Papers
Strecker M, Stuttaford M and London L. 2012. Health rights pamphlets: critical literacy and inclusivecitizenship, South Africa. Health Promotion International, Oxford Journals.
ABSTRACT
The Ottawa Charter recognizes the importance of strengthening community action for health and developing personal skills. At the same time, a rights-based approach
to health includes the right to information, participation and accountability. The Learning Network for Health and Human Rights is a research and learning collaboration
between Civil Society Organisations (CSOs) and universities in the Western Cape, South Africa. For the purposes of this article, a CSO is understood to be any organization that is outside of the state and private market sector. As part of a wider programme of action research, the learning network developed six pamphlets aimed at enhancing individual and collective skills to support action related to the implementation of the right to health. The research reported here analyses how the pamphlets, coupled with directed training, strengthened skills, promoted critical literacy and supported inclusive citizenship. Eighteen semi-structured interviews and eight focus groups were conducted with 59 participants from eight CSOs, their members, beneficiaries and communities. The success of the pamphlets was found to be attributed to the role they played in a wider training programme, requested by the CSOs and developed jointly by CSOs and university-based researchers. Community action on the right to health is contingent on personal as well as collective skills development. Understanding of the right to health and skills for participation and accountability were extended in breadth and depth, which enabled inclusive citizenship.
Available at URL: http://heapro.oxfordjournals.org/content/early/2012/12/13/heapro.das067.full
ABSTRACT
The Ottawa Charter recognizes the importance of strengthening community action for health and developing personal skills. At the same time, a rights-based approach
to health includes the right to information, participation and accountability. The Learning Network for Health and Human Rights is a research and learning collaboration
between Civil Society Organisations (CSOs) and universities in the Western Cape, South Africa. For the purposes of this article, a CSO is understood to be any organization that is outside of the state and private market sector. As part of a wider programme of action research, the learning network developed six pamphlets aimed at enhancing individual and collective skills to support action related to the implementation of the right to health. The research reported here analyses how the pamphlets, coupled with directed training, strengthened skills, promoted critical literacy and supported inclusive citizenship. Eighteen semi-structured interviews and eight focus groups were conducted with 59 participants from eight CSOs, their members, beneficiaries and communities. The success of the pamphlets was found to be attributed to the role they played in a wider training programme, requested by the CSOs and developed jointly by CSOs and university-based researchers. Community action on the right to health is contingent on personal as well as collective skills development. Understanding of the right to health and skills for participation and accountability were extended in breadth and depth, which enabled inclusive citizenship.
Available at URL: http://heapro.oxfordjournals.org/content/early/2012/12/13/heapro.das067.full
Muller A. 2012. Community participation in health. DENOSA Newsletter 2012
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Meier B, Pardue C and London L. 2012. Implementing community participation through legislative reform: a study of the policy
framework for community participation in the Western Cape province of South Africa. BMC International Health and Human Rights 2012, 12:15
ABSTRACT
Background: Amidst an evolving post-apartheid policy framework for health, policymakers have sought to
institutionalize community participation in Primary Health Care, recognizing participation as integral to realizing
South Africa’s constitutional commitment to the right to health. With evolving South African legislation supporting
community involvement in the health system, early policy developments focused on Community Health
Committees (HCs) as the principal institutions of community participation. Formally recognized in the National
Health Act of 2003, the National Health Act deferred to provincial governments in establishing the specific roles
and functions of HCs. As a result, stakeholders developed a Draft Policy Framework for Community Participation in
Health (Draft Policy) to formalize participatory institutions in the Western Cape province.
Methods: With the Draft Policy as a frame of analysis, the researchers conducted documentary policy analysis and
semi-structured interviews on the evolution of South African community participation policy. Moving beyond the
specific and unique circumstances of the Western Cape, this study analyzes generalizable themes for rights-based
community participation in the health system.
Results: Framing institutions for the establishment, appointment, and functioning of community participation, the
Draft Policy proposed a formal network of communication – from local HCs to the health system. However, this
participation structure has struggled to establish itself and function effectively as a result of limitations in
community representation, administrative support, capacity building, and policy commitment. Without legislative
support for community participation, the enactment of superseding legislation is likely to bring an end to HC
structures in the Western Cape.
Conclusions: Attempts to realize community participation have not adequately addressed the underlying factors
crucial to promoting effective participation, with policy reforms necessary: to codify clearly defined roles and
functions of community representation; to outline how communities engage with government through effective
and accountable channels for participation; and to ensure extensive training and capacity building of community
representatives. Given the public health importance of structured and effective policies for community participation,
and the normative importance of participation in realizing a rights-based approach to health, this analysis informs
researchers on the challenges to institutionalizing participation in health systems policy and provides practitioners
with a research base to frame future policy reforms.
Available at URL: http://www.biomedcentral.com/1472-698X/12/15
Stuttaford M, Glattstein-Young G, London L. 2012. 'Dialogue, review and reflect': A spiral of co-learning and co-research to surface knowledge on the right to health. Gateways: International Journal of Community Research and Engagement Vol 5 115-134.
ABSTRACT
This article explores how participants of a Learning Network, comprising members of six civil society organisations and academics from four universities, understand and participate in a dialogical process of co-learning and knowledge generation about the right to health. First, we describe a co-research process that facilitates the surfacing of previously suppressed or undocumented knowledge on the right to health. Second, we explore how co-research captures and disseminates knowledge related to collective action undertaken by civil society organisations working towards translating the right to health into practice. While undertaking this exploration, we maintain an interest in an African appreciation of ‘collective’ knowledge. Through the dialogical process and spiral of reflection, power between the research partners has been shared and spaces for co-learning and co-research created. Subaltern knowledge on the right to health has been placed within a constellation of plural knowledges, rather than at the periphery. Surfacing ‘other’ knowledge on the right to health reflects the lived realities of people and assists in understanding how the right to health can be achieved in practice.
ABSTRACT
This article explores how participants of a Learning Network, comprising members of six civil society organisations and academics from four universities, understand and participate in a dialogical process of co-learning and knowledge generation about the right to health. First, we describe a co-research process that facilitates the surfacing of previously suppressed or undocumented knowledge on the right to health. Second, we explore how co-research captures and disseminates knowledge related to collective action undertaken by civil society organisations working towards translating the right to health into practice. While undertaking this exploration, we maintain an interest in an African appreciation of ‘collective’ knowledge. Through the dialogical process and spiral of reflection, power between the research partners has been shared and spaces for co-learning and co-research created. Subaltern knowledge on the right to health has been placed within a constellation of plural knowledges, rather than at the periphery. Surfacing ‘other’ knowledge on the right to health reflects the lived realities of people and assists in understanding how the right to health can be achieved in practice.
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London et al. 2012. Filling the gap: A Learning Newtork for Health and Human Rights in the Western Cape, South Afica. Health and Human Rights Journal Vol 14, No 1.
ABSTRACT
We draw on the experience of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organizations in the Western Cape, South Africa, aimed at identifying and disseminating best practice related to the right to health. The LN's work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates important lessons for human rights practice. These include (i) the importance of active translation of knowledge and awareness into action for rights to be made real; (ii) the potential tension arising from civil society action, which might relieve the state of its obligations by delivering services that should be the state's responsibility-and hence the importance of emphasizing civil society's role in holding services accountable in terms of the right to health; (iii) the role of civil society organizations in filling a gap related to obligations to promote rights; (iv) the critical importance of networking and solidarity for building civil society capacity to act for health rights. Evidence from evaluation of the LN is presented to support the argument that civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realizing services and policies that enable the most vulnerable members of society to advance their health. Through access to information and the creation of spaces, both for participation and as a safe environment in which learning can be turned into practice, the agency of those most affected by rights violations can be redressed. We argue that civil society agency is critical to such action.
Available on URL: http://hhrjournalarchive.org/index.php/hhr/article/view/452/768
Coomans F, Haricharan H, Heap M and London L. 2012. Can we talk about the right to healthcare without language? A critique of key international human rights law, drawing on the experiences of a Deaf woman in Cape Town, South Africa. Disability and Society Vol 28, Issue 1.
ABSTRACT
A case study in Cape Town, South Africa, explores the right to health for signing Deaf 1 patients attending health services and who are unable to communicate in a language they understand. It argues that, without language, Deaf South Africans’ dignity and right to health is violated, resulting in serious consequences such as incorrect diagnosis, improper treatment and standard of care not being applied. It critiques the provisions of the Convention on the Rights of Persons with Disabilities (CRPD) and the limits of General Comment 14 of the International Covenant on Economic, Social and Cultural Rights. The paper demonstrates that Deaf patients do not have informational access to healthcare. It argues that language via professional interpreter services is essential to their South African constitutional right of access to healthcare. General Comment 14 addresses informational accessibility, but this is insufficient without addressing language as a pre-requisite. The CRPD imposes on the South African government human rights obligations to provide professional interpreter services for Deaf people, but unfortunately it allows a loophole by enabling cost to serve as reasonable grounds to defer action.
Available at URL: http://www.tandfonline.com/doi/full/10.1080/09687599.2012.699277#.UpXue-JLJZI
ABSTRACT
A case study in Cape Town, South Africa, explores the right to health for signing Deaf 1 patients attending health services and who are unable to communicate in a language they understand. It argues that, without language, Deaf South Africans’ dignity and right to health is violated, resulting in serious consequences such as incorrect diagnosis, improper treatment and standard of care not being applied. It critiques the provisions of the Convention on the Rights of Persons with Disabilities (CRPD) and the limits of General Comment 14 of the International Covenant on Economic, Social and Cultural Rights. The paper demonstrates that Deaf patients do not have informational access to healthcare. It argues that language via professional interpreter services is essential to their South African constitutional right of access to healthcare. General Comment 14 addresses informational accessibility, but this is insufficient without addressing language as a pre-requisite. The CRPD imposes on the South African government human rights obligations to provide professional interpreter services for Deaf people, but unfortunately it allows a loophole by enabling cost to serve as reasonable grounds to defer action.
Available at URL: http://www.tandfonline.com/doi/full/10.1080/09687599.2012.699277#.UpXue-JLJZI
Bowers et al. 2009. Obstacles to the rights of access to health care for farm worker women in the Western Cape. Public Health Movement, South Africa, 2009, No 1.
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London L, Heap M, Baldwin-Ragaven L. 2009. Health and Human Rights: New challenges for social responsiveness. Gateways: International Journal of Community Research and Engagement 2009; 2: 61–81.
ABSTRACT
South Africa’s struggle against apartheid discrimination, including struggles in the health sector, laid the basis for a vibrant engagement of staff and students in human rights research, teaching and outreach in the Health Sciences Faculty at the University of Cape Town (UCT). This article provides a brief overview of this background context, then shows how this engagement has continued with new challenges emerging in the post-apartheid democratic period. Teaching at undergraduate and postgraduate levels has been complemented by a programme of ‘Training the Trainers’ in health and human rights. The programme targets teachers of health professionals at institutions in South and Southern Africa, resulting in national adoption of human rights competencies as an essential component of health professionals’ skills base. Research has also extended lessons learnt from the apartheid period into work with vulnerable groups, such as rural farm workers and the deaf, and seeks to build the capacity of marginal populations to change the conditions of their vulnerability in order to realize their rights. Partnerships with civil society organisations have been a strong thread, creating new knowledge and new ways of joint work towards realizing the right to health, including advocacy engagement in civil society movements and regional networks. Further, a focus on health professionals’ practice, in terms of dealing with potential dual loyalty conflicts and their role as gatekeepers in the health services on matters of patients’ rights, has shaped the research agenda. This article illustrates how knowledge production for the public good extends beyond notions of enhancing economic productivity for national development and provides a base for transdisciplinary and transinstitutional engagement. Additionally, non-traditional forms of knowledge networking and transfer have also been explored, including engagement with policy-makers and health managers. Finally, it is shown how the portfolio of social responsiveness activities in the health and human rights envelope has offered significant and novel mutual benefits to the University and the community.
Available on URL: http://epress.lib.uts.edu.au/journals/index.php/ijcre/article/view/1165/1334
London L. 2008. What is a human rights approach to health and does it matter? Health and Human Rights Journal Volume 10 No 1.
ABSTRACT
A human rights approach to health is critical to address growing global health inequalities. Three aspects of the nature of health as a right are relevant to shaping a human rights approach to health: 1) the indivisibility of civil and political rights, and socio-economic rights; 2) active agency by those vulnerable to human rights violations; and 3) the powerful normative role of human rights in establishing accountability for protections and freedoms. Health professionals’ practice, typically governed by ethical codes, may benefit from human rights guidelines, particularly in situations of dual loyalty where clients’ or communities’ human rights are threatened. Moreover, institutional accountability for protecting human rights is essential to avoid shifting responsibility solely onto the health professional. Human rights approaches can include holding states and other parties accountable, developing policies and programs consistent with human rights, and facilitating redress for victims of violations of the right to health. However, underlying all models is the need to enable active social mobilization, without which legal approaches to rights lack sustainability and power. Evidence from South and Southern Africa has shown that different conceptions of what is meant by human rights impact substantially on state willingness and ability to meet constitutional obligations with regard to the right to health. New approaches to health policy development, which draw on the agency of vulnerable groups, link local struggles with
their global context, and explicitly incorporate rights frameworks into public health planning are needed. Models that move away from individualizing conflict over rights between health professionals as disempowered duty bearers and patients as frustrated
rights holders, toward more mutual approaches to shared rights objectives may be possible and are being actively pursued through the development of a learning network to realize the right to health in South Africa.
Available on URL: http://www.hhrjournal.org/2013/09/13/what-is-a-human-rights-based-approach-to-health-and-does-it-matter/
ABSTRACT
A human rights approach to health is critical to address growing global health inequalities. Three aspects of the nature of health as a right are relevant to shaping a human rights approach to health: 1) the indivisibility of civil and political rights, and socio-economic rights; 2) active agency by those vulnerable to human rights violations; and 3) the powerful normative role of human rights in establishing accountability for protections and freedoms. Health professionals’ practice, typically governed by ethical codes, may benefit from human rights guidelines, particularly in situations of dual loyalty where clients’ or communities’ human rights are threatened. Moreover, institutional accountability for protecting human rights is essential to avoid shifting responsibility solely onto the health professional. Human rights approaches can include holding states and other parties accountable, developing policies and programs consistent with human rights, and facilitating redress for victims of violations of the right to health. However, underlying all models is the need to enable active social mobilization, without which legal approaches to rights lack sustainability and power. Evidence from South and Southern Africa has shown that different conceptions of what is meant by human rights impact substantially on state willingness and ability to meet constitutional obligations with regard to the right to health. New approaches to health policy development, which draw on the agency of vulnerable groups, link local struggles with
their global context, and explicitly incorporate rights frameworks into public health planning are needed. Models that move away from individualizing conflict over rights between health professionals as disempowered duty bearers and patients as frustrated
rights holders, toward more mutual approaches to shared rights objectives may be possible and are being actively pursued through the development of a learning network to realize the right to health in South Africa.
Available on URL: http://www.hhrjournal.org/2013/09/13/what-is-a-human-rights-based-approach-to-health-and-does-it-matter/
London, L. 2007. Issues of equity are also issues of rights: Lessons from experiences in southern Africa. BMC Public Health 7:14.
ABSTRACT
Background: Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity.
Methods: The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence.
Results: Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels.
Conclusion: Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity.
Available on URL: http://www.biomedcentral.com/1471-2458/7/14
ABSTRACT
Background: Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity.
Methods: The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence.
Results: Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels.
Conclusion: Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity.
Available on URL: http://www.biomedcentral.com/1471-2458/7/14
Book Chapters
Stuttaford M, Kiewiets D, Nefdt W, Reynolds V, Rhodes G, Sigasana L and London L. 2014. Conceptualising Implementation of the Right to Health: the Learning Network for Health and Human Rights, Western Cape, South Africa. In M. Freeman, S. Hawkes and B. Bennett (Eds) Law and Global Health Current Legal Issues, Volume 16, Oxford: Oxford University Press.
Description of book available at URL:http://ukcatalogue.oup.com/product/9780199688999.do
Description of book available at URL:http://ukcatalogue.oup.com/product/9780199688999.do
Stuttaford, M. 2009. Methods in health and human rights research: towards a spiral of co-learning. In Coomans, F., Kamminga, M. and Grunfeld, F. (Eds) Methods of Human Rights Research, Antwerpen: Intersentia. p. 135-57.
Description of book available at URL: http://www.intersentia.co.uk/searchDetail.aspx?back=reeks&reeksCode=&bookid=100887&author=Fons
Description of book available at URL: http://www.intersentia.co.uk/searchDetail.aspx?back=reeks&reeksCode=&bookid=100887&author=Fons
Student Theses
Jennifer van Heerden
2013
"When university and community are incompatible: An ethnographic reflection on the institutional and contextual challenges of engaged research in South Africa"
2013
"When university and community are incompatible: An ethnographic reflection on the institutional and contextual challenges of engaged research in South Africa"
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Renate Douwes, International Public Health - University Amsterdam / University of Cape Town
2012
"Social solidarity and collective action in rights claims for health in South Africa"
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Morgan Strecker, Master of Public Health - University of Cape Town
2011
"Realising the right to health through the use of print materials in the Western Cape, south Africa"
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Marjan Heida, Master of Health Sciences, International Public Health - University: Vrije Universiteit, Amsterdam / University of Cape Town
2010
"An evaluation of a Toolkit on the right to health"
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Gabriella Glattstein-Young, Master of Public Health - University of Cape Town
2010
"Community health committees as a vehicle for community participation in advancing the right to health"
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Jacky Thomas
2009
"Is knowing your rights enough? A learning network to realise the right to health"
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Policy Briefs
Submission to the National Department of Health on the Draft Policy for Health Governance Structures
October 2013
October 2013
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Submission to the Western Cape Government Health Department: Amendments to the Western Cape Health Facilities Board Act, 2001
November 2012
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Submission to the South African Human Rights Commission – Economic and Social Rights in South Africa (2006-2009)
2009
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EQUINET, TARSC and UCT in cooperation with SEAPACOH. Parliamentary Briefs: Parliamentary roles in protecting rights to health in East and Southern Africa. Parliament Briefing 3. July 2008; and, Using health rights to promote equity oriented health budgets Parliament Briefing 4. July 2008. EQUINET, Harare.
July 2008
Available at URL: http://www.equinetafrica.org/bibl/docs/DISS74parlrights09.pdf.
Conference Reports
National Colloquium on Health Committees in South Africa, Cape Town, September 2014
national_colloquium_report_17_nov_2014_1.pdf | |
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Regional Meeting with Participants from East and Southern Africa: Cape Town, September 2014
regional_meeting_report_final.pdf | |
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Regional Meeting with Participants from East and Southern Africa: Zimbabwe, February 2014
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Learning Network Colloquium on Community Participation: March 2013
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Regional Meeting with Participants from East and Southern Africa Participants: Kiboga, March 2013
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People's Health Assembly 3, Global Health Summit Cape Town, July 2012
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Regional Meeting with Participants from East and Southern Africa: Kampala 2010
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PERC (Programme for the Enhancement of Research Capacity) Seminar Report: September 2010
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PERC Seminar Report: March 2010
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PERC Bibliography
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Other Reports
Hanne Haricharan
2012
"Extending Participation: Challenges of health committees as meaningful structures to community participation"
2012
"Extending Participation: Challenges of health committees as meaningful structures to community participation"
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Boulle T. 2013. Identifying key challenges of health comiitees in Nelson Mandela Bay
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Boulle T and Sofoyiya Z. 2013. Report on the state of health committees in Nelson Mandela Bay
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Haricharan H. 2013. Rapid appraisal of health committee policies in South Africa
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