Trained and experienced paralegals have the potential to improve the respect, protection and fulfilment of clients’ health-related rights. The four staples of LBHM’s paralegals’ work reflect the tangible impacts paralegals bring into the life of marginalized community members. Their role in checking the clients’ health is similar to the role of paralegals as documenters of human rights abuses in detention (6). Their activities in raising clients’ awareness on their own rights to health bring the same components of the ‘traditional’ role of legal empowerment (3,5) but with focused training on the right to health. Similar to the achievements of paralegal programs in Sierra Leone, Rwanda, and Uganda (5,17), paralegals in Indonesia succeeded in demanding pre-trial release or bail by highlighting the need for health treatment.
LBHM’s paralegals’ success in helping clients to obtain non-custodial sentences reflects previous findings where paralegals have been involved in projects aiming to obtain rehabilitation verdict for drug users. A project supported by the United Nations Office on Drugs and Crime in Indonesia sought to train paralegals from civil society organizations and legal aid organizations with the aim of improving their capacity to secure alternatives to incarceration such as rehabilitation (18). Another recent paralegal program in Indonesia also recognized the gap in legal services for drug users and aims to provide adequate legal services through trained paralegals for a verdict of rehabilitation instead of prison time (19). All of these efforts reflect the increasing understanding of the broad roles that paralegals can play to improve access to justice and health.
This research identifies several important factors for success. In respect to awareness raising, LBHM’s paralegals have the advantage of coming from the communities they serve, therefore, it is easier for the client to trust them. As fellow community members, paralegals have a greater sense of the problems faced by their clients, including health-associated risks and needs as the result of their case or of being detained. In some situations, LBHM’s paralegals even have the experience of having been detainees themselves. Previous bodies of literature show that by originating from marginalized communities, paralegals can work more effectively and attract more willingness from their community members to act (2,10,20,21).
Another crucial factor for the success is their networks with healthcare providers and law enforcement agencies which allow them to go the extra mile in ensuring their clients’ health service needs. Some paralegals have regular jobs as health care workers and NGO staff which make them more knowledgeable about healthcare services and facilities. Their relationships with law enforcement agencies also enable them to negotiate clients’ bail or referral to health care facilities. This situation implies that in order to succeed, paralegals should build relationships with law enforcement and develop collaborative solutions (13). Apart from networks with health care providers and law enforcement agencies, paralegals’ affiliation with LBHM is also beneficial for paralegals to obtain advice on how to deal with their cases; this affirms that partnership with local legal aid organizations is imperative for paralegal programs (12).
The need to incorporate paralegals into the global legal system where their work is acknowledged by the local context and civil law is well documented (2,10,22). While the formal definition of paralegal has yet to be made clear, Indonesia has provided regulation on the role of paralegals through its Ministry of Law and Human Rights Regulation No. 1 Year 2018 on Paralegal in The Provision of Legal Aid. Although it is mentioned that one of paralegals’ role is to help protect the rights of their clients, protection of the right to health is not explicitly mentioned. In the future, this research could provide a basis for the government to incorporate paralegals’ function in enhancing the right to health.
The need for and potential significance of paralegals is increasing considering that globally, in 2016, there were at least 10.4 million people in prison as a result of criminal charges (23). There are efforts focusing on increasing the standard of health among people in prison, such as the enactments of international standards which include the provision of adequate healthcare for prisoners under arrest or awaiting trial.[1] However, countries where mass incarceration occurs and prisons are over-crowded, such as Indonesia, immense efforts are need to ensure that these standards move from paper to implementation. Based on the Ministry of Finance Regulation Number 64/PMK.02/2008, the government has cut the meal budget for prisoners to IDR 15,000 (approximately USD 1) per day for three meals. Many prisons, especially police detention centres, do not have in-house doctors. This situation is not unique to Indonesia and highlights the need for increased attention to health-related rights in these settings.
Alongside the above, there is a trend of using criminal charges as a ‘tool of social control to promote public safety, ‘morals’ and public health’ (24). Such punitive approaches put socially excluded groups such as people who use drugs, lesbian, gay, bisexual, transgender and intersex persons, adolescents, women, and poor people, many of whom are already facing health challenges, at a higher risk of facing criminal charges. When this happens, these groups do not only need help in accessing justice, but also in accessing healthcare and facilities while facing charges. One of best practices in providing access to justice for socially excluded groups is through the use of community paralegals (25).
In such situations, some paralegals, mostly those who have access to health services or goods, play an important role in ensuring that clients can obtain the treatment they need. As not all paralegals interviewed in this research applied the same techniques to ensure their clients’ health, more training which includes practical exercises should be conducted. The training should also widen the scope of legal empowerment where paralegals can equip community members with relevant knowledge regarding health-related rights. Paralegals, and lawyers, might not always have access to the clients twenty-four hours a day. In many situations, clients have no choice other than negotiating their health needs directly with law enforcement agencies. When this happens, the client’s knowledge on their right to health becomes an effective tool for negotiation.
It is beyond doubt that paralegals’ work benefits their clients’ legal rights. However, when LBHM started their paralegal initiatives, the benefit on the fulfilment of the right to health was not explicitly considered. Efforts to improve realization of the right to health of people in closed settings are often limited to the provision of doctors, facilities, or goods. This research strengthens the evidence base that paralegals can also become an additional avenue for enhancing detainees’ rights to health through checking clients’ health, raising awareness, ensuring health services in detention, and seeking for alternative or lower sentences where appropriate.
Study Limitations
This study has several limitations. This research is a self-assessment and did not include the perspectives of clients of the paralegals, therefore, the positive impacts reflected in this research might be exaggerated. Further, this research does not incorporate the perspective of health care workers, such as doctors and psychologists, to measure the medical effect of paralegals' assistance on their clients' health. Future research should attempt to combine perspectives from many parties to gain a more holistic picture of paralegals’ impact on the right to health.
[1] These standards including, but not limited to, the revised Standard Minimum Rules for the Treatment of Prisoners and the UN Bangkok Rules.