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Table 2 Impact of legal empowerment programs on healthcare and proximate health determinants

From: The use of legal empowerment to improve access to quality health services: a scoping review

Authors Country Availability Accessibility Acceptability Quality Action on health determinants
Wirya, A; Larasati, A; Gruskin, S; Ferguson, L Indonesia Paralegals ensure that their clients obtain health services by taking medicines directly to them Paralegals help clients to be more aware of their health-related rights, especially regarding their rights to obtain health services inside detention and encourage law enforcement agencies to refer the clients to health services    Paralegals try to reduce incidence of violence against clients and others
Dhital, S & Walton, T Pertinent parts of the article focus on India In response to community request, the implementing NGO secured emergency relief kits during the first COVID lockdown The implementing NGO provided training to paralegals and community organisers regarding health and social protection entitlements specific to COVID-19. During the pandemic, the NGO also filed complaints and petitions when community members were unable to access COVID-related and other health entitlements    
Gruskin S.; Safreed-Harmon, K.; Ezer, T.; Gathumbi, A.; Cohen, J.; Kameri-Mbote, P Kenya   Clients interviewed showed an increase in practical knowledge and awareness about how to improve their access to healthcare. Some were referred to mental health services Clients interviewed showed enhanced ability to communicate with healthcare providers   
Abdikeeva, A. & Covaci, A North Macedonia   Paralegals and others working for NGOs challenged violations such as the outright denial of reproductive health care and of drug dependence treatment, as well as health provider demands for bribes or other illicit payments. One NGO supported individuals to obtain papers required to access health care   The paralegals and others employed by the NGOs described challenged discriminatory treatment in healthcare settings  
Abdikeeva, A.; Ezer, T.; Covaci, A Pertinent parts of the article focus on Romania and Serbia   NGO staff provide individual and community training on rights and entitlements In Romania, they bring cases of discrimination and mistreatment to the College of Physicians In Serbia, NGO staff train duty bearers on their responsibilities under national and human rights law to Roma patients  
Achilihu, I Sierra Leone Paralegals address availability challenges, such as inadequate staff for service delivery, and lack of vaccines and essential drugs at the clinic This program provides legal education regarding health rights and entitlements to paralegals, Facility Management Committees, and community members. Paralegals address accessibility related problems such as demands that patients make informal payments    
Dworkin, S.; Lub, T.; Grabec, S.; Kwenad, Z.; Mwaura-Muirue, E.; Bukusid, E Kenya   The implementing NGO provided supportive services to protect marginalised communities from discrimination and exploitation    This intervention trained paralegals, CHWs and others to assist recently widowed women to use the customary or formal legal system to protect their land rights to reduce their vulnerability to HIV infection
Biradavolu, M.R.; Burris, S.; George, A.; Jena, A.; Blankenship, K India   NGOs and CBOs trained CSWs in their rights and entitlements to reduce abuse by the police, such as arbitrary arrest, improving their access to ongoing HIV prevention programmes    NGOs and CBOs engaged in collective action in order to decrease violence and abuse by the police towards CSWs
Kolisetty., A Bangladesh   A paralegal (shebika) connects community members with legal advice, representation, and mediation services for a variety of issues including health    Paralegals use the customary and formal legal systems, as well as alternative dispute resolution to address a variety of direct determinants of health, including gender based violence and child marriage
Network Movement for Democracy and Human Rights Sierra Leone   Paralegals undertake awareness raising on rights and entitlements among community members, and manage "cases" that arise from the monitoring, including as related to informal payments    
Feinglass, E.; Gomes, N.; Maru, V Mozambique The NGO trains paralegals (Health Advocates) and Village Health Committees raise community awareness about health rights and entitlements. Paralegals facilitate dialogue among communities and clinics and use formal administrative channels as well as dispute resolution skills to address particular gaps related to availability, such as lack of essential medicines The paralegals also address access problems, such as demands for informal payments   The paralegals address quality challenges, such as rude treatment by providers  
Wolfe, D.; Cohen, J.; Doyle, H.; Margolin, T Kenya, Indonesia, Ukraine   Through legal training, joint CSW/police workshops, and use of paralegals, the implementing NGOs sought to reduce police abuse that disrupted access to HIV prevention services    Through legal training, joint CSW/police workshops, and use of paralegals, the implementing NGOs addressed police violence against CSWs and others at risk for HIV
Jagannath, M.; Phillips, N.; Shah, J Haiti     NGO staff and grassroots actors support women who have experienced rape and other types of GBV to receive better medical care and forensic examination NGO staff and other grassroots actors also support women reporting rape and other GBV to demand and receive better treatment from police
Feruglio, F Multiple (but for inclusion—only Kenya)   The implementing NGO provides health and legal awareness raising to female commercial sex workers and other women who are vulnerable to HIV, as well as to health providers and police officers. In addition, paralegals accompany women to trusted providers and facilities    The paralegals hope to reduce police abuse of CSWs and other vulnerable women
Schaaf, M; Falcao, J., Feinglass, E., Kitchell, E., Gomes, N., Freedman, L Mozambique Trained paralegals and Village Health Committees took a variety of steps to resolve cases regarding availability of key inputs, such as essential medicines. They educated health workers and administrators about how to solve a certain problem and assisted them to do it; facilitated a dialogue between the client and the allegedly offending provider; and helped the client and/or the health facility to use formal administrative processes to solve the problem The paralegals also address access problems, such as demands for informal payments   The paralegals addressed key quality problems, such as women being forced to deliver alone and rude treatment  
Joshi, A 3 relevant: North Macedonia, Uganda, Guatemala Paralegals in Guatemala (Community Defenders of the Right to Health) use formal redress mechanisms at local and national level to address basic availability issues, primarily lack of ambulance response and lack of essential medicines. Paralegals and NGO staff in Uganda (Community Health Advocates) mediation and judicial processes to address availability challenges, such as denial of care Paralegals in Guatemala (Community Defenders of the Right to Health) address basic availability issues, primarily demands for informal payments. In North Macedonia, paralegals assist members of the Roma community in accessing legal identity documents required to access healthcare   Paralegals in Guatemala and Uganda address some quality issues, such as rude and/or discriminatory treatment. In North Macedonia, they address discriminatory and rude treatment