Marginalized and minority populations, such as LGBTIQ+ people, people living with HIV, sex workers, and adolescents, often face unequal, unjust, and disrespectful treatment from service providers, policymakers, and program partner organizations, which is often done without conscious malicious intent and with little recourse that does not escalate punitive consequence. The minimum expectations of these populations in service settings and in policy considerations are simply to be treated with dignity and decency. In environments that are resistant or hostile to the diversity of identity and expression, the ultimate goal is to achieve dignity, respect, and equity for all.

It is in this regards, Pema Kenya has collaborated with a Positive Vibes, South Africa in a new project called Living the DREAM [LTD]. LTD is a project whose dream is dignity, respect and equity through advocacy for the sexual and reproductive rights of marginalized and minority populations. Living the DREAM builds on and from the work of preceding years, augmenting those actions, activities and strategies with several new features:

• The existing Community of Practice comprising civil society partners in Botswana, Eswatini, Lesotho, Namibia, Uganda, Zambia and Zimbabwe will be further expanded to include partners in Kenya, Mozambique, Nigeria and Ghana.
• The newly developed Integrated Monitoring and Accountability for Quality Improvement (IMAQI) system. IMAQI supplements existing processes and tools for systematic monitoring dubbed the Setting the Levels process. 

“Setting the Levels” (STL) is a 5 day systematic methodology for community-led participatory monitoring of health facilities. The process brings communities and populations safely into contained, constructive confrontation, engagement, and dialogue with healthcare workers in specific local health facilities to share perspectives, perceptions, and experiences of care, and to plan for measurable improvement that increases service access and uptake. The process is designed to be periodically repeated, to institutionalize a culture of monitoring through community participation in health is institutionalized, and to hold health facilities to account for commitments and undertakings for improvement over time.

STL deconstructs power differentials inherent in formal health systems, drawing service users into equitable dialogue with providers. That effect can be powerfully reorienting of the relationship and distance between communities and healthcare providers. Where responsive accountability to citizen participation is legitimized, public health is democratized. Monitoring is enabling and emboldening for those populations whose voices, typically, may be socially and structurally suppressed, who may be marginalized through silence and exclusion from participation. Communities gain confidence to claim rights and their dignity increases. They make themselves visible, known, demystified to health workers; in so doing, monitoring ultimately deepens the capacity of primary healthcare to be as close to the community as possible.

For more discussions on this please contact: 

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1. Obwanda VINCENT, Head of Programs
2. Kidali MAXINE, Faith Engagement officer
3. Makhoveh COSAM, ICT & Program Officer
4. Wangari KELVIN, Policy and Advocacy assistant officer.
5. Wandera NEKESA, Health Promotion Officer
6. Ominde HENRY, Communications Volunteer