Primary Submission Category: Interventions/Programs
20 country evaluation of community paralegal interventions for HIV, TB and malaria services
Authors: Kati Hinman Joseph Amon
Presenting Author: Kati Hinman*
Community paralegal programs seek both to support individuals facing discrimination (and other harms) to access prevention and treatment services, and to improve accountability and quality of health services. However, the evaluation of the effectiveness of paralegal programs has been limited. Between 2017 and 2023, the Global Fund’s Breaking Down Barriers Initiative supported community paralegal programs in 20 countries. Community paralegals were trained from different key populations, including sex workers (e.g., in Senegal, Ghana, Indonesia, Sierra Leone), men who have sex with men (in Ghana, Ukraine, Sierra Leone), and people who use drugs (in Ukraine). Results from a recent evaluation of Breaking Down Barriers found that paralegal programs were able to advocate for treatment access, negotiate with police for the release of key population members, conduct anti-stigma programs with communities, address discrimination in schools and workplaces, and ensure access to medicines in closed settings. Some highlights include the success of paralegals in Mozambique, trained by Project Viva+, in securing the release of 45 sex workers who were detained for possessing condoms. Another highlight was the expansion of legal services in Sierra Leone, in part due to training of female sex workers and men who have sex with men to support clients in navigating legal assistance, with a focus on addressing gender-based violence. Similarly, paralegals in Ghana helped to identify cases that were referred to legal services and otherwise resolved, including 70 cases involving sex workers and 78 with men who have sex with men. These results suggest that future paralegal interventions should be embedded into wraparound services and systems of care. In addition to expanding paralegal programs to reach more vulnerable populations, further research is needed to identify how community paralegals can best link to existing community health and legal assistance programs.