It is better to light a light than to complain about darkness. (Confucius)
Capacity building for action
16. For capacity building, the Cape Town team successfully uses the adult education method REFLECT (Regenerated Freirean Literacy Through Empowering Community Techniques); they have trained trainers in its use. The REFLECT methodology is based on empowering groups typically deprived of power to change the conditions of their disempowerment. (B. Phnuyal, D. Archer, and S. Cottingham, “Participation, literacy, and empowerment reflections on REFLECT,” PLA Notes 32, 27–30, London: IIED, 1998).
17. To further strengthen CSOs capacity, ‘times for review and reflection’ can be set up, for instance quarterly, supplemented by annual strategic planning meetings. In those meetings, all partners give presentations in which they report on activities, identify new research and advocacy activities, as well as propose lessons for wider learning.* These meetings are key to consolidate equality in internal decision making, with shared agreement on agendas, rotation of chairing roles, and collective agreement on future strategic direction. All partners participate as equals. In this respect, the human rights framework proves invaluable in acknowledging the role of those most affected as critical to changing the conditions of vulnerability responsible for human rights violations.
*: Participatory research into health and human rights issues addressing the problems of those most affected by the myriad of violations in this domain is critical to redress health inequalities. New knowledge is deemed instrumental to the capacity of communities to act. Through their research, grassroots researchers demonstrate that there is a diversity of ways of getting to understand hierarchies of knowledge and of power. In order to translate the right to health into practice, it is important for everyone to accept that the existing dominant knowledge is quite likely incomplete. It is, therefore, necessary to develop new ways of creating and owning knowledge and to identify the lessons learned about knowledge production as part of a community’s engagement. The focus of the research is not only to be on individual rights, but on using human rights to build sustainable health systems for entire communities based on equity and social justice.
18. Bottom line here is that building capacity for human rights is meaningless unless it leads to action. Civil society organization (CSO) members have to use the new knowledge from their sharing of experiences to advance their respective demands.
19. Evidence suggests that human rights-based activities, including the development of materials for capacity building, contribute to increased understanding and are linked to a stronger sense of enhanced skills for action, particularly related to increased recognition of the importance of accountability and of strategies that do work to enforce human rights.
20. Passive distribution of information, often the typical way in which state services distribute human rights information to claim holders, is of limited value. It is, therefore, difficult to say that pamphlet distribution alone will empower community action. Rather, it is a process of various steps, including community meetings, public hearings, workshops on issues raised by the community and, only additionally, pamphlets that eventually provide communities with key information to gather strength to proactively assert their rights.
21. All this highlights the importance of participatory human rights learning and capacity building; it illustrates the role of human rights in reframing the discrimination experienced by so many; it challenges stigma and the conditions of vulnerability.
Caveats
22. Two caveats are called-for here:
i)When people become more aware of their human rights and what those rights mean, they realize the difficulties in claiming them from the state. As a result, those rights paradoxically appear to become less accessible given their lack of trust that the state will honor its obligations. Nonetheless, even in the face of such a paradox, experience shows that people still report greater confidence in being able to empower their constituency members to take action to realize the right to health after going through the training and some initial small victories. This apparent anomaly is thus explained by the increased realization that human rights are best attained through action by ordinary people exerting pressure on the state, rather than relying on state largesse. Therefore, while increasing rights awareness may be associated with decreased trust in the state to deliver on its rights obligations, this is more than compensated-for by a growing understanding that civil society active involvement can be powerful in the realization of the right to health.
ii)While civil society action is deemed essential for realizing the right to health, it nonetheless also presents the possibility of tension between holding the state accountable and taking over state responsibilities when the latter fails to deliver or is perceived as unwilling to deliver. Beneficiaries (members of participating CSO constituencies) and CSO staff can come to expect that CSOs should play a role in providing services that are the responsibility of government. But NGOs or other community-based organizations are not responsible for realizing the right to health. Indeed, as CSOs have become more knowledgeable about human rights and more empowered to act on these rights, they have to realize that health workers do not have a clear understanding of human rights.**
**: This is not a reason for CSOs to gravitate towards filling the gap in services, because of their concerns for the health of marginal groups in their communities; conversely, they should never relent holding public services accountable. Therefore, while providing services which are otherwise not addressed by the state is an important step towards protecting the right to health, it is by itself a totally insufficient measure to fill the gap required for realizing it.
Cross-pollination between organizations (CSO-to-CSO work) is part of filling the gap in HR work
23. Establishing a space for shared learning increases individual CSO members’ skills and capacity, giving their organization credibility with other actors, and creating a sense
• of solidarity, of guidance on how to solve human rights violations;
• of learning between organizations; of providing opportunities for advocacy and lobbying;
• of planning for a cascading knowledge and skills transfer; and
• of how to move from asking for help to thinking about how organizations can be their own agents for change.
24. In human rights work, networking is more than engaging in dialogue as networking encompasses action-oriented elements such as policy influence, advocacy, negotiations and an overarching search for social change by
providing opportunities for participation based on good access to information. Such a cross-pollination is an example of the notion of creating multiple sites for human rights activism, sites that provide an environment in which learning can be turned into practice. Moreover, it appears to be the sense of solidarity and trust amongst co-learners that is most effective in giving adult learners confidence to engage with human rights in their work.
This is why learners have to be guided to create their own understandings of justice, of freedom and of equality.
25. By facilitating this cross-pollinating dialogue at the community level
• we bring the issue of injustice into the public sphere;
• we exert pressure for change;
• we reinforce obligations of the state and the limits of private sector action; and
• we engage in monitoring to ensure government policy is consistent with the human rights discourse.
26. In short, CSOs can initiate a new cascading process to effect policy and the programmatic changes needed to advance health. Many models on a local scale action also show the possibility of embarking in solutions that foster justice on a much larger, even national scale.
27. Ultimately, establishing a space for shared learning allows us to explore several aspects over time, for instance
• how participants see community voices emerging to shape the health agenda;
• changes in the types of actions community members embark-on in the various activities proposed by the organized groups they belong to;
• how assessment/research findings generated by community members are applied by the CSOs;
• how participants view ownership of the processes set in motion;
• what value is identified by participants as added to their organization’s work as a result of participating;
• how decision-making is done in the CSO itself, and whether and how this has changed over time
• what has been the experience and the impact of the work on women and their capacity, i.e., what have been the gender implications of the CSO’s work.
A final word on justiciability
28. Human rights claims do afford judicial review. But using the judicial system can imply draining resources from those most in need. In other words, promoting the use of courts of justice in cases of violations of the right to health can, ironically, disadvantage the poorest of the poor and worsen health inequalities. This, because those who shout loudest and have the financial means, reap advantages in dealing with anachronistic justice systems and this gains them preferential verdicts over those with greater need or disadvantage. Is this contradiction a matter of substance, or is it merely the result of underestimating what human rights and the right to health can really attain? I definitely think the latter. Examples of verdicts in favor of organized claim holder plaintiffs are multiplying fast.
29. Bottom line, understanding what human rights mean in practical terms basically implies that, as a person, you can expect that your rights will be respected. But unless you are prepared to help respect other people’s rights, the eventual fulfillment of human rights simply will not happen. That is why at the People’s Health Movement we talk about rights and responsibilities.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org