Promoting the Right to Health: Increasing Community Awareness of the Right to Health

1. Promoting the Right to Health: Increasing Community Awareness of the Right to Health By E. Miano Munene Health Rights Advocacy Forum (HERAF)

2. The Right to Health • Awareness of the right to health is low among health professionals and other CSOs • There is a need to continually raise awareness, provide information and educate all key stakeholders on the right to health • Unfortunately, the right to health is not recognized under the Kenyan constitution, making it difficult to hold the government accountable • On this realization that HERAF was established to provide forums to monitor, promote and advocate for protection of the right to health in Kenya

3. The Health Rights Advocacy Forum • HERAF is an advocacy initiative that brings together CSOs to campaign for recognition of health as a fundamental human right in Kenya • HERAF was established in April 2006 with support from Physicians for Human Rights (PHR), USA • HERAF is engaged in increasing its members’ understanding of the rights-based approach to health

4. HERAF’s Vision, Mission and Goal HERAF Vision: • A Kenya where health is recognised as a fundamental human right, with access to equitable, affordable health services for all HERAF Mission Statement: • To monitor and advocate for the provision of equitable health services through community and health provider partnerships through a rights-based approach HERAF Goal: • To advocate for recognition of health as a fundamental right in Kenya

5. How is HERAF Increasing Community Awareness?

6. Key strategies • Advocate • Educate • Monitor • Hold policy-makers accountable • Participate in policy development and implementation • Participate in planning and resource allocation deliberation forums • Provide services to the vulnerable

7. Advocate for right to health • Unlike civil and political rights, ESCR are not that known to the citizens. • Civil and political organisations are more prominent when it comes to human rights. • Ensuring right to health is recognized is core mandate. • Show relationship of; • Health and human rights • HIV/AIDS and human rights

8. Example of advocacy in action: the First Annual Right to Health Conference in Kenya

9. How did it work? • Brought together over 80 health workers, CSO representatives, PLWHA organizations, NGOs and FBOs to discuss and create awareness on how to: “Bridge emerging issues in health and human rights”

10. Example of advocacy activity by CSOs • Rejection of proposed amendments to sections of the Industrial Property Act of 2001 by Parliament in July 2006

11. Educate stakeholders • The right to health is a relatively new concept in many countries! • What are the links between human rights and health? • What does it mean that everyone “has a right to the highest attainable standard of physical and mental health”? • What policies in Kenya affect the right to health? • To what extent has Kenya realized its commitments to the right to health? • How are other countries addressing the right to health? • What opportunities are there to become engaged? • HERAF provides information, education and communication in order to answer these questions

12. IEC materials • Identifies documents and files information on health, HIV&AIDS and health • Maintains a resource for books, CD ROMS and other materials on health and HIV&AIDS • Conducts exhibitions during local and international forums to provide information, distribute materials, share and discuss with other stakeholders about health, HIV&AIDS and human rights • Produce HERAF’s newsletter “Health Rights Today” • Maintains website www.heraf.or.ke

13. Monitoring • Finding out if the government fulfilling its obligations? • Monitoring enabled CSOs to learn of govt intention to amend the IP Act, 2001 • Fulfillments of agreed commitment • 3by5 principle – was it achieved why not? • Following of the 3 Ones principle – who is not respecting this agreement? Why? • Is there commitment to KEPH strategy?

14. Post-election violence and HIV • Monitoring enabled CSOs • Discover ART patients had been displaced and were not accessing their drugs • No proper coordination of HIV prevention, treatment, care and support among the displaced • NACC had absconded it responsibilities and assumed MOH should handle the situation alone • This was brought to attention of ICC where NACC was compelled to take up its coordination role • Hence fourth NACC began giving updates of HIV and AIDS due to post election violence. • CSOS should therefore be able to monitor whether government institutions are executing their mandate and put them into task.

15. Holding policy-makers accountable • Policy makers make pronouncements that they rarely fulfill • During 2007 electioneering period, World AIDS Day cerebrations and international human rights day • CSOs demanded for accountability from politicians through – petitions, demonstrations, face to face meetings – demanding they fulfill certain demands in health, education etc ‘Bunge la Mwananchi’ ‘Peoples Manifestos’

16. For example: Sign-on letters and petitions • Students at the University of Nairobi affiliated with HERAF signed a petition on World AIDS Day, demanding the that United States government fulfill its promise of promoting universal access by 2015. • HERAF has signed onto numerous letters and petitions demanding action on the part of policy-makers in Kenya, Africa and around the world. • Promoting access to treatment • Demanding improved participation in the Global Fund • Demanding for increased and improved financing • Demanding an end to foreign recruitment of Kenyan health workers

17. Participation in policy development and implementation • CSOs must be pro-active in development of policies & advocating for implementation

18. How have CSOs participated in this? • There are critical health policies that CSOs have participated in: • Legislations • HIV/AIDS Prevention and Control Act, 2006 • Sex Offences Act, 2006 • Policies • National Health Strategic Plan I & II (AOPs) • National AIDS Strategic Plan 2000 – 2005 & 2005/06 – 2009/10

19. For example: HIV Act, 2006 • Sessional paper of 1997 AIDS in Kenya • CSOs advocated for its implementation • Created awareness and educated policy makers (MPs) on content of the paper • HIV declared national disaster in 1999 • NACC established to coordinate to HIV &AIDS activities • Sessional paper identified legal and human rights as an obstacle in fight against pandemic • AG in implementing that recommendation 2001 established Task Force to look into legal and human rights issues and report back • On reporting back the Task Force was mandated to develop a draft Bill on HIV and AIDS

20. For example: HIV Act, 2006 Cont… • After a lot of deliberations, consultations and advocacy by CSOs • The Bill was passed by Parliament in December, 2006 • In December 2006 it received the Presidential assent • Demonstrates Kenya’s positive stand in domesticating international frameworks in the context of HIV and AIDS into its national laws • Unfortunately, the Act has not been turned into action • It is lacking a commencement date hence the advocacy has to continue

21. Participation in planning and resource allocation forums • There are many links between health rights and finance: • Achievement of the right to health depends directly on budget decisions • A country’s budget is an indicator of the priority accorded to addressing health issues such as the HIV/AIDS pandemic • Informed budgets and funding mechanisms enhances ability to plan and implement interventions effectively

22. Planning Forums • HERAF has sought to find out the involvement of CSOs in District Health Stakeholders Forums • DHSF are supposed to provide a platform for discussion and dialogue on health related issues • However, district health forums are marred by inadequate involvement and participation of the local community groups and other stakeholders • This is attributed to: • weak and insufficient mobilization, partnership, collaboration and coordination among the stakeholders • HERAF is facilitating to establish a better mechanism for coordinating community participation in health sector decisions

23. Resource allocation campaign • Government purports to involve CSOs in the MTEF budget making process; • Unfortunately, the MTEF process is un understood • Characterized by lack of information, capacity and coordination • Provides information and builds capacity of CSOs to adequately engage and participate in MTEF • Make budget proposal on health sector to Treasury for considerations in the National Budget • Participating in public sector hearing forums to provide input into the budget and advocate to have sufficient resources allocated to the sector

24. NHIF • Most Kenyans cannot afford to pay for their health care needs, • NSHIF was conceptualised for implementation with a view to enabling more effective provision of health cover to all Kenyans, at both in - and out-patient service levels. • Dialogues on how best to improve this policy in order to finance health care including the poor are on going.

25. Provision of legal services to the most vulnerable • HERAF is housed at the Kenya Human Rights Commission, where many people come to report abuse and violations of their civil, political, economic, social and cultural rights. • Provides psychosocial counseling services • Free legal services to most needy • Refers some needy cases to law firms and other organizations for re-address • This is a critical part of addressing health rights: do the most vulnerable have access to redress to human right violations?

26. What is the link between key strategies? • Partnership, Networking, Collaboration and Coordination! • One organization cannot advocate for the right to health on its own— Partnership, collaboration, … are key! • HERAF works with health professional associations, CSOs, NGOs, human rights networks, PLWHA organizations, FBOs and CBOs • Builds a constituency of allies • Participates in forums organized by networking and collaborating partners. • Bring together different expertise, different experience, different viewpoints. • The more voices you have, the harder it is to ignore!

27. Remember: the 7 key strategies • Advocate • Educate • Monitor • Hold policy-makers accountable • Participate in policy development and implementation • Participate in planning and resource allocation forums • Provide services to the vulnerable

28. Lessons learnt • Lack of consciousness of health as a right remains a fundamental challenge • In order for the right to health to be meaningful, it must be fully understood by the citizens • CSOs should establish constructive partnerships and collaboration and networks amongst all the stakeholders • In order to succeed, CSOs should maintain their independence from the government in order to be neutral and hold the government accountable

29. Thank you! Students at the University of Nairobi during the 2007 AIDS Week of Action