Demand creation for the Discrimination Reporting System. 2014

Title: Demand creation for the Discrimination Reporting System. 2014

Time frame: Jan – June 2014

Funder: RTI (Research Triangle Institute) 

Project Description: Despite the knowledge in circulation regarding HIV and AIDS, stigma and discrimination (S&D) continues to remain a significant problem for Persons Living with HIV (PLHIV) and Key Populations such as Female Sex Workers (FSWs) and  Men who have sex with  Men (MSMs). HIV disproportionately affects these key populations, meaning that PLHIV who also fall into one of the categories of Key Populations, especially MSM or FSW can face two layers of S&D in society. This is a huge problem because the impacts of stigma can be extremely negative. Stigmatized individuals can be faced with avoidance by their communities, rejection by their families, isolation, denial of access to basic services, and in extreme cases, physical violence, torture, and murder.

While stigmatization and discrimination do not generally escalate to a level of physical violence in health care facilities, it remains a problem to the extent where it can prevent key affected groups from wanting to seek health care.  More so the need for continuous efforts in fighting Stigma and discrimination within health care facilities across Ghana. It is also imperative that PLHIVs and key populations be aware of their basic human rights and know of the resources available to them in case they encounter stigma or discrimination.

Between 2011 and 2013, the Health Policy Project (HPP) with support from PEPFAR/USAID spearheaded a project aimed at developing an online discrimination reporting platform. Through various collaborative and strategic meetings, particularly with the Commission on Human Rights and Administrative Justice, (CHRAJ), Ghana AIDS Commission, (GAC), governmental and non-governmental stakeholders, the efforts of HPP culminated in the launch of a web-based Discrimination reporting system in January 2013.

To facilitate demand and uptake of this innovative Discrimination Reporting system housed and managed by CHRAJ, WAAF partnered with CHRAJ to educate key populations, especially MSM and FSW as well as PLHIV about their basic human rights and what to do when these rights are violated, including reporting such case onto the Discrimination Reporting System.

The project consisted of three parts: 1) the planning and organizing of training on  Basic Rights including responsibilities within those rights for PLHIV, key populations (MSM and FSW) as well as service providers,  across the Greater Accra, Ashanti, Eastern, Central and Western Regions, 2) the carrying out of these training and encouraging and assisting those trained and their contacts to report cases onto the system and 3) the design, printing, and distribution of posters to vantage facilities in the five regions to remind viewers and clients to report discrimination that they encounter or see happening to others onto the reporting system.

Project Beginnings: The project kicked off with an inception meeting, held on the 3^rd of February 2015 at the CHRAJ office. CHRAJ headed the meeting and expressed a need to connect with partners in order to fully and adequately protect the human rights of Ghanaians. At the meeting, problems of stigma and discrimination were discussed, especially in relation to how this affects key populations and how the project could contribute to addressing these. Participants stressed the need for new and creative ways in handling stigma and discrimination issues, in the hopes of reaching the greatest number of people.

Results/Outcomes/Impact:

• Development of Training Manual: Evidence from the field had revealed a general lack of knowledge in human rights among PLHIVs and KPs and as such a training manual focusing on PLHIVs and KPs understanding their fundamental human rights had to be developed. Surfing through a number of available literature, it became evident that in spite of the many works that have been done on PLHIV and Key Population related stigma and discrimination through training, gaps still existed in almost all the HIV-related Stigma and Discrimination training modules from a human rights perspective. While there are excellent training modules available on PLHIV and Key Population related Stigma and Discrimination, in terms of material contents, there is very little or nothing at all on HIV and Key Population related Human Rights education in Ghana. The design of the training module therefore aimed at filling the missing gap of Stigma and Human Rights. The training modules drew on existing best practices and adapted several existing training modules and manuals to provide facilitators with the information, specific activities, and materials needed to effectively plan and deliver a hands-on training program. Designed to address the knowledge and skill gaps reported as the cause for the underutilization of the Reporting system, it provided participants with a complete understanding of the purpose of the system and the benefits to the community, as well as created a sense of agency within the participants.  Emphasis was placed on participant reflection, discussion, and action. A copy of this manual can be accessed
• Training: Training sessions using the designed training manual were planned for PLHIV, MSM, FSW as well as selected service providers in five (5) regions of the country.
• Poster Creation and Distribution: The final part of the project involved the designing, printing and distributing of marketing materials with the goal of reminding people of the CHRAJ’s Discrimination Reporting System and to prompt them to report any instances of rights violation.  Based on recommendations from the target group themselves, posters were developed which were subsequently approved by the Communications Technical working group of the Ghana AIDS Commission. The posters were distributed to various facilities in the 5 regions such as the OPDs of hospitals and clinics, ART centers, counseling centers of the clinics and hospitals, DICs, office places of partner CSOs with the goal of adding value to the project as many would constantly be reminded of the Discrimination Reporting System and would more likely use the platform.
• Dissemination Meeting: An exit conference was organized to engage key stakeholders as part of efforts to climax the project. The meeting which was held to officially announce the closure of the project brought together key partners and beneficiaries to share their responses and contributions to the course of promoting human rights and addressing the issue of stigma and discrimination against the marginalized in our societies. In his opening remarks, the then-acting Commissioner for the Commission on Human Rights and Administrative Justice, Mr. Richard Quayson, reiterated the need to fortify efforts of upholding individual rights within the context of human development and peace sustainability. According to him, the risk associated with rights abuses is tied to a lack of knowledge and respect of the law which has intricately woven into the socio-cultural fabric of our societies. Combining efforts with state institutions is therefore one of the ways of building stronger campaigns against right abuse in Ghana. He said the commission remained resolute in protecting individuals’ rights and will continue to open its doors for collaborations in pursuing this course.  He expressed gratitude to the West Africa AIDS Foundation for playing a central role in raising the bar for the demand and use of the S&D reporting systems. Other partner organizations who participated in the meeting including FHI 360, WAPCAS, Prolink, and NAP+ gave brief presentations on their contributions to generating demand for the use of the platform. According to them, the collaboration has seen a rise in cases reported by each organization indicating a general acceptance and trust of the system as a means of bringing to light the darkness of stigma and discrimination. They touted the system as being user friendly and easy to complete. One partner organization shared a success story of using the system to report a case on behalf of a beneficiary and receiving a quick response to that effect. They pledged their commitment to promote awareness and the use of the system.
• Lessons Learnt: Various lessons were learned over the course of the implementation of this project. Worthwhile mentioning was a recognition that in the fight against stigma and discrimination it is important to not only focus on those who discriminate but also on those who are discriminated upon. Contrary to efforts taken over the years that had mostly fought stigma and discrimination focusing on those who might discriminate, the Discrimination outreach project focused on those who are discriminated upon.  Bridging the knowledge gap on their fundamental human rights and what to do when these are violated, is indeed leading to increased reports of such cases which eventually will fight stigma and discrimination as perpetrators are dealt with. The implementation of this project gave enormous insight into what is perceived as stigma from the perspective of key populations and PLHIV which is somewhat anomalous to what is viewed by many activists. From the engagement with them, we realized that the use of some words and phrases which are considered normal are often viewed as offensive on the part of the key affected population. Words such as “boisterous” to describe a lady could make her feel offended. Likewise, the use of “effeminate” to describe a man who behaves like a lady could also make them offended.  These experiences have taught us and many other service providers to be mindful of our choice of words especially when dealing with KP groups to avoid creating animosities that could impact negatively on service delivery. Working closely with the various groups has also led to those of us working on their behalf get to understand them better. During the various participatory training, representatives from the ally CSOs as well as the CHRAJ facilitators, continued to learn more from the different groups such as clear examples of the stigma they continue to face which would only enhance the way we work with them. It also enhances our understanding of how to involve beneficiaries in projects we undertake on their behalf to ensure a bottom-up approach to tackling issues that concern them. Indeed, the project has better enhanced our understanding of how to tailor interventions to address the core needs of KPs.