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Human Rights Reader 42


On capacity building needs: The macro issues in Human Rights.

Capacity development is not merely the acquisition of skills, but also the
capability and power to use them.

Why so little progress:

1.In general, within existing institutions and structures, capacity building
work towards the achievement of the rights to health and to food (or to
adequate nutrition) is currently still highly inadequate.

2.The inadequacies relate largely --but not only-- to constraints imposed by
the international political and economic order which is the one that is
relentlessly deepening inequality, poverty and injustice --the root causes
of the excess malnutrition, ill-health and mortality of poor people.
In other words, the rights to health and food are closely related to, and
dependent upon, the realization of other human rights, frequently beyond the
immediate (but eventually achievable) control of beneficiaries.

3.Poverty is the single most important determinant of health. But health is
very far from being the single most important determinant of poverty. Poor
health exacerbates existing poverty. [From health services one gets health
only...].

4.The enormous gap between human rights declarations and their realization
can only be filled by addressing the international and national dimensions
of power, the root causes of poverty, as well as the relative current
powerlessness (or procrastination) of governments to meet their human rights
obligations.
In most developing countries, the willingness to formulate policy is yet to
be matched by action.

5.And action has to start with capacity building for claim holders and duty
bearers alike for them to unequivocally understand that the determinants of
poverty are fundamental violation of human rights --evidence for which has
been around for over 150 years...
[Under the same optic, the pervasive privatization-of-public-social-services
model is, by itself, a violation of human rights...].

6.People also have to be made to understand that:
-macroeconomic policies imposed by International Financial Institutions
(IFIs),
-the world crisis in democracy,
-the weakening of states,
-the control of information,
-militarization and state terrorism (bringing us to open war), and
-the 'capture' of the UN system by these macro issues so that it finds
itself
 with the hands tied to turn the spirit of human rights declarations into
 reality,
all are equally major obstacles to the achievement of health and adequate
nutrition as human rights (HR).

7.But even under these compelling constraints, the strategies and actions of
the international and national health and nutrition community are still
heavily influenced by neoliberal thinking.
[We all have our preconceptions that limit our resolve to act within a true
HR perspective...].

8.The decision to implement programs and policies within the perspective of
HR implies an enormous effort of consciousness raising and capacity building
at many levels. It is a continuous process that needs to permeate all our
activities in our work and in society as a whole.
[If only this would be universally understood...].

9.But, beware, even adopting a HR framework does not automatically change
the way managers relate to beneficiaries. This, since the latter are still
not always seen as full citizens with the same rights as more fortunate
members of society.

10.Let's face it, in development circles, health is still mostly promoted as
a tool for economic growth rather than as a human right. Medical/technical
interventions are proposed as solutions to health problems... as 'the way
out of poverty'...(!).
Furthermore, this approach disallows discussions about and actions to
directly tackle structural inequalities and the root causes of poverty and
powerlessness and their consequences in terms of preventable malnutrition,
ill-health and mortality. In short, this approach maintains and, if only
tacitly, reinforces the current international order.

11.For example, the power of transnational corporations (TNCs), accountable
to no-one, is in direct conflict with the principles and aims of the UN to
enhance human rights and the capacity for self-governance. IFIs and TNCs
simply have to be made accountable for their actions in terms of meeting
their (so far poorly explicited) HR obligations.
[But do professionals in this area --and some UN agencies flirting with
TNCs-- really worry greatly about this...?].

12.Human rights work, badly needs to produce the evidence on the obstacles
faced by state parties to meet human rights obligations and, more so,
obstacles preventing people/communities from meeting their basic needs --to
then use this evidence effectively in capacity building.

[From the above, then, already flows a full mini-agenda for action...].

Four more areas of need:

13.The 'access-to-treatment-for-HIV/AIDS movement' illustrates numerous
aspects relevant to equity and HR work; it provides an evidence-based
example of a strong grassroots civil society mobilization that has
successfully raised legal and advocacy issues from a strong rights
perspective. Their claims are now increasingly taking a regional and
international dimension.
These groups now urgently need capacity building in HR.
They need to go beyond directly addressing equal access to care in
resource-poor environments and need to start raising more overall health
system concerns. A greater HR focus can help them contesting resources in
ways that are pro-poor and open doors to access resources outside the health
sector.

14.The 'patients-rights movement' has, so far, not been much involved in
promoting a veritable right to health approach. Patients' Rights Charters
have promoted the right to health care alright; but they have focused more
on improving the availability of minimum quality health services and have
addressed health primarily as a socio-economic right; few of these movements
have been linked to de-facto strategies mobilizing beneficiaries. In short,
the limitations of this movement may be as many as its successes. In the
future implementation of such charters, the role of public participation
will be as critical as the further capacity building of their promoters in
HR.

15.The few existing 'civic coalitions (or people's movements) for health'
also have the potential to progressively adopt a rights-based approach to
more effectively influence State policies. Few have done so so far. They
thus also urgently need capacity building in HR.
Where these coalitions are active, the actual expression of social and
economic rights at community level gives them a greater potential to promote
more equitable public policies . This, because the HR approach can clearly
strengthen the proactive engagement of communities with the State by
fostering a participatory empowerment that promotes social justice and
equity, in our case in health and nutrition.
A HR approach will also confront these communities with what they need to
know about how the negative aspects of Globalization impact them (this will
not happen automatically though; the process has to be explicitly steered in
that direction).

16.Furthermore, the role of 'organized labor' in pushing for health equity
through a rights perspective has also been neglected. Labor unions now need
as much capacity building in HR as the above groups.

[Another couple mini-agendas for action here. The challenge is to take a
practical approach to these questions so as to make the HR message central
and, at the same time, accessible to those being empowered through the
needed capacity building...].

State, society and Human Rights:

17.It is the obligation of the State and of society to create easily
accessible legal and administrative mechanisms for use by the population as
instruments to denounce and seek correction of violations of HR.

18.Examples of such violations most of us fail to identify are actions that:
-bring about or facilitate the expulsion of small producers from their land;
-allow importing food products at below national production costs;
-cause reductions in the support to national food crops production;
-create unemployment;
-discriminate against participants in social programs;
-close down social programs directed at vulnerable groups;
-allow enterprises to violate HR, (e.g. mergers that result in
 large dismissals of staff);
-are lenient towards those responsible for oil spills that jeopardize the
 livelihood of small fishermen;
-condone the introduction of dangerous foods in the market;
-allow dishonest advertising of certain undocumented nutritional values of
 foods...

19.Other examples of violations include:
-the allocation of grossly insufficient budgets for health;
-the non-elaboration of national policies on food security;
-the non-fulfillment of agreed-upon health and nutrition (Millenium) goals;
-allowing vaccination coverages to slip;
-the non-information of citizen about their rights in health, education and
other social spheres.
[Do any colleagues you know greatly worry about any of these...?  I
seriously contend that, as part of a HR approach, it is time they did.].

20.To bring home the concept of rights, we can use the not so simplistic
example of our own families: Not all their members can, by themselves,
guarantee their own daily sustenance. In a way, the family has to provide
for those of its members who cannot provide for themselves. In the same way,
society needs to guarantee mechanisms that assure all its members have the
economic and physical possibility to access adequate health and food. Each
individual household simply has to be treated with equity.

21.Condoning preventable hunger, disease and misery represent the negation
of our individual and collective humanity. This dehumanization is not only
the one that affects those who do not get their needs fulfilled, but also
the dehumanization of society that does not guarantee them the corresponding
rights.

22.Paternalistic approaches to secure the fulfillment of needs establish a
relationship of power and submission that, in itself, violates the rights of
beneficiaries. Our societies have a long history of paternalistic and
authoritarian approaches to development.
The process of construction of a truly democratic society passes through the
redefinition of the roles of its social actors and the State.
[How and when will each of us redefine our roles --individually and
collectively...?].

23.Health staff, for instance, has the obligation of informing beneficiaries
of their rights. But there is a lack of information on the side of these
public servants about their duties in relation to people's rights. Only one
thing is sure: There is no justification for the non-realization of HR. So,
again here, these civil servants urgently need capacity building in HR. [We
urgently need to design ad-hoc training modules (both their contents and
effective teaching methods) and to train a rather massive cadre of
alternative trainers; let us hope that the upcoming UNICEF and CARE
materials will guide us in this direction].

24.Many small, unpretentious capacity building exercises in the direction of
HR in different sectors of society will eventually have a synergistic
effect. An increase in the consciousness of the population about their
rights --and decisively exercising the same-- will ultimately increase the
pressure on public and private services, not allowing them to procrastinate
any longer in terms of improving the same.
Joint action of all actors in their different sectors is needed.
[Divided we beg; united we demand...].

Claudio Schuftan, Ho Chi Minh City
aviva at netnam.vn

Mostly taken from Rene Loewenson, EQUINET-news, Feb 11, 2003, Flavio
Valente, HR and the promotion of nutrition and healthy life styles, mimeo in
Portuguese, 2002, SCN News No.25, HR and food security capacity building,
Dec 2002, pp 58+59; and Alison Katz, for the People's Health Movement,
submission to the UN Committee on HR, Sub-committee on the Promotion and
Protection of HR, Feb 2003.