Access to justice: evaluating law, health and human rights programmes in Kenya.
BACKGROUND
In Kenya, human rights violations have a marked impact on the health of people living with HIV. Integrating legal literacy and legal services into healthcare appears to be an effective strategy to empower vulnerable groups and address underlying determinants of health.


METHODS
We carried out an evaluation to collect evidence about the impact of legal empowerment programmes on health and human rights. The evaluation focused on Open Society Foundation-supported legal integration activities at four sites: the Academic Model of Providing Access to Healthcare (AMPATH) facility, where the Legal Aid Centre of Eldoret (LACE) operates, in Eldoret; Kenyatta National Hospital's Gender-based Violence Recovery Centre, which hosts the COVAW legal integration program; and Christian Health Association of Kenya (CHAK) facilities in Mombasa and Naivasha. In consultation with the organizations implementing the programs, we designed a conceptual logic model grounded in human rights principles, identified relevant indicators and then coded structure, process and outcome indicators for the rights-related principles they reflect. The evaluation included a resource assessment questionnaire, a review of program records and routine data, and semi-structured interviews and focus group discussions with clients and service providers. Data were collected in May-August 2010 and April-June 2011.


RESULTS
Clients showed a notable increase in practical knowledge and awareness about how to access legal aid and claim their rights, as well as an enhanced ability to communicate with healthcare providers and to improve their access to healthcare and justice. In turn, providers became more adept at identifying human rights violations and other legal difficulties, which enabled them to give clients basic information about their rights, refer them to legal aid and assist them in accessing needed support. Methodological challenges in evaluating such activities point to the need to strengthen rights-oriented evaluation methods.


CONCLUSIONS
Legal empowerment programmes have the potential to promote accountability, reduce stigma and discrimination and contribute to altering unjust structures and systems. Given their apparent value as a health and human rights intervention, particularly for marginalized populations, further rigorous evaluations are called for to support the scale-up of such programmes.
Program on Global Health and Human Rights, Institute for Global Health, University of Southern California, Los Angeles, CA; gruskin@usc.edu.
Sofia
S
Gruskin
Kelly
K
Safreed-Harmon
Tamar
T
Ezer
Anne
A
Gathumbi
Jonathan
J
Cohen
Patricia
P
Kameri-Mbote
D003695:Delivery of Health Care / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006806:Human Rights; D006801:Humans; D007630:Kenya
AIDS; HIV; discrimination; human rights; programme evaluation; public health; stigma