François-Xavier Bagnoud Center for Health and Human Rights
Harvard School of Public Health

SURVEY OF HEALTH AND HUMAN RIGHTS ORGANIZATIONS

This survey and resulting database are intended to assemble a profile of those organizations working in the area of health and human rights as defined by their missions, programs and policies. For more information on a health and human rights framework or specific health issue areas (Part IV), please visit the François-Xavier Bagnoud Center for Health and Human Rights' website at the internet address given below.

If you have any questions regarding this survey, please contact:
	François-Xavier Bagnoud Center for Health and Human Rights
	Harvard School of Public Health
	651 Huntington Avenue, 7th Floor, Boston, MA 02115 USA
	Tel: (1) 617.432.0656	Fax: (1) 617.432.4310 	
	E-mail: fxbcenter_survey@hsph.harvard.edu

This form may be photocopied.  Additional copies of this form can be obtained on the World Wide Web at www.hsph.harvard.edu/fxbcenter/survey.htm  

______________________________________________________________________________
Part I. Contact Information 
1) Organization Name:
2) Acronym(s):
3) What are the working language(s) for your organization?
4) Mailing Address:


5) Country:
6) Telephone Number:
7) Fax Number:
8) E-mail Address (if applicable):
9) Does your organization have a World Wide Web website?
Yes ___		No ___
a) If yes what is the website address:

10) Who within your organization may we contact for clarification of your responses to the survey?

11) Telephone number, fax number and e-mail person for contact person within your organization: 
a) Telephone Number:
b) Fax Number:
c) E-mail Address (if applicable):

12) May the François-Xavier Bagnoud Center for Health and Human Rights make the information received from this survey publicly available through its directory of health and human rights organizations?
Yes ___		No ___

13) May the François-Xavier Bagnoud Center for Health and Human Rights include a link to your website (if applicable) from its online directory of health and human rights organizations?
Yes ___		No ___

______________________________________________________________________________
Part II.  Organization Mission and Structure

14) What type of institution is your organization?
(check no more than 2 responses):
___ An inter-governmental organization
___ An international network, consortium, federation, etc.
___ A national network, consortium, federation, etc.
___ An international non-governmental organization 
___ A national non-governmental organization
___ An independent national human rights institution (e.g. human rights commission or ombudsperson)
___ An independent national health or development institution
___ A university/university facility/university-affiliated research institute
___ A training/research institute
___ Other (specify):

 
15) What is the mission or aim of your organization?		





16) What are your organization's current programs or what services does your organization provide?
 (please list program titles and/or provide brief descriptions - attach extra sheet if necessary)?









17) What year was your organization founded?
		
18) Please indicate the number of staff and regular volunteers for your organization:
____	Paid staff (in country of headquarters)
____	Paid staff (in other countries)
____	Regular/substantive volunteers (in country of headquarters)
____	Regular/substantive volunteers (in other countries)

19) Please list the names of the current officers of your organization, including senior members of your executive staff:





20) Is your organization a member of any federations or umbrella organizations?
Yes ___		No ___

a) If yes, please list the name of the federations or umbrella organization and describe the relationship between your organization and the federations or umbrella organizations:





21) Does your organization have any regional, national or local branch offices or chapters?	
Yes ___		No ___

a) If yes, please describe the scope and nature of the relationship between offices or chapters (please include a description of the levels of coordination and/or autonomy and indicate the numbers and locations of offices and chapters)








22) If your organization is a member of any networks or consortiums, please list their full names and acronyms:
 






23) Does your organization have members?
Yes ___		No ___

a) If yes, please specify type of membership
___ Individuals	
___ Organizations
___ Other (specify):

24) Please indicate the percentage of funding received in 1999 from the following sources (optional):
____%	Private (funding received through fundraising, individual donations, grants and membership fees)
____%	Governmental (funding received from national, federal, or local governments/authorities)
____%	International (funding received from intergovernmental organizations or international non-governmental organizations)
____%	Self-financed (funding from organizations activities such as sales of products or fees for consulting services)

25) Does your organization prepare and distribute an annual report?
Yes ___		No ___

a) If yes, is the annual report is available the World Wide Web
Yes ___		No ___

i) If yes, please indicate website address for annual report, if different from organizations website:


				

26) Please describe the relationship of your organization, other than financial, with any government with respect to your organization's activities or management.




27) Does your organization have status with any specialized United Nations agency? 
Yes  ___		No  ___

a) If yes please, describe the nature of this relationship.




28) Does your organization have status with any other inter-governmental organizations?
Yes  ___		No  ___

a) If yes please, describe the nature of this relationship.
	


______________________________________________________________________________
Part III.  Organization's Primary Focus
In this section, please respond about the general nature of the work of your organization.

29) Which of the following issues areas are most central to the mission of your organization?
(check no more than 2):				
___ Human rights promotion and protection for general population (or range of sub-populations)
___ The health consequences of human rights violations
___ Development (non-medically-oriented) conditions or needs of general population (e.g. housing)
___ The needs or condition of a specific population(s) - multiple issues (including health and/or human rights)
___ The linkage between promoting and protecting health and promoting and protecting human rights
___ The health and/or human rights conditions or needs concerning specific health or medical issue (e.g. HIV/AIDS) 
___ The health or medical conditions or needs of general population (or range of health or medical conditions)
___ Other (specify):


30) Which of the following strategies are employed in pursuing your organization's mission?	
(check all that apply):
___ Monitoring, documentation or data collection regarding human rights, disease or health conditions
___ Policy/legislation monitoring, review or advocacy
___ Development of advisory guidelines or standards (external to organization)
___ Provision of material assistance (e.g. provision of vehicles, computers, pharmaceuticals)
___ Provision of technical assistance (e.g. provision of trainers, staff, volunteers, consultants or direct services) 
___ Provision of financial assistance 
___ Facilitation of networking or collaboration
___ Other (specify):



31) What populations are of primary concern to your organization in fulfilling its mission? 		
(check no more than 5 boxes):
___ General population (or more than 5 groups)
___ Women
___ Men
___ Children
___ Male children
___ Female children
___ Adolescents
___ Elderly
___ Racial minority
___ National ethnic minority
___ Linguistic minority
___ Indigenous populations
___ Religious
___ Sexual orientation
___ Political or other opinion
___ Property/homeless
___ Workers
___ Economically impoverished
___ Disability
___ Mental disability
___ Physical disabilty
___ Migrants
___ Refugees
___ Internally displaced populations
___ Prisoners/detainees
___ Other (specify):


32) Do the populations of focus vary by program?
Yes  ___		No  ___

33) What is the geographic focus of your organization's programs?
(check no more than 2): 	
___ National
___ Regional
___ Sub-Regional
___ Diaspora
___ International

34) Does the geographic focus vary by program?
Yes  ___		No  ___

35) What are the countries where your organization works (attach additional page if necessary)?






36) Please list of your organization's relevant publications (magazines, newsletters, working papers) in the area of health and human rights released since 1997 and indicate all language versions and whether publications are annual (attach additional page if necessary):





______________________________________________________________________________
Part IV. Health Program Areas

Please indicate whether your organization works within each of the following health program areas according to the following activity classifications and estimate the percentage of your organization's overall work in each of the health areas.  Parts V-IX of the survey will ask you to provide more information on each of the activity classifications listed below.

NOTE: Additional information about each of the health program areas can be found on the website of the François-Xavier Bagnoud Center for Health and Human Rights (www.hsph.harvard.edu/fxbcenter/survey.htm).  There are significant levels of overlap between the issue areas and it is not necessary to select only one area for the total percentages to equal 100% (either within program areas or cumulatively). 

(check all that apply):
 
Access, quality and rational use of medicines:	
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Blood safety and clinical technology:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Child and adolescent health:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Communicable diseases:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%
	
Disability/injury prevention and rehabilitation:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%
	
Emergency preparedness and response:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Food safety:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Health and development:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Health and the environment:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

HIV/AIDS:	
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Immunization and vaccine development:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Information for health policy:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Malaria:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Maternal and infant health:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Mental health and substance abuse:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Non-communicable diseases:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Nutrition:	
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Organization of health services:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Reproductive and sexual health:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Research policy and promotion:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Tobacco control:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Tuberculosis:
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

Women's health:	
	Research ___				Documentation/Monitoring ___	
	Advocacy & Awareness Raising ___	Training & Education ___	
	Client Services ___			Percent of Organization's Work ___%

______________________________________________________________________________
Part V.  Research
Considering the overall work of your organization, please answer the following questions concerning your organization's research activities in the area of health and human rights. 

Areas of research concerning health and human rights are defined for this survey as including, but are not limited to, the following: access to medical care or other health and social services; differential impacts of diseases, health policies or programs on populations at risk; factors interfering with or promoting populations' ability to fully realize health and/or human rights; health or medically-related human rights abuses; the impacts/benefits of utilizing a health and human rights approach to policy development or implementation.

37) Does your organization undertake research concerning health and human rights?
Yes  ___		No  ___
a) If yes, please answer the following questions
b) If no, please go to section VI.

38) What types of research does your organization undertake?
(check all that apply):							
___ Surveys
___ Interviews
___ Data analysis (existing national or local data)
___ Conduct of interventions/trials
___ Evaluation of interventions/trials
___ Policy evaluation (through data collection and analysis)
___ Program evaluation (through data collection and analysis)
___ Epidemiologic surveillance
___ Other (specify):


39) Who conducts your organization's research?		
(check all that apply):
___ Organization staff/volunteers
___ Affiliated institutions/universities
___ Consultants/contractors
___ Other (specify):


40) What percentage of your organization's programs/work is comprised of the conduct of research?	
	
_____________________________________________________________________________		
Part VI. Documentation and Monitoring
Considering the overall work of your organization, please answer the following questions concerning your organization's documentation and monitoring activities in the area of health and human rights.

Subject areas for documentation and monitoring activities for health and human rights are defined in this survey as including, but are not limited to, the following: access to medical care or other health and social services; differential impacts of diseases, health policies or programs on populations at risk; factors interfering with or promoting populations' ability to fully realize health and/or human rights; health or medically-related human rights abuses; the impacts/benefits of utilizing a health and human rights approach to policy development or implementation.
 
41) Does your organization undertake documentation or monitoring activities concerning health and human rights?								
Yes  ___		No  ___

a) If yes, please answer the following questions
b) If no, please go to Part VII.

42) What are the principle sources of data or information for your organization's documentation or monitoring activities?
(check all that apply):
___ Secondary data from government data collection mechanisms (e.g. census, demographic and health surveys, government records)
___ Secondary data from member or partnering organizations (non-governmental)
___ Primary data from key informant interviews
___ Primary data from focus groups
___ Primary data from surveys
___ Other (specify):


43) Does your organization maintain a documentation center or database? 
Yes  ___		No  ___

a) If yes, please indicate type and nature of center or database.



44) Does your organization belong to an international documentation network(s)?  
Yes  ___		No  ___

a) If yes, please specify name and type of network.



45) What percentage of your organization's programs/work is comprised of documentation or monitoring activities?	


______________________________________________________________________________
Part VII. Advocacy and/or Awareness Raising
Considering the overall work of your organization, please answer the following questions concerning your organization's advocacy and/or awareness raising activities in the area of health and human rights.

Advocacy and awareness raising activities for health and human rights are defined in this survey as the use of information to effect policy or legislative changes or to foster public awareness or understanding of issues, conditions or needs concerning health and human rights.  

NOTE: the use of information to train or educate individuals is covered in Part VIII (Training and Education).

46) Does your organization undertake advocacy and/or awareness raising activities concerning health and human rights?
Yes  ___		No  ___

a) If yes, please answer the following questions

b) If no, please go to section VIII.

47) Which of the following best describe the thematic nature of your organization's advocacy and/or awareness raising activities concerning health and human rights?
(check no more than 2):
___ The promotion and protection of human rights
___ The health consequences of human rights violations
___ The effects of human rights on the health of populations 
___ The linkage between promoting and protecting health and promoting and protecting human rights
___ The effects of health policies and programs on human rights
___ The human rights implications of specific diseases or health conditions
___ The promotion of health and/or social services 
___ Other (specify):

 
48) What are your organization's activities concerning government policies or legislation?
(check all that apply):
___ Conducting public hearings/workshops/conferences
___ Direct lobbying (meetings/discussions with legislators or influential parties)
___ Public referendums
___ Direct action
___ Letter campaigns
___ Media campaigns
___ Other (specify):

49) Who are the target audiences for government policy/legislative related activities?	
(check all that apply):
___ Legislators or executive
___ Judiciary (i.e. courts or lawyers)
___ Civil service
___ International (intergovernmental organizations or international NGOs)
___ Other governments (governments other than those responsible for policy/legislation)
___ General public (domestic electoral pressure)
___ Other (specify):


50) What are your organization's activities concerning non-governmental policies or standards (e.g. developing or reviewing standards of practice)?
(check all that apply):
___ Conducting public hearings/workshops/conferences
___ Direct lobbying (meetings/discussions with committees or associations)
___ Public referendums
___ Letter campaigns
___ Media campaigns
___ Other (specify):


51) Who are the target audiences for non-governmental policy/standard related activities? 	
(check all that apply):
___ Civil service/regulatory agencies
___ Professional associations (e.g. medical association)
___ Health or legal professionals
___ Business/industry
___ Specific population(s) (specify if different from those indicated in question 29):
___ General public
___ Individuals (e.g. patients or clients)
___ Other (specify):


52) What are your organization's awareness raising (public campaigns) activities?
(check all that apply):
___ Media campaigns
___ Public education campaigns
___ Individual education/counseling
___ Event coordination
___ Other (specify):


53) Who are the target audiences for your organization's awareness raising activities?		
(check all that apply):
___ Government (legislators/civil service)
___ International (other governments, intergovernmental organizations or international NGOs)
___ Businesses/industry
___ Professional associations (e.g. medical association)
___ Media
___ Specific population(s) (specify if different from those indicated in question 29):
___ Domestic general public
___ International general public
___ Individuals (e.g. patients or clients)
___ Other (specify):


54) What percentage of your organization's programs/work is comprised of advocacy or awareness raising?

______________________________________________________________________________
Part VIII.  Training and Education
Considering the overall work of your organization, please answer the following questions concerning your organization's training and/or education activities in the area of health and human rights.

Training and education activities for health and human rights are defined in this survey as the coordination and/or conduct of training or educational programs and/or the development of educational curricula or and/pedagogical materials regarding health and human rights.
 
55) Does your organization undertake training and/or education activities concerning health and human rights?
Yes  ___		No  ___

a) If yes, please answer the following questions

b) If no, please go to Part IX.

56) Which of the following topic areas best reflect the training and education activities of your organization concerning health and human rights?	
(check all that apply):
___ Human rights - general (general population or range of human rights areas)
___ Human rights monitoring, research or evaluative skills
___ The health consequences of human rights violations
___ The effects of human rights on the health of populations
___ Professional standards and human rights (e.g. rights of patient or client)
___ The linkage between promoting and protecting health and promoting and protecting human rights
___ The effects of specific health policies (or diseases) on human rights
___ The effects of general health policies and programs on human rights
___ Health research or evaluative skills
___ Health - general (general public health or a range of health issues)
___ Other (specify):

57) Who are the principal target audiences for your organization's training and education activities? 
(check all that apply): 		
___ Policy makers (e.g. legislators or executive)
___ Judiciary (e.g. courts)
___ Civil service
___ Health professionals
___ Legal professionals
___ Human rights professionals
___ Specialized groups (e.g. trade unions, religious groups)
___ Educators 
___ Primary and secondary level students
___ University level students(general)
___ Medical-related students
___ Public health students
___ Law students
___ Media
___ Specific population(s) (specify if different from those indicated in question 29):
___ General public
___ Other (specify):


58) What types of professional training and educational activities does your organization undertake?	
(check all that apply):
___ Conference/workshop coordination (including collaborative coordination)
___ Special training/courses
___ Review/design of professional standards
___ Provision of specialized internships/fellowships/residencies
___ Development of bibliographies or collection of reference materials

59) What types of training or educational courses does your organization incorporate into existing educational programs (e.g. medical or secondary schools)?
(check all that apply):
___ Independent academic unit (e.g. university course on health and human rights)
___ Academic module (e.g. portion of course)
___ Review/design of general curricula (e.g. degree requirements or school policies)
___ Conference/workshop coordination (including collaborative coordination) for targeted students
___ Special training/courses
___ Provision of specialized internships/fellowships/residencies
___ Development of bibliographies or collection of reference materials

60) Does your organization develop curricula or pedagogical materials for training or educational programs?	
Yes  ___		No  ___

61) What percentage of your organization's programs/work is comprised of training or educational activities?

______________________________________________________________________________
Part IX.  Client Services
Considering the overall work of your organization, please answer the following questions concerning your organization's provision of direct client services to individuals (regardless of setting) in the areas of health, human rights or health and human rights.

62) Does your organization provide direct client services to individuals?	
Yes  ___		No  ___

a) If yes, please answer the following questions

b) If no, please go to Part X.


63) What types of client services are provided by your organization? 					
(check all that apply):	
___ Client representation
___ Pursuit of claims
___ Referral services
___ Individual education
___ Linking medical and legal services
___ Counseling (clinical or outreach programs)
___ Commodities assistance (e.g. provision of medicines)
___ Medical treatment/clinical services provision
___ Other (specify):

64) What percentage of your organization's programs/work is comprised of the provision of client services?	

______________________________________________________________________________
Part X. Additional organizations

65) Please provide the names and addresses (if possible) of other organizations you feel should receive copies of this survey:










We would also be grateful if you would forward copies of this survey to your branch offices, representative or affiliated organizations.  


Thank you for taking the time to complete this survey. Completed 
surveys may be returned via email to:
	fxbcenter_survey@hsph.harvard.edu

or may be returned by post to the following address:
	François-Xavier Bagnoud Center for Health and Human Rights
	Attn: Health and Human Rights Survey
	Harvard School of Public Health
	651 Huntington Avenue, 7th Floor
	Boston, MA 02115 USA
	Tel: (1) 617.432.0656
	Fax: (1) 617.432.4310