Simon Kabore
Ashoka Fellow since 2012   |   Burkina Faso

Simon Kabore

Network Access to Essential Medicines
Simon Kabore empowers society to promote patients’ rights and dignified healthcare. To accomplish this change, he educates the public about their health rights, builds coalitions to lobby the…
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This description of Simon Kabore's work was prepared when Simon Kabore was elected to the Ashoka Fellowship in 2012.

Introduction

Simon Kabore empowers society to promote patients’ rights and dignified healthcare. To accomplish this change, he educates the public about their health rights, builds coalitions to lobby the government for improved health policies, and builds a citizen-based system to ensure healthcare accountability.

The New Idea

Simon is building a volunteer citizen movement to advance patients’ rights and dignified healthcare in West Africa. In a context where the quality of healthcare is inconsistent and most patients feel disempowered to ask for better healthcare, Simon enables people to improve the local and national healthcare system. He utilizes complementary approaches to first demystify healthcare laws and policies and then engages diverse actors to claim and ensure essential healthcare.

Through this movement, Simon educates the public to first understand their health rights and the commitments that have been made by their government. He utilizes a variety of approaches to reach a wide audience, including creative poster campaigns and public conversations with the government in the form of published letters in prominent national newspapers. Simon hosts a series of roundtable discussions with various populations—students, women, unions, religious leaders, journalists, and administrative officials—targeting his messaging to their perspective. After increasing awareness of how existing health policies affect their group, Simon mobilizes these populations to lobby the government for improved patients’ rights.

Simon mobilizes this newly educated public to take ownership of their health and ensure quality in local health clinics. He has created a communication system for healthcare accountability that bypasses existing power structures. Simon is initiating and mobilizing community health watchdog committees to verify that patient treatment and care at all levels—from national hospitals to remote village clinics—is fair, of high-quality and that national prices and policies are applied locally. These watchdog groups are formed of highly committed volunteers who understand the value of this work. They confidentially report any grievances and situations of malpractice to Simon’s organization. The organization then consolidates and synthesizes these cases and presents them to higher levels of the national health department for correction.

The Problem

Poverty levels in Burkina Faso are high, with over 80 percent of the population surviving on subsistence farming. When Simon began working on access to healthcare, the monthly cost of antiretroviral medicines (ARVs) was more than ten times the monthly salary of an entry level civil servant. Of the 20,000 Burkinabe who needed ARVs, only 300 had access; for the rest, diagnosis was equivalent to a death sentence.

The health level of low-income populations, particularly in rural areas is low. Maternal and infant mortality remain high with over 16 percent of children dying before the age of five. Treatable maladies like malaria and diarrhea claim an unnecessary number of lives. While each village is assigned to the closest basic health clinic in the region, these clinics are often not accessible and can be located up to 20km from the patient’s village.

Funding pours in from international donors to facilitate access to basic healthcare, however, national policies and prices are often not applied outside of major cities. For example, the subsidized price for birth by cesarean section is 9,000 cfa (approximately US$18); however, the staff at some health clinics charge mothers six times this amount and pocket the difference. With little access to information, citizens often don’t know the price of health services and furthermore, they lack a mechanism or ability to negotiate the actual price. Generally, receiving adequate and prompt healthcare requires a personal connection at the clinic. Disempowered, citizens may avoid the health clinics, preferring traditional healers, or they approach the clinic staff with the spirit of a beggar, not realizing that they have rights as a patient.

The lack of feedback mechanisms and controls in the system coupled with a fear to speak out as an individual has created deep-seated frustration, that when inflamed has detrimental consequences. For example, in 2011 in the city of Bobo, a woman died while giving birth in the hospital due to neglect from the nursing staff. Her furious relatives had no mechanism for recourse against the few individuals responsible and in their anger, they incited a mob which burned down the maternity ward.

The Strategy

In 2002, Simon launched Réseau d’Accès aux Medicaments Essentiels—RAME (Network for Access to Essential Medicines) to build a citizens’ movement to persistently and systematically increase access to high-quality and affordable healthcare and medicines. To achieve this improved situation, Simon changes government policies and builds a system to ensure healthcare commitments are applied locally. RAME is composed of individuals who lobby the government as citizen and not as representatives of their organizations. RAME partners with many organizations to mobilize their members to participate; however, institutionally, many Burkinabe organizations face too much pressure to oppose the government which finances many of their activities. To create and spread community watchdog groups, RAME partners with local citizen organizations (CO) in each region that monitor quality and aggregate complaints.

Simon’s strategy for changing government policy is clearly demonstrated through RAME’s success in dramatically increasing access to ARVs, critical for treating HIV. Simon accomplished this by educating and mobilizing citizens to lobby the government to reduce the price, broaden the conditions, and simplify the process for receiving free ARVs.

To change government health policies, Simon brings together a diverse set of stakeholders, including government ministries, international organizations, and informed citizens. When possible, Simon collaborates with the government, but when the government resists collaboration, Simon influences policies by mobilizing citizens to pressure the government. By engaging disconnected Burkinabe government ministries together with prominent international actors, Simon enabled Burkina Faso to purchase ARVs at a more accessible price. Later, Simon built a coalition to lobby the government to provide ARVs at zero cost, which it was receiving for free from an international donor, but selling to HIV+ citizens for 8,000 cfa (US$16.75) per month (about 20 percent of a minimum wage monthly salary). Simon regularly brings patients affected by the health policy in question, including HIV+ persons in the case of the ARVs, to meet directly with government officials to explain how the existing policy or its implementation affects them.

Simon launched an effective public awareness campaign using posters, frequent editorials, and public letters in national newspapers to pressure the government. When government officials were willing to meet with him, he brought patients and others affected by the current system to demonstrate the obstacles they faced. Later when the government refused to meet with him, he forced a public dialogue by writing public letters to the Ministry of Health in a prominent national newspaper. In 2009 Simon’s network prompted the president to announce free access to ARVs for the extremely poor, but set humiliating requirements to prove this level of poverty. Simon collaborated with the government to create a new, less invasive process to determine who should receive free ARVs.

Simon has established watchdog groups in seven regions of Burkina Faso and plans to have a presence in all thirteen regions by 2017. By 2022 Simon aims to have active watchdog groups in each of the sixty regional subunits, reaching even remote areas of Burkina Faso. Simon is using his lightly staffed organization to build a powerful citizen movement. His 2012 staffing level of two full-time staff and five high level volunteers will only need to double for RAME to reach the entire country because they empower local organizations to take on this work. Furthermore, Simon is looking to create partnerships with multilateral donors to incorporate accountability and citizen monitoring into their work, thus leveraging aid money.

Simon is building a citizen-based patients rights movement across the continent. He has partnered with a Cameroonian organization to expand the movement across Africa, launching in Cameroon and the Central African Republic, while RAME is focused on Burkina Faso and Mali. Simon is also advising thirty citizen sector leaders in twelve African countries on effectively influencing African healthcare policies. Using a public mailing list, Simon’s advice is utilized by everyone in the network and is easily shared with other interested organizations.

The Person

In 1993 Simon’s faith propelled him to become active in a Christian human rights movement focused on abolishing torture. Since then, he has worked on improving a variety of human rights issues. In 1996 he launched a human rights course in five Ouagadougou schools to educate students about human rights. Simon’s course reinforced theory with practical applications through role play and theater. In 1999 he was chosen to travel to Cameroon for human rights training and began interacting with many African human rights organizations. When Simon returned to Burkina Faso, he launched innovative campaigns to end the accusation of women as sorcerers and the formerly common practice of beating to death accused thieves without questioning. Simon identified unemployed youth as a prime perpetrator of both violations and realized that their involvement is key to build sustained change. Through discussion and listening to their perspective, Simon identified these youth as key in the prevention of these human rights abuses.

Simon’s enduring focus on healthcare and patient rights began when he was employed in the civil service as a pharmacist in a regional capital. He saw first-hand how lack of access to essential care and medicines prevented healthy communities and how application of health policies and care differed across the country. This experience prompted Simon to focus on patients’ rights and ensuring dignified healthcare across the continent. As access to ARVs was one of the most critical, under-addressed issues at the time, Simon initially focused on this problem. Realizing that at the time, intellectual property rights were the reason for the prohibitively high prices, brought together Doctors Without Borders and the President of the African Intellectual Property Organization to prompt the Burkinabe government to begin purchasing generic ARVs from other countries; recently allowed by the World Trade Organization. Once he accomplished this, Simon began to diversify his approach to increase access to essential medicines and expand his focus to improve health care accountability.

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