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	Injustice Is Bad for Your Health by Tamar Ezer Open Society Public Health Program   Violations of rights pose a fundamental threat to people’s health and well-being.   When police officers arrest or harass those who try to access needle-exchange services, they force people who use drugs to choose between their health and their liberty. When women are denied access to land and property, they face poverty, increased risk of HIV infection, and a diminished ability to cope with illness.   When doctors violate Roma patients’ consent and confidentiality, they imbue medical care with humiliation and abuse. When dying patients and their families are too uninformed or overwhelmed to confront complex legal questions, they may leave inheritance questions unresolved, children uncared for, and social benefits unclaimed.   Thankfully, programs that improve people’s access to justice can help.   Since 2007, Open Society and our partners have experimented with a variety of approaches to improving access to justice for people who are socially marginalized—from people who use drugs and sex workers, to Roma, palliative care patients, and people living with HIV. We have found success with peer paralegals who are trusted members of the community being served.   We’ve engaged lawyers who take their practice beyond the office walls and nine-to-five workday, to connect with communities where they are. We have integrated legal services into medical settings, bringing counselors into the doctor’s office.   We have supported web-based legal advice, and harnessed traditional authorities—like local chiefs—to strengthen human rights understandings.   In our publication, Justice Programs for Public Health: A Good Practice Guide, we take stock of our work and draw lessons to share more widely. In particular, six key findings emerge:   Raising rights awareness is a prerequisite to legal services. Raising rights awareness for socially excluded groups is essential to effective justice programing. People will not access legal services until they understand that they have rights that are being violated.   They need to be able to connect their experiences with the law and available remedies. Moreover, human rights trainings for duty bearers—such as law enforcement agents, government officials, and community leaders—are critical to creating an environment where rights are protected and enforced.   Peers play a critical role. Paralegals drawn from the communities they serve have the community’s trust and, therefore, better access. They also have greater familiarity with community needs. As one sex worker said, “We speak the same language.”   Community paralegals are particularly well placed to deliver rights education and provide “legal first aid,” responding quickly to violations, addressing multiple needs that are not just legal, and connecting their peers to further support as needed.   Lawyers need to meet communities where they are. Lawyers can best serve socially excluded groups when “lawyering for the marginalized.” This entails working outside regular office hours, engaging in outreach, and meeting clients ”where they are at,” embracing a nonjudgmental, harm reduction philosophy. To address the needs of sex workers or people who use drugs, legal support must be available when abuse and arrests take place late at night. Similarly, to support people in need of palliative care or people living with HIV, legal services must be brought to the community, rather than requiring them to make a special trip.   This means engaging clients through support groups and at street-based locations, harm reduction sites, detention centers, and more.   Integrating law and health services leads to better access and care. Integrating legal services into trusted community health services increases access to justice, as well as enables holistic care. Just as HIV-specific clinics can tailor their medical care to the specific health needs of their patients, HIV-specific legal services housed in these clinics can provide customized services in a climate of respect and trust.   In the context of harm reduction, palliative care, or HIV care, people are already accessing medical services. When legal services are added, it is possible to address some of the underlying determinants of ill health, such as discrimination, violence, and lack of housing, rather than just the symptoms. Justice serves as a powerful medicine, helping to heal.   Legal services are not enough. Legal services for socially excluded groups generally work best when paired with psychosocial support and other services. Sex workers and people who use drugs may benefit from the services of a social worker to help stabilize their lives. Palliative care patients may need pain relief, as well as psychological and spiritual support.   When these additional services are provided, people are in a better position to follow up with a case. Effective referral networks and follow-up are thus essential.   Legal services are a step towards systemic change. It is not possible to strive for systemic change without addressing a community’s pressing daily concerns, including basic safety. Individual-level legal services further lay the groundwork for addressing systemic abuse by surfacing issues for broader advocacy. Legal services and advocacy are thus interlinked and complement each other.   We hope the Good Practice Guide will inspire others to recognize the critical importance of justice for health, leading to expansion of this work and interest by investors in health. We hope others will build on our lessons, sharing their own insights and good practices, bringing justice to health in other regions, as well as to socially excluded populations more broadly, access the Guide via the link below. Visit the related web page
	Civil Society in Kenya and Uganda call on World Bank to end support for privatization of education by ESCR-Net Members   May 2015   Hakijamii (Kenya), ISER (Uganda), and GI-ESCR (US), together with over 100 ESCR-Net Members and allies in Kenya, Uganda, and other regions, released a joint open statement addressed to the president of the World Bank, Jim Kim. The statement expresses their deep concerns about the World Bank’s expressed support for the development of a multinational chain of low-fee profit-making private primary schools targeting poor families in Kenya and Uganda, Bridge International Academies (BIA). It comes as a response to a recent speech of the president of the World Bank, Jim Kim, who praised BIA as a means to alleviate poverty.   With signatories including community-based, national, and international organisations, as well as networks and trade unions representing thousands of organisations and millions of individuals in five continents, the statement reflects a growing global movement questioning policies in support for private education in developing countries, including from the World Bank. The statement was written and signed by 30 organisations in Uganda and Kenya, which are the countries primarily affected by the World Bank policy, and received the additional support of 116 organisations.   BIA uses highly standardised teaching methods, untrained low-paid teachers, and aggressive marketing strategies to target poor households, building on their aspiration to a better life to sell them its services. According to a resident of Mathare, one of the oldest informal settlements in Nairobi, where BIA operates:   Bridge, they come here, but they don’t understand how things work. They don’t work with other schools, with the community. They just come from door to door to sell their product.   Nevertheless, the World Bank has invested 10 million dollars in BIA, while on the other hand it has no active or planned investments in either Kenya or Uganda’s public basic education systems.   In his speech delivered earlier in April, Jim Kim claimed that that “average scores for reading and math have risen high above their public school peers” in Bridge International Academies. Yet, the source of the data quoted by Jim Kim has not been disclosed by the World Bank, and it appears to have been taken directly from a study conducted by BIA itself.   The World Bank president further stated that “the cost per student at Bridge Academies is just $6 dollars a month”. This suggestion that $6 is an acceptable amount of money for poor households to pay reveals a profound lack of understanding of the reality of the lives of the poorest. Kenyan and Ugandan organisations have calculated that for half of the population in Kenya and Uganda, spending $6 per month per child to send three primary school age children to a Bridge Academy would cost at least a quarter of their monthly income – whereas these families are already struggling to be able to provide three meals a day to their children.   Moreover, the real total cost of sending one child to a Bridge school may in fact be between $9 and $13 a month, and up to $20 when including school meals. Based on these figures, sending three children to BIA would represent 68% (in Kenya) to 75% (in Uganda) of the monthly income of half the population in these countries.   Salima Namusobya, the Director of the Initiative for Socio-Economic Rights, a Ugandan organisation that also signed the joint statement, said:   If the World Bank is genuine about fulfilling its mission to provide every child with the chance to have a high-quality primary education regardless of their family’s income, they should be campaigning for a no-fee system in particular contexts like that of Uganda.   The speech from Jim Kim came shortly after members of civil society from several countries, including Uganda, met with senior education officials of the World Bank specifically to discuss its support for fee-charging, private primary schools, and funding for BIA in particular.   It also comes at a time where there is an unprecedented increase in financing of private education across the world, especially in Africa, often with the support of foreign investors. These investments have attracted equally growing criticism, including in a recent report highlighting how the UK government, via its Department for International Development (DfID), supports privatising education and health services. DfID is also an investor in Bridge International Academies.   The organisations’ statement calls on the World Bank in particular to stop promoting and cease investing in Bridge International Academies and other fee-charging, private providers of basic education, and instead to support the free, public, quality education which the laws applicable in Kenya, Uganda, and other countries require.   Note: BIA is backed by Bill Gates, Mark Zuckerberg, Pierre Omidiya, and multinational publishing company Pearson, among others. It operates in Kenya and Uganda, with plans to invest in Nigeria, India and other countries. It now has close to 120,000 pupils enrolled in more than 400 schools.   http://www.escr-net.org/economicpolicy Visit the related web page
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