Balancing protection and pragmatism: A framework for NGO accountability in rights-based approaches

Health and Human Rights

Volumn 9, Issue 2, 2006, Pages 180-206

  Mayhew, Susannah ^a   Douthwaite, Megan ^c   Hammer, Michael ^b  

^a LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE   (United Kingdom)

^b The One World Trust   (United Kingdom)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH SERVICES; HUMAN RIGHTS; NONGOVERNMENTAL ORGANIZATION; PARTICIPATORY APPROACH; PROTECTIONISM; PUBLIC HEALTH;

ARTICLE; CONFIDENTIALITY; FEMALE; HEALTH SERVICE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN RIGHTS; MALAWI; MALE; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PAKISTAN; PRISONER; PUBLIC HEALTH SERVICE; SUBSTANCE ABUSE;

CONFIDENTIALITY; FEMALE; HEALTH SERVICES ADMINISTRATION; HIV INFECTIONS; HUMAN RIGHTS; HUMANS; MALAWI; MALE; ORGANIZATIONS; PAKISTAN; PRISONERS; PUBLIC HEALTH ADMINISTRATION; SUBSTANCE ABUSE, INTRAVENOUS;

AFRICA; ASIA; EAST AFRICA; EURASIA; MALAWI; PAKISTAN; SOUTH ASIA; SUB-SAHARAN AFRICA;

EID: 33846921620     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/4065407     Document Type: Article

References (68)

1. J. Theis, Rights-Based Monitoring and Evaluation: A Discussion Paper (Save the Children: April 2003). Available at http://www.mande.co.uk/ docs/Rights-basedMonitoringAndEvaluation.pdf.
2. The Maastricht Guidelines on Violations of Economic, Social, and Cultural Rights. UN Economic and Social Council, 2000: E/C. 12/2000/13, paragraph 18. Available at http://shr.aaas.org/thesaurus/ instrument.php?insid=95.
3. United Nations, Population and Development: Programme of Action Adopted at the International Conference on Population and Development, Cairo, September 5-13, 1994 (UN: Department for Economic and Social Information and Policy Analysis, 1995);
4. Platform for Action of the Fourth World Conference on Women, UN Doc. A/ CONF.177/20 (1995);
5. International Planned Parenthood Federation, IPPF Charter on Sexual and Reproductive Rights (London: IPPF, 1996).
6. These are the Mexico City Policy, first Announced by Reagan in 1984, rescinded under Clinton in 1993, and reinstated by Bush in 2001 -see http://www.whitehouse.gov/news/releases/20010123-5.html - which prevents US funding from going to any organization that delivers abortion or abortion-related services, including counseling and referral for safe abortion;
7. and the President's [US] Emergency Plan for AIDS in Africa (PEPFAR), enshrined in the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act (2003) -Public Law 108-25, 22 USC 7601 (23) (2003),which endorses an abstinence-only approach to the prevention of HIV/AIDS and restricts access to condoms except as a "last resort" for "high-risk" groups, such as sex-workers and drug users. PEPFAR also prevents funding from going to organizations refusing to sign a statement that sex work is immoral and illegal. The full text of the Law detailing PEPTAR is available at http://frwebgate.access.gpo.gov/cgi-bin/ getdoc.cgi?dbname=108_cong_public_laws&docid=f:pub1025.108.pdf.
8. See, for example, Human Rights Watch, The Less They Know, The Better: Abstinence-Only HIV/AIDS Programs in Uganda 17/4 (A) (New York: Human Rights Watch, 2005);
9. Human Rights Watch, Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States - Texas: A Case Study 14/5 (9) (New York: Human Rights Watch, 2002);
10. R. Marindo, S. Pearson, and J. Casterline, Condom Use and Abstinence Among Young People in Zimbabwe: Which Strategy, Whose Agenda? Working Paper No. 170 (Washington, D.C.: Population Council, 2003).
11. There is a large body of literature on the shifting roles and responsibilities of NGOs as they become less philanthropic and more business-oriented. Two useful collections are provided in D. Lewis and T. Wallace (eds), New Roles and Relevance: Development NGOs and the Challenge of Change (Hartford: Kumarian Press, 2000);
12. M. Edwards and A. Fowler (eds), Earthscan Reader on NGO Management (London: Earthscan, 2002). Despite increasing mention of "rights" vis-à-vis health in international discourse and a plethora of literature at conceptual and policy levels, there remains a disjuncture between health providers (NGO and state) and human rights advocates, legal structures, and principles. There is still a lack of literature dealing with how health providers employ human rights in practice.
13. One exception is provided in R. Cook, B. Dickens, and M. Fathalla, Reproductive Health and Human Rights: Integrating Medicine, Ethics and Law (Oxford: Clarendon Press, 2003).
14. In their introduction, the authors describe how separated the work of health practitioners and human rights practitioners is. Their book is an attempt to bring these worlds closer. Another valuable exception is the IPPF Charter Facts on Sexual and Reproductive Rights (London: IPPF, 2003). This document gives examples of how their charter rights have been put into practice at field level.
15. World Health Organization, Transforming Health Systems: Gender and Rights in Reproductive Health - A Training Curriculum for Health Programme Managers, WHO/RHR/01.29 (Geneva: WHO, 2001).
16. Monitoring the AIDS Pandemic (MAP), AIDS in Asia: Face the Facts - A Comprehensive Analysis of the AIDS Epidemics in Asia (MAP: 2004): p.134. Available at http://www.mapnetwork.org/reports/aids_in_asia.htm.
17. Human Rights Watch, Bangladesh, Ravaging the Vulnerable: Abuses Against Persons at High Risk of HIV Infection in Bangladesh 15/6 (C) (New York: Human Rights Watch, 2003). Available at http://www.hrw.org/reports/2003/ bangladesh0803/bangladesh0803.pdf;
18. Human Rights Watch, Thailand, Not Enough Graves: The War on Drugs, HIV/ AIDS, and Violations of Human Rights in Thailand 16/8 (C) (New York: Human Rights Watch, 2004). Available at http://hrw.org/reports/2004/ thailand0704/thailand0704.pdf;
19. XV International AIDS Conference Satellite Meeting, Human Rights at the Margins: HIV/AIDS, Prisoners, Drug Users and the Law (Proceedings Bangkok: July 9, 2004).
20. MAP (see note 8).
21. Human Rights Watch, Thailand, (see note 9),
22. XV International AIDS Conference (see note 9).
23. Human Rights Watch (see note 9).
24. Data on HIV prevalence in prisons is difficult to obtain (generally because governments do not wish to release it), but where it has been documented, it is very high both in Africa and Asia. See, for example, University of Pretoria, HIV/AIDS and Human Rights in SADC, series of country reports on each of the SADC countries by the Centre for the Study of AIDS and Centre for the Study of Human Rights, University of Pretoria (2004);
25. see also work by Penal Reform International, including a report on Health in Prisons (2001);
26. Human Rights Watch, Thailand (see note 9).
27. A human-rights based approach to HIV/AIDS has been part of the international response to the epidemic since the mid-1980s. It was endorsed by governments of the world at a special UN session on HIV/ AIDS, when they made a commitment to tackle the epidemic and to "ensure the fun enjoyment of all human rights and fundamental freedoms by people living with HIV/AIDS and members of vulnerable groups...." United Nations General Assembly Special Session on HIV/AIDS (UNGASS), Declaration of Commitment on HIV/AIDS, GA Res. S-26/2, 26th Sess. (2001).
28. Subsequently, a special Reference Group was established to look at the interface between AIDS and human rights issues: UNAIDS Global Reference Group on HIV/AIDS and Human Rights, Public Report: First Meeting, January 23-24, 2003, Geneva, Switzerland. Despite these developments, the rights of marginal groups remain neglected, and a session documenting the detrimental effect of non-rights-based interventions for high-risk groups at the 2004 AIDS conference was incorporated only as a satellite session: XV International AIDS Conference, available at www.aids2004.org/.
29. US Department of State, Malawi Country Report on Human Rights Practices (Bureau of Democracy, Human Rights, and Labor, February 25, 2004).
30. Amnesty International, "Malawi," in Amnesty International Report 2005 (London, Amnesty International: 2005).
31. African Commission on Human and Peoples' Rights, Prisons in Malawi: Report of the Special Rapporteur on Prisons and Conditions of Detention in Africa: June 17-28, 2001 (IV/9 2001).
32. Amnesty International (see note 16).
33. There are no published data for Pakistan, but our discussions with the NGO staff working with drug users there suggests the same types of abuses that have been documented in Bangladesh, including beatings and incarcerations. For data on Bangladesh, see Human Rights Watch, Ravaging the Vulnerable: Abuses Against Persons at High Risk of HIV Infection in Bangladesh 15/6(C) (New York: Human Rights Watch, 2003).
34. Information in this paragraph was informed by the Pakistan entries to the following two publications: US Department of State, Pakistan Country Report on Human Rights Practices (released by the Bureau of Democracy, Human Rights and Labor, February 25, 2004);
35. and Amnesty International, "Pakistan," in Amnesty International Annual Report 2005 (London: Amnesty International, 2005).
36. N. Haque, T. Zafar, H. Brahmbhatt, G. Imam, S. ul Hassan, and S. A. Strathdee, "High-Risk Behaviours Among Drug Users in Pakistan: Implications for Prevention of STDs and HIV/AIDS," International Journal of STD and AIDS 1519 (2004): pp. 601-7.
37. S. A. Strathdee, T. Zafar, H. Brahmbhatt, A. Baksh, and S. ul Hassan, "Rise in Needle Sharing Among Injecting Drug Users in Pakistan During the Afghanistan War," Drug and Alcohol Dependence 71/1 (2003): pp. 17-24.
38. See R. Horstman, J. Cleland, M. Douthwaite, M. Ambegaokar, and S. Salway, Monitoring and Evaluation of Sexual and Reproductive Health Interventions (London: London School of Hygiene and Tropical Medicine/ Netherlands Interdisciplinary Demographic Institute [NIDI], 2002): p. 112.
39. R. J. Cook, B. M. Dickens, and M. F. Fathalla (see note 6): p. 554;
40. P. Hunt, Special Rapporteur on the Right to Health, Preliminary Report to the Conunission on Human Rights, UN Doc. E/CN.4/2002/58 (2002), especially Section II, which points out the need for right to health indicators and benchmarks to monitor progressive realization. P. Hunt, Special Rapporteur on the Right to Health, First Interim Report to the UN General Assembly, UN Doc. A/58/427 (2003), in which a methodology for use of indicators in relation to the right to health is outlined.
41. J. Bruce, "Fundamental Elements of the Quality of Care: A Simple Framework," Studies in Family Planning 21/2 (1990): pp. 61-91.
42. J. Theis (see note 1).
43. J. Bertrand, R. Magnani, and N. Rutenberg, Handbook of Indicators for Family Planning Program Evaluation (Chapel Hill, NC: University of North Carolina, The Evaluation Project, 1994): p. 222.
44. P. Hunt, First Interim Report (see note 22).
45. African Commission on Human and Peoples' Rights (see note 17).
46. University of Pretoria, HIV/AIDS and Human Rights in Malawi (Pretoria: University of Pretoria, Centre for the Study of AIDS and Centre for the Study of Human Rights, 2004): p. 40.
47. African Commission on Human and Peoples' Rights (see note 17).
48. R. Cook, B. Dickens, and M. Fathalla (see note 6).
49. Government of Malawi, National HIV/AIDS Policy, Office of the President and Cabinet, National AIDS Commission (October 2003): paras 3.2.3, 5.8, and 5.10.
50. University of Pretoria (see note 28);
51. US Department of State (see note 15).
52. F. Namangale, "Legalize Homosexuality Says Human Rights Body," The Daily News (Malawi) (January 28, 2005). Available at http://www.mask.org.za/SECTIONS/AfricaPerCountry/ABC/Malawi/ Malawi_04.htm.
53. It is a constant claim of the religious right that condom promotion increases sexual activity. There are no substantive data to support this; there are, in fact, extensive data to indicate that condom promotion and sex education do not increase sexual activity. See, for example, M. Garvey, Dying to Learn: Young People, HIV and the Churches (London: Christian Aid, 2003). This document provides a review of literature and explicitly addresses Christian and other religious concerns and includes a powerful preface from the Archbishop of Cape Town.
54. UNAIDS, Pakistan Country Report (2004). Available at http://www.unaids.org/en/Regions_Countries/Countries/pakistan.asp.
55. S. A. Strathdee, T. Zafar, H. Brahmbhatt, A. Baksh, and S. ul Hassan (see note 20): pp. 17-24.
56. S. Panda, A, Chatterjee, S. K. Bhattacharya, B. Manna, P. N. Singh, S. Sarkar, T. N. Naik, S. Chakrabarti, and R. Detels, "Transmission of HIV from Injecting Drug Users to Their Wives in India," International Journal of STDs and AIDS 11/7 (2000): pp. 468-73;
57. Monitoring the AIDS Pandemic (MAP) (see note 8).
58. MAP (see note 8);
59. International Programs Center, Population Division, Drug Injecting and HIV/AIDS in Asia (Washington: US Bureau of the Census, 2005).
60. N. Haque, T. Zafai, H. Brahmbhatt, G. Imam, S. ul Hassan, and S. A. Strathdee (see note 20);
61. T. Zafar, H. Brahmbhatt, G. Imam, S. ul Hassan, S. A. Strathdee, "HIV Knowledge and Risk Behaviours Among Pakistani and Afghani Drug Users in Quetta, Pakistan," Journal of AIDS 32/4 (2003): pp. 394-8;
62. UNAIDS, Epidemic Update (Geneva: December 2004): p. 87.
63. J. T. Bertrand and G. Escudero, "Compendium of Indicators for Evaluation of Reproductive Health Programs," MEASURE Evaluation Manual Series 6 (2002). Available at www.cpc.unc.edu/measure;
64. Family Health International, Behavioral Surveillance Surveys (BSS), "Guidelines for Repeated Behavioral Surveys in Populations at Risk of HIV" (2000). Available at www.fhi.org;
65. UNAIDS, National Aids Programmes: A Guide to Monitoring and Evaluation (2000), CD-ROM UNAIDS/00.17E. Available at www.cpc.unc.edu/measure.
66. UNAIDS, United Nations General Assembly Special Session on HIV/AIDS (2002), Monitoring the Declaration of Commitment on HIV/AIDS Guidelines on Construction of Core Indicators. Available at www.unaids.org;
67. WHO, National AIDS Programmes: A Guide to Monitoring and Evaluating HIV/ AIDS Care and Support (Geneva: WHO, 2004): p. 82. Available at www.who.int/hiv/pub/epidemiology/en/napyoungpeople.pdf.
68. These initiatives include work being done by the UN Special Rapporteur on the Right to Health (Paul Hunt), with a team of researchers at Essex University (UK).