Pro bono legal services: a means of improving health and welfare in Colombia

Andres Camilo Garay Nuncira

Fundación ProBono Colombia, Bogotá

andres.garay@probono.org.co

For several years, legal needs surveys conducted in Colombia have revealed that problems relating to the health system constitute the most often experienced legal need among Colombia’s population. For instance, in 2016, the Quality-of-Life Survey conducted by the National Administrative Department of Statistics (DANE) found that 23.4 per cent of the legal needs reported by respondents were associated with the quality, denial or timeliness of healthcare services.

This reality is reflected in Colombia’s justice system. According to Constitutional Court, in 25 per cent of Tutela Actions – the most effective legal action in the protection of fundamental rights – presented between 2019 and 2021, the second most frequent request was a petition for the safeguard of the right to health. Different studies have determined that this constitutes a significant cause of the judicial bottlenecks.

Furthermore, the Covid-19 pandemic has clearly showed that the population’s health problems are affected by social context and circumstances. Social inequalities have a substantial influence on morbidity. In Colombia, this was apparent in the number of deaths caused by Covid-19 among some of the most disadvantaged sectors of society: as reported by DANE, population groups with fewer economic resources accounted for 87.4 per cent of fatalities during the pandemic.

The above demonstrates that legal needs and health needs are related problems in the way they are faced by many people in Colombia. Such social inequalities are provoked or exacerbated by a lack of access to justice and are having a significant impact on health status among the most vulnerable sections of the population. However, in Colombia, there has not been an attempt to develop an alternative comprehensive approach that dedicates attention to the interrelated legal needs, social inequalities and health problems faced by the population.

This contrasts with other countries such as Australia, Canada and the United States, where some mechanisms have been adopted to deal with patients’ diseases, together with the legal needs and social circumstances that have caused or aggravated the medical problem. The main instrument used in these countries has been the Medical-Legal Partnership (MLP) model, also known as Health Justice Partnership (HJP). The MLP or HJP model is built on a comprehensive understanding of two established facts: lack of access to justice can be both a cause and a consequence of poverty and inequality; and in more than 60 per cent of cases, people’s health conditions are influenced by Social Determinants of Health (SDH). That is to say, the socioeconomic circumstances in which people are born, grow-up, live, work and age – also involving the justiciable problems – can affect health.

In short, the MLP model understands welfare and health status as the result of biological conditions plus SDH and the way in which people deal with their legal needs. Accordingly, it integrates lawyers in healthcare settings to facilitate access to legal services for patients and provides them with legal advice to reduce the impact of un-met legal needs – and the related socioeconomic problems – on health.

MLPs and HJPs have demonstrated positive outcomes promoting access to justice and health in support of the most vulnerable populations in countries where they have been adopted. The Pro Bono Colombia Foundation was inspired by these models to design the first MLP in Colombia, which has been adapted for local circumstances. This MLP is to be implemented for a year through sponsorship by The Cyrus R Vance Center for International Justice, the Colombian law firm Brigard Urrutia, General Electric and in association with the Roosevelt Institute – a prominent medical institution in Bogotá, which provides services mainly to children and people with disabilities.

During this period, the MLP will integrate a team of health care professionals from the Roosevelt Institute and a legal team coordinated by the Pro Bono Foundation. They will develop and execute a route for the triaging and monitoring of the Roosevelt Institute’s vulnerable patients, focused on providing free legal advice to complement medical care and resolving the legal needs affecting the health of patients. Furthermore, the year of operation will allow the results to be examined and the project can be adjusted to create a sustainable and replicable MLP model for Colombia.

Overall, with this project, the ProBono Foundation will help channel pro bono work towards the types of legal needs that vulnerable populations in Colombia experience most often. Pro bono activities can only have an impact on social inequalities if they meet the legal services society demands. Responding to these needs, this MLP project expects to contribute to: improving legal empowerment; providing access to justice for the most vulnerable; relieving judicial bottlenecks; and consideration for SDH caused or made worse by the unsatisfied legal needs of disadvantaged people. In this way, lawyers’ pro bono work becomes a tool that is able to not only solve legal problems, but also have a positive impact on the everyday life of socially excluded groups by promoting their health and welfare.