Thursday, July 12, 2007

Friday, June 8, 2007

Experts Examine Global Toll of Pretrial Detention

Criminal justice and law reform experts, including representatives of the Justice Initiative, met in Cape Town on Friday, June 8, 2007, to examine the excessive use of pretrial detention—the practice of holding in jail suspects who are awaiting trial, rather than releasing them on bail or other surety. While acknowledging that there are proper uses of pretrial detention—such as when a suspect is a risk to flee—the experts focused on the high costs of pretrial detention.



According to Martin Schönteich, senior legal officer for the Justice Initiative, these costs include lost economic productivity of those locked away, economic and psychological strains on the families of the detained, and public health costs borne by society when detainees are released, often after being exposed to infectious diseases while in jail. The Friday's meeting looked at several different efforts to reform excessive use of pretrial detention, including different approaches taken in South Africa, Malawi and Nigeria; those reform efforts will be the subject of a forthcoming issue of Justice Initiatives.


Wednesday, June 6, 2007

Module 4 - Moving Forward


Highlights from the Training

Click here to see Ralf Jürgen's powerpoint presentation.

Activities of the Day

09:00 – 10:45 Activity 1: Strategy Building (Working Groups, by Region)
10:45 – 11:00 Activity 2: Training Evaluation (Working Groups)
11:00 – 11:30 Activity 3: Distribution of Certificates (Plenary)
11:30 – 12:30 Activity 4: Closing Plenary (Plenary)

  • Highlights from the training - DOWNLOAD MP3/AUDIO RECORDING – Ralf Jürgens, Chief Workshop Rapporteur

  • Next steps: where do we go from here?
    – Jonathan Cohen, Project Director, Law and Health Initiative, OSI Public Health Program – Yervand Shirinyan, incoming Director, OSI Human Rights and Governance Grants Program

  • Presentation of KARL (Knowledge And Resource Locator) - DOWNLOAD MP3/AUDIO RECORDING
    – Ellen Liu, Program Officer, OSI Public Health Program
    – Janet Haven, Program Manager, OSI Information Program

  • Equitas, future training opportunities - DOWNLOAD MP3/AUDIO RECORDING
  • – Rob Shropshire, Director of Programs, Equitas

13:00 – 14:30 Celebratory Lunch
15:00 – 19:00 Cape Town Orientation (Optional)

A tour of the city; participants will visit all major landmarks, beach area of Camps Bay, and Atlantic Seaboard; includes cable car ride on Table Mountain if weather permits. Participants are requested to meet by the buses in front of the Commodore Hotel at 14:45.

19:00 Dinner and Social Event

Tuesday, June 5, 2007

Module 3 - Applying the Tools


Activities of the Day

09:00 – 09:30 Activity 1: Introduction to Module 3 (Working Groups)

09:30 – 10:45 Activity 2: Analysis of Health and Human Rights Mechanisms (Working Groups)

Participants work together to prepare a short presentation of the documents. Resource persons and facilitators are available in each room to answer questions.

  • International Covenant on Civil and Political Rights (ICCPR); Siracusa Principles on the Limitation and Derogation Principles in the ICCPR
    Resource Person: Yervand Shirinyan
  • International Covenant on Economic, Social and Cultural Rights (ICESCR); CESCR’s General Comment 14 on the right to health; Maastricht Guidelines on Violations of Economic, Social, and Cultural Rights
    Resource Person: Jonathan Cohen
  • International Convention on the Elimination of All Forms of Racial Discrimination (ICERD)
    Resource Person: Willem Odendaal
  • The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), CEDAW’s General Recommendation 24 on women and health
    Resource Person: Françoise Girard
  • African [Banjul] Charter on Human and Peoples' Rights; Protocol to the African Charter on the Rights of Women in Africa Resource Person: Catherine Mumma
  • European Convention for the Protection of Human Rights and Fundamental Freedoms; European Social Charter; European Charter on Patients’ Rights
    Resource Persons: Balázs Dénes, Iain Byrne, Judy Overall

10:45 – 11:15 Networking Break

11:15 – 12:30 Activity 3: Presentations on Health and Human Rights Mechanisms (Plenary) - DOWNLOAD MP3/AUDIO RECORDING (PART 1, PART 2, PART 3)



Groups report back in plenary on the content of the documents assigned to them.
Moderator: Tamar Ezer, Program Officer, Law and Health Initiative, OSI Public Health Program


12:30 – 14:00 Networking Lunch

14:00 – 16:00 Activity 4: Hot Topics in Health and Human Rights (Working Groups)

Participants use documents from Activity 2 and the Resource Guide to work through the following hot topics:

  • Criminalization of Intentional HIV Transmission
    Resource Persons: Delme Cupido and Anne Gathumbi
  • Detainment of Extremely Drug Resistant TB (XDR-TB) Patients
    Resource Persons: Emily Bell and Roxana Bonnell
  • Pregnant Women Who Use Drugs
    Resource Persons: Balázs Dénes and Kasia Malinowska- Sempruch
  • Palliative Care and Human Rights
    Resource Persons: Liz Gwyther and Frank Brennan
  • Reproductive Rights of Roma Women
    Resource Person: Martin McKee and Jadranka Stojanovik
  • Men Having Sex with Men (MSM) in Juvenile Detention Centers
    Resource Person: John Fisher and Sue Simon

16:00 – 16:30 Networking Break

16:30 – 18:00 Activity 5: Presentations on Hot Topics in Health and Human Rights (Plenary) - DOWNLOAD MP3/AUDIO RECORDING (PART 1, PART 2, PART 3)

Groups report back in plenary on their Hot Topics.
Moderator: Susan Treadwell, incoming Deputy Director, OSI Human Rights and Governance Grants Program




19:00 Dinner*

Monday, June 4, 2007

Module 2 - Mapping the Issues

Eager to move forward … but hitting speed bumps in the road
I concluded yesterday’s report by noting how at the end of the day, participants seemed eager to move forward: to work in the next days not to debate why public health and rule of law programs need to work together, but how they can do so in practice. Today, however, participants realized they had to slow down and figure out some practical issues before they could move forward together.

Challenges to collaboration
On this rainy day, participants started in their working groups, familiarizing themselves with the strategic priorities of the Soros network’s public health and law programs. The objective was for all participants to identify the benefits of combining legal and health approaches in their respective work. To do this, public health staff were put in the shoes of law program staff, and vice versa.

Knowledge of fundamental issues
Some problems quickly became apparent that will have to be addressed if collaboration is to become meaningful. The first one is a lack of knowledge about fundamental issues and concepts that, while they are familiar to staff in one program, are not known at all to staff in the other program. Public health staff gasped in horror as some law program staff admitted candidly that they had no idea what the UN Declaration of Commitment on HIV/AIDS is. At the same time, some law program staff noted that, “while some public health staff seem to be committed to using legal tools, they don’t know much about how they can or cannot be used in practice.” Many staff noted that they do not know much about palliative care or harm reduction, two of the priorities of the Public Health Program, or some of the priorities of the Law Program. “We would have appreciated hearing a presentation about some of these issues to learn more about them and understand them better – what is in the resource guide and workshop manual is not enough, or we have not had time to read it.” Strikingly, even some of the legal tools developed or funded by the Public Health Program, such as the model legislation on drug use and HIV/AIDS [Canadian HIV/AIDS Legal Network (2006). Legislating for Health and Human Rights: Model Law on Drug Use and HIV/AIDS. Available via www.aidslaw.ca, in English and Russian], was only known to public health staff, not to most of the law program’s staff or executive directors.

Time, funding, and staff limitations
Participants mentioned other potential barriers and challenges, particularly that “staff already have a lot to do, and there is limited capacity and funding to take on new issues.” One participant said that much will depend on whether coordinators and boards at country level will be supportive. Noting that health work often deals with sensitive issues of sex and drugs, another wondered how willing staff outside the Public Health Program would be to take on work involving marginalized and often vilified communities. More fundamentally, one participant noted how different the various national foundations are, and how different their responses to the challenge of working together for health and human rights, particularly for marginalized communities, likely will be. “The reality is that when the foundations were new, they were cutting edge, but some have had a tendency to become more comfortable and less willing to confront governments on things governments do not want to do.” Public health program work is of necessity cutting edge, and it embodies the spirit of OSI as a human rights organization – but can we expect all national foundations to buy in?

Potential solutions
Ivanka Ivanova, Law Program Coordinator, Bulgaria, urged participants to move to finding concrete solutions: “I don’t have to be convinced. We have done things together. What is missing is an analysis of very practical things inside the Network that are preventing us from collaborating more often, or that are making it more difficult for us.” She pointed out how simple things, like the fact that planning cycles for law programs and public health programs are rarely coordinated, make it difficult to plan joint activities.

Introducing the first panel presentation, Jonathan Cohen stressed that “collaboration is already happening: the integration of rule of law and public health programs has been successful for a number of Soros foundations.” Participants then heard about how rule of law and public health staff from two foundations [the Open Society Initiative for Southern Africa (OSISA) and the International Renaissance Foundation (IRF) in Ukraine] have closely collaborated for a number of years and found institutional arrangements that have made collaboration effective. Sisonke Msimang and Sami Modiba from OSISA and Mariya Savchuk and Roman Romanov from IRF explained how they regularly come together to identify potential areas of collaboration, discuss strategy and approaches in joint staff meetings, review project proposals together, and undertake joint initiatives. Importantly, they highlighted that everything they do, whether public health, law, or other initiatives, is rights-based, and that this approach makes it easier for them to understand the relevance of working together for health and human rights.

During the discussion and question and answer period that followed, presenters and other participants highlighted the need to be practical, to identify concrete areas of common interest to law and public health staff in which collaboration makes immediate sense, and to start with reasonable expectations. Roman said that law and health staff “should not expect everything, but rather focus on achieving concrete results in concrete areas.” “One example is the issue of alternatives to imprisonment, one of the priorities of the criminal justice program. I simply don’t understand why we have not linked public health and law efforts, when it is clear that HIV/AIDS, TB, and drug policy are among the primary reasons why alternatives to imprisonment are needed more than ever.”

Rather than focusing on how collaborations could be effected, the discussion then veered into the never ending puzzle of how human rights organizations and lawyers can be convinced to become more supportive of issues related to HIV/AIDS, harm reduction, palliative care, and other priorities of the Public Health Program. For a moment, participants seemed to forget that this workshop was about collaboration between law and health initiatives within OSI, not about the much larger and more complicated issue of how to engage others.

LAHI rocks!
Participants agreed on one thing: the creation of the Law and Health Initiative (LAHI) represents a unique opportunity to facilitate collaboration between law and health programs, under the inspired leadership of Jonathan Cohen. “LAHI should receive all the support it needs to be able to catalyze more strategic initiatives to advance health and human rights.”

The debate about the right to health
At the end of the day, participants were treated to a riveting panel discussion on the right to health, featuring a group of distinguished, brilliant (and funny!!) judges and advocates. Françoise Girard introduced the discussion by pointing out that “it is often said that social and economic rights are a poor idea” and that “courts are poorly placed to make decisions about resource allocations.” “When courts get in the mix, there may be bad results.” She therefore asked whether “the right to health is dangerous?” The panellists acknowledged that, when interpreting and enforcing these rights, judges often face the unenviable task of weighing the critical needs of individual citizens against the legitimate budgetary constraints of the state. They argued, however, that South Africa’s Constitutional Court has successfully enforced the constitution’s provisions for social and economic rights while balancing the state’s interest in managing its political affairs. Although this balancing approach is not always easy, they concluded that the South African experience has been largely successful and that other countries might reconsider their courts’ approach to the question of social and economic rights.

Collaboration? We are already doing it! Introducing the rapporteur’s team
The rapporteur’s team shows how collaboration between public health program and law program staff can work in practice: two staff from the Human Rights and Governance Grants Program in Budapest (Andrea Simonits and Herta Toth), and four staff from the Public Health Program (Marina Smelyanskaya, Budapest; and Helena Choi, Eleonora Jimenez, and Rachel Thomas, New York) are working with me to provide you with this daily update, and are having fun bouncing off ideas, reflecting on what is happening, and debating how collaboration can be fostered and sustained. We could not do this without the assistance of Ellen Liu and Paola Deles. Our thanks also go to Lila Elman who is working with us to make sure that there is not only a written, but also a photographic record of this historic event that will forever change OSI.

We want you!
We want to hear from you. Please send your comments to rjurgens@sympatico.ca.

- Ralf Jürgens, Chief Workshop Rapporteur

Quotes of the day

“What is of particular interest to you [among the other program’s priorities and activities]? What excites you? That is where collaboration should start.”
Roxana Bonnell, Deputy Director, Public Health Program

“Is the right to health dangerous?”
Françoise Girard, Director, Public Health Program

“I personally think the right to health is essential – otherwise, you can think about health in utilitarian, bureaucratic ways.”
Colm O’Cinneide, Faculty of Laws, University College London

“The fight against apartheid was not only a fight for the right to vote, but also for a decent life. Social and economic rights, and the right to health in particular, are about the sort of society we believe in”
Geoff Budlender, Advocate in the High Court of South Africa

“I am obsessed by this topic.” [using the right to health or other rights to bring complaints of denial of health care]
Colm O’Cinneide, Faculty of Laws, University College London

“Lawyers are more organized than health people.”
Comment by a lawyer – who did not want to be identified – comparing the worksheet filled out by a group of law program staff to that of the public health staff.

“We only had one person in our group [the group discussing harm reduction] who knew anything about this issue, because we were all lawyers.”
Magda Adamowicz, Program Coordinator, Human Rights and Governance Grants Program

“Vision, passion, and action are needed. If lawyers have thus far failed to come on board as partners to fight for the health and rights of marginalized populations, we should not blame them. Maybe we health advocates have failed to make our points, to be clear about what the health implications of bad laws are, and how we can and should work together to advance common goals.”
Robert Newman, Member of the Global Health Advisory Committee, New York

“Our health program is also a human rights program.”
Sami Modiba, OSISA

“We cannot expect any deep collaboration without understanding each other.”
Roman Romanov, IRF

“This is not about collaboration between doctors and lawyers, but about the needs of people.”
Roman Romanov

“We are just at the beginning, we can go anywhere, we can use our expertise, working together, to make a difference.”
Mariya Savchuk, IRF


Activities

09:00 – 10:45 Activity 1: In Your Shoes: Health and Human Rights Programming (Working Groups)

10:45 – 11:15 Networking Break

11:15 – 12:30 Activity 2: Health and Human Rights: OSI’s and SFN’s Engagement (Panel Presentation) - DOWNLOAD MP3/AUDIO RECORDING (PART 1 & PART 2)

  • Sisonke Msimang, HIV and AIDS Programme Manager, Open Society Initiative for Southern Africa (OSISA)


  • Sami Modiba, Programme Manager, Human Rights and Democracy Building, Open Society Initiative for Southern Africa (OSISA)
  • Mariya Savchuk, Public Health Program Director, International Renaissance Foundation – Ukraine


  • Roman Romanov, Rule of Law Program Director, International Renaissance Foundation – Ukraine


  • Moderator: Jonathan Cohen, Project Director, Law and Health Initiative, OSI Public Health Program
12:30 – 14:00 Issue Table Lunch with Poster Presentations


The issue table lunch will provide an opportunity for poster exhibitors to speak informally and engage in an interactive discussion about their health and human rights project. Participants are encouraged to join an issue table of interest, and actively participate in the open, unmoderated discussion to learn how the health and human rights model could apply and be replicated in their own local context.

14:00 – 16:00 Activity 3: Mapping Health and Human Rights Issues (Working Groups)

This mapping exercise will enable participants to examine the connections between health and human rights issues in OSI programming. The process will involve participants identifying examples of health-related concerns in each of OSI’s six priority health and human rights areas:

  • Human Rights in Patient Care
    Resource Person: Dmytro Grosman
  • HIV/AIDS and Human Rights
    Resource Person: Delme Cupido
  • Harm Reduction and Human Rights
    Resource Person: Balázs Dénes
  • Palliative Care and Human Rights
    Resource Persons: Frank Brennan and Liz Gwyther
  • Sexual Health and Human Rights
    Resource Person: John Fisher
  • Health and Human Rights in Minority Communities
    Resource Persons: Martin McKee and Willem Odendaal
These six priority areas will be mapped against the following key rights issues:

  • Policing and Law Enforcement
  • Closed Institutions (e.g. prisons, drug treatment centers, mental health institutions)
  • Discrimination
  • Privacy
  • Access to Information
This exercise will form the basis for developing joint health and human rights programming ideas.

16:00 – 16:30 Networking Break

16:30 – 18:00 Activity 4: The Right to Health: Perspectives from Judges and Advocates (Plenary) - DOWNLOAD MP3/AUDIO RECORDING (PART 1 & PART 2)

This presentation will consist of a judges and advocates’ panel that will discuss the most current thinking on the right to health, giving it content in practice, and grappling with implementation questions.

  • Geoff Budlender, Advocate of the High Court of South Africa

  • Iain Byrne, Commonwealth Law Officer, International Center for the Legal Protection of Human Rights (Interights)

  • Colm O'Cinneide, Senior Lecturer in Laws, Faculty of Laws, University College London and the European Committee of Social Rights (ECSR)

  • Catherine Mumma, former commissioner, Kenya National Commission of Human Rights
  • Moderator: Françoise Girard, Director, OSI Public Health Program
19:00 – 22:00 Wine Country Dinner at Simon’s, Constantia Valley

Sunday, June 3, 2007

Module 1 - Getting Started


A bold new initiative
Over 100 participants from over 20 countries came together today in Cape Town to start a new chapter in the history of the Open Society Institute (OSI) and Soros Foundations Network (SFN). For the first time, staff from the public health and rule of law programs have come together for joint training and strategic planning.

Astonishingly, some of the staff of the two programs, although working in the same city in the same building in places such as Budapest, had never met until today, here in Cape Town – showing how big a task it will be to foster collaboration between the public health and rule of law programs. In her opening remarks, Françoise Girard, Director of the Public Health Program, was half serious, half joking when she said that “collaboration between Network programs is no trivial matter – it may be something like nuclear arms negotiations.”

At the same time, the status quo is no longer acceptable. For many years now, public health staff have witnessed the essential role of law and human rights in achieving positive health outcomes for their target populations. And rule of law staff have seen increasing opportunities to incorporate public health issues into their advocacy and programs. As Françoise put it, “we believe that expanding access to health can be a fruitful and exciting task for lawyers, and conversely, that legal strategies can help health activists make access to health care a reality.”

A beautiful, and appropriate, setting

Françoise remarked on the fact that “is particularly fitting that the workshop takes place in South Africa – in the country where an NGO, the Treatment Action Campaign (TAC), has successfully sued the government to expand access to HIV prevention and treatment” – and in the city where TAC had its founding meeting nearly 10 years ago. On a sunny day, participants were struck by how beautiful Cape Town is, but reminded that only 10 miles from the meeting venue millions of people live in poverty, with little access to health and human rights, despite the fact that South Africa is home to some of the most exemplary health and human rights initiatives in the world.

Inspiration and a call for action
Participants had a chance to hear about these initiatives from two heroes of the health and human rights movement, Khosi Xaba, well-known for her work for women’s health and rights, and Mark Heywood, one of the movement’s most visionary and provocative thinkers. Khosi talked about how, at a critical moment in South Africa’s history as apartheid was coming to an end, a group of determined women managed to put women’s health on the political agenda. Mark started by reminding us of the importance of advocacy and by acknowledging that “a lot of the work we did here in South Africa drew its inspiration from ACT-UP and groups like Gay Men’s Health Crisis.” Mark then talked about the legal action TAC and the AIDS Law Project took in 2001 to secure access to medication to prevent mother-to-child transmission of HIV (for more details, see page 2-26 of the Resource Guide on Health and Human Rights), and about other examples of legal action taken since. While he stressed the importance of litigation as a tool to advance access to medicines, he warned that litigation alone is not enough. “The real success story is how people living with HIV across the country have mobilized to claim their rights.” In an interview after his presentation, Mark said that participants should “build strong links between their public health work and their law and human rights work”, realizing that the people we work for “cannot afford to wait.” He stressed the importance of using legal strategies to achieve progress on urgently needed public health priorities, such as access to treatment for prevention of mother-to-child transmission or access to treatment for prisoners, but said that “simultaneously we need to develop long-term advocacy and legal strategies to secure broader change”. “For example, it is high time that we force governments to establish realistic human resource plans that will allow them to deliver the care people need – if we don’t do that, we will fail.” One of the biggest recent successes in South Africa is the development and adoption of the country’s new National Strategic Plan on HIV/AIDS. “Human rights have driven the process of developing the plan, are integral to all key priority areas, as well as identified as a separate priority in the plan. This represents an opportunity not only for people in South Africa, but also for health and human rights activists around the globe who should use this plan to demand similar, concrete action from their governments.”

At the end of the session, Jonathan Cohen, Project Director of the Public Health Program’s Law and Health Initiative, called upon all participants to “roll up our sleeves and to use the next days to move from inspiration to action.” “Our goal is to be better health and human rights advocates, working together. This means that all of us need to work together to enhance our strategies. We know we will have been successful when these new strategies will start making a difference for the people we work for.”

Open to change
From the feedback they have provided, participants clearly seem to be ready to work hard to make the links between their programs, and to explore all options for collaboration. In one of the working groups, participants said they were “open to new ideas”, saw “massive links between our programs and priorities” and were hoping for “concrete proposals and action.” “We are ready to change our approaches, incorporate new learning, and identify common activities.”

One participant, however, seemed to be more cautious. “It is one thing to get excited about these new ideas here, it will be another to implement them in practice when I get back to my country, to a full plate of work. I see why this important, but I hope we will get concrete, practical ideas about how to make it possible for us to move into this new direction.”

Eager to move forward
At the end of the day, participants seemed eager to do exactly that – work in the next days not to debate why public health and rule of law programs need to work together, but how they can do it in practice. “OSI is and must remain cutting edge. Often, nobody else wants to do the work we do. Who else supports the rights of lesbians in Nigeria? Who else supports groups of drug users in Eastern Europe? Who else is concerned about establishing centers that provide free legal aid to vulnerable populations? We need to figure it out, and we will. It may look like a lot of work, but in the end, it will be worth it because our work will be improved. We owe it to the people we work for.”

Quotes of the day

“We believe that health and human rights are equal partners. We believe that expanding access to health can be a fruitful and exciting task for lawyers, and conversely, that legal strategies can help health activists make access to health care a reality.”
Françoise Girard

“Health and human rights are so linked – the opportunities are massive.”
Sue Simon

My hope is that after the workshop it will be impossible to imagine doing health and human rights advocacy in anything than a collaborative fashion.”
Jonathan Cohen

“The worst way to form alliances is to start a network.”
Mark Heywood

“Without vision you don’t get very far”
Khosi Xaba

“We don’t want this to be donor driven. We want to know how we can encourage collaboration. What will work? What will not work? We want your feedback.”
Emily Martinez

Activities of the day

13:00 – 15:00 Registration at the BMW Pavilion

14:00 – 15:00 Poster Exhibition and Reception

15:00 – 15:30 Activity 1: Welcome and Opening Remarks (Plenary)

15:30 – 16:30 Activity 2: Success Stories in Health and Human Rights in South Africa (Keynote Panel)

  • Moderator: Tawanda Mutasah, Executive Director, Open Society Initiative for Southern Africa (OSISA)
  • Khosi Xaba, University of Witwatersrand - DOWNLOAD AUDIO/MP3 FILE
  • Mark Heywood, Director, AIDS Law Project - DOWNLOAD AUDIO/MP3 FILE

16:30 – 17:00 Activity 3: Overview of the Workshop (Plenary)

17:00 – 17:15 Networking Break

17:15 – 18:30 Activity 4: Introductions and Expectations (Working Groups)

  • Introductions of group members
  • Expectations for the workshop
  • Explanation of the Resource Guide

19:00 – 21:00 Dinner at the Clipper (Commodore Hotel)