Monday, 30 July 2012

Advocacy, Lobbying, and the Caregivers' Conference

I'd always believed in the proportional representation system until it came to working with Namibian MP's, who say they owe their position and power to their party, and not - directly - to the people. Lobbying, therefore, needs to be undertaken differently here.  If we wanted to advocate for the rights of care providers in Namibia, we would have to demonstrate why this would be worth it for the party and the individuals within it - it wouldn't swing it to say "you have an obligation to your constituents, who elected you."  

Liaising with parliamentarians has been an important part of our advocacy work with VSO on the issue of care providers in Namibia.  If we want to make any lasting, important changes for the care providers, then we'd need to go to the decision makers themselves. 

VSO had arranged a lunch date with two MP's - Swartz and Kavetuna - who'd been previous allies of VSO on the issue of care providers.  Swartz had, herself, been a care provider with Catholic AIDS Action down in the South of Namibia, in the Karas region. During the lunch date, which was attended by LAC, NANASO and VSO as well as the MP's, we discussed which organisation might take on lobbying of the issue after VSO departs Namibia, and asked the MP's who they could bring to the table for VSO to talk to. Whilst they gave some interesting ideas and names, afterwards we felt quite dispirited.  It looked like no-one would be willing to advocate for the care providers after VSO's departure: NANASO is facing financial issues thanks to trouble with the Global Fund, and the LAC only takes on projects that donors pay for - issues and lobbying are, therefore, donor-driven.  We'd have to get as much done before March 2013 as possible if we wanted to make any lasting change.

One fantastic suggestion given by Kavetuna was to meet with two standing parliamentary committees (Gender and Human Resources) the following week, to present the case for effective government implementation of the care providers' policy, which would drastically improve conditions for the care providers. Preparation took the whole week, with emails between Friendly Haven, LAC, NANASO and VSO pinging back and forth on division of subjects and coordination. On the day itself, the numbers were impressive: 10 MP's and 9 representatives of civil society attended (2 from NANASO, 2 from LAC, 1 from VSO, 1 from Friendly Haven and 3 VSO volunteers).  NANASO discussed current policy implementation and the need for government to take over the funding of the care provider programmes in the face of donor withdrawal, LAC discussed male involvement in care, and Friendly Haven talked about the experiences of care workers on the ground and the importance of support.

The MP's were clearly pleased with such a slick presentation and asked pertinent questions, eventually asking us outright "so if the government took on financing and implementing the policy, then this would help to address many of the current issues?" "YES!" was the resounding answer.  The MP's asked if they could attend the VSO Caregivers' Conference the following week, and promised that they would lobby the Minister for Health, Kamwe, about the issue - it would be politically beneficial for him to demonstrate that he was proactive in protecting Namibian's rights and health systems, since he'd had a lot of bad publicity recently.  We left Parliament feeling jubilant. NANASO, seeing the huge potential in continuing to lobby for this issue, also indicated that they would be willing to take on the campaign following VSO's departure.  


The following week, VSO held the annual Caregivers' Conference (Alex and I had facilitated at the conference the previous year, and were thrilled to be back). From our travels around Namibia, Alex and I were able to invite more groups of caregivers to this conference, since groups from the South hadn't been present at previous conferences.  VSO did a fantastic job of inviting the Minister for Health, Kamwe, to attend and give his support as well as launch the simple guide of the government policy on caregivers - this guide was project managed by Alex at LAC, and was published in the form of a comic. It's designed to explain the government policy simply so that caregivers would understand what rights they have and what support they should expect to receive. Alex had worked really hard on it, and was pleased to see it in print.

Kamwe launching the Simple Guide

The conference opened with the National Anthem (for those who haven't heard the Namibian national anthem, here it is:  http://www.youtube.com/watch?v=mVfzDhp7d5g&feature=related) and was followed with speeches from Swartz, Kavetuna and MP's from Zimbabwe and Malawi, and lots of song and dance from the Maranatha Singers.  Gabes, Alex's colleague from the LAC, and Sandie from NANASO, gave a fantastic joint speech on the two research reports that we'd done, on the caregivers' policy, and male involvement in care. It went down fantastically well, and Alex, Kat and I could, from that point, breathe slightly easier.  The reports had also been printed and were distributed to everyone. 

Maranatha Singers

The presentation on the research we'd done

Swartz's speech

Carolina from VSO commenting on proceedings

The National Coordinator for community and home-based care programmes then also stood up and gave a speech about how well the government was doing in its implementation of the policy - despite all facts and indicators to the contrary.  It was enormously frustrating, sitting there and knowing that what was being said wasn't true.  Fortunately, the MP's found their voice and challenged him on nearly every point, and questions continued for so long afterwards that the next performance act had to be cancelled.  The caregivers were very excited, and told us they were thrilled that they could finally have their say, and talk directly to MP's about their experiences, and challenge them too.  And they could see that organisations like VSO did care about them, and were working for them.  "We feel more valued" one woman told us, before we headed out of the room for tea and coffee.

Delightful MP from Malawi gives a speech about the challenges facing care providers in his country.

The following day, Alex, Kat and I had big plans.  Whilst VSO and LAC were taking the MP's into another room and discussing lobbying and next steps with them, the three of us, plus Gabes from the LAC, were taking all 50 caregivers, dividing them into two groups, and giving a day of training for them on what advocacy is and how to do it - with some self-care activities added in. 

Friendly Haven care givers and the LAC AIDS Unit Lawyer enjoy the activities

'What is advocacy' activity

At one point, the MP's, who'd finished their discussion in the other room, joined in with our activities and then gave the caregivers half an hour to directly talk to them about their issues, concerns and questions.

Kat's group with the MP's

Continuing discussion

Alex and Gabes' group - Gabes provided an essential translation role, translating into Afrikaans and Oshiwambo

A 'living web' activity on the Namibian political system, demonstrating 'who influences who' and how the 'average Namibian citizen' fits into it all.

A role play on approaching and lobbying political figures

Gabes and Alex in discussion

A self-care activity on 'saying no'.

Amelia, my colleague from Friendly Haven, translates into Oshiwambo when Gabes has to step out

Certificates followed the next day, and bags made by Friendly Haven staff were given to everyone. The big smiles on the faces of the caregivers and MP's was well worth seeing.

The conference was exhausting, but well worth it - and it was with some sadness that we realised that the final VSO Namibia conference had just taken place. We ended it with seven of us from VSO and GEMSA (South Africa) drinking wine around a table while the hotel staff cleared up the room around us.  

Wednesday, 4 July 2012

They Have That Heart and Caring for the Care Providers

Since we completed the two rounds of research trips interviewing men involved in home-based care, we've been writing the subsequent report. It hasn't been an easy process - we've ended up with over 200 pages of notes, 20 lists, over 400 pictures (mostly blurry/badly taken) and an overwhelming sense of responsibility: towards VSO, towards our bosses, and most importantly towards the care providers, whose story we were telling.

We then had to figure out how to write a report about male involvement in home-based care in Namibia. Grouping the large amounts of information under thematic headings, and whittling quotes down to the most useful and/or representative of what the care providers were saying, we eventually managed to work out a structure and necessary chapters for the report.  Choosing a title for the report was the fun part -  over a few glasses of wine, we came up with a choice between 

'Care Bears: Male Involvement in Community and Home-Based Care' 
or 
'They Have That Heart: Male Involvement in  Community and Home-Based Care'. 

The second choice won out, obviously, as it was a phrase we'd heard repeated time and again throughout our travels in Namibia. Writing the substance of the report came next, and took a long time - writing, writing, re-writing, ironing out, re-drafting, proofing, editing, re-editing, tearing up, crossing out and adding in. I suddenly had a much greater appreciation for writers, academics and publishers during those long evenings fuelled by little more than wine, caffeine and a sense of purpose.

During the research trips, our colleague Tricia from the Philippines was also investigating the extent of implementation (or not) of the government's policy on community and home-based care. She then wrote the report 'Caring for the Care Providers', detailing the fact that implementation and levels of support vary widely between Namibia's many regions. Most of the funding that fuels care providers in Namibia currently comes from foreign donors - who are now pulling out of Namibia following its re-classification as a middle-income country. Care providers - who provide frontline health services in Namibia - are going without any support at all, and are not paid.  Imagine if, in the UK, our community health visitors and district nurses were volunteers,  unpaid, with little or no support.  This is Namibia's situation - and the government is resting on its laurels, reporting on the volunteer's hard work on ARV roll-out to donors, whilst volunteers prop up its health system for free.

The health system in Namibia makes me feel very lucky to live in a country where health care is free. Here in Namibia, when you call an ambulance they ask about money first, problem second. Alex had to call an ambulance a few months ago when a pregnant colleague collapsed at work, they asked him how much money he had on him before they would agree to come and get her (and then they didn't turn up 'cos they couldn't find the place).  Alex and I are lucky - VSO covers all our health care needs. But even then, we see how difficult it is, living in a system where health care is privatised.  VSO argued for months about whether they would pay for my wisdom teeth to be extracted here in Namibia as the insurance company didn't consider it an 'emergency' and so wouldn't pay for the procedure.  I was left in considerable pain while they debated the issue. I didn't have the money to pay for a flight home to my dentist, and VSO wouldn't fly me back as it was cheaper to have me treated in Namibia - so eventually, they caved and put me out of my misery, paying the equivalent of £400 for the ten minute (pain-free) procedure.  When Alex fell ill two weeks after we first arrived, VSO organised and paid for everything - here, even just an MRI can cost the equivalent of £1,300. Imagine if you are a caregiver, earning the equivalent of £5 a month, how can you afford insurance for yourself and your family, let alone the procedures themselves? Even the state hospitals still cost money - there was a case a few months ago where doctors turned away a woman and child because they couldn't afford the N$10 entry fee (about 90 pence).  The child died in the mother's arms as a result.  To the idiots in the UK who think it's a good idea to privatise our health care system, think for a minute.  We are so lucky to have a system that looks at you, and not your wallet. Yes, the NHS has its problems (much to learn from the French system), but it still provides an excellent standard of health care, and I will take the NHS' problems any day over the issues and inequality that private health care entails. 

It is in the context of unaffordable and low-level health care that Namibia's care providers work, and therefore one of the reasons why the service of the care providers is so vital. And VSO is passionate about advocating for their rights. Writing these reports is part of VSO's advocacy strategy, as VSO can then use the results to lobby decision makers to make greater provision for care providers.

Once written, getting the reports designed was pretty difficult - VSO London has very strict brand guidelines: a 15% slant line on the front, certain fonts and colours, copyright issues, etc. Each of our organisations also wanted their input on the reports, asking for certain things to be changed (frequently contradicting each other), and our Namibian designer nearly went mad with the constant comments on the drafts streaming from the London office and the various organisations. She came up trumps, however, and we proudly went to print just in time for the VSO Caregivers Conference, with the ISBN registered and printed on the back of both reports. Since then, we've used the reports in various advocacy events and they've been very well received - even quoted by parliamentarians. 

As for us, we're now drinking a fair amount of South African wine to wind down again.  I'm thrilled to have had the chance to write this report, to conduct research and to be published. VSO has given me a chance where many organisations would require you to have 10 years' experience and a PhD. It's going proudly on my CV and is, for me, a highlight of my time in Namibia, having given me the opportunity to travel twice around the country and to talk to hundreds of people who accomplish amazing things every day in their communities.  If only I had half their energy, I might have been able to write the report in half the time!