SDA-RF-AT-3.6.pdf
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SDA-RF-AT-3.6
From Appropriate Technology
in Health to Social Innovations: An
overview and challenging questions
Appropriate Technology in Health - An exploratory workshop
SOCHARA - SELCO - Logistimo
An overview
of Appropriate Technology in Health
and some challenging questions
SOCHARA Team,
Society for Community Health Awareness, Research and Action,
■
Bangalore
I
g'" February 2017
PersoiuilJourney
The Alma Ata Declaration1978
• "The People have the right and duty to
participate individually and collectively in the
planning and implementation of their health
care......
• Primary health care requires and promotes
maximum community and individual self reliance
and participation in the planning, organization,
—operation and control of primary health care,
making fullest use of local, national and other
available resources: and to this end develops
through appropriate education the abilities of
communities to participate"
Inspiration - 3
1978- Alma Ata Declaration-!.
■ Health for All
■ Primary Health Care
■ Health a Fundamental
III
Human Right
■ Equity
■ Appropriate
Technology
■ Inter-sectoral
Development
Alma Ata, 1978:
The International Conference on Primary Health Care
■ Community
calls for urgent action by all governments,all health
and developmentworkers, and the world community to
Participation.
protect and promote the health of all the people of the
world by the year 2000,
1981: Health for All -Prescription of and ICSSR/ ICMR
Fora mass movement post Alma Ata in India
—-—
AN ALItXNAtlVE STRATIGT
•Reduce Poverty inequality and spread
education.
•Organise poor and underprivileged to
fight for their basic rights
1986: The New Community Health Paradigm
of the SOCHARA Experiment
•Move away from the counter
productive Western model of health
care and replace it by an alternative
based in the community.....”
• "Community health is a process of enabling people, to
exercise collectively their responsibility to their own health
and to demand health as their right
• Provide community Health volunteers
with special skills, readily available,
who see health as.......a social
function"
Community health approach involves the increasing of the
Individual, family and community autonomy over health and
over the organizations, the means, the opportunities, the
knowledge and the supportive structures that make health
possible..... "
source: the CHC axioms - red
1
The People’s Charter for Health
National Rural Health Mission 2005-2012
- Evolving through the politics of engagement
Dec 2000
"Promote, support and engage in
actions that encourage people’s
power and control in decision
making in health at all levels
including patients and consumer
rights......
P-t-
....Build and strengthen
people’s organizations to create a
basis for analysis and action....”
Overview of Innovation (Global Forum)
■ "Innovation encompasses the entire process
from the generation of new ideas to their
transformation into useful things. to their
implementation”.
■ “Innovation may involve
new products,
services,
methods,
manufacturing processes
management structures
policy"
Social Innovation:
for Whom? and What?
■ From whose perspective is it being
evaluated?
> Producers- Researcher/ industry
> Policy makers/ Program Planners
r Service providers (govt/private/cso)
> People - Community, and or Patient
■ What Parameter is being used to
assess innovation
Biomedical ?
Economic?
Techno- managerial ? Political?
Socio-cultural ?
Ecological?
A
I
<WIHTW>
(2005-2012/
110th API
Goal:
■ To improve the availability of and
access to quality health care by people,
especially for those residing in rural
areas, the poor, women and children
Principles:
■ It seeks to improve access to equitable,
affordable, accountable, and effective
primary health care.
■ It has as its they component provision
of a female healthsactlvlst in each
village; a village health plan prepared
through a local team headed by the
village health and sanitation committee
of the panchayath.
■ Train and enhance capacity of
panchayathraj Institution to own.
control and manage public health
service.
Overview of Social Innovation in
________ Health (Global Forum)
■ "Social innovation involves new ways to ”
manage people, processes and information,
while technological innovation involves
material invention”.
■ “The technological and social aspects of
innovation are intertwined and
complementary- eg when drugs are made
available to poor people through
innovative schemes like pooled
purchasing, social marketing, community
health action groups etc"
Social innovation : Why
■ Why is something called
innovative?
Promotes Health for All?
Increases personal
/family/community
autonomy?
Prevention/promotion rather
than curative?
or
Promotes health for those who
can pay (Market)?
Promotes
Producers/innovators interest?
Promotes providers interests?
—
G'lnli.l HeallH Watch
Global"?"
Watclit^^
? 1
2
Dimension of Social Innovation-I
(From a Health for All Perspective)
Social Innovation- How
■ How does the social innovation work?
Enhances Autonomy?
Facilitates Control ?
Promotes Well being ?
Promotes Public good?
PRODUCT INNOVATION & APPROPRIATE
TECHNOLOGY:
■ Appropriate economically ( Low cost)
■ Appropriate techno-managerially ( Effective)
■ Appropriate culturally ( Synergistic with local
beliefs)
■ Appropriate socially ( Access and Equities )
■ Appropriate politically ( Control and
Demystification)
■ Appropriate ecologically ( Green and In
Harmony)
Sometimes we miss the innovation - Why?
Tradition or Cultural innovation?
Local creative adaptation?
Eco sensitivity and Harmony?
No do ‘innovation’ ( Acts of Omission) ?
Sourc. CPHE SOCHARA 2009
Sourc* CPH E SOCKAKA 2009
Dimension of Social Innovation -II
(From a Health for All Perspective)
PROCESS INNOVATION
□ Enhancing Equity/Access
□ Community Participation/
□ Community Ownership
□ Community Monitoring
□ Community Watching/
□ Community evaluation I
research
□ Health workers to health activist
Dimension of Social Innovation-Ill
(From a Health for All Perspective)
COMMUNICATION
INNOVATION
■ Low cost communication
■ Decentralized /communication
■ Autonomous communication (
Folk Theatre)
■ Community of learning (IPHU/
CHFP)
---- ■ Communication for
advocacy/change (Culture of
protest)
Source C PHE SOCKARA 2009
Source CPHE SOCHARA2009
Dimension of Social Innovation-IV
(From a Health for All Perspective^
Dimension of Social Innovation-V
(From a Health for All Perspective)
DISTRIBUTION INNOVATION
ECONOMIC INNOVATION
■ Self help groups
■ Micro Credit
■ Community based
organization/association
■ Community Networking
v
■ Health Cooperative
■ Community Health Insurance
■ Cost Sharing Partnerships
■ Cooperatives
■ Demand side and Supply side initiatives
Source CPHE SOCHARA 2009
Source: CPHE SOCHARA2009
3
Dimension of Social Innovation-VI
(From a Health for All Perspective)
PARADIGMATIC INNOVATION
■ Medicine t—health
■ Individual
community
■ Provision and product distribution
Education and social processes
■ Molecular Biology (intracellular)
Balloonist/social/community action
■ Professional control => community
autonomy
SOME PROPOSITIONS -1
Health is not medicine
Health is physical, mental. Social well being and
medicine is focused on ill beingl
We need more holistic / wholistic approach to health
Sourc. CPHE SOCMARA2009
OME PROPOSITIONS - 2
Health system is not
medicine care system
Health system includes housing, nutrition, water and
sanitation, education, livelihoods, recreation, IEC and
primary medical care
Public health and primary health care system linked to
all these sub systems
NDERSTANDING
HE PARADIGM
SHIFT FROM BIO
MEDICAL MODEL TO
SOCIAL /COMMUNITY
MODEL
I-----
FROM MEDICINE TO HEALTH
(From illness care to well being)
4
FROM INDIVIDUAL TO
COMMUNITY
(Collective and Societal action)
FROM TECHNOLOGY (drugs and
vaccines) TO EDUCATION AND
SOCIAL PROCESSES
(From distribution to process of
.empowerment)
FROM COMMUNITY AS
BENEFICIARY/CLIENT TO
COMMUNITY AS ACTIVE
PARTICIPANT/ PARTNER
(COMMUNITIZATION)
5
Whot type oF health uiorbr are you
Arc jou o floor moppet e
o«
a tap turner oFT f
'T—
FROM FLOOR MOPPING TO TAP
TURNING OFF
SOME PROPOSITIONS - 3
Health For All is
different from Health
for Those who can
Pay
Health is primarily a public good not a private good
and hence health systems does not exclude anyone
India’s Population
Reflecting recent changes
■ The elite
65 Millions
180 Millions
275 Millions
150 Millions
■ Consumers
■ Climbers
■ Poor (aspiring)
■ Destitute
200 Millions
SourceL : India Today - MARG Poll, April, 1995
SOME PROPOSITIONS -4
Primary health and public
health need people, public
community as core
component
They are not clients, users, beneficiaries but active
participant of the system. Public health and primary
healthcare therefore need to be communitized. NHM offers
many spaces, mechanism and opportunities
COMMUNITIZATIONNRHM DEFINITION.
“ Institutionalizing
community led action for
health by empowering
community to take
leadership in health
matters”
6
SOME PROPOSITIONS - 5
SOME PROPOSITIONS - 6
Energy ecosystems
must recognise
human energy as a
system
| Technology is essential
for health but not all
technology is relevant
_for HFA goals
Communities knowledge, energy, skill, experience and
capacities are an important energy resource!
The communitisation component of NHM is an
important recognition of this resource
The Socio Epidemiology Paradigm
Technology for health needs assessment and evaluation for
appropriateness. Appropriate technology for healthcare was
an important component of the Alma Ata declaration!
The Socio Epidemiology Paradigm
Tribal population behaviour in Mandla Community
Case study
Use of bednets among
indigenous people in
Mandla, India
Source: Singh N., et al MRC (ICMR) 1993
surveyof-bedne^use--------------------------------
Activity during peak mosquito biting time
Night Mahua collection 16%
Sleep in fields 12%
Tendu leaf collection 21%
Fishing 8%
1200 people out of 2000 are outside the bednet during
peak mosquito biting time!
-Source: Singh N., et al MRC (ICMR) 1993
The Socio Epidemiology Paradigm
The Socio Epidemiology Paradigm
Tribal population behavior in Mandla
Community-survey of bed net users
Reasons for non use
Evidence_______________
What? Whose? Who decides?
Fatigue due to hard field work
Suffocation inside net
Intoxication
Spread on floor
Wrapped around body
Used as pillow
57.85%
9.87%
1.92%
1%
20.9%
2.8%
The people are sharing evidence with the
malaria programme bednet researchers
about poverty, survival, marginalisation and
other social determinants.
-Source Singh N . el al MRC (ICMR) 1993
7
The Socio Epidemiology Paradigm
What is our interpretation?---Social marketing and health promotion of bednets
for malaria to keep them in.
or
Poverty alleviation in the context of sustainable
development and responsive primary health care to
—make the programme more accessible, relevant and
affordable.
r------ ,
Appropriate Technology for a resilient
Health System
SOME PROPOSITIONS - 7
Decentralisation brings
health closer to the
people but it is more
then outreach
Decentralisation is an issue of governance as well. Who
plans, manages, governs, monitors, evaluates the health
systems. PRIs, SHGs, community or programme managers
and governments?
Towards a new epidemiological analysis for
the new public health
1. Building and construction of centers I
spaces for Health
2. Agriculture, food and nutrition technology
3. Water, sanitation and waste disposal
4. Energy generation for PHC
5. Transportation options
6. Medical I Healthcare technologies
/.Information and communications including
monitoring and evaluations
8. Cooperatives, credit systems and
livelihoods
9. And.......................................
Social -Economic- Political- Cultural Determinants
Inspiration - 1975- 1981 - (I)
Inspiration- 1975- 1981-(II)
STtATiCT
' MMWOFIMOMUPOH
. YMlHinllo!
U'HiiBun iy
HiilllljWcrk'r.
HtDIttl (DUCMMM AHO
IW-FORr HANPOWtR
■
■■ ■
: • -r
,
-
Public Health Challenges
Biomedical determinants
Public Health
Challenge
■ National system of Medicine - appropriate integrated
relationships between modern and indigenous.
■ Plural manual for health workers
Janata Health Worker Manual - Ayurveda, Yoga.
Unani, Siddha. Homeopathy. Naturopathy
■ Values from tradition for alternative model of health
care - Ashrama concept, yoga, herbal medicine, non
consumerism etc.
8
AYUSH and People's Health Movement - SOCHARA Initiative -1
Jana Swasthya Abhiyan from 2000
AYUSH and People's Health Movement - SOCHARA Initiative - 2
Global People’s Health Charter - 2000
Indian People’s Health Charter
4X
THtmms MuwwutaBXK
“Support be provided to
traditional healing systems,
including local and home based
healing traditions for
systematic research and
community based evaluation
with a view to developing the
knowledge base and use of
these systems along with
modern medicine as a part of
holistic healing perspective.”
Support, recognise
and promote
traditional and holistic
healing systems and
practitioners and their
integration into
Primary Health
Care...... ”
SSjwg
AYUSH and People's Health Movement - SOCHARA Initiative - 4
South Asian Regional Workshop on Role of
Traditional Medicine in HFA-2006
Perspective
> Indigenous and rural communities
particularly women care takers of
culture, health and eco-system
> Colonization and economic
homogenization destroying local
health cultures
> Not just therapeutic alternatives to
add to western biomedicine
- Learn from concept of health,
healing, harmony, and respect for
environment.
> Laws of nature rather than laws of
market.
LOCAL HEALTH TRADITION - II
SOME ISSUES
Community Knowledge
❖ Family I Household Traditions
❖ Palm Leaf and other manuscripts
❖ Oral Traditions
❖ Rapid Assessment of LHT's ( PRA’s)
❖ Kitchen Herbal Garden
❖Operation “Health at your doorstep”
History of Appropriate Technology in Health
and the SOCHARA Involvement
History of Appropriate Technology
in Health and the SOCHARA
Involvement
II
1. ' The Community Health Decade at St. John’s
2. ASTRA - Exploring Health Agenda
3. AHRTAG to Healthlink - the UK connection
4. mfc Technology and Health - The exploration
in Alwaye
5. JSA and PHM - The globalisation of health
and healthcare debate
6. Global Forum for Health and the Social
Innovation in Health initiative in Cuba
7. Catalysing the Social Innovators in Health
Network!!
9
Understanding
Sanitation In
SEPCE
dolcrmlnant
(Exploratory
Bchjvloral dungs
Sanitation - Technology and
Community Choice: A case study
III
Mawri training
Rural SanlUllon
Appropriate
technology
Environmontol
sanitation
Training on CITS
Method
models (School.
Anganwadl and
Individual
Eco-wnlUilloii
Urban sanitation--------
Waste
management
WASH In Health
Care services PHC - 3 months
prolect
Training-“Community Led Total
Sanitation and Mason training”
Rapport building
Walk of shame
Z
1 KT-V4-1
Mason training
Fecal-Oral transmission
1 rwuixnalMWi-lts
IW
Or
o.
/
Toilets Constructed after the
Training process
School Sanitation
i
MLJ
y
g |
gShi
E2S
10
Sanitation Follow up activities
----------- E'-m.iL.-.'ai!
Training - Children's - Kannamangala Government
school - November 2013
■ ■-c _ iia
11
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