R4D Human Rights

ELLA Policy Brief: Mexico City's Innovation: Budgeting with a Human Rights Approach.

Wed, 16 May 2012 04:25 GMT

Document Type: Briefing
Creator: Oropeza, J.

Production Year: 2011

Citation: Oropeza, J. ELLA Policy Brief: Mexico City's Innovation: Budgeting with a Human Rights Approach. ELLA, Practical Action Consulting, Lima, Peru (2011) 4 pp.

Summary:

Increasingly, the budget is being seen as an effective tool to promote human rights, though most governments around the world still designate their budgets without specifically linking them to human rights improvements. This brief describes how the first budgeting process with a human rights approach was designed and implemented by the Government of Mexico City (GMC) (Gobierno de la Ciudad de México), analysing the process, initial outcomes and lessons learned, to help potentially replicate the initiative in other contexts.

Key Lessons:

Budgeting with a human rights approach can increase the human rights actions undertaken by governments by specifically linking spending allocations with the realisation of human rights.
Incorporating a human rights approach into the budgeting process is feasible, but it requires changes in institutional processes and routines, while also enacting legal reforms to sustain the process over time.
Civil society participation and the multi-stakeholder set up proved crucial to implementing this innovative approach.

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Tue, 15 May 2012 02:08 GMT

Document Type: Journal Article
Creator: Ekirapa-Kiracho, E.; Waiswa, P.; Rahman, M.H.; Makumbi, F.; Kiwanuka, N.; Okui, O.; Rutebemberwa, E.; Bua, J.; Mutebi, A.; Nalwadda, G.; Serwadda, D.; Pariyo, G.W.; Peters, D.H.

Production Year: 2011

Citation: Ekirapa-Kiracho, E.; Waiswa, P.; Rahman, M.H.; Makumbi, F.; Kiwanuka, N.; Okui, O.; Rutebemberwa, E.; Bua, J.; Mutebi, A.; Nalwadda, G.; Serwadda, D.; Pariyo, G.W.; Peters, D.H. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC International Health and Human Rights (2011) 11 (Suppl 1) S11. [DOI: 10.1186/1472-698X-11-S1-S11]

Summary: Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.

Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.

Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.

Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.

Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

Tue, 15 May 2012 01:57 GMT

Document Type: Journal Article
Creator: Pariyo, G.W.; Mayora, C.; Okui, O.; Ssengooba, F.; Peters, D.H.; Serwadda, D.; Lucas, H.; Bloom, G.; Rahman, M.H.; Ekirapa-Kiracho, E.

Production Year: 2011

Citation: Pariyo, G.W.; Mayora, C.; Okui, O.; Ssengooba, F.; Peters, D.H.; Serwadda, D.; Lucas, H.; Bloom, G.; Rahman, M.H.; Ekirapa-Kiracho, E. Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda. BMC International Health and Human Rights (2011) 11 (Suppl 1) S10. [DOI: 10.1186/1472-698X-11-S1-S10]

Summary: Background Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.

Objectives To explore the use of intermediate transport mechanisms to improve access to maternal health services, with emphasis on the benefits and unintended consequences of the transport scheme, as well as challenges in the implementation of the scheme.

Methods This paper is based on the pilot phase to inform a quasi experimental study aimed at increasing access to maternal health services using demand and supply side incentives. The data collection for this paper included qualitative and quantitative methods that included focus group interviews, review of project documents and facility level data.

Results There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilizing mothers to attend services. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations.

Conclusions and implications The findings indicate that locally existing resources such as motorcycle riders, also known as “boda boda” can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilization of maternal health services. However, care must be taken to mobilize the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.

Research translation to inform national health policies: learning from multiple perspectives in Uganda

Tue, 15 May 2012 01:41 GMT

Document Type: Journal Article
Creator: Ssengooba, F.; Atuyambe, L.; Kiwanuka, S.N.; Puvanachandra, P.; Glass, N.; Hyder, A.A.

Production Year: 2011

Citation: Ssengooba, F.; Atuyambe, L.; Kiwanuka, S.N.; Puvanachandra, P.; Glass, N.; Hyder, A.A. Research translation to inform national health policies: learning from multiple perspectives in Uganda. BMC International Health and Human Rights (2011) 11 (Suppl 1) S13. [DOI: 10.1186/1472-698X-11-S1-S13]

Summary: Background Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.

Methods A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12).

Results Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions.

Conclusions This study shows that effective translation of PMTCT and SMC research results demanded a "360 degree" approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.

Working with young people - towards an agenda for sexual health

Wed, 02 May 2012 04:13 GMT

Document Type: Journal Article
Creator: Aggleton, P.; Campbell, C.

Production Year: 2000

Citation: Aggleton, P.; Campbell, C. Working with young people - towards an agenda for sexual health. Sexual and Relationship Therapy (2000) 15 (3) 283-296. [DOI: 10.1080/14681990050109863]

Summary: In this paper the authors outline key elements of a human rights-based framework for sexual health promotion that takes account of young people's needs and interests. This framework is located against the backdrop of a critique of the way in which negative definitions of 'sexual health' and of 'adolescence', as well as restrictions on open and appropriate sex education in schools, undermine the likelihood that young people will achieve optimal benefit from existing services and strategies in countries such as England and Scotland. Central to their analysis is an affirming and positive definition of sexual health-that focuses on the attainment of sexual pleasure and which links sexuality to an expression of individual and collective needs and broader human rights and responsibilities. The authors point to ways in which such a framework might inform the provision of appropriate information about positive sexual health, and of more accessible and integrated sexual health services. They also highlight the need for measures to improve young people's confidence and aspirations, and to increase youth participation in decision making in matters relating not only to their sexual health, but also to the wider social and community environments within which young people's sexuality is negotiated.

insights 82. Innovative approaches to gender and food security.

Wed, 04 Apr 2012 04:54 GMT

Document Type: Briefing
Creator: Susanne Turrall (Editor)

Production Year: 2012

Citation: Susanne Turrall (Editor). insights 82. Innovative approaches to gender and food security. Institute of Development Studies, University of Sussex, Brighton, UK (2012) 8 pp.

Summary:

This issue of insights is the result of a collaborative process involving experts working in policy, research and practice on gender and food security in four global regions. At the centre of the process was a dynamic online discussion, which raised many issues and questions around the gender power dynamics of food production, consumption and governance. Particularly interesting, was the extent to which participants identified transformative development pathways that promote food security and poverty reduction while also enabling shifts in gender power relations. Focusing on six projects in South Asia, Africa, Latin America and the Middle East, the articles in this issue illustrate some of these pathways:

Transforming gender relations in homestead food production in Bangladesh (Emily Hillenbrand)
Challenging cultural values that affect food security in India (Suniti Neogy)
Equal access for women to seeds and food security in Syria (Alessandra Galié)
Engaging the whole family in food security planning in Zambia (Cathy Rozel Farnworth)
Women's groups versus households. Approaches to achieve food security and gender equality (Agnes Quisumbing and Neha Kumar)
Food sovereignty and women’s rights in Latin America (Pamela Caro)

Inclusion of disability within national strategic responses to HIV and AIDS in Eastern and Southern Africa

Mon, 05 Mar 2012 08:19 GMT

Document Type: Journal Article
Creator: Hanass-Hancock, J.; Strode, A.; Grant, C.

Production Year: 2011

Citation: Hanass-Hancock, J.; Strode, A.; Grant, C. Inclusion of disability within national strategic responses to HIV and AIDS in Eastern and Southern Africa. Disability and Rehabilitation (2011) 33 (23-24) 2389-2396. [DOI: 10.3109/09638288.2011.573055]

Summary: PURPOSE: National strategic plans (NSPs) provide a framework for a comprehensive response to human immunodeficiency virus (HIV) including strategies such as prevention, treatment, care and support for all affected. Research indicates limited recognition of the interrelationship between disability and HIV in the Eastern and Southern Africa (ESA). This paper analyses the extent to which NSPs in ESA address disability, and identify good practice.

METHOD: Using a tool based on relevant rights in the UN Convention on the Rights of Persons with Disabilities and the UNAIDS International Guidelines on HIV and Human Rights, a review of 18 NSPs in ESA was conducted to determine the extent to which they included disability.

RESULTS: Although many NSPs fail to integrate disability issues, there are examples of good practice from which much can be learned, particularly with respect to disability and HIV-prevention efforts. There is limited provision for treatment, care and support for disability in the context of HIV and AIDS.

CONCLUSIONS: Many NSPs in ESA are due for review, providing ample opportunities for the development of disability-inclusive responses. Future NSPs need to integrate the needs of people with disabilities within structures, programmes and monitoring and evaluation, and make provision for increased rehabilitation needs caused by HIV. A rights-based approach and specific financial allocation of resources are crucial for this process.

Briefing Note. Indicators and VFM in Governance Programming

Thu, 26 Jan 2012 03:00 GMT

Document Type: Briefing
Creator: DFID

Production Year: 2011

Citation: DFID. Briefing Note. Indicators and VFM in Governance Programming. (2011) 27 pp.

Summary:

This note provides advice to DFID staff on:
i. governance indicator best practice, and
ii. measuring the Value for Money of governance programmes

The annex provides suggested indicators for governance programming within the themes security and justice, civil service reform, elections, parliament support, political party support, tax/revenue, corruption, human rights, media, and empowerment and accountability.

What makes domestic violence legislation more effective?

Fri, 20 Jan 2012 08:00 GMT

Document Type: Research Paper
Creator: Sardenberg, C.

Production Year: 2011

Citation: Sardenberg, C. What makes domestic violence legislation more effective? Pathways Policy Paper, October 2011, 18 pp.

Summary: Domestic violence against women has gained worldwide attention as a form of discrimination as well as a violation of women's human rights. An estimated one in three women in the world is affected, independent of their social standing and cultural background. In many countries around the world, laws are now in place making domestic violence against women a crime. Yet implementation often lags behind legal reforms. Women's organising is vital not only to get laws on the statute books, but can also play an important role in monitoring the implementation of these policies and holding governments to account in making domestic violence legislation more effective. This paper by Cecilia Sardenberg draws primarily on the experiences of the implementation of the Brazilian Maria da Penha Law, a comprehensive legislation package, formulated and monitored with extensive participation from feminist organisations, and passed in 2006. It also draws on examples from Bangladesh and Ghana, where women’s organising has played a fundamental role in the formulation, implementation, and monitoring of policies to confront domestic violence against women.

Rehabilitation: A Crucial Component in the Future of HIV Care and Support

Wed, 18 Jan 2012 08:31 GMT

Document Type: Journal Article
Creator: Nixon, S.; Forman, L.; Hanass-Hancock, J.; Mac-Seing, M.; Munyanukato, N.; Mywzwa, H.; Retis C.

Production Year: 2011

Citation: Nixon, S.; Forman, L.; Hanass-Hancock, J.; Mac-Seing, M.; Munyanukato, N.; Mywzwa, H.; Retis C. . Rehabilitation: A Crucial Component in the Future of HIV Care and Support. Southern African Journal of HIV Medicine (2011) 12 (2) 12-17.

Summary: Provision of antiretroviral therapy (ART) is not an end in itself but a means to achieving improved wellness for people living with HIV. Rehabilitation, broadly defined, is another key contributor to wellness within this context. Understanding the potential for rehabilitation requires that one is able to consider HIV not only within a biomedical model that focuses on body systems, diagnoses and symptoms, but also within a rehabilitation framework that focuses on how these diagnoses and symptoms affect people’s lives more broadly. Furthermore, rehabilitation is a human rights imperative, which deserves the energetic attention enjoyed by other aspects of HIV treatment and care. In particular, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is shining a long-overdue spotlight on the human rights imperatives associated with disability. For South Africa and other countries, proactively and meaningfully engaging rehabilitation in the HIV response will require major shifts on several fronts, including practice, education, policy and research. We argue that in settings where ART delivery is now widespread, HIV should be understood not only as a medical issue, but as a rehabilitation and disability concern. Whereas medicine adds years to life, it is rehabilitation that aims to add life to years.