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RF_DEV_3_A_SUDHA
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Report oiyHealtn of the urban poor held on Peoples Health Day - 7* ‘ April 2003
At Ashirwad Bangalore, facilitated by Community Health Cell and KKNSS
Report by : S.J.Chander
Background
World Health Organization (WHO) having recognized that the health services expected
by the people was not being provided, in 1997 during the World Health Assembly called
for a revolutionary approach In Health Care that would enable the citizens attain a level
of health that will permit them to lead a socially and economically productive life. In
1978_jji_thc conference held in Alma Ata, Russia, Health For All by 2000 AD was
'declared Primary Health Care approach evolved based on the experiences of countries
like Sri41anka and India was suggested as the best way to attain the goal. Sendees based
on PHC approach were developed over the years for the rural poor but to far the urban
pooi lire services available were family welfare and family planiiing.
He said the PRC approach though initially experienced some gains, gradually moved
from comprehensive health care to more a selective primary health care approach. Pulse
polio programme can be given as an example. National Health Policy 2002 draft is out
and it is evident in it the shift. Process of globalization and influences of various lobbies
are some of the factors that have had negative effect on people health. Of late the trend is
moving more towards privatization.
This year is the silver j ubilee of the Alma Ata declaration, it appears that WHO and the
governments have forgotten the goal Health For All (HFA) by 2000 AD. Jan Swasthya
Abhiyan (JSA) in India, known as People’s Health movement internationally believes
that it is the comprehensive health care that is going to help people attain the level that
was envisaged by WHO during the declaration. It is time that both the government and
the people’s organization work together to achieve Health tor Ail now!
Dr. Mala Ramachandian, Diiectoi; Urban Health Training and Research Center,
Bangalore who was invited to share on the health services available for the urban poor
said, approximately there arc 15 lakhs people live in the slums of Bangalore. Population
growth is the cause of the state of affairs in the slums. Usage oi MCH services and
Immunization coverage is low. Problems like cancer, diabetes, hypertension is prevalent.
HIV AIDS and Tuberculosis are the other problems of concern to the urban poor. Safe
drinking water and sanitation continue to be inadequate. During the response to Dr..
Maia's presentation, the participants said, despite the efforts to control corruption^ itis
still rampant. There was concern among the participant regarding the removal of T.ink
Vvorkers who were working at slum level.
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I
Followed by Dr. Maia’s presentation,. Mrs. Ruth Manoramma of Women’s Voice shared
urban poor do not have policy to address their needs. She said national policy of urban
poor is being developed. The present family welfare programmes exclude men from the
service coverage. Regarding sanitation needs, she said 70% of the Indian population still
'I.
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does not have toilets. Women are the ones who are affected more due to lack of toilet
facilities. From the 9five-year plan it was observed the budget for health being
decreased and budget for social welfare continued to face cut. The critiques have said the
following; Public sector is moving towards privatization, public sector budget faced cut,
commodification of health care, population gets major focus and distortion of priorities.
Regarding her suggestions to change the scenario, she said the following:
We should demand for comprehensive primary
Introduction of barefoot doctors cadre and youth for prevention HIV/AIDS „
Recognize urban health as an important component in Health Care sendees
Obtain information regarding health care services and disseminate widely among
people
5. People should demand for transparency and accountability with the govt, services.
6. There is need to understand socio cultural and economic dimension of the causes
of the illnesses.
1.
2.
3.
4.
(5 H r
Followed by Mrs. Ruth’s presentation Ms. Preetham of Janagraha shared about their
work m developing indicators for the health services. She said at present Jangraha is
involved in the following three campaigns: a. ward work campaign, b. Proof
campaign, and 3. Ankoor, which focuses on the services of SJSRY. They approach
they have adopted is budget analysis, in which they analyze the budget allocated,
actually .spent and the quality of service. As an example she gave the education
budget of the
when worked out the equation, the total cost per child per year
works out to g£. 29,000. She said the output for such a high investment is
unacceptabie'TShe said without information based on evidence objective discussion is
not possible with the service providers and performance indicators help us demand
accountability. At present she said they are experimenting with the approach: collect
information, analyze., and organize management dialogue for improvement with
education and heath care sectors of BMP.
Mi; Madhusudhan of KKNSS concluded the meeting with vote of thanks. It was
decided at the end of the meeting to form a forum consisting of voluntary
organization working with the urban poor for identifying and addressing the issues of
concerns to urban poor under Janaarogya Andolana.
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PROOF
Public Record of
Operations & Finance
PERFORMANCE INDICATORS FOR HEALTH
INPUT
OUTPUT
•
Minimum Infrastructure
Standard
General Ward
Labor Ward
Operation Theatre (OT)
Minor Operation Theatre
Toilets
Condition of toilet
Bathrooms:
-- Availability of hot water
— Availability of sewage
system.
Laboratory
Waiting Area
Patient Attendant Space
Outpatient Area
Availability of drinking water
Linen Service
Generator set
Store Room
Ambulance Service
Quarters for Doctors and
Drivers
Telephone Service
Privacy of examination area
Fumigation
• Number of
deliveries
Normal Caesarean and
Assisted
•
Minimum Equipment
Standard.
Availability of required
Equipment in all rooms.
•
Drugs
Availability of minimum
essential drugs.
Availability of emergency
drugs.
• Number of family
welfare procedures.
• Number of high risk
pregnancies detected
during labor / antenatal
care
• Number of
immunizations against
measles.
• Number of
admissions.
• Number of
admission slips.
• Number of patients
registered for postnatal
care.
• Number of patients
registered for antenatal
care.
• Number of
Medically Terminated
Pregnancies (MTP).
OUTCOME
• Number of maternal
deaths.
• Number of neo natal
deaths.
• Number of stillbirths.
• Number of infant deaths.
• Number of perinatal
deaths.
• Number of measles cases.
• Number of deaths due to
measles
• Number of admission to
number of admission slips.
EFFICIENCY
• Downtime of key
equipment.
Autoclave.
Laproscope.
Refrigerator.
Generator.
Ambulance
BP Apparatus
Instrument Sterilisers
Weighing Machine - Adult and
Infant
Incubators
Boyle’s Apparatus
Pulse Oxinator
Hysteroscopes
• Time taken to fill up
vacancies to sanctioned
strength.
• Nurse patient ratio.
• Complaint redressal
system.
• Doctor patient ratio.
• Patient feedback forms.
• Full time employees per
occupied bed.
• Percentage of patients
coming in for 3 postnatal
check ups.
•
• Number of patients
registered for antenatal care
prior to 12 weeks.
• Number of days with
stock outs of essential drugs.
Waiting time for patient.
• Cost of drugs per patient
(inpatient/outpatient).
•
Cost per inpatient day.
• Cost per outpatient day.
PRODUCTIVITY
EXPLANATORY
• Staffing patterns.
• Number of patients below
the poverty line.
• Inventory / Store
management maintenance
mechanism.
*
Furniture.
•
Stationery for
correspondences.
• Staff (Sanctions, Vacancies
and Absentees)
Doctors
Staff Nurses
Auxiliary Nurse Midwives
(ANM)
Lab Technicians
Peons
Ayahs
Sweepers
Drivers
Dhobhi’s (Contracted)
• Capacity Building
Type of training programme.
Periodicity of training.
Number of people trained.
• Financial
Salaries budget
Maintenance budget Equipment
Maintenance budget -Building
Drugs budget.
Equipment budget.
Training Budget.
Fuel and vehicle maintenance
budget
User fees
Laundry budget
Contractual Services budget
Miscellaneous expenditure
budget
• Number of
complaints.
• Display board of
available drugs.
•
• Number of
outpatients per day.
• Amount of user fees
collected.
• Percentage of high risk
cases among deliveries
• Number of referrals.
• Bed occupancy rate.
• Number of
prescription slips
issued
• Number of deaths due to
sterlisation
• Number of complaints
received to number of
complaints redressed
• Number of visits by
the health officer/
supervisor
• Use of equipments
Utilisation of user fees.
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COMMUNITY HEALTH CELL-CHC
Phone : 0091-80-5531 518/5525372
Fax
: 0091-80-5525372
email : sochara@vsnl.com
Website: http://www/geocit:es.com/soch’ara2000
http://www/sochara.com
No. 367, Srinivasa Nilaya, Jakkasandra I Main, I Block, Koramangala, Bangalore - 560 034.
11tn April 2003
Dear friends
Greetings from Community Health Cell !
Subject:
One day workshop on tuberculosis for non -health voluntary
organizations working with the urban poor, jointly organized by CHC,
BMP, NTP and KSTA.
Tuberculosis is one of the major commun cable diseases that kills more than 5 lakhs people
in India. TB affects people in the reproductive age group, particularly the poor. TB was a
dreaded disease 50 years ago without an\ drugs for cure, killing many people. Thanks to the
medical research, which helped in inventing drugs for curing. This disease which was called
the white plague.
TB is curable if the person regularly takes the treatment, which is for a longer duration, from
6-9 months. In India the government is making the treatment available free of cost through
the RNTCP (Revised National Tuberculosis Control Programme) using DOTS (Directly
Observed Treatment Short Course) approach in a few districts. Bangalore urban district is
one such district.
Though the treatment is available free of cos., there are problems from the perspectives of
both the treatment provider and the user. This workshop aims to evolve a collaborative
effort by government and Voluntary organizations in overcoming the problems thereby
assuring cure for the patient. At the end of the workshops the participant will be able to:
1. Understand the nature, magnitude and action taken by government for combating TB
2.
Identify areas of concerns.
3.
Begin to evolve an action plan in collaboration with BMP to make TB care and control in
Bangalore urban effective especially for poor and vulnerable sectors of society.
This workshop will be held at: Community Health Cell ( address given in the letter pad)
On: 3rd May 2003 from 9 am - 5.00 pm
Kindly confirm your participation at the earliest. Looking forward to meeting you to work
together with you.
With Best Wishes!
Yours sincerely
S.J.Chander
For Community Health Cell
Society for Community Health Awareness, Research and Action - SOCHARA
Registered under the Karnataka Societies Registration Act 17 of I960, S. No. 44/91-92
Registered Office : No. 326, Sth Main, 1st Block, Koramangala, Bangalore - 560 034.
1
/■
JANAAROGYA ANDOLANA - KARNATAKA
4
Action Plan for Intervention for Bangalore City for the year
2003-04
- (For Discussion Only)
Goal
To enable a better healthy environment and access to health services for the
urban poor in bangalore city
Objectives
s
❖ To build capacity of the Organisations/CBOs to equip them to address the
health issues in the BMP area
❖ To Facilitate better accessibility of urban poor's Access to Health services
provided by the BMP
❖ To mobilize the- all stakeholders concerning health to directly address the
burning health issues in various locations of Bangalore city
Output
♦ Training programmes regarding health on Infant Health, Nutrition,
Adolescents , reproductive health, communicable diseases(AIDS, Cholera.
Typhoid,
Malaria),non-communicable diseases(Diabetes,
Cancer,
Hypertension), occupational health ( Construction, Municipal Workers.
Domestic Workers) and Substance Abuse(Alochol, Tobacco)
❖
Health Camps or disease detection camps at various locations of bangalore
city
♦ Evolving mechanism for monthly interaction between the users and providers
of BMP
♦ Direct Action on Explosive health hazards at various locations of the city
which affects the slum dwellers.
Si-'
Indicator
> Training programme on 2 health topics ever/ month
> 2 detection camps for detecting the scale of cancer and diabetes among
slum dwellers
> Health Adaiat - Complaints, grievances of urban poor presented, before the
doctors & staff of the health centres. Conducted at each health centres level
for every month
> Improving environment at EWS quarters, slums adjancent to Storm drains.
Slaughter houses, and building health infrastructure
Activities
SL Activity
No.
1
Capacity
building
2
Health/Diseas
e
Detection
Camps
3
Monthly
Interaction
between slum
dwellers and
service
providers
of
BMP's Health
Infrastructure
Process Indicator
Product Indicator
50 Health workers, Infant Health
field workers
and Nutrition
CBOs will be trained. Immunisation
Resource material will Communicable diseases
be
distributed
and Non-Communicable disease
evolving action plan
Adolescent health
Reproductive health
Occupational Health
Substance Abuse___________
3
Health detection Document on Findings of the
camps for organising detection camp
detection
of
high
concentration
of Strategy document on curative
diseases
such
as and preventive measures to
cancer contain the diseases
tuberculosis.
and diabetes________ I ________________________
12 monthly interaction Health Adaiat - a mechanism to
at 55 IPP centres per for exchanges between users
month. The doctors, and providers of BMP's health
staff,
CBCs.
slum system.
dwellers interact to
improve the services of
health infrastructure
>
4
Direct Action
to pre-empt an
explosive
unhealthy
situation
Organising inspections Building
up
an
health
from the government environment in slums adjancent
agencies.
to Storm drains
Media splash
Improving the environment in
Vinobanagar,
Shambupalya
slum etc.,
Enabling
systems
within government to Improving
the environment
prevent such situations within the slaughter houses on
tannery road and protection of
slum dwellers who work there.
Status of Health in the Slums of Bangalore City
By
Madhu Sudhan
Training Research and Documentation Unit
Karnataka Kolageri Nivasigala Samyukta Sangatane(KKNSS)
Bangalore
Introduction
Health is a complete state of Physical, mental and social well being and not
merely the absence of disease of infirmity1. Access to health care was one of the
indicator of measuring reduction in poverty of underprivileged masses in the
rural and urban poor areas of the country. One of the important components of
health care system of consists of : primary, secondary and tertiary care
institutions, manned by medical and para-medical personnel. The Primary Health
Care Infrastructure provides the first level of contact between the population and
health care providers. Realising its importance in the delivery of health care
services, the state and central government has started primary health centres2.
About 30% of the India's population live in the urban areas. The health care
system is much better compared to the rural areas. However , the urban
migration has resulted in growth of slums. The slum population face greater
health hazards due to over crowding, lack of sanitation, no proper access to
drinking water and environmental pollution. Realising that the health
infrastructure is insufficient due to the growth of urban population, the local
government, state government and central government has built up urban health
care facilities. But, there has no effort to provide well planned and organised,
primary secondary teritary care services. Dispensaries, Primary Health Centres^
Government Hospitals and Referral hospitals are the four tiers of the health care
system in the urban areas in the country.
Urban Poor in Bangalore city
In Bangalore city, there are about 472 slums3 in the Bangalore city. Of which
202 are declared under section 3F of the Karnataka Slum Areas Act 1973. The
slum population in the declared slums will provided with basic amenities only the
slum is declared. Therefore the number of undeclared slums in bangalore city is
270 on the lands owned by government agencies, private owners, railways
.defence lands etc., A more realistic figure came from the National Sample
1 . Definition by World Health Organisation
’ .Tenth Five Year Plan Document on Health, Planning Commission of India, 2003
’ . Commissioner, Karnataka Slum Clearance Board. March 2003
i
Survey, 49th Round, in 1993. Here, the slum population was estimated at 32.2
lakhs, making it around 23 per cent of the total urban population in the State.
This study estimated the population of Bangalore's slums at 10 lakhs4.
I. Health Status of Urban poor in Bangalore city
1. Malnutrition
About 70% of the children in the slums of Bangalore city suffer from
malnutrition5. A significant reason for this is poverty many people cannot
afford regular nutritious meals in the slums. In times of economic stress, this
becomes frank malnutrition; the body under such condition is unable to resist
disease and succumbs to it
Children in the slums suffer undernutrition : 1.Marasmus, which is wasting;
frequent cause is underfeeding, diarrhea and infection;2.Kwashiorkor, marked
by swelling of the body. Swelling is due to a fall in circulating proteins.
Stunting (poor height gain) in the slum is the commonest type of malnutrition
in childhood. Some children may be underweight. Both height and weight
suffer due to malnutrition.
Anganwadi(ICDS)
Anganwadi is a community health programme for improving nutrition, health
and pre-school education of children. At present, it covers the slums and
other backward areas in Bangalore city. The target group is children under 6
years.
The target group is divided into two sub-groups, one below 36 months and
the other above 36 :o 72 months. The younger group stays at home with the
mothers. So this programme is ineffective for the younger babies without
home visits. The other group - above 3 years - is accessible in the
Anganawadi ( which is a balwadi and feeding centre). Anganwadis are held
in the morning. The primary health centre is expected to undertake
immunisation and health checkups in the ICDS programme. The anganwadi
worker, who is usually a slum woman with some formal education, conducts
teaching activities too. The helper woman does the cooking and feeds the
children's. The functioning of the Ancanawadis need to be reviewed jointly
by the Government and NGOs and its co-ordination with Primary Health
Centres. The low rate of immunization (except pulse polio) and malnutrition
4 Karnataka Housing Revolution, Parvathi Menon h Frontline Maaazine, Vol 19, Issue 13 June - July
5,2003
5 Dr. Mala Ramachandran, Health Officer Bangalore Mahanagara Palika(BMP), World Health Day(April 7,
2003) at Ashirwad, Bangalore
2
in the age group of younger children in the slums reflects the effectiveness of
Anganawadi network in the urban poor areas
2. Environmental Sanitation
Due to scarcity of pure and wholesome water supply, where water is not
easily accessible, provision for waste disposal facility and sanitary latrine are
in adeuqate. Poor housing conditions, poor personal hygiene, personal
habits are causes morbidties in these areas. The inaccessibility to potable
water is caused the high rise in the epidemics. The following are the two
major causes for the inaccessiblity to water supply system.
(i). Unable to access due to high cost of water connection and service
In order to access the BWSSB water connection to the individual household, a
deposit of Rs. 800 is fixed with an water meter attached for monitor the water
consumption. The one-time connection chaig " prove to be an obstacle for many
households, both in slums and other areas in accessing formal connections.
BWSSB has decided that certain elements of the connection charge, such as the
number of sanitation points charged for(five), can be re-considered and reduced
(to two) in view of the small size of houses in slums and low-income areas and
the limited number of sanitary fixtures. This element alone can reduce the
connection charge by Rs. 360.
The major issue with the slum dwellers is the tariff fixed by the BWSSB. The
existing rate of 1 kilolitre of water is Rs. 6 for domestic consumption under
consumption slab of 0-15,000 litres and Rs. 8 per litre for the domestic
consumption slabs between 15001 to 25,000 slabs. The BWSSB argument for
the recent hike in water charges is to cope with the increasing operational costs.
The slum dwellers have been demanding for fixation of subsidised rate for
slums and much reduction from Rs. 6 for domestic consumption slab of 0-15,000
litres.
On 27-12-2002, About 5000 slum dwellers staged protest rally in
Bangalore city under the leadership of KKNSS, Women's Voice and AVAS for
subsidised rate for water which was one of their demands. Now, BWSSB has
started to experiment for providing subsidised rate for water supply to the slum
dwellers.
On March 4 th 2003, BWSSB has started the process of providing subsidized
water supply for the slum dwellers in Lingarajapuram Each household will be
provided with one water tap, and for a family of five is expected to consume less
than 7200 litres of water per month. . The new initiative will cover 1000 families
by extending 50 percent concession on connection charges and service charges.
The rates for connection charges are Rs. 800 per household and monthly
payment of Rs. 115 for consumption of water.
3
But the majority of the slums in bangalore city are reluctant to accept the BWSSB
package due to high cost of the connection and the monthly charge of Rs. 115.
The slumdwellers expect the BWSSB to reduce the deposit and monthly
charges by half and also a guarantee that the BWSSB's customers in the slums
are exempted from future hike in water charges.
(ii). Absence/low capacity of network in the area
The newly4formedAwards of Bangalore city (from^ward-no-63'tO-100) are out of
the BWSSB network. It is estimated that 30% of the slums in the Bangalore city
could not avail water supply connection due to absence of BWSSB network in
the area. In these slums, the water crisis exist even though water supply is
provided through by public taps with mini tank storage systems. Despite this
there is acute water crisis in this area.
Chart - Slums of the wards where BWSSB network does not exist and partially
exist
Partial
Absence of
Slums
Ward Ward
Infrastructure
Infrastructure
Name
No.
exist
12
5
3
16
17
18
19
HMT____________
Nandini Layout
Geleyara Balaga
Layout__________
Kamalanagara
Vrishabhavatinagar
Kamakshipalya___
Basaveshwarnagar
35
37
38
Marenahalli
Amarjyothinagar
Mudalapalya
3
2
1
39
Chandralayout
10
41
Gallianjaneya temple '
3
52
Hanumanthanagara
3
53
54
55
Srinagara
Srinivasnagara
Padmanabhanagar
4
13
8
1
12
13
9
3
3
3
4
56
57
65
Ganesh Madira
JP Nagar_____
BTM Layout
13
5
10
67
68
Kormanagala
Ejipura
5
7
69
Neelasandra
7
72
73
Domlur
Airport
10
15
74
83
84
JB Nagar________
CV Raman Nagara
Beniganahalli
2
85
87
Sarvagnanagar
Lingarajapuram
13
6
88
89
Banaswadi_____
Kacharakanahalli
2
3
90
93
94
95
96
Sagayapuram
DJ Halli_________
Kadugondanahalli
KB sandra______
Hebbal
4
99
Aramanenagara
Sanjaynagar
4
Total
299
100
Z
1
8
2
4
4
6
12
243
56
Source: - BWSSB: ward wise list of its existance of partial or absence of water
supply Infrastructure.
BASCIS - list of slums.
Health experts agree that if safe drinking water supply is provided to the slum
dwellers a substantial improvecTin'the health status of the urban poor can be
Approved. Therefore, BWSSB package of water supply to the slum dwellers
should be made available at affordable rates so that the spread of water
borne diseases can be eradicated.
5
3. Storm drains
Storm Drains network is an the backbone of the sewerage system in the
Bangalore urban district. The primary storm drains ertend over a lengthi of 184
kms in the city6. They guide water to all the major storm water vaHeys
Vrushabhavathi, Koramangala , Challaghatta Hebbal I and ^eb^' "T
substantial number of slums are situated on the fringes of storm drains. The
conditions of these storm drains is an important factor in the day today lives of
the slum dwellers. There are slums where the pubhc: water taPs w^ch *
placed in the storm drains. For instance, in the case of ISRO slum, near tne
Cambridge layout the slum dwellers collect drinking water, take bath which is at
the silted9 area in the bottom of the storm water drains. Majority of slums which
do not have access to UGD or sanitary lines within the slum, the drainage water
flows directly into the storm drain.
(i). Health hazard
In Prakash nagar slum of Ward No. 23 Storm water
and rot.
In Ward No 26 (Sevashrama Ward) the children of Okalipurami slum, are down
with fever due to clogged drain. Garbage adds to the clogged dram, fl^s and
mosquitoes The air is heavy with stench that breeds disease. Beside,
water drain in the area is surrounded by so much of garbage there is no place for
drain water to flow.
In Ward No 32 Dr. Devaiah, a house surgeon at Padma Devaiah Nursing Home
n KP Agrahara says unhygienic conditions have brought .ri several dl^as®s
slum dwellers are complaining of cholera, typhoid, skin diseases or viral
infections. There is a urinal which is not maintained and is currently used as
garbage bin. Many garbage bins are broken or overflowing.
(ii). Flooding of houses during rains
During rains, the dilapidated storm drains with stench and garbage> spel! m'sery
to theslum dwellers. In Bangalore, the flow of water is from north to south .
woman of Gandhigram slum? are up in arms against the
the
to close the eight feet wide sewage due to its unbearable stink. Dur ng rains t
sewage mixes up with rain water and rushes into their houses. Out of the 300
houses, 250 of them have no sanitation facility.
6 Clogged Network by Aravind Gowda- Deccan Herald, 7 June 2002
7. Assessment by Training Research and Documentation Unit, KKNSS
6
In Ward No 63, adjacent to Chandrappa nagar slum, the huge drainage line
looks like a garbage pit. Due to silt formation the sewage is clogged and the
whole drain is now filled with garbage. For almost a year neither BCC
pourakarmikars nor any one has cleaned this line. If the garbage is not cleared,
the rains bring garbage to the streets and even to the houses. Adjacent to
Mudalpalya slum, of Ward No 38, The Vrishabhavathi storm water drain is the
source of an unholy stench. Most areas are low lying and susceptible to flooding
during rains and subsequent overflowing storm water drains. Storm water drain,
the collecting point of 8WD water from all other wards on the way to the end of
the Vrishabhavathi valley at Kengeri. It does not have retaining wall and has
never been de-silted. Some rain and SWD overflows onto the residential areas
(iii). Flooding severe in the low lying areas
In the Ward No. 44, Faulty drainage and k :k of de-silting in the storm water
drains result in flooding of the low lying areas. Slums such as Rayapuram,
Kamala Nehrunagar, JJR Nagar, Objlesh slum, Salappa line and Narasimhaiah
compound are the most affected. Faulty drainage and lack of de-silting in storm
water drains result in flooding of the low lying areas. The Goripalya slum has
beef shops as added to the pollution of the storm drains.
From August 2002, the residents of Gandhi Gramam in the city, have been
complaining of a stinking eight feet wide open sewage, that often floods their
homes during the rains. The resident complain that the smell of the drain in the
slum is so bad that during monsoons, when most houses are flooded the smell
remains even after the water gets washed away.
One of the problem with storm water drains is blockage due to
accumulation of garbage, waste, faulty drainage systems, and abject neglect by
BCC in maintenance of the storm drains. Even after ambitious launch of the
Swacha Bangalore programme, there is no door to door garbage collection
system and waste bins in the slums and many middle class residential areas.
(iv). Blockages of storm drains by military and security establishments
The problem of storm drain has assumed gigantic proportions, due to
termination of storm drains near the military and security establishments in
Cantonment. The most affected due to storm drains are the slums in the
Koramangala and Ejipura ward. The military authorities have terminated the
storm drain disconnecting its flow towards Bellandur.
4. Absence of or improper UGD systems in the slums
(i).Internal
7
The slums of Bangalore city are the most polluted areas due to the absence or
non-maintenance of UGD lines by the KSCB or the BMP. The sewerage
systems within the slum has added misery to the slum dwellers. Lakshman Rau
Nagar slum and Siddapura slum are the worst affected. The following are the
factors is the contributor for the sewerage crisis in the slums.
(ii). Faulty design of UGD and sewerage drains
In Sambu Palya Slum of Ward No 48, the serious issue of the toilets is its faulty
construction of UGD lines which passes though the narrow lanes of the slums.
The frequent overflowing of the septic tanks in the UGD lines has caused severe
hardship some families in the slum. The septic tanks are situated in front of
houses, the overflowing excreta enter the houses. The faulty design and
construction of the community toilet is the crux of the problem. UGD lines from
the community toilet move upwards to connect the main UGD line. The lack of
inspection by KSCB on the gradient level of UGD line has caused serious health
hazards for the slum dwellers in shambu palya.
(iii) Non-maintenance of the drainage system
In Lingarajapuram Slum, The drainage system is a breeding ground for
mosquitoes, the corporation authorities have not been maintaining these drains.
The slum dwellers are forced to pay Rs. 15 per household for cleaning the
clogged drains in the slums. Due to clogged drains, children in the area are
always falling sick and slum dweller are forced meet the medical expenses as
well.
In Nagina Palya slum, The state of drainage system is in a pitiable state.
The poura karmikas come only once in 15 days and demand Rs. 2 from each
household for cleaning the drainage. They dump all the waste in-front of the
houses which is bad for the health of the slum dwellers. Slum dwellers have to
bear the medical expenses when their sibling are affected with epidemics
In EWS quarters of Vinobanagar , each house has individual toilets with
an open ended sanitary pipes.. As there is no septic tanks, human excreta flows
through the open ended sanitary lines and drops behind the houses coupled with
sewage water and garbage. This has caused huge environment crisis and
diseases to the children.
Communicable diseases such as malaria, diarrhoea, acute respiratory
diseases, tuberculosis are rampant in the slums due to lack of safe living
environment in the slums
5. Non- Communicable Diseases
(i) Cancer
In Karnataka, about 45,000 cases of cancer are detected every year. The
task force on health and family welfare says the prevalence of cancer is about
8
1.5 to 2.5 lakh cases in the state. Cancer is highest among the woman which
is about one in twelve women, breast cancer, cervical cancer and uterus
cancer are the most common incidences of cancer. Among these cervical
cancer(21.5%) and breast cancer(18.6%) are the most common cancer sites
among woman8.
In the slums of bangalore city, the number of cancer patients who have been
detected and undectected is increasing at phenomenal level. Majority of the
slum woman are not even aware that they have been suffering from cancer.
(ii) Diabetes, Hypertension and OVD
Heart disease, high blood pressure, diabetes and obesity are much higher
among the the city dwellers. 16% of f’e urbanites suffer from hypertension. The
Cardio Vascular Disease(CVD) is nc a major health problem with the bulk of it
in developing countries. Ciggarette s. ok g and tobacco chewing all increase
the risk of heart attacks as much as 300 pc cents.
One out of every 20 Bangaloreans may be a diabetic or on the way to becoming
one9. Increasingly sedentary lifestyles, heavy smoking, alcoholism, poor food
habits, obesity and the 'thrifty gene' have resulted in, not only this garden city but
the rest of urban India as well, to reel under a diabetes epidemic.
Various WHO reports point out that between 5-8 per cent of India's urban
population (in some areas even above 10 per cent) are diabetics. In a city like
Bangalore with a population of about 6 million, estimates are that between
2,50,000 to 3,00,000 are already diabetics. Another 1 lakh come from nearby
areas. Many others have impaired glucose tolerance which could mean that they
are within 4 to 5 years from actually becoming diabetics without lifestyle
modification.
Due to high consumption rate of alcohol and tobacco, the rate of diabetes and
CVDS are higher in the slums of bangalore city. Slums where Construction
workers, loading and unloading workers, safai karmacharis and night soil workers
are concentrated had known for high incidences of Diabetes and CVDs
6. Occupational Health
Atleast 50 - 70% of the workers in the unorganised sector residing in the slums
are exposed to heavy physical workloads, leading to musculoskeletal disorders.
Most affected in this category are construction workers, loading and unloading
workers, Nightsoil workers, Municipal workers, woman involved in agarbathi
rolling etc. Workers in the small scale industry are exposed to mineral, vegetable
dusts like silica, asbestos and coal dust which are know to cause irreversible
8 Study by Cancer Patients Aid Association, 2003
9 Study by St Johns Medical College and McMaster University in Canada, 2002
9
lung diseases, TB, lung cancer and allergic reactions like asthama. The risk of
cancer is high in the workplaces of small scale industry where 350 chemical
substances have been identified as occupational carinogens, including benzene,
hexavalent chromium, nitrosamines, asbestos,etc and ultra vilet and ionising
radiations10.
II. Health Care Infrastructure and Services
The Bangalore Mahanagara Palike(BMP) maintains about 30 maternity homes,
37 urban family welfare centres(UFWC), 25 dispensaries and 55 health centres.
These public health infrastructure was built with financial assistance of the world
bank under the Indian Population Project VIII. The health centres and UFWCs
focus on health, nutrition education, entenatal/postnatal care, family planning,
immunization mother & child, nutritional care of children up to the age of five.
Apart from this, medical treatment of minor ailments and to act as referral units
for the maternity homes was expected out of health centres and UFWCs. The
maternity homes focus on delivery and medical termination of pregnancy(MTP)
and laboratory tests. Maternity homes is also responsible for providing
antenatal/postnatal care, family planning non-surgical care for children needing
specialist attention and minor gynaecological
procedures. The services of
health centres, UFWCs and Maternity home is delivered for free.
The India Population Project - VIII
The India Population Project VIII (IPP VI) is a World Bank assisted project and
has been in operation in the city from May 1994. The project aims at expansion
of maternal and child health and family welfare services to the uncovered wards
and population groups mostly the urban poor particularly the slum dwellers. The
norm of IPP project is creation of one new health centre each for every 50,000
people. As planned, all the fifty five health centres have been created under the
IPP VIII. The project also covers to improve the quality of health services being
provided by the existing maternity homes of the BMP such as delivery, MTP and
sterilization etc. for which health centres act as referral units.
The fifty five newly created health centres are presently under the administrative
control of the IPP-VIII which supports the services of doctors, field staff and
honorary link workers to the health centres. The Honorary link workers are
volunteers residing in the slums, where they motivate mothers to utilize facilities
10 Interview with Dr.Shashikala Manjunalh, Occupational Health Specialist, Community Health Cell, S T
Maralhas Hospital, Bangalore, October 2002.
10
and services for ante-natal care, delivery family welfare, immunization. The BMP
was able to build better health infrastructure with medical equipments,drugs and
training for the technical personnel and public communication. IPP-VIII project
was seen as project which improve quality of family welfare, maternal child care
for the urban poor in the bangalore city
Corruption in the delivery of health care services
In 1999, the World Bank initiated process to ascertain whether the health care
needs has been fulfilled and the impact of the IPP-VIII project on the health care
system in bangalore city. The process took the form of consultation with different
stakeholders/ beneficiaries in the selected slums of bangalore city. The findings
underlines the fact that the health ce tres are assessed by the urban poor free
of cost. In the case of maternity horn
maintained by BMP, none of its services
such as sterlisation, MTP, delivery a.e • "liable free of cost. The urban poor
people were forced to pay bribes in majors, of cases.
With the termination of W^dd Bank Assistance in the year 2001, the IPP facilities
has been integrated with the existing system of the BMP for routine operation
and maintenance.
The surveys on maternity homes, UFWC and IPP Health Centres reveals that
maternity homes are more popular among women for antenatal care than the
other two providers. This indicates either a lack of awareness among the
patients
the availability of these failcilties nearer their residences at the IPP
Health centres or a reluctance to go to a new place. In either case there is a
need to educate women on the advantages of using the IPP Health centre.
The level of corruption at Maternity homes is much higher than that of UFWCs
and IPP Health Centres. One of the reasons for this could be that UFWCs and
IPP Health Centres do not involve admission. The reason for which bribes are
paid by most patients are for seeing the baby(69%) and for the delivery
itself(48%). Other services like injections, family planning medicines, etc are also
privided for payment of bribe but the extent is not so large. As far as the average
amounts paid are concerned they are quite large for seein the baby and for
delivery(Rs. 361 and Rs. 277 respectively) while other bribes are smaller in
value.
Referral Role to Maternity homes by UFWCs and IPP Health Centres
Patients who had been to maternity homes were asked who referred them there.
The response show that most of them came there on their own(68%), some were
recommended by friends and reiatives(8%) while 20% had been referred by IPP
Health Centres and 4% by UFWCs.
11
Among patients who visited UFWCs and IPP Health Centres, 63% and 64% said
they referred to maiernny homes for delivery Of these 81% and 67% went ior
their delivery to maternity homes from UFWC and IPP Health Centres
respectively.
Health services to the poor women
BMP maternity homes is the only decentralised set of health facilities in
bangalore that are accessed by relatively low income women and children. A
network of outreach centres has now been created through IPP8 to expand and
further strengthen the services of the maternity homes. While this expansion anc
upgradation of the health facilities for the poor needs is appreciated, it is
important that careful thought is given to their proper utilisation, maintenance and
effectiveness.
The following are the findings of the survey conducted in the year 2000
11
The overall satisfaction of patients was the lowest with the services of the
maternity homes.
Only a third rated them as good while 71% and 60% considered IPP centres
and UFWC respectively as good.
Only 39% of the patients of the maternity homes claimed that they received
all medicines free as opposed to 63% in IPP centres and 61% in UFWCs.
Maternity homes also lead in taking payments for injections. But the staff say
that medicines are given free to all patients.
♦:* Cleanliness of toilets 'is ani indication of the standards of hygiene and
sanitation. Here patients rated maternity homes the lowest (43%) in contrast
to IPP centres (83%) and UFWCs(61%)
❖ Maternity homes were rated the lowest also in terms of stafi behaviour
towards patients. But the gap between them and IPP was much smaller in
this case.
The most distressing finding concerns the prevalence of corruption. About
90% of the respondents reported paying bribes for one service or other at
maternity homes at an average of Rs. 700 each. The 70% pay for seeing their
own babies. One out of two pay for delivery.
If a poor woman paid for all services, it would have cost her over Rs. 1000 for a
delivery. It is reported that a nursing home might give her hassle free and better
quality service for Rs. 2000. A rough estimate of the bribes being paid in all these
" User Feedback Survey by Public Affairs Ccnlrc in colloboration with Sumangali Scvashram, RUDS,
MAV A. ('ili/cns Ac lion (iroup and ('oininunily I Icallh Cell
I2
facilities may be between Rs. One and two crores annually. A similar estimate
based on the finding that 90% of the women pay about Rs. 700 at the maternity
homes would put the total amount of bribes paid at about Rs. 1.6 crores. The
annual emoluments of the staff at the 30 maternity homes also amount to about
Rs 2 crores.
13
8
Report on Health of the urban poor held on Peoples Health Day - 7“’ April 2003
At Ashirwad Bangalore, facilitated by Community Health Cell and KKNSS
Report by : S.J.Chander
Background
World Health Organization (WHO) having recognized that the health sen ices expected
by the people was not being provided, in 1997 during the World Health Assembly called
for a revolutionary approach In Health Care that would enable the citizens attain a lex el
of health that will permit them to lead a socially and economically productive life. In
1978 in the conference held in Alma Ata. Russia, Health For All by 2000 AD was
declared. Primary Health Care approach evolved based on the experiences of countries
like Sri Lanka and India was suggested as the best way to attain the goal. Sen ices based
on PHC approach xvere developed over the years for the rural poor but to far the urban
poor the sen ices available were family xvelfare and family planning.
He said the PHC approach though initially experienced some gains, gradually moved
from comprehensive health care to more a selective primary health care approach. Pulse
polio programme can be given as an example. National Health Policy 2002 draft is out
and it is evident in it the shift. Process of globalization and influences of various lobbies
are some of the factors that hax e had negative effect on people health. Of late the trend is-s
moving more towards privatization.
This year is the silver jubilee of the Alma Ata declaration, it appears that WHO and the
govcLiiniviits have forgotten the goal Health For All (HFA) by 2000 AD. Jan Swasthya
Abhiyan (JSA) in India, known as People's Health movement internationally believes
that it is the comprehensive health care that is going to help people attain the lex el that
was envisaged by WHO during the declaration. It is time that both the government and
the people's organization work together to achieve Health for All now!
Dr. Mala Ramachandran. Director, Urban Health Training and Research Center.
Bangalore who was invited to share on the health services available for the urban poor
said, approximately there are 15 lakhs people live in the slums of Bangalore. Population
growth is the cause of the state of affairs in the slums. Usage of MCH sen ices and
Immunization coverage is low. Problems like cancer, diabetes, hypertension is prevalent.
HIV AIDS and Tuberculosis are the other problems of concern to the urban poor. Safe
drinking water and sanitation continue to be inadequate. During the response to Dr.
Maia’s presentation, the participants said, despite the efforts to control corruption. It is
still rampant. There was concern among the participant regarding the remo\ al of Link
Workers who were working at slum level.
Followed by Dr. Maia's presentation. Mrs. Ruth Manoramma of Women's Voice shared
urban poor do not have policy to address their needs. She said national policy of urban
poor is being developed. The present family welfare programmes exclude men from the
service coverage. Regarding sanitation needs, she said 70% of the Indian population still
I
1
does not have toilets. Women are the ones who are affected more due to lack of toilet
facilities. From the 9th five-year plan it was observed the budget for health being
decreased and budget for social welfare continued to face cut. The critiques have said the
following: Public sector is moving towards privatization, public sector budget faced cut.
commodification of health care, population gets major focus and distortion of priorities.
Regarding her suggestions to change the scenario, she said the following:
We should demand for comprehensive primary
Introduction of barefoot doctors cadre and youth for prevention HIV/AIDS
Recognize urban health as an important component in Health Care services
Obtain infonnation regarding health care services and disseminate widely among
people
5. People should demand for transparency and accountability with the go\ t. sen ices.
6. There is need to understand socio cultural and economic dimension of the causes
of the illnesses.
1.
2.
3.
4.
Followed by Mrs. Ruth's presentation Ms. Preetham of Janagraha shared about their
work in developing indicators for the health services. She said at present Jangraha is
involved in the following three campaigns: a. ward work campaign, b. Proof
campaign, and 3. Ankoor, which focuses on the services of SJSRY. They approach
they have adopted is budget analysis, in which they analyze the budget allocated,
actually spent and the quality of sen ice. As an example she gave the education
budget of the MBP when worked out the equation, the total cost per child per year
works out to Rs. 29,000. She said the output for such a high investment is
unacceptable. She said without information based on evidence objective discussion is
not possible with the service providers and performance indicators help us demand
accountability. At present she said they are experimenting with the approach: collect
information, analyze, and organize management dialogue for improvement with
education and heath care sectors of BMP.
Mr. Madhusudhan of KKNSS concluded the meeting with vote of thanks. It was
decided at the end of the meeting to form a forum consisting of voluntary
organization working with the urban poor for identifying and addressing the issues of
concerns to urban poor under Janaarogya Andolana.
7
Seminar on
HEALTH FOR ALL BY 2000 AD!
URBATN FOOR WHERE ARE WE? HOW CAN WE MOVE
FORWARD?
Date: 7th April 3, 2003
Time: 10.00 am to 1.00 p.m.
Venue: Ashirwad, No.30, St. Marks road cross
Bangalore - 560 001
Objective: A the end of die piogiaiimie die participants will be able to:
1. Understand Health care facilitates available for the urban poor
2. Identify areas of concem/for collabdratron----3. evolve an act^ plan to address the areas of concern.
I
PROGRAMME
Time: 10.00 a.m = 1.00 p.m.
Chairperson: Dr. Samuel Pau! of Public Affairs Centre, Bangalore.
Introduction:
S J. Chander of Community Health Cell
Chairoerson’s Address
Prof Samuel Paul
!
a
J
Presentation:
Lessons iearnt
Discussion:
vote of thanks
Tea break -10- 30 -10.45.
Health care services for the urban poor
by Dr. Mala Ramachandran, Directror,
Urban Health Reserch and Training
Centre, Bangalore Mahanagara Paiike
Advocating for the urban poor Mrs. Ruth
Manoramma, Women’s Voice
□angaiuie.
For identification of areas of concern
and action plan, Facilitated by
Mr. Madhusudhan of KKNSS
10.00 a m to 10.10
a.m
10.10 a m -10. 30
a.m
4 H X K >-<
_ XX A C
I'j.'txJ a.in —
i i .‘t'J.
am
11.45 am-12.00
noon
12 noon -1.00
rx rv»
p.lll.
/-a
(SV^
3rd April 2003
Dear friends
Greeting from Janaarogya Andolana!
Subject: Peoples Health Day (vVorid Health Day)
M Health For All by 2000 AD*
Urban poor, Where are we and
How can we move forward?
Health for all by 2000 AD is a familiar slogan to many people who are involved with
health care services with the people. It is 25 years since the Declaration was made, in
which ail member countries of the World Health Organization signed and made a
commitment to work towards achieving Health for All citizens using the Primary
Health Care approach. Another World Health Day has come with tire theme “Healthy
Environment For Children” the focus on comprehensive is missing.
It would appropriate, if we who are concerned about the Health and Development of
the urban poor meet and plan how we can go forward in the coming year April 2003
to March 2004. There will be a presentations on the experiences of the health service
providers for the urban poor and from the Bangalore Mahanagara Palike. Dr. Mala
Ramachandran Director, Urban Health Research and Training Institute will
make the presentation.
We hope the deliberations would help us draw up an action plan, which would help
address health problems of the urban poor with the Primary Health Care approach. If
you are interested, please join us at:
Ashirvad
No 30j Si Marks Road Cross-,
Bangalore- 560 001
Phone: 2210154
On Monday the Tl April,
T/rom 1 H a m- 1A. 00
A 1VA11 JL K/. C4* 111
W
rn
111
Yours sincerely
S.J.Chander
Tor Janaarogya Andolana
3rd April 2003
Dear friends
Greeting from Janaarogya Andolana!
Subject: Peoples Health Day (World Health Day)
“ Health For All by 2000 AD”
Urban poor Where are we and
How can we move forward?
Health for ail by 2000 Au is a familiar slogan to many people who are involved
with health care services with the people It is 25 years since the Declaration
was made, in which all member countries of the World Health Organization
signed and made a commitment to work towards achieving Health for Ail
citizens using the Primary Health Care approach. Another World Health Day
has come with the theme" Healthy Environment For Children” the focus on
comprehensive is missing.
It would appropriate, if we who are concerned about the Health and
Development of trie urban poor meet and plan how we can go forward in me
coming year April 2003 to March 2004. There will be a presentations on the
pynpripnrPQ nf the health
w/i
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Bangalore Mahanagara Palike. Dr. Mala RaiTiachandran Director, Urban
Health Research and Training Institute will make the presentation.
We hope the deliberations would help us draw up an action plan, which would
help address health problems of the urban poor with the Primary Health Care
approach. If you are interested, please join us at
Ashirvad
No. 30, St. Marks Road Cross-,
DarinolAro
U.UI lyctivi
00'1
VW VV I
Phone: 2210154
Qn
the 7th Anril
x-n i iwisyi iuuj b
i
/
h.
From 10. a m-1.00 p m
Ymirc cinrprplu
I VMI'J UIIIVWIVIJ
S.J.Chander
For Janaarogya Andolana
VOLUNTARY ORGANIZATIONS WORKING IN AND AROUND BANGALORE
sl.noi
1.
rr
I 3.
4.
5.
6.
NAME GF ORGANIZATION AND
L.UH1AV1 1'JLivawrs
TELEPHONE
ADDRESS
NUMBER
c^kEDS Rag pickers education and
Mr Joe Paul
22214247
i develdpfhenf society ~
‘
I 14, Curly street
Langford town
Bangalore - 560 0027
’t-rMAY A MovemenTfor youth Alternatives I Mr. Solomon
r6658T34
I 6346053
' 1117 6*h main 5th Block
' Jayanagar
r<cLCtx
■ C^nn
! Bangalore - 560 0041
BOSCO
! Fr.Verghese
i 2253392
B. street
b* Cross, Gandhinagar
Bangalore - 560 009
►^^iaithiri Sarvaseva Samithi
Mr. Ansiem Kozario
3255543
1300D I cross. I Main
6681244
New’TKippasandaF'
' HAL 111 stage
*
i Bangalore - 560 075
Women’sVoice
; Mrs. Ruth Manorama
6630262
47/1 St. Marks road
Hemalatha
Bangalore - 560 001
Paraspara
71/2 Fu st Floor
I r Cross, Bandappa road
i Yeswanthpura
I
’ Bangalore! -20740'70
C Concern for the Working
i Nandana Reddy,
Children
303/2 LB shastri nagar
vimanapura post
Bangalore - 560 017
'<^YMCA Young .Men Christianj Joseph Chelladurai ;
, Association
. 6 Infantry7 road
■ Bangalore - 560 001
; Asha Deep
| Sr. Lauret Marie
! 2864113
Montfortian Society
7/1 Venkatappa road
Tasker town
Bangalore - 560 051
\ • ar. I/atac H
v k.m\.U.LV.J11
I
\7-
i iT
i
k
rnK
11.
.-----
12.
13.
I
I
APD Association of people with
I disabilities
! 6“ Cross Hutchins road
Hennnr Main road
Bangalore - 560 084
^xAPSA Association for Promoting Social
TT^ctioir^
f Nam mane
• j Annasandrapalya
k
<
■ Vimanapura post
L Bangalore - 560 017
Z World Vision of India
55,Lazor road
Cooke town
/v
Bangalore 560 005
t/^KKNSS Karnataka Kolegiri Nivasigaia
I Samukta Sanghatane
- 6th cross. Pukkraju layout
' Bannerghatta main raod
• Audligodi post
I Bangalore
i Mr. V.S.Basvaraju
I Kamakshi
Di.Kshilij or
| Mr.Lakshapaihi
I \J
i 5475165
; 5470390
r\ -—j 4 r\
jzoz/^y
^4
' Cx>rr»
I
I
MR. Vijayakumar
jV<K-
5476382
%cUo< Abf
Mr. Pakkirsaniy or
i_Mr.Deenaciavalafr
vjvi *
22238739
or^ y>
Malthas Hospital_ _____
• ! Community Health Department
’ Nrupathunga roaad
z Iz^k&angalore - 560 009
15.
; St. Johns Medical college
Community Health Department
Sarjapur road
Bangalore - 560 034
14.
CREEDS
! VI main S.K. Garden
' Benson town
| Bangalore - 560 046
17.
| Deena Seva Sangha
Rasildar street
Sheshadri puram
Bangalore
18.
Fedina xNavachena
______
Zviunikapana Garden________
I II cross Ramasamy palya
! Kammanahali
; Bangalore-560 033
Community Health Department
Ambedkar Medical College
Kadukondanahal I i
Bangalore - 560 0043
21
Services
Bangalore
Medical
’ Trust,
Now Tippasandra Main Road.
HAL III Stage,
Bangalore -- 560 075
22
•H^San jeevini Trust,
' 57, Langford Road,
i Richmond Town,
1 Bangalore - 560 025.
■ Dr. Dara Amar
i 5530 724
I Mr. Ihyagarajan
{ 333Pfl$3
^2)1 7
'CL, t H
I Prof.Ramaiao
<
ono”?
u'-tv
!
Dr. Lata jaganathan
Phone:
i Dr. V edaZachariah
1
' Phone:
23
Freedom Foundation,
9/30, Kaiain Chand Layout,
Hannur Main road,
Lingaraj auram.
____ -Bangalore - 560 084.--------I 24 t _ Madhya m,
I No.l, 10th Main lO^033
| 2257081
(Qu£nl * kixA"
16.
' 19.
D. Shakuntala
Mr.Ashokarao
'i
*. 11UUV.
Phone:
5479766
T'SQI* oei
J
I Bangalore - 560 052
I
^^^Clirisiian Medical Association of Phone:
' 26
x.
India,
III Floor, HVS Court,
21. Cunningham Road
------ r-Bangal^rc—5404X52.-------------------- :----------J.CDSS
I 1st cross
Vivekananda nagar
! Bangalore - 560 033
Dr.Shubha
Yohan.
:■
zi fli'
-
-
2/
|
I
I 28
__ Bangalore Multipurpose Social
’ Service Society
. | Archbishop House
; 4626, Basweshwara road
; Bangalore - 560 046
; Bangalore Children’s Hospital
Dr, Nandini
5th Stage Rajarajeswari Nagar
Munkur
Bangalore - 560 039
29
Karnataka State Council
I Child Welfare ! 3rd Cross Nandidurg road
i Jayamahai
S430552
for
3330846
i Si. Lukes Ragpickeres Welfare i
Programme
Pampa mahiikavi road
Chamrajpet
Bangalroe - 560 018
; 604065
’ Bangalore - 560 046
I 30
!
31
32
; 33
35
r^=h
38
! Convener
i Disability Net Work
' C/o ADD India
: 1 ^Cross
Banashankari II stage
Bangalore 560070
Griha Karmika Okkoota
2,Millers road
Bangalore - 560 046
MnRamachandran
33304338/3330838
^anyog
' Urban Resource Centre
S/b^ Block
! Ranka park apartment
: Lalbagh road
Bangalore - 560 027
Bharat Cyan Vignana Samithi
Dr.Prakashrao
C/o Electro Chemical Society of Mr.Basvaraju
India.
Indian institute of science campus
Bangalore - 560 012
Banashankari
Consuinei
Protection Society
I 9th Mam 27th Cross
' Banashankari II stage
| BANGALORE I
Tntnrn'itinn'j!
1
’ Society
for
Development
Bangalore Chapter
Railway pareUe! road
Nehru Nagar
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Anjanappa complex
I Hennur road
I St. Thomas town Post
’ Bangalore 560 084
Action on Disability Development Mr.Kamachandran
- India
19Li Cross
Banashankari II stage
Bangalore - 560070
V-zVlMOCHANA_____________
i C/o Angela
1st A cross 16th B main
HAL II stage
Banaglore - 560 008
Society for Deveiopmenei
Women and Children
271. Rama leela
W Puram
Bangalore 560 0043
P&P Group
13th Cross road
Wilson Garden______________
* Bangalore - 560 027
5464151
< 5269307/5278628
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44
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i 165, First Floor 9th Cross, I stage
I Lndranagar
Bangalore - 560 038
45
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Ashi^Sen
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146
; Ecumenical Christian Centre
I P.O.Box. 11
i Whitefield
Bangalore 560 066
47
Churches'7 council for child and
youth care in south India
Lavelle road____________________
■ Bangalore
48
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Pottery road
Bangalore - 560 005
GBR Forum________
! 11U1 main BTM layout
■ Stage 1
Bangalore - 560 029
I
' 56
I 5599092
Intervention India Pvt Lid
2, Haudin house
Ulsoor
Bangalore - 560 042
“j^eena Seva Sangha
I School health Programme
1 Sevaashram ( Gandhi School)
AAnin
' I 54
i 5577375
I
3358562/3363661
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; Bangalore - 560 021
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Disability Division
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3? Rest House Road,
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; ivliller road
I Post Box 4600
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’ 104 ( 1537) Cambridge road cross I
| Ulsoor
; Bangalore - 560 008
Institute of Social studies Trust
Shreeshyla
42. 4th Temple street, 15th Cross
Malleswaram .
Bangalore - 560 003
574;5.00*70
3323850/3312861
' 60
61.
Cathoik Health Association ol
India - Karnataka.
. C/o. St. John's Medical College &
: Hospital, Sarjapur R.oad,
Bangalore - 560 034.
Voluntary Health Association of
Karnataka,
No. 60. Rajini Nilaya,
IT Cross, Guruniurthy Street,
Ramakrishna Mutt road,
Bangalore - 560 008._________
-^family Planning Association of
i India, Bangalore Branch,
I 26. Sri Nivasa,
' D. N. Ramaiah Layout, P G Halli,
i Bangalore - 560 020.
i Phone No : 3360205
62
National Alliance for People’s
Movement - Karnataka,
No. 24, michaiel Palya,
New Thippasandra Post.
Bangalore - 569 975.
63
hyam Communications
' 10th Cross, 10th main
; VasanthNagar
j Bangalore - 560 00
64.
rprakruti
■ 79.kanyanapalya
Lingrajapuram
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2281983
5469550
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5454653
354. 10“ main 100 feet road
Dodda Banaswadi
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i Bangalore — 560 Ojj
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Dr. Shobha Yohan._______________
Mr. Peter Vijay Kumar._______
I Executive Officer.
' Christian Medical Association of India.
j South Area Office,
i FEVORD K,
I 21, Cunnigham P^oad,
I 44,11 Floor,
; New Bamboo Bazar Road,
i III Floor. HVS Court,
Bangalore - 560 052.
’ Cantonment,
Bangalore - 560 051.
Phone No.: 2205464 /2205437
I Phone No.: 536 1503
Dr. Ravathi Narayanan / Ms. Amrutha.
! Ms. Vasa nt ha.
Mahila Samakhya Karnataka.
Liaison & Documentation Officer.
No. 68, HAL 11 Stage,
New bnurv tor Social Action.
II Main, I Cross,
93/2, Charles Cambell Road,
Jeevan Bhima Nagara,
PB No. 541.
Bangalore - 560 038.
Cox Town,
Bangalore - 560 005
Phone No.: 5277471 / 5262988
Phone No.: 5485431 / 5483642
i Dr. Achar,
I Society tor Services tor Voluntary
’ Services.
i No. 338-A, III Block,
' Rajajinagar,
i Bangalore - 560 010.
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Anarna
I Main, 4th Cross,
1 Yasavanthopur,
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I Phone No.: 3350970
Ms. Mandira Kumar.
I Sutradaar.
599, 17* A Cross,
7* Main,
Indira Nagar II Stage,
Bangalore - 560 038.
Phone No.: 5288545
Dr. Rati Narayan / Mr. Prahlad A,
Community Health Celt
367. Jakksandra,
I Main, I Block._________________
; Koramangala,
Bangalore - 560 034.
i Phone No.: 553 15 18 / 5525372
' Powers
! No. 3/20
1 Navashakthi complex
I Cambridge road
Opp to Ulsoor. Police station.
Bangalore- 560 008
Dr. Maya Thomas
J-124. 16"1 Main.
. IV BleekTJayanag
I luudcnu.. ju/7viu
Ms. Ruth Manorama.
! National Alliance of Women’s
Organization,
C/o Women’s Voice.
47/1, St. Mark’s Road,
Bangalore - 560 001
Phone No.: 6630262
Dr. Balasubramaniayam,
Vivekananda Foundation.
54, Vidya Paramahamsa Road,
Yadavagiri._________________________
Mysore - 570 020.
i
Phone No.: 6340558 (Dr. T. P^aghunatha
Rao)
Phone: 530 3354/ 5369550
Mr. T.Yoheshwaran
V. Hariharan.
9 ‘ Bangalore - 560 062.
Mr. Vishnu Kamath
CANE
809, 17 E Main,
5^ Block. Rajaji Nagar,
Bangalore.
CIERS
2124, K^RMain,
IA Cross
Bangalore - 560 007.
Dr. M.K. Sudharsban
Kempegovvda Institute of
Fl 4 zir? < o l KJ
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Bangalore-560 004.
Dre Goninath
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M.S. R.aniiah Medical College,
Gokula Extn. Mathikere.
Bangalore - 560 054.
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Community Health Department
Ambedkar Medical College,
K adukon dan ah al 1 i.
Bangalore - 560 044.
Mr. Niranjanaradhya.
Honorary Secretary,
Karnataka Rajya Vijnan Parishath.
Indian Institute of Sciences Campus,
Bangalore - 560 012.
PaaOuc Ng.
Dr. Kavathi Narayanan / xVls. Amrutha,
Mahila Samakliya Karnataka,
No, 68. HAL IT Stave.________________
1 JI Main, I Cross,
Jeevan Rliirna Nagara,
Bangalore - 560 038.
xMr. Peter Vijay Kumar,
Executive Officer,
FEVORD-K,
44, II Floor,
New Bamboo Bazar Road,
Cantonment.
Bangalore - 560 051.
Phone No.: 536 1503
Ms. Vasantha,
Liaison & Documentation Officer,
New Entity for Social Action,
' 93/2, Charles Cambell Road,
P B No. 541,
Cox Town,
Bangalore - 560 005
! Phone No.: 5277471 / 5262988
Phone No.: 5485431 / 5483642
i
i
i
§ I
COMMUNITY HEALTH CELL-CHC
Phone : 0091-80-5531518/5525372
Fox
: 0091-80-5525372
email : sochara@vsnl.com
Website:
http://www/geocities.com/sochara2000
ni
http://www/sochara.<
n|
http://www/sochara.com
No. 367, Srinivasa Nilaya, Jakkasandra I Main, I Block, Koramahgald, Bangalore - 560 034.
Dear friends
I
Greeting from Janaarogya Andolana!
Subject: Peoples Health Day (World Health Day)
44 Health For All by 2000 AD”
Urban poor. Where are we and
How can we move forward?
I
Health for all by 2000 AD is a familiar slogan to many people who are involved with
health care services with the people. It is 25 years since the Declaration was made, in
which all member countries of the World Health Organization signed and made a
commitment to work towards achieving Health for All citizens using the Primary
Health Care approach. Another World Health Day has come with the theme “ Healthy
Environment For Children” the focus on comprehensive is missing.
It would appropriate, if we who are concerned about the Health and Development of
the urban poor meet and plan how we can go forward in the coming year April 2003
to March 2004. There will be a presentations on the experiences of the health service
providers for the urban poor and from the Bangalore Mahanagara Palike. Dr. Mala
Ramachandran Director, Urban Health Research and Training Institute will
make the presentation.
We hope the deliberations would help us draw up an action plan, which would help
address health problems of the urban poor with the Primary Health Care approach. If
you are interested, please join us at:
Ashirvad
No. 30, St. Marks Road Cross-,
Bangalore- 560 001
Phone: 2210154
On Monday the 7lh April,
From 10. am- 1.00 p m
Yours sincerely
S. J. Chand er
For Janaarogya Andolana s
Society for Community Health Awareness, Research and Action - SOCHARA
Registered under the Karnataka Societies Registration Act 17 of 1960, S. No. 44/91-92
Registered Office : No. 326, Sth Main, 1st Block, Koramangala, Bangalore - 560 034.
Seminar on
HEALTH FOR ALL BY 2000 AD!
URBAN POOR WHERE ARE WE? HOW CAN WE MOVE FORWARD?
Date: 7th April 3, 2003
Time: 10.00 am to 1.00 p.m.
Venue: Ashirwad, No.30, St. Marks road cross
Bangalore - 560 001
Objective: A the end of the programme the participants will be able to:
1. Understand Health care facilitates available for the urban poor in Bangalore
2. Identify areas of concern.
3. Evolve a collaborative action plan to address the areas of concern
PROGRAMME
Time: 10 .00 a.m- 1.00 p.m.
Chairperson: Dr. Paresh Kumar, Community Health Cell!
10.00 a.m to 10.10
a.m________
10.10 a.m. 11.10. a.m.
Introduction:
S.J. Chander of Community Health Cell
Presentation:
Health care services for the urban poor
by Dr. Mala Ramachandran, Directror,
Urban Health Reserch and Training
Centre, Bangalore Mahanagara Palike
Tea Break-11.10-11.30___
Advocating for the urban poorrMrs. Ruth. 11.30 am-11.45
Manoramma, Women’s Voice
Bangalore.____________________ ^11.45 p.m. -1.00
Identification of areas of concern and /
action plan.
/ p.m.
Facilitator: Mr.Ramesh Ramanathap,
Jangraha______________
1.00 p.m
Mr. Madhusudhan of KKNSS
Lessons learnt.
Discussion:
Vote of thanks
® PUBLIC AFFAIRS CENTRE
422, 80 Feet Road, VI Block, Koramangala,
Bangalore - 560 095, India.
Tel/Fax:(080) 5537260/3467, 5520246/5452/53
E-mail: pacindia@vsnl.com
07 March 2003
Dear friends,
SUB: KRIA FIELD ASSESSMENT -2nd REVIEW
We thank you for your continued interest and participation in our efforts to effectively
secure the Right to Information in Karnataka. We hope you have been able to
resubmit your applications to the Competent Authorities at BMP, as decided at our
last meeting on 30th January 2003.
We would like to inform you that a team from PAC and CHRI, Delhi had a meeting
with Ms. Vatsala Watsa, Secretary to Government, Department of Personnel and
Administrative Reforms to update her on the status of field assessment. She was
very supportive of our initiative and has expressed keen interest in the findings of the
assessment, while also assuring prompt action on the recommendations that will be
formulated based on the assessment.
In view of this, there is an urgent need to complete the field assessment, analyze the
findings and formulate recommendations at the macro level. This would help
streamline the implementation of the provisions of KRIA. Furthermore, to stimulate
greater transparency in the functioning of BMP, we must ensure that a large number
of KRIA applications are submitted to BMP. However, in order to formulate
meaningful and scientific conclusions from the assessment, we may have to file
additional applications covering a wider range of public authorities.
In order to review the status of pending applications and to finalise our strategies /
action plan for the final round of KRIA applications, we invite you to participate in the
" KRIA Volunteers Meet" being organised on 13th March, 2003 at PAC
Office between 10.30 a.m. and 1.00 p.m. Please bring copies of all the
applications you have filed thus far as well as the completed field observation
schedule.
We are looking forward to your Continued Support and Participation
Warm regards
Sincerely Yours
/
Manjunath Sadashiva
Chief Programme Officer
A
Encl: Where did our money go?
A short compilation of Parivarthan's struggle against corruption using the Delhi Right
to Information Act
9/^
Where did our money go?
Funds meant for development do not reach their destination and are siphoned off in
between. Rajiv Gandhi, former Prime Minister, once said that only 15% of the funds
reach the beneficiaries.
A social audit was conducted by Parivartan, a citizen’s initiative, along with the local
residents of two resettlement colonies of North East Delhi, namely Sundernagri and
New Seemapuri for development works undertaken by the Engineering Department of
the Municipal Corporation of Delhi (MOD) in these two resettlement colonies between
April 1, 2000 and March 31, 2002. Only works pertaining to construction of roads, lanes
and drains and installation of handpumps were taken up for this social audit - a total of
68 contracts worth about Rs 1.42 crores.
On 14th December, a public hearing (jan sunwai) was organized in Sundernagri by
Parivartan along with the National Campaign for People’s Right to Information (NCPRI)
and Mazdoor Kissan Shakti Sangathan (MKSS) of Rajasthan to discuss publicly the
works audited. The public hearing was attended by almost 1000 people including local
residents of the area, journalists and eminent personalities such as Justice P B Sawant,
Aruna Roy, Prabhash Joshi, Viond Mehta, Bharat Dogra, Shekhar Singh, Arundhati Roy
and Harsh Mander. In the public hearing, the contracts were read out and local
residents testified as to whether or not the work was undertaken, and if it was
undertaken whether it was done fully or was left incomplete.
Out of the 68 works audited and discussed in the public hearing, calculations of
estimated misappropriation of funds have been done for 64 works worth Rs 1.3 crore. In
these 64 works, the total amount of embezzlement found on account of missing
items/works is approximately Rs 70 lakhs (i.e. items or works worth about 70 lakhs do
not physically exist at all in these 64 works). This figure does not include the amount
embezzled on account of quality issues like the quantity of cement used etc.
Some examples of missing items are as follows:
•
•
•
29 handpumps with electric motors were supposed to be installed under 10
contracts. However, residents of this area reported that only 14 handpumps had
actually been put. The rest of the handpumps were not installed at all, according to
the residents. Electric motors have not been installed in even a single case. Loss on
account of missing handpumps and missing motors is roughly estimated at Rs
7,85,965.
Whenever a new street is made, new iron gratings are also put on the drains going
across the street. Out of a total of 253 iron gratings weighing 27,557 kg, for which
payments have been made, only 30 iron gratings weighing 3,136 Kgs were actually
put, according to the residents. The loss on account of this is roughly estimated at
Rs 7,30,952.
Whenever a new street is made, the drains on both sides of the street are also
supposed to be demolished and remade afresh. However, this is rarely done. Either
•
•
•
•
•
no work is done on the drains or at best, the level of the existing drains is raised by
just one brick. Out of a total of 35 cases examined, payment has been made by
MCD for construction of fresh drains in all these cases, however fresh drains were
not made even in a single case. In 19 cases, the level was raised by one brick while
in the rest of the cases, no work was done at all on the drains. Loss on account of
this has been roughly estimated at Rs 13,85,175
The thickness of cement concrete layer in the streets should be 10 cm, according to
the bills. However, the thickness, in most of the cases was found to be 5 cm, as
found after digging. This is the most expensive item in such contracts. Loss on this
account has been roughly estimated at Rs 8,33,935
There are some roads and streets, which exist only on paper. The residents of these
areas informed that these streets/roads have not been made at all. In some cases,
measurements have been shown in excess of the actual work done. Loss on
account of missing roads and streets is roughly estimated at Rs 12,92,398.
In two instances, it was discovered that payments have been made twice for the
same work i.e. the work was done once but the bills were raised twice for the same
work.
Two layers of stone aggregate are supposed to be put before bitumen mix is laid in
the construction of premix roads. However, out of 8 cases of road construction, in 6
cases only one layer of stone aggregate was put and in the other two cases, not
even a single layer was put.
A layer of red bajri is supposed to be put in the construction of roads. This has never
been done in any of the roads.
It would require elaborate tests to make comments on quality issues. Such tests are
quite expensive. Two such tests were done for two works at Shriram Institute -one for a
cement concrete lane and the other for a bitumen premix road. The cement content was
found to be one fourth of the contracted amount (it was in the ratio of 1:5:15 against the
prescribed ratio of 1:2:4, where one part is of cement, two parts are for coarse sand and
4 parts are for stone aggregate). The bitumen content was found to be 20% less than
the contracted quantity. The results of these tests are eye-openers and a sufficient
reason for the government to order tests for the rest of the works.
During jan sunwai, the supporters of local political leaders including the MLA tried to
disrupt the proceedings at least thrice. But the public support to the jan sunwai process
was so overwhelming that their efforts did not succeed.
Effects of Jan sunwai:
This social audit was done for works carried out by just one department of the MCD
over only a two-year period in a geographical area, which is smaller than one ward.
Delhi has 134 wards. The embezzelment of Rs 67 lakhs, thrown up by the social audit
and the public hearing, is therefore a very small fraction of the total amount of funds
misappropriated in the name of ‘development’ in Delhi.
>
The jan sunwai at Sundernagari has demonstrated the proportion of embezzlement and
the urgency with which, the issue needs to be tackled. It clearly demonstrates that most
of the time, it is not the inadequacy of funds but leakages, which are responsible for
poor development.
The jan sunwai has had tremendous impact on the psyche and morale of the people of
Sundernagari and Seemapuri. The people are now aware of the amount of money that
was supposed to be used, the works that were supposed to have been executed and
what exists in reality. The community, for the first time witnessed, that it is possible to
hold the government accountable in full public glare in this manner.
Mohalla Samitis (Local Area Committees) are now being formed in Sundernagari for
each block. These would contain representatives from each street in that block. These
Samitis would then monitor the execution of any civil work in their block by obtaining
relevant documents from MOD. It was also seen during the process of social audit that a
number of such works had been executed, which had no utility for the community. The
Samitis, would therefore, also decide the requirements of their blocks and communicate
it to the government at regular intervals, so that the funds could be used for works
useful for the community. It is important that public actively participates in deciding
which works should be carried out in their area and they also monitor the execution of
these works. It will go a long way in ensuring proper utilization of funds.
The jan sunwai has also had great impact on the local bureaucracy. After the jan
sunwai, the officials have realized that the records could be scrutinized by the public
any time and it would not be easy for them to swindle funds any more. The officials are
also quite scared of the consequences that would follow this jan sunwai once the
detailed report of social audit is presented to the government. The officials are far more
responsive and courteous in their dealings with the public of this area now.
It is strongly felt that if people start holding the government accountable in their local
areas by holding such jan sunwais on a large scale, it would mean the beginning of an
effective anti-corruption civil society movement. Parivartan’s immediate efforts would be
directed towards spreading it to every nook and corner of Delhi.
Parivartan, E-109, Pandav Nagar, Delhi-92. Ph: 91-11-22063389, 22064281. E-mail:
parivartan@parivartan. com
Health For All by 2000 AD
Urban Poor where are we, how can we move forward?
World Health Day- (Peoples Health Day) 2003
Ashirwad. 30. St Marks road Cross, Bangalore- 560 001
Introduction
World Health Organization defines health as a state of complete physical, mental and social
well-being and not merely absence of disease or infirmity. The influencing factors for
achieving this lie within and outside in society where the individual lives. The determinants
of health can be classified under the following areas: biological, behavioral and socio
cultural, environmental and social and economic conditions.
WHO having recognized that the health services expected by the people was not being
provided, in 1997 during the World Health Assembly, it called for a social target by the all
the 134 member countries then to work towards helping the citizens attain a level of health
that will permit them to lead a socially and economically productive life.
Further failures faced made WHO-UNCEF in the conference held in Alma Ata, Russia in
1978, call for a revolutionary approach to health care. The conferences called the
governments to accept the goal w Health for All (HFA) by 2000 AD” and adopt primary
health care as an approach to achieve it. Health for All meaning health is to be brought with
the reach of any one in a given community. After the declaration, the Indian government
came out with plans to achieve Health for All through the 1983 National Health Policy.
This approach though initially experienced some gains, gradually moved from
comprehensive health care to more a selective primary health care approach. Pulse polio
programme can be given as an example. National Health Policy 2002 draft is out and it is
evident in it the shift. Process of globalization and influences of various lobbies are some of
the factors that have had negative effect on people health. Of late the trend is moving more
towards privatization. The services available for the urban poor over these years have been
family welfare and family planning focused.
This year is the silver jubilee of the Alma Ata declaration, it appears that WHO and the
government have forgotten the goal HFA. Janswasthya Abhiyan (JSA) in India Known as
People’s Health movement internationally believe that it is the comprehensive health care
that is going to help people attain the level that was envisaged by WHO during the
declaration.
JSA was launched in the year 2000 in Dhaka, Bangladesh where delegates from 90 countries
gathered for the International Peoples Health Assembly. This movement in Karnataka it is
known as Janaarogya Andolana. It is the desire of JAA to bring together health care service
providers, policy makers, voluntary agencies and people for working towards achieving
“Health for All now”
Primary Health Care
Primary health care is defined as essential health care based on practical scientifically sound
and socially acceptable methods and technology made universally accessible to individuals
and families in the community through their full participation and at a cost that the
community and country can afford to maintain at every stage of their development in the
spirit of self-determination.
Components of primary health care
(Declaration of Alma Ata (7) USSR, 1978
Following are the components identified at the Alma Ata conference:
1. Education about prevailing health problems and methods of preventing and controlling them.
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic sanitation.
4. Maternal and child health care including family planning
5. Immunization against infectious diseases
6. Prevention and control of endemic diseases
7. Appropriate treatment for common diseases and injuries
8. Provision of essential drugs.
Health care facilities and process of urbanization
It is presumed that urban poor do not lack health care facilities, as most of the health care
facilities are concentrated in the urban areas. This may be true but how much of the facilities
are really accessible, available and affordable to urban poor is the question for which one
must find an answer.
The process of urbanization in Bangalore further added pressure on the limited resources
available to them. The existing facilities; 38 maternity homes, 6 referral hospital, 55 health
centers and 19 family welfare clinics are barely sufficient for the 12 percent of the five
million residents of Bangalore city. The recent Hindu daily report on 4th January 2003 said
the bulk of the budget goes for solid waste management and salaries of the staff at the
dispensaries and hospitals. The report also said that essential drugs are not available for poor
free of cost and the poor cannot afford to purchase them from private chemist shops. These
services may be geographically accessible but doest it cater to all people living in the slums is
another question that needs a satisfactory answer. Regarding availability, it is the private
practitioners who are available at time of need particularly after they come back from work.
Living condition
The living conditions where the urban poor are living in most places are far below the
standard for human habitation, lacking potable drinking water, facility for disposal of solid
and liquid waste and housing. The Hindu reported quoted above confirms this. The needs
expressed by the slums dwellers according to the report are: safe drinking water, toilet,
underground drainage, trauma care, education and prevention of alcoholism and
empowerment of women to resist alcoholism. The report also emphasized the need for
creating better job opportunities and motivation of better living conditions. How can there be
motivation for better living conditions when their place of habitation is (unauthorized) and
people face the threat of evacuation any time. In the light of the problems faced by the urban
poor where is the resource for better living condition? It is nice to suggest that they need
preventive health care and income to purchase nutritious food. How can one talk about
?
preventive health care in the absence of basic amenities like housing, water and
'
Alcoholism
Alcoholism is another major problem that puts pressure on the limited income of the urban
poor. The survival of the alcohol industry to a large extent depends on the poor. The major
portion of the income that the man earns goes in for alcohol, depriving the families the
money for nutritious food and educational needs. One of the serious consequences of
alcoholisms is violence, particularly against women. Do we need more studies to confirm to
get into action? When would there be a relief for the urban poor form this menace? Who
would act for them? How long the government is going to continue with the excuse that
prohibition would lead to consumption of spurious liquor. As the struggle continues one
wonder is there a way out at all.
Increasing infrastructure development for providing curative care will not provide a long
term solution for the problem of the urban poor. There is need an immediate attention from
the government to address the land issue by notifying the slums. This will help a few
government bodies would come forward to provide the basic amenities thereby paving the
way for promoting preventive and promotive health care. The problem of alcohol has to be
addressed as the next priority. As action for demand reduction continues the government
should bring prohibitory orders. Certainly there is a need for collaborative efforts by
Government, voluntary organization and people for improving and strengthening the existing
services and to identify areas needing intervention through advocacy and address them.
The present health care facilities available for urban poor which is family welfare and family
planning focused should move towards a comprehensive primary health care, enabling people
to take care of their own health not merely providing some services. It is hoped that this
dialogue would help focus th^cliscussion achieving this.
Prepared by:
S.J.Chander
Community Health Cell, Bangalore
PROOF
Public Record of
Operations & Finance
PERFORMANCE INDICATORS FOR HEALTH
INPUT
OUTPUT
•
Minimum Infrastructure
Standard
General Ward
Labor Ward
Operation Theatre (OT)
Minor Operation Theatre
Toilets
Condition of toilet
Bathrooms:
- Availability of hot water
— Availability of sewage
system.
Laboratory
Waiting Area
Patient Attendant Space
Outpatient Area
Availability of drinking water
Linen Service
Generator set
Store Room
Ambulance Service
Quarters for Doctors and
Drivers
Telephone Service
Privacy of examination area
Fumigation
• Number of
deliveries
Normal Caesarean and
Assisted
•
Minimum Equipment
Standard.
Availability of required
Equipment in all rooms.
•
Drugs
Availability of minimum
essential drugs.
Availability of emergency
drugs.
• Number of family
welfare procedures.
• Number of high risk
pregnancies detected
during labor / antenatal
care
• Number of
immunizations against
measles.
• Number of
admissions.
• Number of
admission slips.
• Number of patients
registered for postnatal
care.
• Number of patients
registered for antenatal
care.
• Number of
Medically Terminated
Pregnancies (MTP).
OUTCOME
• Number of maternal
deaths.
• Number of neo natal
deaths.
• Number of stillbirths.
• Number of infant deaths.
• Number of perinatal
deaths.
• Number of measles cases.
• Number of deaths due to
measles
• Number of admission to
number of admission slips.
EFFICIENCY
• Downtime of key
equipment.
Autoclave.
Laproscope.
Refrigerator.
Generator.
Ambulance
BP Apparatus
Instrument Sterilisers
Weighing Machine - Adult and
Infant
Incubators
Boyle’s Apparatus
Pulse Oxinator
Hysteroscopes
• Time taken to fill up
vacancies to sanctioned
strength.
• Nurse patient ratio.
• Complaint redressal
system.
• Doctor patient ratio.
• Patient feedback forms.
• Full time employees per
occupied bed.
• Percentage of patients
coming in for 3 postnatal
check ups.
•
• Number of patients
registered for antenatal care
prior to 12 weeks.
• Number of days with
stock outs of essential drugs.
Waiting time for patient.
• Cost of drugs per patient
(inpatient / outpatient).
• Cost per inpatient day.
• Cost per outpatient day.
PRODUCTIVITY
EXPLANATORY
• Staffing patterns.
• Number of patients below
the poverty line.
• Inventory / Store
management maintenance
mechanism.
Furniture.
•
Stationery for
correspondences.
• Staff (Sanctions, Vacancies
and Absentees)
Doctors
Staff Nurses
Auxiliary Nurse Midwives
(ANM)
Lab Technicians
Peons
Ayahs
Sweepers
Drivers
Dhobhi’s (Contracted)
• Capacity Building
Type of training programme.
Periodicity of training.
Number of people trained.
• Financial
Salaries budget
Maintenance budget Equipment
Maintenance budget -Building
Drugs budget.
Equipment budget.
Training Budget.
Fuel and vehicle maintenance
budget
User fees
Laundry budget
Contractual Services budget
Miscellaneous expenditure
budget
• Number of
complaints.
• Display board of
available drugs.
•
• Number of
outpatients per day.
• Amount of user fees
collected.
• Percentage of high risk
cases among deliveries
• Number of referrals.
• Bed occupancy rate.
• Number of
prescription slips
issued
• Number of deaths due to
sterlisation
• Number of complaints
received to number of
complaints redressed
• Number of visits by
the health officer/
supervisor
• Use of equipments
Utilisation of user fees.
Status of Health in the Slums of Bangalore City
By
Madhu Sudhan
Training Research and Documentation Unit
Karnataka Kolageri Nivasigala Samyukta Sangatane(KKNSS)
Bangalore
Introduction
Health is a complete state of Physical, mental and social well being and not
merely the absence of disease of infirmity1. Access to health care was one of the
indicator of measuring reduction in poverty of underprivileged masses in the
rural and urban poor areas of the country. One of the important components of
health care system of consists of : primary, secondary and tertiary care
institutions, manned by medical and para-medical personnel. The Primary Health
Care Infrastructure provides the first level of contact between the population and
health care providers. Realising its importance in the delivery of health care
services, the state and central government has started primary health centres2.
About 30% of the India's population live in the urban areas. The health care
system is much better compared to the rural areas. However , the urban
migration has resulted in growth of slums. The slum population face greater
health hazards due to over crowding, lack of sanitation, no proper access to
drinking water and environmental pollution. Realising that the health
infrastructure is insufficient due to the growth of urban population, the local
government, state government and central government has built up urban health
care facilities. But, there has no effort to provide well planned and organised,
primary secondary teritary care services. Dispensaries, Primary Health Centres^
Government Hospitals and Referral hospitals are the four tiers of the health care
system in the urban areas in the country.
Urban Poor in Bangalore city
In Bangalore city, there are about 472 slums3 in the Bangalore city. Of which
202 are declared under section 3F of the Karnataka Slum Areas Act 1973. The
slum population in the declared slums will provided with basic amenities only the
slum is declared. Therefore the number of undeclared slums in bangalore city is
270 on the lands owned by government agencies, private owners, railways
.defence lands etc., A more realistic figure came from the National Sample
' . Definition by World Health Organisation
.Tenth Five Year Plan Document on Health, Planning Commission of India, 2003
3
. Commissioner, Karnataka Slum Clearance Board, March 2003
2
i
Survey, 49th Round, in 1993. Here, the slum population was estimated at 32.2
lakhs, making it around 23 per cent of the total urban population in the State.
This study estimated the population of Bangalore's slums at 10 lakhs4.
I. Health Status of Urban poor in Bangalore city
1. Malnutrition
About 70% of the children in the slums of Bangalore city suffer from
malnutrition5. A significant reason for this is poverty many people cannot
afford regular nutritious meals in the slums. In times of economic stress, this
becomes frank malnutrition; the body under such condition is unable to resist
disease and succumbs to it
Children in the slums suffer undernutrition : 1.Marasmus, which is wasting;
frequent cause is underfeeding, diarrhea and infection;2.Kwashiorkor, marked
by swelling of the body. Swelling is due to a fall in circula-ng proteins.
Stunting (poor height gain) in the slum is the commonest type
nalnutrition
in childhood. Seme children may be underweight. Both he
and weight
suffer due to malnutrition.
Anganwadi(ICDS)
Anganwadi is a community health programme for improving nutrition, health
and pre-school education of children. At present, it covers the slums and
other backward areas in Bangalore city. The target group is children under 6
years.
The target group is divided into two sub-groups, one below 36 months and
the other above 36 to 72 months. The younger group stays at home with the
mothers. So this programme is ineffective for the younger babies without
home visits. The other group - above 3 years - is accessible in the
Anganawadi ( which is a balwadi and feeding centre). Anganwadis are held
in the morning The primary health centre is expected to undertake
immunisation and health checkups in the ICDS programme. The anganwadi
worker, who is usually a slum woman with some formal education, conducts
teaching activities too. The helper woman does ' ; cooking and feeds the
children's. The functioning of the Ancanawadis need to be reviewed jointly
by the Government and NGOs and its co-ordination with Primary Health
Centres. The low rate of immunization (except pulse polio) and malnutrition
4 Karnataka Housing Revolution, Parvathi Menon in Frontline Magazine. Vol 19, Issue 13 June - Julv
5,2003
5 Dr. Mala Ramachandran, Health Officer Bangalore Mahanagara Palika(BMP), World Health Day(April 7,
2003) at Ashirwad, Bangalore
2
in the age group of younger children in the slums reflects the effectiveness of
Anganawadi network in the urban poor areas
2. Environmental Sanitation
z
Due to scarcity of pure and wholesome water supply, where water is not
easily accessible, provision for waste disposal facility and sanitary latrine are
in adeuqate. Poor housing conditions, poor personal hygiene, personal
habits are causes morbidties in these areas. The inaccessibility to potable
water is caused the high rise in the epidemics. The following are the two
major causes for the inaccessiblity to water supply system.
(i). Unable to access due to high cost of water connection and service
In order to access the BWSSB water connection to the individual household, a
deposit of Rs. 800 is fixed with an water meter attached for monitor the water
consumption. The one-time connection charges prove to be an obstacle for many
households, both in slums and other areas, in accessing formal connections.
BWSSB has decided that certain elements of the connection charge, such as the
number of sanitation points charged for(five), can be re-considered and reduced
(to two) in view of the small size of houses in slums and low-income areas and
the limited number of sanitary fixtures. This element alone can reduce the
connection charge by Rs. 360.
The major issue with the slum dwellers is the tariff fixed by the BWSSB. The
existing rate of 1 kilolitre of water is Rs. 6 for domestic consumption under
consumption slab of 0-15,000 litres and Rs. 8 per litre for the domestic
consumption slabs between 15001 to 25,000 slabs. The BWSSB argument for
the recent hike in water charges is to cope with the increasing operational costs.
The slum dwellers have been demanding for fixation of subsidised rate for
slums and much reduction from Rs. 6 for domestic consumption slab of 0-15,000
litres.
On 27-12-2002, About 5000 slum dwellers staged protest rally in
Bangalore city under the leadership of KKNSS, Women's Voice and AVAS for
subsidised rate for water which was one of their demands. Now, BWSSB has
started to experiment for providing subsidised rate for water supply to the slum
dwellers.
On March 4 th 2003, BWSSB has started the process of providing subsidized
water supply for the slum dwellers in Lingarajapuram Each household will be
provided with one water tap, and for a family of five is expected to consume less
than 7200 litres of water per month. . The new initiative will cover 1000 families
by extending 50 percent concession on connection charges and service charges.
The rates for connection charges are Rs. 800 per household and monthly
payment of Rs. 115 for consumption of water.
3
i'.r.'.
But the majority of the slums in bangalore city are reluctant to accept the BWSSB
package due to high cost of the connection and the monthly charge of Rs. 115,
The slumdwellers expect the BWSSB to reduce the deposit and monthly
charges by half and also a guarantee that the BWSSB's customers in the slums
are exempted from future hike in water charges.
(ii). Absence/low capacity of network in the area
The newly, formed^wards of Bangalore city (from.ward-no-63’ tO-100) are out of
the BWSSB network. It is estimated that 30% of the slums in the Bangalore city
could not avail water supply connection due to absence of BWSSB network in
the area. In these slums, the water crisis exist even though water supply is
provided through by public taps with mini tank storage systems. Despite this
there is acute water crisis in this area.
Chart - Slums of the wards where BWSSB network does not exist and partially
exist
Partial
Absence of
Slums
Ward Ward
Infrastructure
Infrastructure
Name
No.
exist
1
HMT_____________
Nandini Layout
Geleyara Balaga
Layout___________
Kamalanagara____
Vrishabhavatinagar
Kamakshipalya____
Basaveshwarnagar
12
5
37
38
Marenahalli
Amarjyothinagar
Mudalapalya
3
2
39
Chandralayout
10
41
Gallianjaneya temple
3
52
Hanumanthanagara
3
53
54
55
Srinagara________
Srinivasnagara
Padmanabhanagar
13
8
12
13
16
17
18
19
35
3
9
3
3
3
1
4
5_6
57
65
Ganesh Madira
JP Nagar_____
BTM Layout
13
5
10
67
68
Kormanagala
Ejipura
5^
7
69
Neelasandra
7
72
73
Domlur
Airport
10
15
74
83
84
JB Nagar________
CV Raman Nagara
Beniganahalli
1
8
85
87
Sarvagnanagar
Lingarajapuram
13
6
88
89
Banaswadi_____
Kacharakanahalli
2
3
90
93
94
_95
96
Sagayapuram
DJ Halli_________
Kadugondanahalli
KB sandra______
Hebbal
4
99
100
Aramanenagara
Sanjaynagar
4
Total
299
7
✓
3
4
4
6
12
243
56
Source: - BWSSB: ward wise list of its existance of partial or absence of water
supply Infrastructure.
BASCIS - list of slums.
Health experts agree that if safe drinking water supply is provided to the slum
dwellers^ a substantial improveci in the health status of the urban poor can be
Approved. Therefore, BWSSB package of water supply to the slum dwellers
should be made available at affordable rates so that the spread of water
borne diseases can be eradicated.
5
3. Storm drains
Bangalore3X^trict 'Vhe
d^inslZ"oTr a length184
Ta
substantial number of slums are situated on the fringes of storm drains. The
conditions of these storm drains is an important factor in the day today lives of
the slum dwellers
There are slums where the public water taps which are
placed 7n the storm drains. For instance, in the case of 1SRO slum. ,rrear^toe
Cambridge layout, the slum dwellers collect drinking water, take bath which is at
the silted9 area in the bottom of the storm water drains. Majority of slums which
do not have access to UGD or sanitary lines within the slum, the drainage water
flows directly into the storm drain.
(i). Health hazard
In Prakash nagar slum of Ward No. 23, Storm water drains, spanning the ward
for about 3 9 kms are full of filth, garbage and cow dung. The residents o
Mariappanapalya slum adjancent Storm water drains suffer-from dl^^due °
unhealthv environment. The storm drains runs near the Hanshcnanar
crematorium, collects waste after funerals are conducted where they stagnate
and rot.
In Ward No 26 (Sevashrama Ward) the children of Okalipurani slum, are down
with fever due to clogged drain. Garbage adds to the clogged dram, f|ie^nd
mosquitoes The air is heavy with stench that breeds disease. Beside, the storm
water drain in the area is surrounded by so much of garbage there is no place for
drain water to flow.
in ^paAgra°hara ^arys^unhyag^enic^condiFonsehOanve’broughTneseaverardirseasesOand
sxisxs - s
garbage bin. Many garbage bins are broken or overflowing.
(ii). Flooding of houses during rains
Durina rains the dilapidated storm drains with stench and garbage spell misery
to Sum awellel In Bangalore, the flow of water is from north to soutto The
woman of Gandhigram slunff are up in arms against the corporation authorities
to close the eight feet wide sewage due to its unbearable stink. During rams t
sewage mixesX with rain water and rushes into their houses. Out of the 300
houses, 250 of them have no sanitation facility.
<’CloB^dNdwork by Aravind Gowda- Deccan Herald, 7 June 2002
7. Assessment by Training Research and Docunienlation Unit, KKNSS
6
In Ward No 63, adjacent to Chandrappa nagar slum, the huge drainage line
looks like a garbage pit. Due to silt formation the sewage is clogged and the
whole drain is now filled with garbage. For almost a year neither BCC
pourakarmikars nor any one has cleaned this line. If the garbage is not cleared,
the rains bring garbage to the streets and even to the houses. Adjacent to
Mudalpalya slum, of Ward No 38, The Vrishabhavathi storm water drain is the
source of an unholy stench. Most areas are low lying and susceptible to flooding
during rains and subsequent overflowing storm water drains. Storm water drain,
the collecting point of SWD water from all other wards on the way to the end of
the Vrishabhavathi valley at Kengeri. It does not have retaining wall and has
never been de-silted. Some rain and SWD overflows onto the residential areas
(iii). Flooding severe in the low lying ? eas
In the Ward No. 44, Faulty drainage a;
lack of de-silting in the storm water
drains result in flooding of the low lying a;eas. Slums such as Rayapuram,
Kamala Nehrunagar, JJR Nagar, Objlesh slum, Salappa line and Narasimhaiah
compound are the most affected. Faulty drainage and lack of de-silting in storm
water drains result in flooding of the low lying areas. The Goripalya slum has
beef shops as added to the pollution of the storm drains.
From August 2002, the residents of Gandhi Gramam in the city, have been
complaining of a stinking eight feet wide open sewage, that often floods their
homes during the rains. The resident complain that the smell of the drain in the
slum is so bad that during monsoons, when most houses are flooded the smell
remains even after the water gets washed away.
One of the problem with storm water drains is blockage due to
accumulation of garbage, waste, faulty drainage systems, and abject neglect by
BCC in maintenance of the storm drains. Even after ambitious launch of the
Swacha Bangalore programme, there is no door to door garbage collection
system and waste bins in the slums and many middle class residential areas.
(iv). Blockages of storm drains by military and security establishments
The problem of storm drain has assumed gigantic proportions, due to
termination of storm drains near the military and security establishments in
Cantonment. The most affected due to storm drains are the slums in the
Koramangala and Ejipura ward. The military authorities have terminated the
storm drain disconnecting its flow towards Bellandur.
4. Absence of or improper UGD systems in the slums
(i).Internal
7
The slums of Bangalore city are the most polluted areas due to the absence or
non-maintenance of UGD lines by the KSCB or the BMP. The sewerage
systems within the slum has added misery to the slum dwellers. Lakshman Rau
Nagar slum and Siddapura slum are the worst affected. The following are the
factors is the contributor for the sewerage crisis in the slums.
(ii). Faulty design of UGD and sewerage drains
In Sambu Palya Slum of Ward No 48, the serious issue of the toilets is its faulty
construction of UGD lines which passes though the narrow lanes of the slums.
The frequent overflowing of the septic tanks in the UGD lines has caused severe
hardship some families in the slum. The septic tanks are situated in front of
houses, the overflowing excreta enter the houses.
The faulty design and
construction of the community toilet is the crux of the problem. UGD lines from
the community toilet move upwards to connect the main UGD line. The lack of
inspection by KSCB on the gradient level of UGD line has caused serious health
hazards for the slum dwellers in shambu palya.
(iii) Non-maintenance of the drainage system
In Lingarajapuram Slum, The drainage system is
a breeding ground for
mosquitoes, the corporation authorities have not been maintaining these drains.
The slum dwellers are forced to pay Rs. 15 per household for cleaning the
clogged drains in the slums. Due to clogged drains, children in the area are
always falling sick and slum dweller are forced meet the medical expenses as
well.
In Nagina Palya slum, The state of drainage system is in a pitiable state.
The poura karmikas come only once in 15 days and demand Rs. 2 from each
household for cleaning the drainage. They dump all the waste in-front of the
houses which is bad for the health of the slum dwellers. Slum dwellers have to
bear the medical expenses when their sibling are affected with epidemics
In EWS quarters of Vinobanagar , each house has individual toilets with
an open ended sanitary pipes.. As there is no septic tanks, human excreta flows
through the open ended sanitary lines and drops behind the houses coupled with
sewage water and garbage. This has caused huge environment crisis and
diseases to the children.
Communicable diseases such as malaria, diarrhoea, acute respiratory
diseases, tuberculosis are rampant in the slums due to lack of safe living
environment in the slums
5. Non- Communicable Diseases
(i) Cancer
In Karnataka, about 45,000 cases of cancer are detected every year. The
task force on health and family welfare says the prevalence of cancer is about
8
1.5 to 2.5 lakh cases in the state. Cancer is highest among the woman which
is about one in twelve women, breast cancer, cervical cancer and uterus
cancer are the most common incidences of cancer. Among these cervical
cancer(21.5%) and breast cancer(18.6%) are the most common cancer sites
among woman8.
In the slums of bangalore city, the number of cancer patients who have been
detected and undectected is increasing at phenomenal level. Majority of the
slum woman are not even aware that they have been suffering from cancer.
(ii) Diabetes, Hypertension and CVD
Heart disease, high blood pressure, diabetes and obesity are much higher
among the the city dwellers. 16% of thr urbanites suffer from hypertension. The
Cardio Vascular Disease(CVD) is now major health problem with the bulk of it
in developing countries. Ciggarette smoking and tobacco chewing all increase
the risk of heart attacks as much as 300 percents.
One out of every 20 Bangaloreans may be a diabetic or on the way to becoming
one9. Increasingly sedentary lifestyles, heavy smoking, alcoholism, poor food
habits, obesity and the 'thrifty gene' have resulted in, not only this garden city but
the rest of urban India as well, to reel under a diabetes epidemic.
Various WHO reports point out that between 5-8 per cent of India's urban
population (in some areas even above 10 per cent) are diabetics. In a city like
Bangalore with a population of about 6 million, estimates are that between
2,50,000 to 3,00,000 are already diabetics. Another 1 lakh come from nearby
areas. Many others have impaired glucose tolerance which could mean that they
are within 4 to 5 years from actually becoming diabetics without lifestyle
modification.
Due to high consumption rate of alcohol and tobacco, the rate of diabetes and
CVDS are higher in the slums of bangalore city. Slums where Construction
workers, loading and unloading workers, safai karmacharis and night soil workers
are concentrated had known for high incidences of Diabetes and CVDs
6. Occupational Health
Atleast 50 - 70% of the workers in the unorganised sector residing in the slums
are exposed to heavy physical workloads, leading to musculoskeletal disorders.
Most affected in this category are construction workers, loading and unloading
workers, Nightsoil workers, Municipal workers, woman involved in agarbathi
roiling etc. Workers in the small scale industry are exposed to mineral, vegetable
dusts like silica, asbestos and coal dust which are know to cause irreversible
8 Study by Cancer Patients Aid Association, 2003
9 Study by St Johns Medical College and McMaster University in Canada, 2002
9
lung diseases, TB, lung cancer and allergic reactions like asthama. The risk of
cancer is high in the workplaces of small scale industry where 350 chemical
substances have been identified as occupational carinogens, including benzene,
hexavalent chromium, nitrosamines, asbestos,etc and ultra vilet and ionising
radiations10.
II. Health Care Infrastructure and Services
The Bangalore Mahanagara Palike(BMP) maintains about 30 maternity homes,
37 urban family welfare centres(UFWC), 25 dispensaries and 55 health centres.
These public health infrastructure was built with financial assistance of the world
bank under the Indian Population Project VIII. The health centres and UFWCs
focus on health, nutrition education, entenatal/postnatal care, family planning,
immunization mother & child, nutritional care of children up to the age of five.
Apart from this, medical treatment of minor ailments and to act as referral units
for the maternity homes was expected out of health centres and UFWCs. The
maternity homes focus on delivery and medical termination of pregnancy(MTP)
and laboratory tests. Maternity homes is also responsible for providing
antenatal/postnatal care, family planning non-surgical care for children needing
specialist attention and minor gynaecological
procedures. The services of
health centres, UFWCs and Maternity home is delivered for free.
The India Population Project - VIII
The India Population Project VIII (IPP VI) is a World Bank assisted project and
has been in operation in the city from May 1994. The project aims at expansion
of maternal and child health and family welfare services to the uncovered wards
and population groups mostly the urban poor particularly the slum dwellers. The
norm of IPP project is creation of one new health centre each for every 50,000
people. As planned, all the fifty five health centres have been created under the
IPP VIII. The project also covers to improve the quality of health services being
provided by the existing maternity homes of the BMP such as delivery, MTP and
sterilization etc. for which health centres act as referral units.
The fifty five newly created health centres are presently under the administrative
control of the IPP-VIII which supports the services of doctors, field staff and
honorary link workers to the health centres. The Honorary link workers are
volunteers residing in the slums, where they motivate mothers to utilize facilities
1(1 interview with Dr.Shashikaia Manjunalh, Occupational Health Specialist, Community Health Cell, ST
Maralhas Hospital, Bangalore, October 2002.
io
and services for ante-natal care, delivery family welfare, immunization. The BMP
was able to build better health infrastructure with medical equipments,drugs and
training for the technical personnel and public communication. IPP-VIll project
was seen as project which improve quality of family welfare, maternal child care
for the urban poor in the bangalore city
Corruption in the delivery of health care services
In 1999, the World Bank initiated process to ascertain whether the health care
needs has been fulfilled and the impact of the IPP-VIll project on the health care
system in bangalore city. The process took the form of consultation with different
stakeholders/ beneficiaries in the selected slums of bangalore city. The findings
underlines the fact that the health centres are assessed by the urban poor free
of cost. In the case of maternity homes,
sintained by BMP, none of its services
such as sterlisation, MTP, delivery are cya?^ble free of cost. The urban poor
people were forced to pay bribes in majority c oases.
With the termination of World Bank Assistance in the year 2001, the IPP facilities
has been integrated with the existing system of the BMP for routine operation
and maintenance.
The surveys on maternity homes, UFWC and IPP Health Centres reveals that
maternity homes are more popular among women for antenatal care than the
other two providers. This indicates either a lack of awareness among the
patients of the availability of these faiicilties nearer their residences at the IPP
Health centres or a reluctance to go to a new place. In either case there is a
need to educate women on the advantages of using the IPP Health centre.
The level of corruption at Maternity homes is much higher than that of UFWCs
and IPP Health Centres. One of the reasons for this could be that UFWCs and
IPP Health Centres do not involve admission. The reason for which bribes are
paid by most patients are for seeing the baby(69%) and for the delivery
■ itself(48%). Other services like injections, family planning medicines, etc are also
privided for payment of bribe but the extent is not so large. As far as the average
amounts paid are concerned they are quite large for seein the baby and for
delivery(Rs. 361 and Rs. 277 respectively) while other bribes are smaller in
value.
Referral Role to Maternity homes by UFWCs and IPP Health Centres
Patients who had been to maternity homes were asked who referred them there.
The response show that most of them came there on their own(68%), some were
recommended by friends and relatives(8%) while 20% had been referred by IPP
Health Centres and 4% by UFWCs.
11
Among patients who visited UFWCs and 1PP Health Centres, 63% and 64% said
they referred to maternity homes for delivery. Of these 81% and 67% went for
their delivery to maternity homes from UFWC and IPP Health Centres
respectively.
Health services to the poor women
BMP maternity homes is the only decentralised set of health facilities in
bangalore that are accessed by relatively low income women and children. A
network of outreach centres has now been created through IPP8 to expand and
further strengthen the services of the maternity homes. While this expansion and
upgradation of the health facilities for the ooor needs is appreciated, it is
important that careful thought is given to their proper utilisation, maintenance and
effectiveness.
The following are the findings of the survey conducted in the year 2000
11
❖ The overall satisfaction of patients was the lowest with the services of the
maternity homes.
❖ Only a third rated them as good while 71% and 60% considered IPP centres
and UFWC respectively as good.
Only 39% of the patients of the maternity homes claimed that they rece'ved
all medicines free as opposed to 63% in IPP centres and 61 /o in U. WCs.
Maternity homes also lead in taking payments for injections. But the statt say
that medicines are given free to all patients.
<♦ Cleanliness of toilets is an indicationi of the standards of hygiene and
sanitation. Here patients rated maternity homes the lowest (43%) in contrast
Io IPP centres (83%) and UFWCs(61%)
Maternity homes were rated the lowest also in terms of staff behaviour
towards patients. But the gap between them and IPP was much smaller in
this case.
❖ The most distressing finding concerns the prevalence of corruption. About
90% of the respondents reported paying bribes for one service or other at
maternity homes at an average of Rs. 700 each. The 70% pay for seeing their
own babies. One out of two pay for delivery.
If a poor woman paid for all services, it would have cost her over Rs. 1000 for a
delivery. It is reported that a nursing home might give her hassle free and better
quality service for Rs. 2000. A rough estimate of the bribes being paid in al! these
" User I'ccdback Survey by Publie Affairs Centre in colloboration with Sumangali Sevashram, RUDS,
MAYA, Citizens Action Group and Community Health Cell
12
facilities may be between Rs. One and two crores annually. A similar estimate
based on the finding that 90% of the women pay about Rs. 700 at the maternity
homes would put the total amount of bribes paid at about Rs. 1.6 crores. The
annual emoluments of the staff at the 30 maternity homes also amount to about
Rs 2 crores.
13
Report on Health of the urban poor held on Peoples Health Day - 7lh April 2003
At Ashirwad Bangalore, facilitated by Community Health Cell and KKNSS
Report by : S.J.Chander
Background
World Health Organization (WHO) having recognized that the health services expected
by the people was not being provided, in 1997 during the World Health Assembly called
for a revolutionary approach In Health Care that would enable the citizens attain a level
of health that will permit them to lead a socially and economically productive life. In
1978 in the conference held in Alma Ata, Russia, Health For All by 2000 AD was
declared. Primary Health Care approach evolved based on the experiences of countries
like Sri Lanka and India was suggested as the best way to attain the goal. Services based
on PHC approach were developed over the years for the rural poor but to far the urban
poor the services available were family welfare and family planning.
He said the PHC approach though initially experienced some gains, gradually moved
from comprehensive health care to more a selective primary health care approach. Pulse
polio programme can be given as an example. National Health Policy 2002 draft is out
and it is evident in it the shift. Process of globalization and influences of various lobbies
are some of the factors that have had negative effect on people health. Of late the trend is
moving more towards privatization.
This year is the silver jubilee of the Alma Ata declaration, it appears that WHO and the
governments have forgotten the goal Health For All (HFA) by 2000 AD. Jan Swasthya
Abhiyan (JSA) in India, known as People’s Health movement internationally believes
that it is the comprehensive health care that is going to help people attain the level that
was envisaged by WHO during the declaration. It is time that both the government and
the people’s organization work together to achieve Health for All now!
Dr. Mala Ramachandran, Director, Urban Health Training and Research Center,
Bangalore who was invited to share on the health services available for the urban poor
said, approximately there are 15 lakhs people live in the slums of Bangalore. Population
growth is the cause of the state of affairs in the slums. Usage of MCH services and
Immunization coverage is low. Problems like cancer, diabetes, hypertension is prevalent.
HIV AIDS and Tuberculosis are the other problems of concern to the urban poor. Safe
drinking water and sanitation continue to be inadequate. During the response to Dr.
Maia’s presentation, the participants said, despite the efforts to control corruption. It is
still rampant. There was concern among the participant regarding the removal of Link
Workers who were working at slum level.
Followed by Dr. Maia’s presentation, Mrs. Ruth Manoranima of Women’s Voice shared
urban poor do not have policy to address their needs. She said national policy of urban
poor is being developed. The present family welfare programmes exclude men from the
service coverage. Regarding sanitation needs, she said 70% of the Indian population still
does not have toilets. Women are the ones who are affected more due to lack ol'loilel
facilities. From the 9th five-year plan it was observed the budget for health being
decreased and budget for social welfare continued to face cut. The critiques have said the
following: Public sector is moving towards privatization, public sector budget faced cut,
commodification of health care, population gets major focus and distortion of priorities.
Regarding her suggestions to change the scenario, she said the following:
We should demand for comprehensive primary
Introduction of barefoot doctors cadre and youth for prevention H1V/AIDS
Recognize urban health as an important component in Health Care services
Obtain information regarding health care services and disseminate widely among
people
5. People should demand for transparency and accountability with the govt, services.
6. There is need to understand socio cultural and economic dimension of the causes
of the illnesses.
1.
2.
3.
4.
Followed by Mrs. Ruth’s presentation Ms. Preetham of Janagraha shared about their
work in developing indicators for the health services. She said al present Jangraha is
involved in the following three campaigns: a. ward work campaign, b. Proof
campaign, and 3. Ankoor, which focuses on the services of SJSRY. They approach
they have adopted is budget analysis, in which they analyze the budget allocated,
actually spent and the quality of service. As an example she gave the education
budget of the MBP when worked out the equation, the total cost per child per year
works out to Rs. 29,000. She said the output for such a high investment is
unacceptable. She said without information based on evidence objective discussion is
not possible with the service providers and performance indicators help us demand
accountability. At present she said they are experimenting with the approach: collect
information, analyze, and organize management dialogue for improvement with
education and heath care sectors of BMP.
Mr. Madhusudhan of KKNSS concluded the meeting with vote of thanks. It was
decided at the end of the meeting to form a forum consisting of voluntary
organization working with the urban poor for identifying and addressing the issues of
concerns to urban poor under Janaarogya Andolana.
JANAAROGYA ANDOLANA - KARNATAKA
Action Plan for Intervention for Bangalore City for the year
2003-04
- (For Discussion Only)
Goal
To enable a better healthy environment and access to health services for the
urban poor in bangalore city
Objectives
❖ To build capacity of the Organisations/CBOs to equip them to address the
health issues in the BMP area
❖ To Facilitate better accessibility of urban poor's Access to Health services
provided by the BMP
❖ To mobilize the- all stakeholders concerning health to directly address the
burning health issues in various locations of Bangalore city
Output
♦ Training programmes regarding health on Infant Health, Nutrition,
Adolescents , reproductive health, communicable diseases(AIDS, Cholera^
Typhoid,
Malaria),
non-communicable
diseases(Diabetes,
Cancer,
Hypertension), occupational hearth ( Construction, Municipal Workers,
Domestic Workers) and Substance Abuse(Alochol, Tobacco)
♦ Health Camps or disease detection camps at various locations of bangalore
city
♦ Evolving mechanism for monthly inreraction between the users and providers
of BMP
♦ Direct Action on Explosive health hazards at various locations of the city
which affects the slum dwellers.
/
Indicator
> Training programme on 2 health topics every month
> 2 detection camps for detecting the scale of cancer and diabetes among
slum dwellers
> Health Adalat - Complaints, grievances of urban poor presented before the
doctors & staff of the health centres. Conducted at each health centres level
for every month
> Improving environment at EWS quarters, slums adjancent to Storm drains,
Slaughter houses, and building health infrastructure
Activities
SL Activity
No.
1
2
I 3
Capacity
building
Process Indicator
Product Indicator
50 Health workers, Infant Health
field workers
and Nutrition
CBOs will be trained. Immunisation
Resource material will Communicable diseases
be
distributed
and Non-Communicable disease
evolving action plan
Adolescent health
Reproductive health
Occupational Health
Substance Abuse___________
Heaith/Diseas 3
Health detection Document on Findings of the
e
Detection camps for organising detection camp
Camps
detection
of
high
concentration
of Strategy document on curative
such
diseases
as and preventive measures to
tuberculosis.
cancer contain the diseases
and diabetes________
Monthly12 monthly interaction Health Adalat - a mechanism to
Interaction
at 55 IPP centres per for exchanges between users
between slum month. The doctors, and providers of BMP's health
dwellers and staff,
CBCs.
slum system.
service
dwellers interact to
providers
of improve the services of
BMP's Health health infrastructure
Infrastructure
!
4
!
Direct Action Organising inspections
to pre-empt an from the government
explosive
agencies.
unhealthy
situation
Media splash
Building
up
an
health
environment in slums adjancent
to Storm drains
Improving the environment in
Vinobanagar,
Shambupalya
slum etc.,
Enabling
systems
within government to Improving
the environment
prevent such situations within the slaughter houses on
tannery road and protection of
slum dwellers who work there.
3
|
I
J
I
£
6
what
is
PROOF?
Performance audits and quarterly financial statements are universally
acknowledged as essential mechanisms and criteria of and for
progress. The Corporate sector, the NGO world, CBOs and civil
society have not only embraced the concept, but used it as the basis
of performance measurment and the springboard of good
governance . Today, we need the Government to practice it, PROOF
provides this platform. It is about our Government building
confidence with PROOF.
"I support the PROOF campaign wholeheartedly.
As CEO, I cannot imagine running my
organization without credible iiformation being
produced, disseminated and used on a regular
basis by all stakeholders: investors, management,
employees, board members as well as thefnancial
markets. Especially in todays climate, such
iiformation is more than just about peformance,
building confidence in government
it is aboutfundamental institutional integrity.
If accountability and transparency have become critical benchmarks
for governance in India today , PROOF is a rigorous and systematic
vehicle, to root both in terra firma. The Public Report of Operations
and Finance (PROOF) provides a synergistic opportunity for
government and citizenry to join hands and demonstrate that public
money is being used for public good.
This is infact one of the reasons why the BATF
Lack of transparency in performance reporting from government
institutions is a worldwide affliction. On the other side of the coin,
there have been a variety of initiatives across the world which have
harnessed their energies in building mechanisms to promote regular
and standardised reporting from government institutions. Punching
home the point is the observation of the Governmental Accounting
Standards Board (GASB), which asserts that "Accounting and financial
reporting standards are essential for the efficient and effective
functioning of our democratic system of government". PROOF will
translate this premise into reality.
what is PROOF
A 10 month campaign which kicked off on July 3rd 2002, it's
mechanisms will put in place a systematic structure of government
performance reporting along the lines of the private sector. This
could become the centrepiece of improved government performance
and incrementally be substantiated with additional performance
indicators and explanatory statements .
has invested enormous resources and 200,000
manhours over the past 30 months in supporting
the BMP to put together a world-classfnancial
management system called FBAS. Ultimately,
the payoff is in the social realm, where citizens
see the benfits.
With the ChifMinisters vision, as well as the
commitment and dedication of the Mayor and
Commissioner, the BMP has an unprecedented
window ofopportunity tojundamentally tranform
itself Such an alignment ofpolitical will,
public-private partnership and professional
competence is veiy rare.
PROOF can be a big part ofthis Iranformation."
Nandan Nilekani
CEO, Infosys
1
what
PROOF?
what is in PROOF
While the contents of the Proof document will gradually become more
standardised, a framework of performance information will be gathered
in three crucial areas:
1 .Financial Statements of the institution for the period under scrutiny
comprising :
a) Revenue and Expenditure Statement compared to original
Budget figures
b) Indicative Balance Sheet, with detailed information about
current and long terms assets in addition to short and long
term liabilities.
2. Performance Indicators :
a) Inputs
b) Outputs
c) Efficiency indicators
d) Explanatory notes
3. Management Discussion and Analysis
a) Overall performance
b) Discussion of selected activities
the PROOF campaign
"Starting with the quarter ending June 30th 2002, the campaign is
about the BMP building confidence with quarterly statements of PROOF:
full and accurate performance information to the city's various
stakeholders".
Consequently there will be four quarterly review opportunities. These will take
the shape of public debates and discussions, the first of which will be held in early
August 2002.
Each review by itself will serve as an opportunity to bring financial accountability
and performance into the public space. However, these reviews are also catalysts
in a larger process of bringing government and public closer together. In practical
terms, each review will act as a bench mark and provide the basis to develop,
reshape and accelerate other mechanisms of analysis and participation.
"information sharing through disclosure has
become the NORM, and more sofinancial
disclosures. When corporate and other bodies
are expected to publish theirfinancial results
quarterly, there is no reason why government
bodies which deal with revenue collectedfrom
the public should not publish theirfinancial
status quarterly.
The PROOF campaign is trying to awaken
everyone, and taken to the logical end, this
would bring results to all stakeholders. IJolly
endorse the campaign."
R Thotadri
Managing Director (Retd.)
LIC of India
what
“PROOF?
campaign partners
In order to actualise this process and operationalise the vision, four partners
with different skill sets have subsumed their identities under the PROOF umbrella.
They are:
NAME
RATIONALE
1. CENTER FOR BUDGET AND POLICY STUDIES
Performance
Analysis
2. PUBLIC AFFAIRS CENTRE
Transparency
through Report
Cards
3. VOICES
Community
Awareness &
Communication
4.JANAAGRAHA
Citizen
Mobilization &
Participation
"PROOF as a campaign forfiscal peformance
audit by the public is truly commendable. This
will greatly help to promote transparency,
accountability and efficiency in public decisions.
If
Dr. M Govind Rao
Director
Institute for Social and
Economic Change
conclusion
Disclosure, debate, dialogue and discussion between Citizen and Government
characterises both the spirit and process of PROOF. This is an opportunity for the
BMP to build confidence with its various stakeholders in a manner that is open,
sustainable and constantly deepening.
Your participation will both accelerate and enable PROOF to translate its promise
to performance.
For more information, contact us at:
PROOF
198 Nandidurg Road Bangalore 560 046
Tel: 354 2381/ 354 2382/ 354 2977
Fax: 3542966
proof@vsnl.net
3
format
of
PROOF
format of financial statements
"The taxpayers of Bangalore city who sustain
REVENUE STATEMENT
Major head of account
Actuals
Budget 2002-03 (2002-03) % Achieved
Q1
Comments
on
Performance
Queries
ground, but also regular reports on performance.
A. Revenue receipts
Al. BMP Own sources
a. Property Tax
b. Other taxes
c. Non tax revenues
the BMP expect not only better results on the
R1
R1
R1
PROOF is the answer to this, and I am hopeful
that the BMP will be self-motivated to provide
PROOF. I am glad to leam that this campaign
R1
is actively involved in creating that motivation. ”
Fees - Building license fees
Fees - Road Cutting charges
Rents from shops and markets
A2. Government sources
R1
a. Shared taxes with GoK
b. Finance Commission grants from GoK
c. Other specific grants
Total Revenue Receipts (A1+A2)
B. Capital Receipts
Bl. BMP Own sources
a. Improvement charges
R1. R2
b. Sale of assets (Land, markets etc)
R1, R2
c. Other
B2. Government sources
R1, R2
a. MOU/ Rajdhani fund
b. Other specific grants
B3. Borrowings
R1, R2
From Government
b. From HUDCO
c. From KUIDFC
d. From other sources
Total Capital Receipts
C. Fiduciary Receipts
Cl. Deposits
R1
C2. Cesses
R1
C3. Taxes
R1
C4. Other fiduciary sources
R1
Total Fiduciary Receipts
GRAND TOTAL OF RECEIPTS
R1 - Which are the key items of receipts; how did they fare versus your budget plan;
where did we do better, where did we do worse; what specific ideas are you
adopting to change this in the next 3/6/9 months before the year ends?
R2 - If we are getting funds from capital receipts like sale of assets or improvement
charges etc; do we spend these funds on capital expenditures? As an example,
how do we ensure that improvement charges get spent on the areas from which
the funds were collected?
C G Somiah
Former Comptroller and Auditor
General of India, Govt of India
Former Chairman of the United
Nations Board of Audit
format
“PROOF
"PROOF is a step towards making people know
EXPENDITURE STATEMENT
Major head of acount
Budget 2002-03
Actuals
(2002-03)
QI
Comments
on
Performance
how their money is being spent. And therefore,
Queries
it is welcome. ”
A. Revenue expenditure
Al. Salaries and Allowances
El
A2. Pension
El
A3. Interest on borrowings
El, E2
A4. Maintenance & Repairs
El
Chiranjiv Singh
Principal Sceretary, Finance
Government of Karnataka
a. Buildings
b. Vehicles
c. Engineering (roads/ drains maintenance etc.)
E3
d. Others
A5. Other Revenue Expenditure
El
TOTAL REVENUE EXPENDITURE
B. CAPITAL EXPENDITURE
Bl. Buildings
El, E4
82. Furniture and Fixtures
El, E4
B3. Machinery and Equipment
El. E4
B4. Ward Works (roads/ drains construction etc.)
El, E3
B5. Comprehensive Development of the city
El, E4
B6. Slum Development
El, E5
B7. Solid Waste Management
El. E4
B8. Commercial Complexes
El, E4
B9. Princial repayment of borrowings
El, E2
BIO. Other Capital Expenditure
El
TOTAL CAPITAL EXPENDITURE
C. FIDUCIARY EXPENDITURE
Cl. Deposits
El
C2. Cesses
El
C3. Taxes
El
C4. Other Fiduciary Expenditure
El
TOTAL FIDUCIARY EXPENDITURE
El
GRAND TOTAL OF EXPENDITURE
El - Which are the key items of expenditure; how did they fare versus your budget
plan; where did we do better, where did we do worse; what specific ideas are
you adopting to change this in the next 3/6/9 months before the year ends?
E2- We had taken out the Municipal Bonds a few years ago. Can you give us some
details about the status of these bonds, and the usage of funds: what was the
original usage, versus actual usage?
E3- What is the total expenditure incurred on Storm Water Drains? How much of
this is capital expenditure, and how much was spent on maintenance and
desilting?
E4- Please provide some details on major capital expenditures being incurred this
year. How much has been spent, and what are the additional expenditures in
these areas for the remainder of the financial year?
E5- In the area of Slum Development, what kinds of activities have been taken up?
What is the proposed expenditure for the rest of the year?
5
format
of PROOF
’7 endorse the PROOF campaign.
STATEMENT OF ASSETS
/s an NGO, Myrada tries its best tojulfill its
For QI
As on 30/06/2002
List of Major Assets
Queries
Number
Value
Income
Expenditure
A. Fixed Assets
Mission with passion and professionalism; the
latter demands respectfor adequate and
a. Land
Al, A2
b. Land (leased out)
Al. A2, A3
c. Buildings used by BMP
Al
management systems and indicators of
d. Buildings - Commercial
Al, A3
peformance. Without professionalism, passion
acceptable organizational andfinancial
e. Infrastructure assets
f. Other fixed assets (furniture, machinery etc.)
B. Investments
only makes news, and is often counter
productive. ”
C. Current Assets
a. Receivables
property / other taxes
other receivables
b. Advances
to contractors
to employees
c. Cash and bank balances
Al - We know that the BMP owns several properties in the city. Can you give us a
list of these properties? Have you valued these? How are you managing these
assets, so that they stay valuable for the BMP?
A2 - Are you planning to convert any of these properties into revenue opportunities
for the BMP? If so, how will you do this: by selling the property outright, or
doing a joint-venture? How do you make these decisions so that the BMP gets
the best value? How will you ensure that there is transparency in these decisions?
What will you do in the next 3/6/9 months?
A3 - What are the commercial activities of the BMP?
• What is the total value of all BMP's commercial properties?
• How much money are we spending on building new commercial properties?
• How much money are we spending on maintaining existing properties?
• Since these are commercial properties, are we making a profit on managing
these assets? If so, what are we doing with the profits? If not, why not; what
are you doing to convert these into profitable propositions in the next 3/6/9
months?
• As one example, we understand that the Public Utility Building is a BMP asset;
what rent do we get from this building? what are our expenditures for this
building?
• Why is the BMP undertaking commercial activities? Is there surplus money in
the institution? Is this an obligatory activity of the BMP? Will we continue to
undertake commercial activities in the future?
A4 - What is the total area and number of pieces of land that BMP has leased out?
What are the purposes for which these lands are leased? How are these decisions
made? Are these optimal decisions? If so, how do you say so? If not, how will
these decisions be rectified and what specific action is being planned over the
next 3/6/9 months?
Aloysius Fernandez
Executive Director
Myrada
format
’PROOF
"We support the PROOF campaign.
STATEMENT OF LIABILITIES
As our contrbution to the campaign’s success,
List of Major Liabilities
As on 30.06.2002
Dues QI
Queries
we are happy to organize a seminar at our
1. Specific Grants
premises to help the Corporators and Department
a. From Govt of India
Li
b. From State Government
LI
c. From others
LI
and other disclosure statements neededfor
L3
fostering greater transprency and accountahiliy. ”
2. Loans
a. Government
L1,L2
b. HUDCO
LI, L2
c. KUIDFC
L1.L2
d. Others
LI
officials of the BMP read and understandffinancial
K S Madhava Murthy
Chairman
Bangalore Branch of SIRC
The Institute of Chartered Accountants
of India
3. Current Liabilities
a. Dues to Contractors
b. Dues to Suppliers
c. Other liabilities
d. Cesses & Taxes to Govt
CASH BALANCE
Opening Balance as on 1st April 2002
■
+ (Total Receipts during QI, 2002-03)
Vinay Bruthyunjaya
Regional Council Member
Bangalore Branch of SIRC
The Institute of Chartered Accountants
of India
- (Total Expenditures during QI. 2002-03)
Closing Balance as on 30th June 2002
LI - How many years are left for repayment of the various loans or grants, either
to Government or to HUDCO, KUIDFC etc?
L2 - How does the BMP decide on loan financing of projects? Since these loans have
interest payments, do the assets being created have to generate cash flows to
pay back for the loans, or do these repayments come from other sources?
L3 - Is the BMP considering raising more debt in the next 3/6/9months. If so, what
are these loans for, what are the details of such loans (interest rate, duration
etc.), and how is the BMP intending to pay back the loans?
7
format
“'PROOF
developing performance indicators
Specific Performance Indicators (PI) are not yet developed. Although such performance measures are required, they
need to be developed over time, in areas of concern to the citizens as well as the Management of the BMP. The items
mentioned below are broad questions related to performance measurement, intended to begin the process of identifying
topics and areas of interest.
PI-1: EDUCATION
• How much money is spent on the education department?
• How many students do we have in corporation schools; how many schools do we have?
• Is the cost per student that we spend every year reasonable for the quality of education that is provided?
• If so, how do you determine this; if not, what are you going to do about it?
• Which are your best-performing and worst-performing schools?
• What kinds of performance measures do you think are appropriate for this department?
PI-2: HEALTH
• How many dispensaries and hospitals do we have?
• How much money is spent on the hospitals and dispensaries that we have?
• How many in-patients and outpatients does the BMP treat?
• Is there any measure of cost/outpatient, or cost/inpatient/day that has been evolved?
• What kinds of performance measures do you think are appropriate for this department?
• Which are your best-and worst-performing dispensaries and hospitals?
PI-3: HORTICULTURE
• How many nurseries does the BMP own?
• How much land does this occupy?
• Is horticulture considered to be a revenue-generating activity for the BMP, or an obligatory function?
• How much revenue does this department generate?
• Is this sufficient for the land that it possesses; if so, why do you state this; if not, what are the plans over
the next 3/6/9 months?
• What kinds of performance measures do you think are appropriate for this department?
PI-4: ENGINEERING
• How many works (number and total value) are currently under way in the Engineering department, and
which years do these works belong to?
• How many works (number and total value) will spillover into next year, and what are the causes for such
spillover works?
• How many of these works are maintenance in nature, and how many would you classify as long-term capital
expenditure?
• What kinds of performance measures do you think are appropriate for this department
Management Discussion and Analysis?
format
"PROOF
management discussion and analysis
This section is left open for Management to provide additional qualitative information on various aspects of their
choice. As an example, these items could relate to:
• Management Priorities for the first 3 months, and for the next 3/6/9 months in this financial year
• Key challenges that arose during the past 3 months, and issues related to these challenges
• Human Resource Development discussion
• Any other strategic or operating items
9
frequently ..
asked questions
1. With all the problems being faced by the corporate sector (like Enron etc.), how can these disclosure norms
be considered "Best Practices"?
Disclosure by itself is not a sufficient condition for good governance, either in government institutions or
in the private sector. However, the disclosure of accurate and timely information is a necessary condition
for good governance. Without disclosure, there cannot be good governance. The problems of the private
sector only show that better quality information needs to be disclosed, and that all stakeholders must examine
such information more carefully.
2. Why do we need PROOF when there is already the Budget?
The Budget serves the purpose of a planning instrument, which is very important. We also need stakeholders
to engage on issues of performance, over the course of the year
3. Will this not put additional pressure on the BMP to generate all this information?
The financial data in PROOF is being asked for in a standard format. The BMP Management is probably
already using such information to run the organisation efficiently. Emerging global standards of government
financial disclosure are also in line with PROOF
The BMP and BATF have invested over 200,000 manhours in building a world-class financial management
system, so generating this information should not pose much difficulty
4. What are the legal requirements for the dissemination of such information?
• Karnataka Municipal Corporations Act (KMC Act), Schedule III -1(3): "The account books of the Corporation
shall be open without charge to inspection by any person who pays tax to the Corporation or his authorised
agent on any day or days in each month to be fixed by the Corporation"
• KMC Act, Schedule I -Rule 4: "At an ordinary meeting held in each of the months of April, June, August,
October, December and February, the Mayor shall place before the corporation a statement of receipts
and disbursements on account of the Corporation fund from the close of the last preceding year up to
the close of the month before that in which the meeting takes place."
• KMC Act, Section 61-A-(e): " The Standing Committee for Accounts shall deal with all matters relating tc
Accounts and Audit."
• KMC Act, Section 61-A-3(a)(b): "The Standing Committee..may conduct a monthly audit of the Corporation
accounts and shall be bound to check the monthly abstract of receipts and disbursements for the preceding
month as furnished by the Commissioner."
• KMC Act, 9(2)-Part II- Schedule IX: "The Commissioner shall make ready the annual accounts and registers
and produce them before the auditor for scrutiny not later than the first day of October in the year
succeeding that to which such accounts and registers relate."
• KMC Act, 12-Part-Schedule IX: "The auditor shall submit to the standing committee for taxation and finance
a final statement of the audit and duplicate thereof to the government within a period of three months
from the end of the financial year or within such period as the government may notify."
• These are some of the provisions. There are other provisions dealing with the powers of the Standing
Committee for Taxation and Finance, as well as those of the Chief Auditor
frequently a.
^questions
5. How will the Performance Indicators be created?
These indicators have to be evolved over a period of time, with discussion between the BMP and various
stakeholders so that the appropriate Performance Indicators are created, for example, for roadworks, SWM.
The list of questions currently being asked in the section on Performance Indicators only begin the process
of public participation in the area of performance measurement.
6. How can the public participate in the information that is disseminated through the PROOF documents?
1
There will be a public debate held every quarter. These public debates will be around the PROOF information
that is disseminated by the BMP. These debates are specifically meant to trigger larger public discussion
about the key issues arising out of the quarterly performance of the BMP.
7. Once the BMP releases PROOF, how can the average citizen understand the documents?
The PROOF format itself is quite simple to understand. The financial statements are extremely simple and
straightforward, and presented in a standardised format.
The benefit of using standardised disclosure formats is that there are many who know how to interpret
them: Chartered Accountants, financial analysts, NGOs, students etc.
These skills are already in the communities, and can be used to have grassroot discussion sessions about
PROOF.
Training programmes to understand PROOF will be held, to create a greater awareness of such documents.
In addition to the 4 partners of the campaign, the Institute of Chartered Accountants has offered to conduct
such training programmes for interested persons.
8. How frequently will the PROOF documents be released, and how frequently will the public debates be held?
The Campaign for PROOF is to obtain these documents on a quarterly basis. The Public Debates will also
be held every quarter.
The first public debate will be held around the 1 Sth of August, for the discussion of the First Quarter's
performance of the BMP in the financial year 2002-03.
Subsequent Public Debates will be announced in advance, to ensure maximum participation from the various
stakeholders in the city.
11
partner,
endorsements
C B P S
Centre for Budget and Policy Studies
Dr. Vinod Vyasulu
Director
The Centre for Budget and Policy Studies, Bangalore was established in 1998 by a
group of professionals based in different institutions. The mission of the Centre is to
contribute through research to contemporary debates around issues of poverty,
employment, environment, gender etc. The Centre believes that both economic
growth and equity are essential for all round development, and that it is also essential
to work at the local levels. Therefore, in its work, the Centre has begun with an
analysis of budgets. A budget is a promise made by an elected government to the
people who have given it its mandate. Has the government a followed policies in line
with its promises? Has money allocated been spent? If not, why not? Has the money
required been raised by equitable or regressive tax policies? These are all matters that
impact on the daily lives of ordinary people. Budgets tend to be long and technical
documents. It often needs economists and accountants to act as intermediaries to
make the numbers understandable to the ordinary citizen. This is a task CBPS has
taken on.
CBPS is privilege to work with its distinguished partners in the PROOF campaign.
The Public Affairs Centre is well known for its work, including the innovative Report
Cards on citizen satisfaction with civic services. Voices is a well known organisation
concerned with democratising the media and both reaching, and giving voice to, the
views of the poor. Janaagraha has just completed a campaign in which citizens were
encouraged and enables to interact with their elected corporators in a joint endeavour
to include locally important works into the ward works to be taken up by the city
corporation. Together, we can make the Proof campaign a worthy successor of what
each has already accomplished-and take the exercise to a higher level.
Proof is about building confidence. The BMP offers a Public Report Of Operations
and Finances on a quarterly basis over the next four quarters which will enable
citizens to to understand how things are working. How are projects taken up? How
well are taxes being collected? What problems does the BMP face, and what can
citizens do to help? The potential is great.
If all of us are to contribute to a better Bangalore, we all have to take some
responsibility for how our city develops. The BMP is the prime agency to lead this
task, but without our help it may not be able to achieve all it should. The Proof
campaign is a small beginning to make things better by working together.
1C, S.V. Complex, 1st Floor, 55 K.R.Road, Basavangudi, Bangalore-560004. India
Phone: + + 91-80-6522327 Fax : ++91-80-6618401 email:cbps@vsnl.com
I
partner.
endorsements
NA
G R
A
B Janaagraha OToam up for a Bcttc-r Bangalore ■
PROOF and Janaagraha
i
When Janaagraha was launched last December, it was with the singular focus of bringing
the voice of the citizen into the decision-making process of government.
Our first campaign of ward works budgeting has completed its first phase, and is
continuing into the second phase of participation in implementation of these works.
We believe that PROOF is a remarkable opportunity to create a platform for citizen
engagement. Information that comes out of the PROOF documents will only be the first
step. By itself, this information is passive, inert. It needs to come alive with
participation, internalisation and ownership by the citizens in their neighbourhoods.
Our vision for how this will work is that the PROOF documents act as a catalyst for the
average citizen to engage more, get a firmer comprehension of how - in this case - their
local BMP government works, and then take the next step: ask the question, "What does
this mean in my ward, my locality?" This will in turn spur more disaggregated analysis
and debate.
Another important aspect of PROOF are the Performance Indicators: financial data is a
necessary condition to understand an institution. It is not a sufficient condition, however.
This financial data needs to be supplemented by performance data. How well is the BMP
doing in delivering primary education services to the children in corporation schools?
How efficiently are the hospitals and dispensaries running? These are important
questions, but require careful deliberation before the right parameters of performance can
be evolved.
Our view in Janaagraha is that these perfonnance indicators cannot be developed in a
vacuum; they need to evolve t hrough debate and discussion. Let the people participate in
determining which areas need to be prioritised in the development of performance
indicators - after all there are hundreds of potential metrics. Then let there be discussion
on what these performance indicators ought to be. These could take several iterations,
but the body of knowledge will only grow, and the spaces for engagement will only
become more robust.
In summary therefore, Janaagraha is a partner to the PROOF campaign because we
believe that this marks a radical departure to the mindset of the past: with regular,
standardised information, public engagement can become a reality in tangible terms.
Of course, there will be many obstacles. That is part of change. All we can ask for is to
be, in the words of Richard Hofstader, "a thorn in the side of complacency."
Ramesh Ramanathan
Campaign Coordinator
198, Nandidurg Road, Bangalore 560046
Phone: 080 - 354 2381, 354 2382, 333 0668
email: janaagraha@vsnl.net
partner,
endorsements
PUBLIC AFFAIRS CENTRE
578, 16th B Main, 3rd Cross, 3rd Block
Koramangala, Bangalore 560 034, India.
Tel / Fax : (080) 5537260/3467, 5520246/5452/53
E-mail : pacindia@vsnl.com
PROOF: A Campaign for Tranaparent Governance
The Public Affairs Centre's mission, to improve the quality of governance in India
by strengthening civil society, draws heavily on the power of informed choice and
action by citizens. Its work on Citizen Report Cards, campaigns for electoral
transparency, promoting Self-Assessment of Property Taxes, and demystifying
municipal budgets are a testament to its commitment to make information a basis
of informed action. "PROOF" is a continuation of this effort. It offers PAC the
platform to tie together all the different elements of its work in Bangalore, and be
a partner in an effort that builds on the commitment of citizens and institutions in
Bangalore, to make a different where it matters most.
PROOF is a lot more than another advocacy campaign for PAC. It is an
opportunity to work with four dimensions of citizen - state interaction (Four D's)
that are vital to good governance, namely:
• Meaningful and sustained "disclosure" of information that empowers elected
representatives and citizens
• Providing a plaffomm for meaningful "dialogue" among stakeholders
• Facilitating active citizenship that can "debate" local issues
• Setting agendas based on long term "direction" beyond short term issues.
This first PROOF campaign, for 10 months, is a period for deliberate reflection
and systematic action by PAC and its partners. For the Centre, it is a reiteration
of it's commitment to pursue the goal of facilitating informed action by citizens
while interacting with the state, and has a meaning beyond the immediate results
to be achieved in 10 months.
This campaign is not a stand-alone effort. It builds on the upsurge in civic
consciousness and citizen action as well as the tremendous effort made by the
BMP to reach out to residents of Bangalore. Hence, it is an effort that draws in
citizens, civil society institutions and city government of Bangalore to expand the
scope for active participation and partnership, on a continuing basis.
PROOF is also about the spirit of Bangalore, its citizens and city government.
Which is why the city is home to some of the best-known recent initiatives in
participatory urban governance. To PAC, this campaign is an opportunity to
consolidate the pioneering work by its citizens and institutions, and hold out a
model that others, from all parts of the world, can learn from Bangalore.
July 4, 2002
^SamueTPaul
Chairman
v
partner,
endorsements
I
63 VOICES
a unit of Madhyam Communications
165, First Floor 9th Cross, 1st Stage,
Indranagar, Bangalore ■ 560 038.
Telephone 91-80-5213902/5213903
Fax 91-80-5213901
E-mail voices@vsnl.com
www.voicesforall.org
July 4,h 2002
Access has been universally acknowledged as a critical ingredient for change and
participation . As an organisation committed to democratisation of the media, VOICES
has directed its efforts towards developing and strengthening community media
mechanisms that not only inform but also accelerate the pace of community participation
in governance . These mechanisms, as amply demostrated by the first campaign of
Janaagraha, confirm that community communications are critical catalysts for dialogue,
discussion and debate . VOICES efforts with poor farmer groups in Budhikote village,
Kolar, in partnership with MYRADA is another example of community engagement in
local media. It is also part of a larger process of advocacy and lobbying underscoring the
need for community radio in a country that remains to straddle the literacy gap.
The MKSS and Aruna Roy's efforts in Rajasthan have endorsed exactly why the Right
to Information in not just about rights, but also about responsibilities . If community
participation is at the bedrock of its effort, community communications have been a
vital enabling agent which has taken the process forward . The Jan Sunwais (Public
Hearings) employed by MKSS is a case in point.
<4
P.R.O.O.F. comes at a point when transparency and accountability have assumed crucial
significance in governance . The news today which describes the doublespeak about
the roads at K.R. Puram underlines its relevance . By using quarterly financial
statements as its peg P.R.O.O.F. articulates universally accepted benchmarks for
progress . It provides a powerful opportunity for government and citizenry to join hands
and colletively strengthen governance . Along with the other partners, VOICES will
work through a range of media, to disseminate relevant information and strive to ensure
that community voices take primacy . This process will affirm that P.R.O.O.F is not only
a matter of questions, but also a question of answers.
Ashish Sen
Director
VOICES
15
►
PROOF
Public Record of
Operations & Finance
PERFORMANCE INDICATORS FOR HEALTH
INPUT
OUTPUT
•
Minimum Infrastructure
Standard
General Ward
Labor Ward
Operation Theatre (OT)
Minor Operation Theatre
Toilets
Condition of toilet
Bathrooms:
— Availability of hot water
— Availability of sewage
system.
Laboratory
Waiting Area
Patient Attendant Space
Outpatient Area
Availability of drinking water
Linen Service
Generator set
Store Room
Ambulance Service
Quarters for Doctors and
Drivers
Telephone Service
Privacy of examination area
Fumigation
• Number of
deliveries
Normal Caesarean and
Assisted
•
Minimum Equipment
Standard.
Availability of required
Equipment in all rooms.
•
Drugs
Availability of minimum
essential drugs.
Availability of emergency
drugs. _____
• Number of family
welfare procedures.
• Number of high risk
pregnancies detected
during labor / antenatal
care
• Number of
immunizations against
measles.
• Number of
admissions.
• Number of
admission slips.
• Number of patients
registered for postnatal
care.
• Number of patients
registered for antenatal
care.
• Number of
Medically Terminated
Pregnancies (MTP).
OUTCOME
• Number of maternal
deaths.
• Number of neo natal
deaths.
• Number of stillbirths.
• Number of infant deaths.
• Number of perinatal
deaths.
• Number of measles cases.
• Number of deaths due to
measles
• Number of admission to
number of admission slips.
EFFICIENCY
• Downtime of key
equipment.
Autoclave.
Laproscope.
Refrigerator.
Generator.
Ambulance
BP Apparatus
Instrument Sterilisers
Weighing Machine - Adult and
Infant
Incubators
Boyle’s Apparatus
Pulse Oxinator
Hysteroscopes
• Time taken to fill up
vacancies to sanctioned
strength.
• Nurse patient ratio.
• Complaint redressal
system.
• Doctor patient ratio.
• Patient feedback forms.
• Full time employees per
occupied bed.
• Percentage of patients
coming in for 3 postnatal
check ups.
•
• Number of patients
registered for antenatal care
prior to 12 weeks.
• Number of days with
stock outs of essential drugs.
Waiting time for patient.
• Cost of drugs per patient
(inpatient / outpatient).
•
Cost per inpatient day.
• Cost per outpatient day.
PRODUCTIVITY
EXPLANATORY
• Staffing patterns.
• Number of patients below
the poverty line.
• Inventory / Store
management maintenance
mechanism.
Furniture.
•
Stationery for
correspondences.
• Staff (Sanctions, Vacancies
and Absentees)
Doctors
Staff Nurses
Auxiliary Nurse Midwives
(ANM)
Lab Technicians
Peons
Ayahs
Sweepers
Drivers
Dhobhi’s (Contracted)
•
Capacity Building
Type of training programme.
Periodicity of training.
Number of people trained.
• Financial
Salaries budget
Maintenance budget Equipment
Maintenance budget -Building
Drugs budget.
Equipment budget.
Training Budget.
Fuel and vehicle maintenance
budget
User fees
Laundry budget
Contractual Services budget
Miscellaneous expenditure
budget
• Number of
complaints.
• Display board of
available drugs.
•
• Number of
outpatients per day.
• Amount of user fees
collected.
• Percentage of high risk
cases among deliveries
• Number of referrals.
• Bed occupancy rate.
• Number of
prescription slips
issued
• Number of deaths due to
sterlisation
• Number of complaints
received to number of
complaints redressed
• Number of visits by
the health officer/
supervisor
• Use of equipments
Utilisation of user fees.
Janaarogya Andolana - Karnataka
People’s campaign towards Health for all “Now”!
CHAIR PERSON
Dr. H. Sudarshan
Ref: CHC:
CO- CHAIPERSONS
Dr.Thelma Narayan
Dr. Prakash.C.Rao
Dear Friends,
COORDINATORS
Mr. A.Prahlad
Mr. E. Basavaraju
PARTNERS
All India Janvadi Mahila Sanghatane
(AIDWA)
Community Health Cell (CHC)
Bharat Cyan Vigyan Samithi (BGVS)
Catholic Health Association of
Karnataka (CHA-Ka)
Christian Medical Association of
India (CMAI)
Drug Action Forum -Karnataka
(DAF-K)
Family Planning Association of India
(FPAI)
Federation of Voluntary Organizations
Working for Rural Development
Karnataka- (FEVORD-K)
Foundation for Revitalization of Local
Health Traditions (FRLHT)
Janodaya
Joint Women's Programme (JWP)
Karnataka State Medical & Sales
Representatives Association (KSMSRA)
Karnataka Kolegeri Nivasigala Samyuktha
Sanghatane (KKNSS)
Mahila Samakhya -Karnataka (MSK)
New Entity for Social Action (NESA)
Vivekananda Foundation (VF)
Voluntary Health Association of Karnataka
(VHAK)
PARTICIPA TING ORGANISA TIONS
Various Organizations concerned with
Health care & Health Policy from
within and outside the network.
/03
23rd July 2003
Subject: mid day meal scheme by the Government of
Karnataka
Greetings from Janarogya Andolana, Bangalore Urban (JABU)!
As many of us already know, Government of Karnataka has
introduced the Midday Meal Scheme, which would certainly
have an impact on the child’s general nutrition status. There is a
definite need to understand the implementation of this
programme and identify various ways for strengthening it.
To deliberate upon the Scheme, we shall be meeting on 31st
July 2003 between 2:30 pm - 5:30 pm
Venue:
Christian Medical Association of India,
No 21, III floor HVS Court, opp to Indian Express
Cunningham Road,
Bangalore, 560 001
Ph.: +91 80 2205467
Dr. Archana Mehandale,
Dr. Vasavi, Fellow at National Institute of Advanced Studies, and
Dr. Veda Zechariah, of the Sanjeevini Trust, will facilitate the
discussions.
Kindly confirm your participation at the earliest. Looking forward
to meeting you.
With best wishes
Yours sincerely
S.J. Chander
For Community Health Cell, Bangalore
Address for Correspondence
Community Health Cell, 367, Srinivasa Nilaya, Jakkasandra, I main, I Block, Koramangala, Bangalore - 560 034
Phone : 080 - 553 1518 Telefax: 552 5372- E-mail sochara@vsnl.com
Bharat Cyan Vigyan Samithi, IISC Campus, Bangalore - 560 012, Phone : 080 360 0384- e-mail: bgys_kar@hotmaii<om
AHD DAY MEAL SURVEY, 2003
Part 4: Headmaster Questionnaire (contd...)
1. All children
TotaJ attendance for each day of the month of
i
Total Attendance
1
2
3
4
I 5
6
ls
7
T"
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
13
I 14
15
16
17
18
19
20
21
22
23
24
26
27
29
30
31
26
27
29
I 30
31
Classi
Year 2003(this year)
Classes I-V
j Year 2003(this year)
Class I
Year 2002(last year)
Classes I-V
Year 2002(last year)
2.SC/ST Children only
Total attendance (SC/ST children) for each day of the sionth of
■i ~
rTotal Attendance
I
3
I
4
I 5
7
6
I8
Class I
Year 2003 (this year)
9
10
11
12
i
Classes I-V
Year 2003(this year)
Classi
Year 2002(last year)
Classes I-V
Year 2002(Iast year)
I
I
Investigator please note:
1. Take the calendar month preceding the survey. For example, .'muary if the survey takes place in February and February if the survey takes place in March.
2. Remember to enter the month in the space provided above the tables.
3. For Sundays and other holidays please put a cross "X” in the relevant cell(s).
4. If figures are missing for a particular day, write “NT5 in the relevant cell(s). Do not leave any cells blank.
25
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Mid Day Meal Survey - 2003
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CONSTITUTION OF BOARD OF VISITORS FOR THE
HEALTH FACILITIES OF BANGALORE MAHANAGARA
PALIKE
^^^^’R'-lok^cloH^c**^****************************************^*****************
There are 30 Maternity homes being run by Bangalore Mahanagara
Palike. These hospitals have 24 or 30 beds each and cater to the Urban Poor
mainly. The services provided range from general medical care, Ante-natal
Services, delivery services, MTP's, sterilisations, Family Welfare Services,
Immunization, Basic Laboratotory investigations etc.,
There are 55 Health Centres run by the India Population Projectt-VIll.
These along with 37 UFWC’s provide day care health facilities and Primary
Health Care.
OBJECTIVES OF CONSTITUTING BOARD OF VISITORS.
*
To ensure proper over sight and good governance of health
facilities through the participation of both public and private
sector representatives.
★
To seek and utilize feed back on services with a view to
providing quality care and improving accountability.
To institutionalize Best Practices in health care.
To provide a forum for the staff of the health facilities to present
their plans performances and problems.
To ensure stronger community involvement and ownership in the
facilities and the services.
★
To play a proactive role in the mobilization and use of resources
in the health facilities.
Constitution of Board of Visitors.
A Board of visitors will be constituted for 4-5 hospitals coming under a
particular superintendents zone.
The following will be the constitution of the Board of Visitors.
The Councillor of the concerned wards will be members. One
amongst them will be nominated to act as chairperson by the
other members.
*
★
★
The Superintendent of the Zone will be the convenor.
A representative of a locally functioning NGO.
A respected person in the locality who may be a retired person with
a desire to serve the community.
Principal of a Local Government / Corporation School.
Rotary / Lions / Local industrialists/ Medical Practitioners.
At least 2 of the members must be women.
Specific Responsibilities/Activities of the Board.
1)
2)
3)
Quarterly review meetings.
Review of activities of the Health Facilities in the Jurisdiction.
Review plans budgets programmes and performances of the
health facilities.
4)
Review and approve income from the user charges or other
sources and expenditure out of such funds.
5)
6)
7)
8)
Resource mobilization.
Review and re dressal of un resolved public complaints received.
Proposal of measures for better governance
Apy other subject of relevance.
This committee has no jurisdiction over administrative matters like
appointment of staff, transfers and confidential reports etc.
However it can recommend suggestions to improve the
management practices and services.
Selection of members of the Board.
The Superintendent
in whose zone the committee is constituted will
prepare the names as per the guidelines given above, to be approved by a
committee consisting of
Joint Commissioner ( Health & Education)
Zonal Deputy Commissioner
Project Co-Ordinator, IPP-VIII
Chief Health Officer
-I
Chairperson
Member
Member
Member
Quorum for tho mooting:- At least 50% of tho mombors should bo prosonl lor
the meeting. If the chairman of the committee is not present, the members
present may nominate one among the members, other than the convenor to chair
the session. Any member absent continuously for 3 meetings his or her name
may be deleted from the committee.
Minutes Book:- Convenor will convene the meeting every quarter and will
maintain the minutes of all meetings.
Bank Account:- Action will be taken by the Lady Medical Officer to open a joint
account in the nearest nationalized bank for remitting money collected as user
fees or public donations. The joint account holders will be the Lady Medical
Officer and one representative from an NGO nominated by the Board of Visitors.
Board Guidelines for using the funds:- The amount collected by each facility
may be utilized for the following purposes.
1.
2.
3.
4.
5.
Emergency purchase of Drugs & Equipments not available in the stores.
Minor repairs to equipments supplied
Purchase of plugs, sockets, bulbs etc., for the Health Centre.
Xeroxing, Postage, Stenciling & Stationary etc.
Minor Civil repairs including plumbing, electricity etc.
Period of the Committee:- The Board of visitor so constituted by the orders of
the commissioner based on the recommendation of the selection committee will
be in force for a minimum period of two year initially which may be extended for
one more year. There after the committee will be reconstituted.
TERMS & CONDITIONS OF HELP DESK
1.
The NGO will provide lady volunteers round the clock in
shifts to serve at the "Help Desk".
2.
The Volunteer will act as a liaison between the public and the
hospital to provide the services in case of any difficulty.
3.
The volunteer will assist those who approach the desk to obtain
required services, information and guidelines.
4.
The volunteer will assist the public
pertaining to services in the hospital.
5.
The IPP-VIII will provide a table and chair for the volunteer, at
the entrance.
6.
The IPP-VIII will provide a display board in different languages in the
hospital to inform the public of this service.
7.
The Hospital staff shall respond to the volunteer and immediately
attend to the request.
8.
The field staff of the UFWC attached to the Maternity Home shall
publicize the information regarding the Help Desk.
9.
An orientation programme of the hospital staff and volunteers to
define their roles will be organised by the IPP-VIII.
10.
Any problem encountered by the volunteer will have to be solved by
the Lady Medical Officer of the Maternity Home,.the superintendent
and other officers.
11.
The volunteer will be allowed the use of the telephone
purposes.
12.
Assistance given by the volunteer will be documented.
in
obtaining
8 hours
information
for official
CITIZENS CHARTER - RIGHTS OF THE CITIZEN
The Citizen has a Right to
The following Health Services
General Medical Care
Ante Natal Care
M.T.P.
Sterilization
Laboratory
Delivery
Immunization
Family Welfare
T.B. Control
★
★
★
★
The services of the Medical Officer from 9.00 AM to 4.00 PM.
The services of the doctor for emergencies round the clock.
In-patient services round the clock.
Timely Appropriate Referral Care.
Ambulance services in Emergency Situations
User charges as prescribed, all other services being FREE.
Laboratory Facility
In-Patient charges
M.T.P.
Minor Surgical Procedure
★
★
★
Rs. 10=00
Nil
Rs. 100=00
Rs. 100=00
Clean and Neat environment with good house keeping.
Hospital will be cleaned at 7.00 AM, 2 P.M. & 9.00 P.M.
Toilet will be cleaned at 7.00 AM, 2 P.M. & 9.00 P.M.
Clean Linen will be provided daily.
Polite courteous behaviour from all staff.
High Quality Health Care.
Be attended to within Tz an hour. In emergencies attention will
be immediate
Milk (250ml) twice a daily and 1 loaf of bread.
Seek redressal of a complaint.
w
The Patient has a responsibility to
★
Keep the environment clean.
*
Follow medical advice of the doctor.
*
Maintain harmony with staff and other patients.
*
Safeguard hospital property.
★
Insist on receipt for chargeable services
*
Discourage Bribery.
Participate in the hospital improvements
ATTENDANTS RESPONSIBILITIES
*
★
★
*
*
★
*
Keep the environment clean.
Follow medical advice of the doctor.
Maintain harmony with staff and other patients.
Safeguard hospital property.
Insist on receipt for chargeable services
Discourage Bribery.
Adhere to the visiting hours.
Page 1 of I
Main Identity
From:
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Sent:
Attach:
Subject:
"JANAAGRAHA" <janaagraha@vsnl.net>
<SOCHARA@VSNL.COM>
Monday, August 18, 2003 6:13 PM
Ward Planning Campaign intro 8.18.doc; urban poor w’shop note final.doc
Urban Poor in B'lore Workhop
Mr. Chandar and Dr. Narayan.
Janaagraha is undertaking its second phase with the Ward Planning Campaign (see attached letter)
This programme will facilitate the development of a three-year perspective plan in each ward.
The urban poor are an important, but often marginalized group of residents of their city and their
local area. We want to include them in the full process of ward planning, but also take lime to address
their unique concerns. Attached is a one page document on the Preliminary workshop for the urban
poor.
We are currently reaching out to experts in the ten issues that are relevant to slumdwellers. 1 lealth is
one of the most critical issues, and we hope to have your input and participation in the workshop and
subsequent activities. You both have tremendous experience both with the complex public health
issues, as well as the poor communities in Bangalore.
Please take a look at these documents and let us know if you are interested in participating in this part
of the campaign. I look forward to hearing from you.
Elizabeth Clay
JANAAGRAHA
#198,Nandidurg Road
Bangalore-560046
Ph. 3542381,3542382.3542977
Fax: 080-3542966
G-.T ,
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Ward Planning Campaign: Preliminary Workshop for the Urban Poor
The Ward Planning Campaign at Janaagraha will consist of 5 structured
workshops for all citizens of 10 target wards to identify their local issues and create a 3year perspective plan of their ward. A wide range of citizens will plan to improve their
roads, upgrade parks and address solid waste management and quality of life issues that
affect their everyday lives. During the 4-month process, they will discuss and cost
possible solutions, and prioritize their needs.
A large segment of each ward’s population live in slums. The everyday needs of
these communities are related to more basic infrastructure such as water supply,
community toilets, sewerage, and health. On August 30th, Janaagraha will hold a
preliminary planning workshop for the urban poor citizens of the ten wards. This event is
not a substitute for the main workshops, but an important supplement to the larger
process, so that the urban poor are better equipped to participate in these larger processes
This session is critical for several reasons. First, though the concerns in the slums
are “basic infrastructure”, many are quite complex in the implementation and require
more than one agency for proper execution. This session will offer an opportunity for
multiple agencies to address the compound nature of the problem and their role in any
solution. Second, because of the complexity of the issues, and their near exclusivity to
slums, it is important that the residents have enough time to discuss their needs before
entering the larger workshops where there will be less time for each problem. If only
representative slum-dwellers are present for the five workshops, it should not mean that
critical concerns were not considered. Third, the focused workshop will give them an
opportunity to use the map tools for their own (sub-neighborhood level) areas and give
them familiarity with the planning methodologies used in the mainstream workshop
sessions.
On September 6th, the residents of 65 slums in the ten wards will convene as a
slum community, and split up into the 10 issue sectors. Each sector group will discuss the
problems within that issue (example: Issue- Health, Problems- “No Primary Care
Facility”, “Children are not Vaccinated”). After identifying the problems, the citizens will
explore the potential solutions with agency heads and issue experts and each solution’s
feasibility. The outputs from this preliminary session will be valuable to the full
participatory planning process:
■ Specific problems will be identified for each slum in most issue areas for the Is'
workshop.
■ The discussion on solution feasibility will be valuable in the 2iul workshop
discussion on solutions for all identified problems.
■ After the Urban Poor Workshop, the relevant agencies can estimate costing for
the most common and complex concerns across slum areas, which will be used at
the 3ld workshop on costing.
All of these outputs from this session will ensure that the issues from the slum areas are
not marginalized at the mainstream workshops.
I
August 18th. 2003
Dear Friends,
Sub.: Citizen participation in local-level planning
Janaagraha has brought a different approach to the issue of public governance, specifically urban local
government.
• Janaagraha's first Ward Works campaign has given community groups and residents a platform to
be involved w ith the process of prioritizing for the Ward Works budget. Thousands of citizens in
many wards have worked together to decide what improvements they want to see in their own
areas, and worked constructively with you. their Corporators and BMP Engineers to see those
changes made.
• Janaagraha's second campaign called PROOF was launched in partnership with 3 other civil
society institutions: Public Affairs Centre, VOICES and CBPS. This campaign has completed one
year, and has been heralded as one of the international best practices in disclosure by
governments. The elected leadership and administration of the BMP have actively participated in
this campaign, and in fact led many of the activities in the campaign.
• The third campaign of Janaagraha was also in conjunction with the government, this time both
with the BMP and the DMA. This has been to revitalise the Urban Poverty Programme called
Swarna Jayanti Shehari Rozgar Yojana (SJSRY) in Bangalore. The DMA has taken leadership in
this activity, and a 6-month pilot project is currently under way in Bangalore, with the
involvement of the government, the banking system, the NGO sector and the poor. Already, the
results of the project have reached 50% of the record of the past 4 'A years.
After 18 months, we have completed the first phase of Janaagraha. We are now taking the next step by
launching a campaign for the generation of a 3-year Ward Plan, with the involvement of the BMP. the
citizens,, and other concerned agencies. In this process we will consider many issues that affect us as
residents including parks, garbage and sanitation, water and sewerage, roads, drains and quality of life
concerns.
In keeping with the approach of Janaagraha, a comprehensive and professional approach has been
designed, taking best practices from other states in the country and all over the world, into account. A few
such examples in our country are the Bhagidari plan launched in Delhi by Smt Sheila Dixit, and the
decentralised planning process that has been implemented in Kerala.
This programme launched on Independence Day, and will be spread over the next 4 months, with specific
grassroot-level activities in each of the participating wards. The ten wards (out of 100) have been identified
for the extraordinary atmosphere for citizen participation, and have all been taking part in the Monthly
Review Meeting process for a few months.
Hundreds of individuals have worked together on different aspects of the process so that citizens have a
useful framework within which to engage. The following are some of the details:
JANAAGRAHA
Participatory
Planning
Process
Elements
Ward Survey
Participants
700+ students
from seven
colleges.
Expert Panel
Over 50
professionals and
bureaucrats with
extensive subject
matter experience
Usage of Maps
Use of latest
satellite mapping
technology
available to
generate maps of
high accuracy and
detail as planning
tools
Community
Training
200 Active
Community
members, approx.
20 from each of
the target wards
Janaagraha
Community
Development
Fund
The first
participating
Federation is
Abyudaya in Ward
Purpose
To collect up-to-date, ground
level information about all
properties in the target wards.
BDA will use the citizen
planning outputs as input for
the CDP revision
To give Bangalore-specific,
cutting-edge, expert guidance
on costing and current policy in
each of the issue and solution
areas.
Maps are easy for all citizens to
understand and allow citizens to
discuss their neighborhood in a
comprehensive manner as a
group
Both at the individual and
group levels, citizens can be
more successful in their
endeavors if they improve their
communication, negotiation and
planning skills.
To aid the functioning of
community Federations at the
ward level, for a minimum
period until they are selfsustaining.
Details
Groups of students were trained
to capture important building
information: the process was
meticulous and carefully detailed
The fields of the expert panels
include: Roads, Water Suppl\.
Environmental Issues. Traffic and
Transportation and others
We will use maps to sensitize
citizens in our communications
activities, then they will identify
issues on the maps as individuals
and as a group; each workshop
will also include several
“thematic" maps, such as waler
supply and sewerage, public .
semipublic places, etc. of each
ward
Competency Development
Strategies (CDS) is currently
running two training sessions to
the communities in Team
Building and Meeting
Management.
The funding requirements are
being met through prix atc funders
who support the idea of
community engagement with
local governance issues.
Citizens will participate in a set of 5 workshops in each ward, held on Sundays. Each workshop will build
on the activities of the previous workshop. The topics covered during the workshops are: ISSUE
IDENTIFICATION, EXPLORING SOLUTIONS, COSTING AND REVENUE ANALYSIS, BUILDING
THE PLAN, and finally THE WAY FORWARD.
Another important event will be held during the last week of August. We will have a special workshop for
the poor in the slums in the ten target wards to discuss the important needs of the urban poor, before they,
participate in the main 5 workshop sessions. Your participation at this workshop is very important., the
event has tentatively been scheduled for the 30th August; however, we will confirm the date, time and
location.
This campaign will be an innovative step to bringing better quality public governance through citizen
participation.
Your support has been valuable to us in the last 18 months and we hope to have your continued
encouragement and collaboration with this campaign. You can be involved in many ways depending on
your interests and time, but we hope you can join us in some capacity. Please be in touch with ay questions,
comments or on how you can engage with this second phase of Janaagraha directly.
Sincerely
Swati Ramanathan
Campaign Coordinator
*
’Pane
qT 1
main iuciiui.y
rrom:
Communiiy Heaiin Ceii" ^socharafa;vsni.com>
To:
"JANAAGRAHA” <janaagraha@vsnl.net>
Sent:
Subject:
TtjRsday, August 1Q( 7003 A-36 PM
Rc: Urban Poor in D'iorc Workhop
Dear Elizabeth.
Thank you for your letter regarding the Ward Planning Campaign, it is an important initiative.
Chancer and Bnjendran from CHC are involved with health and related issues of the urban poor.
Dr. Mathew and Xavier are on a fellowship and placemeni^wnh CHC currently ana are also
focussing on iirbsn poverty Getting urban poor communities to voice their concerns, to
pZiOjutioC miid stratcgisc is unportaiiL Communities where our team works have coiisiScCiiuy
raised the issue ot alcohol abuse related to the easy availability and lack ot regulation of alcohol
sales and in fact its active promotion by government. One or more of the 4 team members will
1.
participate in rhe programmes mentioned by you
z.
y ou may ne aware ot me Peoples rieaim Tviovemenr.. the Jan Swasmya. Anniyan ar national ieve.1.
The state level proup is caled the Jan Arogya Andolana. A Peoples Charter for Health has been
developed md h available in Kaimada and English. Currently wc have two ongoing campaigns
the Right to Health Care Campaign and Hunger Watch. There is also an ongoing campaign
sgeinst female foeticide. In Komatoka we have had a series of 9 workshops on Primary Health
Care in different districts The Karnataka Health Task Force also focussed on strengthening
primary health rare ancTpnblir hpqltl^ Jan-3 Arogj^a Andhohna is going to conduct two training
w( )Th shops on herbal remedies m Selgaum ana Tuimui m oeptemuer f Ouiuuur.
With best wishes aad assuring you of our support.
reg; .rdo.
v,Trnr’s cinrwpl^
■ CiDr.Thelma Narayan
IS
==
4
8/19/03
g
♦
I nf 1
Main Identity
From:
To:
Cc:
Sent:
Subject;
"JANAAGRAHA” <ianaagraha@vsnl net>
"Dr.H.Sudarshan" <hsudarshan@vsnl.net>
<socnara@vsnl.com>
Wednesday, October 08, 2003 1:32 PM
Meeting - Performance Indicators for health
Dear Dr. Sudarshan,
30
R^gardsSh
^n^cators
hcahh has been scheduled for Wednesday the 15th of
Chailde1'ftom Comtnunity Health Cell will also be attending the meeting.
Preetha
JANAAGRAHA
#198?Naiididurg Road
Bangalore-560046
Ph. 3542381,3542382,3542977
Fax: 080-3542966
Page 1 of 1
Main Identity
From:
To:
Sent:
Subject:
"JANAAGRAHA" <ianaagraha@vsnl net>
"Dr.H.Sudarshan” <hsudarshan@vsnl.net>; <sochara@vsnl.com>
Tuesday, October 07, 2003 12:52 PM
Meeting on Saturday
Dear Dr. Sudarshan and Dr. Thelma,
This is just to check with you on the Saturday (11th October) meeting scheduled at Janaagraha to
discuss Performance Indocalors for health. Please do let me if I can confirm this meeting. I would
appreciate it if you could also confirm the time that you would prefer to hold this meeting.
Regards
Preetha
JANAAGRAHA
#198}Nandidurg Road
Bangalore-560046
Ph. 3542381,3542382,3542977
Fax: 080-3542966
9k_.
A
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10/8/03
9/11/03
Urban Poor Workshop Outcomes
September 10th
Health
At the Janaagralra Urban Poor Workshop, residents of 31 slums participated in sector
wise discussions about ten important infrastructure and service issues.
The discussion on Health, like the other 9 topics, was led by both a facilitator and an
expert in the field and each participant discussed the major concerns in their area. They
compiled a list of the following critical health problems and service gaps that affect slum
dwellers:
Prevention
1. 1 ,ack of proper sanitation facilities
2. Lack of proper immunization to children (particularly Hepatitis, which is too
costly).
3. Presidents want awareness programs about HIV/AIDS and other diseases
4. No medical care available lor many pregnant women and infant s
Health Services and Facilities
1 T ocal facilities cannot handle emergencies, they refer residents to expensive
facilities
2. Lack of Gov’t/Corporation hospital facility that is nearbv. often residents must
travel over 7 or 8 km to find an affordable facility
3. Without paving money cannot receive treatment at government hospitals, despite
the fact that care is officially free.
4. Doctor should be 24 hours, often arrive at facility and no doctor or nurse is
available
4^
*
J
A
Common Diseases that are not being adequately addressed: Dengue Fever, Tuberculosis,
Skin Diseases, Diarrhea, Wheezing and Typhoid
Hospitals are needed in the following Wards: 54,55,68,96 and 100.
9/11/03
t rtf t
Main identity
t-rom:
To:
Sent:
Attach:
Subject:
" JANAAGRAHA‘' <janaagraha(g)vsn I. net>
<SOCHARA@VSNLCOM>
Wednesday, September 10, 2003 4:25 PM
upw health outcomes.doc
urban poor workshop
Mr. Chander,
Thanks for your participation- as you requested T am sending you the outputs from the workshop
session on health, be in touch with any questions or response.
Best Regards,
Elizabeth
JANA AGP AHA
# 198,Nandidurg Road
Banealore-560046
Ph. 3542381,3542382,3542977
Fax: 080-3542966
Page 1 of 3
Main Identity
From:
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Subject:
”JANAAGRAHA” <janaagraha@vsnl.net>
<SOCHARA@VSNLCOM> ~
Friday. August 29, 2003 5:02 PM
u.p. newp&s grid.xls
follow up information on September 6th event
Dear Dr. Narayan and Mr. Chander3
Thank you very much for agreeing to participate in the Urban Poor Workshop on September 6th.
We are looking forward to a productive and successful event that will support residents of
approximately 40 slums in ten focus wards to make positive changes for their communities. We
have four specific objectives for this event:
■
Orient the urban poor to the methodologies to be used in the larger Ward Vision
workshops including exercises, use of ma ps and methodical identification of problems
and solutions. This will make their participation a fruitful, enriching experience for both
the poor and the middle class.
■
Create a forum that transcends greivance redressal and instead analyzes specific answers
and solutions from each agency.
■
Understand the complex nature of both the problems and solutions (as some will be
different from middle-class areas) and take steps towards addressing them.
■
Encourage the slumdwellers to participate in the five workshops held in their ward
between September and December.
The tentative agenda is as follows:
12-2:30 Registration and tea
i 2:30-2:45 Introduction to Workshop (by Conductor)
I
12:45-3:30 Conductor presents list of sectors; Communities divide their group into sectors so
j that each sector being discussed has a participant from every slum. Everyone moves into
‘ smaller rooms to discuss thenature of the problems within one issue area
■
i
I
' 3:30-4 In 10 sector rooms: Each room discussion focuses on a single sector only. Discussion of
. Problems and Solutionsafifecting each slum within that particular sector.fusing pre-determined
; grid, guided by facilitator, documented by volunteer)
I
14:00- 5:00 Interactive session between communities and agency head and/or sector expert to
■ discuss feasibility of solutions .
I
I
j 5:00 - 5.30: tea and snacks
As the sector expert you will play a critical role in the workshop. The role is not that of an
advocate for the residents. Identification of problems should come directly from the urban poor
themselves as far as possible. Following are the expectations of sector experts in each of the
smaller groups:
z
) b
9/1/03
^15.
Page 2 of 3
1. Facilitate open group discussion in the sector rooms both in identifying problems and
the one-hour session with agency head.
2..
Give valuable inputs where gaps are left in the discussion on potential causes of
problems, gaps in the system (of a larger nature that individual slums) and innovative
solutions.
3.
in the absence of semor representative from the respective agency / admmstration,
serve as principal resource on possible solutions. Solutions that the group determines
based on this discussion will be sent io that agency head for comments before the
main workshops.
Resources at the Workshop (all written material in Kannada):
Large pre-defined problem-solution grid posters for each sector. 1 hese posters
will include the problems and solutions that we have identified and blank
spaces for specific concerns that we have not yet considered. This may be a
usefill tool for the first part of the session.
Large slum-wise solution grid which will aid in plugging in potential solutions
for each represented slum.
Two-sided sheets with maps of areas on one size and list of all sector areas
with icons on other side.
We will also have volunteers who will help with registration, documentation
and other responsibilities throughout the workshop.
Please be in touch with Elizabeth at Janaagraha with any questions or clarifications about the
event. Wo look forward not only to your participation at the workshop, but to your valuable
contributions before and after September 6th.
Attached please find the defined problems and solutions for the sector you will facilitate. This is
a first cut, so please make additions and corrections to Health if needed so we may refine it in the
next few days.
Best regards.
Swali Ramanalhan
Campaign Coordinator
TANAACtRAHA
JANAAGRAHA
9/1/03
Page 3 of 3
4
r ■
Page 1 of 1
Main Identity
From:
To:
Sent:
Subject:
"Dr. H. Sudarshan" <hsudarshan@vsnl.net>
"JANAAGRAHA” <janaagraha@vsnl.net>; <sochara@vsnl.com>
Wednesday, October 08, 2003 4:46 AM
Re: Meeting on Saturday
Dear Preetha
For me 15111 or 16Q1 October is coiiveiieiiit for me.9.30AM would be convenient.
With regards
Sndarshan
*
/
\
*
Page 1 of 1
Main Identity
<*
I
*
I
i
!
From:
To:
Sent:
Attach:
Subject:
"JANAAGRAHA” <janaagraha@vsni.net>
"Dr.H.Sudarshan" <hsudarshan@vsnl.net>; <sochara@vsnl.com>
Tuesday, September 30, 2003 7:42 PM
Referral Hospitals.xls; PI for Health Note Sep 30.doc
PROOF - PerformaTice Indicators
Dear Dr. Sudarshan, Dr. Thelma and Mr. Chander,
j
Please find attached a write up based on our interaction at CHC last Thursday. Please review the
document and let me know iff have captured all the points that you had raised.
1 am also attaching information that we had collected from the Referral Hospitals of the BMP for
your reference to give you an idea of the kind of information we have collected.
Looking forward to your response.
Regards,
Preetha
JANAAGRAHA
tt 198,Nandidurg Road
Bangalore-560046
Ph. 3542381,3542382,3542977
Fax: 080-3542966
J'O
esiiii
'•MH
10/1/03
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10/1/03
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PERFORMANCE INDICATORS FOR HEALTH
■■
Background:
Over the past nine months (Year 1 of the PROOF campaign) the PROOF team has been
working on developing performance indicators for the health department of the
Bangalore Mahangara Palike.
Performance Indicators are means by which the efficiency and effectiveness of activities
can be assessed as well as a means of providing objective information to the involved
stakeholders.
A four-stage process has been identified to develop these indicators, these are:
1. Identifying specific performance indicators for health through an interactive
process involving the stakeholders.
2. Data collection from Referral hospitals, Maternity homes, Family Welfare centres
Health Centres and Dispensaries.
3 Data analysis based on the collected information
4. Management Discussion using performance indicators as the basis for objective
identification of successes and problem areas as well as specific solutions
The PROOF team has thus far developed 52 indicators for the Health department as
*
well as completed data collection from all the BMP institutions based on these indicators. ..
Data Entry has also been completed for 24 Maternity Homes as well as 6 Referral
hospitals.
In the second year of the campaign focus with respect to the Health indicators would be
to bring into the campaign a partner with expertise in the area of health care in order that
the performance measurement system can be further developed and applied towards
improving the quality of service delivery in these institutions.
Meeting at Community Health Cell:
Following an initial meeting with Dr. Sudarshan at his office to discuss opportunities for
partnership a second review meeting was held at the Community Health Cell with
;
Dr. Sudarshan, Dr. Thelma Narayan and Mr. Chander to review the work of the PROOF
campaign (represented by Preetha Radhakrishnan) as well as define a broad agenda for
partnership between PROOF, CHC and Karuna Trust.
The following points were raised at the meeting as points to be considered while defining
the scope of the performance indicator activity:
• The performance indicators developed by the PROOF campaign are
comprehensive. However these indicators will help assess the strengths and
weaknesses at the institution level
• In order to make the study more effective In terms of policy recommendations an
analysis of the entire system (BMP Health Department) needs to also be done.
• This study would cover aspects related to Budget allocations for health, Duties
and functions of the BMP with respect to health care, Current Policies and
procedures followed by the Health Department. Such a comprehensive study
would supplement the data gathered with the help of the performance indicators
and provide information white making policy recommendations.
• As partners in the PROOF campaign Karuna trust and CHC would facilitate this
study and provide all required inputs.
'■i
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•
•
While studying the performance of the Health department, the current scope of
the performance indicator framework should be expanded to emphasis the
Preventive and Promotive aspects of health care.
Given the technical nature of health care an intervention programme similar to
the one currently being implemented by Akshara Foundation in the area of
Education as a partner in the PROOF campaign may not be possible. Over the
course of the next two weeks a programme objective will be defined clearly.
Next Steps:
• Meeting to be held with Dr. Sudarshan, Dr. Thelma Narayan, Mr. Chander and
Mr. Ramesh Ramanathan to discuss the scope and objectives of the partnership.
This meeting is tentatively scheduled for the 11th of October.
• A prior meeting between Mr. Chander and Preetha share the information
collected by PROOF as well as CHC with respect to the BMP health department.
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5th main road,
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MC Layout
27th Cross,
Vgayanagar
Bangalore-70
Bangalore-40
S-reerampum
Refeoal
Hosiutel
Referral
Sreerampura
Bangalore- 21
3350810
3128447
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ICCD Procedures
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20.32-2003
29
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20-31-2002
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-—J
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20022003
tNumber
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2002__
Number of immunizations
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0
0
1-30
156
i; 1523
385_______ i°«o
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170
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400
480
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1812
11184
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2166
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2400
2000
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42 15000/year
140
140
100
40
120
45
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(per day)
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200220-33
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8430
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4564
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2001 2002200120-3220-31 2002 200120-3220-31 -
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Number ofMedically
.A
__ ____ TH_______ 1608
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20-312002-
for ante natal care_________
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i£i
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20-32-2003
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407
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2002-______________ 65___________ 24$ ;__________ )_______________ 4 no___________ "
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Number of cases
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referred to
2001,____ _
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>36
major hospitals
tals iReferrals)
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200230
2
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Numbcr cfprescription
iresoiption slips
20017Q0:
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[2002»30|
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Number cfvisits by the
20)1 _ ______ 2.5 : : - ; .
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Supervisor
.
21
Number ofvisits by the health 2031- .
3
6
_____________
20322
officer
I I t M j 30 ------- ^-211,
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Use of equipment as per
2031yes^
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20312032Number ofneo ratal deaths
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2002-
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(birth to 30 days)
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Number ofmeasles cases
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2032-
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HUM
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I
CONTENTS
l.A. PERFORMANCE INDICATORS - AN OVERVIEW
l.B. PERFORMANCE INDICATORS FOR EDUCATION
!
2.
SCHOOL INTERVENTION PROGRAMME - AKSHARA
FOUNDATION
J
I
i
APPENDIX A: INTRODUCTION TO PERFORMANCE
MEASUREMENTS
APPENDIX B: PERFORMANCE INDICATORS FOR EDUCATION
*
APPENDIX C: SAMPLE DATA COLLECTION FORM
APPENDIX D: METHODOLOGY OF DATA ANALYSIS
APPENDIX E: PERFORMANCE INDICATORS - DESCRIPTION
SHEET
1
l.A PERFORMANCE INDICATORS - AN OVERVIEW
A holistic assessment of the performance of a government entity necessitates information, on both
the source and use of resources as well as the efficiency and effectiveness of the activities being
performed. This means that in addition to analyses of government budgets and financial statements,
other measures of performance need to be used to estimate the quality of service delivery.
Traditionally, the focus of government performance assessment has been on resource mobilization
and usage, however a more complete framework of information would include not only measures
of service efforts / resources, but service accomplishments and the relationship between efforts and
accomplishments.
Performance measurement is essentially, an assessment of how well an organization (a government,
in this case) performs when providing goods and services. Performance measurement can be made
by developing measures or indicators of the volume, quality, efficiency and outcomes of public
services.
Performance information provides the systematic framework, within which the administration
elected representatives, and the public can identify and monitor the missions, goals and objectives
of public services.
There are different ways of measuring performance; the PROOF campaign has adopted the
methodology developed by the Governmental Accounting Standards Board (GASB), a five —
indicator framework measuring service efforts and accomplishments1. These are:
iWasnrr of Rennet
Efforts
ijnput ijnoicarors
iWaourcof fetroicr
fftcromplfcftmtnts
lOurput fjnoiraroro
lOutcomr ijntrirarors
iMeaetttc that rdarc France
fffom ro flcromplisbmetits
Mfinemy ijniricarors
l&rotmctW ijncricarors
1 Refer Appendix A Introduction to Performance Measurements
2
l.B PERFORMANCE INDICATORS FOR EDUCATION
The PROOF campaign was launched on July 4th 2001 with the objective of putting in a place a
systematic structure of performance reporting along the lines of the private sector. The PROOF
document, which defines this structure, has three principal components:
Public Record Of Operations and Finance
Financial Statements
>
>
Revenue and Expenditure Statement
Assets and Liabilities (form of Balance Sheet)
Performance Indicators
>
Barometers of efficiency
Management Discussion & Analysis
>
Areas of focus, concern and priorities
Performance Indicators provide the scope for non-financial analysis thereby forming the crucial
link between analyzing financial statements and management decision-making.
Over the past 4 months the PROOF campaign has been working with the education department of
the Bangalore Mahanagara Palike to develop performance measures. A four-stage process has been
identified for developing these measures:
3
1. Identifying specific performance indicators for Education through an
interactive process involving all stakeholders.
CITIZENS
BMP ADMIN
PERFORMANCE
INFORMATION
ADVOCACY
GRPS
STATE GOVT
ELECTED REP’S
PARENTS
Over the course of two workshops 47 indicators were identified for the Education Department
covering the dimensions of: Infrastructure, Teaching Staff, Accountability, Community
Involvement, Subject Based, Financial, Other 2
2. Data collection from the schools of the city corporation
3
xy 8>dj
32
n
2 Refer Appendix B Performance Indicators for Education
3 Refer Appendix C Sample Data Collection Form
4
Generators of Performance Information- Bangalore Mahanagara Palike
< Senior \
Management
lOjief plcnninrs Ulfficrr
Middle Management
Operational Level
Erarijm# feraff
3. Data analysis based on the collected information 4
Developing composite indices
leudl
Composite ijnsrirurion ijnoe^
leudZ
Composite i)nse^ for cacb Catroorp of rbe fiurinoicator framnuorb
lnjd3
Composite ijnijex for eacb dimension of rhe B oimensions
leueiti
Ektaflet) {Jnoe* for eacij of the 46 indicators toentified
4 Refer Appendix D Methodology of Data Analysis
5
4. Management Discussion using performance indicators as the basis for
objective identification of successes and problem areas as well as specific
solutions
Using the framework of performance information the PROOF campaign along with the
BMP has now identified five schools from among the 33 high schools of the city
corporation, requiring immediate stakeholder intervention. Over the course of the next few
months an action plan for intervention will be to improve service delivery in the 5 selected
schools.
This kit provides information on the conceptual framework behind performance measurements as
well as the action plan to facilitate stakeholder involvement in the identified schools.
6
2. SCHOOL INTERVENTION PROGRAMME - AKSHARA
FOUNDATION
SEVEN SCHOOL PROFILE
I.
Corporation iSirts primary School jftarayan ^iUai
£>trtrt
2.
ihafi^a Corporation ihipber Clanrnrary School
iBroaOuiay
3.
Corporation ibiober JJtnncmarp J&ctjool Hasher Houin
4.
Corporation fyipber primary School /THarappan i&alya
5. Corporation Cjipber Ctentrnrary School fcjlsoor
8.
Corporation iiiohcr Ctanrnrary School pusrin Houin
7. Corporation tyipber Ctnncnrary School jlkrlasanora
Theme based intervention:
Theme Ilnfrastructure
Example: Physical Infrastructure such as Toilets, Playgrounds, Classrooms as well as Facilities
such as Water Supply, Electricity and Security
Theme II
Community Involvement
Example: Formation and functioning of the SDMC
Theme III
Scholastic Outcomes
Example: Pass percentage, Minimum levels of learning , Attendance rates
7
APPENDIX A; INTRODUCTION TO PERFORMANCE
MEASUREMENT
Government Accounting Standards Board (GASB) on Performance Measurement
What exactly is performance measurement?
Simply put, it is the assessment of how well an organization (a government, in this case)
performs when providing goods and services. In other words, it is the process of asking and
answering the questions above. Performance measurement produces information that can be
used to help make decisions. Literally, it creates measures or indicators of the volume, quality,
efficiency and outcomes of public services. Like the measure "miles per gallon" for an
automobile, the products of performance measurement are yardsticks we can use to figure out if
government is working well or poorly, or somewhere in between.
What is so important about performance measurement?
Governments should be accountable for the proper use of tax dollars and for providing the
services citizens demand. Performance measures equip citizens with the information necessary
to ensure accountability—to make sure that governments do what they are supposed to and
achieve results that will improve people's lives.
Successful long-range planning requires reliable and useful data. Performance measures give
governments the kind of information they need to make accurate assessments of what has
happened and what needs are not being met, and to devise a plan to meet those needs.
Governments also require this information to ensure their day-to-day operations run smoothly.
In general, performance measures aid persons in making decisions. For example, suppose you
are planning to move and want to compare the schools in several districts. Will my child get
enough attention from the teacher? Comparing each school's number of students per teacher
might help to answer your question. Are the classes crowded? Check the student-to-classroom
ratio. What about academic standards? Take a look at graduation rates, mastery test scores, or
changes in student achievement as they progress through the school system. These and other
measures give you the ability to make informed choices.
A municipal sanitation department could use performance measures to decide how to respond
to rapid residential growth (and, therefore, increased demand for garbage collection). Two
indicators could help the department determine if there is enough room in the trucks and if the
workers have enough time to collect the additional garbage: Tons per truck shift (how much
trash, on average, each truck collects each day) and the average number of hours it takes
workers to complete a daily collection route. If the tons per truck are below capacity and routes
are completed in less than a full day, then the extra trash could be collected by simply
extending the routes. If the opposite is true, then the department will have to buy more trucks
and hire more employees.
Performance information is needed for:
•
Setting goals and objectives
8
•
Planning program activities to accomplish these goals and objectives
•
Allocating resources to programs
•
Monitoring and evaluating results to determine if progress is being made toward achieving
the goals and objectives, and
•
Modifying program plans to enhance performance.
Performance measures organize information for use by the decision-makers engaged in those
activities. Through the measurement, analysis, and evaluation of performance data, public
officials can identify ways to maintain or improve the efficiency and effectiveness of activities
and provide the public with objective information on their results.
What characteristics should performance information possess?
Relevance
■
Understandability
■
Comparability
Timeliness
■
Consistency
■
Reliability.
What role can citizens play in performance measurement?
Although more governments are engaging in performance measurement than ever before,
according to a Government Accounting Standards Board (GASB) survey more than half still do
not. Furthermore, only one out of five governments reports its performance measures to the
public.
Citizens are the largest and most important audience for performance measures, but most do not
have the opportunity to use such information to make decisions. Citizens should let their
governments state, city, county, village, school district—know that performance measures are
crucial, and ask that they be collected and reported to the public. Citizens and governments
should collaborate to identify what performance information is needed, to develop useful
measures and to establish a system for collecting and reporting those measures.
TYPES OF PERFORMANCE INDICATORS WITH EXAMPLES
Input Indicators.
Government Accounting Standards Board (GASB) defines them as indicators that are designed
"to report the amount of resources, either financial or other (especially personnel), that have
9
been used for a specific service or program. Input indicators are ordinarily presented in budget
submissions and sometimes external management reports."
Examples of such indicators include total dollars spent, the number of teachers or nurses
employed, or the number of garbage trucks or fire engines used.
Output/Workload Indicators.
These indicators report units produced or services provided by a program. Workload measures
indicate the amount of work performed or the amount of services received.
For example, school graduation rates, number of patients treated in the emergency room, tons
of garbage collected, or number of fires extinguished.
Outcome/Effectiveness Indicators.
These measures are designed to report the results (including quality) of the service. According
to Paul D. Epstein, "effectiveness measurement is a method for examining how well a
government is meeting the public purpose it is intended to fulfill. In other words, effectiveness
refers to the degree to which services are responsive to the needs and desires of a community. It
encompasses both quantity and quality aspects of a service."
Examples of outcome indicators are the change in students' test scores, change in the value of
property lost due to crime, cleanliness ratings based on routine inspections describing a city's
success (or lack thereof) at cleaning its streets or parks. To gauge its success, a fire department
might track the number of fire-related deaths and injuries, or the dollar value of property lost to
fire. A hospital might utilize mortality rates and the results of random patient surveys. A school
district might collect information on the percentage of graduating students gainfully employed
or continuing education two years after graduation.
Efficiency (and Cost-Effectiveness Indicators).
As Epstein defines them, efficiency measurement is a method for examining how well a
government is performing the things it is doing without regard to whether those are the right
things for the government to do. Specifically, efficiency refers to the ratio of the quantity of the
service provided (e.g., tons of refuse collected) to the cost, in dollars or labor, required to
produce the service. According to GASB, these indicators are defined as indicators that
measure the cost (whether in dollars or employee hours) per unit of output or outcome.
Examples of input-output comparisons include annual cost per inmate in jail, cost per lane-mile
of road repaired, and ratio of nurses to patients discharged.
Input-outcome measures include cost per inmate successfully rehabilitated, cost per lane-mile
of road maintained in good or excellent condition, and cost per patient cured without remission.
Productivity indicators.
David N. Ammons defines productivity indicators as combining the dimensions of efficiency
and effectiveness in a single indicator. For instance, whereas "meters repaired per labor hour"
reflects efficiency, and "percentage of meters repaired properly" (e.g., not returned for further
repair within 6 months) reflects effectiveness, "unit costs (or labor-hours) per effective meter
repair" reflects productivity. The costs (or labor-hours) of faulty meter repairs as well as the
costs of effective repairs are included in the numerator of such a calculation, but only good
repairs are counted in the denominator—thereby encouraging efficiency and effectiveness of
and by meter repair personnel.
Explanatory Information
In many cases, along with the above-mentioned indicators, some additional information is
needed to make a sound judgment about service provision. GASB, for example, specifies
10
certain types of Explanatory Information for its suggested list of indicators for service efforts
and accomplishments. GASB defines a variety of information about the environment and other
factors that may affect an organization's performance on Service Efforts and Accomplishments
indicators, for example weather conditions for road maintenance.
Explanatory information includes socioeconomic and other factors that are largely beyond the
control of government, such as median household income, inflation, and annual inches of
snowfall. It also covers factors within the government's control, like ratios of public employees
to service recipients.
11
APPENDIX B: PERFORMANCE INDICATORS FOR EDUCATION
INPUT
INFRASTRUCTURE - Number of toilets.
- Number / Area of
playgrounds.
- Number of classrooms.
- Height of the ceiling.
OUTPUT
OUTCOME
EFFICIENCY
PRODUCTIVITY
EXPLANATORY
- Number of children per
classroom.
- Availability of library.
- Availability of electricity.
- Availability of drinking
water.
- Availability of Laboratory.
- Classroom furniture
Tables
Chairs
- Classroom equipment
Blackboards
Chalk
Dusters.
- Teaching material
Teacher guide
Library Books
Storage Area
Globe
Science Kit
Maths Kit
Musical Instruments
Toys
Art and Craft Material
12
TEACHING STAFF
- Number of teachers in the
school.
Full Time
Part Time
OOD
- Teacher attendance rates.
- Pupil teacher ratio.
- Number of
teachers teaching
outside their
primary subject
area.
- Average teacher salary.
Junior
Senior
Head Master / Head Mistress
- Number of teachers meeting
pre-service qualification
requirement.
- Number of in-service skill
training programmes.
ACCOUNTABILITY
- Pass percentage.
- Reduction in
absenteeism rates.-
-Attendance rates by sex.
-Completion of daily
lesson plan
- Reduction in
Dropout Rate
-Completion of
Programme of works
- Minimum levels of
learning (MLL)
- Test scores
13
COMMUNITY
INVOLVEMENT
- Existence of SDMC / SBC/ - Number of meetings.
or PTA.
- Number of parent
attendees per meeting.
- Number of OTHER
nominees attending.
- Availability of
information kit.
- Availability of minutes
book.
- Availability of
complaints book.
SUBJECT BASED
- Number of language
teachers.
- Number of teachers for other
subject
FINANCIAL
- Total expenditure on
Infrastructure
Salary
Equipment.
OTHER
- Number of complaints
received to Number of
complaints redressed.
- Fees per student.
- Cost per student.
- Distribution of supplies
Uniforms
Text Books
Notebooks
- Number of extra
curricular activities.
- Number of Transfer
- Cohort compliance
certificates (TC) applied rates.
for to Number of Transfer
certificates (TC) issued
- Number of
students attending
only for mid day
meals.
- Immunisation.
- Number of first
generation school
goers.
14
APPENDIX C: SAMPLE DATA COLLECTION FORM
DATA COLLECTION FORM FOR PERFORMANCE INDICATORS
SECONDARY SCHOOLS.
GENERAL INFORMATION
Name of School:
Name of Principal:
Location:
Phone No:
Ward Number:
Year of Inception:
Number of sections per class:
Medium of Instruction:
PERFORMANCE INDICATOR INFORMATION
I.
INPUTS
These are indicators that are designed to report the amount of resources, eitherfinancial or other
(especially personnel), that have been usedfor a specific service or program.
INFRASTRUCTURE
SCHOOL LEVEL
■ Number of toilets:
Male
Female
Common
16
■
Availability of safe and adequate drinking water for the children: Y
I
N
Number of playgrounds:
Total Area of the playground:
Number of Buildings:
Number of classrooms:
Y / N
Availability of library
Availability of laboratories
Science
Y /
Computer Science
Y
N
I
N
Y /
Availability of electricity
N
CLASSROOM LEVEL
Class 10
Class 9
Class 8
Area of the classroom
Height of the ceiling
Are the Number of Tables
or Writing Stations
adequate
Y
I
N
Y
I
N
Y
/
N
Are the Number of Chairs
or Benches Adequate
Y
I
N
Y
/
N
Y
/
N
Blackboard
Y
/
N
Y
I
N
Y
I
N
Chalks
Y
I
N
Y
I
N
Y
I
N
Dusters
Y
/
N
Y
I
N
Y
/
N
Teacher’s Guide
Y
/
N
Y
I
N
Y
/
N
17
Junior
Senior
Head Master
CLASSROOM LEVEL
Class 8
■ Number of
Teachers
Class 9
Class 10
Full
Time
Part
Time
OOD
(Off on
Duty)
COMMUNITY INVOLVEMENT
SCHOOL LEVEL
■
Does the school have an SDMC (School Development and Monitoring Committee).
SUBJECT BASED
SCHOOL LEVEL
■
Number of language teachers in the school.
Hindi
Kannada
Tamil
Sanskrit
Urdu
Other
Total
19
Science Kits
Y
/
N
Y
/
N
Y
/
N
Math’s Kit
Y
/
N
Y
/
N
Y
/
N
Globe / Atlas
Y
/
N
Y
/
N
Y
I
N
Library Books
Y
/
N
Y
/
N
Y
/
N
Musical Instruments
Y
I
N
Y
/
N
Y
I
N
Storage area for material
Y
/
N
Y
I
N
Y
/
N
Sports Equipment
Y
/
N
Y
/
N
Y
/
N
Art and Craft Material.
Y
I
N
Y
/
N
Y
/
N
TEACHING STAFF
SCHOOL LEVEL
Number of teachers meeting pre-service qualification requirements.
■
Number of annual in-service skill training programmes in:
1999-2000:
2000-2001:
2001-2002:
2002-2003:
Average teacher salary (Rs. per month) (Gross)
18
■
Number of teachers for each other subject.
English
Maths
Social Studies
Science
Total
FINANCIAL
SCHOOL LEVEL
■
Annual expenditure on physical infrastructure such as buildings and furniture.
■
Annual expenditure on other teaching equipment.
■
Annual expenditure on teachers salary.
■
Annual expenditure on salary of administrative staff.
II OUTPUT
These indicators report units produced or services provided by a program.
A. TEACHING STAFF
SCHOOL LEVEL
Teacher attendance:
Irregular
Regular
20
No of vacancies:
(Number of Sanctioned Posts - Number of teachers)
B. ACCOUNTABILITY
CLASSROOM LEVEL
Class 8
Pass percentage
19992000
Class 9
Class 10
F
M
20002001
F
M
2001 2002
F
M
20022003
F
M
■ Enrollment by Sex
1999 2000
F
M
20002001
F
M
20012002
F
M
2002 —
2003
F
M
21
■ Average attendance
rates (%)
19992000
F
M
20002001
F
M
2001 2002
F
M
20022003
F
_____ L_
M
Are Minimum Levels of learning
(MLL) attained?
Y
/
N
Y
/
N
Y /
N
Y
N
Average test scores
■ Completion of Programme of works.
Y
/
N
/
Y
/
N
■ Completion of Daily lesson plan.
Y
/
N
Y
/
N
Y
/
N
F=Female M= male
C. COMMUNITY INVOLVEMENT
SCHOOL LEVEL
■
Number of SDMC meetings per annum.
■
Average number of parents attending SDMC meetings.
■
Average number of other members attending SDMC meetings.
■
Availability of minutes books during the SDMC meeting.
■
Availability of a complaints register.
22
Availability of SDMC information kit.
D. OTHER
SCHOOL LEVEL
Distribution of supplies (Per annum)
No of Uniforms Distributed:
No of Text books distributed:
No of Notebooks distributed:
How many extra curricular activities does the school provide:
Music
Games
Debate / Public Speaking
Crafts
Yoga
Drawing and Painting
Others
23
Ill OUTCOME
These measures are designed to report the results (including quality) of the service.
A. ACCOUNTABILITY
CLASSROOM LEVEL
Class 8
Absenteeism
rates (%)
19992000
Class 9
Class 10
F
M
20002001
F
M
20012002
F
M
20022003
F
M
Drop out rates
(%)
19992000
F
M
20002001
F
M
20012002
F
M
24
Drop out rates
(%)
20022003
F
M
F=Female M=Male
IV EFFICIENCY
These measures are designed to report the ratio of the quantity of the service provided to the cost, in rupees or
labor, required to produce the service.
A. INFRASTRUCTURE
SCHOOL LEVEL
Number of children per classroom
B TEACHING STAFF
SCHOOL LEVEL
Pupil teacher ratio.
CLASSROOM LEVEL
Class 8
"
Class 9
Class 10
Pupil teacher ratio.
C COMMUNITY INVOLVEMENT
SCHOOL LEVEL
■
Number of complaints received to number of complaints redressed.
D SUBJECT BASED
SCHOOL LEVEL
■
Number of language students to number of language teachers.
25
E FINANCIAL
SCHOOL LEVEL
■ Fees per student.
Cost per student
F OTHER
SCHOOL LEVEL
■
Number of Transfer certificates applied for to number of Transfer Certificates issued.
V. PRODUCTIVITY
Cohort compliance rates
Average Age of entry at class Eight:
Average Age of exit at class Ten:
VI. EXPLANATORY INFORMATION
A TEACHING STAFF
SCHOOL LEVEL
■
Number of teachers teaching outside their primary subject area.
B OTHER
SCHOOL LEVEL
■
Number of first generation school goers
■
Number of children immunised as per requirements.
■
Number of students attending only for mid- day meals.
26
APPENDIX D: METHODOLOGY OF DATA ANALYSIS
SNAPSHOT OF PERFORMANCE INDICATORS ON EDUCATION
Dimension
Infrastructure
Teaching
Staff
Community
Involvement
Accountability
Subject Based
Financial
2
2
Other
TOTAL
Category
Input
7
■ Output
6
1
1
4
2
1
1
3
1
7
1
1
Productivity
I TOTAL
17
4
8
2
: Outcome
Efficiency
19
9
8
6
10
2
5
>
The table above represents the break down of identified Performance Indicators for Education across the fiveindicator framework.
>
These five indicators are categorised as Input, Output, Outcome, Efficiency, and Productivity indicators.
6
The identified Performance indicators for Education fall under seven broad dimensions, namely Infrastructure,
Teaching Staff, Community Involvement, Accountability, Subject Based, Financial and Other.
>
The values in the cells represent the number of Performance Indicators for each Category and Dimension. For
example there are 8 Performance Indicators, which fall under the classification Input Infrastructure.
27
46
LEVELS OF INDICATORS
IHSTITVHOH
INPUT
OUTPUT
LEVEL 1
LEVEL 2
OUTCOhE
EFFICIENCY
I
INFRASTRUCTURE
TEACHING
STAFF
FINANCIAL
PRODUCTIVITY
I
I
COMMUNITY
INVOLVE KENT
SUBJECT
BASED
LEVEL 3
Open Space per
Student
LEVEL 4
Number of Toilets
Per Student
Level 1
Level 2
Level 3
Level 4
Composite Indicator for the
Institution._____________
Composite Indicator for each
Category.
Composite Indicator for each
dimension._____________
Detailed Indicator for each
dimension.
28
REFERENCE TABLE
Conversions Formulas and Weight Assignments.
Dimension
Level 4 Indicator
Conversion Formula
Score
Weight for
Level 3
Weight for
Level 2
Infrastructure
- Number of toilets
Number of toilets / Prescribed
Value * 100__________
OSS / Prescribed value * 100
50
75%
25%
50
25%
- Open space per
student (OSS)
Teaching Staff
Weight for
Level 1
35%
INPUT
10%
Subject Based
15%
Community
Involvement
10%
Financial
TOTAL
15%
100 %
100%
OUTPUT
10%
OUTCOME
20%
EFFICIENCY
PRODUCTIVITY
25%
35%
TOTAL
100%
>
Level 4 Indicators represent detailed indices for each dimension falling under a category. Forty-six Level 4 indicators have been identified for Education.
>
The conversion formula forms the basis for converting the level 4 Indicator into a score.
>
Level 3 weighting assigns weights to each Level 4 indicator within a dimension according to its perceived importance within the dimension.
29
>
Level 2 weighting assigns weights to each Dimension within a category according to its perceived importance within the Category.
>
Level 1 weighting assigns weights to each Category in the five-indicator framework according to its perceived importance.
EXAMPLE: CALCULATION OF WEIGHTED INDICES
Dimension
Level 4 Indicator
Score
Infrastructure
- Number of toilets
50
Level 3
(Score * Level 3 Weight)
50 * 75%
- Open Space Per
student
50
50 * 25%
Composite Input
Infrastructure Index
37.5+ 12.5
Level 1
Composite Input
Infrastructure Index *
Level 2 Weight
50 * 25%
50
Teaching Staff
INPUT
Level 2
Composite Input
Teaching Staff Index
Composite Input Teaching
Staff Index * Level 2
Weight
25 * 35%
Subject Based
Composite Input Subject
Based Index.
Community
Involvement
Composite Input
Community Involvement
Index.
Financial
Composite Input
Financial Index.
Composite Input Subject
Based Index * Level 2
Weight
Composite Input
Index * Level 1
Weight
26.75 * 10%
10 * 15%____________
Composite Input
Community Involvement
Index * Level 2 Weight
10 * 10%_____________
Composite Input Financial
Index * Level 2 Weight.
20 * 15%___________
Composite Input Index
12.5 + 8.75+ 1.5 + 1 + 3 =
26.75
30
APPENDIX E: PERFORMANCE INDICATORS - DESCRIPTION SHEET
INPUT
DETAILS
RAW SCORE
CONVERSION
Number of Students / Number of Toilets.
Ratio
Median / Ratio* 100)
Open space per student
Area of the Play Ground / Number of Students
Ratio.
Ratio / Median* 100
Room space per student
(Total Class room Area * Number of class Rooms ) / Number of Students.
Ratio.
Ratio / Median* 100
Height of the Ceiling
Gives the height of the ceiling in feet.
Height in feet
Ratio / Median* 100
School facilities
This indicator takes into account availability of water, library, lab facilities and electricity.
Four point scale Score/4 * 100
score.
Classroom Furniture
This indicator takes into account the availability of Writing Tables and Benches.
Score on a two
point
Score / 2*100
Teaching Equipment.
This indicator takes into account teaching material such as availability of blackboards, chalks,
books, maths and science kits etc.
Score on a 123oint scale.
Score / 12 *100
Score on a one
point scale
Score / I *100
INFRASTRUCTURE
Number of Students per toilet.
TEACHING STAFF
Number of teachers meeting pre Number of teachers meeting pre service requirements. Qualitative response.
service qualification requirements
Total. Number of training
Programmes
The total number of training programmes over the past four years.
Number.
Number / Median * 100
Average Teacher salary Junior
Teachers Salary for Junior Level, if a range is given the average was taken.
Salary
Salary / Median * 100
Average Teacher salary Senior
Teachers Salary for Senior Level, if a range is given the average was taken.
Salary
Salary / Median * 100
Salary of HM
Teachers Salary for HM Level, if a range is given the average was taken.
Salary
Salary / Median * 100
OOD - Off on Duty. Includes teachers on the pay role of the school on deputation to another
school.
Number.
Median / Number * 100
Number of OOD teachers.
31
COMMUNITY
INVOLVEMENT
Does the School have an SDMC / The indicator estimates the number of parent teacher interactions.
SBC or PTA
Number
Number / Median * 100
Number
Number / Median * 100
Number
Number / Median * 100
SUBJECT BASED
Number of Language teachers in
the school.
financial"
Total Salary Expenditure
Annual Expenditure on salary of teachers and administrative staff.
OUTPUT
TEACHING STAFF
Teacher attendance.
Qualitative Response.
One point scale Score/Median * 100
score
COMMUNITY
INVOLVEMENT
Number of SDMC meetings per
annum.
Number of parent teacher meetings in a year.
Average percentage of parents
attending SDMC meetings.
Average Number of other
members attending SDMC
meetings.
Material For SDMC meetings.
This includes information on availability of complaints register, minutes book and information
kit.
Qualitative response.
ACCOUNTABILITY
Class ten pass percentage 20012002
Average Pass Percentage Class
Ten
Average pass percentage over the past three years.
Gap between Pass Percentage in St^dninr66"
Class Eight / Nine and Class Ten
Number
Number / Median * 100
Percentage
Percentage / Median * 100
Number
Number / Median * 100
3 point scale
Score.
Score / 3 *100
Percentage
Percentage / Median *100
Percentage
Percentage / Median * 100
aVerage PaSS perCentage in class ten and avera.“ P^s percentage for class Ventage.
Median / Percentage * 100
Total Enrollment in 2002-2003
Average attendance for Class 8, 9
and 10 in 2002-2003
Minimum levels of learning
(MLL)
MLL as perceived by the principal for class eight nine and ten.
Number
Number / Median * 100
Percentage
Percentage / Median *100
3 point scale
Score.
Score / 3 *100
32
Average test Scores
Average test score for class 8? 9 and 10.
Qualitative response.
Percentage.
1 point scale
score
Percentage / Median *100
Score / 1 * 100
1 point scale
score
Score / 1 * 100
Distribution of Supplies
Number of uniforms
1 Point scale
score
Score / 1*100
Distribution of Supplies
Number of textbooks.
1 point scale
score
Score / 1*100
Distribution of Supplies
Number of notebooks.
1 point scale
score
Score /1*100
Number of extra curricular activities provided by the school
Seven Point
Scale score.
Score/7 *100
Average absenteeism rates for class eight nine and ten over the past four years.
Percentage.
Median / Percentage * 100
Number of Children per classroom Number of children / Number of classrooms.
Ratio.
Ratio / Median *100
TEACHING STAFF
Pupil teacher ratio
Ratio.
Ratio / Median *100
Ratio.
Ratio / Median *100
Fees
Fees / Median * 100
Completion of Programme of
Works:
Completion of Daily Lesson plan Qualitative response.
OTHER
Extra Curricular activities.
OUTCOME
ACCOUNTABILITY
Average Drop Out Rates
EFFICIENCY
INFRASTRUCTURE
Number of teachers / Number of students.
COMMUNITY
INVOLVEMENT
Number of complaints received to Qualitative Response,
number of complaints redressed
FINANCIAL
Fees per Student Regular
Rs per student per annum.
33
Fees per Student SCST
Rs per SC /ST student per annum.
Fees
Fees / Median * 100
Salary Cost per student.
Total Salary Expenditure / Number of students.
Ratio
Median / ratio * 100
Age of entry at class eight
Average age should be 13
Age of entry at class ten
Number
Number / 13 * 100
Average age of exit should be 16.
Number
Number / 16 ♦ 100
PRODUCTIVITY
OTHER
34
COMMUNITY HEALTH AND EPIDEMIOLOGY
1.
Concepts of Health
•
Definitions : Health, Community Health,
Public Health
Determinants of Health
•
Primary Health Care - Alma Ata Declaration
Causation of diseases
Indices in the measurements of health
•
Community participation, Organisation and
Mobilization for Health
2.
Environment and Health
•
Physical, biological, social, economic and
cultural environment
•
Water : safe drinking water; sources of water
•
Sanitation; waste disposal
•
Pollution : air, water, soil
•
Housing
Pesticides
3.
Health Promotion
Health education
•
I
Healthy lifestyles. Control of use of alcohol,
tobacco, addiction, forming drugs
•
4.
J. 5.
1
School health
Communication for Health
•
Individual, group, mass
•
Media - folk, electronic, print
Food and Nutriton
•
Food security; nutrition security
•
National nutrition policy
•
Malnutrition. Anaemia.
•
Food hygiene. Safety of food. Food
adulteration.
1
6.
Occupational Health
•
Physical, chemical, biological and social
hazards
•
Effects of heat, humidity, cold, radiation, noise
on health
7.
•
Accidents; injuries
•
Factories Act. Employees State Insurance Act
Medical Sociology
•
Socio-cultural factors related to health and
disease
•
Rural and urban communities; impact of
urbanization
8.
Health Care Facilities
•
Public Sector : Primary Health Centres, sub
centres, Community Health Centres, Sub
district and District Hospitals, Teaching
Hospitals, Speciality Hospitals
9.
10.
•
Private Sector
•
Voluntary Sector
National Health Policy
•
Health Systems in India
•
Health Committees
•
National Health Policy - 2002
Vital Statistics
•
Vital statistics and surveys
•
Socio-economic indicators
•
Disparities in health
2
11.
Epidemiology
•
Definition; concepts
•
Sources of epidemiological data
•
General principles and methods of
epidemiology
•
Communicable and non-communicable
diseases and their control
•
Vaccines and vaccine preventable diseases.
Universal Immunization programme.
•
Water related diseases
Vector borne diseases
12.
Epidemiology of selected diseases
•
Acute Respiratory infections
•
Diarrhoeal diseases
Malaria
Tuberculosis
HIV/AIDS
•
National Disease Control / eradication
programmes.
13.
Health of the Disadvantages
•
Empowerment
Child Health
•
Health of the Aged
•
Women’s Health
Persons with Disabilities
14.
15.
Rational Use of Drugs
•
Essential Drugs
•
Drug Patents. Cost of drugs.
Research in Health and Diseases
•
Why Research?
•
I low to carry out research in communities?
3
16.
Medical Ethics
•
17.
18.
Ethical guidelines
Poverty and Health
•
Ill-health and poverty
•
Poverty alleviation
Health Planning
•
Planning for health. Five Year Plans and
Health
•
19.
Decentralisation. Panchayati raj
Health Financing
•
Expenditure on health
•
Public Health Expenditure
•
Budget allocation and utilization
PRACTICALS
•
Collection of Water and stool samples for
microbiological examination and evaluation
•
Calculation of health indices.
•
Problem solving exercises
•
Spotter - nutrition, environmental health,
entomology, helminthes, parasites
Scheme of Examination
Books
4
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