69. Health and Human Rights Readers (cont.)

29. On Vulnerability, Access and Discrimination

Food for questions to be asked

Typical Human Rights questions one should ask about services are:

Is there sufficient attention being paid to the most vulnerable groups?

Is there equal access to services?

Do service providers practice non-discrimination towards people with scant means or no de-facto entitlements?, and further,

Are privacy and confidentiality observed?

But the vulnerable themselves do not have the clout to pressure for this to be done.

It is we, the providers, who have to start working with the most vulnerable so they can pick the tools they need to claim the specific rights of their own.

Human Rights do provide a tool of analysis that will help ‘the forgotten’ identify key societal determinants that are responsible for their vulnerability and their violated rights.

Human Rights can and should thus be used to reduce those vulnerabilities and violations by modifying pertinent behaviors, attitudes, power relations, and ultimately programs, regulations and laws.

Because Human Rights focus on ‘the forgotten’, understanding the diseases of poverty (which are foremost the biological translation of social, economic and political diseases) necessitates an understanding of Human Rights.

Human Rights puts the individual at the center, and this is not to be seen as contradictory but synergistic and complementary with public health which deals primarily with populations rather than with individuals.

As a process or an approach, Human Rights actually also call for a broad-scale movement that engages people in achieving specific goals and outcomes.

To live up to this, we have to promote practical ways of participation that make Human Rights relevant to people’s everyday lives! ...this, not necessarily an easy task.

The road will be long and tortuous. Sustainable social and behavioral changes will be needed at many levels and we have to foster those --starting yesterday...

In practical terms, Human Rights define what governments can do to us, cannot do to us, and should do for us. It is in this context that we have to understand their obligation to respect, protect and fulfill:

· Governments respect when they refrain from directly or indirectly interfering with the enjoyment of people’s rights, e.g. by providing non-discriminatory social services for all.

· Governments protect when they rescind old decrees or prevent third parties from interfering with or infringing people’s rights, e.g. by canceling user fees, or by de-facto impeding that pharmaceutical houses or the insurance industry affect equal access to health (as recently in South Africa).

· Governments fulfill when they adopt legislation towards the full realization of people’s rights, e.g. by providing redress for people whose rights have been impinged, or by ensuring strictly equal protection under the law, or by stopping discrimination in the access to the procurement of services such as health.

(Freedom from discrimination is central in international Human Rights law.

As a matter of Human Rights, women have to have (!) the ability to control and make decisions about their lives).

Human Rights are thus important standard setters in the assessment of government performance, of governments taking the appropriate measures and ensuring internationally sanctioned provisions.

And civil society simply has to take up the challenge and become the protagonist in these accountability checks.

Governments may decide to embark on a ‘progressive realization of Human Rights’, i.e. progressively proceeding --‘to the maximum of their available resources’-- to get there. If this can be independently proven, that is OK. (Conversely, lack of government resources, is not a reason for not implementing Human Rights provisions!).

From the global perspective, and under exiting provisions, the international community does have the obligation to support the upholding of Human Rights in such resource poor countries, especially if the latter are genuinely embarked in the progressive realization of rights.

Three more issues need be emphasized here at the end:

1.- The neglect of the right to information/education does have a substantial health impact, especially for women. For instance, mis or lack of information about antenatal care, nutrition, TB, HIV, or epilepsy (to mention just a few), or even about available curative and preventive treatments can and does make the difference between life and death.

Therefore, a retooled (!) public health IEC (information/education/communications) will have to play its role in eliminating Human Rights violations.

2.- Human Rights have implications for data collection and use.

Human Rights principles and norms are relevant when choosing which data are to be collected to determine the type and extent of, for example, health problems affecting a population. Decisions on how to disaggregate data equally have direct influence, not only on the policies and programs that are put into place, but also on the sub-populations to be reached as a matter of priority.

3.- Commercial sex workers, substance abusers and AIDS patients are being particularly stigmatized and criminalized in our societies; they are pushed to the margins.

This does not obviate their right to equal and non-discriminatory access to information, prevention and treatment services, as well as to the social services that address the underlying and structural causes of these facts of 21^st century social life.

*: Some topics do and will repeat themselves slightly in these readers. It has been my experience that by being exposed to them from slightly different angles they slowly begin to sink-in into our consciousness.

Reference:

- (2001): Stop TB Guidelines for Social Mobilization: A Human Rights Approach to TB. Health and Human Rights in Sustainable Development Group, World Health Organization, Geneva.

30. Potpourri

Food for some not so disparate thoughts

More on Accountability Analysis

Capacity/accountability analyses (that tell us why duty bearers at many levels do not seem to be able to perform their duties as expected) are a cornerstone of Human Rights planning (see previous Human Right reader on Human Right planning).

The key question is: Who gets to do these needed analyses and who the calling to account? It sometimes sounds much too much as if it is some outside authority who is going to do these things for us and, ‘with a lightning bolt call the sinners to account’.

This attitude/suggestion that some outside agency will/must do this has to be combated. The task cannot simply be disembodied and left up to outsiders.

Primary (but not exclusive) attention needs to be given to local grassroots groups to lead these analyses. Bottom line: it is unthinkable to talk about capacity/accountability analyses in any other way than in a participative way.

But we should not concentrate too narrowly on grassroots either; agents at all levels have roles to play; we need to figure out their (and our own) respective responsibilities and inter-relationships in this drama. Also very prominently, then, national governments need to be actively lobbied to concretize their commitments to pass framework national Human Rights laws. (1)

On the other hand, ambitious capacity/accountability analyses risk leading us to too many priorities. We have to reduce the analyses to a limited set of claim-duty relationships that are likely to be most critical in a given situation. If not limited, we risk ending up with a very large number of claim-duty relationships and actors who we will not be able to productively involve in new actions for which we will now hold them accountable.

Therefore, the recommendation is to --with people’s participation-- arrive at a list of the most crucial two or three ‘sins of omissions’ for each particular set of selected rights violations; later in the AAA (assessment/analysis/action) cycle, people can reevaluate and pick their new priorities. (2)

On Goals and Means

We always need to keep in mind that Human Rights do not proscribe --they prescribe-and on broad goals at that.

Further, Human Rights do not specify means for reaching those broad goals.

There thus is a separation in Human Rights work between goal setting and figuring out how to reach them. The first part is done; the second is history in the making.

For the time being --and hopefully not for too long-- it is we (you and I and growing numbers of others) who are called upon to take up the challenge of furthering the operational aspects of Human Rights so as to translate them into concrete actions. (1)

As we do so, we have to be absolutely clear that there is no neutral territory in combating oppression and eradicating poverty. Those who believe in neutrality will ultimately become prey to the agendas of the conservative social forces. As long as the movement for Human Rights does not seek to dismantle the structures of power that breed and sustain inequity with its accompanying Human Rights violations, the latter will remain untouched or just cleverly manipulated to make them look like progress. (3)

Moreover, work on Human Rights, as well as work on reshuffling power relations to tackle the problems of poverty will have to pass through gaining the support of the middle class. For example, services must be made equally accessible to all on a basis that is perceived as fair by all; this also means that Human Rights principles have to be equally applied to all citizens --not only to the poor.

The current emphasis on privatizing the provision of services and on targeting only the victims of the most severe violations (alas to offer them only token palliative measures) goes in exactly the opposite direction of what is meant here. Such current policies are unmistakably making the solidarity work needed for the attainment of Human Rights next to impossible. (4)

Therefore, rights should not be theorized in the sense of claims playing themselves out in a vacuum. Achieving them will mean a struggle. As we have said before, rights are not a standard granted from above, but a standard bearer around which people have to rally to bring about a struggle from below. (5)

Know where you stand and know on whose side you wish to be counted as an actor.

More on the Right to Information

Although there are several references in Human Rights instruments to the right to education/information and the right to share in scientific advancement, such provisions are not supported by an effective enforcement mechanism. Conversely, the new WTO global regime for intellectual property rights does have at its disposal such enforcement procedures, i.e. cross-retaliatory trade measures.

This is a flagrant paradox, because

- everyone has the right to knowledge (including the entitlements to access to knowledge),

- no one can be arbitrarily deprived of the sources of knowledge,

- the right to knowledge implies due recognition and respect for the rights and freedoms of others, and - all peoples and all nations have the right to share their knowledge with one another.

The international community has to come to the realization that the right to knowledge is far too important to be left to commercial forces only.

The much-heralded ‘knowledge societies’ of the information superhighway will amount to little more than paper tigers if their governance is delegated to the marketplace:

The market will simply produce and distribute knowledge according to people's purchasing capacities.

Conversely, a Human Rights-inspired system of governance will favor the availability of knowledge not according to people’s means, but according to people's needs and aspirations. (6)

More on Human Rights and International Financial Institutions (IFIs)

In an apparent recent rediscovery of ‘the social’, the Bretton Woods IFIs are now also turning to Human Rights.

But this ‘revalidation’ of ‘the social’ and of Human Rights is happening mainly at the micro level in these institutions. At the macro level, IFIs’ attention to social questions is, in all honesty, still very much an afterthought!

In reality, (purportedly) ‘sound’ macroeconomic policies continue today to be designed mainly based on cold economic considerations.

Then, [luke-(warm)] social ‘band-aids’ are applied in order to achieve acceptable outcomes --outcomes IFIs feel they cannot be blamed for by the rest of the international community.

IFI prescriptions for the privatization of basic social services (i.e. the privatization of social protection) is antithetical to Human Rights, antithetical to the basic tenets of wealth redistribution, antithetical to poverty eradication strategies, and, therefore, antithetical to equity. (4)

References:

(1) Kent. G. Personal e-mail dated 26/2/2001.

(2) Jonsson, U. (2000): An approach to Human Rights-based programming in UNICEF ESAR, SCN News, No.20, July, pp.6-9.

(3) Manji, F. (1999): Editorial, in Development and Rights, A Development in Practice Reader, Oxfam Publications.

(4) UNRISD (2000): Social policy in a development context, UNRISD News, No.23, Autumn/Winter, pp.10+11.

(5) Shivji, I. (1989): The concept of Human Rights in Africa, CODESRIA, p.71.

(6) Hamelink, C.J. (2000): Who has the right to know?, UNRISD News, No.23, Autumn/winter, p.20.

31. Human Rights and South-South Cooperation

Food from the thoughts of the mwalimu

An intellectually sound analysis around the new Human Rights-centered development approach is needed to arrive at a collective platform or policy for the South. This is needed as part of the South countries’ quest for solidarity and cooperation with one another --in their endeavor to follow a genuinely people-centered development path in freedom.

It is our collective responsibility to organize and coordinate up-to-date analyses --analyses by the South and for the South-- specifically on the new and not-so-new specific national and general international Human Rights issues. The countries of the South will be able to cooperate and act together more effectively only when they have access to greater knowledge and a shared understanding of the major Human Rights questions at stake in their own development --including the implications of these questions for their continued freedom and independence. There is a need for global action in the field of Human Rights and the changes needed have to be channeled to serve all of mankind, but especially the people in the South.

The economic, political, military and social units which have most of the knowledge, skills and capital necessary to make a difference in Human Rights worldwide currently have far-reaching power over those who lack these assets. No country can escape the effects of these powers.

We in the South, must try to understand what Human Rights are in our context and what it will mean not to adopt the Human Rights approach.

We need to know about and seize the opportunities in front of us and be aware of the dangers to our development ambitions if we fail to act accordingly. It is imperative that the South understands its own needs in Human Rights as distinct from the needs and desires of richer and more developed countries; only then can we negotiate from a position of strength.

Countries in the South need to be in a position to act together to maximize the South’s benefits from and bargaining power in international negotiations and decisions related to Human Rights. Central to this action is to work towards a common position on Human Rights for collective consideration. Such a position paper is to give information and to analyze the major new and evolving Human Rights issues; it is then to recommend to the countries and organizations of the South what actions they could usefully consider taking, separately or together.

Identifying and articulating the South’s common Human Rights interests does not imply seeking confrontation with the countries of the North. The existence of distinct groups of countries (e.g. Group of 8, OECD, Group of 77, Non-aligned Movement) is an expression of a reality: the imbalance in the level of development --and therefore the imbalance of power-- in the world. These imbalances impose an obligation on all of us to continue the endeavor to reduce them. Actions of the rich and powerful have a greater effect on others than do events in poor and weak countries. That is the everyday meaning of the imbalance of power. (But even so, the poorest or smallest of us do affect others --either by what we do or fail to do!). Within this imbalance, different degrees of interdependence have always existed. But now, with the speed and nature of modern communications, the effect of external developments or decisions can be very quick and great. For the weak, these effects sometimes have been and are catastrophic.

Therefore, we in the South must be able and ready, at any time, to speak for --and more often to defend-- our own Human Rights interests as these power-induced changes actually take place, or as we are collectively threatened with them. Doing this is the normal process of negotiations between groups with different interests. For, ultimately, progress can only take place on the basis of respecting human and national equality; changes will only be beneficial to world peace and to our collective betterment when respect is accorded to all by all and when justice is available to all.

Neither Human Rights nor development can be based upon the oppression of might, whether this be economic, scientific, political or military might. [Nor can the current acquiescence of silence on the part of those whose Human Rights have been and are ignored and violated --but who feel too vulnerable themselves to argue or protest-- continue!].

All governments sometimes find it helpful to have someone who can say what they would like to say, but from whose words they can, under pressure, disassociate themselves if necessary. As members of civil society, we need to say such things! And the call is here to do it for Human Rights concerns which do relate to economic, social, cultural and many other questions which underlie and affect the peace and development of our countries and our people.

The need is there. We thus have to set up the participative mechanisms to work towards making recommendations concerning possible action by the South in the realm of Human Rights. But then it will be for the governments and the people to ultimately determine what actions they wish to, have to and can take. We can only persistently lobby. Therein lie our challenges, because what we do in this domain has to be used by the people, by the governments and by the institutions of the South... An instrument becomes useful only by it being used!

Our countries face an international environment and a world economy dominated by the strong developed nations and corporations of the North. Moreover, international institutions are, to a considerable extent, shaped on the basis of the values and interests of the North. It is an understatement to say that often the values, aspirations and interests of the South are ignored as if they were unimportant.

Developing countries can have strength on this issue of Human Rights only if and when they act together, in cooperation and in a coordinated effort. We do not have to be ignored. We are too many to be ignored. If the South wants to count, it must stand up and be counted! Let's encourage this needed collective action and let’s continue to advocates the reforms of international institutions as and when this seems necessary to achieve our declared Human Rights goals.

But let’s also be conscious of the things we have not done which ought to have been done and in particular which it would have been useful to do.

To focus on the most important Human Rights issues of current or future relevance to development requires political, diplomatic and intellectual support from the South governments and from nongovernmental organizations; it also requires financial support from the South.

Our capacity to achieve the goals of the South will depend on the support these goals receive from the countries of the South. Assistance from friends in the North will, of course, be helpful. But we in the South must continue to be the prime engine.

The value of what we achieve in Human Rights will lie in our intellectual autonomy and independence.

Note:

- Adapted from Mwalimu Nyerere s address given at the South Center in Geneva, Sept.18, 1995. (South Letter, Vols.1+2, No.37, 2001).

32. A Call for Substance and Networking

Food for a mid-summer’s night thought

The Substance

I do not know about you. But I have the feeling that not much is happening in advancing the Human Rights cause in development work.* We hear (and write) praises about how this is the right way forward, but an expanded understanding and concrete steps remain scanty. A lot of what is said sounds disturbingly progressive... but has not enough substance to base praxis on.

We cannot continue to blame everything on the global power structure only. (Lamentations alone do not lead to liberation). Likewise, we must be critical of our efforts at grassroots level and --in all honesty--of ourselves.

We have to stop talking about utopian generalities. It behooves us to give a clear sense of what might be the next best steps that organized groups working on Human Rights could and should take. We need to make practical suggestions on how to convert our dreams into reality. In short, no more slogans, but a sense of direction, i.e. an integrated framework needs to tie all the main issues into an action plan.

Ultimately, to counter the Human Rights opponents’ arguments, the people’s movement fighting for Human Rights needs to be much better informed and what its members say must be well documented. Just in terms of awareness creation alone (which is essential in the struggle for change), we still have a long way to go.

Success will depend on concrete actions and activities our affiliated groups manage to undertake. Ultimately --let’s not lose sight-- this is a movement struggling to transform current unfair Human Rights conditions. The question is: What small but significant steps will each of us take to effectively contribute to this?

Since the recommendations for mechanisms and actions to do this have not yet been clearly worked out, the “Human Rights movement” many of us are part of can and has to provide a platform around which people can organize, mobilize and lobby (or protest) for change. Novel approaches to solve old problems must be proposed and --as important in Human Rights work-- solidarity channels must be set up and/or reinforced and then sustained.

Building such an international solidarity primarily means giving people a chance to air their grievances and be exposed to the grievances of others. The usually silenced victims of Human Rights violations should be the first to be given the chance to express themselves. Free speech is the path to liberation.

Only the ongoing sharing of critical Human Rights analyses and successes will lead us to liberation... or at least has a chance of doing so. This, because it is these analyses that we need to use for grassroots organizing and for the careful planning of strategic actions. It is no longer enough to clarify and rally around key Human Rights issues by only carrying out comprehensive analyses of causes and hoping this will awaken dormant combativity: Collective strategic planning of how to get where we want to go is the real important thing.

Responses to questions like: Where is all this leading us? and How do we get there? must be inclusive of practical suggestions for specific Human Rights-promoting actions that individuals and organizations can/should take, i.e. a sense of direction must be given. This is what leadership is all about.

A degree of collective guidance and facilitation is indispensable to give such a sense of direction. People should have a chance to hear the views and learn from the analysis of those who are more fully informed and experienced. Therefore, the ‘public forum’ we ought to aim for should not simply be a ‘chat room’, but rather a well moderated educational communications tool which can help guide people to come to realistic conclusions and to the formulation of their own practical plans of action.

The discussion of an integrated Human Rights framework and of collective, coordinated strategic Human Rights plans can indeed be started and advanced through such a ‘public forum’.

At the base here is more a tactical than a strategic debate; and for it, I do not necessarily have all the answers. What I do know is that, in today's world and perhaps more than ever, there can be no liberation (i.e. respect for Human Rights) without a strategy... and no strategy without a struggle.

It will thus be a ‘facilitated search of direction’ based on a unifying analysis (framework) that will lead us to the so much needed host of workable local plans of action. We can give global general guidelines, but only local plans will be realistic. If we fail, people will come away with a blurred sense of what might be the next step their group should take in promoting Human Rights. If the direction is ambiguous, so will the actions!

The Network

The only way to do what is proposed above on a scale commensurate with the current needs is to establish an active Human Rights communications network, a mechanism whereby groups in different parts of the world can be supportive of one another in times of crisis and can be ongoingly exposed to this vital exchange of information on Human Rights. (The People’s Health Assembly is in the process of exactly setting up such a network. We could all learn from it). It will be critical then to maintain this channel of information sharing which, among other, could be used to coordinate inputs from NGOs, other organized civil society groups or movements and from activists, as well as from similar coalitions working in other sectors on other reivindications.

The first viable channel that comes to mind is an email list-server. However, only maximum 10% of the world’s population has direct or indirect access to computers and less even to the Internet. More traditional means of communication are thus also indispensable (and could be linked to and triggered by the email network): We are talking about newsletters, radio, videos, webs of community workers and union organizers, and other such channels.

While doing all this, we have to keep the process democratic yet on track, i.e. advancing! For that, a balance has to be sought between guided facilitation and open-ended Human Rights discussions. The presentation of successive drafts of a unifying analytical framework and of strategic plans for us to discuss on-line is the first step to focus the discussion and to make steady progress towards agreed upon objectives.

I call on you to contribute to fill the gaps I here depict and to encourage others to contribute, each in their own way. I thought that starting this Human Rights Reader was a contribution in the right direction, but it remains desperately academic, and few of you react. It could evolve into a list-server though as the basis for an ongoing real multi-centric dialogue. Others among you would have to help by contributing the ‘substance’ for the concerted actions that I am pleading for here.

We will need skilled communicators to help us give simple language, clear and accurate summaries of the key issues starting from an assessment of where we are and then pointing to what needs to be done next. They also need to check what people are understanding of what is being said in this virtual and face-to-face communications network. Explicit plans for follow-up action are crucial and all our correspondents should have the mailing addresses of all in the group (or access to all through the list-server).

So --as we come out of an always sleepy summer in the North-- this is, in short, the challenge I perceive: Would anybody care to comment?

Note:

Adapted from Werner, D. and Sanders, D. Liberation from What?, Newsletter from the Sierra Madre #44, March 2001, pp.1-7. www.healthwrights.org

*A welcome exception is CARE s publication of the Newsletter Promoting Rights and Responsibilities. jones@care.org

33. Human Rights are Very Much on the Agenda of Development Work

“The sovereignty of States must no longer be used as a
shield for gross violations of Human Rights.”

- Kofi Annan

1. Betting on the invisible hand of the market and ignoring the needs and rights of the socially excluded is just dangerous and morally unacceptable.

2. It is therefore that the macroeconomic policies insisted-on by the IMF do not simply have a negative social impact; their design embodies a profoundly unjust social content giving the financial rights of creditors priority over Human Rights of the people; the IMF chooses to prioritize the interests of the creditors.

3. Rights can be usefully seen as the codification of needs. Reformulating needs as ethical and legal norms implies a duty on the part of those with the power to provide all the means necessary to make sure those needs are met.

4. Without Political and Civil Rights, there is no guarantee that other rights --even when they are inscribed in laws and constitutions-- will be made effective; the lack of citizens’ power to make governments accountable and responsible to them is perhaps the greatest obstacle to all rights-based agendas.

5. But democratic elections (allegedly giving citizens off-and-on, periodic power) do neither guarantee state responses to collective needs, nor the participation of civil society in decision-making, nor, for that matter, guarantee greater social and political accountability.

6. On the other hand, claims are sometimes wrongfully made that universal rights are a form of Western hegemony; the caveat in this assertion is that a right is a right only when it is universal; otherwise it is a privilege.

7. There is also the wrong belief that the Human Rights approach is ‘political’ while the humanitarian approach is not...and is therefore ‘safe’; others phrase the same groundless fear saying that applying the Human Rights approach compromises one’s ‘neutrality’.

8. The reality is that any legal Human Rights system (including humanitarianism) is indeed (and must be) related to political theory and social values.

9. Nevertheless, let us not forget, International Human Rights Law only recognizes the obligations and duties of States (!). To cover the entire web of interrelated Human Rights violations, there is indeed a need to extend the same obligations and duties to other subjects at sub-national level.

10. This, because Human Rights obligations are closely linked to a multi-layered system of accountabilities. For a duty bearer to be accountable, three conditions are needed:

· the person must accept the responsibility and obligation to uphold Human Rights (‘should act’);

· the person must have the authority to act (‘may act’); and

· the person must control the resources needed to act (‘can act’).

Note:

- Taken from UNRISD News, CARE s Promoting Rights and Responsibilities Newsletter and SCN News (Jonsson, Levine and Young, The Right to Nutrition in Conflict Situations).

- Quotation of Kofi Annan is taken from Nobel lecture, Dec 2001.

34. Rights are Guaranteed Entitlements: Right?

[The title question is a political and not a legal one: the legal obligation already exists!].

1. The strength of a rights-based approach is that it allows one to talk about entitlements and to challenge unwilling governments. (“One person should not have to decide whether s/he can eat or go to the health center to seek care”).

2. Forcefully applied, a rights-based approach is a strong tool to change government behavior, as well as to initiate societal processes of accountability.

3. But in international fora, the United States, for example, has most often taken the position to avoid any (in-writing/binding) formulation of entitlements and of economic, social and cultural rights. That has progressively lead to people getting fed up with international conferences that result in ever-weaker statements.

4. Actually, many heads of state of rich countries (and many poor) are not the least interested in the Human Rights (Human Right) question beyond lip service. Human Right problems are basically problems of marginalized groups and, therefore, not a priority concern for many main stream politicians.

5. This indifference is a crime at a time when the world is moving back to jungle capitalism and when actual access to productive resources for the poor is a key issue in guaranteeing Human Right.

6. It is in this North-dominated climate of ‘soft issues being pushed to the fringes’ that we have the not-easy task to build an international alliance or coalition against Human Right violations.

7. Experts and international bureaucrats keep talking about good examples and best Human Right practices yet discussions about the legal obligations these would entail fail to come to concrete proposals (when, by now, we clearly need to give guidance to states to embark in actions that go beyond mere ‘best practices’). Codes of conduct guiding the implementation of rights are needed (for example, one has been proposed for the right to adequate food).

8. Applying the Human Right-based approach is not creating new obligations and, further, Human Right obligations do not ask states to do the impossible; applying it rather requires that states be monitored against Human Right criteria set in existing international covenants they are signatories-of already; they prefer not to be checked on these though, in an effort to avoid being exposed for their lack of commitment...That is why the term obligations is so much more attractive to civil society.

9. Conversely, it is the use of the term obligations which makes some governments reluctant to use a rights-based approach. This, because governments are not only obliged to respect existing rights; they must also protect people living within its borders from having any of their rights violated, and must implement all codified rights using their maximum available resources. Governments also must give victims of violations the means to seek redress and challenge violations by establishing recourse procedures. They are to check that national policies do not have a negative impact on established rights; they are also to check existing legislation and develop a national Human Right implementation strategy including new legislation and the setting of benchmarks for the implementation of concrete steps and the achievement of intermediate objectives over a given period of time. All this requires implementing administrative innovations and setting up monitoring mechanisms....clearly a scary prospect for many non-committed governments.

10. Moreover, states have Human Right obligations vis-a-vis international organizations and in controlling the private sector. (The activities of the private sector --especially transnational corporations-- do need to be regulated in a Human Right-based approach; the sector cannot be allowed to benefit or take advantage by interfering with or violating Human Right in any country).

11. Although states are already obliged to use existing international reporting mechanisms to report on the progress of Human Right in their countries, it is civil society actors that should actively monitor this, in addition to providing inputs for national Human Right-linked legislation and for coming up with a roadmap for its implementation. (Plans of action have to help set priorities on what must be implemented immediately and what progressively).

12. Overcoming the most common trap in the discussion of whether changes are necessary nationally or internationally, do bare in mind that states also have international obligations to assist other states to implement Human Right.

13. Human Right obligations of non-state actors do exist, but are not codified in international covenants; they are nevertheless crucial. For instance, international organizations and the private sector also have Human Right responsibilities.

14. We have to think in terms of a veritable Human Right web where co-responsibilities among different actors exist although not all actors are equally important.

Note:

- Taken from Hungry for what is Right, FIAN-Magazine for the Human Right to Feed Oneself, No. 2002/02.

35. ‘Charity is Obscene from a Human Rights Perspective’

- Immanuel Kant

1. In many communities, Human Rights values still need to be promoted from above, because they have not yet been internalized by unknowing, potential claim holders. This promotion from above is far removed from traditional charity approaches (*) to development though.

2. Ultimately, Human Right cannot be imposed; they must be sought/pursued from within, and only be supported from outside.

3. In our work, it is primarily the (majority) deprived/poor people (**) who are the main holders of rights; our Human Right work with them is to have them empower themselves to claim their rights and to choose their own development path (i.e., circumstances and chance should no longer dominate their lives).

4. Human Right are thus to be seen as what they really are, namely, the legal expression of our human dignity. Because of that, Human Right are universal; they are indivisible; and they are interdependent. There is nothing like ‘basic rights’.

5. But Human Right do not yet feature explicitly (***) in the charters or mission statements of many international private voluntary organizations (importantly those NGOs traditionally involved in mostly charity-type work); we all need to become more vocal in demanding this be done.

6. Participation, you may not know, is a Human Right per-se; it should be treated as a necessary outcome of development work and has to become a necessary part of the process. Charity may share this concept, but definitely does not share the Human Right perspective that it is inescapable to directly address the basic/structural causes of rights violations (see below).

7. So, what is then involved in a truly participatory Human Right-based planning and programming? And who is to do it?

8. To start with, UN and bilateral agencies and NGOs with active programs in the field should already be applying Human Right-based programming --with the participation of their respective constituencies!

National governments should, ideally, follow suit as a way to concretize their commitment to Human Right (this can, therefore, at the same time, be a test of commitment).

9. Participatory Human Right-based planning has several recognized steps:

9A. Participatory Causality Analysis:

Before anything, communities must first recognize they have problems, and then characterize them; they must then collectively identify the causes of the same. (Without a reasonable consensus on the causes of the problems at hand, it is not likely that there will be a consensus later-on about how to solve the same). Any causality analysis is greatly helped by an explicit Conceptual Framework (e.g., the one UNICEF uses since 1990 for the causes of preventable ill-health, malnutrition and deaths). Planning in a Human Right context requires a full understanding of the causes at all levels (immediate, underlying and basic) with simultaneous attention being given to addressing the causes at different levels. Causes of problems related to the violation of people’s rights that are identified with the help of the framework need to be analyzed for each violation at each level of causality; then, a quali and quantitative relationships must be established among them. This is to be followed by reaching consensus regarding the most important determinants affecting the realization of those rights found to be violated.

The Causality Analysis will thus produce a list of rights that are being violated together with the major causes of these violations.

9B. Participatory Pattern Analysis:

This step explores the relationships between claim holders and duty bearers; these relationships form a pattern. The work to identify duty bearers for each particular right benefits from the earlier causality analysis in that one can identify duty bearers at different levels. One has to insist that, at this point, it is necessary to focus on priority problems to reduce the analysis to a limited set of claim-duty relationships that are likely to be the most critical in the given situation; if not limited, one risks ending up with a very large number of such relationships that we will not be able to tackle and a number of actors too large to involve and support (i.e., the situation analysis should cover all rights while programming will address the most relevant violations first).

Pattern Analysis thus arrives at a list of the most crucial claim-duty relationships for each particular set of rights violations selected.

9C. Participatory Capacity Analysis:

This next step is about analizing why duty bearers do not seem to be able (or capable) to perform their duties as is expected from them. It s about identifying their shortcomings and confronting them with such evidence. As pointed out in Human Right Reader 33, this analysis looks at the responsibility/ authority/resources components of capacity (or about how duty bearers should act, may act, and can act). The importance of two-way communication systems are to be recognized here so as to put resources to really work for the benefit of claim holders.

Capacity Analysis thus ultimately identifies capacity gaps of each duty bearer for each identified rights violation to be redressed (also see Human Rights Reader 33, page no. 70).

9D. Participatory Selection of a Strategy and Best Actions:

Here, actions are selected to help close capacity gaps identified in the previous step.

This step thus results in a list of candidate actions organized into a draft strategy.

9E. Partnership Analysis:

At this point, discussions are held with key partners/strategic allies with the aim of reaching agreements on who will do what, how, where and when.

9F. Programming:

This final step aggregates all activities in the strategy into (a) program(s) and/or project(s). No general advice is sensible enough here to prescribe how best to do this. Groups involved in the planning will have to learn from practice on how to best cluster activities for maximum results (by sector, by theme, by geographical location, by level of causality, etc).

11. But, beware, the Human Right approach is not a magic panacea either. It will not see resources and policies and power instantly transferred to the poor and vulnerable... Keep in mind that --unlike the WTO-- the UN or any other international body have no practicable way of imposing punishment or fines on governments that violate or ignore their internationally sanctioned commitments to Human Right; we all need to contribute our grain of salt to help empower people to stop these violations.

Note:

*: Charity is here seen as love and the right feeling towards one s fellow human being.

**: Poverty is here seen as a lack of choice and minimum control of resources.

***: Or may have been added lately without those organizations having operationalized these principles in their field work yet.

****: The principle of low cost high impact pursued in traditional development planning is merely utilitarian; in Human Right-based planning it must thus sometimes be rejected. Simply put, morality often leads to a different set of priorities than those of an economic analysis.

- Mostly taken from Jonsson U., An approach to Human Right-based programming in UNICEF ESARO, SCN News No.20, pp.6-9, July 2000.

36. Perspectives on Human Rights: Furthering the Debate

On Power and Human Rights

1. To be a fully empowered claim holder is to have the ability to compel the performance of some obligation; before being empowered, people are unable to compel important others to perform their obligations.

2. This, because in our societies, having a right means having the power to command respect, to make claims and to have them heard and acted upon. Put another way, to have a right is to have a power; to have to obtain a right is to be powerless.

3. That in these same societies some are powerful, dialectically suggests that others are powerless. So, any coherent notion of rights must, therefore, recognize this connection between power, respect and inequality in our societies.

4. Seen from such an angle, our performance in the Human Rights arena is still largely inadequate, because so far, it has failed to reverse the powerlessness of the poor. This failure of ours is coupled to our continued choice of rather paternalistic interventions. (How many of us are aware that, in our work, rather than empowering the poor, we may be empowering ourselves to intervene in their lives?).

5. Power and powerlessness are fundamental dialectical opposites in society; they regulate the interactions between individuals, the state, and its citizen. It is inconceivable to imagine a world without power --and utopian to believe that such a world might exist.

(A rights theory which envisions what should be, rather than what is, lacks the force and persuasiveness to effect true change): Rights must be tied to the notion of power and powerlessness.

6. What this means is that a Human Right-based approach will indeed challenge patterns of authority and power. Placing claims does not grant equality per-se, but merely grants equality of attention; it is a first step in challenging existing hierarchies; placing claims is part of a slow historical process that will eventually lead to a better life for the poor.

7. But a caveat is called for: Rights arguments are also increasingly being used to justify particular sets of policies imposed on the poor. Human Right arguments may actually be used against them.

8. Human Right can contribute (positively or negatively) to the power struggles of the poor: they can be used as much in defense of privileges and the powerful in society, as they can be used to advance the interests of the poor and marginalized. Economic rights of the haves (e.g., to property) are often used against the interests of the deprived majorities, as much as legitimate rights of people (e.g., to information, to assembly) are not infrequently contested in litigation or simply trampled using brutal repression.

9. If Human Right-based interventions prioritize the needs of the poor and marginalized, rights can become powerful tools to advance democracy provided they do not ignore the power imbalances that exist between and within countries. This, because rights are easily co-opted to serve those who already benefit from inequity and imbalances of power.

10. So, how do rights-based interventions put the poor first?

An active pro-poor civil society has a key role to play here. Their social mobilization activities have to aim for the structural changes needed for meaningful and sustainable changes that will discriminate in favor of the poor. In some countries, Human Rights Commissions have been put in place, but are no panacea if they ignore tying rights to the notion of power and powerlessness in the country.

11. While Western preoccupation with good governance makes a misnomer of what good governance should be, it is only active grassroots everyday public participation (and not ‘democratic’, often rigged, elections in which only a minority votes) that can really influence governments. Using a Human Right approach to foster such an active participation is paramount --remembering that individual rights and group rights are naturally compatible.

12. The success of the Human Right approach should thus be judged by its capacity to strengthen the least powerful in society to act in their own interest, individually and collectively (indirectly leading to better governance).

13. We have to better understand Human Right and the role they can play in the context in which each of us works and in which these Human Right are to be applied; therein lies the immediate challenge.

Note:

- Mostly taken from L. London, email, Univ. of Cape Town, Oct.5, 2002, and from K.H. Federle, Rights flow downhill, The Intl J of Children s Rights, 2: 343-368, 1994.

37. Putting Equity and Human Rights in Health on the Agenda: The Role of NGOs - I

Introduction

1. Equity and Human Rights are by no means new concepts to NGOs.

2. Moreover, Equity and Human Rights are inseparately linked since equity is key to the realization of Human Rights. The question here is what NGOs are doing with/about these two concepts in the realm of their work in health and nutrition.

3. A paradigm shift is clearly in the making in development and in health/nutrition work. New models are more politically driven in a direction that hinders and hampers the resolution of the problems at hand. Therefore, these days, more and more NGOs are discussing and trying to operationalize the ‘Equity and Human Rights-based Approach’ to apply it to their work.

The Background

4. Underlying the analysis here made are several statements found in a recent publication; they read as follows:

“Most NGOs today have become very specialized and contribute marginally to the relief of poverty/ill-health/ malnutrition, but significantly to undermining the struggle of the people to emancipate themselves from oppression. Programs delivered by these NGOs do not really seek to redress the social circumstances that cause impoverishment/preventable ill-health and malnutrition. The development discourse is framed not in the language of emancipation or justice, but using the vocabulary of charity, technical expertise, neutrality and paternalism. NGO programs have often worked to undermine popular mobilization. NGOs accept or do not comment on the manner in which the State exercises its power. NGOs work is limited to project work, armed with manuals and technical tricks rather than seeking justice and standing up against violations of Human Rights. Many NGOs were co-opted by funders to take up such a role (a typical example is health and nutrition work done to set up ‘safety nets’ for the poor). NGOs have become an integral part of a system that sacrifices respect for justice and rights, instead taking a missionary position. If NGOs stand in favor of emancipation, then the focus of their work has invariably to be in the equity/Human Rights/political domain, supporting those social movements that seek to challenge a social system that benefits a few and impoverishes the many”. (Manji and O’Coill, 2002)

5. Most NGOs tend to work on the issues that are before them, and forget those that are hidden away; such hidden truths have to be brought to the forefront. For example, issues of voice, power, risk and neglect are essential in a Human Rights discourse --as difficult to surface as they may be.

6. The fallacy that actually needs to be uprooted is that health programs addressing the urgent needs of women and children implicitly address Human Rights. In the Human Rights approach, nothing is left implicit; without an explicit retooling to a Human Rights focus, such claims remain but hot air; they are hollow commitments to Human Rights that allow controlling hierarchies to persist.

7. NGOs have ample accumulated knowledge of what is going on....and have just begun to realize that, if they do not act on that knowledge, they are not really serving the people of the communities that they work with to the fullest.

8. There is a need, then, for a more determined commitment to pro-poor social policies and programs (including health)and an increase in the funding for such an approach. Activities are to concentrate on institutional capacity building to better promote education and consciousness-raising at the community level. A key question is to give advocacy tasks more prominence so as to hold governments more accountable.

The Concept of Human Rights in Health and Why it is Used

9. In contrast to a ‘deficit-filling approach’ to poverty and preventable ill-health alleviation, the Equity/ Human Rights-based approach (E/Human Rights-based approach) defines poverty as social exclusion. Instead of focusing on creating an inventory of public goods or services that must be provided and then seeking to fill the deficit via foreign aid, the rights-based approach focuses on trying to identify the critical exclusionary mechanisms. This, because work in health and development is about assisting poor communities overcome obstacles, rather than about the endless pursuit of grant aid for social goods.

The E/Human Rights-based approach enables NGOs to see much more clearly the kinds of power relations and systemic forces that drive and perpetuate poverty.

But the transition to mainstreaming a rights-based approach into the organizational structure of NGOs is a complex enterprise; it cannot simply be decreed and implemented.

10. The E/Human Rights-based approach asserts that work in health should be seen as a process that unequivocally leads to people fully realizing all their Human Rights (and not only their right to health); the approach should thus be reflected both in the processes engaged and the outcomes pursued by NGOs.

11. More importantly, the E/Human Rights-based approach sees ill-health, malnutrition and poverty as a denial of human dignity, i.e. as an important part of the denial of people’s economic, social, cultural, civil and political rights.

And these rights are more than just moral principles and norms governing human behavior ... they are international legal standards.

Poverty itself is seen as an abuse of Human Rights... The poor and marginalized are not where they are by accident...

12. Because health is not the exclusive business of governments, this broad approach definitely brings an added value to communities and to NGOs when sitting down among themselves and with government representatives to jointly evaluate and plan local or national health strategies. It brings something different and potentially powerful to existing efforts by all actors in their efforts to overcome ill-health, malnutrition and poverty in a more sustainable manner.

13. The principles of equity in health (and prominently those related to gender equality) are not currently codified in any way to allow monitoring their implementation; more often than not, they are lost when implementing health sector reform or macro-economic corrective measures.

Human rights, on the other hand, are enshrined in legal covenants that protect human dignity and place obligations (or duties) on providers and others, mainly but not exclusively the State. While NGOs do have the responsibility to respect the rights of others, it is now widely accepted that states have very specific obligations to respect, protect and fulfill Human Rights in the realm of health and nutrition.

14. It is thus timely for NGOs to use the equity and Human Rights-based approach --to apply the internationally agreed Human Rights standards to health policy and practice-- emphasizing active grassroots participation and the right of people to choose their own path.

15. When doing so, priority is to be given to the poor, the marginalized and the vulnerable --those currently most denied their rights due to their lack of choice, of control and of resources.

16. The conceptual basis that justifies (and prescribes) the use of an Equity and Human Rights-based Approach in the health and nutrition work of NGOs is the following:

· Human Rights are entitlements all people have, to develop their full potential; they are valid for everyone --they are universal (A right is a right only when it is universal; otherwise it is a privilege).

· There is a difference between just delivering services and making clear to beneficiaries that they are legally entitled to specific services and can go somewhere to complain if they do not receive what is due them.

· Human Rights objectives are not to stabilize the problems at hand, but to make them disappear by tackling them at their roots.

· Human Rights are pre-conditions that must be met for people to have the opportunity to live with full dignity, full health and self-worth.

· Human Rights lack cultural legitimacy in many parts of the world; communities are traditionally more concerned with needs than with rights; that is why NGOs have to start from people’s own initial understanding of their rights (and the issues of power) to then support a bottom-up dialogue that deepens the ownership of Human Rights by the beneficiaries they work with. (Without concerned citizen action to uphold Human Rights close to home, we shall look in vain for progress).

· Rights are different from needs; rights are relational: where someone has a right, someone else has a duty or responsibility to honor and satisfy that right. There are two critical distinctions between health rights and heath needs: first, health rights always trigger duties and responsibilities, whereas needs do not; second, health rights imply standards that can be measured whereas needs do not. Therefore, NGOs need to start thinking in terms of rights rather than needs, of rights-holders (or claim-holders) rather than beneficiaries and of enabling rather than giving.

· In the E/Human Rights-based approach to health beneficiaries hold claims against those who are responsible (through their actions and omissions) for their health and nutritional wellbeing. People can only realize their rights in health if they are first exposed to the root causes of the marginalization they suffer from, and if they are empowered to claim and fulfill the rights essential to their health/nutrition and livelihood security. Rights, then, have an enormous potential to attract and mobilize people. First and foremost, this means NGO interventions have to transfer ownership to the people served; key actions for this to happen are Human Rights education and capacity building for community members to claim and defend their rights. Empowerment here is to be understood as generating several forms of power: self-respect (power within), community cohesion (power with), and a clear agenda for action (power to).

· The E/Human Rights-based approach addresses abuses and/or neglect of Human Rights in health mostly found in the form of discrimination or exclusion. It brings to the light underlying power relationships between rights-holders and authority structures; it emphasizes dignity, equality, and participation of the former and accountability of the latter.

· Moreover, let it be very clear that advancing gender equity issues is part and parcel of work on girls’ and women’s rights in relation to health.

· Such an approach means NGOs must stand in solidarity with the poor (women, children and men) whose rights are being denied --holding themselves accountable to them (and in addition ensuring they do not violate people’s rights themselves). NGOs must support people’s efforts to take control of their own health and lives. This also includes NGOs holding others accountable for fulfilling their responsibilities, as well as opposing discrimination of any sort, addressing the root causes of poverty/ill-health and malnutrition and the corresponding rights denials in their work with rights-holders. Finally, they must work in concert with others embarked in the same endeavor (forming a supportive coalition of NGOs on these issues).

· In short, the E/Human Rights-based approach calls for a purposeful and transparent de-facto engagement of NGOs in the more structural aspects of the determinants of ill-health while remaining steadfast allies of local communities throughout.

· NGOs will not be alone in this E/Human Rights-based approach since the paradigmatic (and mindset) shift towards it is growing globally with the force of international law behind it.

· Therefore, NGOs definitely need to take steps now to improve the Human Rights impact of their current actions in health. This means identifying previously unforeseen gaps and opportunities. But although focusing on health, NGOs have to take into account the whole range of Human Rights since Human Rights are indivisible.

· Weighing-in on rights can risk harsh reactions from the authorities. Standing up for communities whose rights are not respected, protected or fulfilled is inevitably being political in the sense of challenging those actors responsible for abuses. So NGOs have no choice but to take a stand against authorities, policies or practices when the communities they serve are abused, neglected or excluded. The name of the game is: Remain non-partisan, but at the same time take issue.

· Even if the E/Human Rights-based approach is inherently about confrontation --confronting the injustices of real world situations-- two approaches are possible:

a) denouncing violations (which is often confrontational), and

b) engaging actors in the pursuit of rights, helping them to more fully live up to their responsibilities (which is more related to promotional work).

· Monitoring Human Rights conditions is also very important for NGOs, and there is a need to share and disseminate information about such violations (making documented grievances public); this information will ultimately strengthen advocacy. Human Rights-sensitive (and gender and socio-economically disaggregated) data and indicators are critical to keeping aware of gender, equity, Human Rights and other issues.

· Despite growing clarity about all the issues above, there is no one blueprint for an equity and Human Rights-based approach to programming in health; each NGO will have to go through its own retreat(s) to revision and remission their mandates to adjust their very own approach and programs to it. (Adapted from CARE, 2002)

38. Putting Equity and Human Rights in Health on the Agenda: The Role of NGOs - II

Experiences from Some NGOs Already Using the Equity/Human Rights Approach

17. As far as international NGOs are concerned, CARE has probably advanced the most in its efforts to operationalize the Equity/Human Rights (E/Human Rights)-based approach. Since January 1999, they have had a (CARE) Human Rights Initiative with a HQs coordinator and program advisor and a field program assistant devoted full-time to the Initiative. They have been raising awareness in most CARE country offices around the world, building the capacity of their staff globally, ensuring that CARE’s principles and policies facilitate the Human Rights-based approach being progressively adopted, and they have been forging strategic alliances with like-minded programs and initiatives. They carry out training, research and pilot activities in Human Rights, and they publish a quarterly newsletter (‘Promoting Rights and Responsibilities’) featuring cases from the field, staff reflections, conceptual pieces, a section called Window to the Wider World and a section on worldwide new resources. They are about to publish a Rights-based Training Manual and a set of Case Studies on CARE’s Implementation of the Rights-based Approach. Very helpful has been the compilation of a Frequently Asked Questions About the Adoption of a Rights-based Approach document which has been revised a few times. (More information to be had from Michael Rewald at rewald@care.org)

18. Note: Equity and Human Rights do not feature explicitly in the charters of international financial institutions (IFIs) and those of many donors although most bilateral development agencies now give prominence (and mostly lip service?) to both participation and the promotion of equity and Human Rights. Moreover, the commitments of national governments to respect, protect and fulfill health as a right has yet to be properly reflected in their policies and practice. The E/Human Rights-based approach demands that government policies address ill-health and malnutrition ‘to the maximum of available resources’ (including resources available through international development assistance). It is this what some NGOs are starting to make governments accountable for. Finally, also note that a new publication of WHO states that poorly designed and implemented current health programs and policies can (and do) already violate Human Rights.

Practical Ways for NGOs to Adopt the Equity/Human Rights Focus in their Health Work

19. The Equity/Human Rights approach does not offer a panacea or magic bullet that will see resources, services and power instantly transferred to the poor and vulnerable. In part, this is due to the fact that the international community has no practicable ways of imposing punishments or fines on governments (or others) that violate or ignore their commitments to Human Rights. On the other hand, NGOs have not used their potential to more proactively seek government compliance in this area. There are proven tactics that can be used --and these need to be shared more widely.

20. The main question at hand here for NGOs is: If current health programming is mostly time-bound, donor-driven, and supposedly apolitical, how can they pursue meaningful, long-term and rights-holders-driven transformations in the sector based on challenging oppressive power relations?

21. Understanding how societies construct the system of inequities that include inequities in health is the first step for NGOs to help people claim their rights.

22. But understanding is not enough. The E/Human Rights-based approach insists on behavioral changes of the NGOs professional staff themselves (to be seen as a ‘staff investment’) rather than the latter simply starting more ‘Human Rights-compatible’ new programming; it insists that the E/Human Rights-based approach entails a different concept of development programming that does not only focus on the methods of implementing new activities. Without behavioral changes, staff will simply repackage what they are currently doing in an ‘E/Human Rights-based approach language’.

23. When designing projects, a formal analysis of the rights being addressed has to be done with the community; this includes understanding how aid can compound some of the problems to be solved, as well as analyzing the unintended consequences of the work to be undertaken. (Unintended impacts on people’s rights happen for three different reasons: a lack of knowledge about the context in which NGOs work; a lack of thought about unintended impacts of their interventions, and a failure to take responsible actions).

24. For all the above reasons, from now on, a growing part of NGO efforts should focus on making governments accountable to meet their Equity/Human Rights obligations; and there are concrete steps that can be followed to do this (see below). More and more, the root causes issue (i.e., taking a new look at issues of power, control, ownership and sustainability) and the rights violations actually found should become the main agenda for discussions with authorities.

25. That is why calling for an NGO (re)organizational meeting (or retreat) on these issues is now necessary. It is high time that people in NGOs find out more about this Equity/Human Rights-based approach to health and particularly about how to operationalize it. This expertise is now badly needed.

26. The real tough challenge NGOs face in these organizational meetings is in translating what some feel are still vague principles into concrete plans and actions --even if they find it difficult to alter power relations in the short-term.

What Does it Take, Then, to Understand and Adopt an E/Human Rights-based Approach?

27. To start from scratch and to familiarize NGO staff with this approach, a one-day general introduction to Human Rights and the E/Human Rights-based approach, defining its characteristics, is suggested; this is to be followed by a series of meetings in which exercises are presented for staff to learn how to carry out causal/ responsibility analyses and to identify the responsible actors (duty bearers) at each level; this is followed by exercises on how to develop advocacy strategies to influence pertinent decisions an actions. A final session should focus on identifying the NGOs strengths and weaknesses to adopt the E/Human Rights-based approach and should conclude with delineating the steps proposed to progressively implement this approach. At the end of the training, each staff member should be asking him/herself: ‘Am I really committed to this?’ ...and this should be discussed.

28. There is no shortcut or blueprint methodology to achieve a shared understanding of these concepts. NGOs must acknowledge that this is a time consuming and intense process. What is clear though is that NGOs will identify a host of new priorities.

29. What the addition of these priorities will mean for each NG, and what it will lead to in the future, is also to be explored in these meetings. Towards the end, each NGO should have a long-term vision for health --one that adds the Equity/Human Rights perspective. This should be ultimately reflected in increased funding for activities that point to that vision (funding needed for this is considered to be neither very substantial nor very difficult to raise); it should also mean that NGOs will become more vocal advocates for both Health and Human Rights and better watchdogs of Human Rights violations and of existing and emerging inequities in health.

30. Only after going through such a collective learning process will the NGO’s internal organizational systems, its processes, policies and organizational culture change as needed. It is more, only when a critical mass of people in the organization changes to think in the new way will the NGO as a whole change. Each staff has relationships with people at many levels of the organization; each should gradually work to influence them so that more and more staff join by understanding and supporting the changes called for.

31. After going through the training, the next challenge for NGOs becomes to use the international Human Rights agreements, they now will be more familiar with, practically:

· in the health policy making process (their own and the government’s),

· to guarantee people’s participation (beyond mere dialogue),

· to assess and analyze people’s health and nutritional needs together with them,

· to set commonly arrived at and agreed objectives,

· to, together with and/or backing claim-holders, place informed and effective demands in front of authorities and demand for accountability, and

· to call for and get involved in networking and solidarity work.

33. Further, NGOs have to decide whether they start applying the E/Human Rights-based approach in their current projects or rather wait for new projects to come to do so. Alternatively, they can begin implementing the E/Human Rights-based approach in selected projects and experiment using the new Human Rights work tools, at the same time building the capacity of a core team of trainers/implementers and encouraging senior management to take a lead role. They also need to make sure they have the capacity and the resources to implement these principles.

34. Later, NGOs will need to periodically review whether their programs are reflecting the E/Human Rights principles, document how they do deviate from them and articulate steps to progressively get back to and realize them.

35. Ultimately, the aim is to cede power in NGO programming to the people they serve, ensuring they are increasingly represented and heard in program/project decisions.

36. When Northern NGOs become actors in a rights-based framework, they also need to recognize the existing tensions in their relationship with Southern partners; these often relate to economic and other inequalities in their relationship at a time when Northern NGOs are seeking equity. (Beware that, in Human Rights work, Southern NGOs are indispensable allies, because they are better placed to exploit the opportunities and avoid the dangers of Human Rights advocacy in their own countries).

37. An additional point for NGOs to ponder is that, in an era of Globalization, it is not sufficient for them to work exclusively at the community level. The drivers of poverty and inequity are much more global than local. Northern NGOs are in a better position to act at the global level and should do so. Agreement on the agendas for such advocacy work should be sought with Southern partners.

What will refocusing on E/Human Rights mean to NGOs working in the health sector? What is the added value of and the new visibility gained from adopting an E/Human Rights-based approach?

38. Working with an Equity/Human Rights focus will mean finding gaps in Human Rights in the current health work they do; it will mean revising their plans; it will mean increasing their staff’s skills to analyze health from a Human Rights perspective; it will mean adopting a ‘Human Rights language’ in most of their work; it will mean focusing more on activities they are not familiar with yet; it will mean selecting a new set of health priorities (or priorities in health) and determining whether they do conflict with or complement their existing priorities and whether they will mean extra work; it will mean reexamining who their strategic allies are (and which they should take on), as well as look at their allies’ respective roles to find synergies/conflicts/gaps; it will mean NGOs will also have to increase their resolve to say no to certain donors; it will mean changing their focus on monitoring and evaluation. And, last, but not least, it will mean a major repositioning of the NGO’s identity with its various publics and stakeholders.

39. NGOs’ Human Rights advocacy should, from now on, also be internationalized. A successful example is NOVIB’s Social Watch Initiative that watches over the implementation of governments’ commitments taken up and signed on in global UN meetings; initiatives like this should now be expanded to cover monitoring E/Human Rights violations in health and other domains.

40. Operationalizing the E/Human Rights-based approach therefore requires NGOs to work at the target group level, work on civil society building, work in monitoring and influencing government policies, as well as work internationally. What this challenging agenda means is that without a political commitment to social equity and Human Rights, PHC strategies will fail. This, because poverty erradication strategies cannot ignore the health status of rights-holders --and that requires addressing unequal power relations (i.e. analyzing who wants and needs changes in health and who wants to maintain the status quo).

41. NGOs are, therefore to remain active in structural poverty/ill-health/ malnutrition erradication. Demanding for rights is a battle that has to be fought in the social and legal arenas, at national, regional and international level. NGOs cannot do this by just implementing government commitments and absolving the state of their responsibilities. The difficult struggle against the impunity of state-related perpetrators of violations of Human Rights has to be undertaken now. NGOs must combine political action (with a small p) with capacity building and service delivery to achieve the needed change. Strategies used should not be confined to the use of legal resources that ignore the political nature of the struggle. (But, at the same time, beware: NGOs cannot risk creating expectations which, in the end, they may not be able to fulfill). Governments have simply to be pushed (using a combination of means) to redefine their responsibilities towards health.

42. In short, NGOs need to shift from working from a welfare perspective to an economic justice perspective. The E/Human Rights-based approach is rather a matter of commitment than of just another way of approaching the problems of ill-health and poverty. (SIM 2000) To undergo the shift, NGOs have to take stock of their social investments so far in social development, as well as in health and nutrition so as to create themselves a new niche in Human Rights work and lobby governments and multilateral agencies alike.

43. To sum up, adopting the Equity/Human Rights-based approach to health is not a matter of choice anymore; NGOs have to decide what?, how? and when? This, since the E/Human Rights-based approach will become the overall ‘best practice’ of the decade...and this is irreversible.

Note of interest:

- There are one million NGOs in India; 210,000 in Brasil; 35,000NGOs are operating internationally. All NGOs put together dispense an estimated 12-15 billion USD per year.

Acknowledgements:

The preparation of this paper was financially supported by NOVIB (Oxfam Netherlands).

39. Social Exclusion and Human Rights

Who’s In and Who’s Out

1. The process of social exclusion is closely linked to/with many current day economic and Human Rights (Human Right) problems.

Social groups are excluded, because they have no access to the opportunities afforded to others in society, including public health care services, adequate nutrition, public education, public housing and employment. The many barriers to access prevent people from reaching their full productive potential --in turn constraining equitable economic growth, as well as poor people’s revenues and their Human Right. Lack of access makes the poor more likely to incur in health and social services expenditures they can ill afford. The exclusion process is exacerbated by prices of basic services out of reach for most of the poor.

The Faces of Social Exclusion

2. Social exclusion has many faces; among other, it includes residential segregation, exclusion from health care, barriers in access to legal services, inequalities in education, language barriers and schooling inequities for ethnic minorities...

The Word ‘Excluded’ has a Double Meaning

3. More often, exclusion refers to the social classes and social groups (indigenous people, black people, women, etc) that are excluded

-from receiving social services,
-from the products and the income they generate, and
-from the political institutions that govern the country.

Who are the Excluded?

4. Many of the excluded play an important or even essential role in the production and distribution processes of the prevailing system: they are unemployed or they work as domestic workers, as agricultural wage laborers, as construction workers, as subsistence farmers, as factory workers with shoddy contracts, or they are the youth that never had a stable job, or the army of the underemployed vendors in the gray market... In a word, overwhelmingly, the excluded are the poor majority, or a greater than 50 % of the working-age population.

5. Not paradoxically, they are thus already integrated in the system of production, but do not receive any of its benefits --mainly because they are excluded from the structures of power.

6. The main battle is, therefore, not for the poor to be ‘incorporated’ into the system --since they already are a part of it (but are basically subordinated, powerless, landless, ‘rightsless’, excluded from owning property, from receiving services...).

7. The real problem of the excluded is more the ‘transformation’ of the system of property, of power and of violation of Human Right so that they can get greater access to and control over the resources and services they need.

8. Today, the poor are not only excluded from employment; they do dirty work, hold unstable jobs; they are poorly paid; they resort to the informal (gray) sector of the economy to eke out a living; they receive no fringe benefits (retirement, paid vacations, health benefits).

Who Excludes?

9. States, corporations, banks, the globalization process, unfair trade, cheap/ subsidized imports destroying local industries and causing further unemployment, the WB, the IMF (as instruments of, for example, forced privatization that further pauperizes the poor) are all part of the culprits of exclusion.

10. The excluded and the excluders are essentially in dialectical conflict: the condition for domination of some is the exclusion and the violation of the Human Right of the many.

11. The first cry of the excluded erupts when they refuse to suffer in silence--when their poverty becomes intolerable. This then leads to organized social movements that demand justice, land, jobs, food, decent housing, schools....rights. Then, the cry of the latter is not a cry of desperation anymore, but a struggle cry; it is a cry that now goes beyond immediate concessions; it demands the socialization of the means of production and of state power; it demands the reversal of Human Right violations. In short, these movements demand a new society --one that no longer has excluded.

12. The cry of the excluded reflects a world:

of exploitation, of urban and rural hunger, of social decadence, of school desertion, of economic pilfering, of concentration of wealth in the hands of a few, of un-enforced labor legislation, of an agro-industry oriented towards export markets, of forced displacements, of a fall in real wages, of the progressive pauperization of retirees, of an end of staple food subsidies, of a relentless loss in purchasing power (the cost of living has outstripped minimum wages often severalfold), of a massification of poverty.

In short, most of these are violations of Human Right.

13. All this has also led to a popular rejection of electoral processes that are considered viciated, rigged and controlled by the media at the service of (or for sale to) the powerful.

14. Only identifying and acting upon the causes of exclusion will enable more people to lead productive lives, have their rights respected and enjoy access to all the benefits of society.

15. To eliminate exclusion, then, the struggle for rights has to go hand in hand with a struggle for power.

Note:

- Mostly taken from J.R.Behrman et al, Social Exclusion in Latin america, IADB, 2003, www.iadb.org/exr/pub/ pages/book.asp?id+141 and J.Petras, Grito de los Excluidos, 2003, http://attac.org/attacinfoes/attacinfo175.pdf

40. Beyond Capacity Analysis: Additional Elements of a Human Rights-Based Development Strategy - I

In this Human Rights Reader series, we have focused on quite a few elements called for in the implementation of the emerging Human Rights-based approach to development --mostly in health and nutrition. Additional conceptual and operational elements for its implementation are added at this time. As said once earlier, the repetition of some Human Rights concepts is both inevitable and also part of this Reader’s intention to have them ‘sink-in’ into the readers’ alter-ego by looking at these concepts from different angles.

1. The ‘chronic emergency’ situation in the health, nutrition, education and other service sectors in an important number of the developing countries only sporadically becomes a ‘loud emergency’. However, if things stay their present course or worsen, such loud emergencies will increasingly become inevitable.

2. At the base of this is the fact that we are witnessing a failure of governments to sustain the provision of basic services, to pay the full cost of such public services and to respect, protect and fulfill people’s Human Rights. Moreover, traditional sectoral approaches to development --aid-backed or not-- are not delivering expected results (or are not delivering them fast enough to reach the Millennium Goals).

The Need and the Challenges

3. There is thus an urgent need to accelerate the implementation of a Human Rights-based development strategy centered around this emerging development paradigm that incorporates the poor beneficiaries as protagonist actors. This paradigm also merges ethics and science, ideology and politics and theory and practice (i.e., what ought to be done and what can be done) into one consolidated development compact --one that effectively responds to the dire necessity here briefly sketched and one that is taken up as an active engagement or covenant with the people whose rights are being violated day-in, day-out.

4. A much wider participative and empowering Assessment-Analysis and Action (AAA) process (2) --as an operational framework for the Human Rights-based approach-- has to be set in motion (or strengthened if elements of it are already in place). To bring about change, people have to come from their very own experience (getting at their own realities). AAA processes are thus tools of social mobilization and of mobilization and progressive control of the resources needed. Such proactive AAA processes should be ultimately pursued in all areas and sectors of development. Social mobilization only succeeds if the repetitive/iterative character of the AAA operational framework begins to work. Positive AAA processes will then lead to the needed social mobilization at the community level. This mobilization envisions a key role for mobilizers/animators with three types of skills, namely:

· Moral Advocacy skills,
· Social Activism skills, and
· Political Advocacy skills.

All active concomitant development AAA processes have to be identified and assessed at national and sub-national level so as to select our strategic allies and mark and neutralize our strategic opponents in implementing this new Human Rights-based approach.

5. This rights-based approach will give equal importance to process and outcome achievements, carefully targeting the most vulnerable in society --those whose rights are most flagrantly being violated-- so as to make the endeavor truly equitable.

6. Quite a bit can be learned from successful coping mechanisms already used by households. Poor people are already doing; we need to asses what they are doing and build from there. [Note that reinforcing coping mechanisms risks locking the poor into a ‘low level of changes’ trap; it may keep them away from pursuing a more radical reappraisal of their needs, one more related to the structural determinants of their present condition]. Be it as it may, these spontaneous (or project-related) success factors need to be documented and better understood to consider them for eventual replication. (Keep in mind that going for small gains first is OK provided the ultimate vision remains to fully reverse gross violations of Human Rights).

The Strategy

7. The new Human Rights-based strategy will focus-on/center-around the household and its members, i.e. around legitimate household members’ rights and their respective entitlements/claims. This means first providing for the household members’ basic entitlements, i.e., reaching a minimum level of family security. It is at the household level that we ultimately need to achieve significant changes, especially in health, nutrition and sanitation behaviors and status.

8. The needed community support mechanisms and structures to help identify and assist vulnerable households will have to be developed and/or strengthened. It is here where mobilizers (activists/ advocates) become essential. We will not achieve our Human Rights goals unless we put in place a veritable “army” of such animators. (3)

9. The household entitlements/rights we are talking about here are in the realm of:

· food and nutrition (macro and micronutrients)
· cooking fuel
· health (curative and preventive)
· the care of children an the support of women to do so
· clean water supply and sanitation facilities and services
· education (pre-primary and primary with a focus on girls and female literacy/numeracy)
· shelter and clothing
· income (in kind and in cash including employment opportunities)
· women’s own gender-related needs and entitlements
· access to credit (especially by women) and to selected agricultural inputs subsidies
· legal protection (especially of women’s and children’s rights)
· physical environmental safety
· physical personal safety during armed conflicts, and
· women’s personal safety from domestic violence.

11. To make sense of these indicators, the Human Rights-based strategy will have to have its own Conceptual Framework (2) that will allow us to move up and down the causality chain to inquire about/find out what determines the findings represented by those indicators. Such a conceptual framework is crucial to help us create a consensus on the causes of family insecurity and the violation of its members’ rights. When using the conceptual framework, interpretation of the analyses is inevitably value laden; therefore, the values have to be shared. (It is good to be reminded that, as social actors, we inescapably become technicians with an identifiable --even if hidden-- political agenda).

(My own preference is for this conceptual framework to be “upside-down” in relationship with the 1990 UNICEF conceptual framework of the causes of preventable ill-health, malnutrition and early deaths: i.e., the basic causes should be on top. If interested in one such tentative conceptual framework being prepared for wider discussion, you can request a copy from aviva@netnam.vn).

12. The role of an indispensable (and specially designed) Information/ Education /Communication (IEC) component in the Human Rights-based strategy needs to be emphasized here.

References:

(1) Capacity Analysis takes what is being proposed to be done for each determinant of a Human Rights violation at each causal level and looks at what is already being done or not being done (and why) for that problem. It then looks at who should be doing something about it [individual(s) and/or institution(s) who is (are) the corresponding duty bearer(s)] and attaches the name of that (those) person(s) or institution(s) to each proposed solution. This results in a list of the most crucial persons/institutions that have to be approached to push them to get the major proposed solution(s) for each main problem implemented.

(2) Situation analyses have to be based on an Assessment and an Analysis of the existing situation that will then lead to decisions being made for Action; this has been called a triple A (AAA) process. But the assessment and the analysis cannot be done in a vacuum --without previously having worked on a Conceptual Framework of the causes of the problems that are to be solved. This means that one has to have an in depth understanding of how those problems come about --what their determinants are before one can, in a participatory way, decide what the best options are to do something about them, i.e., "one finds what one looks for". The essence of a good situation analysis, then, is to carry out a Causal Analysis based on a pre-existing Conceptual Framework and to base all decisions for action to be taken on this analysis. Therefore, appropriate interventions for the main causes at each causal level have to be found. Addressing each cause is necessary, but not sufficient to change the outcome (i.e. preventable ill-health, malnutrition and excess deaths). That is why communities need to act at all levels of determinants at the same time (and this is also why so many selective PHC interventions have failed in the past). AAA processes are happening all te time already (consciously or not) in all decision-making. From the perspective of the outcomes we want to achieve, we can identify positive, negative and neutral AAA processes: it behooves us to start and strengthen positive and neutralize the negative AAA processes in the realm of Human Rights.

(3) A mobilizer has a complex set of roles. Among them, some of the following can apply:

she listens, observes and consults, she validates scientific information, she validates what is permissible/fair/possible/ doable/right for the local context, she shares knowledge, she influences perceptions, she puts things/concepts in a local context, she fosters evidence-based decision-making, she catalyzes/facilitates, she mobilizes/inspires people in the community, she advocates/convinces/persuades, she influences actions, she builds people s capacities, she empowers them, she lobbies, she networks/liaises, she negotiates and goes into strategic and tactical partnerships, she carries out social and political mapping of resources, she mobilizes local and outside resources, she educates, she organizes, leads, manages, she sets an example, acts as a role model and is trustworthy, she assesses/re, analyzes/re, she coordinates/starts new actions, she creates space for such actions, she supervises, monitors and evaluates, she fosters and instills a vision and a hope, she raises political consciousness, she delegates, she makes decisions and solves problems, she is interested in learning from outside.