Citizens’ Role in Meeting MDG’s – Promoting Adequate Health Care Services

Have you ever wondered whether you have a “say” in what happens in your community? And if the thought crossed your mind, what did you do? Did you just “sit there” and did nothing about following up, or exercising your mind about that sporadic or constantly nagging feeling or notion? If the thought had jabbed your mind, you may then feel bewildered that your silent reflection is no longer secret- you are reading about here. Well, fear not, many persons are also asking themselves the same question, and a few are doing something about it.

Two days ago, I walked past a group of people discussing a predicament occurring in a remote village. According to one of the opinion leaders, an NGO built a clinic on a family’s land, without the knowledge of any one member of the family who owned the land. The situation has created a rift among a few of the town’s elders – with one group accusing the other of selling a family’s property, while the other group remains on the defensive.

Now, how did that happened? Did the NGO in question involve all sectors of that community in the planning of its “developmental program,” or just a handful of those whose “voices are louder,” or those who are domineering and speak the loudest?  In every society, there are those who speak the loudest, but being loud and dominance at every platform doesn’t necessarily equate to being organized and articulate.  However, since citizens must have input in decisions affecting their lives, does it mean that those who shout the loudest are going to get the most get attention? Well, that may not always worked, especially if the involvement of all members of society becomes necessary, and somehow an obligation for initiating developmental programs.

Including Liberia, most postwar societies are faced with the herculean task of rebuilding social services, and meeting the Millennium Development Goals. The Millennium Development Goals, (MDG’s) includes eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, combating HIV/AIDS malaria and other diseases, ensuring environmental sustainability and developing a Global Partnership for Development. The aim of the MDGs is to encourage development by improving social and economic conditions in the world’s poorest countries. And for poor countries that experienced wars and crises like Liberia, its development (human and infrastructure) has been gravely reversed by the war and crises. 

As I conversed with one of the participants at the gathering, the presence of a new comer moved the group to a new level of enthusiasm. The new comer was a health worker, who had also been taken aback by the “development” in her village. This person then brought forth a whole lecture about the challenges of health care services in our country. We all listened, but as the lady continued to speak, I began considering some practical approaches learned from a Development strategist, Ms. Maria Green. At several lectures and training programs, Maria Green, now Visiting Scholar at Northeastern University School of Law underscored the need for organizations to incorporate the Rights-Based Approach (RBA) to planning and implementing developmental programs. That’s because the RBA method encourages full participation of citizenry in the planning and process involved in developmental activities to ensure empowerment, productive outcome and sustainability.

I learned from Ms. Green strategies for integrating human rights approach to development in ways that linked developments with human rights, accountability, empowerment, full participation, remove non-discriminatory practices and paying attention to the most affected people in societies.

When I told the health staff and participants at this informal gathering about the RBA approach, it was glaringly evident that there was a need to also apply the RBA approach in educating/informing and sensitizing the group about the Rights-Based Approach to Development.

An organization applying the Rights-Based Approach (RBA) to Development methodology will differ from an ordinary developmental program in many ways.  However, in applying the RBA approach, NGOs can adapt some human rights based approach on the provision of health care to the indigenous community and other vulnerable groups in the country without appearing confrontational, especially since the general perception about human rights (by most “advocates” and a segment of society) is that human rights is only successful if it is confrontational, or seems to be in a battle?

A conventional non-governmental organization like the (non-RBA) NGO operating in the small village may have good programs, but it doesn’t necessarily make sustainable progress in ensuring that members of the community, particularly the indigenous and vulnerable groups in the society are receiving adequate health care services. The shortcoming of such organizations is probably because of its inability, or limited approach in identifying and addressing the root causes of the prevailing health care services in the communities.  Unlike a conventional NGO, an organization that applies the Rights-Based Approach seeks to find out why the needs and rights of certain segments of society are unmet. After its assessment, which would basically involve the full participation of citizenry, the RBA NGO would then galvanize the input of the people in strategizing how the needs and rights of members of society can be met.

The United Nations High Commissioner for Human Rights briefly summarized a Rights-Based approach as, “under a human rights based approach, the plan, policies and processes of development are anchored in a system of rights and corresponding obligations established by international law.” The traditional rights approaches (not RBA approach) focus solely on the State’s obligations and responsibilities, leaving little space for active citizenship or community driven alternatives essential for long-term, sustainable transformation. The RBA differs by empowering those living in poverty to negotiate their roles and entitlements with the authorities.

What this means is that a rights based approach to the provision of health examines the “rights” and policies on the delivery of health care services,  assess gaps in development programs, and if any, the exclusion of groups from health care services, and how these negatively impact sustainable development programs. Rights- based Approach also works with “rights holders” in the planning of policies and programs, wherein States or the “rights holder” will put in place measures to ensure the “availability” of adequate and functioning health services. The States or “rights holder” will also institute measures to make sure that health services are “accessible” to everyone; that the services at health services are freed of any form of barriers that will result to “discrimination,” and that the services are of “good quality” and appropriate in fulfilling the rights of everyone.

Another feature that distinguishes a Rights-Based Approach to development from organizations that focuses on traditional approach is the full participation of citizenry in programs. Unlike other organizations where participants are invited to program, and participation of members of community is minimal during the planning, the progression and implementation of all programs, in the Right-Based Approach, participation is the “fulfillment of respect for an individual’s human rights, ” a key component to empowering people to claim their rights, and  approach to fulfilling the “claimants” right to participate in decision making processes of issues affecting their lives, and the world around them. Unlike traditional programs that focuses on the outcome of developmental programs, under a Rights-Based Approach the process applied in the provision of health services is as essential as the outcome. Rights-Based Approach looks at the method used to reach the outcome. If the method is faulty, the outcome is considered flawed.

Every NGO or organization can adapt the Rights-based Approach without taking an oppositional stance against the government. While Rights Based Approach may at times require holding the government accountable, most organizations formulate strategies to hold government accountable without appearing confrontational. In working with government, NGO and organization will help in designing and implementing programs to promote good health, and the delivery of adequate health services to all citizens. Programs designed around Rights-based are non discriminatory; they are designed to empower people to claim their rights, while fulfilling the rights to health of all members of society.

While the Rights-Based Approach may appear like it is assuming a “human Rights’ stance, the approach presents NGOs the opportunity to become an active participant in working towards the advancement of people and the development of society, including the indigenous groups.  A rights-based approach  offers strategies  for government and other “right holders” to increase their capability to uphold their obligations in providing adequate health services and programs to fulfill the rights of all members of society, without always taking an aggressive position.

At the end of the discussion, heads were nodding. The group’s discussion filtered to compensating the family whose land was [forcibly] used to build the clinic, as a first step in embracing the Rights-Based Approach to development and promoting health care services that is accessible and available to all persons, irrespective of background.