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Abstract Brazilian policy responses to violence against women: Government strategy

and the help-seeking behaviors of women who experience violence Abstract Filling
the gap: A earning !etwork for "ealth and "#man $ights in the %estern &ape' (o#th
Africa
Filling the gap: A earning !etwork for "ealth and "#man $ights in the %estern &ape'
(o#th Africa
eslie ondon' !icol) Fick' *hai "oan +ram' ,aria (t#ttaford
Abstract
%e draw on the experience of a earning !etwork for "ealth and "#man $ights -!.
involving collaboration between academic instit#tions and civil society organizations in
the %estern &ape' (o#th Africa' aimed at identifying and disseminating best practice
related to the right to health/ +he !0s work in materials development' participatory
research' training and capacity-b#ilding for action' and advocacy for intervention
ill#strates important lessons for h#man rights practice/ +hese incl#de -i. the importance
of active translation of knowledge and awareness into action for rights to be made real1
-ii. the potential tension arising from civil society action' which might relieve the state of
its obligations by delivering services that sho#ld be the state0s responsibility2and hence
the importance of emphasizing civil society0s role in holding services acco#ntable in
terms of the right to health1 -iii. the role of civil society organizations in filling a gap
related to obligations to promote rights1 -iv. the critical importance of networking and
solidarity for b#ilding civil society capacity to act for health rights/ 3vidence from
eval#ation of the ! is presented to s#pport the arg#ment that civil society can play a key
role in bridging a gap between formal state commitment to creating a h#man rights
c#lt#re and realizing services and policies that enable the most v#lnerable members of
society to advance their health/ +hro#gh access to information and the creation of spaces'
both for participation and as a safe environment in which learning can be t#rned into
practice' the agency of those most affected by rights violations can be redressed/ %e
arg#e that civil society agency is critical to s#ch action/

4ntrod#ction
5espite having adopted one of the most progressive h#man rights-oriented constit#tions
in the world and created additional mechanisms to s#pport its implementation' (o#th
Africa has lagged behind in the practical realization of socioeconomic rights for its
people/6 !owhere is this more obvio#s than in relation to health/ ,aternal mortality in
(o#th Africa do#bled between 6778 and 988:' and' as a res#lt' (o#th Africa is #nlikely to
meet all of its ,5G targets and will be hard-pressed to red#ce this #pward trend/9 &hild
mortality' seen as an indicator of health care ;#ality' has also remained high' with levels
in 988: similar to those from 677<1 mortality in #nder-fives' having risen since 677<' is
=#st beginning to tail off/> ,ortality rates vary greatly between provinces' with large
disparities on the order of threefold between provinces with the worst and best rates/<
4n its 988? p#blic hearings on health' the (o#th African "#man $ights &ommission
identified ongoing violations of the right to access health care services/@ "#man $ights
%atch recently reported severe problems with maternity care in the 3astern &ape
province' incl#ding health workers ab#sing maternity patients and other examples of
s#bstandard care that increase the risk of morbidity and mortality amongst women and
their newborns/A 4ndeed' (o#th Africa remains a co#ntry with profo#nd ine;#alities in
health stat#s and in the distrib#tion of reso#rces needed for health/ Bnderlying these
ine;#ities are varying degrees of powerlessness that render comm#nities and individ#als
v#lnerable to factors that lead to ill health/? +his sit#ation reflects' by and large' growing
global ine;#alities in power and reso#rces needed for health' and s#ch disparity is evident
partic#larly in this region/: "#man rights-based approaches are key to addressing health
ine;#alities b#t are dependent on two key factors/7 Firstly' case st#dies from (o#th and
(o#thern Africa ill#strate the importance of comm#nity agency in realizing the right to
health/68 +hey ill#strate that for h#man rights approaches to redress social ine;#alities
effectively' s#ch approaches m#st incorporate the f#ll spectr#m of civil' political' and
socioeconomic h#man rights and empower those v#lnerable to h#man rights violations/ 4t
is both at the individ#al and collective levels that civil society action is able to redress
social ine;#alities/ For example' the social movement behind the +reatment Action
&ampaign changed treatment access and prevention related to "4C in (o#th Africa' and
to a lesser extent' within (o#thern Africa/66 4n contrast' a seminal co#rt victory for
residents of an informal settlement resisting eviction in an area near &ape +own' while
hailed as a precedent for =#sticiability of social and economic rights #nder (o#th Africa0s
constit#tion' was not accompanied by civil society action to press#re the state/69 As a
res#lt' no steps were taken to provide the comm#nity with ho#sing' and the primary
plaintiff in the co#rt case' 4rene Grootboom' died in 988: in the same state of poverty and
homelessness that she was in at the time of her historic co#rt victory eight years prior/6>
(econdly' health workers can facilitate and promote the right to health or act as barriers to
achieving health rights/6< 4ntervening with health professionals to identify and engage
with h#man rights concerns in their practices' whether at the individ#al or pop#lation-
based level' is therefore a critical component of enhanced civil engagement with h#man
rights/ %here a health system protects and promotes h#man rights' health professionals
are often agents of change helping to advance ob=ectives related to social =#stice and
e;#ity in the health sector/ Dn the other hand' where health workers act as gatekeepers
controlling access to reso#rces' as has happened with abortion services in (o#th Africa'
participatory mechanisms may res#lt in conflict that limits the extent to which health
rights can be realized/6@
+hese cases provide lessons as to the importance of strong civil society agency as
essential for realizing the right to health/ +h#s' a h#man rights approach is not only abo#t
state acco#ntability' b#t also abo#t active participation of those most affected by state
policies and gaps in state delivery of services/6A For that reason' the key role of civil
society in realizing health rights is essential to combating poverty/6? F#rther' the right to
information is instr#mental to this capacity to act/ Access to information #nderlies the
acco#ntability and participation components that are essential to a rights-based approach
to health/ For that reason' h#man rights ed#cation can be key to t#rning awareness into
action' b#t has also s#ffered from a lack of eval#ation/6:
A earning !etwork for "ealth and "#man $ights
+his context provides the backgro#nd for the origins of a novel collaboration between
fo#r #niversities and six civil society organizations -&(Ds. in the %estern &ape seeking
to identify better practice for the realization of the right to health/ +he earning !etwork
for "ealth and "#man $ights -!. was established in 988:' emerging from different
pieces of previo#s research that realized the importance of civil society agency in
achieving the right to health/67 Dne of the recommendations emerging from a st#dy with
three civil society organizations of their #nderstanding and #se of h#man rights
approaches was the need to establish a space in which &(Ds co#ld share experiences'
both positive and negative' in order to learn from each other what strategies work best to
realize health rights/98
+he ! was therefore established with an explicit agenda to b#ild member organizations0
capacity to be agents for the realization of comm#nities0 rights to health/ 4t also seeks to
share the lessons generated from this process with organizations beyond the !' and to
strengthen civil society action more broadly for the right to health/ 4t brings together six
comm#nity-based organizations in the %estern &ape that represent a diversity of different
organizational types' approaches' constit#encies' mandates' and geographical locations/
,ost of the beneficiaries of the organizations0 services and advocacy are women1 women
also constit#te the ma=ority of most ! member organizations0 staff/ +he beneficiaries of
! member organizations are also mainly drawn from working class and
socioeconomically depressed comm#nities in both #rban and r#ral settings' and while
many had limited formal ed#cation' were mostly literate in their mother tong#e/ %hile
the ! has operated as a closed network' it has partnered with other &(Ds on similar
campaign and activities' partic#larly in relation to work aro#nd the right to health/
+able 6/ $esearch activities #ndertaken within the ambit of the earning !etwork for
"ealth and "#man $ights -!.' 988:-9866
Eear $esearch Activity 5escription
988: Drganizational profiles
&ollection of basic demographic information
on all the earning !etwork -!. member
organizations
988: and
9868
*nowledge and practices
of participant
organizations
F#estionnaire administered on the
knowledge' attit#des' and practice of h#man
rights among ! member organizations at
baseline and after three years
988: 4n-depth interviews
&(D #nderstanding of health rights and
perceptions of ! activities
9887-9866
Drganization learning for
health and h#man rights
-Gh5 thesis.
,ixed methods research to explore the
impact of ! participation amongst member
organizations1 does the ! generate social
capital in enabling members to integrate
h#man rights into their health programsH
9887 Ghotovoice pro=ect &(D members involved in taking photos
abo#t health and h#man rights' which are
#sed as a basis for reflection thro#gh foc#s
gro#ps and in-depth interviews
9887
&ase st#dies' incl#ding
evidence of coerced "4C
testing
4n-depth interviews regarding health
violations experienced by comm#nity
members1 #se for training and advocacy
9887-9866
+oolkit on the right to
health
5evelopment and piloting of a toolkit on the
right to health as a training and advocacy
tool1 monitoring and eval#ation of roll-o#t1
adapting for #se in (o#thernand 3ast Africa
9887
3val#ation: I&omm#nity
Garticipation +hro#gh
"ealth &ommitteesJ
-,aster0s thesis.
,ixed methods st#dy of comm#nity health
committees as vehicles for comm#nity
participation in advancing the right to health
9887-9866
A#dit of health
committees
(t#dy of the capacity-b#ilding needs of
health committees and barriers to
participation
9887
5oc#menting health team
development
+racking the development of a health team in
a r#ral farming region
9887
ang#age as a component
of the right to health
An exploration of how lang#age acts as a
barrier to realizing the right to health1 based
on data from experiences of deaf persons
#sing (ign ang#age and Khosa-speaking
patients
9868
3val#ation of !
pamphlets
-,aster0s thesis.
F#alitative thesis assessing the coverage and
effectiveness of the ! pamphlets
9868 Golicy st#dy
5oc#mentary review and key informant
interviews analyzing the provincial draft
policy on comm#nity participation and health
committees
9868
5isability and h#man
rights
F#alitative st#dy by ! member
organization of the #nderstanding of h#man
rights among disabled people
9868
&o-learning and
knowledge creation
,onitoring and reflection on the process of
co-prod#ction of knowledge on health rights
by Bniversity-based researchers and &(D
partners within a earning !etwork
9868
3xploring the contrib#tion
of African philosophy to
concept#alizing the right
to health
iterat#re review generated an annotated
bibliography1 theoretical analysis of the
traditional val#e of LBb#nt#0 as being
expressed in the rights concept of dignity1
rights explored as collective entitlements
9866
%omen0s development
within the !
3thnographic st#dy of the experience and
development of women participants in the
!
9866
Gower and tr#st in the
context of Bniversity-
&(D engagement
,ixed methods research to explore the
process of knowledge generation thro#gh
rights-based research processes
9866
"ealth care provider
training
5evelopment and eval#ation of mod#les for
in-service training on the right to health for
health care providers
+he ! has fo#r roles related to linked ob=ectives: 6. An informational role to ens#re
comm#nities are better informed abo#t rights to health1 9. A research role to doc#ment
and analyze best practices in realizing the right to health1 >. A capacity-b#ilding role to
promote access to learning opport#nities for member organizations1 <. An action role to
#se the learning gained by member organizations to s#pport services and advocacy
aro#nd health/ Bnderlying these ob=ectives are three principles that inform the !0s
practice: that empowerment implies knowledge' assertiveness' critical engagement' and
collective action1 that health is a state of wellbeing' determined by access to health care
and healthy social conditions1 and that networking for rights m#st be based on a
partnership of m#t#al respect' benefit' and e;#ality/
+his paper explores the extent to which these ob=ectives and principles have been p#t into
practice and examines the lessons that emerge from the !0s experience for wider
application in health and h#man rights practice/ By bringing together evidence from the
!0s experiences over the past fo#r years' teasing o#t how an action research programme
centered on learning and sharing has changed organizational and individ#als0 views and
practices related to the right to health and its achievement' we hope to identify
opport#nities for increasing #nderstanding in the field' with a view to moving from
research to action/
earning by doing and doing by learning
At its inception' the ! conceived of the process of b#ilding capacity as one in which the
! activities wo#ld be iteratively linked in a contin#o#s process2research cond#cted
with and by &(Ds wo#ld be presented back to organizations to inform &(D action'
training' advocacy and f#rther co-research ;#estions/96 A second constr#ct was that the
strengthening of comm#nity members0 agency wo#ld proceed apart from activities aimed
at health workers' the gatekeepers of health rights/ +he comm#nity members and health
workers activities were to come together at a later stage/ Both these notions' while
attractive in concept' have proven less than rob#st in reality/ %e explore below how the
! has operated' drawing o#t from this analysis some of the key themes we believe
helpf#l for consideration of health and h#man rights in practice/
,aterials development and networking
4nformation is instr#mental in affording the most v#lnerable with opport#nities to change
the conditions of their v#lnerability1 indeed' recognizing the importance of information is
central to the realization of h#man rights/ Both participation and acco#ntability' as key
elements of the right to health are irrevocably dependent on information in order to be
act#alized/99 +he ! therefore foc#sed on developing materials for comm#nity and
organizational #sers intended to enable comm#nity members to realize their rights/ +he
materials consisted of a series of pamphlets and a toolkit on health and h#man rights/9>
%hereas the pamphlets were part of a strategy to ens#re that the information was
#nderstandable' the toolkit was specifically designed to t#rn knowledge into action' and
both relied on easy-to-#nderstand vis#al and written material s#ited for #ser gro#ps with
little formal ed#cation/ For example' in one ! review meeting' a ! member framed the
importance of materials as follows I%e learned that there is a great need for the toolkit'
providing information on how to identify health rights violations and how to respond to
these violations/ / / / 4mportance of #sing the pamphlets in con=#nction with the
workshop1 the pamphlets alone are not eno#gh for people to feel that they know their
rights/J
%hereas typical state obligations of respecting' protecting' and f#lfilling rights do not
necessarily become reality witho#t comm#nity action' meas#res linked to rights
promotion2a specific (o#th African constit#tional provision which obliges the state to
take positive action to promote rights2aims to create an enabling environment for people
to exercise their rights/9< "owever' notwithstanding the presence of a n#mber of
instit#tions intended to promote a h#man rights c#lt#re in (o#th Africa -s#ch as' for
example' the (o#th African "#man $ights &ommission' the G#blic Grotector and the
Gender &ommission' all bodies set #p in terms of &hapter 7 of the (o#th African
&onstit#tion.' the low level of awareness of and engagement with h#man rights identified
in st#dies to date s#ggest a gap in realizing the constit#tional imperative to promote
rights/9@ 4n this sense' the ! materials have filled a gap' aiming to empower comm#nity
members to take action for their rights to be realized/
+he ! also #ses other methods to disseminate knowledge abo#t h#man rights/ Bse of
electronic comm#nication amongst member organizations -email and an internal pro=ect
website. to share information abo#t events' meetings' and new knowledge' along with
periodic presentations of research findings' strengthened both the networking f#nction of
the ! as well as the role of information dissemination/
$esearch
$esearch activities within the ! aimed at identifying best practice were not classically
aligned with the participatory research norm in that &(D members did not participate in
the design of the original research proposals and the initial f#nding application/ "owever'
as the ! has developed' &(D members are increasingly identifying research ;#estions
for which they need answers and which the ! can and has #ndertaken to research/ For
example' faced with ambivalence on the part of health services in recognizing str#ct#res
for comm#nity participation' the ! member with the mandate to coordinate &omm#nity
"ealth &ommittees re;#ested an a#dit of committees in the metropolitan area to identify
areas for capacity-b#ilding and to strengthen its arg#ments for legal recognition of its
mandate for comm#nity participation/9A ,ore importantly' the ! has moved from a
sit#ation where the academic partners were the researchers s#ggesting research to their
&(D IclientsJ to a scenario where organizational meetings have served as spaces in
which all ! members =ointly determine important research needs/9? +he
implementation of the research is also increasingly done =ointly' rather than by academic
instit#tions on behalf of &(D partners1 &(D members act as peer researchers in data
collection' analysis' and dissemination/ For example' social service workers in an !
member organization went from being IparticipantsJ who were asked abo#t their
#nderstanding of rights to being researchers who initiated and cond#cted their own
in;#iry into their client0s knowledge and #nderstanding of disability rights/9:
+able 6 s#mmarizes the research activities #ndertaken thro#gh the !1 these incl#de case
st#dies of &(Ds addressing violations of the right to health -for incl#sion in training
materials.1 examination of lang#age as a component of the right to health1 a#dits of skills
needs of &omm#nity "ealth &ommittees1 research into disability and the right to health1
and examinations of participation and the right to health/ +he collected data foc#sed on
both network research goals as well as the organizational goals of the member &(Ds/
,#ltiple methods were #sed' incl#ding ;#estionnaires' foc#s gro#ps' str#ct#red
interviews' in-depth interviews' photovoice' observation' and doc#ment analysis/ +he
later sections of the paper foc#s on res#lts from three specific st#dies #ndertaken within
the ! to map the impact of the learning process on organizational practice/
+able 9/ (kills training #ndertaken within the earning !etwork for "ealth and "#man
$ights -!.' 988:-9866
+raining Area Foc#s
!#mber
of 3vents +arget A#dience Facilitator
+he right to
health
General information
on what the right to
health means and
how to hold
government
acco#ntable 6<
,ainly ! members
Dne session at p#blic
health s#mmit
+wo sessions
targeting ! member
constit#encies -e/g/
home-based care
workers1 health
committee AG,1
health team on farms1
deaf research
assistants in sign
lang#age.
4nternal to
!
Giloting of toolkit
on the right to
health
: ! member
constit#encies -e/g/
home-based care
workers.1 workshops
for deaf research
assistants in sign
4nternal to
!
lang#age1 participants
in regional meeting1
two train-the-trainer
workshops
+raining of trainers
on the right to
health toolkit 9 ! members
4nternal to
!
5isability and the
right to health > ! members
4nternal to
!
$ights advocacy 6 ! members
4nternal to
!1
external
!GD
&omm#nity
participation as key
to the right to health 9
! members -health
committees1 p#blic
officials1 !GD
sector.
4nternal to
!
3ngaging state
services
Accessing basic
services advocacy
with provincial and
m#nicipal
a#thorities ! members
+wo
external
!GDs
&omm#nity
development
tools
Garticipatory
comm#nity
mapping as an
action research
method 6 ! members
4nternal to
!
Alternative methods
for comm#nity
decision-making in
social str#ct#res 6 ! members
3xternal
visitor
eadership training 6 ! members
4nternal to
!
$e-theorizing
the right to
health based
on o#r
experience
%hat do African
theories and
philosophies say
abo#t h#man rights'
individ#al and
collective rights'
and the right to
healthH 9
Academic seminar
and ! members
4nternal to
! and
Bgandan
collaborator
+raining and capacity b#ilding for action
+hro#gh periodic review d#ring its first three years' the ! identified different areas for
training/ +he areas incl#ded training in the Iright to healthJ concept' and also skills
training in areas organizations identified as important for mobilizing their constit#encies
or for advocacy -+able >./ $ather than a #nidirectional process of academic partners
sharing information with &(D partners' the training incl#ded cross-organizational events
where &(D partners led instr#ction according to their areas of skills and
experience/97For example' the experience of health committees in the metropolitan area
served as a learning opport#nity for a &(D that was organizing r#ral farming
comm#nities to engage with local services to lobby for a health committee to facilitate
comm#nity participation/ As a res#lt' a health agent from the &(D' which is composed of
women workers living on farms' was elected to the newly formed local health committee/
+able >/ *nowledge' attit#des' and practices among earning !etwork participants
5omains
Gercentage
&hange
Baseline Follow-#p
Bnderstanding
-(ix ;#estions. A<M ??M N99M
Agency-(even ;#estions.
@8M A@M N>6M
"&% #nderstanding-+hree ;#estions.
@7M 97M -@8M
&ollectivist #nderstanding of rights-Dne 97M <6M N<8M
;#estion.
(ocial capital-Fo#r ;#estions.
:6M 76M N6>M
General tr#st-+hree ;#estions.
@?M :AM N@9M
+r#st in government-+wo ;#estions.
@>M 96M -A6M
Bonding social capital
-(ixteen ;#estions. A>M ?9M N6<M
4n another example' an ! member organization that #ses the ad#lt ed#cation method
$3F3&+ -$egenerated Freirean iteracy +hro#gh 3mpowering &omm#nity
+echni;#es. trained an ! 3xec#tive &ommittee in the method/>8 +he $3F3&+
methodology is based on empowering gro#ps typically deprived of power to change the
conditions of their disempowerment1 as s#ch' it provided an ideal base on which to see
&(Ds t#rn h#man rights entitlements into active engagement in solving their most
pressing problems/ As previo#sly noted' the ! materials were geared towards
s#pporting members0 action aro#nd health rights/
astly' a key learning element has been the systematizing of opport#nities for !
member organizations to review and reflect on progress and diffic#lties experienced in
realizing the right to health/ +hese times for reflection have taken place approximately
fo#r times a year' and have been s#pplemented by periodic strategic planning processes
and the establishment of an exec#tive committee str#ct#re to take ownership of key
decisions/ All partners give presentations in which they report on activities' identify new
research and advocacy activities -see +ables 9 and > for examples.' and propose lessons
for wider learning/ +hese meetings' which have explicitly recognized power differentials
between ! member organizations-partic#larly between academic and &(D partners-
have come to reflect far greater e;#ality in decision making' with shared agreement on
agendas' rotation of chairing roles' and collective agreement on f#t#re strategic direction/
All partners' both academic and civil society' now participate as e;#als on an exec#tive
committee to set organizational goals thro#gh periodic $eview and $eflection %orkshops
and thro#gh an ann#al strategic planning process/ %hile not negating the existence of
power and power differentials within the !' the explicit recognition of power enabled
the ! to work with power in #nderstanding how to strengthen &(D capacity for action/
4n this respect' the rights framework has proven inval#able in acknowledging the agency
of those most affected as critical to changing the conditions of v#lnerability which
predispose to rights violations/>6
Advocacy and interventions
B#ilding capacity for rights is meaningless #nless it leads to action/ ! members have
#sed knowledge from training and sharing of experiences to advance their advocacy'
strengthen their programs' mobilize comm#nities' and improve services/ For example'
one ! member organization went door to door delivering pamphlets to raise comm#nity
members0 awareness of their rights/ ! programs also led a member &(D to #se
photovoice as a local advocacy tool to prompt comm#nity action on waste d#mping
aro#nd an open pond/>9 +hro#gh taking photos and reflecting on the problem together'
local &(D members identified income-generation opport#nities from waste recycling and
mobilized yo#th in the comm#nities to participate in clean-#p activities/
4n addition to highly local activities' the network also facilitated advocacy at a provincial
level in 9868' hosting a str#ct#red dialog#e with health service managers on the ;#estion
of comm#nity participation/ 4n 9887' the network facilitated action at the national level'
contrib#ting to a shared civil society s#bmission on the right to health' presented at (o#th
African "#man $ights &ommission hearings on progress on realizing socioeconomic
rights/>> 3ngagement in other civil society campaigns' both as the ! and thro#gh
member &(Ds0 individ#al participation' has provided a vehicle for advocacy aro#nd
vario#s health iss#es/ &o-hosting a provincial health s#mmit in 9887' for example'
provided the ! a platform to engage with health policy makers abo#t the right-to-health
challenges facing comm#nities/
+he empirical base: essons for health rights in practice
From a range of research investigations the ! cond#cted -+able 9.' we present findings
from three specific research foci that ill#strate important lessons related to p#tting health
rights into practice/
+he first was a ;#antitative st#dy in which a ;#estionnaire' incl#ding both str#ct#red
;#estions -#sing a ikert-type rating scale. and open-ended ;#estions' was administered
at baseline and repeated three years into the st#dy to ! organizational member staff/ Df
<8 ;#estionnaires administered at baseline' 6: participants were accessed again after
three years/ &omparison from baseline to follow-#p reflects shifts in #nderstanding and
beliefs related to health rights amongst ! participants/ +he <8 ;#estions were cl#stered
into eight domains: #nderstanding of rights -six ;#estions.1 belief in agency to implement
rights -seven ;#estions.1 orientation to rights as having collective elements -one
;#estion.1 perspectives on providers0 views and practices relating to rights -three
;#estions.1 the capacity of rights to enhance social capital -fo#r ;#estions.1 tr#st in
general -three ;#estions.1 tr#st in government -two ;#estions.1 and tr#st in' and
identification -as in bonding social capital. with the ! -6A ;#estions./ +able >
s#mmarizes findings across the baseline to the follow-#p' cond#cted approximately >8
months after baseline/ Appendix 6 gives f#rther details on the ;#estionnaire and domains
#sed/
+he second is a ;#alitative st#dy which eval#ated the !-prod#ced series of $ight to
"ealth pamphlets/>< +he eval#ation so#ght to describe how the pamphlets were #sed and
disseminated' and res#ltant changes in #nderstanding and practice of health/>@ 5ata were
collected in 6: interviews and eight foc#s gro#ps involving a total of @7 participants'
drawn from eight &(Ds incl#ding all six ! members and two associated &(Ds working
on the right to health/ (lightly more than half of the respondents -nO><. were &(D staff
or trained vol#nteers' while the others were beneficiaries or constit#ents served by the
&(Ds/
Finally' we analyzed data assembled for a paper examining the process of co-prod#ction
of knowledge within the !/>A +hese data were based on email and face-to-face
interviews cond#cted with 66 ! participants between Dctober and 5ecember 9868' and
doc#mentary review' which incl#ded earning !etwork 3xec#tive ,eeting ,in#tes'
$eview and $eflection %orkshop notes -9887 and 9868.' (trategic Glanning workshop
notes -988:.' and earning !etwork workshop reports -988:./ +hese data so#rces were
managed #sing the ;#alitative data analysis software !vivo/
Given the participative research framework employed' there was no control gro#p against
which to compare changes for the ;#antitative ;#estionnaire/ %hile this design limits the
extent to which changes may be solely attrib#table to the ! activities' the findings can
be regarded as s#ggestive of the impacts of the !' partic#larly when triang#lating the
data emerging from the three s#b-st#dies/
4n analyzing res#lts from these three st#dies' we identified fo#r related themes:
6/ $ights awareness' capacity' and challenges
Grevio#s research has shown that most (o#th Africans are aware at a general level that
they have rights #nder the new democracy' b#t they lack specific #nderstanding of what
that means in practical terms/>?
+here was evidence s#ggestive that ! activities' incl#ding the development of materials
and training' contrib#ted to increased #nderstanding and were linked to a stronger sense
of enhanced skills for action/ 4n +able >' mean scores for #nderstanding and agency
increased by abo#t one-fifth -99M. and one-third ->6M. respectively' partic#larly related
to increased recognition of the importance of acco#ntability and strategies to enforce
rights/ %hen asked to define how health is a right' abo#t a ;#arter of respondents were
#nable to provide any s#ch definition at baseline' whereas at follow-#p all !
respondents capt#red some element of the right to health/
As one ! &(D member explained:
4n Po#r organizationQ' the new knowledge has provided #s with the skills to integrate the
principles of health and h#man rights into o#r existing advocacy' awareness and training
programmes/ / / / +he aim of the programme is to inform and promote the rights of
people with disabilities and to prevent any violations thereof/
(ome comments from in-depth interviews cond#cted with ! members s#pport findings
from the ;#antitative data that s#ggest a positive impact from engagement in the !/ A
service provider in an ! member organization commented:
Grior to the ! pamphlets' o#r organization did not foc#s on the broader theme of health'
b#t rather on the problems facing people with disabilities/ (ince P=oining the !Q' staff
are aware of iss#es s#rro#nding health rights and are developing a program on disabilities
and the right to health/
Another member explained how the !0s capacity-b#ilding had contrib#ted to their sense
of agency and that of their fellow members' creating a cascade of knowledge for action:
D#r organization had a workshop on health rights thro#gh the ! and the pamphlets
Phelped the attendees a great dealQ/ 4t gave them ideas on what was the right to health
PsicQ and the G$& PGatientsR $ights &harterQ/ 4t created a ripple effect among the women
in the organization as they passed information to one another/
+he work of the ! therefore showed how important it was to complement provision of
information with active engagement for capacity-b#ilding/ Gassive distrib#tion of
information' often the typical way in which state services distrib#te patient rights
information' is of limited val#e/>:
%e first saw the pamphlets in a media training with the Geople0s "ealth ,ovement/ +he
training was informative beca#se it triggered disc#ssions and enabled #s to see how all
comm#nity iss#es are interlinked and have an impact on health/ 4t created a platform to
#nderstand' beca#se sometimes written information' like the pamphlets' is hard to
#nderstand/
$ather' it was the combination of information with other comm#nity action that was most
effective/
4t is diffic#lt to say that the pamphlets alone have empowered comm#nity action/ $ather
it is a process of vario#s steps' incl#ding comm#nity meetings' p#blic hearings'
workshops on iss#es raised by the comm#nity' pamphlets that event#ally provide
comm#nities with eno#gh strength to gather and assert their rights/
+hese findings confirm the literat#re highlighting the importance of participatory learning
in an environment that models h#man rights as central to changing attit#des' behaviors'
and practices/>7 For example' writing abo#t the (onagachi Gro=ect' an intervention to
address "4C prevention among sex workers in *olkata' &ornish ill#strates the role of
rights in reframing discrimination experienced by sex workers as something capable of
being challenged rather than being inevitable/ +hro#gh collective action to restore those
rights' the sex workers involved in the pro=ect have #sed the mobilizing effect of h#man
rights to challenge stigma and the conditions of their v#lnerability/<8
"owever' what appeared to emerge in the !0s research was that when people became
more aware of their rights and what those rights mean' they realized the diffic#lties in
claiming rights from the state/ As a res#lt' those rights paradoxically appeared to become
less accessible/
For example' ;#antitative comparisons of knowledge and #nderstanding among !
members' despite showing improved insights into the nat#re of health rights' also
demonstrated that ! members were more likely to report a lack of tr#st that the state
wo#ld honor its rights obligations1 the score for tr#st in government declined by more
than A8M -+able >./ !onetheless' even in the face of s#ch challenges' ! members were
still more likely to report greater confidence in being able to empower their constit#ency
members to take action to realize the right to health -from6:M to <6M./ +his apparent
anomaly may be explained by an increased realisation among ! members that rights are
best realized thro#gh action by ordinary people exerting press#re on the state' rather than
reliance on state largesse/<6 For example' when asked who is responsible for the
realization of the right to health' one ! participant responded:
+he "ealth &ommittees-as they are the forefront of channelling information and activism
for civilians' &(Ds like Pname of organizationQ to be a voice and practically propagate for
health e;#ity from hospitals to state instit#tions/ Drdinary people are vital/
+h#s' while increasing rights awareness might be associated with decreased tr#st in the
state to deliver on its rights obligations' this was more than compensated for by a growing
#nderstanding that civil society agency can be as powerf#l' if not more powerf#l' in the
realization of health rights/
9/ (tate acco#ntability for the right to health and civil society participation
%hile civil society action is deemed essential for realizing the right to health' it
nonetheless also presents the possibility of tension between holding the state acco#ntable
and taking over state responsibilities when it fails to deliver or is perceived as #nwilling
to deliver/
3vidence from the open-ended ;#estions in the baseline ;#estionnaire s#ggested that
clients' member of &(D constit#encies' and &(D staff came to expect that &(Ds wo#ld
play a role in providing services that are the responsibility of government/ For example' a
n#mber of participants indicated that home-based carers' health committees' comm#nity
leaders' !GDs' or &BDs were responsible for realizing the right to health/ Dne
respondent arg#ed that !GD0s sho#ld be IS helping with these home carers to take
treatment for sick people/J Another organization described how engagement in the !
allowed one of the member organizations Ito relook at o#r h#man rights program more
critically and as res#lt S incorporate the right to health and disability rights into o#r
existing program/J +he organization was then able to enhance its own service delivery/
At the same time' one ! member commented' IGeople do not listen to #s in the clinics/
%hen we do assert o#r rights' we are told we are being Ltoo clever/0J ! members0 scores
for their view on how m#ch health workers #nderstood abo#t rights dropped abo#t @8M
over this period' confirming the sense of a serio#s dis=#nct#re between state services and
rights-based &(Ds/ 4ndeed'as &(Ds have become more knowledgeable abo#t h#man
rights and more empowered as to act on rights' they have come to realize that health
workers do not have a clear #nderstanding of rights/
+he gap between state obligations and state delivery therefore looms large and many
&(Ds gravitate towards filling the gap in services beca#se of their concerns for marginal
gro#ps in comm#nities/ "owever' rather than simply s#bstit#ting for state services' &(D
action on the right to health can be more effective where it also holds services
acco#ntable/ +h#s' as explained by two ! participants:
Dne of o#r comm#nity members lost her child d#e to bad birthing medical s#pport/ +his
provided a timely opport#nity to move people in her comm#nity on health rights and
create some awareness and action/
4 led a training on breast wellness and #sed the pamphlets to enco#rage yo#ng women to
go for check-#ps and get tested for breast cancer/ Fort#nately' they all came o#t clear' b#t
this was possible as a res#lt of these yo#ng women #nderstanding their right to health/
Another ! member &(D explained how it increased its participation in b#dgeting
decisions for the health department:
&omm#nity members and patients wanted to be a part of the disc#ssion and planning of
the health b#dget/ +he $ights and $eso#rce Allocation -A. pamphlet created awareness as
well as a sense of responsibility among people as to what their rights and responsibilities
are/ +his has contrib#ted to participation of health committees' for the last two years' in
the provincial planning of the health b#dget/
+h#s' while providing services which are otherwise not addressed by the state is an
important step towards protecting health rights' it is by itself an ins#fficient meas#re to
fill the gap re;#ired for realizing health rights/
>/ Gromotion of rights as filling a gap
+he above ;#otes ill#strate the critical acco#ntability role &(Ds can play in t#rning rights
obligations into reality/ +hro#gh information for action by rights holders' the state
obligations to respect' protect and f#lfill rights are transformed into a dialog#e between
rights-holders and d#ty-bearers' providing what the (o#th African &onstit#tion frames as
an obligation to promote rights/ Dne ! member organization ill#strated the idea:
+hro#gh the work of my organization and the pamphlets' 4 no longer =#st complain abo#t
rights violations' 4 take action/ A man in my comm#nity had chest pains beca#se he was
exposed to pesticides/ 4 gave him the pamphlet on the right to health and explained the
rights he had with his employer/ "e now receives medical treatment/
,oreover' beca#se information is best #nderstood in the context of collective actions -for
example' workshops' comm#nity distrib#tion of materials' p#blic hearings' and other
comm#nity meetings and activities.' the dissemination of information thro#gh an
organizational network is more likely to lead to the type of rights promotion envisioned
in the (o#th African constit#tion/ By increasing &(Ds0 foc#s on collective action -+able
>.' the !0s program co#ld be described as one intended to fill the gap related to
promotion of the right to health/
</ &ross-pollination between organizations -&(D-to-&(D work. is part of filling the gap
+he last theme ill#strated from the data is the #ni;#e val#e of organizational sharing in
contrib#ting to this filling the gap between formal rights entitlements and on-the-gro#nd
rights realization/ 3stablishing a space for shared learning increased individ#al &(D
member0s skills capacity' gave their organization credibility with other stakeholders' and
created a sense of solidarity within the !/ +his was attrib#ted to the opport#nities
provided by ! meetings for stocktaking and reflection1 g#idance on how to solve h#man
rights violations1 learning between organizations1 provision of opport#nities for advocacy
and lobbying1 plans for cascading knowledge and skills1 and moving from asking for help
to thinking abo#t how organizations can be their own agents for change/ +hese views are
reflected in the changes in scores shown in +able >' where meas#res tapping both
bridging and bonding social capital increased in the co#rse of the pro=ect/ For example'
! members reporting that they had Ia lot of tr#st in the organizations with which my
organization collaboratesJ increased from A>M at baseline to 7<M at follow-#p/ +he role
of tr#st as a key factor facilitating collective action enabling people to work together has
been well-doc#mented in the literat#re' as has the importance of forming networking
paths that are both horizontal -across agencies and sectors. and vertical -agencies to
comm#nities to individ#als./<9
!otwithstanding the potential for inter-organizational competition' this increased tr#st
linked to increased capacity was ill#strated in one ! member0s acco#nt:
Drganizations are beginning to share their information' skills' and experiences / / / +he
relationship between organizations has improved and we are able to #tilize each other0s
skills' information' and knowledge in order to provide a more holistic service to o#r
beneficiaries/
+here were two notable main contrib#tors to the increased score for bonding social
capital/ +hose were 6. greater acknowledgement -from A?M to 7<M. that different
organizations0 expertise and experience were recognized thro#gh the !' and 9. wider
disagreement that it was diffic#lt to share Iwhat has not worked so well in my
organizationJ -from <8M to A>M./ *ei=zer and colleag#es arg#e that h#man interaction
aro#nd evidence always leads to some form of learning/<> !etworking is more than
dialog#e as it encompasses action-oriented elements s#ch as policy infl#ence' advocacy'
negotiations' and an overarching search for social change/ By bringing together &(Ds
with different mandates' working in related b#t diverse sectors' and generating spaces that
provide opport#nities for participation and to access information' the ! presents an
example of creating m#ltiple sites for rights/<<
&oncl#sions
A 9887 report by the (o#th African "#man $ights &ommission highlighted low
awareness of rights among patients attending health services' noting that those patients
who are aware of their rights have diffic#lty asserting themselves d#e to feelings of
powerlessness/<@ +he challenge of b#ilding a h#man rights c#lt#re' even in a co#ntry
with a high degree of formal instit#tional commitment to rights' therefore looms large/ 4t
also speaks to the distinction made by capability theorists between f#nctionings -what a
person manages to do. and capabilities -what a person can or co#ld have achieved'
contingent on their freedom to be in a position to choose a partic#lar set of
f#nctionings./<A $ealization of the right to health is not =#st a matter of knowing what
one sho#ld be entitled to2it is also a f#nction of having the freedom to exercise these
entitlements/
%hereas past research has shown that increased awareness and knowledge of rights
improves people0s attit#des to and willingness to take action on rights' o#r experience is
that training alone is ins#fficient to t#rn #nderstanding into action/<? As (tellmacher and
(ommer concl#de' promoting h#man rights skills and action re;#ires more than improved
knowledge and attit#des abo#t h#man rights/<: $ather' agency is b#ilt by providing an
environment in which learning can be t#rned into practice/ ,oreover' it appears to be the
sense of solidarity and tr#st amongst co-learners that is most effective in giving ad#lt
learners confidence to engage with rights in their work' as the responses in +able >
ill#strate/<7 4n other words' thro#gh f#lfilling the right to information' the ! at the same
time ens#res the conditions for comm#nity action/ ,oreover' the importance of
complementing h#man rights learning with opport#nities to practice h#man rights
thro#gh implemented activities is what is needed to b#ild a c#lt#re of h#man rights' in
which learners own #nderstandings of =#stice' freedom and e;#ity can flo#rish/@8 4n this
way' the transformative potential of h#man rights is most evident/@6
astly' we believe that the gap between policy and implementation is one that leaves the
most marginalized people in society partic#larly v#lnerable/ +ranslating the intent of
policy into freedoms that enable v#lnerable pop#lations to change the conditions of their
v#lnerability2realizing their capabilities2is a key role for h#man rights work at all
levels' local' national and global/@9
By facilitating dialog#e at the comm#nity level' bringing in=#stice into the p#blic sphere'
exerting press#re for change' reinforcing the limits of state and b#siness action' and
monitoring to ens#re government policy is consistent with h#man rights disco#rse' &(Ds
can create a new Inorm cascadeJ to effect policy and programmatic changes needed to
advance health/@> ,odels on a local scale show the possibility of sol#tions to iss#es of
=#stice on a larger scale/@< +here is a gap to fill2a gap in terms of access to information
and the creation of spaces for participation2and &(Ds are filling it/
Acknowledgments
+he earning !etwork has been s#pported by f#nders incl#ding +he (o#th Africa-
!etherlands Grogramme for Alternative 5evelopment -(A!GA5.' the !ational $esearch
Fo#ndation of (o#th Africa -!$F.' DKFA, Great Britain' 5CC' the Grogram for
3nhancing $esearch &apacity -G3$&. at the Bniversity of &ape +own and the Dpen
(ociety Fo#ndation -D(F-(o#th Africa./ %e acknowledge $#th !#gent from 3pilepsy
(o#th Africa' %estern &ape branch' and Glynis $hodes from %omen on Farms Gro=ect'
for contrib#ting ideas presented in this paper/ %e thank *risten 5askilewicz for her
assistance in data analysis and Grofessor Fons &oomans for his s#pport in the
development of the earning !etwork/

eslie ondon is Grofessor of G#blic "ealth and "ead of the "ealth and "#man $ights
Grogramme' (chool of G#blic "ealth and Family ,edicine' Bniversity of &ape +own'
(o#th Africa/
!icol) Fick is $esearch &oordinator in the "ealth and "#man $ights Grogramme' (chool
of G#blic "ealth and Family ,edicine' Bniversity of &ape +own' (o#th Africa/
*hai "oan +ram is $esearch Assistant at the D!3 &ampaign' %ashington' 5/&/' B(A
and was a st#dent on the Bing Dverseas (t#dies Grogramme of (tanford Bniversity' Galo
Alto' &alifornia' B(A/
,aria (t#ttaford is (enior $esearch Fellow at the 4nstit#te for "ealth' %arwick
Bniversity' %arwick' B*/
Glease address correspondence to eslie ondon' (chool of G#blic "ealth and Family
,edicine' Bniversity of &ape +own "ealth (ciences Fac#lty' Anzio $d' Dbservatory'
?79@' (o#th Africa or to leslie/londonT#ct/ac/za /

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yo# move forward b#t yo# also look back: A spiral of co-learning and co-research to
s#rface knowledge on the right to health'J in B/ &ooper and $/ ,orrell -eds.' G#rs#ing
and making Africa-centred knowledge: +heories and cases -&ape +own: Grogramme for
the 3nhancement of $esearch &apacity' Bniversity of &ape +own. -forthcoming./
9:/ $/ !#gent' %/ !efdt' !/ Fick' and / ondon' I5isability and h#man rights toolkit as
a best practice methodological approach for realising h#man rights of people with
disabilitiesJ -presentation at +he G#blic "ealth Association of (o#th Africa &onference'
3ast ondon' (o#th Africa' !ovember 9868./
97/ &ross-organizational training areas incl#ded disability sensitization and epilepsy'
advocacy methods to advance rights' and comm#nity mapping as a participatory action
research method/
>8/ B/ Ghn#yal' 5/ Archer' and (/ &ottingham' IGarticipation' literacy' and
empowermentreflections on $3F3&+'J GA !otes >9' 9?->8' -ondon: 4435' 677:./
Accessed from GA !otes &5-$D, 67::-9886/
>6/ ondon -988?' see note 7./
>9/ !/ Fick' ,/ (t#ttaford' (/ Vaant=ie et al' IBsing photo-voice as a participatory method
to explore comm#nity perceptions of healthJ -presentation at +he G#blic "ealth
Association of (o#th Africa &onference' 3ast ondon' (o#th Africa' !ovember 9868./
>>/ (A"$& -see note @./
></ "ealth and "#man $ights Gamphlets/ Available athttp:UUopencontent/#ct/ac/zaU"ealth-
(ciencesUG#blic-"ealth-and-Family-,edicineU"ealth-and-"#man-$ights-Gamphlets /
>@/ (ee ,/ (trecker' $ealizing the right to health thro#gh the #se of health print materials
in the %estern &ape' (o#th Africa' s#bmitted in partial f#lfillment of the re;#irements for
the degree of ,aster of G#blic "ealth' Bniversity of &ape +own -9866./
>A/ (t#ttaford et al/ -see note 9?./
>?/ ,#bangizi -see note 9@.1 "abib and de Cos -see note 9@.1 (A"$& -see note @./
>:/ ondon et al -see note 67./
>7/ F/ +ibbitts' IBnderstanding what we do: 3merging models for h#man rights
ed#cation'J 4nternational $eview of 3d#cation <:U>-< -9889.' pp/ 6@7-6?6 and Batarilo
-see note 6:./
<8/ F/ &ornish' I&hallenging the stigma of sex work: ,aterial context and symbolic
change'J Vo#rnal of &omm#nity and Applied (ocial Gsychology 6A -988A.' pp/ <A9-<?6/
<6/ ondon -988?' see note 7. and ondon -988:' see note 6<./
<9/ For st#dies on the role of tr#st see' for example' V/ &oleman' Fo#ndations of social
theory -&ambridge' ,A: "arvard Bniversity Gress' 6778.1 F/ F#k#yama' +r#st: +he
social virt#es and the creation of prosperity -!ew Eork: +he Free Gress' 677@.1 ,/
%oolcock' I(ocial capital and economic development: +oward a theoretical synthesis and
policy'J+heory and (ociety 9?U9 -677:.' pp/ 6@6-98:1 and $/ G#tnam' Bowling alone:
+he collapse and revival of American comm#nity -!ew Eork: (imon and (ch#ster'
9888./ For st#dies on the importance of networks see' for example' !/ *ei=zer' &/
Yrnemark' and G/ 3ngel' I!etworking for learning: +he h#man face of knowledge
managementHJ 3&5G, Golicy ,anagement Brief 6: -,aastricht: 3&5G,' 988A./
Available athttp:UUwww/ecdpm/orgU%ebW3&5G,U%ebU&ontentU!avigation/nsfUindex9H
readform Z
http:UUwww/ecdpm/orgU%ebW3&5G,U%ebU&ontentU&ontent/nsfU8U:3?<F<<F6:@9B@A5&
69@?9@F88<<756:HDpendoc#ment and C/ Cilhena and A/(/ 5# Gree' I$eflection on
civil society and h#man rights'J 4nternational Vo#rnal on "#man $ights 6 -988<.' pp/ <?-
A@/
<>/ *ei=zer et al/ -see note <9./
<</ ,/ (t#ttaford' G/ "#ndt' and G/ Costanis' I(ites for health rights: the experience of
homeless families in 3ngland'J Vo#rnal of "#man $ights Gractice 6U9 -9887.' pp/ 9@?-
9?A/
<@/ (A"$& -see note @./
<A/ V/,/ Alexander' &apabilities and social =#stice: +he political philosophy of Amartya
(en and ,artha !#ssba#m -Farnham' B*: Ashgate' 988:./
<?/ &/ Gavlish and A/ "o' I5isplaced persons0 perceptions of h#man rights in (o#thern
(#dan'J 4nternational !#rsing $eview @AU< -9887.' pp/ <6A-<9@1 V/ (tellmacher' G/
(ommer' and 3/ Br[hler' I+he cognitive representation of h#man rights: *nowledge'
importance' and commitment'J Geace and &onflict: Vo#rnal of Geace Gsychology 66U>
-988@.' pp/ 9A?-9791 and %/ 5oise' 5/ (pini' and A/ &lemence' I"#man rights st#dies as
social representations in a cross-national context'J 3#ropean Vo#rnal of (ocial
Gsychology 97 -6777.' pp/ 6-97/
<:/ (tellmacher and (ommer -see note 6:./
<7/ ,/ Ba=a=' I"#man rights ed#cation and st#dent self-conception in the 5ominican
$ep#blic'J Vo#rnal of Geace 3d#cation 6U6 -988<.' pp/ 96->A/
@8/ Batarilo -see note 6:./
@6/ ,/ "eywood and 5/ Altman' I&onfronting A45(: "#man rights' law and social
transformation'J "ealth and "#man $ights: An 4nternational Vo#rnal @ -9888.' pp/ 6<7-
6?7/
@9/ A/ (en' I"#man rights and capabilities'J Vo#rnal of "#man 5evelopment AU9 -988@.'
pp/ 6@6-6AA/
@>/ / Forman' I$ights and wrongs: %hat #tility for the right to health in reforming trade
r#les on medicinesHJ "ealth and "#man $ights: An 4nternational Vo#rnal 68 -988:.' pp/
>?-@9/
@</ Cilhena and 5# Gree -see note <9./
Appendix 6/ F#estionnaire on h#man rights #nderstandings and applicationearning by
5oing and 5oing by earning: A &ivil (ociety !etwork to $ealize the $ight to "ealth
+he earning !etwork for "ealth and "#man $ights ;#estionnaire so#ght to tap
knowledge' #nderstanding' and practice related to health rights/ +he ;#estionnaire was
comprised of fo#r sections' as detailed below/ +he constr#ction of scores for different
domains in (ection < is detailed below/
(ection 6(even ;#estions collecting general demographic information
(ection 9+wo ;#estions related to socio-economic stat#s
(ection >!ine open-ended ;#estions -incl#ding ;#estion 9? from (ection <.
(ection <Forty-three forced choice ;#estions -strongly agree' agree' disagree' strongly
disagree' can0t say' don0t know.
5omains F#estions
Bnderstanding of rights 6' >' A' ?' 66' 6>
Belief in agency to implement rights 9' @' 68' 96' 9<' 9@' 9A
Drientation to rights as having collective elements :
Gerspectives on providers0 views and practices relating to
rights <' 7' 69
&apacity of rights to enhance social capital 6<' 6@' 67' 99
+r#st in general 6A' 6?' 98
+r#st in government 6:' 9>
+r#st in and identification with the ! -bonding social
capital.
>8' >6' >9' >>' ><' >@' >A'
>?' >:' >7' <8' <6' <9' <>'
<<
3ach respondent was asked how strongly he or she agreed or disagreed with the
statements below/ +he responses were post-coded as positive for the said domain' and
each ;#estion was weighted e;#ally for a positive response/
6/ 3veryone is e;#ally entitled to have their h#man rights respected/
9/ "#man rights are nice to have b#t yo# can0t enforce them/
>/ "aving a right to health means that someone m#st be acco#ntable/
</ ,ost staff in the health services #nderstand that health is a right/
@/ +he best way to access yo#r rights is by having a clever lawyer to go to co#rt for yo#/
A/ Beca#se one person0s right might clash with another person0s rights' we sometimes
have to balance rights/
?/ A h#man rights approach means that the needs of people who are most v#lnerable
m#st come first/
:/ 4t is easier to #se a h#man rights approach to fight a case for an individ#al claim than it
is to sec#re rights for the whole comm#nity/
7/ 4 think my rights are respected when 4 go to a health service/
68/ 4n (o#th Africa' rich people are able to look after their rights more easily than those
who are not rich/
66/ "aving a right of access to health care means that 4 can expect the state to give me a
liver transplant if 4 needed one/
69/ ,ost staff working in the health services respect patients0 rights/
6>/ All h#man rights are absol#te and can never be limited or restricted/
6</ 4 think it is important that people sho#ld participate in a civic or comm#nity
organization to improve their social conditions/
6@/ 4f 4 had a s#dden emergency' 4 will have a neighbor or friend who wo#ld be able to
help me/
6A/ 4 have a lot of tr#st in the organizations with whom my organization collaborates/
6?/ 4 have a lot of tr#st in the people with whom 4 work/
6:/ 4 have a lot of tr#st in the government departments my organization works with/
67/ 4 think it is important that people sho#ld rather participate in a civic or comm#nity
organization to help others/
98/ &ollaborating with other organizations can often be to the detriment of the
achievement of yo#r own organization0s ob=ectives/
96/ ,y organization can infl#ence decisions by health care professionals in ways that
benefit my organization0s constit#ents/
99/ 4 am confident that if my organization had an #rgent iss#e to take #p' we wo#ld get
s#pport from other &ivil (ociety Drganizations -&(Ds./
9>/ 4 am confident that if my organization had an #rgent iss#e to take #p' we wo#ld get
s#pport from the government/
9</ 4 can easily convey to clients of my organization what it means to have a right to
health/
9@/ 4 find it diffic#lt to empower the clients of my organization to take action to realize
the right to health/
9A/ 4f 4 felt my own rights were being violated' 4 wo#ld be confident to speak o#t abo#t it/
9?/ %ho wo#ld yo# speak to if yo# felt yo#r rights were being violatedH -open-ended
;#estion.
9:/ 4 know abo#t the earning !etwork and the work that the network does/ -EU!.
97/ 4 have attended a earning !etwork workshop/ -EU!.
>8/ 4 am confident that if 4 needed information on a specific right' 4 co#ld get that from
someone in the earning !etwork/
>6/ 4 feel a strong sense of belonging to the earning !etwork/
>9/ Geople in the earning !etwork can be tr#sted/
>>/ (haring information in the earning !etwork abo#t what has not worked well in my
organization is a diffic#lt thing to do/
></ (haring information in the earning !etwork abo#t what has not worked well in my
organization is very important for the ob=ectives of the earning !etwork/
>@/ 4 #nderstand the ob=ectives of the earning !etwork/
>A/ 4 think the earning !etwork will address the learning needs of my organization/
>?/ 4 think the earning !etwork will add val#e to what my organization does/
>:/ +he range of &(Ds in the earning !etwork is appropriate/
>7/ +he &(Ds in the earning !etwork are stable organizations/
<8/ +he earning !etwork has common ob=ectives/
<6/ +here will be shared ownership of o#tp#ts from the earning !etwork/
<9/ +he earning !etwork is facilitated in an open way/
<>/ +he expertise and experiences of all member organizations is recognized/
<</ +he different reasons for organizations =oining the earning !etwork do not infl#ence
participation/

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