices among CSO members regarding human rights. This can help us understand if, and how the participants’ social capital can be enhanced to enable them to integrate human rights into their health programs and work.
7. One methodology that has proven very effective in HRL is implementing what is called a ‘Photovoice Project’ in which CSO members, particularly women, take photos about what they encounter in their daily life as being health and human rights violations. The photos are then used as a basis for a reflection through focus groups discussions and in-depth analyses. Through taking photos and together reflecting on the problems, CSO members can, for instance, mobilize youth in the communities to participate in clean-up activities. (Never forget that there is ample evidence that without strong mobilization of sectors of civil society, rights laid down on paper remain just that).
8. If the participants are already members of any kind of a health committee, prior to the HRL we need to assess, through an audit, the capacity-building needs of these health committees and the barriers they find to effectively participate and have an influence on health equality and RTH issues.*
*: If health committees exist, they are at the forefront of channeling information and activism for CSOs to become active voices and practically promote equality in health from health centers to hospitals to national state institutions. Health committees should also be empowered to act at the provincial planning level of health budgets. To reiterate: The involvement of ordinary people is vital.
9. Another thing to use for learning is printed-easy-language-pamphlets to be distributed to claim holders. Door to door delivering of pamphlets is planned and carried out to raise community members’ awareness of their rights. The pamphlets are thus intended for use to trigger face-to-face discussions.
10. HRL cannot miss covering the special RTH needs of minorities, of disabled people, of people living with AIDS, of sex workers, of men having sex with men, etc.
11. Should there already be modules on the human right to health available for the in-service training of health care providers, the same need to be evaluated. If such modules do not exist, discussions should be held on how to produce them.
12. Ultimately, the training should help participating CSOs to fulfill four roles, namely i) An informational role to ensure communities are better informed about their right to health; ii) A research role to document and analyze best practices in realizing the human right to health;** iii) A capacity-building role to promote access to learning opportunities for their members and for other organization’s members; and iv) An action role to use the learning gained to support services and claim holders’ demands around health. Underlying these roles are two principles that inform practice, namely i) that empowerment implies knowledge, assertiveness, critical engagement, and collective action; and ii) that research conducted by CSOs will be presented back to local organizations to inform their concrete actions, their training, their advocacy and further research questions arising.
**: CSO members are increasingly identifying research questions for which they need answers. Often, these questions need answers to strengthen CSOs arguments for legal recognition of their strategy of active community participation. In last instance, members themselves should determine important research needs. The implementation of the research can be done jointly with an academic institution (rather than by academic institutions on behalf of CSO partners!). In such cases, CSO members act as peer researchers in data collection, analysis, and dissemination. Multiple simple methods can be used by them including questionnaires, focus groups, structured interviews, in-depth interviews, photovoice projects, observation, and document analysis.
13. Additionally, after holding their respective HRL activities, participating CSOs will be expected to target part of their upcoming activities on health workers –the gatekeepers of the RTH –e.g.,
• by hosting a structured dialogue with health service managers on the question of community participation,
• by facilitating action at the national level, in a coordinated civil society submission, demanding changes in the ministry of health,
• by presenting testimonies of violations of he right to health in public hearings, and/or
• by engaging with health policy makers on the issue of the RTH challenges being faced by marginalized communities.
14. Otherwise, participants are to understand that information is instrumental in affording the most vulnerable with opportunities to change the conditions of their vulnerability. Indeed, recognizing the importance of information is central to the realization of human rights. Both participation and accountability, as key elements of the RTH are highly dependent on information. HRL must, therefore, also focus on how to organize to develop appropriate learning materials and how to disseminate relevant information for community and organizational users; this, ultimately intended to enable community members to realize their rights.*** It is through information-for-action for claim holders that the state obligations to respect, protect and fulfill human rights are brought-up in a dialogue of equals between claim-holders and duty-bearers. Furthermore, keep in mind that information is best understood in the context of launching collective actions (for example, clean-up campaigns, community distribution of materials, public hearings).
***: A Toolkit on how to identify human rights violations and how to respond to these violations is available from PHM South Africa and can be easily adapted for use elsewhere. Get it! http://salearningnetwork.weebly.com/
15. We recognize that to create an enabling environment for people to exercise their rights is easier said than done . The use of electronic communications among member organizations (email and a shared website to exchange information about events, meetings, and new knowledge) becomes key. You can start with visiting the PHM website www.phmovement.org
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org