Sathyasree Goswami : The Change Ripple

Item

Title: Sathyasree Goswami : The Change Ripple
extracted text: Report of CH Fellowship

1

the change ripple

Inspiration
Selfless
Action

Support others
journey
Inner
transformation

Report of the community health fellowship
September 2005 to March 2006
Sathyasree Goswami
Rural Volunteers Centre (RVC)
Vill. Akajan 787059, Via. Silapathar, Dist. Dhemaji Assam (India)
sathyasree1974@yahoo.com
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Service is an attitude- a mindset. It means putting the
best of yourself forward no matter where you are or
what you're doing. It’s the generosity of spirit that
transcends our disabilities. Some people wonder what
they have to give the world; without exception we all
have something to give -- arguably one of the best gifts
of all – ourselves!!

What the report contains...
1. Driving Point
2. Six months at a glance
3. Pictorial Framework
4. Annexure
A. Community Health Concerns: Assam
B. Pilgrims Progress
C. Drugging northeast India to dependency and isolation
D. Learning Objectives
E. National Consultation on Food Security Corridor, Hyderabad
F. Food Sovernity Alliance DDS Pastapur
G. Visit to Plachimada
H. WTO and People’s Caravan
I. JSA-NRHM Watch and CSDH
J. AIDAN meeting vellore
K. Mfc meeting vellore
L. Review of the NHRC on the National Action Plan

Driving point
When my eyes opened the clouds came in through the window of the bus and as I looked
down there was a crystal green river flowing much below, on the other side were the
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huge Himalayan Mountains and we were in the Subansiri valley on the north eastern most
border of India. As the bus moved a little further I could see the Chinese territory, which
was equally beautiful, and at that point in time it did not matter if we were different
countries because nature didn’t differentiate anyways. In another three hours of this
beautiful journey we crossed Dumporijo a small town (rather a large village) where
smoke emerged from bamboo and thatch houses on stilts, very small shops sold grocery
and schools with sprawling campus were prominent, another half an hour and we were in
Daporijo town- my destination to begin my tryst with community work way back in 1994
September. After twenty-two years of life on earth I was filled with idealistic and
revolutionary ideas of working for people who according to my ideal and learning needed
help and I had gone there (where eagle’s dare) to “help” the poor and needy! I had
actually waited for this day for nearly five years and on that day I had eloped from the
material world with the belief that I will live in this remote, geographically inaccessible
and difficult mountain terrain all my life and work with women men and children for
their welfare!
As I boarded the train in Kacheguda to reach Bangalore on 18th September 2005 I
realised I had eloped again to a very unknown place and people. I had lived in villages
not just of Arunachal Pradesh but also Rajasthan, Assam and Andhra Pradesh for the last
eleven years of my life. Now I came with a whole baggage of a different kind of
experience; there was a lot of disillusionment and confusion that came with me too as I
landed in my dear friend Eddie’s place. Probably the idealistic me had a come a long way
and the revolutionary was dead but there was a deep conviction inside me that I had not
reached the end of my work and goodwill for working towards equity and social justice.
The past eleven years had unfolded to me great mysteries of “working for the poor”.
Tryst with Community Work
In Arunachal Pradesh I realised that something more than doing transfer of technologies
science camps, health worker training running non formal schools was required; at times
the disinterest of people bugged me and led me to think why couldn’t they simply accept
what is best for them for me. I always felt that since I was educated in posh institutions
and had topped my university they ought to know that I was right. Today when I look
back I am glad I didn’t force difficult pills down people’s throat but read and thought a
lot. I started analysing with my colleagues and going down to the root cause of the
problems and realised there were these things about which the people or I knew very little
1. Constitution of India and the entitlements it gave us etc
2. Policies- what they were, how they were born, what they did to our lives etc
3. Economics and finance- Forex, ex-chequer, hawala money etc
However I also felt that it was really difficult for me as a person or voluntary
organisations to do much to change policies. I lived with this very disturbing thought for
a long time as I left Arunachal and came down to work in the Bramhaputra valley of
Assam in Dhemaji district.
Realities and Real Determinants
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The organization I worked with began from scratch; it was called Rural Volunteers
Centre (RVC) based in a village called Akajan. The experience here was phenomenal,
unlike Daporijo where there was tremendous response from the people for the services
we were delivering, making low cost latrines, sanitary dug wells, imparting skills training
etc. I was actually amazed as to why the same things were not in demand in Arunachal
where remoteness and infrastructure development was very low! Suddenly the entire
issue of constitutional entitlements, policies and economics seems to make sense. The
policies, constitutional entitlements and economics are entirely different in the two states
touching each other!
By the year 1996 I was deeply involved with relief and rehabilitation activities for the
thousands of people who had either lost everything or parts of it. There was still my
question of the larger issue of what are the core changes required, what are the
constitutional entitlements, the appropriate policies and the economy involved. I was also
convinced that if we do not provide relief to people that won’t solve the problem either,
yet there was certain obligation of the State that were not being fulfilled. I juggled
between community work and understanding this larger picture and It was not until the
year 2000 when 14 villages were washed out because there was a dam breach in China
that I was convinced that there are certain things which cannot be solved by voluntary
organizations doing work in isolated pockets however valuable and meaningful for the
area.
While doing all these I was also involved in training community health workers, the first
batch of 25 young women that I trained and monitored showed amazing results in their
allotted villages. They travelled by boats, took up walking to many place and their
dedication to the cause was amazing and I drew strength form the fact that prevention
actually is the cure to a lot of our health problems. Somehow this enthusiasm and
eagerness started dwindling as the first phase of RCH was launched. Almost every
woman screened in the two districts had some or the other form of Reproductive Tract
Infection and the doctors came with a whole lot of drugs as we watched with awe with
what ease they though the infection could be cured!! This led to the larger debate of
whether such government interventions were doing well or they were making our women
more dependent on clinical medicine?
Facilitating Corruption- The real turning point
While this exploration went on I realised I needed to get in touch with my self and
question as to why I was so disillusioned after so many years of relentless service to
communities. Under my supervision there were more than 250 women trained in
preventive health, they were doing well, the schools I worked for were doing well, there
was a ten years commitment of resources but I was constantly questioning myself.
I was a part of the UNDP’s Human Development Report in 1997 when I was as young as
25 years, various State Governments’ would invite me to formulate projects for them.
While I did these I suddenly realised that I was actually helping increase corruption in the
country because the projects I formulated were implemented only 25% or never
implemented at all!! This was the real turning point and my exploration into the entire
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concept of development began. There was enough arrogance by then me to think that
academics, research and efforts carried out for development from urban centres were
meaningless and this came from my constant association with SWRC Tilonia and its
allies. I started exploring working out of the North East India and found reassurance that I
was not wrong in my thinking and that I should continue my search for the real meaning
of work.
Exploration of Rights and Dignity
As I moved ahead I realised that Human Development is basically a process of liberating
oneself and others – liberating from paralysing tradition, from exploitative situations,
from expectations, denial and deprivation. By this very definition, development cannot
be brought, but must come from within through the unleashing and channelling of one’s
enthusiasm, creativity and energy. This also requires the creation and involvement of
committed groups and individuals who, first and foremost, care for and work with it in
setting in motion a process of critical self-awareness for self – directed action for change.
Rights depend on one’s dignity and self-worth, which cannot be given but need to come
from within. It is “about enhancing human well-being” and their “sense of self-worth
and dignity” and not just their net-worth. There are all kinds of good struggling to be
born from way within the person. There are also anxieties and hatreds that are struggling
to be expressed. Deep within, there is a great touchiness for one’s own integrity - a great
tenacity in the face of adversity. They have the unlimited ability to take whatever comes,
to go on surviving in the midst of unbelievable difficulties and persecutions. With these
ideas then not so well formed I went to the Health and Human Rights (HHR) course
offered by TISS and Cehat in Mumbai. It was extremely information packed; though the
theoretical understanding of health and human rights increased there were no answers to
the questions that I harboured. Somehow I thought the session that Abhay Shukla had
conducted on People’s Health Movement could be an answer

Why Community Health?
I now call it one of the best train journey that I took with my dear friend Premdas from
Mumbai to Bangalore. We had just finished the HHR course and going back to the
selected destinations. I was very disillusioned and had a strong feeling that I did not want
to go back without my answers. Since the AC compartment in which I was travelling was
empty Premdas came there and we started discussions that led me to understanding that
there were efforts being taken up on holistically looking at community health. He went
on to explain the principles on which CHC functions and I was amazed that here was a
group (approach) I was looking for to explore my confusions and doubts. Community
Health I realised was a integral part of what I had been doing in the last decade and that I
was real causes and remedies (that seems like a strong word now). I then thought knew
answers to other problems like education, bad governance etc. but the medicalisation of
health and not the human being as the central object of medicine was disturbing.
Soon the fellowship was announced and I applied. In the meantime there was a lot I read
about health status of the country and was involved in preparing a note on the health
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status of Assam because I was convinced and determined I wanted to carry out exploring
community health. The note is attached here as Annexure A, the facts that were revealed
through this study stunned me, 80% women in Assam suffered from anaemia! And I was
again convinced it was not just Iron folic acid but a larger social problem.
Pilgrims Progress
Well as I entered the CHC fellowship I could feel here is an invitation to explore as an
individual or a group on the role each of us has taken in our work situation and the self
with its joy, aspirations, hope and also the feeling of hurt, neglect, anger which are lying
unexplored in our subconscious and acting out today in our lives. How can we integrate
both our role and self and find a ‘meaning’ that can result in the well being of both the
group and the individual.
The orientation started and the sessions started tickling my thoughts and intellect and
there were times when I wanted to say this far please and no further. Internally I felt I
was told there will be no ‘right or wrong’ judgment amongst us, but understand each
other’s feeling and the situation and help each other to find a meaningful resolution both
in our differences and similarities. Our attempt is to articulate those unarticulated feelings
without being judged but understood as legitimate feelings, which need to be taken into
consideration as a group in resolving any present contradictions. We share those events,
which is blocking our relatedness to the present changing situation due to various
experiences in the past and holding back our progress towards the mission set.
Annexure B talks about this experience during the fellowship
However I felt at many times during the orientation that I was being isolated because
people knew so little about the situation prevailing in the north eastern part of the
country; sometimes I also sensed there was a indifference in people to understand the
situation. There was actually a lot of bitterness in me and I poured out all of it in a article
given here in Annexure C. As time went by however I learnt it was not really
indifference but the policies that were formulated specifically for this part of the country
surrounded by international borders that made it so isolated most times!
During the orientation we had enough space to set up our learning objectives and re-look
at them over and over again and work on a plan to work towards community health
during our fellowship, attached as Annexure D. I was guided by the larger objectives but
I could not work with the plan I fixed because the learning that I gathered during the
course of the fieldwork and my reading helped me reflect and go slow. One of the biggest
learning was there was no hurry, I could take the liberty (during this fellowship) of
understanding, reflecting and designing the work gathering pace with the experiences. A
brief understanding of the events are given in the table below-

Six months at a glance

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MONTH DATE
Sept’05

19th
onward
s
st

PLACE
CHC
Bangalore

7

EVENT

LEARNINGS

Orientation on
Community
Health
Orientation on
Community
Health

Community health from a broader
perspective, linking of government policy
with grassroots realities and the need to
work for convergence

National meeting
on Village Grain
Bank and AP
Food Alliance

Understanding Govt. policy on food
Security and studying its effects on rural
communities in AP

1
to15th

CHC
Bangalore

16th to
19th

DDS
Hyderabad
and KVK
Zaheerabad
AP

20th to
22nd

Plachimada
and Pallakad
Kerelam

Field Trip

Akajan village
Dhemaji
district of
Assam

Field work

Guwahati

Workshop

Akajan village
Dhemaji
district of
Assam

Field work

North Assam
and Guwahati

People’s
Caravan

Akajan village
Dhemaji
district of
Assam

Field work

Oct’05

Nov’05

th

th

4 &5
Dec’05

th

Jan’06

9
&10th

th

11

Vishwa Yuvak
Kendra
New Delhi

Vishwa Yuvak
Kendra
New Delhi

Akajan village
Dhemaji
district of
Assam

COMMUNITY HEALTH FELLOWSHIP

JSA’s National
launch of
People’s Health
Watch (NRHM)
Watch
JSA’s National
meeting on
Commission on
Social
Determinants of
Health

Field work

Collective strength of people can affect
the wrong doings of faulty policies there
leading to the closure of the Coca Cola
factory in Plachimada
Understanding people’ priority so far as
community health is concerned. People’s
perspective of a healthy society was
explored
Understanding flesh trafficking and its
larger affects on community health
especially women and their lives later
Translation of relevant materials regarding
various policies and the entire concept of
globalisation and related information was
very welcome by the community.
There were a lot of links to globalisation,
WTO and how adversely people’s lives
and livelihood was being affected; yet the
entire concept of globalisation there is
vicious cycle within the benefits from it
Need to keep people informed regarding
policies that affect their lives. People are
also very keen to know how certain
programs are designed for them without
they being aware of it.
There is a need for civil society to play a
very active role in engaging with the
government on the one hand while also
doing a systematic study of the
implementation problems on the other
WHO has recognised the Social
determinants of health this would be really
helpful for the third world to address their
problems fro a holistic perspective.
Working with various CBOs and the
leaders of three panchayats on
understanding the implication of NRHM
and the State Health Insurance Policy at
the grassroots

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rd

23 to
th
25
th

26

Bangalore

Mid fellows meet

Vellore

AIDAN annual
meet

Vellore

medico friends
circle (mfc)
Annual meet &
visit to CHAD
and CMC vellore

Guwahati

State meet on
flood early
warning

Guwahati

All India
People’s
Science
Congress

Imphal
Manipur

Training on HR
&
Documentation
and Report
writing

Guwahati

Right to Food
Campaign

Akajan village
Dhemaji
district of
Assam

Field work

New Delhi

JSA preparatory
meet for NRHC
review

th

27 to
th
29

nd

2

rd

3 to
th
5

th

6 to
th
14
Feb’06

th

16 &
th
17

March ’06

rd

3

COMMUNITY HEALTH FELLOWSHIP

Sharing and learning from field
experiences
The politics of the pharmaceutical industry
and the global forces acting to make more
profit; government of India’s policy
problems etc.
Quality care in the present state of poverty
in our country is not a possibility. Whose
understanding of quality do we look at?
The low cost efforts put in by CMC were a
learning that if there is a will to cut costs
one can still do it.
In chronic disaster situation public health
of the community is at stake, therefore all
the stakeholders have to be involved to
work on preparedness and early warning
of the community
The BGVS is a large network of teachers
across the country but their understanding
of community health is very limited and
restricted. However this was a good forum
to launch mass based action, as their
presence across the country is large.
The exposure and orientation of young
people of Manipur is very different from
the youth of India. They have to relate
many issues related to human rights in the
everyday political and economic context of
their state. At the same time the redressal
mechanism was very different from the
rest of the country. The civil society
movement is very intertwined with the
political situation; therefore the strategies
used there are different from the other
parts of the country.
Hunger is not reducing inspite of the State
introducing more and more policies to
tackle food insecurity the number of
hungry people in India are increasing.
Therefore a concrete efforts are needed
from all across the country to watch the
implementation and let the poor and
hungry people know their entitlement
Understanding people’s knowledge of the
financing and economic policies of the
country. It was very interesting to note that
people were very interested in knowing
about finances related to development but
not really about health.
There was joint preparation done by all
the state JSA groups and it was very
encouraging to see that all the states were
working towards the common goal –health
for all now!

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th

New Delhi

NRHC review
meeting on
National Health
Action Plan

th

New Delhi

JSA meeting

Bangalore

Annual Fellows
meet

Bangalore

Closing of
fellowship

4

5

th

6 to
th
8

th

9 to
th
16

This was a great learning experience to
understand the power equations between
the policy makers and the people’s
movement groups like the JSA. It was
very interesting to learn that though there
is a general willingness amongst the
bureaucrats to work for people’s benefit
but many decisions are very person
centric in the bureaucracy. Very less
thought is given to the fact that whether
the last house in the village will be able to
access government facilities.
Even though a network wants to work in a
very inclusive way there are problems that
they encounter to keep such a diverse
network together. Since a movement does
not access funds from external agencies,
that could also be a block for the
movement to function effectively
Experiential learning and sharing was very
helpful. The context of globalisation as
experienced by the fellows in the field
were very interesting as to how very small
so called development by the government
can be harmful to people. There were
many informal sessions were the fellows
could think of a way forward.
The rich experiences of the co fellows and
my own reflection of the process took me
through a very emotional journey. This
was one of the best parts of my life and
the learning from the entire experience of
six months has made me stronger as a
person and strengthened my resolve to
work for community health and community
development.

"Much of what we do is like planting trees under
which we may never sit, but plant we must."

Pictorial Framework of the work
done during the Fellowship
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People’s lives and
struggles
Campaigns,
Collective efforts

Community efforts

Public Health
policies
national and
international
policies

Geographical
Challenges

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Annexure A

COMMUNITY HEALTH CONCERNS: Assam
focus on Dhemaji district
According to the government's formula, India is supposed to have one sub-centre for
every 5,000 people (3,000 in hilly areas), one primary health centre for every 30,000
people (20,000 in hilly areas) and one community health centre for every 120,000 people
(80,000 in hilly areas). Whereas the National Health Policy 2002 aims to increase usage
of public health facilities from the current level of less than 20% to more than 75% by
2010, a study shows that the country still need 7,415 community health centres per
100,000 population which is presently less than half the number. The basic staff not being
in place in these facilities, only 38% of our primary health centres have all the required
medical personnel.
Background: India’s North East
The North East of India is usually referred to seven states: Arunachal Pradesh, Assam,
Manipur, Megalaya, Mizoram, Nagaland and Tripura, though Sikkim too has been
included in the region. The region forms 8% of India's land mass and has 4% (33-35
million) of India's population. Modern democratic politics based on numbers does not
give space to the northeast region to voice its concerns. The feeling of being 'unheard'
further accentuates the feeling of neglect and alienation in the people. The strategic
location that encourages physical isolation of the entire North Eastern parts of India
makes it a low development priority for the Centre; it is seen that entire NE is considered
as deserving of singular treatment.

Status in Assam:
Characterised by the presence of river Brahmaputra, the State of Assam shares its borders
with 5 states and three countries assuming geographic, cultural, economic and political
significance. The river runs a regal 800 kilometres in Assam forsaking its channels each
flood season. The State of Assam for the first time has brought out the Human
Development Report 2003 and has done a detail district wise indexing of the Human
Development Index (HDI) considering the three issues of wellbeing- first Income,
Employment and Poverty, secondly Education and Literacy and thirdly Health. The
indicators used for health were Infant Mortality Rate (IMR), Crude Birth Rate (CBR),
Crude Death rate (CDR), Life expectancy at birth (LEB) and nutritional status.
The report reflects uniformly across all the indicators of health a distinct rural urban
divide and a gender gap. It is also seen that though there is an improvement in the
indicators, Assam’s performance as a whole in the health sector in the last decade is
lower than the country’s average (refer Table No.1). LEB of Assam is one of the lowest
in major Indian states, the IMR, CBR and CDR in Assam is higher than the national

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average with a clear urban rural divide. The infrastructure of community health also
reflects lower status than India showing clear urban and rural divide.
The HDR further records that the most common ailment is asthma followed by malaria,
jaundice and TB with very high prevalence of water borne diseases which are on the rise
during floods and monsoons. Being the record high in India, 70% of women in Assam
suffer from anaemia according to the report and Diarrhoea is a common cause of
mortality among children followed by ARI (pneumonia). The expenditure on the health
sector in proportion to the total public expenditure has declined from 5.23% in 1980-81
to 4.65% in 1998-99.
Table 1 Comparative data of the community health
INDICATORS

YEAR INDIA ASSAM

Crude Birth Rate
1998
Infant Mortality Rate
1998
Still Birth Rate
1998
Institutional Birth
1999
Birth attended by trained birth attendants
1999
Neo natal mortality
1999
Doctors per 100,000 population
2000
Nurses per 100,000 population
2000
Hospitals
2001
Dispensaries
2001
PHC
2000
SC
2000
Beds per 100,000 population
2001
Source: Review of Healthcare in India- Cehat

26.5
72.0
8.0
26.6
28.9
53.0
54.27
75.89
1.52
2.08
3.10
18.63
69.34

27.9
76.0
17.0
21.0
16.2
45.0
53.72
33.29
1.01
0.51
2.64
22.13
47.66

The private health care services is sub standard and interestingly the Government of
Assam has enacted the Health establishment Act but the rules under the Act are yet to be
made. The recently announced (July-Aug 2005) Assam State Health Insurance Scheme
tying up with ICICI Lombard has enabled the private drug dealers to flourish further.
Scenario in Dhemaji District
The Dhemaji district of Assam is located in the north bank of river Brahmaputra across
the tea town of Dibrugarh on the south bank. Bordering Arunachal Pradesh Dhemaji is
one of the lowest ranking in HDI district being 20th amongst 23 districts. The data given
in Table 2 explains the population and health status of the district. Chronic flood is the
salient feature of Dhemaji district which leads to the district being isolated every year for
over 30 days.
The roads, railways and telecommunication are most often disrupted during the 4
monsoon months. Therefore it is important to note that even if there is any meagre health
service available, lack of communication isolates it; this is the phenomenon with most of
health sub centres made under the World Bank assisted IPP programme. The district
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having attained a difficult and remote status, the health staffs refuse to be posted in the
district and specialist doctors are rare to find.
Table 2 Indicators of well being status of people of Dhemaji district of Assam
District-DHEMAJI
Area
3237 Sq Km
Population (2001 census)
569468
Urban population
6.91%
Population of 65 years above
4.15%
Population under 15 years of age
45.1%
Decadal growth rate (1991-2001)
18.93
Sex ratio
Rural 932 Urban 717
Households with Sanitation (1991)
16.37%
Households with Safe Drinking water (1991)
48.58%
No. of Hospitals (2000-2001)
3
No. of PHCs- (2000-2001)
9
Rural Family Planning Centre (2000-2001)
1
Dispensaries
5
Hospital Beds per 10,000 population (2000-2001)
4
Infant Mortality Rate (1991)
Males 113
Females 117
Child MR (under the age of 5 years) (1991)
Males 140
Females 138
Crude birth rate (per 1000)
25.90
Source: Government of Assam.
Community Health and civil society efforts: WHAT NEEDS TO BE DONE….
The historical Assam accord that emerged as a resulted of the Assam movement does not
focus on improving the community health scenario though there is emphasis on
increasing access to medical education. The last budget of the Assam Government also
emphasizes on repair and renovation of the medical education infrastructure which has
not been done. However there are only sporadic instances of resistance to the deplorable
condition of the medical colleges from the student bodies and rarely from teachers
associations.
Over a decade it has been observed that the voluntary sector in Assam has not actively
involved in ensuring people’s right to health care. Though there are state chapters of
national networks of organizations working on health, the lobbying and advocacy efforts
are very meagre. There are organizations working on preventive health issues and
collaborating with the Government in implementing vaccination programmes, though
there are no organised pressure groups to ensure the right to health care. Most of the time
it is seen that voluntary organizations treat community health program as an appendix to
rural development programmes. The Christian missionaries have mostly concentrated on
service delivery which at times is no better than private hospitals where discrimination on
the basis of religion is also seen at times.

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Given the above situation a strong need has emerged to carry out focussed work on
ensuring access to health care for the people of Assam. To begin with it may be proposed
that initial work can be started in one district –Dhemaji district of Assam. As mentioned
earlier this is one of the most underdeveloped districts and due to multifarious reasons
community’s access to health care is seldom a reality. However over a period of time
concentrating on a few issues of community health, a state level pressure group can be
formed with various organizations. It is strongly felt that there is a need for development
professionals from Assam (and also North East India) to interact with persons working in
community health in other parts of the country to understand the issues better. The people
of Assam have always considered themselves distinct which has led them to hesitation in
accepting the mainland discussions. Therefore efforts have to be made to replicate some
of the initiatives carried out in other parts of India after tailoring them to suit Assam’s
needs.
The people’s health movement (PHM) in Assam and most states of North East India has
not yet been actively launched. In collaboration with organizations from mainland India
work on the people’s health movement can be taken up also involving other interested
civil society organizations and voluntary organizations. One of the major drawbacks for
the people in this region is that neither do they have access to information on
development planning nor is there any effort to access such information. There is
tremendous need to fill in this information gap to people and further translate material
into vernacular. Systematic networking with the media, voluntary organizations, civil
society groups and concerned individual not just from Assam but even outside the region
will greatly enhance work on accessing health care by all in the long run. Assamese
agrarian community need support to improve their lives by accessing what rightfully
belongs to them and live healthy life.

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Annexure B

Pilgrims progress
Amazing Welcome
This unique fellowship is a journey within oneself. Often exploration of
ones reasons of being here and working towards an equitable and just
society can cloud one’s thinking. I was going through such a phase of
partial disillusion and confusion; though wary whether I will be accepted
me with my confusions, I decided to be open about it. I nearly fell of my
chair three times when I was more than welcome at Community Health
Cell Bangalore with my bundle of confusion and I could hear three people
tell me in unison (through in three different places and times) we welcome
all confusions and you!! This was the first time I was told that questioning
one’s work while doing community work is indeed healthy and that I
should carry on this pilgrimage and my exploration simultaneously.
Pilgrimage of selfself-exploration
Over three weeks now in the company of fellow pilgrims it has been a
pilgrimage of self-reflection. This fellowship is about community health
and in one of my very first discussions with Fr. Claude, he says that
unless the community is devoid of jealousy and selfishness, community
cannot be healthy whatever amount of medicines may be pumped in. I was
amazed at such a profound meaning of community health! This fellowship
takes one through the corridors of prevailing inequity, injustice and
deprivation that most people face today. The inequitable distribution of
assets and the conspiracy to let skills be concentrated in the hands of a
few has left the majority of the people impoverished world over. The
journey of the past few days have bought to light the fact that the people
who have been called to be living in the periphery (the poor) actually are
very centrally located. The resource rich are frightened to acknowledge
this fact and therefore imaginatively keep pushing them to the periphery.
Silent invocation
As we go through the orientation process there is a very silent invocation
of ones inner resources to question the injustice one experiences and
witnesses in day-to-day life. The basic erosion of values in the family and
society and across communities raises questions in one’s mind regarding
the future of human race. However there is a constant reminder that there
is a very strong need for more and more people to start reflecting,
thinking and drawing up action to work against this prevailing persistent
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injustice. The emphasis is on working through the collective strength of
common people who are struggling and facing the challenges in their lives
every day.
Together towards hope
The pilgrims tend to tire out most times as they get exposed to the
injustice and inequality that is so rampant and prevalent in every corner in
life today. At such time the story-tellers remind the pilgrims that there is
always hope around the corner. They talk of journeys that people have
undertaken in the past and through an inclusive approach and that there
are many milestones that have been crossed and much success
celebrated. It is important to critique but not to criticise it is pointed out
by the story-tellers time and again. The most beautiful part of being a
fellow here is having mentors who hold hands and softly tell you to come
back to the path without disturbing the reflection process. It is not a
journey of solitude, the mentors always remind the fellows that there is
hope and that every one shall walk hand in hand in this pilgrimage of
reaching health- mental, physical, social, spiritual for all!!
9th October 05
Bangalore

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Annexure C

Drugging north east India to dependency and isolation
throughout history, it has been the inaction of those who could have acted;
the indifference of those who should have known better
the silence of the voice of justice when it mattered most
that has made it possible for the evil to triumph
- Haile Selassie

Men with sophisticated arms and uniforms (read Indian army) intrude your kitchen or
bedroom for no reason ever known to you is what it means to live life in a land where the
draconian Armed Forces Special Powers Act (AFSPA1958) was imposed and applied by
every leader who was elected by the people since 1958. This happens in the world’s
largest democracy in the north eastern corner connected by a 22 kilometre wide chicken
neck to the mainland India. Under the AFSPA fundamental human rights of an individual
is not only lost but the seven north eastern states of India has at least two generations
with increasing feelings of alienation and hostility towards democracy. Internationally
India has been questioned by UNHRC on the validity and the constitutionality of AFSPA
to which the attorney general of India replied that the AFSPA prevents “secession of
North Eastern States”. India has signed the international covenant on civil and political
rights since 1978, and imposition of AFSPA is a violation of the Covenant; Time and
again India has been questioned on the biggest imposition of AFPSA that is the violation
of “right to life”. Whose life are we talking about? Children, women, men, elderly and
the youth for whom armed personnel in whatever denomination they appear can never be
their friend or provide security, they are people whose shadow makes entire village
deserted in matter of few minutes and at whom if a woman looks she is not assured of her
dignity the very next moment.
Significantly political leaders and Government policy writers pretend to be blind and deaf
to the army conducted mass rapes, deformed sexual organs, mutilated limbs, punctured
eyes, bullet ridden bodies, burning villages and burning granaries, they allocate more and
more funds in the name of defence budget of our country! As I write this piece, the All
India Radio informs in the morning news that Government of India has decided yesterday
to send these armed men to Karbi Anglong district of Assam to control violence!!
Interestingly such policies are largely linked to the flourishing arms market that is
provided for by the larger lobby of the world’s largest industry- the armament industry;
while this happens some Delhi homes get palatial with more conditioned air and a son’s
marriage gets people landing down with choppers chartered by the bribe they offer. The
other side of the story is arming of the resistance movements in the northeast India, which
is a double benefit to the same industry and therefore this industry, would do everything
possible to let the unrest remain and more resistance grow.

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The conspiracy does not end there, the British used poppy cultivation to silence voices by
drugging people and numbing their thinking; even five and half decades after they left the
country’s northeast corner is subject to increased flow of drugs to which the
pharmaceutical companies contribute by sending high dose through cough expectorants
(read phenydrly). There are no concerted efforts to curtail the infiltration of drugs into
northeast by the Indian Government thereby numbing the people’s ability to think and
react to the denial of people’s entitlement to life. Many people from mainland India also
blind themselves and support such draconian acts as they have very little access and
willingness to know that northeast of India is not just jungles, hills, waterfalls, rhinos and
semi naked people doing slow dances but it has laughing children, lively creative women,
young men and story telling elderly people. Many people outside the seven sister states
live in a state of denial of human existence in this area to the extent that when a person
from that region dresses and speaks at par the national tongue or English with the
appropriate phonetics they refuse to believe the person belongs to where s/he claims to
belong to. They unknowingly fall prey to the conspiracy of “prevention of secession” of
the Indian Government and the larger global forces of arms and drugs supporting the
Government. Until the Manipuri women forced themselves to nakedness on 15th July
2005, the oppression was not a part of the Indian subcontinent and its media, like always
the northeast remained tucked away in people’s memory as a disturbed troubled corner.
The State Governments of the seven states succumb to the entire conspiracy and instead
of concentrating efforts for mental de-addiction of their constituencies they go on a
begging spree in the name of eyewash development projects but basically to support
party funds. It is not that people of this region have not resisted oppression. As a young
child of eleven I have witnessed over 10000 people marching more than twenty
kilometres on foot to break the first curfew imposed under the president’s rule during the
Assam Movement led by the students of Assam. Only children and the very old were left
back at home, the women, men, youth, shop owners, cart vendors and elderly walked to
the oil pipeline in the Oil India Limited (OIL) campus to stake their claim over the
revenues Government earns from natural resources of the region and use it for the
development of the northeast region. Rich in resources like oil, natural gas, minerals and
tea, the state of Assam barely receives any revenue from these for its development. When
a section of the students took to a movement to question this there was mass support from
the people of Assam but the dream slowly and steadily collapsed as the new student
leaders’ led Government succumb to the same gimmicks of the conspiracy.
Then came the youth (with arms) who talked of a fair independent state of Assam in
protest against the revenues from the natural resources and the businessmen (mainly from
Rajasthan) being taken away from the region for development elsewhere thereby forcing
the region to take to the begging bowl. Presently though they sometimes explain their
existence through series of bomb blasts and kidnapping they are also more than often
seen satisfying the armament industry with extorted resources from the exploiters. The
victims of extortion are more than happy to extract the extra profit from the common
person and hand it back to the flourishing arms industry through the independence
provider youths. One of the governors of Assam managed to make his way through the
“independence providers” and start another conspiracy of these youth surrendering and
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returning to the mainstream. They were instead used as agents to identify their colleagues
of yesterday and some police officer receives accolades for shooting the pointed one
down. The mainstream returned is not spared either, because there is arms and revenge on
the other side too, who promptly shoot the pointer down amidst Z class security provision
of the Government. This vicious cycle continues as the large global forces is interested in
selling arms and drugs and drugging the entire region to dependency and isolation.
Suddenly the World Bank and its allies have started realising that while the world’s
resources for extracting power and water is depleting the hitherto untapped rivers,
streams and minerals still exist for them to exploit in this very same northeast corner of
India. There is a mad rush to set up energy and water shop now by various corporate
giants, psuedo-development banks and of course the political leaders to pass the political
“will”! The conspiracy continues….
The fundamental question is -Who is going to ask for their entitlement? When people are
(kept) busy confronting the arms conspiracy from the “defence providers” and/or the
“independence providers” or they are in deep mental slumber under the influence of
cocaine or phenadryl how, when and why should people ask? … the voice of justice is
silenced and the conspiracy succeeds!

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Annexure D

Learning objectives for the community health fellowship
Self-reflection on working with community health in a holistic way.
Understanding the shift in working from welfare mode to people’s struggle
towards their entitlements
Self development – clarity of global concepts
The work will concentrate on the monitoring the implementation of National Rural health
Mission (NRHM) 2005-2012. The NRHM has a special focus on the North Eastern States
and 10% has been the committed outlay is for the north-eastern states. My work will
concentrate on working in Jonai, Sissiborgaon Machkhowa and Dhemaji blocks of
Dhemaji district and Dhakuakhana block of Lakhimpur district of Assam. The work
will be done in collaboration with four NGOs in these blocks SRIJON in Jonai, RVC in
Sissiborgaon, SARBU in Machkhowa, SEDO in Dhemaji; shakti will work directly in
Dhakuakhana block of Lakhimpur district.
The work will be mainly done in November and December 2005 and half of January and
entire February another half of March 2006; a total of 4 months. Some of the activities
that I intend doing (tentatively) areNovember – Meeting health officials at the state level to understand the planning process
for the implementation of NRHM. Have a meeting of the four NGOs in the area to
discuss in details about NRHM guidelines for implementation and mission; if possible
this meeting will be held together in RVC’s Campus for 3 days otherwise it will be held
in each organization separately. Introduce PHM and health as a right in this workshop.
The expected outcome of this meeting would be to take up some common criterion for
monitoring the implementation of NRHM.
December – community meeting in selected panchayats on the implementation
guidelines and details of the NRHM with the help of the four NGOs. Try to access
government information if any on the NRHM specifically for Assam and send it to other
organizations in the state.
January - meeting of the four NGOs to understand the progress in implementation of the
NRHM. Decide on the strategy to approach the problems in a collective manner.
At personal level there are a few things I shall be doing:• Regular reading for an hour or more on the subject of health and human rights
• Helping other NGOs conduct training for the community members on right to
health and health care issues.
• Regular visit to the blocks to understand the implementation of the NRHM
• Be in touch with other NGOs in the State like, The ANT Bongaigaon, VHAA
Guwahati, Manav Shakti Jagaran Nalbari, Tezpur District Mahila Samity Tezpur,
GHAROA Silchar, ERLISID Kokrajhar, Morigaon Mahila Mehfil Morigaon,
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CASA Guwahati etc. these are the organisations I am in touch with personally
since a long time. If possible try to work out a common strategy for following up
the implementation of NRHM
Be in touch with CHC mentors telephonically or over email and discuss the
progress and get clarifications for my doubts if any.
Try to work with Dr. Sunil Kaul on the implementation of the State health
insurance scheme in Assam.

Though I have listed out a lot, my priority will be to work in the 5 blocks of two districts
of Assam and stress on personal growth towards understanding the implication of health
policies not reaching the vulnerable and marginalized section of the society.

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Annexure E

National Consultation on Food Security Corridor
17th and 18th October 05,
Venue MANAGE Agriculture University, Rajendranagar Hyderabad
Organised by Deccan Development society Hyderabad and
Development research communication and service centre Kolkata
The major deliberations were about the two models developed by the two organizations
DDS in AP and DRCSC West Bengal. There was emphasis on the fact that after
independence the first decade concentrated on converting forest and wasteland into
farmland to increase productivity and to reduce hunger. After fifty years of independence
India still has over 60 million hungry people and godown full of food!! The green
revolution brought about wide disparity both social and environmental and has practically
made Orissa food deficient. 80% of ground water is consumed by irrigation leading to
social conflict. Apart from that agro chemicals are found in all stages in our food chain.
Further there was discussion on the alternative public distribution system of the Deccan
development society, which ensured food sovereignty for 77 villages.
The presentation on the second day was by various organizations across India who are
directly or indirectly working on food sovereignty issues with various communities. The
days deliberation also focussed on Government of India’s revamping on the village grain
bank. So the emphasis was on storing food produced by the community and not FCI food.
There were four presentations Mr. Rajeev Khedkar ADS Maharashtra
His organization works in Thane and Raigarh district which are predominantly tribal
areas however with urban and industrial influence. In these areas Grain bank was started
to combat moneylenders. Grain Banks are there from time immemorial and ADS revived
them and made them poor people friendly. The emphasis is not just on storing food
produced by the community, but it is also communities’ way to say no to FCI food. It is
also not just a solution to starvation period, but it increases people’s bargaining power, as
moneylenders no more remain powerful. The members of these banks are mainly landless
and small and marginal farmers. Livelihoods of Adivasi people are lost as the forest is
shrinking or they are being asked to leave the forests also land alienation by urban people
is another problem because although they are cultivating in these lands for over 120 years
they sill don’t have ownership of the lands inspite of repeated appeal to the authorities.
He added that Government of India village grain bank scheme called- navasanjeevani
yojana and 25% of this was non functional as they are neither managed nor controlled by
people, food is from outside sources and is not traditionally stored.
Ms. Sheelu from Women’s Collective Tamil Nadu
The women’s collective works in 1500 villages and they have 90% small and marginal
women farmers as their members. The main focus of their work is political empowerment
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of women, the rights of women capturing it locally is an alternative for the marginalized
and the women specifically. The women are trained to contest elections at the panchayats
and stop the MNC entering the GP. Last six to seven year they are focussing on food
security/sovereignty. Organic farming is being facilitated for vegetable cultivation and
organic farming seeds are provided to the women with basic training, these seeds are then
rotated. Women’s groups also take government tamrind trees on lease and process the
tamrind. A new trend is set by the collective where local production is for local people
while the excess production is exchanged with grains from other community village
groups. Chillies, tamrind and dry fishes are now included from Tsunami area. Tsunami
relief work was carried out by food brought from Kodaikanal. Earlier during rice
producing season, the moneylender fixes the price of the rice whereas now credit from
the women’s groups are given and grains were taken back as refund and gave it back as
grains to farmers as credit during difficult time. This has empowered the women. She
concluded by saying that food sovereignty can be ensured only by local people and
through the community consent on how to store, where to store and what to store for
redistribution amongst there community.
Mr. Oswald Quintal, Kutumbam Tamil Nadu
Kutumbam was inititated in 1982 for facilitating sustainable agriculture and have been
doing so along with training of NGO field staff in that together with AME low external
input sustainable agriculture in 13 district with 82 NGOS 10000 farmers in Tamil Nadu.
Documenting traditional agricultural knowledge, and finding alternative solution to green
revolution and related problems and traditional alternative to the problems is the focus
are of work of Kutumbam. Some farmers have developed alternative to chemical
pesticides, soil fertility and water management; documentation of farmers experiments
and shared with the village through wall newspaper. Family food security is of utmost
importance but capacity to purchase food is non existent amongst farmers. Food from
outside is meaningless because of the faulty ration card system.
Ms. Sagari Ramadas, ANTHRA Hyderabad
ANTHRA works with issues of livestock development people’s food sovereignty mainly
with Adivasi and Pastorilist communities working for their rights to resources and
ownership of knowledge, ownership of lands, water, alienation of lands and struggle for
forest. Pastoralist has been blamed as destroying forest and grazing. By so-called
development of resources and arena of production in the last 20 years primarily through
Government of India the pastoralists have been alienated from seeds and breeds. Food
can’t be imported where people’s own seeds and multiple cropping systems exist. There
are no efforts from the governments end towards conserving the breeds and build an
integral relationship of livestock and agriculture. Not losing the female is very important
and local cattle were conserved through community efforts. However the local breeds are
lost by government’s efforts and the local market, destined to be a failure because it has
not touched the local productions. Local national and international policies are a
challenge to the community efforts. The VELUGU (DPEP) has grain banks from FCI and
local production is not there. Micro level hard work has little meaning because the
policies work for promoting international markets, control and ownership of their own
knowledge and production and markets.
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Dr. Prasad Agriculture Man and Ecology
AME started in Netherelands and has eventually the main focus is providing ecological
agriculture and alternate agriculture to farmers. Holistic farming is neglected and the
community degraded lands and ignored by extension agencies. AME hat works in AP,
TN and Karnataka promotes Eco friendly technologies through appropriate participatory
methodologies. Helping people help themselves, participatory technology development,
reabsorbing thing they have forgotten are the focus of the activity called the farmers field
day along with building linkages with key biomass actors.
Mr. Bhanwar Lal Secretary to Government of AP, Ministry of Consumer Affairs,
Food and Civil supplies, Hyderabad
He spoke mainly on the Government of India’s decision to revise the village grain bank
scheme and establishment of new village grain banks. He said production rather than
distribution that has to be the ultimate aim of food security at village level. What we are
aiming at may take some time. In the mean time the person has to survive. GOIs grain
bank may be a time being solution and not ultimate solution it is to provide some relief to
save the person from hunger. In the context of several such schemes, TPDS, Antodaya
Annapurna PDS, EAS in the gamut of all these scheme the role the grain bank can play
along with these schemes. Since capacity to buy food is not there with people so this
helps. Management will be given to NGOs and GOI will see how best the NGOs can be
facilitated. Since it is a revolving scheme, so local production can compensate it. It may
not give the intended results.

Parts of the Joint statement from the participants of the National Consultation on
Food Security Corridor to the Govt. of India
After this Sathyasree was given the responsibility to compile a statement on participants
response on GOI’s village grain bank proposal and the following was compiled and read
out by herIn the view of the Government of India’s decision to revise the village grain bank scheme
and establishment of new village grain banks the participants from Andhra Pradesh,
Assam, Chattisgarh, Delhi, Karnataka, Maharashtra, Orissa, Tamil Nadu and West
Bengal, that people across the have expressed the following concernsThe principles of Local production Local storage and Local distribution have proven
to be success in many community projects, Therefore these principles may as well be
used for the revise the village grain bank scheme
Procurement of food that is produced locally:-It was uniformly agreed by all present
that food produced locally is available, acceptable and accessible to people which is
nutritious in the combination people eat. It is appreciated that government of AP will be
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procuring millets for public distribution; however there should be efforts to leave the
choice to people of the village what food they want to procure for their consumption. It
may be suggested that each mandal may be allowed to procure what has been locally
grown. This would also ensure people’s ownership and control over the programme
which is theirs. In the scheme the 76% is going to FCI, it looks like more a way to get rid
of the rotting grains in FCI godowns. there would also be minimal wastage if the local
food grains are produced as compared to the FCI grains. Food security can be provided
only with uncontaminated food and the permanent damage has been seen to be done by
the rice provided under the TPDS
Local Decentralised storage- There are traditional designs of grain banks that people
have used in their own areas that are made with locally available materials. People have
used such storage designs for a long time now, which ensures that the scheme is
community friendly. Apart from that in the models that have been followed centrality of
women in management has been proved. It should also be kept in mind that the food
scarcity period is only two to three months, therefore to have NGO staff for the entire
year would be a waster. By allowing the women to take charge of the programme the
overhead costs can be reduced.
Local distribution- The other strong concern was tat the management of the grain banks
should be in the hands of the community right from planning, storage and distribution.
The failure of the TPDS is obvious and it has been proven in the case of Alternante PDS
system carried out in 77 villages of Medak district facilitated by DDS that people
controlled distribution is possible.
Some other concerns expressed are that the government officials at the mandal and the
panchayat level needs to be sensitised. This scheme should not be looked at the
permanent solution but just a stopgap arrangement; the efforts should be towards
permanently removing hunger from the society

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Annexure F

Food sovereignty AP Alliance, At Deccan Development Society Pastapur
19th and 20th October 2005
The alliance was started in view of Global week of action with ten networks of NGOs
who are working on sustainable agriculture and natural resource management and
working directly with community. The members of the networks who are present today
are from Andhra Telangana and Rayalseema areas of AP and Mr. Nammalwar who is a
very experienced in organic farming from an organization in Tamil Nadu called
Kutumbam. The objective of the alliance is moving beyond food security to food
sovernity on the one hand and looking towards building conclaves on both sides of the
food security corridor.
Mr. P.V. Satish gave an overview of the entire context From food security to livelihood security; looking at increasing people’s purchasing
power. In the World food summit in Rome, large north countries made very less
commitment (800 million hungry people in the world), Castro walked out of the summit.
Food security was seen as production problem; therefore international measures were
designed to take care of the above problem. However comparative advantage was seen
with northern countries. The conspiracy was that trade was linked to foods security by the
north countries as they said that they have better productivity. By the end of the world
food summit, ground was ready for TNCs and now world food trade runs into hundred of
millions of dollars. Food and seed are seen as new tools for imperialism (petrol and oil
was earlier tools for imperialism). There has always been one dimensional argument
(only on low production). Even though south Asia is self sufficient in grain production, in
the last decade 8% rise was there in food grain production and 8% rise in hungry people
also! Food security also meant adequate calories and nutrition out of reach of people as
people had too little money to buy food and access food where and when needed.
Then a shift in paradigm happened and the term FOOD SOVEREIGNTY was coined by
Via Campasina which meant ones right to produce one’s own food in one’s own
location. Food sovereignty within the COMMUNITY (even if the godowns are full of
grains in the country food security is not ensured).
Critical perspective on the process of globalisation and understanding that inequities are
inherent to free market. Critically understanding the position of the government and inter
government positions in the international trade matters questioning credibility of
government. No rhetoric but grounded in the fact that State cannot address the food needs
of the people since it is seriously curtailed by multi lateral trade regimes and numerous bi
lateral agreement linking trade, and security arrangements. Denying food is culturally
inappropriate and political act (destroy the food culture…. Colas and pizzas). Eg. Star
Bucks Cafe of US kills the culture of people by introducing their cafes in culturally
important locations. Food sovereignty means food appropriate to ecology and culture.
Further food sovereignty implies….Ecological techniques and stewardship of agriculture,
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agriculture biodiversity, moving away from intensive agriculture, creating of rural
employment and diverse food culture.
At national and local level it should advocate farmers’ control of regime that involves
access to land, control over seeds and ending women’s exclusion. There cant be patent on
life. At global level reforms are required in global food trade, which ensures end to
duping and subsidies for intensive agriculture and ensuring fair price for farmers and
protecting local markets. Preference for domestic food crops over export crops has to be
stressed and realised. Some of the current experiences he mentioned are that There is a
conspiracy of denying food producers the right to remain food producers (grape farmer
will get subsidy, jowar farmer wont get) which can be explained very well in case of the
Phillippino farmer’s case where the change in govt policy with trade regime changed the
farmers from food producers to commodity crop growers from that to contract from
contractors to so called importers and finally telling the farmers they cannot do any of
these so the option left to them was to be construction labours

Ardhendu Chaterjee
spoke on the ecological sustainable agriculture and food sovereignty. Farms are agro eco
systems designed to increase harvestable food and fodder he said. He began by saying
Humans were hunters gatherers, nomads, the first watershed was when man learned how
to domesticate animals, this meant settling down, man needed water. The 2nd watershed
was irrigation system carrying water from the farm. The 3rd watershed was feeding
human food to animals (earlier humans cannot eat food was given). Inequitable relation
in other countries started countries consuming high beef; therefore there were colonies of
fodder growing in Asia and Africa. Eventually the faring system has becoming
mechanised and substitution with synthetic and unnatural things- pollination, irrigation,
seed propagation, mannurization everything replaced by synthetic and unnatural things!
He said Man is becoming Super god by genetic modification by crossing cow with
pumpkin!!!!
Crisis in India
Social crisis
1.
Productivity per hectare increased but hunger has remained (social,
ecological and social equitable reasons) and malnutrition has remained
with people with or without land and increased low purchasing power
2.
People consuming wrong food (out of season vegetable, same vegetable
through out the year, potato is a starch tuber becoming vegetable)
3.
Farmers are not getting remunerative price; farmer will remain poor
because he cant produce enough, farmers will remain poor because he
produces more…. So where do farmers go???
Environmental crisis
1. Soil pollution and degradation, accelerated land soil erosion leads to silting of
river resulting in flood with shallow river and also drought because rivers dry
up

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2. Filling water into a pot with holes is like letting the top soil to flow away (top
soil….. blood of earth flowing in the red waters in the rivers); 1 inch of top
soil from 1 hectare is equal to 20 lorries of soil going away
3. Forest and rivers of India are sick or dying…. They are our insurance which is
gone because many varieties of fishes and birds are disappearing everyday
and not much is discussed about this.
4. Many valuable plants are there like the hibiscus (gongura), The yams
(diascorea) that are disease tolerant flood drought tolerant are never taught in
the agriculture university. Potato create heart disease, yam cures heart
disease… we have left yam to poor because they don’t look good. They are
not water intensive, high yielding yet the government does not encourage us
to cultivate it.
A good farm is where a lot of animals birds and fishes get protection along with the entire
eco system unlike a high yielding farm that gives us a lot of yield. There is difference
between a Productive rice field and a deadly rice field because more rice and profit less
food and decreased fodder. Ecological farming is a combination of all the diversified
integrated ecological farming (nutrient for the farm is produced in the farm)…… more
welfare, employment. Ecological farmer does not throw away and create harm but are
more responsible …. Conserving ecology these ecological farmers don’t get paid for
doing this service to the country. Diversity means many varieties, elements and yields
and Integrated means no export of water, nutrients, poison

Shalini Bhutani
A lawyer from an international organization called GRAIN talked against genetic
engineering, understanding the trade regime related. Sovereignty means self-governance,
a concept less than a decade old. It is neither an absolute right nor meant as ownership
over genetic resources by the state govt. though it seems so because government is
signing treaty after treaty at the international level. Legally without consulting the
communities sovereignty cannot exist. Food sovereignty is an attempt to realise the Right
of the people of each country to determine the sowing, growing, reaping and eating.
Some other points she spoke areVIA CAMPESINA (international peasant movement) principles
Right to food
Agrarian reforms
Resource conservation (free of IPRs)
Reorganising food trade (food first trade later)
Addressing globalisation
Social peace (change in the Iraq govt. policy totally written by US)
Democratic control
Food sovereignty is a counter proposal to the neo liberal macro economic policy
framework . How…. Politically……. at the national level while Practically……. at the

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local level. Why…. Sovereignty is obvious in a sovereign country… but why do we need
to state it??
The challenge is with the trade regime is…
Trade oriented production
Handling of hunger and malnutrition
Technical solutions (pharma crops)
Alienation of resources (physical and the intangibles…. Patent regimes)
WB-IMF-WTO are Funding welfare activities by WB and the IMF have paved
the way for WTO and More trade and commerce to come in
Why did agriculture come under WTO regime? Because Food is the ultimate weapon
AGREEMENT ON AGRICULTURE
Domestic support
Market access (cant protect local industry because same treatment has to be given
to foreign countries)
Subsidies (remove in India but can increase in their countries)
WTO’s TRIPS
Patents
Plant variety protection
Geographical indicators
GATs (privatisation of the three sector under the GATs agreement)
Environment
Health
Water
Hong Kong will want to derail WTO as people want that WTO must get out of
agriculture to ensure people’s food sovereignty throughout the world, as WTO is the
antithesis of the idea of people making their own decision about food. The Indian laws
are being made in keeping with the WTO. In the last decade the following laws are
passedBiodiversity
Seed
Protection of plants
Agriculture
Geographical indication of goods act
Patents
Seeds Act
WTO+
WTO-WIPO-UPOV
World intellectual property organization
Bilateral trade agreements
Bilateral aid agreements
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Free trades Agreements
Signing away resources and countries property

Sagari
From Antara a organisation working for pastoralist spoke on Livestock diversity. She
began by a saying from chittor- No fodder------ no livestock------ no crops----- no fodder
Development of dual purpose animal was the focus after independence animals that
contribute to agriculture (work) and milk. In 60s World food Programm was the first
dumping. That was the time dairying was also brought in operation floods. 5th to 7th plan
had emphasis on dairying as a separate enterprise, approach was to bring animals from
outside and convert our animals to high dairy outside animals. The green revolution and
the white revolution went hands in glove with each other. Those animals need more
water, more fodder when on the other hand the intensive crops did not give fodder.
Poultry industry had nothing to do with the farmers, International Food research
Institute (IFPI) brought out “livestock revolution 2020” in early 90s, they have done
analysis of international economics says the developing countries will need 30% demand
huge opportunity for produces, this means opening new markets (TNCs trade in dumping
of poultry, milk product etc Africa)
If the small farmers have to rise to the challenge, they have to do 4 steps prescribed by
IFRI
Verticalization (corporate farming that is Feed to TNCs)
Improve hygiene and standards upto international trade
Livestock health a major issue and privatise veterinary care
Open dairy to private sector

The current issues areDividing livestock and agriculture. AP bullocks have come down y 25% therefore
mechanisation of farming
Manure is fading out in A P more than 50% farmers are without any livestock
Micro credit and what is happening… micro credit groups are being pushed with
crossbred cows by Financial Institutions. No loan is given for local variety breed.
All the livestock are export oriented. NDDB can’t sell milk at present how will
the farmers who are pushed for export sell the dairy product?
Anti goat syndrome, get rid of goats for JFM
Withdrawal of govt from vet services
FAO- pro poor policy initiative program
Working with policy makers of privatisation
Poor pay for the services of veterinary
gopal mitra (para vet)
High capital-intensive livestock production
The picture without livestock food sovereignty is only half

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Nammalwar
Very appreciative of DDS’s APDS and feels that all NGOs are in a battle field. The crisis
of agriculture is fast approaching and the natural resources are being privatised. The
organic farming movement was launched from the south as the green revolution which is
launched in south had done much damaged mainly from AP and TN. Swaminathan is
promoting computer in every village for that corporate farming can be done. People have
realised in TN that organic faring is the way out. People are listening to Nammalwar now
because he was doing organic farming in own land, once working in green revolution in
university, now again doing organic so none can challenge him. Have faith in the
knowledge of people. He spoke that Salt application preserves lemon, fish, meat etc….
but does not become a part of nature. Salt in lorries is being put on our lands like Urea
Soil, animal and human beings are three things being fed by permaculture, but our
women have been practicing this since a very long time. . We give to soil and cow what
we don’t need. Green revolution said bring fertiliser, fodder everything from outside….
This was the paradox. Biodiversity is same everywhere, suebabool used in phillipines for
fattening cows, glyrecidia used as fodder, and pesticide, crutalilia sun hemp is nitrogen
fixing (12000 legumes in India), suppressing TB one of the ornamental plants, stylanthus
(nitrogen fixing) and wild rabbits get attracted and then leave manure n the soil. Marigold
controls nematodes if cultivated in between crops. Acacia has very good leave drop for
mulch. under the shade of the acacia we can plant other trees than cut the main tree., the
seeds are protein rich. Wild mint is a pesticide, soak in cattle urine for 10 days and 10
times water and pesticide s ready. Nothing in the environment is waste. He prescribed a
few organic compositions.
Amrita pani
10ltreWater c1KGdung 1Lurine and jaggery 25 gm keep 24 hrs, add ten times water and
spray on plants
Herbal pesticides
Plants not eaten by cattle is soaked in cattle urine for 10 days and added with 10 times
water, spray,
Panchagabya
COW- 5 Kg cowdung, 3L cow urine, 1Kg cow ghee, 2L cow milk, 2L cow curd stir it for
21 days, after fermentation becomes rich in all the minerals, tested in the lab and certified
(30 ml in morning 30ml in the evening for human consumption) kept in mud pot and
3litres is enough for 1 acre. Buffaloes also this succeeds in Erode, goat was also tried and
it was twice as efficient as the cow.
What the scientist are telling is not science. Green leaf is the kitchen of the plant.
Scientist tell that the plant has to be fed, but right from blue green algae to banyan tree
they are all producers. Human is a consumer; consumer can never give to producers. We
are providing food to animal’s and the soil not to the plant. Scientist are foolish as they
think they are feed the plant, they are only agents of fertilizer company. SOIL has three
properties Physical Biology and Chemical; it is a living thing. The American told us to
start with chemical element put UREA and kill all the micro-organisms. Traders,
scientist, ministers are all against us n the battlefield and it s difficult to fight them. So
build people to people relation in our state and strengthen
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Annexure G
Visit to Plachimada in Pallakad district of Kerelam

T. Pratap
At Pallakad Mr. hosted me, an ex activist from the Silent Valley Agitation that succeeded
in stopping the government form building the dam in the silent valley over a decade back.
I had a detailed discussion with him on the state of Kerela. He gave the overview of the
water availability status of the district. It was surprising to know that in one panchayats of
Pallakad district there are four dams that have come up in the last ten years but that is
driest panchayats and as a result of which the rivers are drying up and the government is
working on plans to decommission the dams!! He further accompanied me to meet the
people and also acted as a interpreter and could explain the matter in the local context.

Krishnankutty
It was in a place called Vandithavanam of the Perumatty Gram Panhayat we met Mr.
Krishnankutty sitting MLA of the left front who was eagar to talk about the Plachimada
issue in its present status. Plachimara is located in the perumatty panchayat under
pallakad district of Kerela. Mr. Krishnankutty informed that people were suffering from a
lot of stomach ailments, as food could not be cooked with the water available locally and
also because of presence of cadmium in the slurry in the agricultural fields. He informed
us that the entire state of Kerela has 12 TMC of ground water and pallakad has 10 TMC
out of that, however due to the Coca cola factory exploiting water the ground water table
has fallen from 120 feet to over 900 feet. He also pointed out that since the ground water
table has fallen below the sea level of 625 ft, there is ground water contamination by the
sea water further rendering the water un potable. Over 66 water sources of the area have
dried up he said. Further he mentioned that the panchayat os also using a study
conducted by the UN in Bangladesh that when ground water table falls, further drawing
water through bore wells could result in oxidation thus rendering the water source very
harmful.

Valayodi Venugopal
was in the NAPM historic Samarpanthal in front of the Coca Cola factory in Plachimada
along with a few others like Muruganam. They explained how the agitation was on the
1279th day that day on 22nd October 05 ever since the agitation began. He further
explained that the palnt has stopped its operation for the last 20 months. Hpwever
Murrugan went to explain how the company had diveted the water from parambikula,
Chulliyar, Kambalathara, meenakara and Vengalakayam canals and replenished their
open wells to continue production while people went thirsty. Further the company has not
yet received clearance from the Kerela land use board.
Thus the trip to Pallakad was a learning how an empowered panchayat could work for
people’s right over their resources successfully!

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Annexure H

Health and (derailing) the WTO
The other incident that happened was the “ peoples’ caravan” that was started in the
entire country to build public opinion on the WTO ministerial meeting that WTO should
be derailed. For the caravan it was seen that not much information was available on how
WTO affects health and health care, therefore a translated version of the book “Health
for All NOW!” chapters 1, 2 and 5 of section 1 was done and 1000 copies published in
Assamese with financial support from Rural Volunteers Centre (RVC); over 300 copies
were distributed free to village people, NGOs, people’s representatives, media personnel
etc. further another book was also published by RVC which was sources and layout done
by me- “Derailers Guide to WTO”. The concluding meeting was held on 4th and 5th of
December 05 and on the 5th Dr. Sunil Kaul and I conducted the session on affect of WTO
on the health sector jointly. Some of the major subjects of discussion of the session were
- the Assam government should have a proper drug price control policy and make
drugs available to people in the public health care units
- the people were unaware of the Assam Governments recently launched State
health insurance for all voters, this should be made more public and transparent
- since food security is related to preventive health, government should out the food
security schemes in place
- the entire public health system should be more transparent and more focus should
be on improving the public health sector rather than giving sanctions for the
growth of public health sector.
Though a host of academics and educated people were present in the meeting of over a
crowd of 150 people, not many people were aware about the NRHM, state health
insurance or other matters that relate to public policy, WTO related to health sector.

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Annexure I

Jan Swasthya Abhiyaan’s People's Rural Health Watch
8th and 9th of January 2006

Vishwa Yubak Kendra Chankyapuri

New Delhi
A two-day meeting of some members of the Jan Swasthya Abhiyan was convened at New
Delhi to discuss and initiate the activities of the Peoples’ Rural Health Watch.
8th January
The introductory remarks were followed by a short presentation on the NRHM, on the
reasons for the launch of National Ruaral Health Mission, current way it is advancing
and JSA position on various components of NRHM.
The presentation and discussion on the NRHM and the Peoples’ Rural Health Watch was
followed by updates from the representatives of the states present.
Updates from state JSA units on status of NRHM and their respective activities
ASSAM
In Assam the NRHM was launched in November 2005. There was much publicity
over baby shows in the districts. While there is not much talk of NRHM per se right
now, it is also being confused with another programme, namely the CM’s Health
Insurance Scheme, launched with ICICI-Lombard. There is talk of raising funds –
Reliance is promising measures for health. There has been an increase, by 10 per
cent, in user fees in hospitals. The perception at the district level is that the AWW
can be trained to ASHA, as there is no remuneration for ASHA. Questions arise
about where the funds allotted for the SCs will go, as there are no SCs in many
districts, including ours. A similar situation prevails in the neighbouring state of
Arunachal Pradesh, where NGOs are to run PHCs. Tenders are being floated for this
purpose, and nursing home owners are taking NGO-status for this purpose.
BIHAR
In Bihar the NRHM was inaugurated at a function held at the Maurya Hotel in Patna.
Not all civil society organisations were informed. When a JSA team tried to meet the
Health Secretary in connection with the NRHM he claimed that he was very busy
with the Mission and did not have time for us. There is much misinformation in the
state over the selection and honorarium for ASHA, who is being addressed as ASHA
DEVI. It is being told by the PHC and Block-level officials that she will get Rs 2000
pm. While selection of ASHAs is yet to take place, several NGOs in Patna are
offering training courses and awarding certificates for ASHA. There have been
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demands of Rs 10,000 as bribe for ASHA to be selected. At the village level people
say that they need not do anything about the ASHA selection – the mukhiyaji will do
the needful. In brief there is no clear understanding about the programme. PHC
officials appear to have some information. Also, in Bihar tenders are being floated
for NGOs to run hospitals.
CHHATTISGARH
In Chhatttisgarh village-level monitoring committees, comprising largely of women, monitor
performance of ANMs, availability of ANCs, at staff availability in remote PHCs, DOTS
functioning, and so on. As far as the implementation of the NRHM is concerned, the mitanins,
who function in almost 60,000 villages, have been recognised as ASHAs. The amount of Rs
10,000 has also been given to the SCs. The Collector and CMO between them took decisions on
what items should be bought with the funds. They placed orders for items such as sterilisers for
institutions where there is no electricity supply, and so on. However, the local peoples’
organisations have put pressure to not to go ahead with such purchases, and so these items have
not been bought. Some local organisations was called to participate in the formulation of the
District Health Plan. While most of their suggestions were accepted, some were turned down
(which ones were accepted and which were the ones turned down?).
With respect to involvement of panchayat institutions, there has been some training of
panchayats on health indicators and health status. With the help of the panchayats. a
survey (by whom?) on these aspects has been conducted in about 80 blocks. So there
is some awareness among panchayat members of health issues.
A survey on drug procurement found that the drugs were from some local traders, and did not
conform to WHO standards.
HARYANA
Haryana is not among the focus states for NRHM. It is being implemented as part of the RCH-II
programme, under the RCH Director. There has been increase in the budget allocations in the
state. There is much worry about how this amount is to be spent, as even the smaller sum of 40
crores was not being fully utilised (some clarification on this?). Some amount has been spent on
building delivery-huts. The money has been spent `on paper’. In some instances, delivery huts
have been constructed where SCs already exist. Medical Officers have been ordered to select
ASHAs. They have completed this work and sent the list of selected ASHAs. Their training has
not yet begun. As regards PPP, private gynaecologists and anaesthetists are being hired and
being paid on case-by-case basis. 2 CHCs are being selected for upgradation. There has been
improvement in infrastructure, such as in condition of building, availability of ambulance, and or
medicines. JSA intervention is possible in ASHA training. There has been no activity so far
towards the Rural Health Watch.
HIMACHAL PRADESH
The NRHM is being implemented in HP, although there has been no formal inauguration,
nor is there any talk about it. According to newspaper reports since August 2005 the
state has already received more than Rs 7 crore under the mission and the authorities
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have disbursed much of the funds to the grassroot level institutions. However, the
functionaries at this level do not seem to be aware about the Mission. According to the
Director looking after the NRHM in HP 45 PHCs and 15 CHCs have been selected in the
first phase of the Mission; those having required structure and staff for 24-hour service
have been identified (for strengthening or for 24-hour service?). The sum of Rs 10,000
each for strengthening of the selected SCs had also been released and there was a sum of
Rs 20 lakh each for CHCs which was to be utilised as per need. Not all the institutions
chosen for strengthening seemed to be aware about their selection. Or about how to
utilise the funds given to them. According to the doctor at one such PHC chosen for 24hours service, his PHC did not have the infrastructure.
Several of these institutions
identified for upgradation for 24-hour service were either located on highways, or were
very close to each other, thereby leaving remote areas uncovered. Recruitment of new
personnel is not taking place. There is resentment among the specialists in the district
hospitals over the move to shift them to CHCs.
District level health committees have not been constituted; no training of officials
concerned; no involvement of civil society organisations so far. Selection of ASHAs has
not taken place; it is anticipated that AWW will be converted to ASHA.
There are indications of promotion of PPPs. For instance – at a FP camp the concerned doctor
did not turn up. The private doctor who came instead charged Rs 200 per case and had made a
lot of money at the end of the day. At a government hospital the Red Cross approved laboratory
has been vacated and a private laboratory instituted in its place by the District Commissioner, as
head of RKS. The MS of the hospital was reprimanded by the DC for not getting the place
vacated for the private laboratory.
Some of the health schemes, which were previously under the RCH programme and that were
subsequently shifted to the NRHM in August 2005, were not doing well, for want of initiative
and monitoring on the part of district health authorities.
JHARKHAND
In Jharkhand there has been special emphasis, and pressure, on FBOs (faith-based
organisations) to participate in the District Health Planning meeting. There were only
3 NGOs and a large number of state officials. After the Planning FBOs have been
sidelined; people from XLRI have been involved in the Planning process. The
District Health Committee comprises largely of local Sangh parivar organisations, the
FBOs that helped in forming policy do not figure in it. Health coupons are being
distributed among the people, and they are being told to go private nursing
homes/doctors. One private doctor has three different syringes, each corresponding
to the denomination of the coupon! While there is a district order on sahiya [ASHA],
the procedures regarding sahiya selection are not being followed. Sahiyas (ASHA)
are being trained by the TATAs and few big NGOs. There is no interest about sahiya
as she is not being paid (not very clear). PPP and health insurance are being pushed
strongly. Private nursing homes and private practitioners are being assisted by the
government to extend their services (how exactly is this happening?). There is
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emphasis on institutional delivery, safe abortion and the 2-child norm, but no talk of
safe delivery. The big investors in steel – Tatas and Mittal have promised
investments in health in the state.
Civil society organisations were called for a meeting with concerned NRHM officials,
to discuss about resource centres and training. The criteria for building and
infrastructure were such that the specified facilities are available only with Tata.
There is a move towards privatisation of diagnostic facilities (x-ray facilities in 16
district hospitals are non-functioning – all 16 are reported to have burnt down).
However, this may turn out to be time-consuming process
MADHYA PRADESH
In MP a team has already been constituted for the Watch programme, and meetings
have already been held on the NRHM.
There is a proposal to change the selection criteria for ASHA, and to convert anganwadi workers
(AWW) into ASHA. The processes of selection and training have started. The target is that 40
per cent of the ASHAs should be selected (by when?). While the Centre guidelines allow some
flexibility in the ASHA selection criteria, however it is not there at the state level. For instance:
in one place there was insistence, even by the state health committee, on education upto class 5.
District Health Committees have been formed in some places. A team of 5-6 Collectors has been
constituted for the entire state. This team says that there is no information yet from the Centre,
and there has been orientation or communication regarding the NRHM. Even the CMO-HO has
no information. In some places awareness on NRHM is being sought to be created by combining
it with AIDS slogan. (Circulation of posters by the state on worship of Dhanwantari). The
overall situation in MP regarding the NRHM seems to be chaotic implementation needs to be
watched. In MP, as in Rajasthan, actual implementation is proceeding as per instructions from
Centre, funds are tied to the Centre’s orders. This needs to be challenged.

RAJASTHAN
Acccording to the Centre Rajasthan is reported to be ahead in some NRHM activities; in some
parts nearly 40 per cent of the ASHAs are reported to have been selected. As regards selection
of ASHA, what is actually happening is that either the female member of the couples working in
the Jan Mangal Programme, or the worker in the non-formal education programme is being
selected as ASHA. The amount of Rs 10,000 has been given to the sub-centres, although no
guidelines have been framed yet for their utilisation. While these activities have been initiated,
the District Health Plans have not yet been drawn up; according to officials it will be done in due
course (plan baad me ban jayega). A workshop on PPP was conducted in the state, for which
local people were not invited. Parties like Apollo and Escorts were present and there was talk of
connecting hospitals through telemedicine, while the situation is such that local health
functionaries are not available in many places.
Civil society organisations feel that the implementation of the NRHM is taking place
in an extremely mechanical manner. The spirit behind NRHM has not been grasped.
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(jis bhavna se bana hain, uska koi andaza nahin hain). Civil society organisations
have not yet been drawn into the process of implementation. The programme is being
implemented as per instructions from the Centre (Dilli se sab chal raha hain); statelevel initiative and activity is nil. According to state-level officials disbursement of
funds is tied to implementation in the manner that the Centre wants, no matter what
the documents say. There is also pressure to utilise funds quickly. So, in reality the
programme is not being implemented by the state, but is taking place as per
instructions from the Centre. The state health system officials view the NRHM as
merely another way of getting funds. In short it is felt that the whole process of
implementation is taking place in a very haphazard manner, the focus is on the endproduct and no attention is being paid by the implementors to the processes by which
such a programme should be implemented.
Civil society organisations have held a consultation on the NRHM, and it was felt that
a radical transformation was needed to achieve the objectives laid out in the NRHM.
They plan to initiate activities to evaluate and monitor the programme. One of these
was to have a discussion on the NRHM at a meeting on Women’s Health, to be held
on 1st February at Jaipur. This meeting is being organised by Prayas, Rajasthan.
UTTARANCHAL
In Uttaranchal the ASHA component has been implemented and there is a lot of
publicity. According to newspaper reports 28,000 ASHAs are to be trained. District
Health Committees have not been formed. Actually there is no clarity regarding the
programme. We have been working on health issues, but have not been included in
any programme.
UTTAR PRADESH
In UP the process of implementation of the NRHM has yet to begin properly; there is
not much enthusiasm for it. In october 2005 about 8 CMOs were called for NRHM
training; not all of them participated. Talks with the 2 CMOs who went for the
training indicate that there is no clarity and awareness among them. Some PHCs tried
to initiate the process of selection of ASHAs – ANMs were asked by the PHC doctor
to select ASHA, we were asked to give a list of candidates. In Azamgarh ASHA is
being addressed as ASHA KIRAN, and the (mis)information circulating is that she
will be paid Rs 2000. Application forms are being sold, and many people are filling
up these forms and handing them over to the panchayat in the hope of being selected.
There are no District level health committees, nor is there involvement of panchayats.
We have been told by the Director, RCH programme, that there is no role envisaged
for NGOs associated with education. No role has been assigned to NGOs in training
of ASHAs. While nothing is very clear now, we suspect that a female member of the
pradhan’s family will be selected as ASHA.
The afternoon session began with a presentation of the objectives of the Rural Health
Watch, the specific activities to be undertaken by it, and the way of going about these
activities. It was pointed out that the Rural Health Watch could be viewed as the next
step in the `Right to Health’ campaign of the JSA, as a way of assessing whether or
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not people are getting health services with the introduction and implementation of the
NRHM. With respect to the study envisaged by the Watch to systematically collect
information on, and assess the NRHM, it was pointed out that the study was not
purely an academic study, but more a way of looking at the performance of rural
public health system and analysing the issues arising out of implementation of the
NRHM, in order to make NRHM more accountable, and to be able to intervene at the
policy level.
Each of the tasks that had been identified to undertake the Watch activities, was then
taken up for discussion.
1. Formation of a National Core Group: to co-ordinate the Watch activities, with support from
the Watch Secretariat. Besides the Delhi based people, the following persons who have been
involved in NRHM activities at the national level were identified to be part of the Core
Group. The names suggested: Abhay Shukla, Abhijit, Ashok Khandelwal, Annie Raja, Dr.
Dahiya, Narendra Gupta, Sebastian, Sundararaman, Thelma Narayan, Renu Khanna, Dr. O.P.
Lathwal. The Core Group will formulate the methodology, design the guidelines and tools
for the field survey. Members of the National Core Group will also participate in the
state-level workshops for the orientation of field investigators for the survey. Those
members of the core group who were present in the meeting have agreed to be available for
training at the state level.
2. States for Watch: Rajasthan, UP, Himachal Pradesh, Bihar, MP, Jharkhand, Assam, and
Chhattisgarh and Uttranchal were identified for intense watch activities. While these maybe
the `intensive watch’ states, it was suggested that watch can be initiated in non NRHM focus
states depending on the interest of respective state JSA units. In such cases the tolls and
formats can be used. However the financial requirement should be managed by the states.
The possibility of initiating watch activities in Orissa should be checked with JSA state
contact persons.
3. State core groups: Those state JSA units that were present have decided to convene a oneday meeting, mobilise other organisations and for a state level core group in their respective
state, The state core group will have to identify state-level partners for the watch survey,
collect policy documents at the state level, assist in organising the orientation and training
workshop, conduct the survey, prepare state-level Report, disseminate the report and other
developments relating to implementation of the NRHM.
4. Sampling:
It was felt that the district be considered as the unit for monitoring and for sampling. The
number of districts in each states will be decided according to ability of JSA partner
organization to undertake the watch activity. The following numbers of districts and blocks
have been put forward by the states where they can conduct the survey:
Himachal Pradesh: 12 districts and 15blocks
Rajasthan:
5 districts – 20 blocks
Uttar Pradesh:
7+
Madhya Pradesh:
14 districts – 14+ blocks
Bihar:
15 districts
Chhattisgarh:
7 districts

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Report of CH Fellowship

40

The ‘watch’ need to be clear about what is feasible, keeping in mind the requirements of the
quality of information. Hence need to balance quantity (numbers) with quality). It was
suggested that Watch should try to cover about 3 blocks in every district – which means 3
CHCs, 3 PHCs, 9 SCs, and 9 villages. There was concern that the watch should exercise
caution in assessing SCs, as they are the most vulnerable structure in the rural health system,
which is likely to be dumped as there already suggestions in this direction.
A presentation was made to update states about the financial resources available for the Rural
Health Watch activity. The finances available to states are about Rs. 20000 for organizing
state workshops and Rs. 3000 for state level report preparation.
9th January
The participants split up into three groups to discuss and draw up the specific
format/guidelines for collecting information in the selected areas on: CHCs, PHCs, and
ASHA-programme respectively.
The group that had looked at ASHA-programme presented a list of questions, looking at the
selection, training and the actual work of ASHA, and addressed to the ASHA herself, to the
village community, and to the ANM. In the ensuing discussion it emerged that how we
viewed the ASHA was critical. It was felt that in the NRHM the ASHA is conceived of as an
activist, whereas in practice she has to function as a service provider with some
remuneration. JSA needed to be clear about how it viewed ASHA, and that it should
emphasize the activist-component, where she can empower the community and can be
supported by the panchayat. There was concern that ‘Watch’ should not emphasis
monitoring ASHA service provision component and hauling her up for any deficiencies
in her functioning. It was pointed out that `should we be scrutinizing a poor village woman
with little education for not providing services, and let the highly educated doctors at the
CHC-PHC go free of their responsibilities?’ Rather the objective should be to look at the
way in which the ASHA-programme was being implemented, and was progressing, and
clearly the idea was not to target individual ASHAs. In this context it was important to
look at whether or not she was getting support from other personnel and from the
health institutions.
The group that looked at the guidelines for survey of CHCs used the IPHS Proforma on
CHCs to initiate the discussion. It was felt that it was too detailed and comprehensive a
proforma, and it was neither feasible nor necessary for our purposes, to use it. They
suggested modifications to the Proforma, and their check-list consisted of guidelines for
observation of certain indicator CHC services and infrastructure, and for an
interview/discussion with the staff, with patients, and with health committees.
The group that looked at guidelines for survey of PHCs and SCs also had the IPHS proforma
for PHCs. They also felt that it was too lengthy and detailed, and it was not feasible for them
to use it. They drew up a schedule that looks at PHC infrastructure, as well as provides for
interview/discussion with the village people about the PHC, with PHC staff about their
working conditions and infrastructure, with patients, and with PRI members.

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Report of CH Fellowship

41

In the afternoon session there was a brief discussion on how to monitor state Finances &
Budgets related to state rural health mission– on how to read and understand state-level and
zilla parishad budgets, and locate budgetary allocations for health and family welfare. In this
context it was pointed out that it is possible to get very detailed expenditure items in state
budgets.
An important issue that was brought to notice, which has implications for programmes like
NRHM, was that the bulk of the money for Family Welfare –nearly 95 per cent – comes from
the Centre. This is projected to remain at 75 per cent. In view of this control will remain
with the Central Government. This may affect the desire of state governments to own and
implement the programme.
As far as analysis of budgets was concerned, it was proposed that firstly, Ravi Duggal may
circulate a note/manual on `How to Read and Understand Budgets’, and secondly, state JSA
units could send their respective state budgets (which usually are in the respective regional
language) to the Secretariat, which would forward it to CEHAT for analysis.
CONCRETE TASKS AND TIME-FRAME
-

The preliminary state level meetings, to discuss the NRHM and the PRHW (Peoples’
Rural Health Watch) and to form a state core group – preferably should be held by the
15th February 2006.
- The survey design and the checklist/tools are to be prepared by the National Core Group
and circulated by the 15th February 2006.
- While the survey format and tools will be prepared in English the MP state unit will
translate it into Hindi, to be subsequently adapted by the states for use in their area.
- The Action Alert document will also be translated into Hindi by the MP Group.
- The survey schedule will be centrally printed. Additional sheets, in case of modifications,
can be attached by the state.
- The orientation and training workshops are to be held through the month of March.
- An amount of Rs 20,000 is available from the Watch for certain state-level activities,
namely, for the state workshop, travel of state participants for state workshop and Rs.
3000 for preparation of Reports. The state units should send a budget for this amount
along these heads.
- The sources for obtaining state-level policy documents are: the website of the state health
ministry; the NGO-members of state health missions; directly contacting the state health
ministry; the Watch Secretariat and National Core Group members can pass on
documents that they collect or have access to; and use of Right to Information Act, if the
need arises.
- A review meeting will be held in April after the workshops have been held in all the
selected states.

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Report of CH Fellowship

42
Annexure J

National meet of the All India Drugs Action Network Vellore
DATES: 26th January 2006
VENUE: Sneha Deepam Retreat Centre, Sathuvachari, Vellore-632009
The major discussion centred around the Draft National Pharma Policy 2006. the
Government of India had put the draft policy on the website and open to public
comments. Since the last date by which the comments had to be sent was already over
by 24th of January therefore this was taken as a priority agenda to be completed. Anant
Bhan compiled the draft comments circulated by net and it was put up for discussion and
comments. There were two parts of the draft, one was the general comment and the
other was the section wise comments sections as taken from the draft pharma policy
2006. some of the major concerns of the draft pharma policy on public health and
accessing medicines by the poorer sections of the society was discussed and compiled.
It took over eight hours of work to compile this as thorough work was done and
everyone’s opinion taken into consideration.
This was a good exposure for me as this showed that unless there is enough reflection
of the people’s perspective in the public policies the policies will only benefit a affluent
section of the society and cause more harm than god to the real needy people. The draft
pharma policy is a clear reflection of the government being blind to the real need of
people. There are sections of the policy where there will be indirect effects on the lives of
the poor who are continuously being deprived of their entitlements over their resources.
The policy proposes to set up large pharma parks (obviously of the private sector) in
large areas of land; the question raised by many of us was that where would such large
areas of land come from? It seems obvious that to implement these parks there will
some land required and people will be displaced from their homes and these will
obviously be the people from the economical weakest sections of the society.
Later the organization reorganisation of AIDAN was done and there were new co
convenors and joint convenors chosen. Further AIDAN opened its membership to new
people.

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Report of CH Fellowship

43
Annexure K

31st Annual Meet of the medico friends circle (mfc)- Quality and Costs of Health
Care: in the Context of the Goal of Universal Access
27th and 28th January 2006
VENUE: Sneha Deepam Retreat Centre, Sathuvachari, Vellore-632009
With the objective to critically examine the cost and quality aspects of the health care in
India, in the context of the goal of 'health care for all’ the two days workshop was a great
learning experience for me both in terms of the contents and format. I have coordinated
in compiling the report and by the end of the two days we were able to (with a team of
nine reporters) make the draft report of 24 pages and hand it over to Sathyamala for
finalisation.

There were very enriching presentations on both the days and there was a plenary at the
end of each session. Issues related to quality assessment were presented and it was
understood that the concept of quality was very market driven as the entire understanding
of quality came from the industry. Further it was also examined as to what is the
benchmark from quality assessment come? Does it come from a person’s background or
does it come from the expectations of the community and the economically weak. In a
country like India ca we even talk of quality when the basic health facilities are not
available to the poor 70% population?
When the cost and access of health care was talked about there were many experiences
from across the country that was narrated. Instances from the rural surgeons of Sittilingi
to the leprosy hospital in Bilaspur and the cross subsidization of CMC Vellore were
discussed in length. The most significant expression of the meeting was that even though
you cut down costs to the last extent there are people who cannot access health care!!
This was also a great learning for me and the entire house was left with the thought of
how to make accessing health care a reality for all.
There were various sessions on Oral Polio vaccine, Leprosy, National Rural Health
Mission and each day would almost spill over to the next day. Though many sessions
were technical the people around helped in understanding and demystifying te technical
aspects. There was a great turn over of many young people from all over the country and
all young people left the meeting with a loot of warmth, love and exposure to many new
areas of knowledge in relation to the present context.
The fellows of CHC Bangalore also met briefly on oe of the evenings and caught up with
each others lives.
Annual general body meet of medico friends circle

visit to Christian Medical College the Lowcost Unit and the CHAD unit at Bagayam

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