Health & Human Rights Programs:  Practical Linkages September 30, 2008
S eminar Outline <ul><li>Overv iew of DOW mission, operations, and guiding principles </li></ul><ul><li>Two case studies i...
Doctors of the World-USA (DOW) - Mission <ul><li>DOW works with local partners to build sustainable access to health care ...
DOW - Operations <ul><li>DOW is active in  11  countries in 2008 </li></ul><ul><ul><li>India, Kenya, Kosovo, Mexico, Nepal...
DOW –  Project Methods <ul><li>D esigned and implemented with  local partners </li></ul><ul><li>Build  capacity  of local ...
DOW – Focus Areas   <ul><li>TB and AIDS epidemics </li></ul><ul><li>prevention,  treatment , support, stigma reduction </l...
International Human Rights Framework (1) <ul><li>Rooted in 1948 Universal Declaration of Human Rights </li></ul><ul><li>Ad...
International Human Rights Framework (2) <ul><li>Key Documents include:  </li></ul><ul><li>Universal Declaration of Human ...
International Human Rights Framework (3) <ul><li>KEY PRINCIPLE:   </li></ul><ul><li>Everyone has the right to the enjoymen...
DOW - Guiding Principles <ul><li>Health and human rights are inextricably linked </li></ul><ul><ul><li>Dr. Jonathan Mann <...
Case Study from Human Rights Evaluation: Kosovo De-Institutionalization Project <ul><li>In Eastern Europe, people with dis...
Case Study:  Kosovo De-Institutionalization Project (2) <ul><li>In Kosovo, DOW worked with UNICEF and other partners to re...
 
Case Study:  Kosovo De-Institutionalization Project (3) <ul><li>Additional DOW Activities:  </li></ul><ul><li>Surveyed nei...
 
Framing Project Activities in Human Rights Terms <ul><li>The Rights of Children with Disabilities </li></ul><ul><ul><li>In...
Kosovo-Key Findings (1) <ul><li>Project beneficiaries had faced multiple rights violations, not just of the right to healt...
Kosovo-Key Findings (2) <ul><li>The project enabled progressive realization of rights at the individual level, where the s...
Kosovo-Key Findings (3) <ul><li>DOW also created community-level impacts on human rights, by building an enabling environm...
Kosovo - Key Messages <ul><li>Public sector partners’ capacity needs to be built from Day One. </li></ul><ul><li>To plan f...
Case Study: Russia – At-Risk Children and Youth <ul><li>A child deprived of his or her family environment is entitled to s...
Case Study: Russia – At-Risk Children and Youth <ul><li>Reflecting human rights evaluation findings, DOW shifted program e...
Case Study: Russia – Street Children <ul><li>A child deprived of his or her family environment is entitled to special prot...
Case Study: Russia  Impacts of Rights-based work  <ul><li>At the INDIVIDUAL level </li></ul><ul><li>Child and his/her care...
Key Messages/Lessons (1) <ul><li>Indicators of rights impact can be as precise as indicators of health impact,  for ex.: <...
Key Messages/Lessons (2) <ul><li>Challenges for public health NGOs in doing human rights work </li></ul><ul><ul><li>Rhetor...
How can NGOs Conduct Rights-Based Programs?  <ul><li>At the level of goal statements:  </li></ul><ul><ul><li>“ Increase co...
How can NGOs Conduct Rights-Based Programs? (2)  <ul><li>A pply key principles and tools from the human rights framework: ...
DOW Ways of Working  –   Build  local   h uman resources for maximum impact                 4 staff 25   peer educators 13...
DOW Ways of Working  <ul><li>Creat e  new public health and social services facilities for excluded populations </li></ul>
DOW Ways of Working <ul><li>Expand the catchment area of existing p ublic  services to hard-to-reach communities </li></ul>
DOW Ways of Working <ul><li>Train health providers to respond to neglected health issues and populations  </li></ul>
DOW Ways of Working <ul><li>Conduct action-oriented research targeting neglected issues or populations </li></ul>
DOW Ways of Working  <ul><li>INSERT PIC (Mexico, Russia-AIHA) </li></ul><ul><li>Rais e  awareness of health and human righ...
DOW Ways of Working  <ul><li>Build local capacity for advocacy to sustain health and human rights impacts </li></ul>
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Tripathi (DOW-USA) on Practical Approaches to Health and Human Rights

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  • Tripathi (DOW-USA) on Practical Approaches to Health and Human Rights

    1. 1. Health & Human Rights Programs: Practical Linkages September 30, 2008
    2. 2. S eminar Outline <ul><li>Overv iew of DOW mission, operations, and guiding principles </li></ul><ul><li>Two case studies in human rights impacts of child health programs </li></ul><ul><li>Key messages/lessons learned in implementing rights-based approaches </li></ul><ul><li>DOW ways of working that promote human rights impacts </li></ul>
    3. 3. Doctors of the World-USA (DOW) - Mission <ul><li>DOW works with local partners to build sustainable access to health care for excluded populations. </li></ul>
    4. 4. DOW - Operations <ul><li>DOW is active in 11 countries in 2008 </li></ul><ul><ul><li>India, Kenya, Kosovo, Mexico, Nepal, Romania, Russia, Vietnam, Ukraine, United States </li></ul></ul><ul><li>In 2007, DOW: </li></ul><ul><ul><li>Trained over 2,700 providers and educators. </li></ul></ul><ul><ul><li>Directly assisted over 40,000 community members. </li></ul></ul><ul><li>Trained providers go on to serve tens of thousands more community members. </li></ul><ul><li>Services are delivered through projects establishing or scaling up models of care for vulnerable or marginalized groups. </li></ul>
    5. 5. DOW – Project Methods <ul><li>D esigned and implemented with local partners </li></ul><ul><li>Build capacity of local providers and communities </li></ul><ul><li>Seek long-term outcomes (vs. emergency assistance) </li></ul><ul><li>Involve volunteers when possible </li></ul><ul><li>Work in the U.S. and around the world </li></ul><ul><li>Are rights–based , meaning they </li></ul><ul><ul><li>Involve communities in design </li></ul></ul><ul><ul><li>Seek progress in human rights as well as health indicators </li></ul></ul><ul><ul><li>Focus on disparities in access to health services </li></ul></ul><ul><ul><li>Support civil society and local advocacy </li></ul></ul>
    6. 6. DOW – Focus Areas <ul><li>TB and AIDS epidemics </li></ul><ul><li>prevention, treatment , support, stigma reduction </li></ul><ul><li>Orphans and vulnerable children </li></ul><ul><li>foster care, community-based services </li></ul><ul><li>de-institutionalization, family preservation </li></ul><ul><li>Women’s health </li></ul><ul><li>safe motherhood , equal access to information, education and service </li></ul><ul><li>Survivors of gross human rights abuses </li></ul><ul><li>services for those who have been tortured, trafficked , seek asylum </li></ul>
    7. 7. International Human Rights Framework (1) <ul><li>Rooted in 1948 Universal Declaration of Human Rights </li></ul><ul><li>Addresses: </li></ul><ul><ul><li>Civil and political rights, e.g., right to freedom from torture and slavery, freedom from arbitrary arrest/detention </li></ul></ul><ul><ul><li>Economic and social rights, e.g., right to adequate standard of living, to free primary education </li></ul></ul><ul><li>Defined by treaties, conventions, and other agreements among UN member states, both legally binding (e.g., ratified Convention) and non-binding (e.g., Declarations) </li></ul>
    8. 8. International Human Rights Framework (2) <ul><li>Key Documents include: </li></ul><ul><li>Universal Declaration of Human Rights </li></ul><ul><li>International Convention on the Elimination of All Forms of Racial Discrimination </li></ul><ul><li>International Covenant on Civil and Political Rights </li></ul><ul><li>International Covenant on Economic, Social and Cultural Rights </li></ul><ul><li>Convention on the Elimination of All Forms of Discrimination against Women </li></ul><ul><li>Convention on the Rights of the Child </li></ul>
    9. 9. International Human Rights Framework (3) <ul><li>KEY PRINCIPLE: </li></ul><ul><li>Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health - Article 12, International Covenant on Economic, Social and Cultural Rights (entered into force, 1976) </li></ul><ul><li>Key concepts in rights-based approaches t o health *: </li></ul><ul><ul><li>Hold duty-bear ers accountable - r espect, protect, and fulfill rights (¶ 33-37) </li></ul></ul><ul><ul><li>Progressive realization ( ¶ 30,31) </li></ul></ul><ul><ul><li>Non-retrogression ( ¶ 32) </li></ul></ul><ul><ul><li>Non-discrimination ( ¶ 18-19) </li></ul></ul><ul><ul><li>Available, accessible, acceptable, quality services </li></ul></ul><ul><ul><li>( ¶ 12 a-d) </li></ul></ul><ul><ul><li>*from the General Comment on the Right to Health </li></ul></ul>
    10. 10. DOW - Guiding Principles <ul><li>Health and human rights are inextricably linked </li></ul><ul><ul><li>Dr. Jonathan Mann </li></ul></ul><ul><li>Human rights abuses (e.g., discrimination, torture, deprivation of liberty or of information ) diminish and endanger health (e.g., by fueling epidemics, damaging health) and promote health dispari ties (e.g., by maintaining lower status of subgroups) </li></ul>
    11. 11. Case Study from Human Rights Evaluation: Kosovo De-Institutionalization Project <ul><li>In Eastern Europe, people with disabilities are often segregated in institutions </li></ul><ul><li>> 800,000 children ‘warehoused’ in region.* </li></ul><ul><li>*UNICEF, MDRI </li></ul>Abandoned To the State , Human Rights Watch. 1998
    12. 12. Case Study: Kosovo De-Institutionalization Project (2) <ul><li>In Kosovo, DOW worked with UNICEF and other partners to remove children from an adult institution where they had been held without services, neglected, and abused. </li></ul><ul><li>Children were transferred to DOW-created community-based homes staffed by nurses and caretakers trained in rehabilitative care. </li></ul><ul><ul><li>One home in ethnic majority area (Shtimje), one in ethnic minority area (Gračanica) </li></ul></ul>
    13. 14. Case Study: Kosovo De-Institutionalization Project (3) <ul><li>Additional DOW Activities: </li></ul><ul><li>Surveyed neighboring communities to understand needs of disabled children, including those ‘hidden’ in their homes. </li></ul><ul><li>Developed Community Advisory Boards and Parents’ Support Groups </li></ul><ul><li>Transferred responsibility for homes to Ministry of Labor and Social Welfare </li></ul>
    14. 16. Framing Project Activities in Human Rights Terms <ul><li>The Rights of Children with Disabilities </li></ul><ul><ul><li>Individual (CRC Article 23.1-2) </li></ul></ul><ul><ul><ul><li>Creation of the Children’s Homes </li></ul></ul></ul><ul><ul><li>Community (CRC Article 23.3) </li></ul></ul><ul><ul><ul><li>Parent and Community Groups </li></ul></ul></ul><ul><ul><li>Systemic (CRC Article 23.4) </li></ul></ul><ul><ul><ul><li>Ministry of Labor and Social Welfare </li></ul></ul></ul>
    15. 17. Kosovo-Key Findings (1) <ul><li>Project beneficiaries had faced multiple rights violations, not just of the right to health, e.g.: </li></ul><ul><ul><li>Right to education, non-discrimination, social assistance (ICESCR, CRC) </li></ul></ul><ul><ul><li>Rights of persons with disabilities to independence, social integration and participation in the life of the community (CRC, European Social Charter) </li></ul></ul>
    16. 18. Kosovo-Key Findings (2) <ul><li>The project enabled progressive realization of rights at the individual level, where the state had failed to fulfill rights of disabled children. Specific rights protected and fulfilled include: </li></ul><ul><ul><li>Health information and services ICESCR 12) </li></ul></ul><ul><ul><li>Education (ICESCR 13) </li></ul></ul><ul><ul><li>Freedom from torture (ICCPR 1, CAT 1) </li></ul></ul><ul><ul><li>Freedom from arbitrary detention (ICCPR 23) </li></ul></ul><ul><ul><li>An adequate standard of living (ICESCR 11) </li></ul></ul><ul><ul><li>Freedom from sexual exploitation and abuse (CRC 39) </li></ul></ul><ul><li>This suggests a bi-directional relationship between health and human rights – to promote health, other rights need to be protected. </li></ul>
    17. 19. Kosovo-Key Findings (3) <ul><li>DOW also created community-level impacts on human rights, by building an enabling environment, reducing stigma, and working across ethnic groups </li></ul><ul><ul><ul><li>Non-discrimination (GC RTH ¶ 18-19) </li></ul></ul></ul><ul><ul><ul><li>Social re-integration (CRC, 23) </li></ul></ul></ul><ul><li>However, the rights impacts were fragile and retrogression was a risk because: </li></ul><ul><ul><li>System-level rights impacts were weaker </li></ul></ul><ul><ul><li>Project buil t system- level health infrastructure , but not necessarily human rights capacity – e.g., capacity to monitor quality of services. </li></ul></ul><ul><ul><li>Children's homes could resume character of institutions after handover to Ministry, esp. as community advocacy/monitoring capacity is limited </li></ul></ul>
    18. 20. Kosovo - Key Messages <ul><li>Public sector partners’ capacity needs to be built from Day One. </li></ul><ul><li>To plan for sustainable impact, DOW may need to use ‘rights threshold’ criteria: </li></ul><ul><ul><li>Presence of local civil society </li></ul></ul><ul><ul><li>Local structures for enforcement, advocacy </li></ul></ul><ul><ul><li>Partners to take on follow-up – not just service implementation, but monitoring of quality and non-discrimination </li></ul></ul>
    19. 21. Case Study: Russia – At-Risk Children and Youth <ul><li>A child deprived of his or her family environment is entitled to special protection and assistance by the State Article 20(1) Convention on the Rights of the Child. </li></ul><ul><li>Up to 60,000 children and youth live on the streets of St. Petersburg, Russia. Thousands more live in fragile families unable to care for them. </li></ul><ul><li>Due to government models emphasizing shelters and orphanages, few options exist for these children and youth. </li></ul><ul><li>Due to increasing rates of injecting drug use, 37.5% of street children (15-19) in St. Petersburg are HIV-positive. </li></ul><ul><li>~20% of children born to HIV-positive mothers in St. Petersburg are abandoned. </li></ul>
    20. 22. Case Study: Russia – At-Risk Children and Youth <ul><li>Reflecting human rights evaluation findings, DOW shifted program emphasis, moving from direct service delivery to promoting government ownership of services and building capacity for delivery of services through network of government and local NGO sites. </li></ul><ul><li>Services for At-Risk Children and Youth (local government administrations) </li></ul><ul><ul><li>Drop-In Centers for youth </li></ul></ul><ul><ul><li>Overnight shelters </li></ul></ul><ul><ul><li>Home visits to at-risk families </li></ul></ul><ul><ul><li>Halfway Houses </li></ul></ul><ul><li>Foster Family Placement (NGOs, local government) </li></ul><ul><ul><li>Public awareness campaigns </li></ul></ul><ul><ul><li>Recruitment and training of foster parents </li></ul></ul><ul><ul><li>Foster child placement and follow-up support </li></ul></ul><ul><li>Prevention of child abandonment (NGOs, local government) </li></ul><ul><ul><li>Material assistance, counseling, family support </li></ul></ul>
    21. 23. Case Study: Russia – Street Children <ul><li>A child deprived of his or her family environment is entitled to special protection and assistance by the State Article 20(1) Convention on the Rights of the Child </li></ul><ul><li>Up to 60,000 children live on the streets of St. Petersburg, Russia with thousands more living in shelters and institutions. </li></ul>HIV Model Components
    22. 24. Case Study: Russia Impacts of Rights-based work <ul><li>At the INDIVIDUAL level </li></ul><ul><li>Child and his/her caregiver receives services, support without condition of institutionalization </li></ul><ul><li>At the COMMUNITY level </li></ul><ul><li>Increasing support for foster care and other alternatives to institutionalization </li></ul><ul><li>Decreased opposition to service points for at-risk children and youth </li></ul><ul><li>At the SYSTEM level </li></ul><ul><li>Government allocates resources to alternatives to institutions (e.g., personnel and infrastructure for halfway houses), adopts laws to support services (e.g., foster care) </li></ul>
    23. 25. Key Messages/Lessons (1) <ul><li>Indicators of rights impact can be as precise as indicators of health impact, for ex.: </li></ul><ul><ul><li>Measuring decreases in disparity of care for men vs. women, majority vs. minority, children vs. adults </li></ul></ul><ul><ul><li>Measuring improvements in State capacity to provide services, civil society capacity to monitor State </li></ul></ul><ul><ul><li>Like all M+E work, this begins at the level of goal statements </li></ul></ul><ul><ul><li>Human rights documents go beyond rhetoric to guidance for activities and indicators (e.g., CRC article 23) </li></ul></ul>
    24. 26. Key Messages/Lessons (2) <ul><li>Challenges for public health NGOs in doing human rights work </li></ul><ul><ul><li>Rhetoric: language of rights vs. language of medical ethics, quality of care </li></ul></ul><ul><ul><li>Addressing de jure vs. de facto violations </li></ul></ul><ul><ul><li>Affecting the many vs. the few (disaggregating data) </li></ul></ul><ul><ul><li>Meeting needs directly vs. pushing States to meet needs </li></ul></ul><ul><ul><li>Defining State vs. private in ODA context (e.g., PEPFAR) </li></ul></ul><ul><li>Opportunities for public health NGOs </li></ul><ul><ul><li>Partnering with and building on the reports of human rights watchdogs </li></ul></ul>
    25. 27. How can NGOs Conduct Rights-Based Programs? <ul><li>At the level of goal statements: </li></ul><ul><ul><li>“ Increase community-wide access to affordable TB services” vs. “Reduce TB incidence and increase completion of TB treatment” </li></ul></ul><ul><li>At the level of methodology </li></ul><ul><ul><li>“ Train local providers to deliver services” vs. “Deploy short-term ex-pat physicians to deliver care” </li></ul></ul><ul><ul><li>“ Ensure delivery of services at public/MOH facilities” vs. “Provide health services through stand-alone centers” vs. </li></ul></ul><ul><ul><li>“ Create systems for stateless migrants to become registered” vs. “Provide services to undocumented migrants” </li></ul></ul><ul><li>At the level of impact </li></ul><ul><ul><li>Measure local capacity built and structural changes vs. services directly delivered </li></ul></ul><ul><li>***THESE ARE NOT MUTUALLY EXCLUSIVE! </li></ul>
    26. 28. How can NGOs Conduct Rights-Based Programs? (2) <ul><li>A pply key principles and tools from the human rights framework: </li></ul><ul><li>Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health - Article 12, International Covenant on Economic, Social and Cultural Rights (entered into force, 1976) </li></ul><ul><li>Hold duty-bear ers accountable - r espect, protect, and fulfill rights (¶ 33-37) </li></ul><ul><li>Promote p rogressive realization ( ¶ 30,31) </li></ul><ul><li>Monitor n on-retrogression ( ¶ 32) </li></ul><ul><li>Promote n on-discrimination ( ¶ 18-19) </li></ul><ul><li>Increase and m easure the a vailab ility , accessib ility, acceptab ility , and quality of services </li></ul><ul><ul><li>( ¶ 12 a-d) </li></ul></ul>
    27. 29. DOW Ways of Working – Build local h uman resources for maximum impact               4 staff 25 peer educators 13,000 community members DOW Roma TB Program Local NGO
    28. 30. DOW Ways of Working <ul><li>Creat e new public health and social services facilities for excluded populations </li></ul>
    29. 31. DOW Ways of Working <ul><li>Expand the catchment area of existing p ublic services to hard-to-reach communities </li></ul>
    30. 32. DOW Ways of Working <ul><li>Train health providers to respond to neglected health issues and populations </li></ul>
    31. 33. DOW Ways of Working <ul><li>Conduct action-oriented research targeting neglected issues or populations </li></ul>
    32. 34. DOW Ways of Working <ul><li>INSERT PIC (Mexico, Russia-AIHA) </li></ul><ul><li>Rais e awareness of health and human rights issues among health providers </li></ul>
    33. 35. DOW Ways of Working <ul><li>Build local capacity for advocacy to sustain health and human rights impacts </li></ul>

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