RF_NGO_8_SUDHA.pdf
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MCC
RF_NGO_8_SUDHA
MURRAY
CUES HAW
CONSULTING
Guiding good causes
Helping voluntary organisations
communicate and fundraise
Certificate programme 2004
MENTORING | TRAINING | RECRUITMENT | RESEARCH | EVALUATION | PUBLICATIONS
MURRAY
CULSHAW
CONSULTING
GUIDING
GOOD
CAUSES
Certificate programme in public communication and fundraising
MCC announces its third certificate programme in public communication and fundraising, to be conducted from 4-22 October
2004. The course is aimed at voluntary organisations wanting to build a constituency of support within Indian society. It is also for
people who would like to work as communicators and fundraisers in voluntary organisations. Public communication and
fundraising implies communicating social causes to, seeking support from and becoming accountable to the public within India.
The MCC programme will train participants over a period of three weeks during which they will learn the basics of communication
and fundraising, and apply it to the needs of their organisation. On completion of the programme, they will either be absorbed by
the organisation that has sponsored them; or, if they have sponsored themselves, will find placements in the expanding demand
for these skills in the voluntary sector.
Fee
The total course fee is Rs 20,000. This will cover faculty, facilities and course materials. The fees can be paid in two instalment^
Rs 10,000 at the time of registration and Rs 10,000 on the orientation day.
Faculty
The faculty includes MCC staff, experienced voluntary sector fundraisers, and media and advertising professionals. MCC's core
faculty includes:
Bharati Ramachandran
Murray Culshaw
Former director of Oxfam in India,
Murray has 30 years of experience in
the voluntary sector, predominantly in
India - in managing development initiatives; formulating
policy and programme priorities; advising on institutional
development; evaluating project plans for financial resource
agencies and in developing communications and
fundraising strategies.
Head of consulting at MCC, Bharati
has over nine years of experience in
writing and editing, for newspapers,
magazines, as well as print and online publications. Bharati
trains and provides hands-on assistance to voluntary
organisations with their communication materials and strategies
to communicate with and raise resources from individuals,
institutions, trusts and companies.
Curriculum
■ Module I - Introduction to
philanthropy
■ Module II - Getting started
with resource mobilisation
■ Module ill - Communication
methods
• History of the voluntary sector in the
region
• International and regional perspectives
• Importance of a diverse income base
• Principles of fundraising
• Psychology of giving
• Tax exemptions
• Resources for fundraising
• Ethical policies
• Drafting an organisational ethics policy
• Fundraisers1 code of conduct
• Introduction to resource mobilisation
• Importance of public fundraising
• Role of boards and staff in fundraising
• Introduction to databases
• Building your constituency database
• Organising yourself to raise resources
• Fundraising mission and vision
statements
• Communication audit
• Characteristics of a good fundraiser
• Accountability and transparency
• Building credibility through regular
reporting
• Why people communicate
• Importance of communication in
fundraising
• Methods of communication
• Principles of communication
• Stories of change and statements of
achievements
• Use of photographs, aesthetic rules
• Making effective presentations
• Introduction to writing and editing
• Visiting card
• Brochure
• Newsletter
• Annual report - importance, guidelines
• Email and personalised mass moil
• Effective search techniques
• Online briefcases and web calendars
MENTORING | TRAINING | RECRUITMENT | RESEARCH | EVALUATION | PUBLICATIONS
Duration
Intensive course: 4-22 October 2004
Follow-up and evaluation: 17-21 January 2005
The programme contains six intensive modules that will be covered in three weeks at the MCC training centre in Bangalore. Three
months after this, a week has been scheduled for follow-up and evaluation. Classes will be interspersed with discussions, seminars,
field visits, debates, hands-on exercises and guest lectures. During the three-month period in between, the student will go back to
his or her own organisation and implement specific assignments. The faculty will keep in touch with the students during this period.
MCC will issue a certificate on successful completion of the programme.
MCC also offers mentoring services to voluntary organisations in communication and fundraising. We would be very happy to
provide this to participants and their organisations either during or after the course for an additional fee.
Eligibility
^gs, Mass Communications or Journalism graduates, who wish to work in the voluntary sector in communications and
TOndraising; or graduates with experience in the media, public relations, marketing and social work can apply. We are looking
for individuals with positive personalities and possessing good people skills. Good spoken and written English is essential.
Ranjini Victor
Nisha Purushothaman
Head of training at MCC, Nisha has an
MS in communications and over the last
three years has developed training
curriculum and course content. Nisha trains voluntary
organisations in developing strategies for a diverse income
base and skills for preparing communication materials like
interesting annual reports, brochures, newsletters and direct
mail packages.
Coordinator of MCC's training
programmes for over a year now,
Ranjini has a background in English
literature and has conducted research on various aspects of
the voluntary sector in India, like patterns of giving in
religious institutions. Ranjini organises skill building and
custom-built courses and also trains voluntary organisations
in the basics of communications and fundraising.
e
■ Module IV - Building
relationships
■ Module V - Fundraising
techniques
• Donor relations
• Interpersonal and presentation skills
• Letters - covering letters, thank you
letters, envelopes
• Creating a media database
• Types of coverage
• Press releases, press kits, photo ops
• Planning a media strategy
• Researching corporates and types of
support
• Approaching and cultivating
relationships with corporates
• Drafting a corporate plan
• Involving all staff in fundraising
• Involving your Board in fundraising
• Introduction to face to face fundraising
• Types of fundraising events
• Planning an event
• Role of volunteers in special events
• Why direct mail? Cold and warm mail
• Elements of a direct mailer
• Writing effective appeal letters
• Mailing lists
• Types of grants
• Key elements and guidelines
• Writing a proposal idea and a
concept note
• Proposal to raise funds for fundraising
• What internet fundraising involves
• Introduction to payroll giving
□ Module VI - Planning
• Analysing income and setting targets
• Analysing existing experience, capacity,
opportunity
• Drafting outline budget
• Preparing an outline communication
and fundraising plan fora year
• Basic monthly reporting
'The long-term training course was an enriching experience for me at both
the personal and professional levels. I feel that my self confidence and quality of
presentation have improved through this training. I liked the way the course was
designed and the methodology (participatory, lectures, presentations, individual tasks
and work to do at our organisations).'
Sandra D'Souza, Trusts and foundations fundraiser
National Campaign on Dalit Human Rights, Bangalore
Certificate programme in public communication and fundraising 2003-2004
'... Last year my contribution to Khushboo was Rs 77,000 and this year it was Rs 9.5 lakh
- this includes a van. The organisations I brought in were Perfetti, Narain Dharmarth
Aushdhalya Trust, British Gas and Concern India Foundation. I am really grateful to
your training.'
Sudeshna Sengupta, Khushboo Welfare Society, Gurgaon
Certificate programme in public communication and fundraising 2002-2003
(in March 2004, by email)
M|C|C
Guiding good causes
Murray Culshaw Consulting (MCC) is a Bangalore-based organisation working with
good causes, primarily in India and South Asia.
Established in 1995 under the name Murray Culshaw Advisory Services, MCC
enables organisations to communicate with, seek support from and become
accountable to the public. We do this through a combination of hands-on help,
training and research.
Send in your application to
Head of Training
MCC - Murray Culshaw Consulting
2nd Floor Vijay Kiron Building
314/1 7'Cross Domlur Layout
Bangalore 560 071 Indio
Tel: 91 -80-2535 2003/ 5115 0582/ 3061 2622
Fox: 91 -80-2535 2003
email: lraining@lundroising-india.crg
MENTORING I TRAINING I RECRUITMENT I RESEARCH I EVALUATION I PUBLICATIONS
www.fundraising-india.org
Certificate programme in public communication and fundraising
Application form
INDIVIDUAL DETAILS
-—------------
Name (in BLOCK Letters)
first name
(Ms/ Mr/ Mrs) main name/ surname
_ _____________________________________________________
Home address
State
Country
Email ID
Telephone
with area code
____
Pin
District/ City
--------------------------------------------------------
------------------------------------------------------------------------------
home
_
Educational qualification
Languages known
^3 ate of birth
—----- ——
Position/ Designation
Describe in 100 words any experience you have in communication and fundraising. Use reverse or separate sheet.
Describe in 100 words why you want to enrol in this programme. Use reverse or separate sheet.
Describe in 100 your career objectives in the next 5-10 years. Use reverse or separate sheet.
ORGANISATION DETAILS (if applicable)
Name-------------------------------------------------------------------------------------------------------------------------------------- •------------ —----------------------
Organisation address
-------------------------------------------------------------------------------------------- ——-----------—-----------------------------------
Pin
District/ City------------------------------------------------------------------
State
^•Telephone number
with area code
Email ID
Country
------------------------------------------------------------------------ -—
------------------------------------------------------- ------------------------Fax
work
....
Website ----------------------------------------------------------------
PAYMENT DETAILS (please note cheques/DDs to be drawn in the name of Murray Culshaw Consulting Pvt. Ltd., payable at Bangalore)
|/We
hereby enclose a cheque/ demand draft number
dated
I agree to pay the balance in full/
Signature
instalments as agreed with MCC.
Da,e
Note- MCC reserves the right to conduct an interview before the start of the training (travel expenses to be borne by the sponsoring organisation)
to help decide on the suitability of a particular candidate for this programme. If a person is not accepted, any fees paid will be returned.
Applications to- Head of Training, MCC, Vijay Kiran Building, 2nd Floor, 314/1, 7th Cross, Domlur Layout
Bangalore 560 071 • Tel: 91 -80-2535 2003 / 5115 0582’ email: training@fundraising-india'org
Last date for receipt of applications is 20 September 2004. Successful candidates will be informed by 24 September 2004.
'
culturally cultivated people in this hemisphere”.
Besides the embargo, Cuba was more recently devastated by the
collapse of the former Soviet Union, its long-time ally and trading
partner. Currently, Cuba has few ties with the successor state, the
Russian Federation.
Additionally, the global recession has severely affected Cuba's
sugar industry, the victim of falling international prices compounded
by the industry's domestic ills.
The country now depends primarily on tourism (which brings in
about one billion dollars annually) and expatriate remittances
(about 600 million to about one billion dollars annually) for its
economic survival.
(END)
DEVELOPMENT-U.S.: Aid Promises Misleading - Report
By Emad Mekay
WASHINGTON (IPS) - The Bush administration's loudly trumpeted
recent announcements of development aid hikes coupled with more
money to fight HIV/AIDS globally do not match budgetary realities
and may translate into far smaller increases than anticipated, say
two economic think tanks.
In a report released on Tuesday (May 20), the Center for Global
Development (CGD) and the Center on Budget and Policy
Priorities, both based in Washington, say the promised aid
increases will be far more modest than announced and that U.S.
aid remains well below historical standards and far below other
donor countries.
’
"The administration was quick to make large announcements and
has been much slower in following through and ensuring that those
announcements translate into actual new spending on the ground,"
said Brian Deese, programme associate at the CGD.
"I think this is more of a reality check ... given adequate pressure
and considerable bi-partisan support in Congress, we could still
see positive development," he added.
On Wednesday, Bush said he was looking forward to signing a bill
next week, passed by Congress on Wednesday, to give 15 billion
dollars - including 10 billion^doljarsjn newly-pledged money - over
five years to fight HIV/AIDS in Africa and the Caribbean.
He called the plan -the largest, single up-front commitment in
history for an international public health initiative involving a specific
disease-.
The AIDS money comes on top of the president's announcement in
Printed for Jose Utrera, 27 May 2003, 17:53
Page 6 of 12
March 2002 of the largest increase in development aid since the
Kennedy administration (1961-63), through a proposed hike of 10
billion dollars for the Millennium Challenge Account (MCA). ~
The promised increases were hailed as steps to fundamentally
transform U.S. development policy and maximize its impact in the
developing world, and received positive reviews from aid agencies,
development groups and some civil society organisations.
Yet, the new report reveals that although the administration's
original proposal for the MCA called for a whopping 10 billion
dollars over three years, to reach and sustain annual funding of five
billion dollars a year starting in 2006, Bush's actual request for the
MCA in the 2004-2006 budget is only four billion dollars.
"The administration's budget proposes funding the Millennium
Challenge Account at levels far less than it has announced," says
the report, whose authors say they used data from Office of
Management and Budget, the Congressional Budget Office, and
the U.S. Agency for International Development (USAID).
"This is only 40 percent of the administration's initial public
commitment," it adds. On top of that, some of the four billion dollars
would be spent after 2006.
To further undermine the administration's MCA forecast, the report
quotes figures from the Congressional Budget Office (CBO), a
usually optimistic body, that estimates that actual MCA spending
from 2004 through 2006 will be 1..7 billion dollars, or 17 percent of
the president's initial public commitment.
When the budget was released in early February, some
administration officials suggested that the request was an error,
and that the figures for 2005 and 2006 would be corrected to reflect
the increase to five billion dollars a year.
But the 11-page report notes that till now, "the numbers have not
been corrected".
"If the administration does clarify this issue, it will need to reduce
resources proposed for other areas in the budget or build in a
higher expected deficit," the report adds.
The disparity between rhetoric and reality also extends to promised
funds to battle AIDS. In his State of the Union speech Bush
pledged 10 billion dollars in new spending over the next five years,
but the report says the president originally requested only 450
million dollars for his new HIV/AIDS initiative for 2004.
The request, says the report, left unclear how that figure would be
raised over the coming five years to reach the much-touted 10
billion dollars.
Printed for Jose Utrera, 27 May 2003, 17:53
Page 7 of 12
Again here, the CBO dampens the forecast, estimating that only 45
million dollars (of the originally proposed 450 million dollars) is
IiRely to be spent on AIDS in 2004.
With the fine print in place, U.S, aid spending totals a mere 0.12 1/
percent of the economy, or about 12 cents of every 100 dollars, ” I'
well below the amount devoted to aid from the end of World War II
through 1996.
Measuring aid as a share of the economy is the standard approach
used in international comparisons.
The report says that after adjusting for inflation, the president's
budget, plus a recent wartime supplemental request of 2.5 billion
dollars to help reconstruct Iraq, would together result in an increase
in development aid spending from 2003 to 2004 of five percent in
real terms, continuing a string of recent increases.
"But because this spending has been so low in recent years, and
fell so much in the 1990s, the proposed level would still be meagre
by historical standards, particularly when viewed as a share of the
economy and as a share of all government spending," it adds.
Still, the proposed increases merely reflect expected economic
growth, it points out.
Under the budget, development aid spending as a share of the
economy would equal an estimatecT07T23 percenfirr2008, virtually
the~same as~fb^0712Tpercenf level forecast in 2004.
That means that for the next several years, aid as a share of the
economy is likely to be lower than it ever was in the 50 years of
1946-1996, and well below one-half the level of Overseas
%= Development Assistance (ODA) now provided by the typical donor
country, estimated at around 0.30 percent"
"The United States would still be at the bottom of the barrel among
all donors in its spending on development aid (excluding military
aid) as a share of the economy," concludes the report.
According to the Organisation for Economic Cooperation and
Development (OECD), in 2002 Washington contributed 0.12
percent of its economy to ODA. This was the lowest share of the 22
nations examined, with the second lowest country, Italy,
contributing 0.20 percent ofits~economy.
But Deese, one of the report's authors, warned against interpreting
the paper as a call to simply increase foreign aid. He said the Bush
administration should continue to pressure developing countries to
make aid more effective.
"It's not necessarily that the U.S. should immediately increase its
foreign aid budget to some set level but in fact it should continue to
Printed for Jose Utrera, 27 May 2003, 17:53
Page 8 of 12
put some real meat behind a commitment (by developing nations)
to do more and do it well."
(END)
*************
ENVIRONMENT-BURKINA FASO: Each Year, Consumers Face Similar Water Crisis
By Brahima Ouedraogo
OUAGADOUGOU (IPS) - For 25-year-old Ablasse Kindo, selling
water has been his life. For nearly half his life, it has provided him
with all his comforts.
But of late Kindo has been experiencing unusual water scarcity as
he plies his trade in Pissy, a poor suburb of Ouagadougou, the
capital of Burkina Faso.
"You have to wait until 2 or 3 O'clock in the morning when water
begins to trickle from the tap," Kindo says. "In the past, water
rationing used to start in April".
Not anymore. The weather pattern seems to have changed. Since
February, the City of Ouagadougou has experienced water
shortages, and rationing has begun in earnest in parts of the
capital.
"The poor can't afford to sleep anymore because if they do, they'll
never get water," says Sita Kabore, a housewife in Pissy.
Before February, a 200-litre barrel of water used to cost 60 CFA
(about 10 U.S. cents). But the price has now shot up to 1,500 CFA
(about 25 U.S. dollars), thanks to the shortage and speculation by
vendors.
In January, the National Office of Water and Sanitation, a state-run
corporation, banned washing vehicles and filling swimming pools in
a bid to conserve water.
"Demands are greater than supplies and our production capacities
are limited," says Dieudonne Sawadogo of the National Office of
Water and Sanitation. "Rapid urbanisation and population growth
require alternative resources of which, unfortunately, there are
few".
About 80 percent of Ouagadougou's population, estimated at 1.2
million, is served by the National Office of Water and Sanitation,
which has 40,000 subscribers and 600 public water outlets.
During the hot season, which begins in February, temperatures in
Burkina Faso, especially in Ouagadougou, frequently hit the 44degree-centigrade mark.
The water deficit in the capital stands between 15,000 and 20,000
cubic metres per day during peak time. Unfortunately, the National
Office of Water and Sanitation can only supply 58,000 cubic metres
Printed for Jose Utrera, 27 May 2003, 17:53
Page 9 of 12
FRLHT
Ref: GG/Hos'03/02
Foundation for
Revitalisation of
Local Health Traditions
To
Dr.Ravi Narayanan
No. 362, 5th Main,
1st block, Koramangala,
Bangalore-34
Ph: 55315181
24th July 2003
Sub: Interface Meeting with scientists, and medical professionals to discuss the design of
an Ayurvedic research hospital, pharmacy and training centre, which is proposed to be
established at FRLHT Campus, Bangalore on August 7th2003.
A’-So pm
Dear Dr. Ravi Narayanan
I am writing to invite you to an Interface Group meeting to advice on a project that FRLHT is
developing for establishment of an Ayurvedic research center, pharmacy and International
training centre, at Bangalore. This meeting will be held on Thursday, August 7111 at the FRLHT
Campus in Bangalore (Yelahanka).
Please permit me to briefly introduce FRLHT to you!
FRLHT is committed to the vision of revitalisation of India's medicinal heritage.
During the last ten years, FRLHT has designed and implemented several significant programs
involving conservation and sustainable use of medicinal plants. Enclosed, please find a small note
on FRLHT describing our activities.
As a part of FRLHT’s mission, we are in the process of establishing an Ayurvedic research
hospital, pharmacy and an international training center:
•
THE RESEARCH HOSPITAL will focus on management of such conditions pertaining
to curative, preventive and, promotiyg. health care which are relevant today and have
successful measures in Ayurveda. We visualize this center to be a center of excellence in
clinical medicine which documents the effectiveness of Ayurvedic treatment and
therapies, on modern medicine parameters. It will focus especially conditions for which
allopathic medicine is either ineffective or too costly.
•
THE RESEARCH PHARMACY will be developing standards on modern parameters for
Ayurvedic products, to be developed as per "Bhaishajya kalpana" principles, which can
be applied at home, cottage industry and industrial settings.
•
AN INTERNATIONAL TRAINING CENTRE for medical community and health care
professionals from India and abroad to receive training in clinical and non-clinical
applications of Ayurveda, which they can use in their own institutions.
# 74/2, Jarakabande Kaval
Post Attur, ViaYelahanka
Bangalore S60 064, India.
Phone 491 080 8S68000 / 8568001
856S760 I 856.8299
Fax 491 080 8567926
We are taking on this unprecedented task to link two culturally diverse medical knowledge
systems as a stratergy in order to promote understanding of the contemporary relevance of
Ayurvedic health-care, to the modern medical world. We are inviting experts from the fields of
modern science; 1 T Tele medicine, pharmacy, pharmacology clinical medicine and biochemistry
to appraise our proposal. A detailed program for the day will be sent to you on confirmation of
your availability to attend this meeting.
A first draft concept note on our idea of this centre is enclosed for your kind persual. A second
draft will be sent to you shortly after we incorporate inputs from a focus group meeting on
12.7.03 and Peer group meeting with Ayurvedic experts, that we are having on 26.7.03. We
would like to have this interface with veterans in the fields like you, to help us to design the
project to deliver its goals.
To make it convenient for you to attend FRLHT will be pleased to reimburse your travel costs
and provide for local hospitality and a per deim.
Kindly confirm your ability to attend the interface meeting on Thursday, August 7lh as soon as
possible! We look forward to a fruitful interaction and exchange of ideas.
Thanking you in anticipation,
Sincerely yours,
Ph: Direct: 080-8460549
Fax: 080-8567926
Email: vaidya.ganga@frlht.org.in
Ps: Please send your email address,
so we have your ID
Joint Director, FRLHT
List of Invitees
1. Ms.Urmila thate
2. Dr. M.S Valiyathan
3. Prof. Ranjith Roy Choudari-Delhi
4. Mr. MURNaidu
5. Dr. Nithishetty
6. Dr. Ravichandar GKU
7. Mr. DBA Narayanan
8. Dr. Anisha, Pargal
9. Dr. Premilla - Chennai
10. ISRO (Telemedicine)
11. Mr. Farooqui IAS
12. Dr. Ramanadhan
13. Prof. Seetharam
14. Dr. Ashok vaidya
15. Dr. Ravi Narayanan
16. Dr. T.K Parthasarathy
17. Dr. Vipul Chawla
18. Dr. C.Suresh Kumar
4
FRLHT
interface meeting
7th AUGUST 2003
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A note On Establishment of
Ayurvedic health centre, pharmacy and research centre.
At
Bangalore, India
Conceived and promoted by
FRLHT
(Foundation for Revitalisation of Local Health Traditions)
FRLHT
No. 74/2,Jarakabande Kaval,
Attur P.O., Yelahanka Via,
Bangalore - 560 064
India
Ph: +91 080 8565760,8568000,8568001,8568299, Dir.8565895
Fax: +91 080 8567926
Email address: info@frlht.org.in
Web site: www.frlht.org.in
Ayurveda The Ancient Science of Life Establishment of Research health
centre, Research pharmacy and training centre at Bangalore.
1.
Future of world medicine
The futuristic vision for “world medicine” has to be pluralistic. India with its rich medical
heritage has a responsibility & opportunity to contribute to this future.
A centre of excellence as a first step towards this need, an international centre of
excellence for Ayurveda is proposed to be created in Bangalore, India to promote
learning of the theory and practice of Ayurveda with a focus on:
a)
Positive health
b)
Therapeutics,
c)
Clinical-research
d)
Pharmacy
e)
Training
Plan for the future
•
An Ayurvedic health center will be designed to offer genuine Ayurvedic treatment for
prioritized healthconditions and the pharmacy will develop manufacturing protocols
for classical Ayurvedic drugs based on Ayurvedic principles of Bhaisajya Kalpana.
•
Both these facilities will however use “advanced bio-medical facilities”, to evaluate
the treatments and standardize the manufacturing protocols, so that the outcomes of
the hospital and pharmacy activities can be ‘replicated’ all over the world.
Both the health centre and pharmacy will therefore have a strong “training function”,
in order to promote the development of similar centres and pharmacies, in different
Indian states and foreign countries.
•
Objectives of Health center
1)
To establish a centre of excellence in Ayurvedic management in selected thrust areas.
2)
To communicate strong aspects of Ayurveda including preventive & promotive health
care using tools of modem science for clinical documentation.
3)
In due course of time to develop it as a centre of advanced clinical & pharmaceutical
training in Ayurveda of international standards.
4)
To replicate the Bangalore type centre in different parts of the country and abroad.
2.
Objectives of Research Pharmacy
The pharmacy will develop products and processes and dosage forms based on Ayurvedic
principles. These will be standardised using modern pharmaceutical tools.lt will
standardize products at household, cottage & industrial scales
It will also get into the intricacies of bioactivity and bio availability of products which
will help modem drug delivery methods.
It will also look into the factors like improving palatability, sensorial and user
friendliness.
The research pharmacy will also dwell into the possibilities of the issues of individual ;
drug and formulation standardisation based on Ayurvedic principles of “desa kala vicar”
Objectives of training
The training centre will concentrate on short term and long term, clinical and nonclinical, professional and public, programmes for different kinds of clientele.
The training centre has to become the link between two knowledge systems inorder to
promote medical pluralism
Overall goals
Overall objective of this multifaceted programme of clinical, pharmaceutical and training
components is to put Ayurveda in the global focus.
3.
FRLHT’s Track Record (1993 - 2003)
FRLHT has in its 10 years of existence demonstrated that it has the ability to visualize
and implement in a focused manner ‘pioneering projects’ that ‘impact’ national policies
and programs in its chosen area of operations.
The main focus of FRLHT operations during the last 10 years has been on
“CONSERVATION of medicinal plant resources”.
4.
Milestones:
1993
In 1993 the Ministry of Environment & Forests, Govt, of India & the Dept, of
Economic Affairs, Govt, of India approved phase I (1993 - 1997) of the
country’s first “insitu conservation programme for medicinal plants” designed
by FRLHT for the Western Ghats region. This programme was supported
under a bi-lateral aid agreement with the Govt, of Denmark.
1997
1997 a joint Govt, of India and DAN1DA appraisal team declared the project
implementation to be outstanding and supported a 7-year phase II (1997 2004)
1998
1998 Dorabji Tata Trust (DTT) came forward to support a pilot extension of
the conservation project to Maharashtra.
1998
In 1998, FRLHT received the prestigious Norman Borlaug award for its
contributions to this field.
1999
In 1999 UNDP extended support under its Country Cooperation Framework
(CCF) for extension of the program to Andhra pradesh and Maharashtra.
2000
In 2000 DTT granted FRLHT a corpus of Rs.2 crores to strengthen
“Medicinal Plant databases” and its pharmacognsy Lab.
2001
In 2001 the Global Environment Facility and Ministry of Environment and
Forests, Govt, of India, commissioned FRLHT to prepare a comprehensive
plan for expansion of the conservation program to northeast, northwest and
central India.
2002
In 2002 FRLHT’s ‘Medicinal Plants Program’ was one of the 27 programs
selected by the United Nations from around the globe for the Equator
initiative prize. This prize was awarded in Johannesburg at the World Summit
on Sustainable Development.
2002
In 2002 the Ford Foundation, New Delhi granted FRLHT a corpus of Rs.3.6
crores to strengthen its community outreach activities.
2002
In 2002 the Ministry of Environment & Forests, Gov. of India recognized
FRLHT as a national Center of Excellence for Medicinal Plants & Traditional
Knowledge.
2003
•
In 2003 the UNDP and MoEF, Govt, of India under their CCF- II (2003 2007) have decided to support an FRLHT designed program linking
conservation to livelihood and health security in nine states in the country,
covering the western and eastern ghats region and including Rajasthan,
Madhya pradesh and West Bengal.
5.
CRITERIA FOR SELECTION OF “HEALTH CONDITION” FOR FOCUSED
WORK, IN THE HEALTH CENTRE.
1.
Diseases categorized by Ayurveda as “krichrasadhya” (that can be cured with
concerted effort) and “yapya “ (those, which can be managed and kept under control
by critical management followed by life long life style adjustments).
Diseases of the above category, which are prevalent today and are of national or
international concern will be preferred.
Diseases that do not have an appropriate and satisfactory treatment in other system
of treatment.
Diseases, which cause higher mortality and morbidity.
Health Practices of a preventive and promotive nature that are unique to Ayurveda - ■
2.
3.
4.
5.
6.
UNIQUE FEATURES OF THE HEALTH CENTRE
This will be a centre, which will comprehend and put into practice all aspects of
Ayurvedic management.
AHARA VIHARA OUSHADHA
MANI MANTRA
OUSHADHAM (medicine) will include
YUKTH1VYAPASRAYAM
SATWAVAJAYAM
DAIVAVYAPASRAYAM
- food, life style and medicine
- use of precious stones and sound
- based on medical diagnostic skills
- based on psycho analysis
- based on cultural and spiritual aspects
These features will be consciously adopted in a sophisticated manner so as to evolve a
secular and universal nature of health management. Modern diagnostics will be
introduced and used to document & communicate the efficacy of Ayurvedic
management.
7.
RESEARCH PHARMACY
It will be a part of the Research Hospital. The main objectives of the pharmacy will be to
set standards based on Bhaishajya kalpana
1. For products at
a) House hold level
b) Cottage level
c) Industrial level
- For housewives eg. Kajal: good users practice (GUP),
quality, safety & efficacy.
- For Vaidyas I Hakims, good users practice.
- GMP (Good manufacturing practice)
development - user-friendly products, new dosage form development,
improving the bioavailability, improving payability, textures etc.
Product
2.
Resource
3.
management - how to improve extraction and optimum utilization of
resources.
4.
Technology
adoptions-criteria for using technology without compromising basic
premises of Ayurveda.
S.Develop methods to improve storage mechanism, increase of shelflife, use of non
destructive plant parts instead of parts like root, stem etc.
6.Technology transfer to new units in the area of pharmacy.
8. Physical features
The physical features of this hospital should architecturally so designed to reflect the
intrinsic serene & eco-friendly characteristics of Ayurveda.
It will have fourteen components as follows:
Patient’s rooms or cottages:
1.
a. 60 double rooms bath attached. Common kitchen and treatment rooms for a block
of 5 rooms (total 12 blocks of 5 rooms = 60). Rooms should have opening in the front
and back. At the backside a small sit out with a small garden open air. Ground floor and
first floor. For two'people to stay, one patient, one family member, simple and functional.
b.
20 cottages, with treatment rooms / kitchen attached/ two bedrooms.
Opening to a garden in front.
2.
Out Patient Department
Consultation rooms - 5 nos. for 5 departments with common waiting room/ drug
store/dispensary/reception.
3.
Diagnostic Centre.
Clinical lab, blood bank, x-ray analytical instruments, scan etc., all modern gadgets for
diagnosis and prognosis - with space for chief pathologist and other technicians. At least
10 technical staff plus waiting place for patients and reception to direct patients to
respective areas.
6.
5.
6.
7.
Operation Theatres (OT) - 2 nos.
a.
Obstetrics
b.
Minor surgery I ksarasutra / orthopaedics
Yoga I meditation hall for 50 people to do yoga and pranayama at a time.
Kalaripayattu pit.
Space requirement, location etc., to be collected from authentic centers (CVN Kalari,
Kozhikode or Thiruvananthapuram).
A temple of Lord Dhanwanthari with a place for daily Havans.
8.
A Goshala for around 20 cows.
9.
a.
b.
c.
d.
Staff Quarters for 40 staffs
15 for doctors
5 for senior administrative staffs
19 for masseurs and other technical staffs
1 for chief physician
10.
Power house, security house and other common requirements extra.
2 bedrooms
2 bed rooms
1 bed room
3 bed rooms
Pharmacy - 4000 sq.ft. For modern lab 1st floor,
4000 sq.ft. For Ayurveda pharmacy ground floor.
Canteen
12.
for twenty people to dine at a time with patya apatya components.
11.
13.
Animal house for animals other than cows.
...
14.Physiotherapy centre
, .• '
Special Notes (Zero Energy concept in Design)
>1 ' ’
1.
2.
3.
4.
5.
Solar power for lights & fans
Natural cooling system so all rooms are at 20 - 23 0 C temp throughout the year.
Rainwater harvesting
Sewage water recycling.
Herbal gardens interspersed with physical layout.
9. CURRENT STATUS OF THE RESEARCH HEALTH CENTRE AND
PHARMACY IDEA.
•
Around 100,000 sqft. Of land is available on FRLHT campus at Yelahanka,
Bangalore for constructing the Research hospital and Research pharmacy.
•
Dr. G G Gangadharan, former Vice-President of Arya Vaidya Pharmacy, Coimbatore
has joined FRLHT in April 2003, to serve as the project leader.
•
The next steps towards operationalising this project include:
a)
Preparing a detailed techno-economic plan for the hospital and pharmacy (by Dec.
2003)
b)
Selecting a core team to execute the plan and designing and implementing a training
programme for them (by Dec. 2003)
c)
Preparing an ecologically sensitive architectural plan for construction of the hospital
and pharmacy (by Jan. 2004)
d)
Raising the necessary resources for the plan, bail-park figures are: around Rs. 5 crores
for infrastructure, Rs. 5 crores for equipment and Rs. 5 crores for working capital (by
Dec. 2004).
•- '8Page 1 of 1
Robin C. Davis
"Robin C. Davis” <rdavis@globalhealthaction.org> >?c#From:
<reddemma@rediffmail.com>
To:
Thursday, March 06, 2003 2:21 PM
Sent:
INSA
2-03.doc
Attach:
I
Subject:
IFw: Future Plans RE: INSA/lndia
Reddemma,
I could not get your e-mail at nimhans to go through. Will you please send me the full e-mail address for it.
Thank you,
Robin
---- Original Message----From: Robin C, Davis
To: reddemma@rediffmail.com
Sent: Thursday, March 06, 2003 2:18 PM
Subject: Future Plans RE: INSA/lndia
Dear Reddemma,
It was wonderful to speak with you today on the telephone. I have attached the memo that we spoke about for
you to share with the officers of the Governing Board before the March GB Meeting. As we discussed, this item
can be on the next meeting agenda as "Future Plans" for the GB Mtg. It would be good as we discussed, for the
GB officers to meet and discuss this before the next GB Meeting. Please feel free to call me or send an e-mail if
you have any questions about this memo. I will post a hard copy to you by express mail as well. Please confirm
by e-mail when you receive this e-mail and attachment. Also, I would appreciate having your FAX number for
quick communication. In a few days,I will forward you some sample job descriptions that we use at GHA, but
these of course would only be for ideas since the responsibilities at GHA and at INSA/lndia are somewhat
different. I look forward to hearing from you.
Warmest regards,
Robin
Robin C. Davis
Executive Director
Global Health Action
404-634-5748
www.globalhealthaction.org
Healthy People, Healthy Communities, Healthy World
3/6/2003
Healthy People/, Healthy Cowurumittei', A Healthy World/
March 5, 2003
Global
Health
Ration
To: The Honorable Justice S. Rajendra Babu, President, INSA/India Governing Board
Dr.V. Benjamin, Vice President
Dr. K. Reddemma, Secretary
Mrs. Vatsala Nagarajan, Treasurer
From: Robin C. Davis
Executive Director
Global Health Action
Subject: Congratulations on 20 years of INSA/India &
Recommendations as we look to the future
It was such an honor to participate in the UTS AV for the 20th-Year Anniversary of
INSA/India, to participate in the workshops, and to learn more about the amazing work
being done by INSA/India staff and participants. The organization has grown from a
little seed into a significant presence for better health in India and neighboring countries.
With growth comes the need to further specify and clarify the roles of staff, particularly
the staff leaders. When Sujatha retired, the Governing Board decided to give a co
directorship structure a try. Having been part of that discussion before the decision was
made, including the pros and cons, I think it is time to reassess this leadership structure in
light of the organization’s growth and the added pressure to raise more funds and sustain
programs for INSA/India. During December, I had the opportunity to work with all staff
for a week and a half in the office and at the workshops to see the current structure in
action.
I respectfully request of and strongly recommend to the Governing Board that the
following be implemented for the new fiscal year, beginning April 1, 2003:
The organization needs one ultimate staff leader/decision maker to guide the organization
in its day-to-day operations and with its long-term plans. In my experience of over 25
years in this field, that person must be one with organizational leadership experience,
solid management and financial skills, the ability to raise money, and the knowledge of
programs and services needed and rendered. Therefore, I recommend that Florence
David become the Executive Director of INSA/India and that Edwina Pereira become the
Director of Programs, to clarify their roles and the channels of communication within the
organization and outside of the organization. It is very difficult for staff to have two equal
bosses and it is confusing to those on the outside, particularly when difficult decisions or
communications are required. With the current and future demands on the program area,
this is a fulltime job in itself and Edwina has shown over the years that this is her strength
and her passion. Florence on the other hand is a very good administrator, financial
manager, planner, and fundraiser for INSA/India. In the year 2001-2002, the team
2250 N. Druid Hills Road, Suite 130 • Atlanta, GA 30329 U.S.A.
Mailing Address: P.O. Box 15086 ♦ Atlanta, GA 30333 • phone: 404/634-5748 • fax: 404/634-9685
gha@globalhealthaction.org • www.globalhealthaction.org
A Tax Exempt 501 (c) (3) Non-Profit Corporation
Printed on Recycled Paper
brought in 1 Lakh 4,000 rupees through consultancies. Florence brought in the large
majority of these consultancy funds. This year the ICCO consultancy conducted solely
by Florence has brought in 82,000 rupees already. Effective this year the relationship
between Global Health Action and INSA/India has changed from one of GHA being a
financial sponsor to one of GHA and INSA/India being in a collaborative partnership
relationship where both work together when appropriate to get outside support for joint
efforts. GHA’s financial support in 2003 will be US$12,500 and in 2004 it will be
USS5,000. By 2005 this type of support from GHA will cease. I believe this also
requires a change in the organizational structure where an Executive Director would
focus more on building organizational partnerships, building the visibility of INSA/India,
and mainly raising funds through consultancies, contributions, grants, and program
partnerships to support the organization. These responsibilities will involve focused time
and travel, leaving only 10 to 15 percent time for participation in training programs.
Program development and implementation requires a fulltime effort and Edwina is very
skilled in this role. Florence on the other hand, has years of experience running an
organization and managing its financial and administrative matters. This is why I
recommend Edwina for Director of Programs and Florence for Executive Director (the
overall decision maker). I recognize that Edwina has more years at INSA/India, but
Florence has as many years in the field of health and education in key leadership
positions. Given the current staffing situation, I would recommend the salary of the
Executive Director be at least equal to that of the Director of Programs. Currently
Florence has a lower salary than Edwina and all staff knows about this from the account
vouchers that are signed in the office.
In this revised structure, the Executive Director would make the final decisions about the
operations of the organization, future organizational plans, and the budget and financial
management, including the actual expenditure of funds and the generation of income.
Fifty per cent of the Executive Director’s time should be allocated to organizational
development, fundraising and income generation activities such as consultancies,
including the necessary travel required to accomplish these activities. Another ten per
cent of the Executive Director’s time needs to be allocated for travel related to
conducting consultancies and attending networking/fundraising conferences and
meetings. The remaining time would be spent on administrative and organizational
matters, including working directly with the Governing Board.
All program site visits and follow-ups need to be made by the Director of Programs and
the program staff. The Director of Programs and the program staff need to spend their
time on planning and conducting programs, courses, and workshops for the organization.
This would include the recruitment of course participants and program partners. The
program-related travel needs to be conducted by Edwina as Director of Programs and the
program team.
In this recommended structure, the Executive Director (ED) is the leader of the staff, with
all administrative staff and the Director of Programs reporting to the ED. All program
staff would report to the Director of Programs.
I regret that I cannot be there in person to discuss these recommendations with all of you,
but please feel free to contact me about them. My office number is 404-634-5748 and my
home number is 404-847-0336. My e-mail address is: rdavis@globalhealthaction.org.
I would be happy to share examples ofjob descriptions that would clarify the
implementation of these two positions. Even for someone like me who has been closely
involved with INSA/India from its inception, the current dual leadership structure often
makes communication cumbersome and confusing. Now more than ever, clear lines of
authority and responsibility are needed in today’s organizations.
I ask that you give the above recommendations your full consideration for
implementation on April 1, 2003, the new fiscal year.
Each of you is to be congratulated for your faithful and committed service to INSA/India
and its important contributions to health and development. The staff should be
acknowledged for their committed and professional work to help INSA/India grow into
such a great organization.
A
HRFDL WORKING AREA
20 Taluks from 10 Districts 400 villages,
Population coverage around 1 lakh peoples.
HRFDL-K
A NESA partner working in 12 districts in the
state of Karnataka for Dalit human rights.
It has a participatory approach to community
development and has a rights-based
perspective.
It campaigns for Dalit land rights, promotes
Dalit women leadership and provides legal
support to victims of atrocities.
HRFDL-K
• Primary Objectives:
J Abolition of caste discrimination and
untouchability.
J Empowerment of Dalits through promoting
awareness and capacity building.
■/ Working for basic rights to land, education and
employment and life with dignity for Dalits.
J Provision of legal support to victims of atrocities.
J Facilitation of political participation of Dalits at
Panchayat level.
J Promotion of mutual collaboration with other
Dalit movements, activists and NGOs.
HRFDL-K HIV/AIDS
Programme
Focus:
Dalits and other minorities and other
communities. Peoples living with HIV/AIDS.
csws
Programme Components:
Mainstreaming the issue of HIV/AIDS in Dalit
communities.
Capacity building.
Advocacy Activities.
Community Participation.
hiv/aids Programme
Objectives.
To prevent the spread of HIV/AIDS in Dalit
communities.
To build perspectives on hiv/aids as a rightsbased development issue.
TO provide STD treatment facilities.
To advocate and lobby for rights for people
living with HIV/AIDS.
To sensitise Dalit communities to the issue of
HIV/AIDS and remove the stigma attached to
the disease.
Capacity building
Orientation training for 12 hrfdl-k district
convenors on hiv/aids, STIs and RTis.
Counseling skills training given to district
convenors and co-convenors. A total of 30 people
participated in the programme.
Sensitization training for Dalit women and their
husbands through SHGs
Sensitization training for youth groups and
school and college students,
Formation traditional cultural teams for street
play and public programmes,
Achievements.
District level training for Dalit
leaders and activists.
Training on HIV/AIDS, STI's and RTi's conducted in 8
districts with the participation of 40 local Dalit
organisations and 800 Dalit leaders.
50 volunteers trained in peer education in 5-day
workshop.
Achievements.
Self-help groups sensitisation
programmes.
162 SHGs receved training in 8 districts.
3,240 women sensitised on HIV/AIDS and STIs.
Achievements.
TOT (Training for Trainers) for
traditional cultural activists.
15 members 2 teams prepared.
15 shows performed, reaching out to 30,000
people.
Public programme conducted in Pavagada and
Anaekal taluk.
Activities and Achievements.
» Mainstreaming issue of hiv/aids
through creation of taluk level
information centres.
• Provision of condom outlets (50,000 condoms
distributed).
■ HIV/AIDS and STI referrals for treatment.
' Promotion of community volunteers for care and
support.
3 information centres opened.
5 more to be established shortly.
Activities and Achievements.
• Advocacy and lobbying for people
living with hiv/aids.
> Provision of condoms at local health centres.
> Discussions with local government and private
doctors regarding STI treatment.
Health Action Committee formed in collaboration
with other organisations in 3 taluks to carry out
advocacy work.
Case Study 1
Govindamma, an Hiv Positive Aganavadi teacher
in Pavagada taluk, Tumkur district was
discriminated in her village and workplace due to
community prejudice.
HRFDL-k activists discussed the issue with the
relevant departments, local doctors and village
leaders.
Since this intervention, village prejudices have
been addressed and the issue has been resolved.
Govindamma is now happy in her life and work.
Case study 2
in Yethanahally, hrfdl-K formed 2 womens SHCs
and 1 mens SHG. As a result of this initiative, and
the training and sensitisation that they received,
the SHGs organised an "Audio Cassette Release
Function" for awareness-raising purposes.
Dr. venkataramiah, a local doctor, attended the
function and was impressed by the initiative
taken by HRFDL-K. He offered to provide free or
low cost STI treatment to Dalits and other
economically poor persons. Women with STIs are
now able to receive treatment for the first time.
case study 3
Sukeshini is a young Dalit woman who runs a
beauty parlour in Indi Town, Bjapur district.
Following a 3-day hiv/aids training programme in
her area, she became very interested in the issue.
She now raises awareness through her parlour,
educating her customers on STDs and hiv/aids
prevention, and giving condom demonstrations
and distributing them.
Sukeshini is a very committed person and will
soon received further training and support.
impact.
This is the first programme in Dalit communities
in Karnataka.
Following HRFDL-K activities, people in Dalit
communities are starting to ask about condoms,
and they are using condoms.
Dalit men and women are independently going
for STI treatment.
HRFDL-K
HIV/AIDS Workshop
Hth-i2th December
2003.
HRFDL-K
• Primary Objectives:
v Abolition of castelsm and untouchability.
v Empowerment of Dalits through awareness
raising and capacity building.
v Assuring basic rights to land, education and
employment and life with dignity for Dalits.
v provision of legal support to victims of atrocities.
v Facilitation of political participation of Dalits at
panchayat level.
v promotion of mutual collaboration with other
Dalit movements, activists and NCOS.
hiv/aids Programme
Objectives.
to prevent the spread of HIV/AIDS In Dalit
communities.
HRFDL-K
A nesa partner working In 12 districts In the
state of Karnataka for Dalit human rights.
it has a participatory approach to community
development and has a rlghts-based
perspective.
it campaigns for Dalit land rights, promotes
Dalit women leadership and provides legal
support to victims of atrocities.
HRFDL-K HIV/AIDS
Programme
• Focus:
Dalits and other minorities living with
HIV/AIDS.
• core Programme components:
• Mainstreaming the Issue of hiv/aids in Dalit
communities.
■ Dalit capacity building.
■ Advocacy Activities.
■ Community Participation.
Activities and Achievements.
• Capacity building for HRFDL-K
district convenors.
to build perspectives on hiv/aids as a rlghts-
based development Issue.
TO provide STD treatment facilities.
To advocate and lobby for rights for people
living with HIV/AIDS.
to sensitise Dalit communities to the Issue of
hiv/aids and remove the stigma attached to
the disease.
• Orientation training for 12 hrfdl-k district
convenors on hiv/aids, STIs and RTls.
• Counselling skills training given to 30 district
convenors and co-convenors.
Activities and Achievements.
Activities and Achievements.
• District level training for Dalit
leaders and activists.
• Self-help groups sensitisation
programmes.
• Training on hiv/aids, sns and rtis conducted In 8
districts with tne participation of 40 local Dalit
organisations and 800 Dalit leaders.
• 162 SHGs receved training In 8 districts.
• 3,240 women sensitised on hiv/aids and STIS.
• 50 volunteers trained in peer education in 5-day
workshop.
Activities and Achievements.
Activities and Achievements.
• TOT (Training for Trainers) for
traditional cultural activists.
• Mainstreaming issue of HIV/AIDS
through creation of taluk level
Information centres.
• 15 participants from 3 districts trained and a
cultural team formed.
* 10 shows performed, reaching out to 25,000
people.
• Cultural programmes reaching out to 12,200
people In 5 villages undertaken.
• Provision of condom outlets (50,000 condoms
distributed).
• hiv/aids and STI referrals for treatment.
• Promotion of community volunteers for care and
support.
• 3 Information centres opened.
• 5 more to be established shortly.
Activities and Achievements.
Case Study 1
• Advocacy and lobbying for people
living with HIV/AIDS.
Covlndamma, an HIV Positive Aganavadl teacher
In Pavagada taluk, Tumkur district was
discriminated In her village and workplace due to
community prejudice.
• provision of condoms at local health centres.
• Discussions with local government and private
doctors regarding STI treatment.
• Health Action committee formed In collaboration
with other organisations In 3 taluks to carry out
advocacy work.
hrfdl-k activists discussed the issue with the
relevant departments, local doctors and village
leaders.
Since this Intervention, village prejudices nave
been addressed and the Issue has been resolved.
Covlndamma Is now happy In her life and work.
2
case study 2
Case Study 3
in Yettianahally, HRFDl-K formed 2 womens SHCs
and 1 mens SHG. As a result of this Initiative, and
the training and sensitisation that they received,
the SHGs organised an 'Audio Cassette Release
Function' for awareness-raising purposes.
Sukeshlnl is a young Dalit woman who runs a
beauty parlour In indl Town, BJapur district
Following a 3-day hiv/aids training programme In
her area, she became very Interested In the Issue.
Or. venkataramlah, a local doctor, attended tne
function and was Impressed by the Initiative
taken by hrfdl-k. He offered to provide free or
low cost sn treatment to Dalits and other
economically poor persons, women with STIs are
now able to receive treatment for the first time.
She now raises awareness through her parlour,
educating her customers on STDs and hiv/aids
prevention, and giving condom demonstrations
and distributing them.
sukeshlnl is a very committed person and will
soon received further training and support.
Social Accountability and Social Audit of NGOs
Some loud thinking for an approach to conduct it.
NGOs (or Voluntary Organisations!VO], as some of them insist on calling themselves - to
distinguish themselves from private commercial organisations which, also,, in a way, arc non
government by status and therefore NGOs) come into existence because (they strongly feel) that
something needs to be done to harness "progress” of the society in a meaningful and appropriate
manner, "Something critical is wrong! Something critical is lacking! Something critical is side> lined! Some sections of society are wronged or neglected or cheated and something needs to be
■ done to address these issues". These (and other compelling) issues trigger initiation of VOs.
; In many ways these VOs arc self-appointed and arc simultaneously 'independent' (in being self; appointed) and yet answerable to society (which is their raison-d’etre). They arc also answerable
to the society and to themselves to ensure that their practices and endeavour moves appropriately
k in the direction towards 'ideal' society (they proclaim to cherish) and also the values generally
i attributable to humane society e.g. secularism, eftalitarianism. pluralism, transparency, honesty,
and most importantly humane interactions.
VOs use monitory, human and other resources (of the society) in their "social" entrcpriinership.
These resources arc tools) and tools can be 'used', 'mis used' and 'abused'.
In any enterprise, the
function and (with it), the importance of audit is self-evident
1.
Fiscal audit
Mandatory (legal) requirements call for fiscal (and monitory) accounting and fiscal (and
monitory) audits. Fiscal audit has the longest history and have continuously developed into
•
more and more sophisticated exercises. The important feature of this type of audit is that it is
more or less standardised and universally accepted
Because of this reason it is also
relatively easy to conduct.
Unfortunately, with its sophistication, fiscal accounting praclice(s) has (have) also carved out
ingenious methods for 'hiding' I or camouflaging / or colouring fiscal picture. Auditor's work
(in this area) is to 'monitor1 'access' and "point out" variances in the fiscal picture and to
ensure that 'legal requirements are complied with before certification or to give 'qualified'
certification. Audited report may not be 'transparent' In this ease the auditor is not expected
to ‘penalise’ In fiscal audits, the auditor merely checks, monitors, reports findings and makes
qualified certifications.
Management audit
2.
The next in line has been the management audit.
With important strides in techniques of
management (of resources and people), management accounting and management audit has
grown in importance and harnessed in practice. The area has been nurtured and developed
inainly to usher in ‘efficiency’ and 'effectiveness' and navigation towards the goals set.
There are many important tools and concepts that have been generated through the development
of management science (and art) but the most important for the purpose of the discussion here is
the concept of'optimal'
"Optimal". We use the word 'optimal' to distinguish from the word 'minimal' I 'maximal'/
'average'.
To my mind "optimal" means that which "appropriate with holistic considerations".
(What is optimal keeps changing from time to time with changes in the situation). It takes into
under its wings considerations of (I) economically sustainable, & (ii) harnessing of resource e.g.
fiscal, time, effort, personal and personnel etc , on the one hand and creation of space and
opportunities for nurture, growth and development of individuals and Organisation.
Social Audit
3.
1 do not know if the term 'Social Audit' is precisely defined. Which is good for now because
it gives one a lee way to define it as one pleases. 1 would define it as auditing the existence
(and performance of Organisation / individual) in terms of meaningful value to the society
and its 'idealised' future.
What would that include. 1 do not know for sure, but for brain storming 1 am enlisting some
'heads' and elaborating on these wherever I can. (See below)
•
•
Worthiness Indices
hiyestment_wo.rthine.ss index
•
In an Organisation like CEI Iz\T (he funders invest money, the staff its time and effort and
the peer Organisations their 'concern and support'
(whatever that means). To each of
these segments, a repeat of investment would be reason enough to signal an increment in
'worthiness.' Again the more investors would mean a signal for greater perceived
worthiness by that investor segment. A scale w ould be drawn out based on this 'repeated'
2
■ or continued investment. A scale could also be drawn out based on the number ol such
investors. Larger the base, the larger would be the perceived worthiness to that segment.
Based on the score, of each of these a "Worthiness Index’ (lor this segment) could be
coii.sliueted. 'I bis index could be limn the invcsloi's angle l ikewise theie could bo those
from the point of view of (1) social action angle (which could be sub-divided into
sections as 1 have tried to list below.
•
” ‘
Social action angle
•
Support to existing social action
•
Research for new avenues for social action
•
Lobbying facilitation
•
Academia facilitation / support
•
Debt ; Equity ratio (A little diversion for the moment)
i
This is a thumb rule popular within the Corporate circles. "If the Share-holders arc willing to
W invest 'x* amount of funds (i.e. investment) then the 'lenders' would brave a risk of'2x' and all
this '3x' would be worthwhile, if the product of the enterprise is valued at
least '300x'
Perhaps if one is able to give 'value' representations to the dibits (and time) put in by the
Organisation in terms of'money' (That is already done because the Organisation pays 'salary
'where the notion is based on converting effort into 'money' - even if this is I lobson's choice.
The difficulty would be to set values (in monitory' terms) to product_of enterprise.
•
1 loncsty index
It will take some time and dibit to develop on this. 1 have put it here for brain-storming
exercise.
•
Transparency index
The term "Transparency" is well known and abundantly used. And yet, I suspect everyone's
notion of transparency is slightly (and sometimes widely) different. Thankfully across the
board there is a common consensus that the greater the transparency between the interacting
entities the better it is.
I shall therefore qualify what I presume transparency means in the context of Organisational
behaviour. Used in the context of Organisational behaviour, it entails that entities interacting
"with" and "within" the Organisation know (or have access to) infoimation that is (or can be)
relevant to the interacting entity.
Docs this mean everything that goes on within the
Organisation is out on display? 1 think not. There are a number of matters that need to be
shielded from exposure on ethical grounds (eg confidentiality of the personal working
within the Organisation and many such matters) or on grounds of' vulnerability to
competition (commercial grounds), but transparency demands that these area be demarcated,
notified to the entities interacting and be substantiated with appropriate explanation
(particulaily the ethical merits for such non-disclosutcs). The commercial (or political)
shields against disclosures must also be spelled out with adequate explanations. The more the
disclosure the more Open would be the Organisation. One could workout a scale for
Openness of the Organisation based on this concept.
Likewise, there could be non-disclosures scoring also.
Positive scoring for ethically
appropriate to null score for commercially / politically <ippiopriatc_to negative for
unacceptable reasons.
(++++ I +++ / it- / + / o / - / — / — I—)
Based on the Openness
score ( 0 % to 100%) and the Non-disclosure score an index of transparency can be worked
out.
CEI1AT is (1 am told) planing to have a 'web page' on the internet.' On the web page, it is
common ‘o have a sub-site titled "about us". In this 'about us' what is the site visitor able to
access information (even if that calls for a payment of a fair fee) about CEIIAT would give
a degree of "Openness" and if properly extended transparency of the Organisation.
fairness index
1.
Is the Organisation fair to employees
2.
Is the Organisation fair to funders
3.
To the society it uses for its work (e g community in field research)
4.
Is the Organisation fair to the society in which it operates (country)
Equality index
To be developed
Sensibility index
To be developed.
Reference index / Reference score (no. of citations of research products)
CEHAT is a research Organisation It publishes papers and other publications which are to be
referred to and quoted. Based on the densityf?) of citations a score can be constructed.
New approach index :
Different positions > common goals (Hospital accreditation)
positions" to common acceptable and workable level is - to my mind an innovation - value
that could be constructed for 'worthiness index.
•
Universal publication (on the internet) access to beat plagiarism? (Web page) (Floppy)
(data publication in Journals)
'I his is yet another innovation to defeat copy-right madness.
This 'value' could be
subjected to 'scoring'
•
•
Outreach accessibility
i
To be worked out.
i
Internal democracy - Mow much? How effective exercised? How fruitful in nurturing
internal 'pluralism' A score could be devised
Interdependence - support index
CEIIAT has liased with a number of Organisations ( programmes) - complimentary / and
supportive functions for a common goal.
These inter-responsiveness could be subjected to a
value score.
Optimisation index (?)
To be developed.
Ripple (meaningfulness) elTect index
•
Immediate next group > next immediate group > so on.
Each Organisation builds its
ethos. The founding members (are presumed to imbibe this ethos maximally). The next
proximal segment (say, the staff) is expected to
be influenced
next and so on. For
instance practising doctors (who founded the Forum for Medical Ethics FMES) are
*
expected to fully contribute to the ethos of l-'MKS. The next proximal groups is expected
to be influenced more preferentially in relation to the distal groups. Audits could aim at
exploring the reality of this presumption.
Personnel growth and development index
(In house poll Entrance poll / Exit poll) The entering stall' and the exiling stall’ of the
Organisation have their 'picture' of the worthiness of the Organisation. Some times this is
coloured by personal fancies or prejudices. These prejudices or fancies arc at their high point
immediately (on entering) or (on leaving). Some Organisations (or their representative) try
and evaluate the perceptions of these segments after a cooliny period, say of 6-iuonths This
score ( it is believed) is useful..
Intra-Organisation personality gradient. - Space score / involvement score /'belonging' score
In house value nurture index - ethics-ethos / social justice index / empathy index / open-,
mindedness index
There could be more areas that could be included, with further work in this area.
One method of scoring
(Many of these indices are intangible in character. It is difficult to make measured scoring. The
approach adopted in sports like gymnastics or figure skating is that there are 6/8, or 10
evaluators. They record their instant score. The highest and the lowest scores arc weeded out
arid an average of the rest is drawn out for arriving at score of that individual).
10 evaluators to cover the range of proximity levels (very close to very distant). Evaluators
1.
who are dose to Organisation and those which are notclose, form a team of evaluators.
On each index organise score gradient (highest to lowest) Leave out the highest and the
2.
lowest and add the rest and divide by 10 (or eight) to get scoie for each. It-is expected that•
scoring of individual evaluators follows a (^’7'clt^e
If it happens to be otherwisc\^y/the
evaluators need to be changed 3.
Organise indexes score wise and divide the range into 3 components The highest segment
4.
need to be sustained and middle segment needs to be fortified and the lowest needs to be
urgently addressed to for improvement.
.5. There are some indices which may need monitoring throughout Some may need to be
moderated on the basis of age of the project. Some based on the category of the'project
Some through correspondence. Some through personal interview
6.
Grading of project vis-a-vis meaningfulness
•
to social action
•
to academia
•
to lobbing value
•
7.
to peer Organisations
Slippery slopes and Iceberg technique.
It is important to be aware of areas with slippery slopes and Iceberg technique could be
harnessed to investigate these areas. Some such areas that come to my mind arc:
•
Asset-building - an exercise for sustenance and necessity or for ego and avarice.
Anusandhan
A note for (potential) Social Accountability Group (SAG) members for CEHAT.
Relevant History
Anusandhan Trust was envisaged and formed in 1991.
Though, the thinking then was to engage in
rigorous research in the areas of health - (research, particularly from the pro-people (particularly the
disadvantaged) perspective) - there was a clear understanding that the outcome of research should make
enabling environment for social action. Also, (additionally) (it was conceived) that it was important
(where existing social action was not evident) to research and establish data that could lead to initiating
social action.
To Anusandhan. it was clear that all pro-people work was important and restricting itself to areas-of
research would not suffice and hence whilst drawing the Trust Deed a wide spectrum of possible areas to
work in were included. It was envisaged that initially there could be a centre for research, but if the need
arose, Anusandhan would initiate other centres as well. CEHAT (Centre for Enquiry into Health and
Allied Themes) was started some three years later and is engaged in research and action in areas related to
health. Over the past six years CEl 1AT has grown speedily.
Whilst initiating its endeavour. ANUSANDHAN pledged itself to the values of (1) transparency (ii)
honesty, (iii) openness, (iv) democratic functioning, (v) collective governance, (vi) constantly improving
standards for quality output and (vii) social accountability in all its units. When CEHAT was started,
structures for implementing these values were gradually put in place.
The Trust Board of Anusandhan - since the very beginning - realised that merely constructing structures
pvas not enough to ensure their effective purposes. Anusandhan believes that just as featuring of financial
audit report is mandatory in a company's report to the public, social audit report must also be a
responsibility of an organisation in its report to the society in which and for which it exists. Nonetheless,
Anusandhan also is alive to the ground realities. While norms for financial audit are tangible and
quantifiable and by and large universally accepted, those for social audit are not yet sufficiently well
developed.
Largely, this is because of three reasons viz. (1) organisations themselves have not laid
enough priorities and efforts in developing these aspects (ii) there are no existing paradigms on setting up
social audit procedures and (iii) outcomes relevant to social benefits &. harms arc difficult, if not
impossible to quantify and measure.
Rather than wait until such procedures arc set up, Anusandhan thought.it best to subject its 'efforts' to
social accountability. It was envisaged to set up a Social Accountability Group (SAG) of persons with
iniquity, sensibilities and ability to critically review all tfyqt uent into the work of its centre and along
with it the output oj its work. It would be mandatory to include (attach) report ol' SAG along with the
Annual Report of' that year. As response to SAG report. Anusandhan would carry (in its next annual
report) the action taken report on the recommendations of the SAG report. This way Anusandhan would
have the benefit of critically evaluated appraisal for improving its own endeavour on the one hand and
would serve to social accountability report before the society it aims to work for. by making it accessible
to anyone w:;o requires it and requests for the report. In time, perhaps, parameters (to build up a system)
for social audit would (may) also emerge.
In 1994 (check<~thc^>ycar'7~datc). the first SAG - comprising of
Dr.Ashwin Patel, Dr. S L Shelly
Dr Nccra Desai, Dr.S.K.Pandya,
& Dr Ravindra Soman was constituted and served until now (a tenure
of 5 years). A worthy exercise was an outcome of this SAG. But this was the first SAG and Anusandhan
requested this SAG to assess die 1 rust's centre in the way the SAG deemed it fit.
For this purpose;,
CEIIAT provided extensive material that was generated in the centre (e g all papers / reports published
and unpublished , minutes of the Trust Board Meetings, the Staff meetings, rules & regulations & salary'
structure of CE1IAT, etc.).
Reviewing the exercise of SAG now. the Trust now feels that specific & critical evaluation of tl]p
Centre (from SAG) in important areas would be helpful to the Trust and the Centre for development and
direction in which the Centre moves. I his note attempts to list out these areas and also suggest procedures
for interactions between the Trust, the Centre and SzXG.
CEHAT's working structure
1.
present, CE1 IAT has offices in Mumbai & Pune and other field offices in Maharashtra and
MP
2.
The Centre has as its chief administrator the Co-ordinator.
He / She has duties &
responsibilities towards (a) the Trust (b) the administrative wing (accounts I personnel etc.),
die research wing, the external contacts. 1 le / she is authorised to depute anyone to this work.
In addition, the Co-ordinator has his / her own research responsibilities on the Research
Projects he/ she is involved in.
3.
Wage structure and Rules and Regulations are written down and arc available for anyonp
(even outsider) who asks for a copy. A new employee is furnished with these. These could
serve to foster transparency. Whenever, revisions in die wage structure are made, a meeting
with staff is organised and the subject is thrown open to debate.
4.
In order to nurture collectivism, democratic practices and effective space for communicatioi)
within personnel and to evolve leadership qualities within the staff, the Centre has instituted
3 Working Group (WG). WG has elected representatives from both the Mumbai and Putjc
offices. The WG meets once a month. 'Hie Co-ordinator is an ex-officio member of tlic
WG. Expenses (travelling etc.) are borne by the Centre. Elections to the WG arc held every
?
year and any member of the staff is eligible for this. The tenure of the member is 2 years
with one-third retiring each year. Care is, however, taken to ensure that both flic Mumbai &
tlic Pune offices arc represented on WG. Work on the WG entails responsibilities in addition
to the work that the individual on the WG has. However, for (his additional work
the
members do not get any allowance. T his is made explicit to the individuals on the WG.
5.
In addition to the WG meetings Staff Meetings arc held twice a year. These arc organised
as residential meetings at some resort that is both convenient and economical. The agenda
for such meetings try and incorporate presentations of the work done by die staff, changes in
administrative I accounting as also die huidies and difficulties in the procedures etc. And any
other personnel matter. Often die agenda tries to include a lecture from someone outside the
Centre or a workshop.
These meetings try to provide space for the staff to have a general
awareness of die status (as also the difficulties, challenges etc.) of the work of other members
of die staff.
It also can (and hopefully docs) provide space for harmonising personnel
matters.
6.
The Centre has put in place the Grievance Rcdressal Structure (GRS). This is currently under
review.
7.
The financial accounting and reporting is the responsibility of the accounts wiiijJ and Co
ordinator heads this wing. Chartered Accounting Firm is entrusted to oversee and certify the
financial accounting. This accounting is done on the half \early basis but the certification of
accounts by the Chartered Accounting Firm is only done after the financial year ends. The
Centre has an FCRA account and accounting for this purpose also forms the part of the duties
of the accounts wing.
8.
Research Projects arc submitted by the Centre for funding. 1 hesc projects arc drawn out by
the Principle Investigator (PI) and discussed within the staff and the WG. For every research
project (involving primary data collection) setting up of
Ethics Committee (EC) is
mandatory. This EC reviews the work at the beginning (planning stage), intermediate stage
and final stage. As a procedural requirement all research and action work is subjected to a
peer review at various stages and the work discussed threadbare. Copies of publication of
these works (and any other publication brought out by the Centre) is sent to SAG members
9.
The Trust Board sends the minutes of its meetings to the SAG. CEIIAT sends the minutes of
the Staff meetings to SAG and the 1 rust Board Members. CEI IAT also sends the minutes of
GRS to SAG members and the Tnist Board.
10.
The Trust Board Members and the SAG members are encouraged to meet the staff.
.Trust Board and the constitution of new SAG.
Trust Board of Anusandhan has laid great importance to the report of SAG and its (SAG's) report along
with the ATR will be a part of Anusandhan's Annual Report this year. Learning from the experience, the
3.
Trust Board recommended some inputs to address the issue. For one. it has to facilitate the co-ordination
between SAG and the Trust Board on the one hand and to make Trust's requirement written and itemised
for facilitating SAG report. I his note is for that purpose.
Anusandhan Trust seeks to have SAG opinion /evaluation / recommendations on the following areas:
•
On meeting core objectives of CHI IzXT
•
On transparency of CEI lATs work within the Centre and with the outside environment.
•
On Worthiness of the output of CEI IzXT - preferably with respect to individual projects and
administration
•
•
On honouring ethical concerns
On the aspect of CEHATs
provision of space for nurturing excellence and leadership
qualities of individuals on the Staff.
•
•
On CEI LXTs interaction with other Organisations
On the space and nurturing of democracy and collective functioning within the Centre and
between Trust Board and Centre.
•
On CEI IATs grow th and development
•
’ die Gricvcncc Rcdressal mechanism and functioning and effectively of it
•
On the quality of research and shortfall in the area.
•
Other areas that SzXG may think pertinent and important.
Anusandhan believes that with a written request to SAG. it may facilitate the SAG to include the items in
its report to the Trust on the one hand and to tire Public on the other. It will be a binding for Anusandhan
Trust to publish (as attachment to its own Report) die SAG report and to state its response to SAG report
in form of ATR and what is not taken up for action with explanation to the Public.
Facilitating the functioning of SAG.
For facilitating the functioning of SAG. CEHAT had been furnishing to SAG (on a regular basis) (a)
reports of the research work published and unpublished (b) the minutes of Stall' Meeting and any request
■’that SAG makes. The minutes of XVG are not sent (because these take place every month and arc mainly
relevant to the staff co-ordination) (check if this is correct) but if the SAG makes a request these also can
be sent to members of SAG. The Trust Board furnishes (on regular basis) the minutes of die deliberations
at Trust Board meetings.
CEHAT helps SzXG in organising venues for SAG meeting and re-rmburses the expenses incurred for
travelling and organises hospitality. Anusandhan Trust has now resolved the ethical hurdle of making
allowance payment to members of SAG. Allowance for the SAG members for the days of meeting will
be borne by Anusandhan Trust - not from CEHA Ts funds. Also to facilitate administrative work of the
SAG. - particularly in the 3,J year (when the written report of the SAG is sought) the Trust will provide
. funds for a secretariat (of one or two persons) diat the SAG may like to set up. I h'c I rust urges SAG to
appoint a Chairperson to co-ordinate its activities and to facilitate liaison between Co-ordinator CEIIAT
and Managing Trustee Anusandhan and SAG.
This note is for preparing a foreground to initiate the new SAG.
It is hoped that in the first meeting
between SAG members, Trust Board Members and Co-ordinator CEIIAT a complete protocol will
emerge.
Anil Pilgaokar, eJuly 2000
Ravi Duggal, cAugust 2000, minor modifications
Following section added by Ravi Duggal
Modalities of SAG
It is suggested that the SAG should have five members. These members should be sensitive to social
research and action and must have made some significant contribution in it. They will select a Convenor
from amongst themselves. The tenure of the SAG would be for three years, at die end of which a social
audit report will be produced.
The SAG will get all secretarial assistance needed by diem from CEIIAT. CEIIAT will provide SAG
members all documentation, reports, papers, minutes etc., to members once every quarter for review of
work. The SAG should meet once a year to take stock of the work of CEIIAT and discuss amongst
themselves. Also they should meet and hold discussions w ith all staff members at this meeting. The SAG
members may choose to review the work of CEIIAT selectively as per their area of interest etc.. This the
9
, SAG mcnr.bcis must decide at dicir first meeting. At diis meeting they must work out how they would like
to structure their working and distribute responsibilities and the process of review to be followed etc..
At the end of each year a brief report after dicir annual meeting must be sent to the Trustees. The
members arc also free to send feedback to die Trustees as and when they desire. At the end of three years
the SAG should carry' out a formal social audit for which Anusandhan Trust will provide resources to set
up a Secretariat w ith an anchor person of the SAG’s choice, if such a person is necessary. Once the social
audit report is ready it will be presented to the Trustees at a meeting and discussed. Once it is finalised the
. SAG report will be made public. 'Hie Coordinator and Managing Trustee will subsequently prepare an
: ■ Action Taken Report and both these will be published in the next Annual Report of CEI1AT / AT.
Ravi Duggal
24,h Oct. 2000
UM-
N Gio - 8 -
ANKURUtsava
31st March 2003, Shodhagram, Gadchiroli
.
.
One million newborn children die without care every year in India.
A new method of providing them medical care at home by training a semiliterate
woman in villages in Gadchiroli was remarkably successful. (Lancet, 1999)
On 31st March 2003
.
.
.
•
.
1000 children who were saved by these women will assemble to celebrate the gift
of life.
Poor, illiterate parents of children who were saved by the village workers in 39
villages in Gadchiroli have collected a Gratitude Fund to save children in other
places.
This method is now being introduced in 100 new villages in Maharashtra.
100 village women, trained as the ‘barefoot neonatologist’ will receive their
‘degree’ in a convocation ceremony in the forests of Gadchiroli.
They will start working in their villages on 2nd April 2003.
We invite you to join us in celebrating the ‘human miracle' by ordinary village women in
Gadchiroli. Annually more than a million newborn babies die in the huts and homes in India. No
doctor reaches them. Most often, their deaths go unrecorded. These newborn deaths constitute
75% of the Infant Mortality Rate in India
Ten years ago we started looking for a solution. There was no technological miracle or
^accine which would save these babies. So we decided to try the human miracle! We decided to
educate pregnant mothers and dais, and trained a literate village woman to become the barefoot
village neonatologist in 39 villages in this poorest, semi-tribal district in Maharashtra.
Women in villages of Gadchiroli who are saving newborn babies
Three years later:
The scientific experiment in 39 villages showed that the newborn deaths reduced by 62%
These ordinary village women could manage seriously sick newborns in villages and save them.
The study was published in the Lancet in 1999 as an original research paper (Bang A T etal. Effect
of home-based neonatal care and management of sepsis on neonatal mortality : field trial in rural
India, The Lancet Vol. 354 : (1999): 1955-61.
The study has acquired an international recognition in the scientific circle.
As result of such simple ‘human’ interventions the Infant Mortality Rate (IMR) in these poor 39
villages has reduced from 121 to 30 i.e. equivalent to a semi-developed country!
Newborn
Mortality Rate (NMR) in 39 villages in Gadchiroli
Is it a one place wonder?
An initiative called ‘Ankur” was launched on the 1st January 2002 with the first rays of the rising sun.
Aew villages came forward from different parts of Maharashtra. Their women, 101 new village
health workers took the oath on that day from Baba Amte to save every newborn baby in their
village.
Shri Baba Amte gave the oath to new village women
Celebration of human potential to save lives.
-
For last 15 months, these 101 village women were learning under guidance and practicing in
their villages the art of saving the newborn - Home-based Newborn Care (HBNC). When
evaluated by a team, including international experts, these village health workers scored
mean 84% marks and 92 have passed the tests.
-
We will confer the ‘degree’ on them in a convocation ceremony and celebrate their beginning
of action of saving newborns in 100 villages scattered in different parts of Maharashtra and
even in urban slums!
-
One thousand children from 39 villages in Gadchiroli who were seriously sick during newborn
period but were saved by these village workers, and have now grown up, will also assemble
to celebrate life!
-
Their parents - poor, illiterate - have collected a ‘gratitude fund’ for helping to save children
in other places. They will dedicate that fund.
Following eminent persons will bless this ‘Ankur’ and felicitate the new village neonatologists.
•
Mr J V R Prasada Rao, Secretary Family Welfare, Govt, of India
•
•
•
Dr Armida Fernandes, President, National Neonatology Forum of India
Mr Parvin Verma, Executive Director, Child Relief and You
Justice C S Dharmadhikari
•
Noted film maker Ms Sumitra Bhave
The function will be organised in the deep forest, at ‘Shodhagram’, in Gadchiroli (175 Kms from
Nagpur) on 31st March 2003 from 2.00 to 4.00 PM.
You are invited to participate in this celebration.
Dr Abhay Bang and Dr Rani Bang
Directors, SEARCH, Gadchiroli (Maharashtra)
Members, National Commission on Population
Phone 07138-255407, 255406
Fax 07132-233403, 07138-255411
E-mail: search@satyam.net.in
Ref.: CHC/Mis/2003/ 6 G .
September 3, 2003.
Prof. Madhu S.Mishra,
Chairman,
Centre for Management of
Rural Development Programmes,
1IM-C Joka DH Road,
P.B. No. 16757,
KOLKATA - 700 027.
Dear Sir,
Sub: Directory of Voluntary and Other Organizations in Rural
Development (Vol. XXXI). Your reference Nil, Dated 21.7.2003.
I
Urban
Thank you for your kind enquiry with regard to the proposed publication of Vol. XXXI
of the Directory of Voluntary and Other Organizations. Enclosed please find the filled in
format sent by you. We would be happy to receive the copy of the Directory when
published.
Enclosed is a copy of our Annual Report.
With regards,
Yours sincerely.
Dr.Thelma Narayan
Coordinator
QUESTIONNAIRE FOR INFORMATION ON ORGANIZATIONS INVOLVED
IN
RURAL/URBAN DEVELOPMENT ACTIVITIES
Professor Madhu S. Mishra
Centre for Management of Rural Development Programme
Indian Institute of Management Calcutta
Joka, Diamond Harbour Road
Calcutta 700 104
IDENTIFICATION
1.1
Name and address of the Agency/Organization
H ggtl-Hn OJI.j -36^
__ -L BloJc__ iLn.'^a
'T
Rni/v^lnre -k~bOo3Q--------------------------------------------
Telephone
cS?.■S3>!.5'J9:...Fax :0!3Q.'7.£\£2-£z7?/?%.. E-mail
VSnl' Conn
1.2
Type of Organization
. Voluntary; Local/Regional/National/Intemational
2.
Semi-Government
3.
Government
4.
Any other (Specify)
Name & Address of Collaborating Agencies/Organistions :
1.3
i.
2
GtOOl'"
3
't/Q Ho |cOHD-£EM.O_______________________
_____________________
frf
4_______________________________________ ___________________________ »
5
1.4
1.5
(j°nha-P.- | C-M A.
M A-tc<-k oo
/GoX_
Year of Establishment: .JW--..-
Geographic Area of Operation :
Number
Name
V.t.
State/s
District/s
BI0Ck/s
Village/s
__ oy^Jr----------------------------------- ------------ --------------------------------
Town/s---------------------------------------------------------- --------------------------------------Any other
fintokxxl leAz&x.
1.6
Main objectives ofthe Organization when established :
—>
Co-'->e
/ EvtvCvwv'f
Qb—'Y^tS^j^ / lv\\~e.<3^rro^l^.c^
“
Main objectives at present:
1.8
' ■'1 r
1
Name and Mailing Address of the Head of the of the Organization :
__________
CjWr\VY\^ry^y
Contact Telephone
Fax:
O&0-SS3IS18
1.9
E-mail Address:
<5 VSt^L- Corr>
Major activities of the agency/organisation (Please rank in order of importance):
ACTIVITIES
1.
2.
vX3
,^4.
5.
6.
Agricultural/Animal husbandry
Developing appropriate technology.
Education CH
Health/Sanitation/Medical Care .
Housing/Infrastructure Development
Skill formation/Self-employment
Training
\^X" Socio-economic development
9. Relief/rehabilitation
^>0. Slum improvement
11. Extension Service
^^'’Environment Development
Women & Child Development
RANK
1
3
9b
£
14. Any other (specify)
kCCX-H^ rsSKfi^
„f^.^bui)r!.-2dLuK^..„.
1.
10
Area of concentration :
1. Rural
Urban
Both
Any other: "T-vc bc^-IL
III
Target Group/Population Covered by the agency/organisation
^aA-L&jP-YrzvvHIp X-looflo Cj!^rr>mu.riU^
■I
SI.
OPERATIONS* (Major projects implemented since inception).
Name of
Year of
No. Projects Storting
Yr-irnr
i Me^co
2GUAd
l^sq. -
r»u-
completion
<•
.
”"
MS<t- «6
TrzxXi/Jvg s^^pperf-
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4.
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t^TSTfiJ^CA.
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4
Kindly give details of projects/schemes implemented by your organization during last five
years with Government Funding support.
SI. Name of the Project
No. Scheme
Year of
Implementation
Financial/
lOHBV
1.
No. of Beneficiaries
Remarks
"71000
________________ '2-Dc )_________ComI
hnP
2.
(j~royF~ c^~
•
III.
(Please attach additional sheets in case the space is not enough. If reports/details of
Project's available kindly attach a copy with the Questionnaire).
RESOURCES :
1.
A.
PERSONNEL
No. of Technical Personnel (agronomists, doctors, engineers etc.)
| At Present
Category
B.
Number
Category
| ID
(q3+-OH'+c>^
Number
No. ofNon-Technical (trained) personnel
I At Inception
Category
3.
I £>2_
Number
At Present
Category
[o
Number
5
5-0
Total No. of Personnel in your organization
C.
At Inception^ QC>
Category
At Pesent
|
| ^_q
Category
Number
-
Number
1.
2.
3.
2.
OTHER RESOURCES
Value (in Rs.)
No.
(1) 1. Office Building
2. Land
3. Equipment
4. Implements
5. Vehicles
6. Food
7. Medicines
8. Any other (Specify)
(2) Funds (Annual)
1 - 5 lakhs
Less than I lakh
2. •
3.
5-10 lakhs
4.
10 - 15 lakhs
5.
15 - 25 lakhs
6.
25 - 50 lakhs i
7.
50 - 70 lakhs
8.
75 and adove
A. 1.
B. Source (Percentage of funds)
•— N. A
1.
Government .
2.
Non-Government
3.
Foreign Govt., —'M A- —
4.
Foreign Non-Government
5.
Any other. (Specify)
CotO HSb
C. What resources could you share with other agencies Project Funding
Tech. Expertise
Medicines
Food
Equipments
Vehicles
Any other (Specify)<]^<7^cJ-\jO/'gr
Art^lS
6
IV.
WHETHER FACILITIES FOR TRAINING AVAILABLE ? (IF YES) SPECIFY THE
AREAS AND NUMBER OF PROGRAMMES CONDUCTED DURING THE LAST FIVE
YEARS.
3o
__ (XCcorn
___
..tr.cuLizk2.2S_______________________________________
_____________
PROBLEMS :
A.
Identify three of your major problems (In order of importance)
3.
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B.
Specify the type/nature of help required to solve these problems
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c.
Indicate areas in which you would be willing to help other agencies for solving their
problems.
1.
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FUTURE PLANS
A.
.
Kindly give details of plans of action/diversification in the next five years :
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7
B.
What according to you are the present “strengths” and “weaknesses” of your agency/
organisation?
WEAKNESSES
STRENGTHS
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OTHER AGENCIES/ADDITIONAL REMARKS
Please let us have the name and address of other similar agencies/organisations working in
your region.
Name and mailing address of the agencies/organisations
2.
Additional Remarks :
(A)
Whether the oiganization is registered under section 35 CCA to undertake rural devel
opment activities ?
i-----------1----------- 1
(B)
Whether the organisation is registered under Foreign Contribution Regulation Act,
1976 with Ministry of Home Affairs, New Delhi.
(C)
Whether the organisation is registered under 12A Section of the Income Tax Act.
(D)
Whether the organisation is a member of any NGO Forum/Association
I fes I
[ \Yes"'j
[ Afes' [
I^Yes [
No. [
No. |
No. | (if yes, specify)
Thanks,
Kindly return this to :
Prof. Madhu S. Mishra
Indian Institute of Management Calcutta
Joka, Diamond Harbour Road,
Post Box No. 16757, Aliporc P.O.
CALCUTTA 700 027
Telephone (office) : 467 8300 - 04
Fax : 467 8307/8062
E-mail madhu_sm@hotmail.com .
.
NtnO-3
Page 1 of 1
"Sarijay Mukheijee" <.sarijay@iinicai.ac.in>
<Sochara@vsnl. com>
Wednesday August 27 2003 5 02 PM
August 27 2003
August 27. 2003
Dear Sir/Madam
Sub: Management Development Programme on Management of
Nn-t <TOVsmmer,t f
Se**teiabSl 11 13 2003
We arc happy t<> inform you that. the Management Centre for Human Values, Indian Institute of
Management. Calcutta, is offering, in line with its professed ideals, a Management Development
at me Joka. Kolkata. Campus.
Designed specifically for NGO heads, practising managers and donor organisations, this
nHwranime specifically addresses issues confronting NGO's in lheir operalions Modern
management techniques are bro ught to bear on the issues in the context of the value perspectives
or ethos that inspired the inception of the NGO. A South Asian perspective is unique to the
continent.
We trust this programme will be of benefit to your organisation, To reach out to NGO's. with
sincerity and commitment, the programme has been very heavily subsidised. We look forward to
your participation to enrich this programme. For details, kindly use our web-site www.mchv.org. /
aomdpfainmcai.ac.in
Sincerely yours.
(Prof. Raman Mitten
N GiO -■?
Ref : CHC/2003/3-o
Date : 16"' July, 2003
Credibility Alliance,
South Zone,
C/o.Nagariaka Seva Trust,
No. 514, 5th Cross, 7th Main,
HMT Layout, RT Nagar,
Bangalore 560 032.
Dear Mr.Ranjan Rao Yerdoor,
Greetings from CHC!
1.
Thank you for sending us the “Draft Norms for enhancing Credibility
in the Voluntary sector in India”. On behalf of CHC I have given this
to Dr. C.M.Francis, our senior consultant for a detailed look. Given
below are his comments.
Comments on “Draft norms for enhancing Credibility in the
Voluntary Sector, in India (December 2002)
Page 27. Governance :
Principle : “The organisation is committed
donations”.
Delete the words “specially because voluntary organisations
draw upon public funds and private donations”. Good
governance is needed always.
Page 29. “Robust accounting”. It is not clear as to what is meant by
“Robust”. What is needed is “Accounting with integrity and
full disclosure”
Page 29. “Consultative decision-making”. Change to “Participatory
decision-making”.
Good Practices :
Page 34. Organisational information
Add a clause : “Positions currently held by the members of the
Board in other voluntary organisations”.
Page 38. Recruitment
Include a provision for “by invitation”
Page 40. Salary
Delete the words “ especially when projects are supported by
Government and other donor agencies, either national or
international”. Minimum wages must always be paid to fulltime employees. The attempt should be to pay ‘fair’ or ‘living’
wages.
Page 40. Leave
“Ensure that 6 weeks paternity leave is granted”. This need
not be mandatory but discretionary, depending in the
circumstances. The person can avail of other leave such as
“earned” leave, if available.
Page 41. Holidays
Holidays other than on the declared list should be based on
state laws (National. Festival Holidays Act”. It is not clear what
is meant by this clause. The three National Holidays are
mandatory.
Other holidays must be decided by the
Organisation in consultation with the staff.
Page 41. Travel Policy
Invitation to National
event”. The invitation may be
personal to a particular person. The clause may be notified.
“Invitation to national and international events should be
considered an organisational invitation, if permissible. The
person most likely to contribute and benefit from the event and
able to contribute (as a result of participation in the event) to
the development of the organisation should be sent to the
event.”
Page 42. ’’Encourage a 360 degree appraisal system
”. It is not
clear as to what is meant by “360 degree appraisal system”.
Page 43. “Consider appraisals at the time of deciding increments,
whenever given, that is, increments should partly be linked to
performance”. This may be deleted. Increments are not
“incentives” or bonus”.
2.
We feel this initiative is relevant given the changing values and
composition of the NGO sector with the present market economy and
LPG forces.
With best wishes,
Yours sincerely,
For Community Health Cell,
Dr.Thelma Narayan
Co-Ordinator
% 5^^
Credibility Alliance
C/o NAGARIKA SEVA TRUST
(Development Support Group)
No 514, 5'h Cross, HMT Layout, RT Nagar, Bangalore - 560032. Phone & Fax: 080- 3535532.
Email: nstffisancharnet.in
20.6.2003
Dear friends,
idlest you to attend this very important meeting to discuss the “Draft Norms for
enhancing the Credibility of the Voluntary Sector” prepared by the Credibility Alliance.
The meeting will be held in different districts of the Karnataka State. The details of
the meetings, dates and venues are furnis hed on the other side of this letter. A senior
person preferably a member of the board is requested to attend the meeting.
Fevord-K as you are aware has taken this initiative to have this issue discussed as
extensively as possible in the State of Karnataka. Other networks have also
endorsed the move.
The draft norms book has been already sent to you. If you have not received the
book please let us know along with your.'contact address. The details of the initiative
are available in the document. Both English and Kannada copies are available with
local convenors and NST Bangalore. For soft copy of the document, send a mail to
nst@sancharnet. in. The Kannada version is in Baraha, free software available in the
net at www.baraha.com. If requested welcan also email the entire software.
_
The schedule of meetings to be held in Karnataka along with the local convenors are
listed here below, you may attend any ol\ these meetings at your convenience if you
are unable to attend the one organised fcpr your district/region. However let us know
in advance as to when and where you wi 31 be able to attend the meeting for logistic
arrangements. As the entire initiative is being done with a very small budget we
request you to cooperate with us by sha ring expenses as far as possible. We are
also requesting the local convenor to col ilectively meet the travel expenses of only
those participants who have absolutely no other support and are unable to travel and
attend otherwise.
Regards,
■^rOrhjreQ‘t>tiity Arnance,
Ranjan Rao Yerdoor.
)
2
SI.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Districts
Date and Venue of the Meeting and Time
Udupi,
Dakshina
Kannada
7'" July 2003
School of social Work (SSW), Roshni Nilaya,
Mangalore.Phone:0824-2435791
Mangalore
10 A.M. to 2 P.M.
Mandya,
12,n July 2003
Mysore,
ODP-Organisation For Development Of
Chamarajnagar People, ’Pragathi",
Bannimantap B Layout,
Mvscre, Karnataka/S70@lo _ _
10 a.m. to2p.m
r 7
16,h July 2003.
Belgaum,
Dftarawad,
institute for Sustainable Agriculture and Rural
Development-ISAR&.Pune-Bangalore Road,
Gr.dag
Near Malaprabha Grameen a Bank,
Dharawad. Phone:
10 a.m. to 2 p m
.
Haveri,
17'" July 2003.
.
Davanagere,
Rotary Balabhavanh; ; \
Opp. Inspection
nrWb vanagere
Chitradurga.
Club, Davanagere ;■
10 a.m. to 2 p.m. '
Chikmagalur,
18in July 2003
Hassan,
Christa Sharana, Birur, ChiHmagalur District,
Kodagu.
Karnataka 577116. Phone: 911-826-755714
Mob: 9448211275
10 a.m. to 2 p.m.
20'" July 2003
|
=
Raichur,
D.C.Compound,
/
Koppala,
Bellary.
N.G.O.Club,
f
Bellary.
j
10 a.m. to 2 p.m.
/
Bidar, Gulbarga, 21“'July 2003
f
Bagalkote and
SEARCH Organisation,
,
Project Office, C/o Gumas|e Deshpande,
Bijapur.
Vijaya Nagar, Road 21*',' Jidyagiri, Bagalkot.
Phone: 08354-433256.
1
2 p.m. to 6 p.m.
23'° July 2003
Tumkur, Kolar
ano Bangalore
Ashirwad,
Rural.
# 30, St. Marks Road,
Bangalore- 560 001.
{
080-2210154.
|
080-2279922
24,h July 2003
Bangalore
Urban
’Ashirwad,
t
# 30, St. Marks Road,
Bangalore- 560 001.
080-2210154.
080-2279922________ -___ *______________
Contact Person,
Organisation and Address
Ms. Rita Noronha
Roshni Nilaya, Mangalore.
Phone:0824-2262421
Mr. Stanley,
ODANADI, Mysore,
Phone:
0821-22402155
Mob: 9448079155. ^^
Ms. Meera Halkatti,
Executive Officer, IDS,
Dharawad.
Phone 0336-244720.7
G.N. Simha,
REACH, Kumaranahalli,
Phone: 08398-820177
Ms. Tara Serrao,
Christa Sharana, Phone: 91826-755714
Mob: 9448211275
Sr. Mary Mathew,
Arunodaya Poirada
Phone: 08394-446045
Mr. Venijatesh
SEARCH
Kamathgi,
Phone: 08351-787801
Muttappa,
DISC,
No. 44, New Bamboo
Bazaar Road, Cantonment,
Bangalore-560051.
Phone:080-5361503
Muttappa,
..
-—
DISC,
No. 44, New Bamboo
Bazaar Road, Cantonment,
Bangalore-560051.
Phone:080-5361503
r
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DEENA SEVA SANGHA
22.RISALDAR STREET, SESHADRIPURAM
BANGALORE - 560 020
BACKGROUND INFORMATION
Deena Seva Sangha is a voluntary organisation founded in 1930 by a band of
dedicated Gandhian workers to provide education, health care, rehabilitation
of orphan and destitute children and for eradication of social evils in the
society.. The sangha has a number of programmes for assisting very poor
people in the slums of Bangalore.
The Deena Seva Sangha is a registered society administered by a Board of
Management which is the supreme decision making body assisted by the
Standing committee, the Finance Committee and the Life Workers Council.
VISION. AIM AND OBJECTIVES:
VISION: To meet the basic needs of the poor people in the field of education,
health care, training, shelter, food, clothing, rehabilitation of disabled,’
orphans, destitutes and socially handicapped, thus providing them a life of
hope, dignity and a better tomorrow.
AIM: To alleviate the suffering of the poor.
OBJECTIVES: Eradication of poverty and illiteracy, by establishing schools,
training centres, dispensaries, school for mentally retarded children,
community health programme, formation of self help groups, homes for
orphans, destitutes and daliths, vocational training programmes for women
etc.
The Sangha continues to follow the basic principles of Gandhism namely love,
compassion, tolerance, simplicity, self-help, non-violence and truth.
PROGRAMMES:
Educational health care, rehabilitation, computer training, reading room,
library, Deena Seva Sangha Community Health project, Deena Seva Sangha
School Health Programme, Deena Seva Sangha Free Dispensary, Feeding
Programmes, School for special groups, Vocational Training centres for
women, Girl’s home, Children’s home, Deena Seva Sangha Student’s home.
These are the centres of works of Deena Seva Sangha.
DEENA SEVA SANGHA - COMMUNITY HEALTH PROJECT (DSS-CHP):
The concept of the project was thought of and a Consultant was called into
formulate the project for slum development to be submitted to WaterAid,
London. The project itself started in November, 1992 And from there onwards
upto date the project has .been implemented year after year. The details are
furnished in appendix....
The Vision, Aim and Objectives were defined in accordance with the
philosophy of funding agency. The Consultant in collaboration with the
authorities selected the first four slums located right around the office of
Community Health Project at No.22, Risaldar Street, Seshadripuram,
Bangalore-20. A preliminary survey was organised and a comprehensive
project drawn up and submitted to WaterAid, UK for supporting the project.
ABOUT WATERAID, LONDON, UK:
WaterAid, in London, is a company registered under charity, mobilising the
resources from water industry, Corporate Sector and General Public to
support projects to help the poor in the countries of Africa and Asia. It works
in these countries by establishing country offices.
Its vision, aim and
objectives are;
Vision: WaterAid’s vision is of an enlightened world in which all people have
access to safe water and sanitation.
Aim: WaterAid aims to work through partner organisations to help poor
people in developing countries achieve sustainable improvements in their
quality of life by improved domestic water supply, sanitation and associated
hygiene practices.
Objectives: .
Support projects that integrate water, sanitation and hygiene education
activities;
Help partner organisations develop their capacity to undertake integrated
water projects.
Influence other organisations to adopt waterAid’s approach.
Obtain the necessary financial resources
Improve continually the management of WaterAid’s work
Planning hygiene education interventions, promoting behavioural change and
monitoring impact.
Taking into consideration the above vision, aim and objectives of the
WATERAID, LONDON, the project drawn up was considered and approved
by WaterAid, London. The first phase of the project commenced on
November 13, 1992 and thereafter the project has been continued in fresh
areas and fresh slums located in and around Seshadripuram and
Malleswaram.
Altogether a total of 11 slums have been taken for
development during the course of 1992 to 2001. The present area taken up
from 1st April 2002 consists of three more slums adopted for development
under the same project objectives bringing the total slums adopted to 14. It
very closely follows Vision, Aim and Objectives of the Wateraid, U.K. The
details of these projects with their project numbers and other particulars are
furnished separately in appendix.... The present project is in the IX Phase
and is approved for implementation from 1st April, 2002 to 31st March, 2003.
(See Appendix.... For Phase chart).
The achievements after implementations of these 9 phases are furnished in
Appendix... with full particulars.
Staff has varied from time to time depending upon the needs of the project
implementation and till June 2001 the staff was in tact and as much as they
were fully geared to the activities taken up. In June 2001 the resources were
curtailed by 40% and the staff has to be retrenched according to availability of
resources. At present the staff of CHP consists of:
2 hygiene educators,
1 Civil Engineer,
1 Stenographer,
1 Multipurpose Worker, in addition to the Consultant. See Organisation Chart
at appendix....)
The Community Health Project (CHP) has a high power committee called the
Steering Committee which lays down policies, reviews it from time to time at
their monthly meetings and gives direction to the Project Implementing officer.
The project has a Chairman, a Secretary, a Treasurer and five other
members. (See appendix.).
HIGH LIGHTS OF THE PROGRAMME:
The progranmme may be classified into those concerning improvement of
watersuppiy, concerning improvement of sanitation and those in relation to
hygiene education of the resident population of the slums.
In the 11 projects that have gone by, achievements are projected and
presented in appendix... as already stated. It has to be emphaised here that
the implementation of the project in all its phases is spearheaded by focus on
Hygiene education as also gathering of the basic data concerning the
population who are involved and who are actively participating in the
programmes. The hygiene education programme is a programme undertaken
by all members of the staff though two hygiene educators are particularly
involved in educating the residents, giving them information, education and
communicating with them on all aspects of health and diseases. A detailed
programme of health education wherein we have launched a one day’s
Training programme has its origin in the year 1994 since the other methods of
conventional education yielded very poor results and showed that it did not
have the impact that was expected from the programme especially education
of the individual, the family and the community. This had to be changed over
to a lesson of education of one day's training programme and selecting a
target population from the women of the residential area. This showed that
our education did have a considerable impact, while the conventional
methods continued concurrently. The baseline data served as the main
source of information involving data on the area, its people, demographic
component, social, economic and cultural • milieus, food habits, medical aid,
etc., etc. The profile of the slums has been published. Profile of Phase-IX is
furnished in appendix. The baseline survey was also helpful in identifying the
risk factors, problems that may be faced, the felt needs of the community and
various other factors involved for successful implementation of the project.
With this information one could easily set forth not only the profile but also the
strategies to be adopted with a Work Plan and Plan of Action for guidance. It
was also necessary to think about not only the strategies to be adopted but in
case of failure, alternatives had to be thought of much before implementation
and priorities had to be fixed. This was all possible with the baseline data
available and building considerable rapport with the community particularly
participatory approach for the community was essential and have yielded very
good results.
BUDGET: The Budget, as already stated, has varied from about Rs. 10 lakh
per annum to a high of Rs.20 lakh and cuts down by 40% in the 2001. It is
now hovering at the level of Rs. 12.24 lakh. We hope to carry on the work with
the available staff as per the Work Plan and Plan of Action.
During the course of implementation, many problems have arisen, many
lessons have been learnt and many strategies have been worked out with the
experience gained. These experiences are all documented in many of the
reports submitted to WaterAid, apart from our routine progress reports, which
are submitted every quarter. See list of Special reports at appendix
Documentation of all activities and procedures has been widely appreciated.
The team from London, UK deputed in 1995 arrived in Bangalore and
evaluated the projects that had been implemented upto that period. They
were satisfied and they stated that the documentation was excellent. The
opinion of the Evaluation Committee was of very good help in view of the fact
that it paved the way for grants and approval of projects during the future
phases of the projects that were sanctioned from year to year.
CONCLUSION:
In conclusion it may be stated that the project implementation has been a
challenging experience right from the start and it enriched experience of the
staff and it has had its effect on the job satisfaction. WaterAid, London, has
been approving and sanctioning grants since 1992. Deena Seva Sangha
feels that the continued patronage of an opportunity given to DSS by the
supporting agency for the last nearly 10 years is an indication of confidence
that it has built and feels privileged and honoured to have been a partner
agency of WaterAid, London. On behalf of DSS and beneficiaries we express
our grateful thanks to Wateraid, London.
****************
f^|0 - g
z Child In Need
Institute (CINI)
Local
Initiatives
Program
Building Sustainability
Through Better Management
CINI
LIP
Local Initiatives Program For Reproductive And Child Health
Child In Need Institute has been working relentlessly for the last 28 years to
improve the health and nutritional status of women who are disadvantaged by the
pressures of poverty and living on the fringe of society. However, CINI’s health
interventions have primarily served the rural areas adjoining Kolkata. The Local
Initiatives Program (CINI LIP) made it possible to extend reproductive and child
health services to people living in the slums of Kolkata who were overburdened
by poverty, illiteracy and ill-health.
Initialed in 1999. CINI LIP is a pilot program, which works to support and
strengthen the efforts of the Government to provide high quality sustainable
reproductive and childcare services in the slums of Kolkata. The main focus of
this programme is on family planning, safe motherhood, child survival and
immunisation, adolescent health and prevention of RTI/STI/HIV/A1DS. It covers
a population of 2,38,000 and is being implemented through a network of 725
trained community health volunteers from 34 health posts located in 12 wards of
Kolkata Municipal Corporation.
CINI LIP offers a range of services through health posts located in the slums of
Kolkata. Services provided encompass family planning, pregnancy care, child
survival including immunization, adolescent health, prevention of STD/HIV/A1DS
and limited curative care. Besides service delivery, the health posts serve as a
nodal point for awareness generation, education and motivation of community
members to facilitate effective behaviour change communication.
Community participation is an inherent aspect of the programme. Trained
volunteers from the community are directly involved in implementing the
programme. Each volunteer has 50-100 families under her charge and is
responsible for their health. RCH committees involving local leaders have been
formed, to monitor the program at the local level. The community is effectively
tapped to mobilize resources and develop infrastructure for service delivery.
The programme establishes linkages with target communities and existing medical
facilities through a three-tier referral system, which enables community members
to access services from local private medical practitioners and local government
hospitals.
Designed in line with the National Population Policy, the programme has resulted
in greater family planning acceptance, expanded immunisation coverage and
increased number of safe deliveries.
(CINI-LIP receives technical assistance from Management Sciences of Health,
Boston and Technical Assistance Incorporated, Bangladesh.)
LOCAL INITIATIVE PROGRAMME (LIP) IN SLUMS OF CALCUTTA
Radha (28 yrs) lives in a shun of Calcutta. She is a mother of three children. She is pregnant
yet again Her husband is a rickshaw-puller. Radha supplements her family income by
working as a maid. Her last child. Champa is a year old. Champa was delivered at home.
because the city hospital refused to admit Radha. Champa didn't complete her primary
immunisation and has so far received only polio drops. Radha hash't gone for an antenatal
check up for her current pregnancy She is visibly malnourished and extremely anaemic. She
has never used anyfamily planning method. Her husband believes ‘children are gift of God'.
Local Initiative Programme (LIP) in the slums of Calcutta caters to the needs of thousands of
women like Radha. 60% of the total 12 million population of Calcutta are slum-dwellers.
where women are often trapped in the cycle of ill-health made worse by frequent child
bearing and hard physical labour.
GEOGRAPHICAL COVERAGE
LIP is being piloted in selected slums, scattered around four municipal wards (36, 56, 58 &
59) of eastern and central Calcutta by Child In Need Institute (CINI). LIP covers a total
population of 2.61,000 within a three year period from September 1999 to August 2002.
PROGRAMME COMPONENTS
Encouraging Community Participation And Local Capacity Building - The entire
programme is being implemented through a large network of community volunteers. The
volunteers receive extensive training under the programme. They are well equipped to handle
local reproductive and child health (RCH) issues. Volunteers act as the direct link between the
programme and the communities. Local RCH Management Committees, comprising of
members from the local communities, will be ultimately responsible for monitoring the
programme. Volunteers and committee-members will remain as permanent resources in the
communities and thus long-term programme sustainability is ensured.
High Quality Gender Sensitive Service Delivery - LIP introduces the concept of Health Posts
and Satellite Clinics in the target communities. Health Posts, located within the communities.
offer a range of preventive and promotive services. Curative services are provided by the
Satellite Clinics run by the local practicing doctors. Service delivery from the Health Posts
and the Satellite Clinics are based on the specific needs of the communities.
Establish Linkage Between The Target Communities And The Existing Facilities &
Programmes - LIP acts as a catalyst for the slum-dwellers to access quality health care
sen ices from the existing health care facilities and referral hospitals in the city of Calcutta.
SALIENT FEATURES
Built-in Mechanism For Constant Community Needs Assessment - LIP starts with a
baseline survey, which provides a clear understanding of the RCH-sccnario in the target
communities. Volunteers and programme staff jointly review the situation periodically by
using community mapping tools and various other participatory methods.
Male involvement - Active female participation in the programme depends upon the attitudes
of their male counterparts. LIP strives to motivate male community members by addressing
the male issues as well.
Life Cycle Approach & Adolescents’ Involvement - LIP works on a life cycle approach.
Along with mothers & children and male community members, the programme also addresses
the psycho-social and health needs of the adolescent boys and girls in the target communities.
CINI
Child In Needs Institute
(CINI) is working in the
Held of reproductive and
child health in rural and
urban West Bengal since
last 25 years. CINI has
strong commitment
towards sustainable
health and nutrition
development for women
and children, living on
the fringe of society and
disadvantaged by the
pressures of the poverty .
TECHNICAL
ASSISTANCE
provided by
Management Sciences
for Health (MSH).
Boston. USA
Technical Assistance
Incorporated (T AI).
Bangladesh
RCH PACKAGE
Family Planning
Safe Motherhood
Child Survival
Child Immunisation
Nutrition Education
Adolescent I lealth
Prevention of Rl'ls i
STDs/HIV/AIDS
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01.vsnl.net.in
PROJECT LAUNCHING
THE PROGRAM
The goal of the CfNI-LIP project is to support and strengthen the efforts of the Government of India to provide
high quality, sustainable reproductive and child care services at the local level. Its guiding principle is that
effective, high quality and sustainable service delivery is based on involving local government officials, service
providers, community leaders and members in managing and participating in their own Programme.
Specifically, the programme will provide gender sensitive, reproductive health services including prevention of
STD/H1V/A1DS to the members of the community.
THE PROJECT LAUNCH
The LIP forms a core team of a Project Manager, a Monitoring and Evaluation Officer, a Health Officer, a
Communications Officer, three field supervisors with research backgrounds and experience in the field of
preventive, diseases and public health. Twelve qualified Health Workers have also been appointed. The
community groups for motivation and referral services have also identified 600 Community Health Volunteers
to work in the slums.
THE COMMUNITY NEEDS ASSESSMENT (CNA)
To establish a baseline, determine the current pattern of service utilization and understand how to organize new
interventions to better meet community needs a community based need assessment was conducted. The sample
for the CNA consisted of 120 mothers with children under the age of two years and 210 female adolescents.
Results of the baseline survey are being used to formulate future plans and intervention strategies. The
Management Information System (MIS) is also being revised taking into account new data collection needs to
ensure that community needs are served.
THE LOCAL CAPACITY BUILDING
Capacity building has taken place at all levels. TAI, Bangladesh conducted a basic training and orientation
program for program and field staff. TAI also conducted a training of trainers (TOT) on quality of care.
Overview was provided for a comprehensive MIS and other reporting formats. A training program for the health
workers was organized by the CINI-LIP technical team focused on health and related topics, MIS and the utility
of behaviour change communication (BCC) materials. Community volunteers were provided with information
about the project, resources and ties that can be built along with the basic training on pregnancy care, safe
motherhood, child survival and healthy nutritional practices. Each health worker has identified 10 volunteers.
Each volunteer is in the process of identifying and contacting 50 households with their respective communities,
consulting one Community Extension Unit (CEU).
SERVICE DELIVERY POINTS
To provide comprehensive, quality Reproductive and Child Health (RCH) services, 8 health posts have been
identified. Community volunteers will be the first point of contact with the community and will also provide
basic promotive and preventive health care. Some private medical practitioners have been identified and
contacted in each slum who will also function as ‘Satellite Clinics.’
SHARING IMPLEMENTATION LESSONS
The CINI-LIP holds orientation and advocacy meetings with local formal and informal leaders, elected
counselors, clubs, NGOs and other organisations to establish contact and ties. Quarterly progress reports are
being sent to TAI. CINI also works with two partner NGOs (CRRID and HIHT) in LIP implementation. CRRID
works in four states in northwest India and HIHT is located in Uttar Pradesh. Coordination with CRRID and
HIHT has begun, to share implementation lessons and other issues.
May 2000
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01 .vsnl.net.in
CINI LIP BASELINE SURVEY
CINI LIP aims to provide high-quality gender-sensitive RCH (reproductive and child health) services,
including adolescent health and prevention of STD/HIV/AIDS, to the slum population of Calcutta. This
project intends to sustain itself through community participation, local capacity building and resource
mobilization.
Ameena, a health worker, was initiating an adolescent program amongst her community members. Since she
was a new recruit at a newly created health post her interaction with the community was still at a nascent stage
Ameena was conscious of the myths and misconceptions they encountered in
their daily lives and the personal turmoil in their lives. Her knowledge came
from the findings of the survey conducted in the slums at the beginning of the
program. The baseline survey proved to be a blessing as she was aware the
struggle they had to face in their daily lives.
The baseline survey was conducted to assess and prioritise the reproductive
and child health needs in the slums of Calcutta as well as to formulate tools for
monitoring and intervention. The survey presents a dismal picture of the conditions
prevalent in the slums.
Lifestyle: A major percentage of the slum population live below or at the brink of
poverty. The average per capita income is only Rs 329.50 per month. Large
families of 6 or more live in cramped temporary shelters with no sanitation
facilities. Women are engaged in an assortment of jobs like working as maids,
strap cutters or daily labourers in small manufacturing outfits. Their husbands work
as rickshaw/ van pullers, cobblers, masons, carpenters, rag pickers etc.
Maternal Health: Early marriages and pregnancies are common. Most women get married before they are 17
years old and have their first child by the time they are 18. They undergo five pregnancies on an average and
one-third of the deliveries take place at home. Antenatal and post-natal follow-up is poor.
Family Planning: The key reasons for not accepting family planning are a lack of knowledge, lack of faith in
family planning methods, religious barriers, family pressure and side effects. Around 65% of the populations
surveyed were not family planning acceptors and, it was the women who were using family planning methods.
Not a single case of male sterilization was recorded.
Child Health: Over 50% of the children were not immunized or were only partially immunized. Immunization
against measles was extremely low. Common child morbidities are acute respiratory infection and diarrhoeal
diseases. A doctor is consulted only in one-third of the cases.
Female Adolescents: Most of the physical problems of female adolescents are closely associated with
menstruation, often blurred with various myths and taboos. Old clothes are predominantly used as sanitary
napkins, which could be the reason behind the high prevalence of reproductive tract infections in the slums.
Awareness on STDs is very poor and 98% do not know the routes of transmission. Awareness on AIDS is
relatively high but only 12% know that it is incurable.
As there was a lack of accurate information on the conditions prevalent in the slums the baseline survey has
been a guiding factor for. It has helped us identify the needs of the community and prioritise the interventions.
August 2000
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01.vsnl.net.in
COMMUNITY HEALTH VOLUNTEERS
C1N1 LIP aims to provide high-quality, gender-sensitive RCH (reproductive and child health) services,
including adolescent health and prevention of STD/HIV/AIDS, to the slum population of Calcutta. This
project intends to sustain itself through community participation, local capacity building and resource
mobilization.
Seema, and her fellow community health volunteers are sitting at the
Khaidar health post busy completing their specially designed work maps.
They are talking amongst themselves about how they managed to convince
Fatima’s mother-in-law to get Fatima registered at the hospital for her
delivery. Their enthusiasm is apparent and they are very proud of their
work. They are delighted at their newfound enhanced status in the
community and possess a sense of achievement. Seenia had to face stiff
opposition from her husband initially, as he was totally against her being a
health volunteer, but today her husband is extremely proud of Seema and
her work.
Aw.-
fl •
_:.S
Role of the Volunteers ~ CINl-LIP’s success in the last one year is due to the community health volunteers
(CHVs) like Seema. There are around 700 volunteers till date, actively involved, reaching out to 85000 people
and continuously monitoring the reproductive and child health status of the community. Each volunteer keeps an
account of all eligible couples, pregnant women and children below 2 years in 50 families in her vicinity which
she is responsible for. Volunteers motivate couples to practice family planning and counsel them on the right
choice of contraceptives besides supplying pills and condoms. They follow up every pregnant woman in the
community and ensure that they receive all hospital and domestic care during pregnancy. The volunteers follow
up children below two years for primary immunization and booster doses. Volunteers create awareness in the
community on specific RCH issues through cluster meetings. They also intervene at the family level to ensure
proper RCH care to the women and children.
About them -Volunteers undergo rigorous training according to our training guidelines, in all aspects of RCH
by the health workers. Apart from technical knowledge, they also receive training on community mapping tools
and Behaviour Change Communication. A CINI-LIP volunteer is generally a married woman between 20-35
years of age with good verbal communication skills. A major challenge for CINI-LIP was to overcome the
obstacle of lack of education among the volunteers. Many illiterate volunteers have achieved a minimum
literacy level to be able to report, which is an additional motivation for them. Pictorial registers have been
developed as a reporting tool to suit their purpose. The community-RCH-map, which they draw, themselves
helps them focus on specific intervention in their areas.
Resource Mobilisation - They enjoy their new responsibility as community health volunteers and possess a
sense of empowerment. They also play an active role in local resource mobilisation. In some cases volunteers
have helped us to secure a place for the health posts and create a new batch of volunteers. Volunteers remain as
everlasting resources in the community and work towards the long-term sustainability of LIP.
Oct 2000
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01 .vsnl.net.in
SERVICE DELIVERY: THE THREE-TIER APPROACH
CINI LIP aims to provide high-quality, gender-sensitive RCH (reproductive and child
health) services, including adolescent health and prevention of STD/HIV/AIDS, to the
slum population of Calcutta. This project intends to sustain itself through community
participation, local capacity building and resource mobilization.
Reena was suffering from excessive discharge and severe abdominal pain. Frequent trips to
the local quack provided no relief and were a drain on her already meager income. Left with
no money and suffering from acute pain she approached the CINI LIP health worker who
referred her to Dr Nandi whose clinic was in the neighborhood. Dr Nandi diagnosed Reena's
illness as syphilis. It was discovered that her husband also had similar symptoms. Both of
them were treated and counseledfor safer sexual practices.
HEALTH
POSTS
Primary
care
Counseling
PMP
Referral
services
Secondary
health care
Reena is just one of the many who have availed of the services offered by CfNI LIP. CINI
LIP offers a three-tier health system, which consists of the health posts at the bottom rung of
the ladder.
First tier: Health Posts
The health posts are the focal point around which the whole CINI LIP health care system
HOSPITAL
revolves. They are located in the heart of the community and act as a centre for health
Tertiary
promotion. They are also involved in awareness generation and preventive cure. The health
posts provide limited curative care and medicines for conditions such as first aid, mild
health care
infections like cough, cold, fever, management of diarrhoea, cuts and wounds, worm
Pregnancy
infestation and mild anaemia. A health worker is in charge of the health post and the
care
community volunteers assist her in her work. When a patient requires more intensive care the
health worker refers her to a private medical practitioner.
Second tier: Private Medical Practitioners
The 21 private medical practitioners who are associated with CfNI LIP are an essential link in our three-tier set
up. They are qualified professionals who live in the vicinity of the slums and are motivated by CINI LIP to work
for the under-privileged section of society. CfNI LIP organizes training sessions, discussions and workshops for
private medical practitioners to enable them to share their experiences and increase their knowledge base.
The private medical practitioners offer promotive, preventive and curative care. They provide expert
consultancy at an extremely low rate, subsidised by CfNI LIP. A special referral slip is designed for use by the
patients, which ensures follow up care at a nominal cost.
CfNI LIP ensures the highest Quality of Care by establishing standard treatment protocol and an essential drug
list that the private medical practitioners must follow. A preventive approach, based on emerging health
information, is stressed and a follow-up system is ensured
Third tier: Government Hospitals
These private medical practitioners refer the patient to the local hospitals when she requires institutional care.
All delivery cases as well as other emergency medical conditions referred by the private medical practitioners
are referred to the government hospitals, which have the necessary infrastructure to handle such cases.
This three-tier system has proved to be extremely successful and will go a long way in ensuring program
sustainability.
t
January 2001
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01.vsnl.net.in
VOLUNTEERS WEEK
The captivating words of a song
*
dedicated to the community health
volunteers of CINI LIP, captures the
essence of the ‘Volunteer’s Week’. The
song was specially written by a CINI LIP
Health Worker on the occasion of
‘Volunteers Week’, a week specially
created by CINI LIP to commemorate its
volunteers. The main objective of
celebrating such an occasion was:
To dedicate one day to the volunteers
To bring forth the hidden talent of the
volunteers and try to utilize their talent for the benefit of the programme
• To improve solidarity between the programme staff and the community health volunteers.
All the health posts of CINI LIP dedicated the last week of May2001 to honour their
community health volunteers who play an extremely important role in programme
implementation and community development. This was held at every health post involving all
the volunteers of the health post. In some cases neighbouring health posts got together to hold
a joint event. Councilors and local leaders also attended the function.
The ‘Volunteers Week’ agenda was more or less uniform at all the health posts. The
volunteers were given a free hand in organizing the proceedings and most of them proved to
be extremely talented and entertained everyone with a variety of songs, dances, plays and
poems. Game shows and discussions on RCH related topics were organized. Volunteers gave
emotional speeches during the event. The health posts wore a festive look and the CINI LIP
logo occupied a prominent place on the walls.
Particularly noteworthy was a drama on family planning staged by the volunteers of
Khanaberia health post and a dance on a song by Rabindranath Tagore, by a volunteer of
Lattupara health post. It spoke about the dreams and aspirations of a young unmarried girl but
her aspirations remain unrealized once she gets married. This song is based on folklore and
taken from the epic, ‘Mahabharat’. Another volunteer became nostalgic when she said "the
last time I recited a poem was when I was in class VIII, 25 years back". This showcase of
talent was an eye opener for every one as in spite of the problems and the poverty that the
volunteers have to face they still manage to cultivate their culture.
One got to witness the immense potential of the volunteers, the same people who did not step
out of their homes before they joined CINI LIP. The local leaders present at the event also
lauded the volunteer’s efforts towards community development as well as their motivation
and involvement in the program.
* Always with you O' Dear/We, the 50 LIP volunteers
CINI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01.vsnl.net.in
Reproductive Tract Infection (RTI) is a widespread health problem faced by the adolescent girls and women in
slums. Among all RTIs the most common is white discharge, which is often perceived as a normal phenomenon
and therefore ignored. The problem is aggravated by the unhygienic menstrual practices and lack of basic
awareness about the causes of RTI. CINI LIP has evolved a comprehensive strategy to ensure that every
RTI/STD case is identified, treated and followed up till the patient is fully cured. Partner treatment is also
stressed upon.
Identification ~ The community health volunteers undertake a rigorous identification of all RTI patients. An
innovative RTI map has been specially designed to enable an illiterate or semi literate volunteer to maintain a
pictorial record of the families she is responsible for. Once an RTI patient is identified she marks the house with
a black color. When the patient is under treatment the black colour changes to red and after the patient is fully
cured the map is marked with green. The RTI map gives a snapshot of RTI-status in the community.
Treatment ~ Soon after the patient is identified she is sent to the referral medical practitioner through the
Health Post. Whenever required the patient is accompanied by the volunteer. Treatment of RTI is based on the
Syndromic Management Guideline recommended by National AIDS Control Organization (NACO). Camps are
also organized to create rapid awareness in the community.
Follow up ~ Every single patient is followed up by the referral doctors and the volunteers. While the doctor
monitors the prognosis of the disease, the volunteer ensures patient compliance and maintenance of general &
menstrual hygiene. This is done through a structured format specially designed for the programme.
Capacity Building ~Everyone concerned including the referral doctors, health workers and the volunteers has
been specially trained for the purpose.
Efficacy ~ As a result of awareness created due to this programme, a number of RTI cases have been identified
in women and adolescent girls who are now coming forward for treatment.
CfNI-LIP
63, Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: ciniasha@giascl01.vsnl.net.in
User friendly MIS for marginally literate health volunteer
Due to the diverse nature of activities, vast geographical coverage, thrust on quality of care and a
huge field force, a comprehensive MIS was necessary in order to effectively monitor the progress
of the project. However, the greatest challenge lay in developing a system where illiterate and
marginally literate community health volunteer could maintain records. This led to innovations
like the pictorial ELCO register and the ELCO map which allowed the volunteer to work
unhindered in spite of her illiterate status
ELCO Map
A powerful management tool, this
map provides an overall RCH status
of the community at a glance. Each
volunteer prepares a map of the 50100 families she covers that reflects
the status of the key RCH
components, which need to be
monitored. Each family is denoted
by a block, which is further divided
into several compartments. Each
compartment reflects a particular
RCH indicator viz. pregnancy,
delivery, post natal care and
childcare under one and two years of age. An outer circle in various colours represents the family
planning method where a particular colour reflects each family planning method. The status of
the family represented is denoted by various colours where a green colour reflects an excellent
status, a red shows a moderate status and a black indicates a poor status. These ELCO maps
serves the purpose of a participatory MIS, where the community health volunteers themselves
participate in the analysis and report generating process.
ELCO Register
An innovative pictorial register, which
enables an illiterate or semi literate
community health volunteer to maintain a
record of the families in her charge. It is a
pictorial register
simplified to such an extent that the
community health volunteer just has to put
a tick or a cross against each pictorial
representation. Each page reflects each
family where a detailed record of her
family planning status, pregnancy care and
childcare is maintained. It truly is a unique
example of a simplified record keeping
method.
These unique innovations have enabled
CINI LIP to overcome shortcomings like illiteracy and have also succeeded in enhancing the
motivation level of the community health volunteers who continue work with zeal and
enthusiasm.
CINI-LIP
„„„
Rafi Ahmed Kidwai Road, Kolkata- 700 016
Phone: 033-245-2705, 246-5301. Fax: 033-245-2706. E-mail: clniasha@giascl01.vsnl.net in
Child In Need Institute (CINI)
63, Rafi Ahmed Kidwai Road
Calcutta-700016, India
Tel: 245-2705/246-5301
Fax: (033) 245-2706
E-mail: ciniasha@giasc!01 .vsnl.net.in
Management
M J H SCIENCES FOR HEALTH
tjCIJ
up
Centre for Research in Rural and
Industrial Development
Sec. 19-A, Madhya Marg,
Chandigarh-160019, India
Tel: (0172) 775136,775406,775660
Fax: (0172) 775215
E-mail: crridchd@ch1.dotnet.in
Himalayan Institute Hospital Trust (HIHT)
Rural Development Institute
Jolly Grant, Dehradun, UP-248140, India
Tel: (0135) 412095,412125,412081-83
Fax: (0135) 412008,412143
E-mail: hihtrdi@nde.vsnl.net.in
7/8 Sir Sayed Road,
Mohammadpur
Dhaka-1207, Bangladesh
Tel: 880-2-8110284,9120480
Fax: 880-2-8111049
E-mail: tai@bttb.net
Management Sciences for Health.
165, Allendale Road
Boston, MA-02130-3400, USA
Tel: 617-524-7799
Fax: 617-524-2825
E-mail: development@msh.org
URL: http://www.msh.org
Chapter 2
Organisational Reform,
and research
Project management, monitoring
" God grant me the serenity
To accept the things I cannot change;
The courage to change the things I can;
And the wisdom to know the difference;"
- Reinhold Niebuhr.
Reforms in Administration
2.1
The current structure of health services has evolved over the years, with differing emphasis on
the preventive and curative aspects at various points of time. There is a need for the
reinstitution of a strong public health element in health services. This element, which was
the foundation on which these services were instituted, has virtually disappeared due to
changing approaches towards the content of these services, mainly from a preventive
approach to a curative approach. It is evident that even in current limes the absence of the
public health element has resulted in skewed sendees, de-emphasizing fundamental issues
such as sanitation and prevention. What would seem essential is to reconstitute the system to
have a fair balance between both preventive and curative approaches.
The proposed re-structuring of health sendees has been indicated by the Task force in its
Final Report. The current posts have been redistributed I redesignated. For example, the
Maintenance / Engineering Division now included in the Directorate is the transfer, in effect,
of the one that is now part of the Karnataka Health Systems Development Project. Also, the
posts at all levels have been redistributed..
The posts indicated do not include supporting staff. It would also be necessary to take into
consideration the current levels and numbers in the professional cadres while putting in place
the proposed structure with the revised positions and designations. The Task Force has kept ’
the following main principles in view while considering the changes to be made in the
structure of health services:
1.
2.
3.
4.
5.
6.
The emphasis on Public Health should be revived and its essentiality recognized;
Separate cadres would be constituted for Public Health and Medical (clinical)
responsibilities of the Department;
Common functions such as IEC and publicity, supplies and maintenance would be
integrated to avoid duplication and lack of internal coordination;
The Divisions would be reorganized on the basis of integrated responsibilities and
current needs;
The cadres should be reorganized so that all health personnel up to the district level
form District Cadres, selection being the mode for filling up higher posts. The latter
would constitute Slate Cadres;
The State Cadres would constitute the Karnataka I Icalth Sendee.
The availability of services at PHC and taluk levels should be ensured through.
administrative means, including institution of special pay, a team at taluk level, etc;
All national programmes which now function in vertical fashion would be integrated
into the system so that local supervision and management of these programmes is at
District level;
9.
The structures for implementing Externally Aided Projects (EAP) would be more
directly integrated into the structure of the Directorate of Health Services;
10.
Discipline and control measures would be strengthened while, at the same time
building up both expertise and morale through nurturing enhancement of skills and a
transparent transfer policy;
11.
A Commission on Health wotdd be constituted as a mechanism for interaction with
professionals and to assist in policy formulation.
7.
8.
2.2
Strengthening Institutions and Capacity Building
A key element in tlie process of restructuring the Department is in making various units in the
organisation functionally empowered and accountable. In specific terms this will imply the
following:
The Directorate of Health and Family Welfare has a large number of very senior
officers. However, there is hardly any delegation of powers to them. As a result they
are not made accountable and responsible for their sphere of work. Additional
Directors need to be given powers of minor heads of department and made fully
accountable in their sphere of work. Some autonomy has been given in the
functioning of the RCII project to the Project Director, but here too the unit clearly
needs to take greater initiative and become more accountable. Tw'o new positions of
Additional Directors have been put in place to look after Primary Health Centres and
Communicable Diseases and they have been recently given job responsibilities.
However, these two vitally important offices arc yet to be given clear'budgets and
responsibility in implementation of programmes.
The role and responsibilities of the Commissioner has now been more clearly spelt
out. There is need to delegate greater financial and administrative powers to the
Commissioner so that routine programme implementation goes on unimpeded. This
matter is currently under examination in the Government.
Over a period ol time (he Secretarial and ils Held organisation, the Directorate has
become distanced. With the creation ol the position of the Commissioner some
administrative restructuring is called for to ensure speedy decision-making and
avoidance of duplication of work. Apart from delegation, introduction of reforms
such as “single file system” and “desk officer system"-arc under consideration of
government. The Administrative Reforms Commission has also recommended these
changes.
Clarity of roles, responsibilities and specific accountability upto Joint Director level
need to be worked out. Internal decentralization mechanisms for Joint Directors and
District level functionaries need to be put in place with adequate powers. Freedom
and accountability systems need to be developed.
’
Rapid communication systems and mechanisms need to be established. Modem facilities
of fax, email, and internet access need to be provided below district level at Taluka and
PHC level also.
94
Karnataka Health Service
2.2
All posts that constitute the State level cadre could be constituted into a service called the
“Karnataka Health Service". This would contribute to morale building and create a sense of
common identity. The major advantage of constituting such a Service would be that young
professionals would, through a process of selection, rise to occupy middle level management
positions fairly early. This would ensure that officers with a reasonably long tenure would, in
due course, hold senior positions so that stability in management is ensured at higher levels.
Often, officers are promoted to senior positions when they have very short periods (a few
months) of tenure remaining before they are due to retire. The main features of this Service
would be as follows:
1.
2.
3.
4.
5.
6.
2.3
The Service would consist of all posts above the District Cadres and would include
both the Public Health and Medical Cadres;
Posts in the Service would be filled through two methods:a. Promotion from the District Cadres on the basis of merit cum seniority; and
b. Through a process of direct induction from the District Cadres.
Appropriate proportions of the posts of the State Cadre, in both Public Health and
Medical Cadres, would be reserved for promotion and for induction from the District
Cadres. It has been recommended by the Task Force that this proportion be 50 per
cent each;
All officers in the District Cadres who have the necessary qualifications and satisfy
such other criteria as may be specified, including minimum period of experience,
would be entitled to apply and compete for the posts reserved in the Health Service
for recruitment through this method.
All officers appointed to the Karnataka Health Service will, on appointment, be
trained in administration and management.
In public interest, if officers who satisfy the stipulations of the Cadre and Recruitment
Rules are not available for appointment to posts at any level in the Service, and for
such time as they are not available, such-posts may be filled by induction of suitable
persons, with the stipulated qualifications, laterally, on contract basis.
District Cadre and Zilla Panchayats
The cadres, both Public Health and Medical, up to the District level would be District Cadres
coming under the management of the Zilla Panchayat.
With the institution of Constitutional local governments at the village, taluka and district'
levels, it would be necessary to consider how, in the long run, social services, including health
services, appropriate mechanisms could be established to ensure community participation and
management of social sendees, including health services at the district level.
All health sendees at all area levels are now departmentally organized and managed. The
revised structure envisages all health services within a district being managed by the Zilla
Panchayat. The health services assigned to the ZP would be those currently offered by PHCs
(and Sub Centres), CHCs and Taluka Hospitals. All specialized institutions would continue to
be under the Department.
In effect, the ZP, and at the lower area levels, the other panchayat organizations would be
responsible for management of the health services in their local areas. The ZP would be the
nodal agency and would oversee the working of these services in the talukas and at village
level. Such an arrangement is already partly in existence, but what is envisaged in the revised
structure is assigning full responsibility to the ZP and including all health services and
programmes within the ambit of its responsibilities. It need hardly be mentioned that financial
95
allocations commensurate with these responsibilities would have to be allocated, to that extent.
reducing the allocation to the Departmental budget.
The revised structure would imply that all posts of health and medical officers from the
village level up to and including the district level, excluding nil district level posts such as the
DUO / DMO and equivalent, would be part of the establishment of the ZP. The recruitment,
control, postings within the district and related matters would be entirely within the
competence of the ZP. It must be emphasized that this would not at all mean the absence of
Government control, supervision and monitoring. The ZPs would function within guidelines
and other stipulations specified by Government with regard to all matters relating to health
services. The DHO / DMO, as at present, would continue to represent Government. In effect,
a distinct cadre of health personnel would have to be constituted for each district, with
common features.
It is recognized that the structure suggested here is a radical departure from the current one.
However, it has the merit of ensuring that local persons find employment within their
districts, which would reduce the difficulty of filling rural posts. It would also mean that the
community, through their elected bodies, takes full responsibility for the adequacy,
accessibility and quality of the health services in their district. The Department would then be
responsible for overseeing and monitoring of the health services and not have direct'
administrative responsibility for these services. Ils energies would then be better spent in
ensuring the efficiency and effectiveness of these services and setting standards through more
intensive inspections and reviews.
2.4
Commission on Health
The health services must be responsive to the expectations of the public and must meet
current needs. The working of the Department should be transparent and the structure should
be able to induct outside expertise as and when necessary for special studies or consultancies.
It would be desirable to create a mechanism for general overseeing of the health system which
would assist the Government and for providing policy inputs. The facility of lateral advice
being tendered at the highest level would assist in ensuring both transparency and public
confidence. For this purpose, it is recommended that a Commission on Health be established
by Government consisting of both senior officers and non-oflicial professionals. -
Commission on Health
Chairperson
Principal Secretary of Health and FW
Members
Secretary (Medical Education), Project Administrator of EAP,
Director of Health Services, Director of Medical Services,
Director of Medical Education, Director, State Institute of
Health and Family Welfare, Director, Indian Systems of
Medicine anil Homeopathy, Drugs Controller, Vice Chancellor,
RGl'HS. 8 to It) eminent persons from professionals, NGOs
and prominent persons.
Member Secretary
Commissioner of 11
FW
The functions of the Commission would include:
1.
Preparation of the Perspective Plan for health services;
2.
Monitoring inter-sector issues and recommending corrective appropriate measures;
96
3.
Monitoring implementation of Plan programmes, externally funded projects and
Central Schemes and general management of health services;
4.
Ensuring that public health is an important component of the health services;
5.
Suggesting such studies or consultancies that arc found to be necessary from time
to time;
6.
Reviewing all such aspects of health sendees as it may consider necessary for
ensuring improvement of such services.
Tlie Commission would not be concerned with the administration of the Department,
or with disciplinary cases. The Planning and Monitoring Division could serve as the
secretariat of the Commission.
2.5
Review and Amendment of Cadre and Recruitment Rules
The structure suggested would need considerable amendments to the existing Cadre and
Recruitment Rules.
Recommendations have been made with regard to introducing mandatory tenures of service in
rural areas and selection criteria being introduced for certain posts. Also, elsewhere in this
Report, there are recommendations that have implications for the C & R Rules. It would,
therefore, be necessary to review these rules to take into consideration the recommendations
made herein and to bring them up to date. In particular, the rules should identify posts which
for which selection criteria should apply such as Joint Directors and above, introduce
stipulations regarding tenure in rural postings for entitlement Io confirmation / promotion. It
is recommended that a Committee for Review of the C & R Rules be set up, with the
Commissioner as Chairman, and the Director of Health Services, Joint Secretary, Health
Department and a representative of the Law Department as members.
It is recommended that the new structure should be in place within the next one year, with
recruitment and cadre choice to new recniits being as suggested above.
2.6
Corruption and enforcement of discipline
I he prevalence of corruption in the health services is a serious issue. Corruption in any ■
official agency is deplorable and must be eliminated. However, its presence in an essential
social sector such as health is particularly obnoxious because it increases the costs of the
services the public is entitled to and quite often determines both availability and quality of the
services provided. It is pernicious and pervasive and operates at different levels in different
manner. It could range from (a) demanding payment for services which are free or even paid
for and for carrying out the legitimate duties of the personnel involved, (b) direct diversion of
supplies meant for patients or from hospital supplies, (c) carrying on private practice when
this is prohibited, (d) deliberately treating patients outside stipulated hours and charging
persona] fees for such services, and (e) diverting patients to private clinics with which one is
associated and charging fees or obtaining commissions. In particular, corruption in
government hospitals has a serious effect on the availability of medical services to the poor.
How to eliminate corruption ?
That corruption exists, the various methods adopted in its practice and points at which it is
practiced are well known. The issue is the mechanisms for its detection and elimination. The
detection of corruption is dependent on the cooperation of the public and the internal
97
mechanisms for this purpose. In this context, it is admittedly difficult for the public to
complain of corruption in a situation where medical services are required because, unlike •
other official contacts, the need for these services cannot be postponed. However, the system
should encourage complaints being received even after the event. Secondly, the consideration
of complaints and completion of enquiry proceedings must be quick and thorough. The latter
is particularly important to avoid enquiries being deemed as improperly conducted on
procedural issues, as is quite often the case.
The current mechanisms inhibit quick enquiry. In particular, the procedures where major
punishments are proposed to be imposed are complicated and invariably tend to delay
enquiries beyond reasonable periods of time. It would, therefore, be vital for these procedures
to be reviewed so that, without taking away constitutional rights to justice, enquiries could be
completed within two to three months. It is recommended that the Commissioner of H & FW
evaluate the current procedures to determine how they could be modified to ensure quick
completion of enquiries.
In the majority of cases, under the current procedures, officers of a senior level are appointed
as enquiry officers in individual cases. Such assignments are invariably viewed as an
additional burden and given very low priority. There is rarely a sense of urgency and quite
often enquiries have dragged on indefinitely. This results in a feeling of complacency in the •
corrupt that the system is incapable of dealing with them while, at the same lime, reducing the
morale of the honest and hardworking. The mechanisms for enquiry being within the
Department would also seem to inhibit quick enquiry and strong action.
The enquiry into corruption cases, depending on the nature and content of the complaint, are
either dealt with by the Vigilance Commissioner or within the Department by the appointment
of an enquiry officer. There is. however, no institutional mechanism for detection of
corruption. It is recommended that such a mechanism be set up on the lines similar to the
Food Cell or Forest Cell. In the latter, a senior police officer on deputation is independently
assigned the responsibility of follow up of complaints on corruption, carrying out test checks
and the like. This cell should be preferably under the Principal Secretary or under the
Commissioner for Health and not an adjunct of the DHS. The specific role and duties of the
Cell could be defined. It should be empowered to investigate and take action against
corruption and absenteeism. An appeal procedure would have to be provided but time limits
must be fixed for disposal of such appeals.
The public should be aware of the services they are entitled to in the Sub Centres, the PHCs,
at the Taluka and District levels and in Government Hospitals. Prominent boards should be •
put up indicating what services are free and the fees for services for which charges are levied.
The officer who should be contacted if money is demanded should be indicated and an
assurance held out that corruption charges would be investigated. The hospital Visitor system
should be strengthened and one of the functions should be to enquire about harassment and
demands of money, particularly from the poorer patients. Wide and constant publicity should
also be made of measures taken promptly. All complaints of corruption should be
acknowledged against corruption.
2.7
Centrally Funded Projects and integration of vertical programmes
A number of Centrally Sponsored Schemes have been implemented, at various points of time,
as part of the successive Plans. These include programmes relating to control of blindness,
malaria, AIDS, tuberculosis, leprosy and goitre, and enhancement of nutrition. The general
principle of funding has been that for the Plan period these are funded either fully or partially
by the Central Government, with the financing being taken over by the State at the end of the
Plan period. There have, of course, been some exceptions to the latter.
98
The main issue is not so much the funding or the content of these schemes, since they all deal
with important aspects of health services. It is the structural aspects that need consideration .
since separate hierarchies, with Programme Officers, were established under each such
scheme for a specific purpose. This has created vertical hierarchies of a specialized nature
within the Department. Also, it has complicated the reporting system by requiring different
streams of reporting within the Department and to the Government of India. Such a structure
does not lend itself to cost effective use of personnel or coordinated management of services.
The difficulty of control and management of such separate vertical hierarchies for some
activities is particularly noticeable at the district level. It is al this level that management and
coordination need to be clear and effective. The relative seniorities between the DUO and the
Programme Officers have added to the problems of coordination.
The vertical programmes must be reviewed to determine the mechanisms of eliminating the
concept of independent vertical hierarchies, better utilization of the professionals in the
Department, and establishing only one focal point of administration of personnel,
management of services and reporting at the district level. It must be emphasized that this can
be done without in anyway diminishing attention to these important programmes. As in most
activities of the Department, designated officers would be responsible for specific activities.
What is desirable is to eliminate vertical hierarchies that are under-utilized and give rise to
loose administrative practices. Such integration is possible at all levels, including the senior.
posts at headquarters. It may, at this point he mentioned that a revised structure for the
Department has been suggested later. The review of the vertical programmes would be part of
this new structure.
2.8
Externally Aided Projects
There are a number of externally aided projects in operation in the State. In the health sector,
the Karnataka Health Systems Development Project and the India Population Project are the
major externally funded projects. These projects deal with specific health issues and are not
experimental in nature. They operate independent of the DBS though they are very much
concerned with health issues in terms of objectives, structure and content. The management
structure of these projects is independent of the DBS and so devised as to ensure efficient
performance. Special officers are placed in charge of such projects, with officers of various
specializations on deputation, and the induction of outside expertise is often assured through a
system of appointment of consultants. Decision-making in these projects is expeditious
because the high power Project Governing Board and the Standing Committee are delegated
with full powers. The conventional system of seeking sanctions, administrative and financial,
with many layers of official scrutiny and many departments to be consulted, is absent. There
are no financial constraints and performance is intensively monitored by both external and
internal agencies. In view of the structure and management independence, these projects are
successful and appear as islands of excellence in governance of health services.
These projects are successful because they have well defined objectives, with leadership not
generally available in other activities of government, selected competent staff and with
operational independence. They provide lessons in management of the health services and
innovative structures of delegation of authority and of monitoring and internal control and
review systems. However, experience would indicate that once the project is over and the
maintenance phase commences, the same performance levels rapidly disappear and the work
gets “routinised”. While the projects definitely add to both assets and experience, there are
fundamental issues that need to be considered if full and, more importantly, permanent
advantages have to accrue to the health system from the implementation of such projects.
These arc (a) how one transplants the work culture of these projects into the larger, parent
organization, namely the I Icalth Department, (b) how the tempo and efficiency of the project
implementation period could be sustained, (c) -how the assets created are maintained for
effective use, (d) how the human resources created could continue to be used effectively and
99
productively and (e) how is adequate funding to he ensured for these purposes. In short, the
issue is one of sustainability us er time of both the organizational and professional advantages
of these projects and building them into the culture of the department itself.
2.9
Sustainability
The issue is essentially one of sustainability of the protects objectives and systems. It would
be difficult to integrate the project structure in toto into the departmental structure at the end
of the project period, nor would this be necessary. I lowcvcr, the main difficulty would be that
the project leadership would no longer be available and the Director of Health' Services would
have been only generally associated with the project '. If integration of project activities in
the maintenance phase has to be effective, it would be necessary to ensure that the project is
built into and implemented within the departmental structure from the start. While a separate
wing or division could be considered desirable because of the special needs of the project and
the need to complete it within a fixed period, this wing / division should be a part of the
Department; an exclusive project division within the Department should implement such a
project. Tins would ensure that the Director is not merely involved in the project but is also
responsible for its efficient implementation. It is recognized that this could limit the choice of
officers for being appointed as project administrators but the Project Governing Board and the
Steering Committee of the project should be able to enhance their supervision / monitoring to
ensure effective implementation. Also, the Commission on Health, suggested as part of the
restructuring of the Department, could also be empowered to monitor / review the
implementation of the project. The present practice of establishing a separate but temporary
project administration structure outside the Department should be given up and the special
unit created for implementation of such projects should be placed within the department, even
while maintaining its separate identity, with the appropriate structure and operational
freedom, for expeditious and efficient completion of the project. The Director should be
responsible for not merely fostering the work culture of the project but also for the spread of
such a work culture in the other divisions of the Department.
2.10
Transparency / morale building
The Department of Health Services is one of the larger administrative organizations of the
State. Its importance both in terms of size and responsibilities dictate that the morale of the
officers and staff should always be high. It should be managed in such a manner that
administration is not accused either of favouritism or lack of direction. Morale building
would depend on the personnel having a conviction of fair dealing in matters such as
postings, selection for postgraduate courses, promotions and quick redressal of grievances. At
present, unfortunately, there would appear to be no internal guidelines or traditions for many ’
of these aspects,
2.11
Transfer Policy
Transfers are admittedly necessary in the department for manning vacant posts, on promotion
or for other reasons. However, the system of routine transfers that are made every year has
virtually deteriorated into a scramble for “good” postings or for postings in Bangalore, with
pressures and pulls of all sorts having free play. In particular, it is most unfortunate that
political pressures predominate. T his works to the disadvantage of those who adhere to the
rules or who have no political backing, and encourages indiscipline and inefficiency. It would
be necessary to formulate and adopt a transfer policy under which the transfers would be
transparent and unassailable.
100 '
2.12
Delegation of duties and powers
Morale and functional efficiency arc also dependent on the ability to exercise powers
appropriate to each level in the hierarchy. Currently, there are orders delegating both
administrative and financial powers various levels. In particular, the powers of the senior
otficers arc well defined to permit them to function with adequate independence. However, in
practice, these powers do not seem to be exercised fully because traditions have been built up
that favour centralization of decision-making or excessive caution operates in exercising.
them. Tliis is reflected in complaints of inability to carry out adequate touring, delays in
processing of even simple requisitions, etc. The adequacy of the delegations and, more
importantly, the processes through which they are exercised would need review.
There is need to carry out a review of the administrative and financial powers delegations in
the Department to I.
2.
2.13
Evaluate their adequacy and determine if any further delegations are necessary;
Examine the procedures of exercising of the delegated powers to determine if there
are any procedural factors that reduce their effective use.
Ensuring Overall Responsibility on Health Matters in Urban Areas
The administration of health services in urban areas is largely the responsibility of the local
administrations such as the municipalities and Municipal Corporations. The staff in the larger
cities are appointed and managed by the Corporations. While the administration of the
sendees in these areas and the management of the staff would be the responsibility of the
municipal body, it would be necessary to ensure that the Commissioner, the Director of.
Public Health and Director of Medical Sendees have overall responsibility for the technical
aspects of these services so as to ensure quality and availability. The Directors should have
the right of inspection and monitoring. Such general authority would be specially important in
periods of outbreak of diseases and emergency situations. In particular, the public health
aspects of urban areas, including water quality and the like, should be reviewed by the
Director of Public I leal th.
2.14
Inter-sectoral Coordination
Health should not be viewed in isolation. While, for pragmatic administrative purposes, the
DHS is in charge of health services, the success of the latter depends on the successful
implementation of many other programmes. The latter include programmes relating to
nutrition, sanitation and water supply, meeting minimum housing needs, literacy,
transportation, communication, and the like. It is also dependent, in a larger sense, on social
policies, as for example, raising the age of marriage of girls. More specifically, the health
services are closely associated with the ICDS and school health programmes.
It is evident that health services would need to be coordinated with activities of the.
programmes referred to. Such coordination would be necessary both with regard to the
relevant elements of these programmes and with the implementing agencies. The
establishment of an effective coordination mechanism would also ensure more optimum use
of the funds invested in the health services and these programmes. The establishment of a
high level mechanism for coordination would develop synergy among these activities. It is
recommended that a High Power Coordination Committee be set up with the Development
Commissioner as Chairperson, and members being the Commissioner of Health and FW,
Director of Health Services. Principal Secretary and Director of Primary / Secondary
Education, Principal Secretary, Woman and Child Welfare Department and Director ICDS,
Principal Secretary Rural Development and Panchayati Raj, and officers in charge of rural
101
water supply and sanitation programmes. Other officers could be co-opted if necessary.
Representatives of prominent NGOs could also be inducted as members. Similar coordination
mechanisms must be established at the district and taluka levels.
2.15
Coordination with other institutions
There are autonomous specialty institutions, which include the Kidwai Memorial Institute of
Oncology, Sri Jayadeva Institute of Cardiology. .Sanjay Gandhi Accident Hospital and
Research Institute, and others. Government is represented on the management of these
institutions and, therefore, mechanisms are present for ensuring coordination. The links
permit review of performance, monitoring of activities and also provide for an active role of
intervention if necessary.
2.16
Contracting out non-clinical services
The KHSDP has identified 28 non-clinical services, which could be performed by private.
sector agencies on contract. The advantages arc obvious. Large number of staff need not be
on the permanent payroll of government. Services are likely to be performed better because
penalty clauses could be enforced, which would not be easy in the case of government
employees. It would allow more time and effort to be invested in health and medical issues. It
is recommended that this system of contracting out non-clinical services could be extended to
as many hospitals as possible.
In the context, the view that general services cannot be contracted out under the laws relating
to abolition of contract labour would seem to be of doubtful validity. In the arrangement
contemplated, the contract would be with service firms and not individuals.
2.17
Improving Registration of Births and Deaths
The importance of improving the system of registration of births and deaths cannot be
overemphasized. The data provided by the system, if complete in coverage and valid in
recorded information, would provide information at regional, sub regional and micro level on
health parameters.
The placement of the system of reporting would seem to need consideration. Currently, it is
monitored by the Director of the Bureau of Economic and Statistics, with a network of
notifiers and registrars at the field level. The latter are revenue officials. The system merits a
review for its reorganization and vitalization. It is recommended that this be examined in
consultation of the Departments involved. The Government of India would also have to be
consulted at the final stages.
2.18
Planning and monitoring
Health services must meet current needs and the management must have the capacity to adapt
them to such needs. Any modifications or expansion of services have implications in terms of
staff, training, and financial outlay. It is therefore neccssar. to have an in-built ability for
carrying out such reviews and in the preparation of perspectix • plans. Tthe Department should
also have a strong, unified system of reporting as part of the I lealth Management Information
System. This would necessarily have to form part of the planning and monitoring structure of
the Department. These activities would call for the establishment of a Planning and
Monitoring Division.
102
Present structure
There is, a( preseni, a Joint Director in the office of the DUS in charge of planning. The post
is currently designated as Joint Director (Health and Planning). The JD (II & P) is assisted by
a Deputy Director (Planning) with supporting staff. The functions of this post include
preparation of the annual plans, five -year plans, and preparation of the monthly monitoring
reports (MMR) which deals with financial anti physical progress and the Karnataka
Development Plan which deals with staff and organizational issues, that are submitted to
Government. An important function is the preparation of the Annual Report of the
Department. The Preparation of these reports involves obtaining information from all units in
the Directorate, including the Programme Officers on a monthly basis. Coordination and
constant interaction with the other Divisions and sections in the office of the DI IS are
essential elements of the post. The JD (II & P) is concerned with the preparation of only
schemes relating to the Plan. Non-Plan elements are prepared by the Chief Accounts Officer
cum Financial Adviser. This is because the latter arc more concerned with staff and
maintenance issues. However, information on the latter is incorporated in the reports
mentioned above. The JD (H & P) is also in charge of the Bureau of Health Intelligence.
Role ofthe Planning, and Monitoring Division
The planning process in the office of the DI IS is restricted in scope and serves the immediate
administrative needs of routine reporting. The process of preparation of Plan schemes is also
fairly well established, as well as statistical reporting in specified formats. These are essential
activities in themselves but the constant internal monitoring of perfonnance, particularly the
sensitive appraisal of available infonnation, is near absent. The Planning Unit, which should
be designated as the Planning and Monitoring Division in view of its importance, should play
a more central role in the management of infonnation systems within the Directorate. It
should be responsible for all information flows, appraisal of such infonnation and feed back
of such appraisal to the functional divisions concerned. Currently, the appraisal of
perfonnance is within the functional divisions concerned, which would render it routine.
Also, a total appreciation of the functioning of the Directorate would not be available to the
Director.
The reporting system is envisaged as common to the Department and not in sectional
components, more related to individual programmes, as at present. With this change in the •
stnicture and focus of the HMIS, it would be logical to place its management under the
Planning and Monitoring Division.
Functions ofthe Planning and Monitoring Division
1.
Coordination of all reporting activity as part of the unified system of the HMIS and
providing the information that other Divisions would require on the basis of the unified
HMIS;
2. Coordination of all statistical activity in the Department, at various levels, including
ensuring of quality of data, and processing and analysis of such data in the prescribed
manner as may be required for various purposes;
3.
Production of the Annual Report, periodic reports such as the Monthly Monitoring
Reports, Karnataka Development Plan, and such other prescribed reports. The reports of
the projects such as 1PP and KIISDP should be incoqioratcd so that there is one report for
the entire health department;
4.
Monitoring progress in implementation of Plan programmes and schemes each month to
enable mid-course corrections to be made;
103
5.
Preparation of Annual Plans and Five year Plans of the Department, coordinating with the
other wings such as Medical Education, Stale Institute of Health and Family Welfare and
the like;
6.
Preparation of a perspective plan for the 1 lealth Sector and its updating at appropriate
intervals.
7.
Organization and management of the Geographical Information System that is
recommended for establishment;
8.
Organization and management of the Computer System that is recommended for
establishment;
Structural changes in the Statistical System
The statistical system within the Department has developed in a rather ad-hoc manner. The
statistical and reporting system at headquarters could be said to consist of three distinct wings •
as follows:
a)
b)
c)
I he Bureau of I lealth Intelligence (Bill)
The Demography and Evaluation Cell (D & E Cell)
The statistical units / personnel attached to some Divisions on an independent
basis.
The Bill is the unit that generates the Annual Administration Report and all statistical reports,
excluding those relating to the RCII programme. It is also responsible for collection and
collation of information on health indicators, including the macro indicators from the RCH
programme. One important responsibility of the Bill is collection and processing of data
relating to morbidity and mortality.
It would be evident that if the planning process in the health sector has to be unified, as
indeed it should, it would be necessary to recognize the need for basic structural changes. •
Such changes would include (a) unifying the statistical functions at all levels and of the
various units, (b) the inclusion of the reports of distinct projects such as the 1PP and KHSDP
within the unified reporting system, and (c) coordination within the Department with the
Chief Accounts Officer / Financial Advisers of the Department itself and of the special
projects.
The distribution of the posts in the various statistical / reporting units, as would be seen from
the table above, is very uneven. There is no uniformity in the work load and the levels of
posts seem to have been determined more by what was acceptable to the sanctioning
authorities than any rational considerations of work load, position in the hierarchy, etc.
The efficiency of the HMIS and GIS, the ensuring of quality of data, the management of the
computerized system of maintenance and analysis of data and production of monitoring
reports for better management would depend on the structure of the reporting and statistical
system. If the system has to perform at peak efficiency and be able to serve its purpose, it
would be necessary to consider certain structural changes.
In principle, it would be desirable to have a unified statistical and reporting system so that the .
planning and monitoring requirements are adequately met. The Planning unit in the office of
104
the DUS may be designated as the Planning and Monitoring Division, as suggested earlier, ’
and assigned a central role of information management and appraisal, with the functions
indicated.
Structural chanties at Headquarters
The Planning and Monitoring Division should be constituted with the following sections:
•
The Reporting and Monitoring Section for production of reports based on the
analytical statements generated by the Computer Section, and for preparation of all
monitoring reports required by Government or needed for internal management;
•
The Computer Section for information processing
•
The GIS Section for assisting in monitoring and planning
•
A Perspective Planning Section which would formulate the Five Year Plans and the
annual plans, monitor plan implementation, prepare and continuously update the
perspective plan of the Department and monitor implementation of the Health and'
Population Policy of the Slate.
This Division should be responsible for the following:
Strategic Planning of activities of the entire health system, including long term
planning;
Coordination with the Zilla Panchayats to ensure that the health plans of the districts
are formulated, including taluka and Gram Panchayat plans, and integrate them into
the State Health Plan;
• Assess budget resources for current and future needs, taking into consideration
■ population, level of services, nonns for services and other relevant parameters;
• Assess human resources and all material resources on a continuing basis.
•
•
All statistical and reporting functions in the headquarters should be unified. The various
wings and units referred to earlier would form part of the Planning and Monitoring Division.
These would include the Bill and the D & E Cell. There is a senior officer of the rank of Joint
Director on deputation from the Directorate of Economics and Statistics, who heads the D &
E Cell. This officer could be the Joint Director in charge of HIMS, the GIS and all statistical
reporting within the Directorate. This Joint Director could be designated as Joint Director,
Health Information System. This officer would be the Chief Statistical Officer and Head of
the DIMS / Monitoring Section.
Structural changes at District level
Strong statistical units would have to be established in the offices of the DHO / DMO and all
reporting and statistical functions in the district should be placed under them so far as their
jurisdictions are concerned. A computer cell in their offices would also have to be set up.
These cells would generate reports in standardized formats, which would be sent to
Headquarters for consolidation and analysis. However, analysis at the district level would also
be carried out so that monitoring by the DHO / DMO is possible at the district level. The
Programme Officers of the district would get the reports in the formats they need from this
cell
The central role of the Planning and Monitoring Division
105
The role of the Planning and Monitoring Division, as envisaged herein, is much wider than
what it is at present and its responsibilities arc much heavier. It is the Division that plans for ’
and monitors the performance of the Department. In view of this expanded role, the
Planning and Monitoring Division may be headed by an Additional Director. This Division
would function as the secretariat for the Commission on I lealth that has been recommended to
be established. The division will use an evidence-based approach & hence have close links
with the HMIS & Surveillance system. It will need to establish good inter-sectoral linkages
with departments dealing with nutrition, water supply and sanitation, education, Panchayati
Raj, etc. The unit needs to develop multidisciplinary capacities in Epidemiology, Health
Planning and Management, Health Economics, Bio-statistics, Anthropology, Social Sciences
etc.
Strengthening the capacity for Strategic Planning had been identified as a key objective under
KHSDP. However, mechanisms to ensure that Strategic Planning begins to take place are yet
to get institutionalized. There is an immediate need to fill up the newly created positions in
the Strategic Planning Cell (SPC) so that studies, research, and planning functions can start
taking place. These initiatives planned under KHSDP need to be carried forward in to the
present project as well.
2.19
Project implementation and integration
Earlier experience with national health programmes, and more recently with externally aided
projects, teach us that;
a)
Basic objectives and strategies, even if explicitly outlined in policy documents/ project
proposals, are often re-interpreted or forgotten, in such major ways that expected
outcomes are not achieved.
b)
The focus of attention and activity tends to be on construction, purchase of
equipmcnt/consumables and appointments. ‘Softer’ service issues such as quality of
care, access to care, establishment of referral services, surveillance and health
management information system etc. have not yet become functional. Training of health
personnel has been undertaken but outcomes of this activity have been variable.
c)
The Department of Health, as a whole, does not manifest a sense of ownership of
important health programmes. Responsibilities and systems have become fragmented
with vertical programmes and specific projects.
Hence, during the next five years, the PRIMARY FOCUS of this project will be to ensure,
IMPLEMENTATION and IN TEGRATION, particularly at the critical point of interface
between the public and service provider at sub-centres, PHCs, CHCs, schools, anganwadi
centres, Mahila sanghas and hospitals at different levels.
Special planned efforts will be made to internalise and embed processes and factors that
ensure implementation, into the institutional functioning of the system.
2.20
a.
Safeguards to ensure implementation
Involvement of credible and knowledgeable NGOs, people’s movements, academic
institutions, i.e. representatives of civic society in the steering committees. The choice of
representatives is critical, as the objective is to bring in openness, transparency,
accountability, knowledge of field realities and alternative expertise. It will also enhance ■
collaboration, cooperation and a joining together of forces if appropriately facilitated.
106
b.
Make public the annual statements of income and expenditure of the project. Explanatory
notes to be given for non-utilization of funds.
c.
The Annual Report of the DHFW, under which achievements of the different programmes
and projects are given, need to be more widely disseminated. The DHFW could also have
a Website on which reports are made available. With increasing computerization of the
Department these reports will be easily available to peripheral/ all health institutions and
their stall
d.
The supervisory and senior management staff to take responsibility and be accountable
for implementation at all levels. For this there needs to be adequate delegation of
authority and financial powers - i.e. a decentralization within the department. This is
separate from decentralization under Panchayati Raj.
e.
Supervisory staff to provide technical guidance, problem solving advice and
encouragement, rather than focusing on fault finding and inspection. Maintaining
motivation, morale and job satisfaction of field staff is an important responsibility of
senior staff.
f.
DHFW staff needs to be given strong feedback on the wide gap between the people's
expectations and the health services. At the same time, the good committed and •
competent work by several government personnel needs to be recognised and appreciated.
Recognizing that this factor is critical to implementation, the department will introduce a
series of measures to facilitate behaviour change, c.g. sessions on group dynamics,
personal growth, interpersonal relations, and management techniques. The Task Force on
Health has also recommended steps to be taken Io reduce corruption and political
interference in appointments, transfers, and promotions.
g.
While taking steps to provide a good working atmosphere, the DHFW will also tighten its
administrative functioning by taking disciplinary action, as per the rules; clarifying job
responsibilities and ensuring that they are carried out; keeping to time frames.
2.21
Project management structure
The KHSDP has built up a fairly extensive management structure, headed by a super-time
IAS officer. Another super-time officer is heading the project team dealing with IPP VIII and
IX, The government has recently also put in place the post of Commissioner, who is also a
very senior. Secretary-rank IAS officer. A team of senior Doctors and Engineering staff
supports both the KHSDP as well as IPP projects. Given the nature of the project which is ’
very ambitious both in size and scope, and the limited capacity, at the present moment, within
the Directorate, there is need to have a strong management team to lead the project. Multidisciplinarity, and management capacity will need to be part of the long-term leadership
structure in the health sector. The experience of KHSDP has been that the presence of a
dynamic leadership is able to give the necessary momentum to the project. At the same time,
in view of the large size and scope of the civil works and equipment procurement
requirements, the project team is unable to give the required attention to service delivery and
some other “software components’. The KHSDP staffing structure will be continued at the
end of the project and integrated into the health system as a dedicated, specialised,
professional management support agency of the department for all civil works construction
and maintenance, equipment procurement and maintenance, and other specified "hardware
components". This wing will continue, as at present, to be headed by a senior IAS officer.
This wing will also manage all the civil works and procurement components of the new
project. This will free the project director, who is proposed to be a full time super-time IAS
officer to concentrate on actual service delivery, lie will lead a project team that will work
107
closely with the Commissioner and the Director and directly with the slate programme
officers so that there is full integration from the commencement of the project.
A dedicated management structure will also be put in place for the special project initiatives
proposed for the backward category C districts of the state.
2.22
Project Governing Board, Project Steering Committee and Project Implementation
Committee
The Project Governing Board constituted under the KHSDP with the Chief Secretary as
Chairperson has worked well and it is proposed to retain the same structure for the proposed
Project. Similarly, the Project Steering Committee has also provided a structure that has
facilitated quick decision-making. In addition to these two structures there is need to ensure
that decisions taken at the Project Steering Committee are implemented and there is constant
monitoring in respect of all components of the Project. There is also need to integrate the
Project management structure with the DI IS. It is therefore proposed to have a Project
Implementation Committee under the Chairmanship of the Commissioner Health and Family
Welfare.
2.23
Local project consultancies
The project has several new uncharted thrust areas, such as in the area of women’s health,'
health promotion, and community participation, I IMIS etc. where the services of experienced
NGOs and other professionals will be required from the commencement of the Project. They
will support not only the project team but more critically be asked to directly work with the
State Programme Officers to ensure, that the department has a feeling of "oneness’ with this
external team and vice versa. Their main role will be in providing both expertise as well as
elements of “capacity building” into the department.
2.24
Capacity building for programme implementation
Cadre ofprofessional managers
Over time the DHFWS has created at Taluka, District and State level an adequate number of
positions to supervise and implement various National Health and Family Welfare
programmes. In recent years, it has been noticed that at all levels the Taluka Health Officers,
DHOs, as well as Deputy Directors/Joint Directors have very short tenures and are unable to
spend time on management of national health programmes.
In many States and in several countries around the world health programme managers and ■
hospital managers arc non-mcdical professionals in public health, and hospital administration.
The Project therefore seeks to develop a cadre of professional managers to help in programme
management at the district level, state level and to help in hospital management. It is proposed
to recruit young graduates, preferably with post-graduatcs/diploma in management. Hospital
administration, Masters in Social Work (MSW), Masters in Economics, Masters in Nutrition/
Communication and related disciplines to function as Assistant Programme Managers at the
District level, in major Hospitals, and at the State level. These officers will be recruited at the
Group B level and will have opportunities for career advancement based on their performance
and merit. They will be recniited through a very transparent system based on their qualifying
marks and a Common Entrance Test and will undergo specialized training for six months
before being assigned any responsibilities. About 150 posts will be created for this purpose.
To ensure management teams including this new cadre become effective, there will also be a
need to develop manuals on integrated health care responsibilities for different institutional
levels and various programmes.
108 •
Introducing merit and competence in respect ofsome crucial posts
Currently all senior positions are filled by seniority, except the post of Director. There is
therefore no incentive for good performance or any system to reward good work. Private
sector structures need to be brought in at least to man crucial positions at the district and State
levels. Meritocracy and transparency would be introduced and seen in the overall context of
good governance. A study has been commissioned by the Task Force to review the
organisational structure and design job responsibilities.
The DIIFWS is a very large
organisation in terms of manpower and responsibilities, with about 60,000 personnel of which
more than 4700 are grade A officers. There arc several levels of technical expertise. The
study makes a systematic effort to identify requirements at various levels & to develop job
responsibilities. The Task Force final recommendations and study findings will be
incorporated to the project proposal.
Engineering wing
Under the KHSDP an Engineering Wing has been established which is exclusively dedicated
to designing, constructing and maintaining all the facilities taken up under the Project. A
Chief Engineer heads the Engineering wing while a Deputy Chief Architect heads the Design
wing. These positions are supported by the necessary complement of supporting staff. All
these positions will require to be continued to support the Civil Works in the present Project.
The present proposal envisages the renovation of a large number of primary' health institutions
scattered throughout the niral parts of the State. There is a need to prepare detailed estimates, '
design renovation, for each of the over 1000 buildings proposed for renovation/expansion in
the project.
There is also need to ensure that the major civil works component is taken up and completed
quickly so that more substantive programme components get full attention during the project.
IPP VIII has successfully demonstrated capacity to take up construction of a large number of
small institutions in quick time by employing the services of a consultancy agency on a "turn
key” basis. There is need to identify an appropriate Civil Works consultancy Agency to
survey all the institutions, make detailed estimates for renovation and expansion well in
advance of the Project start, as a pre-project activity. The Agency can be selected through a
bidding process.
Routine maintenance of sub-centres, PHCs and Taluka hospitals will have to continue to be
looked after by the Zilla Pajichayat engineering divisions and the engineering divisions.
Enabling work environment
One reason for poor work culture at the state and district levels is due to the shabby physical
environment in which the offices are maintained which is also an expression of work culture.
It is expected that an integrated office complex for all health programmes, including for the
Project staff will be constructed under KHSDP. The building will require maintenance
expenditure etc. Similarly provisions will require to be made for the DIIOs office buildings,
including the seven new districts.
2.2S
Implementation challenges and strategies of the integrated health project
Karnataka has had mixed experience in implementation of health programmes and services.
Health programmes so far have largely used a top-down problem centred approach, that is
largely rational (focusing on major decisions), linear and prescriptive. Implementation has
been on the whole hierarchical and techno managerial, attempting measurable outputs and
compliance, with people often seen as target groups or objects. Evaluations of several
109
programmes report big implementation gaps even in programmes and projects with well
thought out health goals, objectives and strategies. In Karnataka this is seen in the National
Tuberculosis Programme (NTP and RNTCP), the Reproductive and Child Health (RCH)
programme, the National Programme for Control of Blindness (NPCB), the National AIDS
Control Programme etc. The Karnataka Task Force on I leal th has raised poor implementation .
capacity as an issue of serious concern by senior government officials and. The public have
expressed a lack of confidence and tmst in the services tlirough elected representatives,
through peoples health dialogues conducted as a part of the peoples health assembly process,
and through increasing protest as recorded by the media. ]t is imperative that implementation
processes are given importance and viewed as being as critical as decision-making, resource
allocation and proposal writing. It is what happens between front line implementators and the
public that really determines policy.
Current opportunities and strengths
It is therefore suggested that using the same policy and programme / project management
approach may not improve functioning of the system adequately.
Achieving good quality
performance or implementation should be the key strategic objective or mantra of the entire
Department of Health during the next five-year phase. There is a window of opportunity
presently open with government showing signs of greater political commitment to health;
with the participatory processes already initiated by the Karnataka Task Force on I lealth; with
a small but critical mass of good leadership at the lop; and with the possibility of augmenting
financial and technical resources through a healthy process of dialogue with partner donor
agencies. Therefore a slightly different approach will be utilized in this implementation plan.
It will build incrementally on the several good initiatives of the past decade including the
mechanisms and management systems that are functioning well. It will use the learning points
and evidence gathered from studies already undertaken and then planned.
Broad approach
It will use the bottom up integrative approach that is process orientated, recognizing the
political, iterative, interactive and evolutionary dimensions of policy process. This will
require a major change in mindset, through regular workshops and training programmes. It
will consciously build motivation, capacity, work strategies, work culture and ethics of
implementors, especially at front line and different levels.
It will increase
interorganizational and inter-departmental interaction. People and communities will be given
opportunities to become active participants in decision-making and in becoming change
agents of health services and of their own health status.
The social construction and complexity of disease, ill health, poorly functioning health
services and programmes are accepted, including underlying iniquitous social relations and
issues of power and conflict. Hence, no magic or perfect solutions are offered, nor miraculous
changes expected. However, planned, systematic efforts that are responsive to ground
realities will be made, to use public health policy to move towards some leveling of social
inequity.
Specifics
Some of the factors important for implementation are:
Health policy so far has not been explicit but has developed in an ad hoc. add-on manner.
often driven by national health programmes or by externally aided projects. A ('omprehensive
Integrated Draft Health Policy has been recently written by the Karnataka Task Force on
HO
Health and published for wide discussion within the government health sector by the
Government of Karnataka (KHSDP) and with others. Aller modification and adoption this
will provide a cohesive framework for the next five-year period.
Developing leadership at state district, taluka and local levels. State leadership for all’
components should have the ability and acumen to mobilise power, political, financial and
other resources for health and to positively influence implementation. Leadership that
nurtures encourages and supports its teams to perform better. Leadership that is open to
questioning, demands and pressures from the public and civil society organizations, seeing
tliese as a positive sign of interest and support and not as a threat. Leadership that looks
ahead, beyond and is inspirational. Leadership that is sometimes willing to follow. Selection
of leadership will necessarily need to depend on competence and capacity and will have to be
free of political interference. Leadership for district and state level will depend on track
record of past performance, with seniority coming as the lower criteria.
This is a complex project and selection of the Project Director (PD) is critical. The PD will
require having good management skills, good interpersonal skills, a firm administrative hand.
and an understanding of the project goals and objectives, especially the technical, health
aspects. It is advisable that the PD is available to steer the project for a period of 5 years.
Develop a core implementation team working with the Commissioner and Director of
Health and the Project Director: with a mandate to see that implementation of all key aspects
outlined above occurs on time, maintaining quality. Members of the Project Preparation ’
Committee who have been active will continue in the Implementation Team.
Taking forward the Task Force recommendations - The recommendations of the Task
Force, especially Health Systems Management and on Implementation will influence all
programmes. Mechanism for implementation of recommendations will be initiated in 2001
and will carry over into the integrated health project being proposed. The preliminary' steps in
brief suggested by the Task Force arc:
a)
b)
c)
d)
e)
Formation of a small core group to process, prioritize and set time
frames for implementation of recommendations:
Formation of an Implementation Committee (for health system
reform and reorganization);
Formation of Subject .Matter Sub-Commitlee reporting to the
above:
Formation of a small secretariat or cell to support the
Implementation Committee and follow up on action points: this
function to be taken over by the Planning and Monitoring division or.
unit;
Formation of a Commission for Health.
The Task Force recommendation broadly fall into four categories:
a)
b)
Structural changes to re-institutionalise public health and primary
health care, with district and state cadres and increased professional
capacities in public health, management and administration, primary
health care and curative care:
Governance issues - transparent appointment and transfer policies;
mechanisms for motivation and morale building: personal appraisal
systems: supervisory systems; monitoring finances and performance:
relationship with elected Panchayat hollies; access of the public to
information: feedback systems from the public and patients;
improving ethical and legal aspects of work:
c)
> d)
Building of institutional capacity - through training and continuing
education; good intra and inter-organizational communication
systems; partnerships with NGOs and private sector: developing
administrative and management skills at I’HCs. CIICs, tahika and
district hospitals; assessment of need and impact through studies and
research:
Those relating to equity, quality, integrating access and to
technical aspects.
The department will be taking action on the recommendations that are accepted by the
government. Mechanisms evolved will link with the project.
The KHSDP and IPP IX systems for construction and procurement will be integrated into
the department and will be utilized for this project. Maintenance functions will be allocated
to the same unit. Minor repair and maintenance work will be undertaken locally upto a
specified financial level. Annual maintenance contracts for equipment may be made with
companies concerned after studying the cost effectiveness of such arrangements.
Good communication systems will be evolved to keep all functionalies or team memheis of
the Dept, of Health (DOH) informed on a monthly (or two monthly basis Io start with) of the
process and activities in the project and the department. The public should also be kept
informed through information boards in each institution and through the mass media.
especially the radio and press. Specific communication systems for specific aspect, such as
surveillance and referrals, make use of faxes, telephone, and emails. These systems will have
to be introduced. Rapid and free flow of information is important for optimal functioning.
rvcj o - S’
Social Accountability and Social Audit of NGOs
Some loud thinking for an approach to conduct it.
NGOs (or Voluntary Organisations[VO], as some of them insist on calling themselves - to
distinguish themselves from private commercial organisations which, also,, in a way, are non
government by status and therefore NGOs) come into existence because (they strongly feel) that
something needs to be done to harness "progress" of the society in a meaningful and appropriate
manner. "Something critical is wrong! Something critical is lacking! Something critical is sidei lined! Some sections of society are wronged or neglected or cheated and something needs to be
■ done to address these issues". These (and other compelling) issues trigger initiation of VOs.
. In many ways these VOs arc self-appointed and ate simultaneously ‘independent' (in being self■ appointed) and yet answerable to society (which is their raison-d'ette). They are also answerable
to the society and to themselves to ensure that their practices and endeavour moves appropriately
in the direction towards 'ideal' society (they proclaim to cherish) and also the values generally
i attributable to humane society e.g. secularism, egalitarianism. pluralism, transparency, honesty,
and most importantly humane interactions.
VOs use monitory, human and other resources (of the society) in their "social" entreprunership.
These resources arc tools) and tools can be 'used', 'mis-irscd' and 'abused'.
In any enterprise, the
function and (with it), the importance of audit is self-evident'
1. Fiscal audit
Mandatory (legal) requirements call for fiscal (and monitory) accounting and fiscal (and
0
monitory) audits. Fiscal audit has the longest history and have continuously developed into
more and more sophisticated exercises. The important featuie of this type of audit is that it is
more or less standardised and universally accepted
Because of this reason it is also
relatively easy to conduct.
Unfortunately, with its sophistication, fiscal accounting piactice(s) has (have) also carved out
ingenious methods for 'hiding' / or camouflaging / or colouring fiscal picture. Auditor's work
(in this area) is to 'monitor1 'access' and "point out" variances in the fiscal picture and to
ensure that 'legal requirements are complied with before ceitillcation or to give 'qualified1
certification. Audited report may not be 'transparent' In this case the auditor is not expected
to ‘penalise’ In fiscal audits, the auditor merely checks, monitors, reports findings and makes’
qualified certifications.
2.
Management audit
The next in line has been the management audit.
With important strides in techniques of
management (of resources and people), management accounting and management audit has
grown in importance and harnessed in practice. The area has been nurtured and developed
mainly to usher in 'efficiency' and 'effectiveness* and navigation towards the goals set.
There are many important tools and concepts that have been generated through the development
of management science (and art) but (he most important for the purpose of the discussion here is
the concept of'optimal'
"Optimal". We use the word 'optimal' to distinguish from the word 'minimal' / 'maximal'/
'average'.
To my mind "optimal" means that which "appropriate with holistic considerations".
(What is optimal keeps changing from time to time with changes in the situation). It takes into’
under its wings considerations of (I) economically sustainable, & (ii) harnessing of resource c.g.
fiscal, time, effort, personal and personnel etc., on the one hand and creation of space and
opportunities for nurture, growth and development of individuals and Organisation.
Social Audit
3.
1 do not know if the term 'Social Audit' is precisely defined
Which is good for now because
it gives one a lee way to define it as one pleases. I would define it as auditing the existence
(and performance of Organisation I individual) in terms of meaningful value to the society
and its 'idealised' future.
What would that include. I do not know for sure, but for brain storming I am enlisting some
'heads' and elaborating on these wherever I can. (See below)
•
•
Worthiness Indices
Investment .worthiness index
•
In an Organisation like CE11 AT the funders invest money, the staff its time and effort and
the peer Organisations their 'concern and support'
(whatever that means). To each of
these segments, a repeat of investment would be reason enough to signal an inclement in
'worthiness.' Again the more investors would mean a signal for greater perceived
' '
worthiness by that investor segment. t\ scale would be drawn out based on this 'repeated'
2
or continued investment. A scale could also be drawn out based on the number of such
investors. Larger the base, the larger would be the perceived worthiness to that segment.
Based on the score of each of these a "Worthiness Index' (for this segment) could be
coiistiucteii. ’I'liis index could be lioin the investors tingle Likewise Iheie could bo those
from the point of view of (I) social action angle (which could be sub-divided into
sections as I have tried to list below.
•
” ‘
Social action angle
•
Support to existing social action
•
Research for new avenues for social action
•
Lobbying facilitation
•
Academia facilitation I support
Debt : Equity ratio (A little diversion for the moment)
This is a thumb rule popular within the Corporate circles. "If the Share-holders arc willing to
invest 'x' amount of funds (i.e. investment) then the 'lenders' would brave a risk of'2x' and all
this 3x' would be worthwhile, if the product of the enterprise is valued at
least '300x'
Perhaps if one is able to give 'value' representations to the dibits (and time) put in by the
Organisation in terms of'money' (That is already done because the Organisation pays 'salary
'where the notion is based on converting effort into 'money' - even if this is Hobson's choice.
The difficulty would be to set values (in monitory terms) to produclof enterprise.
Honesty index
It will take some time and effort to develop on this I have put it here for brain-storming
exercise.
Transparency index
The term "Transparency" is well known and abundantly used. And yet, 1 suspect everyone's
notion of transparency is slightly (and sometimes widely) different. Thankfully across the
board there is a common consensus that the greater the transparency between the interacting
entities the better it is.
I shall therefore qualify what I presume transparency means in the context of Organisational
behaviour. Used in the context of Organisational behaviour, it entails that entities interacting
"with" and "within" the Organisation know (or have access to) information that is (or can be)
relevant to the interacting entity.
Docs this mean cveiything that goes on within the
Organisation is out on display? 1 think not. There are a number of matters that need to be
shielded from exposure on ethical grounds (eg confidentiality of the personal working
within the Organisation and many such matters) or on grounds of vulnerability to
■
competition (commercial grounds), but transparency demands that these area be demarcated,
notified to the entities interacting and be substantiated with appropriate explanation
(particularly the ethical merits for such non-disclosures). The commercial (or political)
shields against disclosures must also be spelled out with adequate.explanations. The more the
disclosure the more Open would be the Organisation. One could workout a scale for
Openness of the Organisation based on this concept.
Likewise, there could be non-disclosures scoring also.
Positive scoring for ethically
appropriate to null score for commercially / politically appropriate to negative for
unacceptable reasons.
(++++ / +++ /++/ + / 0 / - / — / — /-—)
Based on the Openness
score ( 0 % to 100%) and the Non-disclosure score an index of transparency can be worked
out.
CEHAT is (I am told) planing to have a 'web page' on the internet. On the web page, it is
common *o have a sub-site titled "about us". In this 'about us' what is the site visitor able to
access imormation (even if that calls for a payment of a fair fee) about CEHAT would give
a degree of "Openness" and if properly extended transparency of the Organisation.
fairness index
1.
Is the Organisation fair to employees
2.
Is the Organisation fair to funders
3.
To the society it uses for its work (e g community in field research)
4.
Is the Organisation fair to the society in which it operates (country)
Equality index
To be developed
Sensibility index
To be developed.
Reference index / Reference score (no. of citations of research products)
CEHAT is a research Organisation It publishes papers and other publications which are to be
referred to and quoted. Based on the densityf?) of citations a score can be constructed.
New approach index :
•
Different positions > common goals (Hospital accreditation)
9
In Hospital accreditation programme - a new approach to zero-in segments from varied
"positions" to common acceptable and workable level is - to my mipd an innovation - value
that could be constructed for 'worthiness index.
•
Universal publication (on the internet) access to beat plagiarism? (Web page) (Floppy)
(data publication in Journals)
I his is yet another innovation to defeat copy-right madness.
•
•
This 'value' could be
subjected to 'scoring'
;
Outreach accessibility
i
To be worked out.
,
Internal democracy - How much? How effective exercised? How fruitful in nurturing
internal 'pluralism' A score could be devised
Interdependence - support index
CEHAT has liased with a number of Organisations ( programmes) - complimentary / and
supportive functions for a common goal.
These inter-responsiveness could be subjected to a
value score.
Optimisation index (?)
To be developed.
Ripple (meaningfulness) effect index
•
Immediate next group > next immediate group > so on.
Each Organisation builds its
ethos. The founding members (are presumed to imbibe this ethos maximally). The next
proximal segment (say, the staff) is expected to
be influenced
next and so on. For
instance practising doctors (who founded the Forum for Medical Ethics FMES) arc
r
expected to fully contribute to the ethos of I-'MES. The next proximal groups is expected
to be influenced more preferentially in relation to the distal groups. Audits could aim at
exploring the reality of this presumption.
Personnel growth and devcIopnumtjndex.
(In house poll Entrance poll I Exit poll) The entering staff and the exiting staff of the
Organisation have their 'picture' of the worthiness of the Organisation. Some times this is
coloured by personal fancies or prejudices. These prejudices or fancies arc at their high point
immediately (on entering) or (on leaving). Some Organisations (or their representative) try
and evaluate the perceptions of these segments after a cooling period. say of 6-months This
score (it is believed) is useful..
Intra-Organisation personality gradient. - Space score / involvement score / 'belonging' score
In house value nurture index - ethics-ethos / social justice index / empathy index / open-,
Inindedness index
There could be more areas that could be included, with further work in this area.
One method of scoring
(Mahy of these indices are intangible in character. It is difficult to make measured scoring. The
approach adopted in sports like gymnastics or figure skating is that there are 6/8, or 10
evaluators. They record their instant score. The highest and the lowest scores arc weeded out
and an average of the rest is drawn out for arriving at score of that individual).
1.
10 evaluators to cover the range of proximity levels (very close to very distant). Evaluators
who are close to Organisation and those which are nqt_closi\ form a team of evaluators.
2. On each index organise score gradient (highest to lowest) Leave out the highest and the
lowest and add the rest and divide by 10 (or eight) to get score for each. It‘is expected that
scoring of individual evaluators follows a (^)~clqvc
If it happens to be othcrwisc'\^y/the
evaluators need to be changed 3.
Organise indexes score wise and divide the range into 3 components The highest segment
4.
need to be sustained and middle segment needs to be fortified and the lowest needs to be
urgently addressed to for improvement.
There arc some indices which may need monitoring throughout Some may need to be
5.
moderated on the basis of age of the project. Some based on the category of the'project.
Some through correspondence. Some through personal interview
Grading of project vis-a-vis meaningfulness
6.
,
•
to social action
•
to academia
•
to lobbing value
•
7.
to peer Organisations
Slippery slopes and Iceberg technique.
It is important to be aware of areas with slippery slopes and Iceberg technique could be
harnessed to investigate these areas. Some such areas that come to my mind are:
•
Asset-building - an exercise for sustenance and necessity or for ego and avarice.
»■
9
Anusandhan
A note for (potential) Social Accountability Group (Sz\G) members for CEHAT.
Relevant History
Anusandhan Trust was envisaged and formed in 1991.
Though. the thinking then was to engage in.
rigorous research in the areas of health - (research, particularly from the pro-people (particularly the
disadvantaged) perspective) - there was a clear understanding that the outcome of research should make
enabling environment for social action. Also, (additionally) (it was conceived) that it was important
(where existing social action was not evident) to research and establish data that could lead to initiating
social action.
To Anusandhan. it was clear that all pro-people work was important and restricting itself to arcas of
research would not suffice and hence whilst drawing the Trust Deed a wide spectrum of possible areas to
'work in were included. It was envisaged tliat initially there could be a centre for research, but if the need
arose, Anusandhan would initiate other centres as well. CEHAT (Centre for Enquiry into Health and
Allied Themes) was started some three years later and is engaged in research and action in areas related to
health. Over the past six years CE11AT has grown speedily.
Whilst initiating its endeavour. ANUSANDHAN pledged itself to the values of (1) transparency (ii)
honesty, (iii) openness, (iv) democratic functioning, (v) collective governance, (vi) constantly improving
standards for quality output and (vii) social accountability in all its units. When CEHAT was started,
structures for implementing these values were gradually put in place.
The Trust Board of Anusandhan - since the very beginning - realised that merely constructing structures
pvas not enough to ensure their effective purposes. Anusandhan believes that just as featuring of financial
audit report is mandatory in a company’s report to the public, social audit report must also be a
responsibility of an organisation in its report to the society in which and for which it exists. Nonetheless,
Anusandhan also is alive to the ground realities. While norms for financial audit arc tangible and
quantifiable and by and large universally accepted, those for social audit arc not yet sufficiently well
developed.
Largely, this is because of three reasons viz. (1) organisations themselves have not laid
enough priorities and efforts in developing these aspects (ii) there arc no existing paradigms on setting up
social audit procedures and (iii) outcomes relevant to social benefits & harms arc difficult, if not
impossible to quantify and measure.
Rather than wait until such procedures are set up, Anusandhan thought.it best to subject its ’efforts' to
social accountability. It was envisaged to set up a Social Accountability Group (SAG) of persons with
intcy^rty, sensibilities and ability to critically review all tfyqt went into the work of its centre and along
with it the output oj its work.
It would be mandatory to include (attach) report of SAC} along with the
Annual Report of that year. As response to SAG report. Anusandhan would carry (in its next annual
report) the action taken report on the recommendations of the SAG report. This way Anusandhan would
have the benefit of critically evaluated appraisal for improving its own endeavour on the one hand and
would serve to social accountability report before the society it aims to work for. by making it accessible
to anyone wi;r. requires it and requests for the report. In lime, perhaps, parameters (to build up a system)
for social audit would (may) also emerge.
In 1994 (checkjbc.'year?/."date). the first SAG - comprising of
Dr.Ashwin Patel, Dr. S L Shutty
Dr. Nccra Desai, Dr.S.K.Pandya,
& Dr Ravindra Soman was constituted and served until now (a tenure
of 5 years). A worthy exercise was an outcome of tin's SAG. But this was the first SAG and Anusandhan
requested this SAG to assess die Trust's centre in the way the SAG deemed it fit.
For this purpose,
CE11AT provided extensive material that was generated in the centre (e g all papers / reports published
and unpublished , minutes of the Trust Board Meetings, the Stall meetings, rules & regulations & salary
structure of CEILAT, etc.).
Reviewing the exercise of SAG now, die Trust now feels that specific & critical evaluation of the
Centre (from SAG) in important areas would be helpful to the Trust and the Centre for development and
direction in which the Centre moves I his note attempts to list out these areas and also suggest procedures
for'interactions between the Trust, the Centre and SAG.
CEHAT's working structure
1.
-’>» present, CEI1AT has offices in Mumbai & Pune and other field offices in Maharashtra and
MP
2.
The Centre has as its chief administrator die Co-ordinator.
He / She has duties &
responsibilities towards (a) the Trust, (b) the administrative wing (accounts / personnel etc.),
the research wing, the external contacts. 1 le / she is authorised to depute anyone to this work.
In addition, the Co-ordinator has his / her own research responsibilities on the Research
Projects he/she is involved in.
3.
Wage structure and Rules and Regulations are written down and arc available for anyone
(even outsider) who asks for a copy. A new employee is furnished with these. These could
serve to foster transparency. Whenever, revisions in die wage structure arc made, a meeting
with staff is organised and the subject is thrown open to debate.
4.
In order to nurture collectivism, democratic practices and effective space for communication
widiin personnel and to evolve leadership qualities within the staff, the Centre has instituted
a Working Group (\\ G). WG has elected representatives from both the Mumbai and Pune
offices. The WG meets once a month.
Die Co-ordinator is an cx-officio member of the
WG. Expenses (travelling etc.) are bome by the Centre. Elections to the WG arc held every
2
year and any member of die staff is eligible for this. The tenure of the member is 2 years
with one-third retiring each year. Care is, however, taken to ensure that both the Mumbai &
the Pune offices arc represented on WG. Work on the WG entails responsibilities in addition
to the work that the individual on the WG has. However, for this additional work
the
members do not get any allowance. This is made, explicit to the individuals on the WG.
;
5.
In addition to the WG meetings Staff Meetings arc held twice a year. These arc organised
as residential meetings at some resort that is both convenient and economical. The agenda
for such meetings try and incorporate presentations of the work done by the staff, changes in
administrative/ accounting as also the hmdlcs and difficulties in the procedures etc. And any
other personnel matter. Offen die agenda tries to include a lecture from someone outside the
Centre or a workshop.
These meetings try to provide space for the staff to have a general
awareness of die status (as also the difficulties, challenges etc,) of the work of other members
of die staff.
•
C
It also can (and hopefully docs) provide space for harmonising personnel
matters.
'
6.
The Centre lias put in place the Grievance Rcdressal Structure (GRS). This is currently under
review.
7.
The financial accounting and reporting is the responsibility of the accounts wing and Co
ordinator heads this wing. Chartered Accounting Firm is entrusted to oversee and certify the
financial accounting. This accounting is done on the half yearly basis but the certification of
accounts by the Chartered Accounting Firm is only done after the financial year ends. The
Centre has an FCRA account and accounting for this purpose also forms the part of the duties
of’ the accounts w ing.
8.
Research Projects arc submitted by the Centre for funding.
1 hese projects arc drawn out by
die Principle Investigator (PI) and discussed within the staff and the WG. For every research
project (involving primary data collection) setting up of
•
Ethics Committee (EC) is
mandatory. This EC reviews the work at the beginning (planning stage), intermediate stage
and final stage. As a procedural requirement all research and action work is subjected to a
peer review at various stages and the work discussed threadbare. Copies of publication of
these works (and any other publication brought out by the Centre) is sent to SAG members
9.
The Trust Board sends the minutes of its meetings to the SAG. CE1IAT sends the minutes of
the Staff meetings to SAG and the Trust Board Members. CE11AT also sends the minutes of
GRS to SAG members and the Tmst Board
10. The Trust Board Members and the SAG members are encouraged to meet the staff.
.Trust Board and the constitution of new SAG.
Trust Board of Anusandhan has laid great importance to the report of SAG and its (SAG's) report along
with the ATR will be a part of Anusandhan's Annual Report this year. Learning from the experience, the
3.
.
.
'
. .3 and
.
:
~
.
e issue. For o ic. it I
tc facilitate the
, r ins
Board on the one hand and to make Trust's requirement written and itemised
tor facilitating SAG report. I his note is for that purpose.
Anusandhan Trust seeks to have SAG opinion /evaluation I recommendations on the following areas:
•
On meeting core objectives of (Til lz\T
•
On (rniispnrciicy of CEHATs work within the Centre and with the outside environment.
•
On Worthiness of the output of CEII AT - preferably with respect to individual projects and
administration
•
•
On honouring ethical concerns
On the aspect of CEHATs
provision of space for nurturing excellence and leadership
qualities of individuals on the Staff.
•
•
On CEI IATs interaction with other Organisations
On the space and nurturing of democracy and collective functioning within the Centre and
between Trust Board and Centre.
•
On CEI IATs growth and development
•
■ the Gricvencc Rcdressal mechanism and functioning and effectively of it
•
On the quality of research and shortfall tn the area.
•
Other areas that SAG may think pertinent and important.
Anusandhan believes that with a written request to SAG. it may facilitate the SAG to include the items in
its report to the Trust on the one hand and to the Public on the other. It will be a binding for Anusandhan
Trust to publish (as attachment to its own Report) lite SAG report and to state its response to SAG report
in form of ATR and what is not taken up for action with explanation to the Public.
Facilitating the functioning of SAG.
For facilitating the functioning of SAG. CEHAT had been furnishing to SAG (on a regular basis) (a)
reports of the research work published and unpublished (b) the minutes of Staff Meeting and any request
’that SAG makes. The minutes of \VG are not sent (because these take place every month and arc mainly
relevant to the staff co-ordination) (check if this is correct) but if the SAG makes a request these also cap
be sent to members of SAG. '1 he Trust Board furnishes (on regular basis) the minutes of the deliberations
at Trust Board meetings.
CEHAT helps SAG in organising venues for SAG meeting and re-imburscs the expenses incurred for
travelling and organises hospitality. Anusandhan Tnist has now resolved the ethical hurdle of making
allowance payment to members of SAG. Allowance for the SAG members for the days of meeting will
be borne by Anusandhan Tnist - not from CEHATs funds. Also to facilitate administrative work of the
SAG. - particularly in the 3"* year (when the written report of the SAG is sought) the Tnist will provide
funds for a secretariat (of one or two persons) lliat the SAG may like to set up. The Trust urges SAG to
appoint a Chairperson to co-ordinate its activities and to facilitate liaison between Co-ordinator CEIIAT
and Managing Trustee Anusandhan and SAG.
I his note is for preparing a foreground to initiate the new SAG.
It is hoped that in the first meeting
between SAG members, Trust Board Members and Co-ordinator CEIIAT a complete protocol will
emerge.
Anil Pilgaokar, eJuly 2000
Ravi Duggal, cAugust 2000, minor modifications
Following section added by liavi Duggal
I Modalities of SAG
It is suggested that the SAG should have five members. These members should be sensitive to social
research and action and must have made some significant contribution in it. They will select a Convenor
from amongst themselves. The tenure of the SAG would be for three years, al the end of which a social
audit report will be produced.
rhe SAG will get all secretarial assistance needed by them from CEIIAT. CEHAT will provide SAG
members all documentation, reports, papers, minutes etc., to members once every quarter for review of
work. The SAG should meet once a year to take stock of the work of CEI 1AT and discuss amongst
themselves. Also they should meet and hold discussions w ith all staff members at this meeting. The SAG
members may choose to review the work of CEI IAT selectively as per their area of interest etc.. This the
; SAG members must decide at their first meeting. At this meeting they must work out how they would like
Flo structure their working and distribute responsibilities and the process of review to be followed etc..
At the end of each year a brief report after their annual meeting must be sent to the Trustees. The
members arc also free to send feedback to the Trustees as and w hen they desire. At the end of three years
the SAG should carry out a formal social audit for which Anusandhan Trust will provide resources to set
up a Secretariat with an anchor person of the SAG's choice, if such a person is necessary. Once the social
audit report is ready it will be presented to the Trustees at a meeting and discussed. Once it is finalised the
SAG report will be made public. The Coordinator and Managing Trustee will subsequently prepare an
. Action Taken Report and both these will be published in the next Annual Report of CEI IAT / AT.
Ravi Duggal
24’" Oct. 2000
5
I x/1[XOO)
NAGARPALIKA (74TH AMENDMENT) ACT, 1992
THE ROLE OF
VOLUNTARY ORGANISATIONS
REPORT OF THE NATIONAL WORKSHOP
HELD IN BOMBAY
MAY 14-15, 1994
ORGANISED BY
YOUTH FOR UNITY AND VOLUNTARY ACTION, BOMBAY
AND
VOLUNTARY ACTION NETWORK INDIA, NEW DELHI
ACKNOWLEDGEMENTS
VAN1 acknowledges the support of all those who worked hard to make the National
Workshop on 74th Amendment (Nagarpalika) Act, 1992: Role of Voluntary Organisations
held on May 14-15,1994 in Indian Council of Social Sciences Research (ICSSR), Bombay
a great success. The report is based on this workshop. We are greatful and obliged to all
those who extended support and solidarity.
In particular, VANI deeply acknowledges the support and solidarity of the Youth Unity and
Voluntary Action, (YUVA) the local host, who not only made all arrangements for the
workshop but also mobilised participants and resource persons and prepared design of the
workshop. Ourspecial thanks goes to all participants and resources persons, especially Dr.
Nawas Mody, Shri Dinesh Mehta, Dr. (Mrs.) Marina Pinto, Ms Sneha Palnitkar, Ms. Sheela
Patel, Shri B.M. Suktankarand Shri Amitabh Kundu fortheir participation, preparing paper
and its presentations during the workshop.
The first draft of this report has been prepared by YUVA team and final text by Seema
Gaikwad, Vimi Khanna and Anil K Singh.
New Delhi, August 1994.
ANIL K SINGH
EXECUTIVE SECRETARY
© Voluntary Action Network India, 1994
Price: Rs.25/-orUS$5. Available also at a subsidised price of Rs. 15 to individual activists,
small and non-funded organisations, students, and the unemployed.
VANI- Voluntary Action Network India
H-17/1, Malyiya Nagar
New Delhi 110 017
SUMMARY OF THE NATIONAL WORKSHOP
A National Workshop on the Nagarpalika (74th Amendment) Act, 1992 was jointly organised
by Voluntary Action Network India (VANI) and Youth for Unity and Voluntary Action (YUVA)
on May 14-15,1994 in Bombay.
The aim of the workshop was to enhance the understanding of the legislation among different
actors of civil society, academicians, social activists, voluntary organisations, media persons,
bearing in mind that civil society has an important role to play in strengthening grassroots
democracy.
The presentations, recommendations and discussions of the workshop may be summarised
as follows:
Implications of the Act:
*
The discussion on the historical context’of the Act stressed the fact that the Act is a belated
but welcome constitutional acceptance of the principle of urban local self - governance.
The Nagarpalika Act is expected to refurbish the whole system of urban local self
governance.
*
The Amendment had become essential due to the systematic erosion of autonomy in the
municipal functional domain. Inadequate financial resources, the inadequacy of personnel
staffing, outdated management systems, stifling control of the State Government, invasion
of factional politics in local self-government, the development of a nexus between the
underworld and the political set-up and increasing corruption were seen as some of the
factors ailing the current system.
*
The implications of the Act on urban affairs was outlined and its scope was detailed
especially that, issues of social justice including aspects of urban poverty alleviation, slum
upgradation etc. would greatly enlarge the scope of the municipal government. The idea
of democratic decentralisation, transferring power to the people, reservation for women
and scheduled castes and scheduled tribes, establishment of a State Finance Commission
anda District Planning Committee were stressed. Another important issue for consideration
was that of accountability of the governing mechanism to the people at large.
■*
The discussion on municipal finance and the 74th Amendment underlined two important
aspects:
i) the setting up of a State Finance Commission which can make recommendations to
the Governor to suggest measures needed to improve the financial position of the
Municipalities and Nagarpalikas.
ii) empowering municipal corporations to impose taxes directly as well as obtain taxes
imposed by State Governments; however, the powers of the Municipal body to borrow,
have not been specified.
It was noted that a disparity in distribution of and access to resources exists between
different types of towns and cities. An analysis of patterns of urbanisation show that
class I cities show greater financial stability because of their sounder economic footing
whereas small and medium towns with a weak economy are unstable. The need to
stabilise the infrastructure of small and medium towns was expressed.
* A need to review the participation of women who have been elected was expressed as
women are increasingly being seen as a third force in politics. It was felt that since poor
women are caught-up in a daily struggle for survival, they are unable to play the role
envisaged for them since democracy is more than just representative governance. It
becomes meaningful only if those who represent the group are able to articulate the
issues of that particular group.
* The findings of a study undertaken by Sneha Patnitkar on the elected women
corporators of Bombay Municipal Corporation (BMC) were presented. It was found that
reservation had resulted in an increased number of women in politics, most of who
women were found to be from the upper castes. It was felt that though there is a
one-third reservation, this could be increased to 50% as they would be able to win from
open wards also. Sneha Palnitkar saw an increasing confidence among 9 women
about their ability of women to perform their roles. This perception was however not
shared by the BMC officials who felt that there was inadequate intervention and
participation by women during meetings. The study also revealed that women
corporators were comparatively less corrupt.
THE FOLLOWING ARE SOME ISSUES WHICH WERE HIGHLIGHTED :
*
Political will is necessary to implement the provisions of the Act.
*
The provision for the involvement of non-elected members in Ward Committees is vague
and unclear.
*
The role of the State Finance Commission (SFC) and the mechanism through which the
SFC would review the financial position of Municipal bodies, their capacity to raise
resources, resource-gap etc. and then make recommendations for supplementation of
resources.
*
The uncertainty of the State Legislature accepting the recommendations of the SFC ?
•
The first exercise to be carried out at the State level would be that of enacting obligatory
State Legislation in congruence with the Central Act. Overall reforms of Municipal functions
such that the local bodies can be made most responsive, and the need for instrumentalities,
such as ward committees to become a reality.
*
Financial decisions which uptil now are not debated and are shrouded in secrecy should
be presented in a simple, transparent manner.
*
Overall context of centre-state relations, decentralisation and dissolution of power from the
centre to the states.
*
The necessity for laying down broad guidelines detailing how such transfers would take
place.
The basic principle of public finance is that taxes should be collected at points where it is
most efficient to collect. At local levels, certain functions have been usurped by the State
Government. Local self-governments need to be restored the power of accessability to
resources.
*
Role of Voluntary Organisations:
Outlining the role of voluntary organisations in urban local self - governance, it was stressed
that the voluntary organisations need to play an intermediary role between “government", “the
system” and The people”.
Recommendations of the Workshop
The roles envisaged for voluntary organisations therein are:
*
*
*
It was agreed by the participants that the voluntary organisations should:
hold regional level workshops on similar themes;
*
extensively disseminate information related to Nagarpalika Act and other related issues;
*
to develop a list of learning material and list of resource persons;
to initiate political processes at the people's level - in the context of elections, ensuring
voter education, voter association by preparation of ‘people's manifestos; ‘people's
observers’ during election and 'people's audit’ of elected candidates.
’
to organise awareness campaigns to educate the people politically and to make them
aware of their voting right, to enable them to actively participate in the election process;
to train women, scheduled caste and scheduled tribe elected representatives on
Municipal Bodies and District Planning Committees, as well as evolve mechanisms where
by the functioning of the committees are monitored. .
*
to develop training modules and training strategies for elected representatives and train
them, so that they can play their due role in municipal bodies;
*
Emphasise the role of women and other weaker sections of society in this process.
to ensure space in the ward committee for voluntary organisations - to include people's
organisations, and local coalitions as representatives of the people.
3
2
CONTEXT
The question of Governance has acquired a significant and critical status at this juncture.
Questions have often been raised about the accountability of governing mechanisms to the
public at large. Issues of transparency and responsibility in Governance have also become
vital.
In ou r country the process of governance has moved from local control to a supra-national
centralised activity in the last 46 years. It is shrouded in secrecy and smacks of an 'anti
public interest’ posture. Anonymous decision making and the absence of accountability
are the hallmarks of the system of governance in India. Movements, institutions and
associations within the civil society are demanding a direct and active role in governance.
The demands to set up and build institutions of local self-governance have thus acquired
an urgency in India today.
While the urban local self-government institutions have operated in some form orthe other
in post-independent India, it is only now that the political leadership of the country is trying
to provide it with an autonomous, independent constitutional identity. The 74th Constitutional
Amendment Act provides such possibilities. The Nagarpalika Act provides for regular and
time -bound elections, gives the responsibility of an extensive role in socio-economic
development of urban centres and makes provisions fortransferof resources from central
to state governments for various sectors of development. Most important, the Act provides
for 1/3rd reservation for women and a proportionate reservation for scheduled caste and
scheduled tribe members. It is true that party politics may vitiate the process of elections,
still the potential for strengthening institutions of local self-governance and creating a
system of accountable development exists within the realm of this Constitutional Amendment.
The question, therefore, is whetherconcemed citizens and voluntary organisations will take
this opportunity to contribute positively to the possible of formation of strong, vibrant and
accountable institutions of urban local self-governance. Two roles need attention: The
first, and most critical role is to provide orientation and necessary inputs to the newly
elected members. This orientation will be critical forwomen and members of the scheduled
caste and tribes. The focus of such orientation should include the rightful and responsibile
role in making such institutions a viable reality; Second, Voluntary Organisations, with their
vast experience in micro level planning and implementation, could be effectively utilised and
made available to the institutions of urban local self-governance. It is in this context that
a National Workshop was held in Bombay during May 14-15,1994. Nearly 80 participants
(the majority from Bombay) and respresentatives of voluntary organisations from 8 states
(Maharashtra, Uttar Pradesh, Bihar, Rajasthan, Kerala, Tamil Nadu, Gujarat and Delhi and
eminent persons in the field of civil society participated in this workshop. It helped to
understand the implications of the 74th Amendment Act and the potential role of voluntary
organisations in strengthening institutions of Urban Local-Self Governance.
This report summarises the extensive discussions which took place during the workshop.
Lord Ripon, the founding father of the municipal authorities in British India, implanted the
concept of municipal authorities as the basic units of "self-government”. Their role as such
has substantially declined over the years. The debate concerning the relevance and utility
of the Urban Local Self-Governance system has been going on since Independence.
The initiative to accord a constitutional status and reactivate the urban local-self
government bodies began relatively recently. The initial debates and activities, led to the
consultations and conferences of State Chief Secretaries and State Ministers of Local SelfGovernment in 1988-89, which was followed by a conference of State Chief Ministers in
New Delhi on July 7,1989. The present amendment was introduced after review in the Lok
Sabha in September, 1990. Later, the Constitution Bill, 1991 relating to municipalities which
was essentially based on the Constitution (65th Amendment) Bill, 1989 was introduced.
The Constitution (74th Amendment), Act 1992, also known as the Nagarpalika Act was
passed by the Parliament and the Central Legislation came into force on June 1,1993. As
the urban local self-governance comes under the list of State subjects, all the States and
the Union Territories were asked to ratify the Act and bring the existing State legislation in
congruence with that of the Central Act.
The objective of the legislation is primarily to strengthen local democracy in India by
transferring ‘power1 to the ‘people’ and encouraging their participation and involvement in
the decision- making processes concerning the overall concept of ‘Governance’.
WHAT AILS THE EXISTING SYSTE^I
The existing scenario has a number of anomalies which has led to a substantial decline in
the System. Some of these are :
1.
The undefined role of municipal authorities has resulted in considerable erosion in the
municipal functional domain. This is manifested in state encroachments into municipal
functions on the plea that the traditional municipal authorities do not have requisite
resources to effectuate the challenging tasks.
2.
On the resources front, the local resource base has been shrinking. The share of
municipal authorities in the total public sector expenditure has declined from about
eight per cent in 1960-61 to about 4.5 per cent in 1977-78.
3.
The executive powers in the municipal corporations are vested in the Council and its
executive committees, while the executive functions are performed by the appointed
Commissioner. Substantial executive powers enjoyed by an appointed executive,
ratherthan by the elected representatives has led to bureaucratic control and hence
erosion in local democracy and self-rule.
4.
An elaborate state control on the day-to-day functioning of the municipal authorities
has a crippling effect on them. These powers are frequently exercised through
inspection, calling of records, giving directions for performing civic functions and
framing of bye-laws and rules. Despite being the units of self-government, it is
incredible that the municipal authorities do not have the powers to approve their own
budgets and decide the tax rates. Even the Municipal Corporations are required to
obtain state approval of expenditures beyond certain limits which in Kerala is Rs. one
lakh, in Andhra Pradesh, Rs.50,000 and in Himachal Pradesh, Rs.20,000.
5.
The most drastic mechanism of control is applied by the Act of supersession whereby
the Council need not be reconstituted through a fresh election for years together. Due
to this, a large number of municipal councils are under prolonged suspension.
All these have gone a long way in weakening the institutional capability of municipal
authorities.
The second tier, that is, the Ward Committees, are to be composed of the Members
of the Municipal Council representing the wards within their jurisdiction and one of the
elected representatives from within the wards is to be appointed as its Chairperson. In
addition to the elected representatives, the Ward Committee is to consist of nominated
members. It will be the prerogative of the State Governments to decide the composition
and the manner in which the seats in the Ward Committee are to be filled (Article 243S(2)). This provision to nominate the members does not go well with the ethos of selfgovernment.
74TH AMENDMENT (THE NAGARPALIKA) ACT
AND ITS SALIENT FEATURES
To comprehend the efficacy of the 74th Amendment it is important to look at the important
provisions of the Constitution Amendment in terms of (i) structure, (ii) composition, (iii)
powers and functions, (iv) finances, (v) Urban planning, and (vi) Empowerment of women
and weaker sections of society.
(i)
(iii)
Structure :
Through the Amendment, the Constitution provides for constituting three new types of
institutions for urban self-government. These are: (a) NagarPanchayatsforanarea
in transition from a rural to an urban area; (b) Municipal Councils for smaller urban
areas, and (c) Municipal Corporations for a larger urban area. The right to decide which
areas are to be called “transitional", “smaller"’ and "larger" urban areas have been left
to the discretion of the State Governments. It also provides for decentralisation of
municipal administration by constituting Ward Committees in territorial areas of such
municipalities which have populations of over three lakh which would help bring the
citizens and units of local self-government closer.
The Amendment is completly silent about the future fate of Cantonment Boards which
are important variants of municipal authority performing similar functions constituted
under a Central Act. If this silence implies the demise of Cantonment Boards, is implied,
it will be injurious to the civic administration of cantonments.
A very important provision in the Amendment pertains to the right of the Municipal
authorities' to exist (Article 243-U). It allows a five year term to the Municipalities, and
stipulates that if at all they have to be dissolved, they must be given an opportunity to
be heard, and then fresh elections must be held within a period of six months. This will
hence forth prevent their prolonged supersession for years together. In fact, this
provision remedies one of the major problems facing Municipal authorities in the recent
past the continuous interference in their functioning by the State Governments.
(ii)
Composition:
The Composition of Municipalities has been designed in such a manner that all the
seats are to be “filled by persons chosen by direct election” (Article 243-R (1)) to make
it more responsive to the people. Forelections the territorial constituencies in municipal
areas have been divided into wards and each seat shall represent a ward in the
Municipality. The nature and method of the election of the Chairperson has been left
to be specified by the concerned State Legislatures.
8
Powers & Functions:
The Amendment envisages that functions relating to preparation of plans for economic
development and social justice as well as for implementation of various development
schemes shall devolve to the municipal authorities. It has appended a new Twelfth
Schedule (see enclosure -1) to the Constitution of India which lists out 18 functions
to be performed by them.
Some of the unconventional and ambitious functions include urban planning,
regulation of land use, construction of buildings, roads and bridges, urban forestry,
slum improvement and urban poverty alleviation programmes (Article 243-W). This
would indicate that hence forth the gradual encroachment by the State on Municipal
functions will stop as these have been so clearly specified in the new Schedule.
But this hope is belied primarily because of the discretionary powers the Amendment
allows to the State Governments. Left to the State Governments, the devolution of
functions would not be as complete as is envisaged in the Twelfth Schedule.
Ithas, therefore, been suggested that theTwelfth Schedule should be made mandatory,
not discretionary and should provide for a Local List of functions in the Constitution of
India in unambiguous terms.
Another area of doubt relating to the devolution of functions pertains to the nature of
some of the functions which seem to be quite ambitious and even redundant and
irrelevant forthe municipal authorities. Planning foreconomic and social development,
protection of the environment and promotion of ecological aspects, and urban poverty
alleviation are functions which belong to this category. It is not that these are not
important functions. Performance of such functions requires a much stronger financial
capability and human resources than which the municipal bodies command. With the
existing funds they are not in a position to discharge even the basic functions. Even
the provisions relating to the strengthening of their financial base are not likely to
achieve this objective in the nearfuture, as is discussed here subsequently. Toexpect
9
them to discharge these functions efficiently, therefore, seems to be a tall orderindeed.
Yet another grey area of the Amendment pertains to the functions to be performed by
the Ward Committees. It simply talks of devolving to them such functions by the State
Governments which may be necessary to enable them to carry out responsibilities
conferred upon them. Thus the second tier of local government has been created
without specifying the functions to be performed by it.
(iv)
Finance :
Devolving of functions without devolution of sources of revenue does not carry any
meaning. As discussed earlier, the decline in the institutional capability of municipal
authorities is largely due to weak fiscal capabilities. However, the Amendment has very
conveniently ignored this critical area of municipal governance. The taxes, duties, tolls
and fees to be levied by them and assigned to them as also the grants-in-aid to be given
to them have been left to the discretion of the State Governments. We. have seen in
the past that a large number of states, the State Governments have not only been
indifferent to the need for revamping of municipal finance but have even encroached
upon the legitimate sources of local revenue. Profession Tax, for example, has been
taken over by the State Governments in Karnataka, Haryana, Madhya Pradesh,
Meghalaya, Nagaland, Tripura and West Bengal, in Andhra Pradesh, the Entry Tax
is being used by the State Government. In Madhya Pradesh, even Property Tax had
been taken over in the past by the State Government. Left to the discretion of State
Governments, the prospects for refurbishing of the municipal finance system do not
seem to be very bright. It was, therefore, required to specify the sources of local
revenue in the Constitution of India itself so that these could be constitutionaly
protected and guaranteed.
Features of the Finance Commission:
The only redeeming feature of the Seventy-Fourth Amendment in the financial
sphere is the mandatory constitution of Finance Commission by the State
Governments once in every five years.
The State Finance Commission (SFC) is to make recommendations regarding
principles to govern the sharing of the state taxes, duties, tolls and fees between
the State Government and the municipalities and also its distribution between the
municipalities.
The SFC is also to suggest the principles for the determination of taxes, duties, tolls
and fees to be assigned to them and the grants-in-aid to be given to the municipal
10
authorities out of the Consolidated Fund of the State.
* It also has the mandate to suggest ways and means of improving the financial
position of the municipal authorities.
* The Governor is required to lay before the State Legislature the recommendations
made by the FC along with an explanatory memorandum containing the action to
be taken on it. Thus the suggestions and observations of the SFC shall have to be
taken note of by the State Governments. This is one of the most important aspects
of the Seventy-Fourth Constitution Amendment.
The mechanism of the SFC seems to be the only hope forthe refurbishing of municipal
finances, as the decision on sources of revenue has been left to the states discretion.
The recommendations to be given by the SFC will fill this void as it has the mandate
also to suggest the taxes, duties, tolls and the fees to be devolved upon the municipal
authorities. This Amendment will go a long way in integrating the non-plan municipal
financial needs with the state and federal finances through the mechanism of the
committed expenditu re of the State Governments. It is worth stressing, even at the cost
of repetition, that the exercise of the SFC is based on the functions performed by the
municipal bodies. If the functions of the Twelfth Schedule are not devolved upon them,
the transferscheme suggested by the SFC will be shortsighted, limited and meaningless.
Moreover, as it is to be a composite State Finance Commission forthe Panchayati Raj
institutions as well as forthe municipal authorities, one has to wait and watch if it gets
dominated by the rural local bodies' interests.
Another provision of the Constitution Amendment Act having important ramifications
forstrengthening the financial capabilities of the municipal authorities is the amendment
of Article 280 of the Constitution pertaining to the Terms of Reference of the Central
Finance Commission (CFC). The new provision requires the CFG to suggest measures
needed to augment the Consolidated Fund of a State to supplement the resources of
the Municipalities in the State on the basis of the recommendations made by the SFC.
Thus, the need for non-plan funds of the Municipalities is now to be looked into by the
CFC as well.
Federal transfers will now be available also for the municipal authorities from the
Eleventh Finance Commission onwards. This is an amendment of far-reaching
importance.
The Amendment however does not say anything about the borrowing powers of
municipalities, on mechanisms of determining user charges on services rendered by
municipal bodies, on disposal of municipal properties, etc.. There are also restrictions
imposed on investment of funds by local bodies.
It is sometimes felt that decision to be taken at the municipal and panchayat level could
not be taken up at the higher level due to larger size of community, exposure to media
etc. .
which can hardly yield any revenue to the civic authority. The tertiary activities in these
towns are also poorly productive. As a result of these, the level and quality of basic
services are extremely low. What is worse is that the situation is deteriorating overtime.
It is, therefore, important that the issues are analyzed not within a framework of
competition between state and local administration, since mere transfer of power to
raise resources to the elected representatives at local level, may not necessarily result
in larger earnings.
It would, therefore, be reasonable to argue that the Act, by making the civic
bodies in small and medium sized towns increasingly dependent on their own
tax and non-tax resources, would increase the disparity in the level of services
and economic infrastructure across different size classes of urban centres. This
would affect the capacity of small and medium sized towns to absorb the future
growth of population and attract new economic activities.
A study conducted by Prof. Amitabh Kundu of Jawaharlal Nehru University, New Delhi
shows that the pattern of urban growth in India shows a significant distortion across
States, districts and size classes. The small and medium sized towns with populations
below 50,000 in the backward states have experienced rapid growth during the
seventies and eighties similar to that of the class I towns. In the developed states,
however, the larger towns grew at a relatively faster rate. Detailed statistical analysis
reveals that the growth of small and medium sized towns was not backed up by the
growth of manufacturing or other economic activities and infrastructural facilities.
Interestingly, a large majority of these towns are located in the backward districts. Rural
pover y, stagnant agriculture, absence of sectoral diversification etc. would, therefore,
emerje as possible factors in explanation. With the decline in central assistance to
Stat js, most of the towns have already gone dry in raising resources and are unable
to nake investments for improving infrastructure and basic services;. This has
cc .npounded the problem of inadequacy of basic amenities in these towns, experiencing
h gh population growth. It is thus evident that the small towns have come to depend
i icreasingly on grants-in-aid, primarily due to their poor economic base and incapacity
.0 mobilise tax and non-tax revenues.
The same study brings out that a disparity exists in per capita ordinary income and its
various components across size class of urban centres at the All India level. It may be
noted that taxes make up, as a proportion of the percapita ordinary income for Classes
IV, V and VI, one-third in the metropolises and about half in Class-1 cities. The tax and
non-tax revenue together constitute 70 per cent of the ordinary income in the case of
the former while in the case of metro cities, the figure is 85 per cent. While the grants
for the smaller towns have grown by about 200 per cent at current prices during the
period between 1974-75 and 1979-80, the corresponding increase in the case of metro
and Class I cities is 100 per cent only. The low economic strength of the small and
medium sized towns may be also inferred from the fact that while the Class I cities, on
an average, have over30 percent of the male work force engaged in manufacturing,
the figure is less than 8 percent forthe towns with less than 50,000 population. As high
as twenty percent of the male workers in the latterare engaged in the agricultural sector
12
The segmentation of the cities into rich and poor colonies, with an increasing gap in
the level and quality of urban amenities has been very sharp in recent years. The
process is backed up by market forces as well as governmental programmes, pushing
the poorout of the high income localities. Poor migrants have generally sought refuge
in slum colonies in city peripheries or on marginal lands within the cities.
(v)
Urban Planning :
The Amendment provides forsetting up of District-Planning Committees to consolidate
the plans prepared by the Municipalities and the Panchayats within the district and to
prepare an Integrated Development Plan forthe district as a whole. The municipalities
are to be represented on it. The integrated development plan has to be prepared with
respect to the matters of common interest between the Panchayats and Municipalities,
including spatial planning, sharing of water and other physical and natural resources,
integrated development of infrastructure and environmental conservation. Plans so
prepared are to be forwarded by the Chairperson of the District Planning Committee
to the State-Government. Similarly, Metropolitan Planning Committees are to be set
up in the metropolitan areas with representatives from the municipal authorities. The
Committee will be doing a similar planning exercise for the metropolitan areas as is to
be done by the District Planning Committee in a district.
However, one wonders as to how the plans prepared by the Panchayati Raj Institutions
are to be consolidated to form the draft District Plan. As this is not provided for in the
Seventy-Third Amendment, from where will these institutions derive the powers to
formulate the plan? And if the plans are not prepared by the Panchayat Raj Institutions,
how are they to be consolidated along with the municipal plans to form a District Plan?
The setting up of a Metropolitan Planning Committee is going to create further
confusion about the role and relationship of the Urban Development Authorities
(UDAs) vis-a-vis the proposed Metropolitan Planning Committees (MPCs). Does it
mean the demise of the UDAs? Or are the UDAs to be merged with the municipal
authorities as their planning and development agencies? These questions are not13
settled in the Amendment. If, however, the MPCs and the UDAs are to exist side by
side, it will make the planning function fragmented and chaotic, adding further to
already compounded problems of coordination.
*
(vi) Empowerment of Women and other Weaker Sections of the Society:
Empowerment of the weaker sections of society and of women is one of the most
substantive provisions of the Amendment (Article 243-T). With a view to empower the
scheduled castes and tribes as well as women, it provides for reservation of seats in
the Council according to the proportion of these groups in the total population of the
municipal council. The most important provision is the empowerment of women for
whom one-third of the total seats are to be reserved. It also provides that the
chairpersons in the municipal authorities have necessarily to belong to the scheduled
castes and tribes and women.
Another important feature of the Amendment is the appointment of a statutory
authority that will conduct elections to the Municipalities. All the powers of election
superintendence, and control will be with the State Election Commission. This will
reduce the control of the State Government and introduce impartiality and independence
into the election system.
The Amendment is hence the first serious attempt to ensure adequate constitutional
obligation so that stabilisation of democracy in Municipal Government is established.
ROLE OF VOLUNTARY ORGANISATIONS
The active political role of voluntary organisations was debated. While some feel that
voluntary organisations should primarily function as intermediaries between people and
governments, others feel that voluntary organisations should express themselves at all
levels of civil society and especially at the level of local self-governance, since local self governance is supposed to be part of citizenry and non-party. Voluntary Organisations
need to critically analyse their role in development and in political processes. It is also felt
that voluntary organisations need not necessarily participate in political area but should
attempt to make systems and service delivery more efficient. Voluntary organisations could
form a federation to act with a consensus on matters of local self - governance, and create
city resource centres to provide information to municipalities and its elected members etc.
Sometimes it is also debated whether voluntary organisations are true representatives of
the people. We should also see how community - based organisations and local groups can
be helped to participate in the process. It is, therefore, stressed that the role of voluntary
organisation would be to act as support organisations to community groups, to be
intermediaries between local organisations and the system. Voluntary Organisations need
to have a strategic vision and have external linkages with the system.
Voluntary organisations can thus play important roles before the election, during the
election, and after the election.
a. Before the elections:
The role of voluntary organisations is not merely to interface between governments and
the people but between multilateral agencies and the people and even between people
and people.
14
15
c. Post-election
*
Voluntary Organisations should educate and organise voters to assert their rights.
Voters' fora can be formed which would help the education of voters, analyse
manifestos of political formations, prepare alternate Peoples' Manifestos and have
candidates declare their support etc. The academic community can help people
analyse political manifestos, and experts on urban issues can help evolve alternate
plans or policies.
Voluntary Organisations can form a Committee of 3-4 people in each municipal area to
audit' or review the performance of the elected representative so as to ensure
accountability. Corporators should also be prevailed upon to tell people of their agenda,
to listen to the people's views on them, etc..
d. Long-term
Voluntary organisations have a long term role to play. This would be that of preparing
both the leadership as well as the community to enable effective participation.
b. During elections
•
*
Voluntary Organisations can play a major role in identifying peoples' observers who
could move around communities and polling booths ensuring no election were
malpractices are taking place. Seeing peoples' observers trying to ensure free and fair
elections would also increase the confidence of people. Human rights activists, literacy
figures, jurists, and cultural groups can also be enlisted as peoples' observers.
*
The criteria for nomination to Ward Committes should be objectively defined and
voluntary agencies can play a role in this through lobbying and advocacy.
*
To curb election malpractices, voluntary organisations must insist that all citizens are
provided identity cards.
*
Alliance between (Ward Committees, Voluntary Organisations, Community based
organisations, academicians needs to be built.
16
(i) Training
Women and members belonging to the scheduled castes and the tribes among
the elected representatives, who have been left out of the political processes for
centuries need to be trained to enable them to perform their role effectively. As
assigned in Twelfth Schedule of the 74th Amendment Act, Nagarpalikas are
supposed to plan and implement 18 types of developmental activities. Newly
elected members of the Nagarpalika may not have experience or knowledge about
these developmental activities. Voluntary Agencies have a vast experience in
handling such of developmental activities. All those voluntary agencies working in
urban areas or on urban issues can help the Nagarpalika and its elected members
in these endeavours.
17
(ii) Ensure proper representation
Voluntary Organisations should ensure that Ward Committees and District planning
committees are represented by people’s organisations and voluntary organisations.
Mechanisms by which the functioning of these committees can be monitored need
to be developed. Alternate plans fordevelopment can also be drawn up by a process
which would require a broad alliance between researchers, people's organisations,
community-based organisations and voluntary organisations. Many voluntary
organisations have vast experience in micro-level planning and they can assist the
Nagarpalikas.
(iii)Public Interest Litigation
preparation of people’s manifestos etc.. However, some participants felt that onethird reservation for women and Scheduled Castes and Scheduled Tribes can be
a form of cooption.
(viii) Dealing with Political Parties and formations
Voluntaryorganisations cannotescape having to deal with political parties. During
election and after Political Parties will try to influence the Nagarpalika and its
decisions. Voluntary Agencies are working on a neutral basis and therefore they
can resist being influenced by political parties. For such functioning a strong
ideological basis is a must for voluntary organisations.
(ix) Sharing dual relationship
Communities can be organised to file public interest litigation if institutions of local
self-governance are not functioning properly or working against the people's
interest. However, this should be as a last resort. The attempt must be to mobilise
people to pressurise local bodies.
(iv)Social accountability
Voluntary Organisations can insist on the social accountability of the Municipal
system, for example urging the local corporator to share information about his role,
responsibility, performance etc. through mechanisms such as monthly bulletins,
pamphlets etc. . They should also mobilise people in support of public hearings,
discuss the agenda of their meetings and seek people’s views on the matters to be
discussed.
Elected representatives share a dual relationship with voluntary organisations. It is
only when voluntary organisations are cooperative and don’t raise too many
questions that elected representatives are open to discussion with them. Voluntary
Organisations are also used by elected representatives to gain mileage. Therefore,
it should be ensured that a amicable relationship is established between the two,
to maintain a flow of information.
(x) Capacity building of voluntary organisations
Voluntary Organisations need to build their capacity to equip themselves to play
these above mentioned roles, because all voluntary agencies do not have the
capacity or skill to play these roles.
(v) Form networks
Voluntary Organisations should form a network of people having different kinds of
experiences and expertise and build linkages with the Municipal structure. Networks
between Ward Committees also needs to be built.
(vi) Dissemination of information
Voluntary Organisations have an important role to play in the dissemination of
information about the Act as well as on other developmental issues, programmes,
structures, socio-economic political system etc.
(vii) Function as pressure groups
Voluntary Organisations must explore areas where there is no danger of getting
coopted, and. function as pressure groups, enable people’s audit, and in the
18
19
ROLE OF WOMEN
The role of women in political processes cannot be understood without looking at the
ongoing processes in the entire society. Women in poor communities are caught in a
struggle forsurvival and face the contradiction between inclusion in the political processes
and the tremendous stress on the economic front, if they do give up their jobs and take part
in the political process.
(i)
Training of elected representatives
An analysis of the participation of
elected representatives, from poor income
groups shows that they have not really been
successful in representing their issues.
Women need to be trained so that they
understand how systems actually work.
Support structures to enable women from
poor income groups to stand for elections, if
they wish to do so, need to be generated.
(iii)Women voters' forum
In the pre-election phase, encourage activities such as formation of women's voters'
fora which would monitor the manifestos of different political formations to see
whether they are gender sensitive, secular, democratic or not; prepare alternate
women’s manifestos and have candidates express their commitment.
(iv)Mobile observation teams should be formed
To prevent malpractices during election, mobile observation teams should be
constituted. This would ensure unbiased elections. If women came out in large
numbers, they can check malpractices and ensure peaceful elections.
Women should not be satisfied with one-third reservation but demand reservation
equivalent to their proportion in the population. However, though the reality is that
women constitute 50 percent of the population, they have no power or no control
over resources. They have no base, no mechanism by which they can utilise these
legislations.
In the post-election phase, elected
women representatives, would need to be
trained so as to increase their confidence.
Areas of training would include gender
sensitisation, personality and leadership
development, etc. . Training manuals in
regional languages should be developed.
(ii) Political Education to be emphasised
Mere representative participation is not democracy. Representation of a group is
meaningful only if the representatives are able to push forward the agenda of the
group they represent. Women's participation is generally around very practical
issues like water, food prices, etc.. They have been unable to demand changes
in the system itself; they do not know how to interact with the administration etc.
Thus, political education and mobilisation of women should be ensured if they are
to effectively participate.
20
21
ANNEXUREI
RECOMMENDATIONS OF THE WORKSHOP
*
It was decided that regional level workshops on similar themes would be
organised. Participants from different states agreed to organise such meetings
within the next few months. These meetings/workshops would be organised to
encourage as well as equip the members of the voluntary sectorto educate the
masses in their own areas of operation.
’
It was also decided that a comprehensive list of learning materials and list of
resource persons available in different states would be prepared and widely
circulated. VANI was assigned this responsibility.
*
Participants were of the view that more stress should be given on women and
other weaker section of the society.
*
Representatives agreed to do lobbying and advocacy at the state level for
formulation of progressive state legislations.
*
All representatives were of the view that a massive awareness campaign is
needed to educate the people politically and to make them aware of their voting
rights and the importance of these, and thus prepare them for active
participation in the election process.
THE CONSTITUTION (SEVENTY-FOURTH
AMENDMENT) ACT, 1992
[20th April, 1993]
An Act further to amend the Constitution of India
Be it enacted by Parliament in die Forty-third Year of the Republic of India as follows:
NOTES
The only distinction between a law amending the Constitution and an ordinary law in a rigid constitution is that an amendment of
the Constitution has always to be made in the manner and form specially prescribed by the Constitution. Kesavananda Bharah v. State of
Kerala, (1973) 4 SCC 225, paras 1345 and 1579.
1.
Short title and commencement. —(1) This Act may be called the Constitution (Seventy-fourth
Amendment) Act, 1992.
(2)
It shall come into force on such date as the Central Government may, by notification in the Official
Gazette, appoint.
2.
Insertion of new Part IX-A.—After Part IX of the Constitution, Hie following Part shall be inserted,
namely:—
PART IX-A
*
Participating, organisations agreed to develop training modules and training
strategies for elected representatives of Nagarpalika. It was also agreed upon
that special efforts would be made to train elected women, and those belonging
to the scheduled castes and tribes and other backward classes so that they can
effectively participate in the Nagarpalika.
*
It was suggested that learning materials, should be prepared in popular forms,
forthe grass-root level activists. Films could be one Such effective learning tool.
*
VANI and YUVA agreed to prepare and publish a detailed report of the
workshop in Hindi and English for wider dissemination.
The Municipalities
243-P. Definitions.—In this Part,'unless the context otherwise requires,—
"Committee" means a Committee constituted under Article 243-S;
"district" means a district in a State;
"Metropolitan area" means an area having a population of ten lakhs or more, comprised in one
ormore districts and consisting of two ormore Municipalities or Panchayats orother contiguous
areas, specified by the Governor by public notification to be a Metropolitan area for the
purposes of this Part;
(d)
"Municipal area" means the territorial area of a Municipality as is notified by the Governor;
(e)
"Municipality" means an institution of self-government constituted under Article 243-Q;
(f)
"Panchayati" means a Panchayaf constituted under Article 243-B;
(g)
"population" means the population as ascertained at the last preceding census of which the
relevant figures have been published.
243-Q. Constitution of Municipalities.—(1) There shall be constituted in every State,—
(a)
(b)
(c)
1
Received die assent of die President oil April 20, 1993 and published in the
Gazette of India, Extra., Part II. Section 1. dated 20th April, 1993 pp. 1-10, SI. No.70
(a)
(b)
22
a Nagar Panchayat (by whatever name called) for a transitional area, dial is to say, an area in
transition from a rural area to an urbtm area;
a Municipal Council for a smaller urbtm area; and
23
(2)
In this article, "a transitional area", "a smaller urban area" or "a larger urban area" means such
area as the Governor may, having regard to the population of the area, the density of the population dierein,
die revenue generated for local administration, the percentage of employment in non-agricultural activities.
die economic importance or such odier factors as he may deem fit, specify by public notification for die
purposes of this Part.
243-R. Composition of Municipalities.—(I) Save as provided in clause (2), all the seats in a
Municipality shall be filled by persons chosen by direct election from the territorial constituencies in die
Municipal area and for tiiis purpose each Municipal area shall be divided into territorial constituencies to be
known as wards.
(2)
The Legislature of a State may, by law, provide—
(a)
for the representation in a Municipality of—
(i)
Persons having special knowledge or experience in Municipal administration;
(ii)
die members of the House of the People and the members of the Legislative Assembly
of the State representing constituencies which comprise wholly or partiy die
Municipal area;
(iii)
the members of the Council of States and the members of the Legislative Council of
the State registered as electors witiiin the Municipal area;
(iv)
die Chairpersons of the Committees constituted under clause
(5) of Article 243-S:
Provided that die persons referred to in paragraph (i) shall not have die right to vote
in the meetings of the Municipality;
(b)
The manner of election of the Chairperson of a Municipality.
243-S. Constitution and composition of Wards Committees, etc.—(1) There shall be constituted
Wards Committees, consisting of one or more wards, witiiin the territorial area of a Municipality having a
population of three lakhs or more.
(2)
(b)
a Municipal Corporation for a larger urban area, in accordance with die provisions of this Part:
(c)
Provided that a Municipality under this clause may not be constituted in such urban area or prrrt thereof
as die Governor may. having regard to the size of the area and the municipal services being provided or
proposed to be provided by an industrial establishment in that area and such odier factors as he may deem fit
by public notification, specify to be an industrial township.
the manner in which die seats in a Wards Committee shall be filled.
(3)
A member of a Municipality representing a ward witiiin the territorial area of the Wards
Committee shall be a member of that Committee.
(4)
Where a Wards Committee consists of—
(a)
one ward, the member representing tliat ward in die Municipality; or
(b)
two or more wards, one of die members representing such wards in die Municipality elected
by die members of die Wards Committee, shall be die Chairperson of tiiat Committee.
(5)
Notiiing in tiiis article shall be deemed to prevent the Legislature of a State from making any
provision for the constitution of Committees in addition to the Wards Committees.
243 T. Reservation of seats.— (1) Seats shall be reserved for die Scheduled Castesand the Scheduled
Tribes in every Municipality and die number of seats so reserved shrill bear, as nearly as may be, the same
proportion to die total number of seats to be filled by direct election in that Municipality as the population
of the Scheduled Castes in die Municipal area or of die Scheduled Tribes in die Municipal area bears to die
total population of dial area and such seats may be allotted by rotation to different constituencies in a
Municipality.
(2)
Not less tiian one-tilird of die total number of seats reserved under clause (1) shall be reserved
for women belonging to the Scheduled Castes or as die case may be, die Scheduled Tribes.
(3)
Not less titan one-tilird (including die number of seats reserved for women belonging to die
Scheduled Castes and die Scheduled Tribes) of die total number of seats to be filled by direct election in every
Municipality shall be reserved for women and such seats may be allotted by rotation todifferent constituencies
in a Municipality.
(4)
The officers of Chairpersons in die Municipalities shall be reserved for die Scheduled Castes, the
Scheduled Tribes and women in such manner as die Legislature of a State may, by law, provide.
(5)
The reservation of seats under clauses (1) and (2) and tlie reservation of offices of Chairpersons
(odier than die reservation for women) under clause (4) shall cease to have effect on die expiration of the period
specified in Article 334.
(6)
Nothing in tiiis Part shall prevent'die Legislature of a State from making any provision for
reservation of seats in any Municipality or offices of Chairpersons in die Municipalities in favour of backward
class of citizens.
243-U. Duration of Municipalities, etc.—(1) Every Municipality, unless sooner dissolved under any
law for die time being in force, shall continue for five years from die date appointed for its first meeting and
no longer:
The Legislature of a State may, by law, make provision with respect to—
Provided tliata Municipality shall be given areasonable opportunity of being heard before its dissolution.
(a)
the composition and the territorial area of a Wards Committee;
25
24
(2)
No amendment of any law for the time being in force shall have the effect of causing dissolution •
of a Municipality at any level, which is functioning immediately before such amendment, till the expiration
of its duration specified in clause (1).
(3)
An election to constitute a Municipality shall be completed,—
(a)
before the expiry of its duration specified in clause (1);
(b)
before die expiration of a period of six months from the date of its dissolution:
Provided-that where the remainder of the period for which the dissolved Municipality would have
continued is less than six months, it shall not be necessary to hold any election under this clause for constituting
the Municipality for such period.
(4)
A Municipality constituted upon the dissolution of a Municipality before the expiration of its
duration shall continue only for the remainder of the peirod for which the dissolved Municipality would have
continued under clause (1) had it not been so dissolved.
(b)
the Committees with such powers and audiority as may be necessary to enable diem to carry out
the responsibilities conferred upon diem including diose in relation to die matters listed in the Tweitii
Schedule.
243-X. Power to impose taxes by, and Funds of, the Municipalities.—The Legislature of aState may.
by law.—
(a) autiiori.se a Municipality to levy, collect and appropriate such taxes, duties, tolls and fees
in accordance witii such procedure and subject to such limits;
(b) assign to a Municipality such taxes, duties, tolls and fees levied and collected by the State
Government for such purposes and subject to such conditions and limits;
(c)
provide for making such grants-in-aid to die Municipalities from die Consolidated Fund of
the State; and
(d)
provide for constitution of such Funds for crediting all moneys received, respectively, by
or on behalf of the Municipalities and also for the wididrawal of such moneys dierefrom.
as may be specified in the law.
243-V. Disqualifications for membership.—(1) A person shall be disqualified for being chosen as, and
for being a member of a Municipality—
(a) if he is so disqualified by or under any law for die time being in force for die purposes of
elections to die Legislature of the State concerned:
Provided that no person shall be disqualified on die ground that he is less than twenty-five
years of age, if he has attained the age of twenty-one years;
243Y. Finance Commission.—(1)
The Finance Commission constituted under Article 243-1 shall
also review die financial position of die Municipalities and make recommendations to the Governor as to—
(a) die principles which should govern—
(i)
(2)
If any question arises as to whether a member of a Municipality has become subject to any of die
disqualifications mentioned in clause (i), the question shall be referred for the decision of such authority and
in such manner as the Legislature of a State may, be law. provide.
die distribution between die State and die Municipalities of the net proceeds of die taxes,
duties, tolls and fees leviable by the State, winch may be divided between them under tiiis
part mid die allocation between die Municipalities at all levels of their respective shares of
such proceeds;
(ii)
die determination of die taxes, duties, tolls and fees which may be assigned to, or
appropriated by, die Municipalities;
243-W. Power authority and responsibilities of Municipalities, etc.—Subject to the provisions of
this Constitution, the legislature of a State may by law. endow—
(iii)
(b) if he is so disqualified by or under any law made by the Legislature of die State.
(a) die Municipalities with such powers and audiority as may be necessary to enable diem to
function as institutions of self-government and such law may contain provisions for the
devolution of powers and responsibilities upon Municipalities, subject to such conditions
as may be specified therein, with respect to—
(i)
die preparation of plans for economic development and social justice;
(ii)
the performance of functions and die implementation of schemes as may be entrusted to
them including those in relation to the matters listed in the Twelfdi Schedule;
26
die grants-in-aid to the Municipalities from die Consolidated Fund of the State;
(b) die measures needed to improve the financial position of the Municipalities;
(c)
any otiier matter referred to the Finance Commission by the Governor in die interests of
sound finance of die Municipalities.
(2)
The Governor shall cause every recommendation made by die Commission under diis article
together witii an explanatory memorandum as to die action taken tiiereon to be laid before die legislature of
die State.
243-Z. Audit of accounts of Municipalities.—The Legislature ofa State may, by law, make provisions
witii respect to die maintenance of accounts by die Municipalities and die auditing of such accounts.
27
243-ZA. Elections to the Municipalities.—(1) The superintendence, direction wu control of the
preparation of electoral rolls for, and die conduct of, all elections to die Municipalities shall be vested in die
Suite Election Commission referred to in Article 243-K.
(3)
(a)
Provided diat die President may, by public notification, direct diat the provisions of diis Part shall apply
to any Union territory or part diereof subject to such exceptions and modifications as he may specify in the
notification.
243-ZC. Part not toapply to certain areas.—(1) Nothing in this Part shall apply to die Scheduled Areas
referred to in clause (1), and die tribal areas referred to in clause (2). of Article 244.
(2)
Notiiing in this Part shall be construed to affect the functions and powers of die Darjeeling Gorkha
Hill Council constituted under any law for the time being in force for the hill areas of die district of Darjeeling
in die State of West Bengal.
(3)
Notwithstanding anytiiing in diis Constitution, Parliament may. by law, extend die provisions of
this Part to die Scheduled Areas and the tribal areas referred to in clause (Ijsubject to such exceptions and
modifications as may be specified in such law, and no such laws shall be deemed to be an amendement of
diis Constitution for the purposes of Article 368.
243-ZD.
Committee for district planning.—(1) There shall be constituted in every State at die
district level a District Planning Committee to consolidate die plans prepared by die Panchayats mid the
Municipalities in the district and to prepare a draft development plan for the district as a whole.
(2)
have regard to—
(i)
(2)
Subject to die provisions of diis Constitution, die Legislature of a State may, by law, make
provision with respect to all matters relating to, or in connection with, elections to die Municipalities.
243-ZB. Application to Union territories.—The provisions of diis Part shall apply to die Union
territories and shall, in tiieir application to a Union territory, have effect as if die references to die Governor
of a State were references to die Administrator of the Union territory appointed under Article 239 and
references to die legislature or die Legislative Assembly of a State were references in relation to a union
territory having a Legislative Assembly, to that Legislative Assembly:
Every District Planning Committee shall, in preparing the draft development plan,—
(ii) die extent and type of available resources whether financial or otiierwise;
(b)
consult such institutions and organisations as die Governor may, by order, specify.
(4)
The Chairperson of every District Planning Committee shall forward the development plan, as
recommended by such Committee, to the Government of the State.
243-ZE. Committee for Metropolitan planning.—(I) There shall be constituted in every Metropolitan
area a Metropolitan Planning Committee to prepare a draft development plan for the Metropolitan area as a
whole.
(2) The Legislature of a State may. by law. make provision with respect to—
(a) the composition of the Metropolitan Planning Committees;
(b) the manner in which the scats in such Committees shall be filled:
Provided that not less than two-thirds of the members of such Committee shall be elected by. and from
amongst, the elected members of the Municipalities and Chairpersons of the Panchayats in the Metropolitan
area in proportion to the ratio between the population of the Muncipalitics and of the Panchayats in that area;
(a) the composition of the Metropolitan Planning Committees:
(b) the manner in which the seats in such Committees shall be filled:
Provided that not less than two-thirds of the members of such Committee shall be elected
by, and from amongst, the elected members of the Municipalities and Chairpersons of the
Panchayats in die Metropolitan area in proportion to the ratio between the population of
the Municipalities and of the Panchayats in that area;
The legislature of a State may, by law, make provision with respect to—
(a) the composition of die District Planning Committees;
(c)
the representation in such Committees of the Government of India and the Government
of the State and of such organisations and institutions as may be assigned to such
Committees;
(d)
the functions relating to planning and coordination for the Metropolitan area which may
be assigned to such Committees;
(b) the manner in which die seats in such Committees shall be filled:
Provided diat not less than four-fifths of die toed number of members ofsuch Committee shall be elected
by, and from amongst, die elected members of the Panciiayat at die district level and of die Municipalities
in the district in proportion to die rato between die population of the rural areas and of the urban areas in die
district;
(c)
die functions relating to district planning which may be assigned to such Committees;
(d)
die manner in which the Chairpersons of such Committees shall be chosen.
28
matters ofcommon interest between the Panchayats and the Municipalities including spatial
planning, sharing of water and other physical and natural resources, the integrated
development of infrastucture and environmental conservation;
(e)
the manner in which the Chairpersons of such Committees shall be chosen.
(3)
Every Metropolitan Planning Committee shall, in preparing the draft development plan.—
(a)
have regard to—
(i)
the plans prepared by the Municipalities and the Panchayats in the Metropolitan area;
29
(ii) matters of common interest between the Municipalities and the PauCTayats, including.
co-ordinated spatial planning of the area, sharing of water and other physical and natural
resources, the integrated development ofinfrastnictureand environmental conservations;
(iii)
the overall objectives and priorities set by the Government of India and the Government
of the State;
(iv)
the extent and nature of investments likely to be made in the Metropolitan area by
agencies of the Government of India and of the Government of the State and other
available resources whether financial or otherwise;
TWELFTH SCHEDULE OF 74TH AMENDMENT ACT
1.
Urban planning including town planning.
2.
Regulation of land-use and construction of buildings.
3.
Planning for economic and social development.
4.
Roads and bridges.
(b)
consult such institutions and organisations as the Governor may. by order, specify.
5.
Water supply for domestic, industrial and commercial purposes.
(4)
The Chairperson of every Metropolitan Planning Committee shall forward the development plan.
as recommended by such Committee, to the Government of the State.
6.
Public health, sanitation conservancy and solid waste management.
7.
Fire services.
8.
Urban forestry, protection of the environment and promotion of ecological aspects.
9.
Safeguarding the interests of weaker sections of society, including the handicapped and mentally
retarded.
10.
Slum improvement and upgradation.
11.
Urban poverty alleviation.
12.
Provision of urban amenities and facilities such as parks, gardens, playgrounds.
243-ZF Continuance of existing laws and Municipalities.— Notwithstanding anything in this Part.
any provision of any law relating to Municipalities in force in a State immediately before the commencement
of the Constitution (Seventy-fourth Amendment) Act, 1992, which is inconsistent with the provisions of this
Part, shall continue to be in force until amended or repealed by a competent Legislature or other competent
authority or until the expiration of one year from such commencement, whichever is earlier;
Provided that all the Municipalities existing immediately before such commencement shall continue till
the expiration of their duration, unless sooner dissolved by a resolution passed to that effect by the Legislative
Assembly of that State or. in the case of a State having a Legislative Council, by each House of the Legislature
of that State.
243-ZG. Bar to interference by courts in electoral matters.— Notwithstanding anything in this
Constitution.—
(a) the validity of any law relating to the delimitation of constituencies or the alloment of seals
to such constituencies, made or purporting to be made under Article 243-ZA shall not be
called in question in any court;
(b) no election to any Municipality shall be called in question except by an election petition
presented to such authority and in such manner as is provided for by or under any law made
by the Legislature of a State".
13.
Promotion of cultural, educational and aesthetic aspects.
14.
Burials and burial grounds, cremations, cremation grounds and electric crematoriums.
15.
Cattle ponds, prevention of cruelty to animals.
16.
Vital statistics including registration of births and deaths.
17.
Public amenities including street lighting, parking lots, bus stops and public conveniences.
18.
Regulation of slaughter houses and tanneries.
3.
Amendment of Article 280.— In clause (3) of Article 280 of the Constitution, sub-clause (c) shall
be relettered as sub-clause (d) and before sub-clause (d) as so relcttercd. the following sub-clause shall be
inserted, namely:—
"(c) the measures needed to augment the Consolidated Fund of a State to supplement the
resources of the Municipalities in the State on the basis of the recommendations made by the Finance
Commission of the State;"
4.
Addittion ofTwelfth Schedule.— Schedule to the Constitution, the following schedule shall be added.
namely:—
31
30
^NNEXURE II
03.00 pm - 03.^->m
03.45 pm - 05.00 pm
DESIGN OFTHEWORKSHOP
May 14,1994
SESSION I
SUBJECTS
SPEAKERS
Welcome
10.05 am -10.15 am
Inaguration
10.15 am -10.30 am
Introductry Talk and Context
10.30 am -11.00 am
Evolutionary Description
of the Nagarpalika
(74th Amendment) Act, 1992.
11.00 am -11.15 am
11.15 am -12.00 pm
Tea Break
Implications of the Nagarpalika
(74th Amendment) Act, 1992,
on the Urban Affairs.
Discussion & Conclusion by
Moderator.
Lunch
12.00 pm 0 01.00 pm
Shri Minar Pimple
Hon. Director, YUVA
Ms. Nirmala Samat
Mayor of Bombay (Invited)
Shri M.Z. Shahid
Co-ordinator, YUVA.
Dr. Nawaz Mody,
Professor,
Dept, of Civics & Politics, University of
Bombay.
Shri Dinesh Mehta, Director
National Institute of Urban Affairs
(NIUA) Delhi.
Moderator
Additional Municipal
10.00 am -10.30 am
Urban Local Self-Governace
in India & the Nagarpalika
(74th Amendment) Act, 1992
— A Critical Analysis
10.30 am -11.00 am
Urban Local Self-Governance
Shri S.M.Y. Sastri,
in India — what Ails the
All India Institute
Existing System?
of Local Self-Government, Bombay.
Tea-Break
Municipal Finance and the
Shri D.M. Suktankar,
Constitution (74th Amendment) Ex Chief Secretary,
Act, 1992 — Implications
Government of Maharashtra
11.00 am-11.15am
11.15 am -11.45 pm
11.45 am -12.15 pm
12.15 pm - 01.00 pm
01.00 pm - 02.00 pm
Session II
Shri B.M. Ambhaiker
Commissioner, MCGB
Dr. Gangadhar Jha
Research Professor
NIUA, Delhi
Urban Planning & the
Prof. Amitabh Kundu
Constitution (74th Amendment) Centre for the Study
Act, 1992 - Implications
of Regional Develop ment.JNU, New
Delhi.
Discussion & Conclusion
by Moderator
Lunch
Sesson IV
Moderator
02.00 pm - 02.30 pm
Experiences in the
Local Self-Governnace
02.30 pm - 03.00 pm
Role of NGOs in Urban
Local Self-Governance
Role of Women in the Urban
Local Self-Governance
03.00 pm - 03.30 pm
May 15,1994
Session III
10.00 am -10.05 am
01.00 pm - 02.00 pm
Tea - Break
Discussion & Conclusion by
Moderator
32
Dr. (Mrs.) Marina Pinto Reader,
Dept, of Civics & Politics,
University of Bombay. (Invited)
Ms. Sneha Palnitkar
Director, AIILSG,
Bombay
Shri Minar Pimple
Hon. Director, YUVA
Ms. Sheela Patel
Director, SPARC
Moderator
Shri Minar Pimple
Hon. Director, YUVA
Workshops in Groups
on Agenda for Action. Area: Women’s
Participation NGO’s Role Municipal
Finance Governance
02.00 pm - 03.00 pm
Future Planning
03.30 pm - 03.45 pm
03.45 pm - 04.45 pm
Tea-Break
Plenary & Conclcusion by
Moderator
Vote of Thanks
04.45 pm - 05.00 pm
33
Shri Anil K Singh
Executive Secretary,
VANI & Closing.
ANNEXURE ni
LIST OF PAPERS CIRCULATED AT WORKSHOP
Papers specially prepared for Workshop
Gangadhar Jha
The Seventy-Fourth Constitution Amendment and the Empowerment
of Municipal Government PP-20
Nawaz B. Modi
The Seventy-Fourth Amendment Act, - Its Implications for Urban Local
Self-Governance India PP-20
M.Z. Shahid
Perspective Note : National Workshop on the Nagarpalika (74th
Amendment) Act, 1992, PP-3.
Amitabh Kundu
The Seventy-Fourth Constitution Amendment Act: Search for a New
Federalism PP-5
Shri S.M.Y Sastri
Urban Local Self-Governance in India-What Ails the Existing System?
34
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Hope you are weii. I nave been writing reguiariy to some of you, to keep you in
■rko
smimri r?-.x=> Izinrl nr o<~rii/iri<=»c rtCiCiRH
rlri^e rrr>m rimzs rn ■Hrr>fO Vuc> h^\/P
just finished organising a vASTkA-DAAn coiiecrion camp, iast weekend, in Noida
e»
**»r Df
t#**t/*t
then ’H a company- Jotersoiutions. Both
went well. From today we've a camp at Aicatei, Gurgaon and then on Sunday at
Main if Vihnr F^olhi
•
.......... — /
i he successful coiiecrion camps, as some of you who have participated wiii bear
VTIVIlCSj VVZ, ui\- UMVMU VWIUII'.VVIJ V4I IM VIIV.II X-l IVI I M.JIUUI I I MVfMIII-^V V4II WJV4^. l iy I1VMIV
felt thanks to all GOONJ.. Volunteers and a fervent call to all who read this mail
thwt »vc dcspcrctc!y rsccd people who believe in WuSt we orc wOincp to
come and volunteer your time for GOOIMJ.. Collection camps and other
I do hope to hear from you soon.
-r-zll
*•«!/«
a in uicii carxc ’^cuc cai iu
im
ivuui.
With warm regards.
Anshu K G'.mta
rvP. PEOPLE WHO ARE <-ETTIH5 MY MAIL FOP. THE FIRST TIME:
A brief introduction : GuuNJ.. a strong force of over 300 volunteers is
working on a very basic concept that out of the three basic needs of mankind i.e
Koti, Kapra & MaKan (Food, Clothes ana Shelter), we can solve the problem of
z*'!n+*ki>-sri 4-r>
r> vam
£>\/4'ov>4iiir+
kxr 4-k^
riiv»nl«5
<-r\r*z.or\4* wi i v.wy vni ly mi ixj ■ v.
vivviiiiiy
vw v«
<w» j lorna
iMiyv. x-nvwi
iv jmm
>. wjr
vi iv. wii
i ifstw wnvvpv.
using.
In the iast five Axears of its existence GOONJ. has achieved this target to some
extent, in the last tew months itself we have been able to send thousands of
4.^
d;i _
VIMMIVJf VIVK.I IOII^>, VVWIVIIJ, IWUYYVQI 1.W VW VQI IVUJ ^7QI VO VI VI !□□«, WIIIQI QI IV4 YYVJ
Bengal.
Apart from thousands of people, among the contributors to this movement are
Maruti Udyog Ltd., American Express, Delta securities, Gillette, HSS, Xansa &
Intersoiutions, who organised camps in their premises involving employees to
come forward and donate. Our regular collection camps in residential areas are
also doing very well with the continuing support of volunteers.
In our nationwide movement VASTRA-DAAfM, we are not asking for much 4...U.
juju yuui
«|J
yvwiuiij/
__ n/kl-^Uu-n/
.-k^n
y*-i i\-i gi uiuuiiuj/jiivuj/uiaiiauuj/ uuw 01 iv.v.is, MCioivany
anything you don't use anymore,, and if possible just 97 paisa with each cloth.
This money takes care of expense on collection, sorting, packing anw
transportation to the remotest part of the country.
;M I—~
rnr\Mi
*.k^.
uciicvc uaf in icoo vnon a iupccz uvviv>. van icavii a muuiz anyvvncic in uic
country., solving atleast one basic need of someone and giving him an
Opportunity tu icailuCatc uiS iTicagci' i'cSOui'CcS to i'l'iuic impuitai'it tuinyS like food
and health.
ricaSc COi'itii'iuc vvitl’i ail yOlii' yOOu WOi'k. Oui” aim IS to involve mOi'c ai’iu iTiOie
people Corporate houses, officer, residential areas., school and colleges in this
Campaign. AiTyOi'ic WuO Cail Support ii'i any Oi tncSc aicaS picaSc COi'itaCt US.
a?
ne»wl>a ac waii cat?- circulate th!« waii t*?
manw
people as you can. we want io organise a number of camps in various
----- B------------------------- -------------------------------- --- -------- r------- -- ~ ~~r--- ----- ------- ----------------------------------
with inis noie is enclosed, a iisi of coiieciion centers in vein! and NCR,
and Koikata whom ixeu can donate materia!. This wide snread
network has been made possible with the heip of volunteers. We are now trying
rr> lArnrUmif* rQller+inn renl-erc in
Dime
Rannalnre
Chennai and in t-oiai nhher
piaces from where we keep getting regular inquiries.
Dleaee reel n-on rn lAirire nr rail nnrl aclr ac manv mwcHnnc ac A»nn XA/anh nn PmiAi
where and whom etc. But do take out time, we have seen in the iast five years
that ever, an oid cloth has a ^oten^’a! to save ^omeone's life on the roads in the
far-fiung areas..
With wsrm regards
Director
TeL- 011-26972351, 98681-46978
E-maii- anshu_goonj<ipindiatimes.com, anshu@goonj.org,
You can aiso contact- Rahui at- rahui_goonj@indiatimes.com,
ruchika goonj@indiatimes.com or Mini Dwivedi at minid@indiatimes.com
Our sincere thanks to Actionaid India, Sir Dorabji Trust and NFI
baliAvinn in our efforts and supporting us ..
VASTRA-DAAN
WHAT ALL CAN YOU DONATE^
-•~s r»TMP«- woolens' Sarees' Salwar Suits' Kurta' Pyjamas/Trousers/Shirts,'
children clothes/' Bedsheets/ Blankets, Old / New but in wearable condition.
FOOTW EA El
uieNsjlLS - uia/ New- nans, Piates, Bowis, Glasses, i awa, Spoons & Ladies,
Cooksrz Cups/Toncjs stc
stationary- Pen, pencil, sharpner, eraser, scale, Oid/new school bags, lunch
k»r\\zior> uinPor kvrsH-l or*
PAPER- News paper, magazines, one side used paper
For Communication/ Collection ramps/ storage/ sorting/ packing / travel
/Ti diispurlaiiuii, local distribution expenses. Cash donations can be made at the
collection centers or you can send an account payee Cheque/ Draft in the name
rT\CM\ It _ K i
«•?&.. I /?!- - - R>_. r*S~n-! A dr
OL J“boz Oflliva VIIICJI f INCW MCIIII”TT
( All donations to GOONJ.. are tax exempted u/s 80 G of IT act.)
Ul
TIME DONATIONS
WE ALSO NEED VOLUNTEERS, who can spare a few hours to be with us for door
to door carnpainns and who can heln us in sortinn. nackjnn etc.
SPACE DONATIONS
We need many more collection centers to ensure easy accessibility for everyone
who wishes to make a donation. So if you can spare a corner in your
house/office piease inform us, aiso check with your friends/reiatives if they
would allow the use of a small place in their premises as collection center
COLLECTION CENTRES
•
Please make sure to cal! im to check the availability of the
voiunieer and for directions to avoid any inconvenience,.
E^ELHZ
•
Aiaknanda
AAE
»,*■.»•«
.—A1 Ww'f
IUIIIMIIU A♦*,€-,-*+■
S.I I 1^1 l\.f TeJ
IVI. ... 'TtCTHTC/iXZ
£_Wfc_
l\Jf V-WI IV IXUJVJI I »VMI
1
a
C,R,P«r?<
~. ■’oro r' r»
t->
"'r/ic’-?"?/-?
w*- iuvv,l..i\. raiix f ici.“ ^.vnrv//nr/ \^vuv.“ no. w>unccpa
*
Dwarka
8-702, ri'ayjyOtiihpui' appt., Scvtui'-lO, Plut-7, Dvvarka, Tc!.- 50111*74024
Cont.- Ms. R-hinushrhita
•
janakpori;
A-2-A'244 Tel: 25529244 25535435 Cont.- Ms.Lvnda
,
Karoi Baqn:
gfi/57 wpa Tsi; 25723892 25746993 Cont.- Mrs.Sushma Kumar
.
Khan Market:
»
Mayor Vihar-
103, SaiTiaCnai' appafuTicrit, Tci.* 22713460 Cunt. kcSnaV CnatuiVcui
.
Patr-amsn'i:
C-501,UNESCO Appt,,I.r. exin. Tei; 22431308, Coni.- Mr .-Rajcev Sathueva
•
Paschsrt? Yihar:
Fiat No.-262, GH-9, behind Sunder vihar, Tei.- 25282682, 98112-95790
Co nt.* FvIini Dwivcdi
»
Kohini:
22-B,Dhruv Appt., Sec-13, Tel: 27552754, Cont.-Mrs/Mr. Pankaj Mehta
Saket
C 7Qr Sakct Cont.' S.S. Vonkat On 981SZIO21S6 / Gautam Shanba^h on
9818402187
50 RPS Flats, Shekh Sarai phase- T Tel.- 26017477,. Conf.- Reena Mohan
South Exin-;
Standard Chartered Rank, M-1, South Extn. Part-II, N.D.Te!: 26252671/
26252674
b-6/34/2,DDA Fiats, New Delhi, Tei.- 2610/260, Cont.- Mr.Sunii Kao,
GOONJ..,J-93,Sarita Vihar.N.D. lei: 26972351, 98681-46978 Cont. -Anshu K.
Vasa nt Kuni:
Chopra
Vikas Pui"
Promise Appt. F-114, Near Oxford School, N.D. lei: 20067174,
Cont.- Pooja/ Ruchika
FARIDABAD
1. H.No.939, Sec-2i-C, lei: 95129-5425261, Cont.-Dr.P.L.irakroo
OQSP1-4KO7S
Cont.- Anshu K.Gupta /' Meenakshi,
12/5,Basement No-I, Opp. Charmwood Plaza, Tel.- 95129-2253268
Cont.- Mr. Manoj Kohli
(1)- Flat No.-201, block-B, Rail vihar, Sector-15/2 Tel.- 95124-2307850
cont.- Mr. S.D. Gupta
i iwusc no. 315^ Housing Cosrcl colony, SoraSvVsti vihsr, cnskksrpur^ Gur^non
Tel.- 98182-41421, cont.- Rahul Vashishtha
nviiz»C
C-1, Ser-15, Tel: 95120-2511552. Cont.-Ms. Upasna Pandey
mlimSAI-f Caii up Mi'. Gyaiiesliwai' Kauga oii 26324312, only on evuiy
1st a Sra Saturday between 11am & 3 pm )
Add- c/o Mr. Priyavrat Goenka, brighton units 5 # 9, Lokhandwaia complex,
Andheri ( west Mumbai- 53
KOLKATA5 /g
Alinore Park road Ko!kata-27 Contact- Mr. Rajsev Goenka
Tei.- 24791887 ( K ), 2449753 ( 0 )
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- 2 ■
Parti
Introduction
1
Scaling-up the developmental impact of NGOs:
concepts and experiences
Michael Edwards and David Hulme
Introduction
There are now some 4,000 development non-govemmental organisations (NGOs)
in OECD member countries alone (OECD 1989), dispersing almost three billion
US dollars' worth of assistance every year (Clark 1991, p.47). They work with
around 10,000 to 20,000 ‘Southern’ NGOs who assist up to 100 million people
(ibid p.51). Yet despite the increasing scale of this sector, and the growing
reputation that NGOs have won for themselves and for their work over the last ten
years, their contribution to development on a global level remains limited. Many
small-scale successes have been secured, but the systems and structures which
determine the distribution of power and resources within and between societies
remain largely unchanged. As a result, the impact of NGOs on the lives of poor
people is highly localised, and often transitory. In contrast to NGO programmes,
which tend to be good but limited in scope, governmental development efforts are
often large in scale but limited in their impact. Effective development work on a
sustainable and significant scale is a goal which has eluded both governments and
NGOs.
One of the most important factors underlying this situation is the failure of NGOs
to make the right linkages between their work at micro-level and the wider systems
and structures of which they form a small part. For example, village co-operatives
are undermined by deficiencies in national agricultural extension and marketing
systems; ‘social-action groups’ can be overwhelmed by more powerful political
interests within the state or local economic elites: successful experiments in
primary health care cannot be replicated because government structures lack the
ability or willingness to adopt new ideas: effective NGO projects (and not all are)
remain ‘islands of success’ in an all-too-hostile ocean. ‘If you see a baby drowning
you jump in to save it; and if you see a second and a third, you do the same. Soon
you are so busy saving drowning babies that you never look up to see that there is
someone there throwing these babies in the river’ (Ellwood, quoted in Korten
1990a). Or, as an Indian development worker once asked us in Rajasthan, ‘Why
help trees to grow if the forest is going to be consumed by fire?’ In other words.
14 Making a difference: NCOs and development
small-scale NGO projects by themselves will never be enough to secure lasting
improvements in the lives of poor people. Yet what else can NGOs do, and how can
they increase their developmental impact without losing their traditional flexibility,
value-base and effectiveness at the local level? Resolving this dilemma is the
central question facing NGOs of all kinds as they move towards a new millennium.
Of course, an emphasis on quality in NGO work is never misplaced. Good
development work is not insignificant just because it is limited in scale, and some
might disagree with Clark’s statement (in this volume) that ‘maximising impact is
the paramount objective of NGOs.’ As Alan Fowler (1990. p.l 1) rightly points out,
the roots of NGO comparative advantage lie in the quality of relationships they can
create, not in the size of resources they can command. Some NGOs appear to have
lost sight of this fact in a headlong rush for growth, influence and status, forgetting
that ’voluntarism and values are their most precious asset’ (Brown and Korten
1989). Simple, human concern for other people as individuals and in very practical
ways is one of the hallmarks of NGO work. There is a danger that these qualities
will go ‘out of fashion’ because of mounting concerns for strategy and impact, but
in so doing the voluntary sector will lose its most important defining characteristic.
Nevertheless, all serious NGOs want to increase their impact and effectiveness.
ensure that they spend their limited resources in the best way possible, and thereby
maximise their own particular contribution to the development of people around the
world. The question is. how are these goals to be achieved? We believe that there
are many possible answers, but none which ignore the importance of macro-level
influences in determining the success of people's development efforts at grassroots
level. We find it inconceivable that NGOs will achieve their objectives in isolation
from the national and international political process and its constituent parts. It is
this interaction, this search for greater impact, that forms the central theme of this
book. Although many contributors use the term ‘scaling-up’ to describe the goal of
‘increasing impact’, it should be noted at the outset that this does not imply
expanding the size of NGO operations. There are many different ways in which
impact can be achieved, and the contributions to this book have been chosen
deliberately to reflect the wide diversity of approaches chosen by different NGOs at
different stages in their development. There is no attempt to identify the ‘best’
strategy for achieving greater impact, still less to impose a consensus where none
exists.
The term ‘NGO’ also embraces a huge diversity of institutions, though the
chapters in this volume are consistent in differentiating between: international
NGOs such as Save the Children and Christian Aid (commonly referred to as
Northern NGOs or NNGOs); ‘intermediary’ NGOs in the South (SNGOs) who
support grassroots work through funding, technical advice and advocacy: grassroots
movements of various kinds (grassroots organisations or GROs, and community
based organisations or CBOs) which are controlled by their own members; and
networks and federations composed of any or all of the above. Clearly, each of
these ‘NGOs’ plays a distinctive role in development and faces a different range of
choices and strategies when considering the question of impact. Added to this is the
obvious importance of context in determining which strategies are chosen and how
effective they are in practice, and the observation (made with particular force in
Ireland and Klinmahorm’s paper in this volume) that ‘scaling-up’ is often a
spontaneous process rather than the result of a pre-planned strategy. These
complications make generalisation difficult and dangerous.
Introduction
15
Nonetheless, a conceptual framework is needed if any sense is to be made of
such a wide range of case studies. There are at least five models of scaling-up we
have considered in writing this introduction. The first comes from Clark (1991),
who differentiates between ‘project replication', ‘building grassroots movements’,
and ‘influencing policy reform’. These distinctions are echoed by Howes and Sattar
(in this volume), who separate organisational or programme growth (the ‘additive’
strategy) from achieving impact via transfers to, or catalysing other organisations
(the ‘muliplicative’ strategy). Mitlin and Satterthwaite (also in this volume)
comment that successful NGOs concentrate on ‘pulling in’ resources rather than
expanding the scale of their own service provision, while Robert Myers (1992:379)
makes the opposing case, defining scaling-up as ‘reaching as many people as
possible with services or programmes.’ This is a limiting definition, but Myers goes
on to make a useful distinction between ‘expansion, explosion and association’.
‘Explosive’ strategies begin with NGO operations on a large scale and adapt
programmes to local circumstances afterwards. In contrast, ‘associationaT
strategies ‘achieve scale by piecing together coverage obtained in several district
(and not necessarily coordinated) projects and programmes, each responding to the
needs of a distinct part of the total population served’ (Myers 1992. p.380). In
Myers’s model the most obvious form of scaling-up is direct programme
expansion. Robert Chambers (this volume) adds a further important dimension to
the debate by highlighting what he calls ‘self-spreading and self-improving
strategies’ - ‘to develop, spread and improve new approaches and methods’.
gradually extending good practice through NGO and government bureacuracies
until their entire approach is transformed, and rejuvenating the NGO sector by
stimulating the formation of new, independent NGOs.
From all this, and on the basis of the experience recounted in the chapters that
follow, it seems to us that the most important distinction to be made lies between
additive strategies, which imply an increase in the size of the programme or
organisation; multiplicative strategies, which do not imply growth but achieve
impact through deliberate influence, networking, policy and legal reform, or
training; and diffusive strategies, where spread is informal and spontaneous. These
distinctions are important because each group of strategies has different costs and
benefits, strengths and weaknesses, and implications for the NGO concerned.
Different strategies may be more, or less, effective according to circumstance, and
it may not be possible to combine elements of each one in the same organisation.
We make some preliminary observations about these trade-offs in the conclusion to
this volume. The value of a strong conceptual framework is that it can clarify the
strategic choices available to different NGOs and help them to make the decisions
appropriate for the specific realities they face.
For the sake of clarity, we have divided this introduction and the rest of the book
into four sections, each representing a particular approach to scaling-up. Three of
these approaches fall into the ‘multiplicative’ and ‘diffusive’ categories: working
with government, linking the grassroots with lobbying and advocacy, and advocacy
m the North. The fourth strategy - increasing impact by organisational growth falls under the ‘additive’ approach. These categories are not intended to be wholly
self-contained, and indeed as the chapters illustrate there is a good deal of overlap
between them. In particular, when this volume was edited, we found that several
examples combined support for local-level initiative with lobbying at the national
level (see the chapters by Constantino-David, Dawson, Hall, and Mitlin and
16 Making a difference: NCOs and development
Satterthwaite) so that Section IV covers both of these approaches and looks at their
linkages. Nonetheless, a structure is needed to order the debate and to ensure a
degree of clarity in the discussion.
Working with government
Traditionally, most NGOs have been suspicious of governments, their relationships
varying between benign neglect and outright hostility. Governments often share a
similarly suspicious view of NGOs, national and international, and their
relationship, at least in Africa, has been likened to cat and mouse (Bratton
1990). It is not hard to see why this should be the case. Government structures are
often rigid, hierarchical and autocratic. Power and control rest at the topmost level
where programmes are designed and resources allocated. All governments are
encumbered with authoritarian relationships with their citizens, for they are
collectors of taxes, enforcers of the peace, and protectors of the social order
(Copestake 1990). They have a natural tendency to centralisation, bureaucracy and
control, NGOs, on the other hand, are (or should be?) distinguished by their
flexibility, willingness to innovate, and emphasis on the non-hierarchical values
and relationships required to promote true partnership and participation.
Nonetheless, there are sound reasons for NGOs to enter into a positive and
creative relationship with the institutions of both state and government.
Governments remain largely responsible for providing the health, education,
agricultural and other services on which people rely, though this is changing under
the impact of the ‘new conditionality' and its attempts to expand the role of the
private sector at governments’ expense. The state remains the ultimate arbiter and
determinant of the wider political changes on which sustainable development
depends. Some would argue that only governments can do these things effectively
and equitably - that any attempt, for example, to privatise services is bound to
result in declining access to quality care for the poor. Whether or not this is true, it
remains a fact that (in most countries) government controls the wider frameworks
within which people and their organisations have to operate. While this remains
true, NGOs ignore government structures at their peril. An increasing number of
NGOs have acknowledged this and are working actively to foster change at various
levels. International NGOs tend to restrict themselves to the institutions of
government, working within ministries to promote changes in policy and practice.
National NGOs, on the other hand, can take a more active role in the political
process and the wider institutions of the state. Usually, this takes the form of
subjecting these institutions to various forms of external pressure and protest, as in
the case of social action groups in India lobbying the local Forest Department or
Block Development Officer (a strategy covered under ‘linking the grassroots with
lobbying and advocacy’ below).
A more direct approach is to work within the structures of government in an
explicit attempt to foster more appropriate and effective policies and practices.
which will eventually be of benefit to poorer and less powerful people as they filter
through into action by civil servants 'lower down’ the system. The aim here is to
ensure that governments adopt policies which are genuinely developmental at
national level - policies which will ultimately enable poor people to achieve greater
control over their lives in health, education, production and so on. NGOs have
attempted to do this via direct funding, high-level policy advice, 'technical
Introduction
17
assistance’, the provision of ‘volunteer’ workers, or (usually) a mixture of these
things. Many NGOs provide government with a ‘package’ of inputs which includes
material support as well as people and ideas. It is important to remember that these
strategies are not an attempt to ‘replace’ the state, but rather to influence the
direction of government policy or support existing policies. ‘NGOs cannot seek to
replace the state, for they have no legitimacy, authority or sovereignty, and,
crucially, are self-selected and thus not accountable’ (Palmer and Rossiter 1990).
Although the case studies in this section of the book cover a wide range of
approaches and contexts, their conclusions are strikingly similar. First, when the
decision is taken to work within government, the constraints and difficulties of the
government system have to be accepted as a starting point. Unlike in NGO
programmes, good staff cannot be handpicked and supported with high salaries or
generous benefits; systems and structures cannot be changed at will and resources
are always in short supply. Motivation is often lacking because salaries are low and
conditions poor. Public services are suspicious of change and often officers at lower
levels in the hierarchy have been actively discouraged to experiment, innovate or
take initiative. Inevitably, progress, if it is achieved, will be slow, and agencies
must commit themselves to partnership for long periods of time. The chances of
succeeding in this approach are increased if NGOs agree to work within the
government system, right from the start. This increases the likelihood of sustainable
reforms and enables the NGO to understand and deal with the constraints faced by
the official system.
Second, personalities and relationships between individuals are a vital element in
successful govemment-NGO partnerships. If these relationships do not exist, no
amount of money or advice will make a difference. In addition, conflicting interests
and agendas within government ministries may make dialogue and consensus
impossible, undermining the efficacy of even the strongest NGO inputs. The whole
notion of ‘counterpart training’ needs to be closely examined to ensure that NGO
expatriate inputs really do have a lasting impact when faced with such a range of
constraints. Even when good relationships do exist, this is no guarantee of success.
This is partly because individuals are moved around the government system with
alarming regularity (making influence through individual training and advice
difficult to achieve), and partly because there is often a barrier between the ‘pilot
project’ stage of co-operation (which is heavily dependent on a small number of
likeminded officials) and the acceptance and diffusion of new approaches
throughout the government hierarchy. The case of special education in Bangkok
related in this volume by Ireland and Klinmahorm provides a graphic illustration of
this problem. VSO has also had some success in making this transition by using
what Mackie (in this volume) calls ‘the planned multiplication of micro-level
inputs' - the slow and careful evolution of different forms of support which are
small in themselves but significant in the aggregate. Such approaches appear most
likely to make an impact in smaller countries where NGOs have better access to
key decision-makers. John Parry-Williams’s account (in this volume) of legal
reform in Uganda provides just such a case.
Third, NGOs are generally ‘small players’ when it comes to influencing
governments, as compared to bilateral and multilateral donors such as the World
ank. It is these much larger agencies that tend to determine the ideological context
in which policies are formed, a classic case in point being the ‘new conditionality’
0 good governance and free markets which NGOs have thus far largely failed to
18 Making a difference: NGOs and development
influence (Edwards 1991). In addition, in a situation where donor funds abound and
government needs are acute, NGOs which insist on detailed assessment of
programmes and on long-term, low-input strategies may be labelled as 'unhelpful'
and 'obstructive', a case in point being SCF's work at provincial level in
Mozambique (Thomas 1992). There are many official donors (and NGOs?) who
are willing to commit large-scale resources for immediate consumption or illthought-out interventions, with little acknowledgement of the longer-term implica
tions of their actions. The impossible recurrent cost burdens imposed by vertical
programmes in basic services are a good example of this problem.1
Certainly, greater success may be achieved if NGOs allow governments to take
credit for progress in programme and policy development, regardless of their own
influence in these areas (for an example of reforms in Primary Health Care in
Indonesia see Morley et al 1983, p. 13). Something similar may be happening in the
much-vaunted District Development Programme supported by Britain's Overseas
Development Administration (ODA) in Zambia (Goldman et al 1988). There is also
evidence that concentration at central ministry level, and coalitions of NGOs re
inforcing each-other's influence, can help to combat the impact of the larger donors
(Edwards. 1989).
The relative influence of NGOs and official agencies on Southern governments is
a useful reminder that this strategy needs to be approached with care. The decision
to work with (but not for) government must be based on an assessment of the
‘reformability’ of the structures under consideration, the relationship between
government and its citizens, the level at which influence can be exerted most
effectively, and (for international NGOs), the strength of the local voluntary sector.
NGOs must also calculate the costs and benefits of this strategy in relation to
others. For example, it may be difficult to operate simultaneously as a conduit for
government and an agent of social mobilisation, or to work both within government
and as an advocate for fundamental change in social and political structures. There
are also dangers in identifying too closely with governments, which may be
overthrown or voted out (as in the case of well-known health activists in
Bangladesh). Nonetheless, even under the most authoritarian governments there are
often opportunities for progressive change. For example, the Ministry of Health in
Pinochet’s Chile developed a strong policy on breastmilk substitutes with help from
NGOs. The example quoted by Clark (in this volume) of an OXFAM programme
which worked alongside rigid government structures in Malawi is also instructive.
There are certainly enough examples of NGO impact on government policy and
practice to give hope for the future, so long as the conditions for influence are right.
The direct approach: increasing impact by organisational growth
For many NGOs the obvious strategy for increasing impact is to expand projects or
programmes that are judged to be successful. Over the 1980s this approach has
been pursued in the South, where it has led to the evolution of a set of big NGOs in
Asia (see the chapters by Howes and Sattar and by Kiriwandeniya in this volume
for discussions of two such cases), and in the North where many NGOs have
dramatically expanded their operational budgets and staffing. Expansion can take
SCF is currently carrying out a major research programme on the 'Sustainability of HealthSector Development' to address these issues. Contact Anne LaFond at SCF for details.
Introduction
19
several forms. It may be geographical (moving into new areas or countries); by
horizontalfunction (adding additional sectoral activities to existing programmes, eg
adding a housing component to an income-generating programme); by vertical
function (adding ‘upstream’ or ‘downstream’ activities to existing programmes, eg
adding an agricultural processing project to an agricultural production scheme); or,
by a combination of these forms.
Apart from the strong common-sense appeal there is a logic in supporting direct
operational expansion. At its foundation is the argument that any agency capable of
alleviating poverty has a moral obligation to help as many poor people as it can.
Added to this are the claims that, in a resource-scarce situation, NGOs can use
existing resources more efficiently than other agencies (but, Robinson, in this
volume, disputes this claim) and can mobilise additional resources. Successful past
experience means that NGOs have already ‘learned’ what to do, so that they can
tackle development problems with comparatively short ‘start-up’ times. For the
NGO itself large-scale operational successes enhance credibility for other scalingup strategies (eg lobbying domestic governments or international agencies is more
effective for organisations that demonstrate a considerable operational capacity in
the field). Finally, one can draw upon institutional theories arguing that
organisational pluralism in service delivery creates choice and efficiency that
makes poverty-alleviation more probable (Leonard 1982).
Those who espouse the direct expansion approach recognise that difficulties will
be encountered, particularly in terms of how to manage organisational change (see
the chapters by Hodson and by Billis and MacKeith for a detailed discussion of
issues). The characteristics that are presumed to explain NGOs' comparative
advantage in local-level poverty-alleviation - the quality of relationships with
beneficiaries, their flexible and experimental stance and their small size (Fowler
1988; Tendler 1987) - all require modification or compromise as expansion occurs.
If we conceptualise the internal features of an organisation in terms of its systems
or procedures, its structure and its culture (values and norms), then we can identify
the nature of these problems. Commonly, expanding NGOs assume that the systems
or procedures developed in a locally ‘successful’ project or programme can be used
on a wider scale, providing that internal structures are suitably modified. These
modifications usually require: i the extension of the hierarchy that separates those
who manage the organisation from those who manage field operations; ii increased
functional specialisation between parts of the organisation, and; Hi increased
capacity to raise resources, both material and human. The need to raise significant
additional finance almost invariably requires ‘Southern’ (and often ‘Northern’)
NGOs to take grants from official aid agencies. This fosters upward accountability
1990^
t0 NGO5 being increasingly ‘... driven by the procedures ...’ (Fowler
The impact of these changes on organisational culture can be dramatic, as Billis
MacKeith (in this volume) demonstrate. There is a shift from a task-orientation
o a role-orientation; control from ‘higher up’ the hierarchy grows in significance;
p. Professionalism subordinates commitment and ‘mission’-related values. As
>c ter (1989:2) warns, many NGOs encounter severe problems as they expand
cause they retain ‘... cultural predispositions to non-hierarchical structures and
e often anti-management ’. The NGOs that seem best able to avoid partial
ysts during such transitions are those directed by charismatic, and often
autocratic, founder-leaders.
20 Making a difference: NGOs and development
As expansion occurs, these changes in culture, structure and accountability may
accumulate to change the organisation from a voluntary organisation (based upon
the pursuit of a developmental mission) trying to shape events, to a public service
contractor oriented towards servicing needs as defined by donors and national
governments. Korten (1990) has provided examples of NGOs foundering with
expansion and, in particular, has charted the evolution of the International Planned
Parenthood Foundation (IPPF) from a path-breaking crusader on a forbidden topic
to
an expensive and lethargic international bureaucracy
(ibid: 126).
For observers who adopt a more explicitly political form of analysis then the co
optation of expansionist NGOs by the status quo (both domestic and international)
is not simply the result of changes in organisational characteristics. Rather, it is an
outcome that is consciously sought by those who hold power as they respond to the
growing popularity of NGOs. At the level of local and national power structures it
can be argued that a strategy of service delivery expansion permits the alleviation
of the symptoms of poverty without challenging the causes. From this radical
perspective, NGOs are seen as eroding the power of progressive political
formations by preaching change without a clear analysis of how that change is to
be achieved; by encouraging income-generating projects that favour the
advancement of a few poor individuals but not ‘the poor’ as a class; and by
competing with political groups for. personal and popular action.
A focus on international relations yields a different but equally distressing
scenario. NGO expansion is seen as complementing the counter-revolution in
development theory (Toye 1987) that underpins the policies of liberalisation, state
withdrawal and structural adjustment favoured by official donors. NGOs are
viewed as the ‘private non-profit’ sector, the performance of which advances the
‘public-bad, private-good’ ideology of the new orthodoxy.
It is no surprise to such radical commentators that strategies of operational
expansion emasculate NGO attempts to serve as catalysts and advocates for the
poor and lead to a focus on delivering health care, credit, family planning and
housing while issues such as land reform, access to public services, civic and
human rights, the judicial system and economic exploitation lose significance.
Given the strength of these counter-arguments in some contexts, the strategic
decision to scale-up by additive mechanisms should never be seen as incontestable
‘common sense’. At the very least, NGOs that are considering operational
expansion need to plan for the stresses of organisational restructuring and cultural
change; examine how dependent they will become financially on official donors
and consider the consequences of this for accountability; study the trade-offs and
complementarities with other strategies for enhancing impact; and analyse the
implications of such a choice for the poor majority who are not beneficiaries of
their projects or programmes.
Advocacy in the North
Rather than working directly within the stmctures they intend to influence, NGOs
may choose to increase their impact by lobbying government and other structures
from the outside. This is a time-honoured activity for NGOs around the world.
particularly for Northern NGOs. some of whom focus exclusively on advocacy and
have no ‘practice base’ overseas. The rationale for this approach is simple: many of
the causes of under-development lie in the political and economic structures of an
Introduction 21
unequal world - in trade, commodity prices, debt and macro-economic policy; in
the distribution of land and other productive assets among different social groups;
and in the misguided policies of governments and the multilateral institutions (such
as the World Bank and IMF) which they control. It is extremely difficult, if not
impossible, to address these issues in the context of the traditional NGO project.
Other forms of action are necessary, particularly on the international level where
the biggest decisions are made.
However, success at this level has proved elusive. There are, for sure, some signs
of impact, and Clark (in this volume) provides examples such as the international
baby milk campaign, increasing environmental awareness, and better systems for
food aid. to illustrate how effective and sophisticated NGO advocacy has become.
One commentator goes so far as to claim that ‘non-governmental groups managed
by half a dozen professionals have shown that they can change the course of
decision-making about a country they may never have seen’ (Jha 1989). Nonhem
NGOs have made some progress on the debt issue (playing a major part in lobbying
for successive improvements in the terms on offer for debt-relief); on 'structural
adjustment’ (though here the influence of another multilateral agency - UNICEF was more important than that of the NGOs); on international refugee issues (with
NGO consortia persuading international agencies to adopt improved food regimes
for refugees): and in primary health care (Save the Children Fund-UK in particular
being a constant thorn in the flesh of UNICEF and WHO on the issue of
sustainability in health-sector development).
NGO strategies in this field range from direct lobbying of key individuals within
bilateral and multilateral agencies, through staff exchanges and working together in
the field, to publications, conferences and participation in joint committees (such as
the World Bank-NGO Committee). One of the most controversial issues here is the
choice all NGOs must make between ‘constructive dialogue’ (the incrementalist or
reformist approach) and ‘shouting from the sidelines' (the abolitionist approach).
Opinion differs widely among NGOs as to the usefulness of these opposing
approaches, the choice resting on the degree to which the NGO concerned feels its
‘target agency’ is reformable over time. This debate has been fuelled by the
increasing profile given to NGOs by neo-liberal thinking on ‘governance and
democratisation’. Most NGOs see their relationship with bilateral and multilateral
agencies as a dialogue on policy, but the donors themselves are increasingly
enthusiastic about NGOs as implgmenters of projects. This is true of both Northern
and Southern NGOs. and indeed, some NGOs are perfectly happy with this trend. It
gives them vastly-increased resources and enables them to ‘scale-up’ their work
directly as never before (see Part III of this volume, on organisational growth). The
international NGO community is deeply divided over this issue. ‘NGOs have
generally been used for the ends of the borrowing governments or the (World)
Bank, and not as partner institutions with their own unique development purposes’
(Salmen and Eaves 1989). The same internal World Bank report states that only 11
Per cent of NGOs with whom the Bank co-operated in 1988-89 were used in the
esign phase of projects (Salmen and Eaves 1989). If this remains the case it is
ifficuit to see how NGOs will be able to take advantage of the wider windows for
*J’te,pational advocacy which Clark claims are opening up to them in the wake of
e new conditionality’, environmentalism, the end of the Cold War. and the
increasing scale of NGO operations (Clark, this volume).
1 is probably true to say hat. while NGOs have succeeded in influencing official
22
Making a difference: NGOs and development
donor agencies on individual projects (such as the Narmada Dam in India and the
Polnoreste Project in Brazil), and even on some programme themes (such as
participation and the environment), they have failed to bring about more
fundamental changes in attitudes and ideology, on which all else depends. Nagle
and Ghose (1990) make the telling comment that, while operational guidelines on
participation in project design will be useful to World Bank staff, many do not
actually see the connection between ‘participation’ and ‘development’ that NGOs
take as axiomatic. They do not, in other words, see why people should be placed at
the centre of the planning process. Clark’s optimistic assessment of the future of
NGO advocacy in this volume needs to be tempered by an acknowledgement of the
limited gains made thus far. Lobbying, alongside the other strategies examined in
this book, has to be carefully planned and evaluated to establish what really works,
and why. The importance of advocacy cannot simply be taken for granted. It is
worth reminding ourselves that decades of NGO lobbying have not dented the
structure of the world economy and the ideology of its ruling institutions, nor has it
brought about the alternative vision of development that most NGOs ascribe to,
albeit poorly articulated in practical terms. Indeed, one of the criticisms often made
to NGOs by official donor agencies is that insufficient work has gone into
developing workable alternatives to the policies NGOs oppose: alternatives which
will guarantee rising living standards without the social and environmental costs
imposed by current systems.
NGO contact with the wider structures they seek to influence is often too limited
to effect any real change. By definition, NGOs are peripheral to the systems they
are trying to change, and lack the leverage necessary to maintain their influence
when there are other, more powerful interests at work (World Bank 1991).
Although NGO lobbying networks do exist (organised, for example, around debt
and environmental issues), they have yet to make a concerted effort to work
together on a common agenda, a weakness highlighted by Chris Dolan in his
contribution to this volume. In contrast to Clark, Dolan is sceptical of the future of
NGO lobbying, arguing that, at least in the United Kingdom, development NGOs
lack the shared vision and commitment to working together on a joint agenda which
might make success more likely. They also have to deal with a more restrictive
legal framework which makes ‘political activities’ a sensitive area.
In addition, the sheer size and complexity of international institutions is often
overwhelming, even to large NGOs such as OXFAM and Save the Children Fund.
Many NGOs do not understand the way in which multilateral agencies operate,
though the specialist advocacy groups have developed a good knowledge of their
targets. Even if the agency’s structure and procedures are known, these
organisations remain hierarchical, technocratic and often unwilling to listen.
Multilateral and bilateral donors have been keen to set up internal ‘NGO liaison
units’ in recent years, but it remains to be seen whether these are to facilitate
communication or merely keep NGOs away from the departments that take
significant decisions. The fundamental requirement for successful influencing is a
degree of openness on the part of the organisation that is being lobbied; if this is not
present, no amount of information or experience-sharing will induce changes in the
system.
Many NGOs maintain that a practice base overseas is essential for successful
influencing. There are organisations (such as the World Development Movement)
in the UK which have no involvement in development practice, but they are not
Introduction 23
registered as charities; there are also charities outside the UK (such as Bread for the
World in the USA) which are purely advocacy-based. For the majority of British
development charities, however, there is no escaping the linkage between practical
experience and influencing, for it is their practice base which generates the themes
and the evidence (and therefore the legitimacy) for their related, but subsidiary,
information and educational work. In his presentation to the Manchester workshop
on scaling-up. Ahmed Sa’di of the Galilee Society for Health Research and
Services made a powerful plea that NGOs put much more effort into research and
information work based on grassroots views and experiences, in order to counter
the ‘knowledge produced by the official institutions which reflects the interests of
the powerful’ (Sa'di 1992). John Clark (in this volume) takes this one step further
by admonishing NGOs for their failure to capitalise on their knowledge of
grassroots realities in their dialogue with governments and donor agencies. As the
role of Northern NGOs changes in response to the growing strength and range of
Southern development institutions, they will have to develop new attitudes, skills
and partnerships as they move from ’operational’ work overseas to international
advocacy in support of local NGO efforts - from ‘projects' to ’information’, as
Clark puts it. How many NGOs recognise the need for such a transition, let alone
being equipped to manage it successfully?
A consistent theme in the chapters that follow is the need for much stronger links
between development efforts at micro-level, and NGO advocacy at meso- and
macro-levels. Only when these activities are mutually supportive can lasting
change occur. For example, the success of the Voluntary Health Association of
India in influencing government policy comes only partly from its sophisticated use
of the Indian media and parliamentary process, but also because it maintains very
strong links with thousands of voluntary health workers and organisations around
the country. In this way. advocacy is anchored in real experience and the messages
transmitted to government have a power and legitimacy which is difficult to ignore.
NGO agendas for advocacy must grow out of grassroots experience if they are to
claim to ‘speak for the poor.’ Similar themes are raised in this volume by Dawson
and Hall, who show how progress in particular cases was achieved in Peru and
Brazil respectively through a combination of pressure ‘from above’ (national and
international advocacy) and ‘from below’ (strengthening grassroots organisation
and concrete initiatives), acting towards the same goal. In this analysis.
development at local level and advocacy at other levels form complementary
components of the same overall strategy. The key question (to which we return in
°ur Conclusion) then becomes how to strengthen these complementarities so that
action at each level informs and supports the other. Few agencies have achieved
this, either in their own work or in the partnerships they have formed with other
organisations working for the same objectives.
If it is true that advocacy will become a more important strategy for NGOs in the
•ore, then legitimising this activity in the eyes of governments, official donor
agencies and the general public (whose financial and moral support is vital) is
g°>ng to be a vital task in the years ahead. Development education among the
countries of the rich Nonh will play a key role in generating widespread support for
? anging NGO roles, just as official donors will have to see NGOs as valuable,
Rodent actors with something different and positive to offer. Unless this
fa??.ens *S d*®9uit to see how the NGO voice will be heard, let alone acted on.
y undermining the credibility of this approach to achieving greater impact.
24 Making a difference: NCOs and development
Linking the grassroots with lobbying and advocacy
Grassroots organisations (GROs) or community-based organisations (CBOs) that
are managed by members on behalf of members, have been central to the activities
of many NGOs. Such organisations can originate spontaneously from local
initiative but '... while isolated instances of local institutional development can be
impressive their cumulative effect is negligible ... what counts are systems of
networks of organisations, both vertically and horizontally’ (Uphoff 1986:213). As
a consequence of this many Southern and Northern NGOs have recognised and
adopted an intermediary role to accelerate the creation of local organisations
(sometimes referred to as catalysis), to provide assistance in strengthening and
expanding such organisations, and fostering linkages between them. This, it is
believed, will lead to the proliferation of grassroots organisations that can. as a
‘people’s movement’, have a beneficial impact on development policies and wider
political processes.
The main emphasis for NGOs involved in such efforts is usually held to be the
‘process’ involved in supporting local initiative - awareness raising, conscientisation. group formation, leadership, training in management skills - rather than the
‘content’ of the programmes and activities which local organisations pursue. This is
because such a strategy seeks the ‘empowerment’ of people - a much used and
abused term that we take to mean the process of assisting disadvantaged individuals
and groups to gain greater control than they presently have over local and national
decision-making and resources, and of their ability and right to define collective
goals, make decisions and learn from experience. While in its pure form such an
approach would mean that NGOs should not influence GRO activities, many
intermediaries mix catalysis with their other programmes and provide members
with loans and services. Mitlin and Satterthwaite (in this volume) present a number
of examples of such mixes. The relative weightings in such mixes - ie whether
catalysis or service delivery is paramount - are usually very difficult to determine.
Many different ideas underpin strategies of grassroots organisation but all have
in common the notions that disadvantaged individuals need to be stimulated into
taking group action, that groups of the disadvantaged can have a discernible impact
on the local situation, and that the combined efforts of grassroots organisations can
coalesce into movements that have the potential to influence policies and politics at
the national level. The conceptual bases for these ideas range from liberaldemocratic notions of pluralism (for example Esman and Uphoff 1984) to radical
formulations that see grassroots organisations as confronting (sometimes violently)
oppressive social forces. Paulo Freire’s ideas have been particularly influential on
those agencies adopting the radical perspective, arguing the need to ‘conscientise’
the poor as an initial step in the process of identifying and ultimately challenging
the social and political structures that oppress them.
Differences in the conceptual roots which intermediary NGOs recognise, along
with local contextual factors, mean that approaches to supporting local level
initiative vary considerably. Amongst agencies that seek to serve as catalysts for
group formation there is a vast analytical gulf between those who believe that
membership should be open to all in a ‘community’ (ie inclusive) and those who
opt for exclusive organisational forms in which membership is open only to the
disadvantaged. Depending on the ideas that guide an approach, the work of the
promoter (facilitator, change agent, catalyst) may initially focus on the advantages
Introduction 25
of group action and the management of group activities or alternatively,
concentrate upon an analysis of the social and political causes of poverty in a
locality and the need for groups to see themselves as political actors. Group
formation is usually recognised as a slow process (at least in public statements if
not in practice) and one in which non-govemmental intermediaries have a
significant comparative advantage over state intermediaries, because of the quality
of their non-directive, ‘participatory’ interaction with intended beneficiaries.
While a vast number of GROs can be seen as having the potential to achieve
locally beneficial results, intermediary organisations are usually keen to create
linkages between GROs (see Chris Roche's chapter on ACORD). In part this is to
promote more effective local action (through exchanges of knowledge and access
to pooled and external resources). Even more significantly, however, such linkages
are seen as making it possible to take actions that are beyond the capacity of local
associations. Karina Constantino-David (in this volume) examines the highly
sophisticated networking and federating of NGOs that has occurred in the
Philippines in an attempt to challenge national policies and establish new
institutions. Linkages may be horizontal (ie networking between GROs so that they
can exchange information and negotiate collective action) or vertical (ie federating
GROs into a regional or national level organisational structure, in the direction of
which all member organisations have a say and a vote).
From the foregoing arguments a strong case can be made for supporting and
linking grassroots organisations: they ‘empower’, relate knowledge with action, are
sensitive to local contexts, flexible and, when collectivities take collective action.
can tackle regional and national level issues. In addition, and in contrast to other
NGO activities, this approach may permit a degree of downward accountability so
that NGOs which claim to represent the ‘voice of the poor’ may add some
legitimacy to the image they seek to portray.
There is, however, a potential ‘downside’. From a programme management
perspective, there are difficulties in maintaining the interests of poor people in
conscientisation, mobilisation and empowerment when they have pressing short
term needs. Hence, many intermediary NGOs incorporate a ‘service’ element, such
as savings and credit schemes, in their approaches. The case study of BRAC
(Howes and Sattar in this volume) provides an illustration. This helps to maintain
member interest, but it can also be seen as contradicting the logic of empowerment
and group autonomy. In some cases it leads to the beneficiaries of NGO
mobilisation strategies reporting to independent researchers that they are recipients
of service delivery programmes (Hashemi, forthcoming). There is also the practical
problem of ‘who’ does the catalysis. Few NGOs have been able to tap into
volunteers on a significant scale, and so they rely on paid staff. This places them in
a Position, not dissimilar to government mobilisation efforts, of having to maintain
,: commitment of change agents for whom mobilisation is a means to a livelihood.
rrom a political perspective a number of objections can be raised. For some, the
assumptions of pluralism that underpin liberal configurations of mobilisation are
■splaced. Genuine empowerment will generate responses from local and national
es, and the state, that range from intimidation to violence (as in the case of
i and in the mid-1970s when more than 20 organisers of agricultural labourers'
tations were murdered). There is thus an ethical dilemma for NGOs, about
wheth118 Staff and intended beneficiaries to violence, and a practical dilemma as to
er entrenched local and national elites need to be confronted more radically.
26 Making a difference: NCOs and development
For those who adopt a radical view (for Bangladesh this position is examined in
Wood and Palmer-Jones 1991:220-4) then NGO mobilisations are seen as
supporting the status quo. They are ‘diversionary’ in that they take resources
(finance, leadership, popular action) away from political parties and underground
movements dedicated to fundamental political change, and they create false
impressions of pluralism and change.
Have the results of mobilising strategies been as negative as the radical critics
suggest? Much depends on the cases and regions one examines. In terms of the
‘narrow’ goal of providing tangible benefits to members, then Uphoff (1986:208)
provides considerable evidence of success in South and South-East Asia. In terms
of broader political change, claims have been made that networks of local
organisations significantly helped the push for democracy in the Philippines (the
fall of Marcos) and Bangladesh (the fall of Ershad). However, these have only been
weakly substantiated. In Latin America, the evidence of local organisations
working together to promote political change is clearer (Hirschmann 1984) in no
small part because such organisations saw the local and national political arena as a
major focus for their actions. Tony Hall’s study of Itaparica (in this volume)
provides a clear example of the way in which well-supported local initiative has
influenced national and multilateral development policies in Latin America. Elsa
Dawson’s chapter illustrates the complementarities that can be found between
strengthening local level organisations and advocating policy reform. The
involvement of groupings of grassroots organisations in African development
would appear, from the literature available, to be much more limited than in Asia or
Latin America. The reasons for this are complex (Fowler 1991) but clearly a major
factor in many countries has been the desire and ability of the state to control or
eliminate any non-official mobilisation of the populace. Clearly contextual factors
are of great significance in determining the feasibility and results of such
approaches.
Commentators on the future role that NGOs should play in development are
presently highlighting strategies for catalysing and federating local-level
organisations. Clark (1991:102-19) sees such movements as reshaping national
politics, redefining and ultimately ‘democratising development’. Hirschmann
(1984) sees ‘collective action’ as the means by which the economic and political
well-being of the masses is most likely to be attained in Latin America. For Korten
(1990:127) the key to future effectiveness is '... to coalesce and energise self
managing networks over which it [the NGO] has no control whatever' and
*... involve themselves in the broader movement of which they are a pan as social
and political activist’. Developmental NGOs will not only forge linkages between
grassroots organisations, but they will also forge linkages with other movements
that have related missions - peace, environment, women, human rights and
consumer affairs. In this grand vision NGOs become a force for dramatic social
change that restructures class relationships and reforms global economic processes
by non-violent, non-revolutionary means.
Organisation of the book
This introductory chapter is followed by two further background chapters. Mark
Robinson's chapter presents a summary of the Overseas Development Institute’s
research on NGO effectiveness and reviews the implications for scaling-up. It finds
Introduction
27
that NGOs are effective in reaching the poor, but not the poorest, and that their unit
costs are broadly comparable with those of the public sector. The chapter by Robert
Chambers makes the case for diffusive strategies to enhance NGO impact.
The book is then divided into four sections, following the framework outlined in
this chapter. The section on ‘working with government’ includes three case studies
of specific projects (Klinmahorm and Ireland, Jones and Parry-Williams), a study
of Voluntary Service Overseas (Mackie) and a summary of a large-scale research
project into NGO-govemment interaction in agricultural technology development,
drawing on cases from Africa, Asia and Latin America (Bebbington and
Farrington).
Part III examines the strategy of scaling-up by organisational growth or
operational expansion. Two of these chapters describe and analyse the growth of
individual South Asian NGOs (Kiriwandeniya and Howes and Sattar). Although the
Sri Lanka case study is based on a multiplicative strategy it is included in this
section because it illustrates problems that arise when growth is achieved by using
official finance. The two other chapters examine the management problems
encountered by expanding NGOs with particular reference to northern agencies
(Hodson, and Billis and MacKeith).
The next section focuses on ‘strengthening the grassroots’ and linking grassroots
action with lobbying and advocacy, with case studies from Peru (Dawson) and
Brazil (Hall), a review of initiatives in the urban sector (Mitlin and Satterthwaite), a
description and analysis of NGO networking in the Philippines (ConstantinoDavid) and a detailed examination of ACORD’s experiences in supporting local
level initiative in Africa (Roche). Several of these papers illustrate the advantages
of linking local-level institutional strengthening with national-level policy
advocacy.
Part V is comprised of two papers that focus on lobbying and advocacy in the
North. Clark reflects on the lessons of experience gained from many years of
advocacy work targeted at bilateral and multilateral development agencies by
OXFAM, while Dolan draws pessimistic conclusions about the likelihood of British
NGOs achieving the ‘shared vision’ and resource commitment that would permit
them to make their lobbying more effective.
In the concluding chapter we summarise the lessons that can be generated from
the materials that have been presented and identify the key issues that form a basis
for future action and research on enhancing the developmental impact of NGOs.
x ~ ,j?7.
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CROSSCURRENTS
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Calling the Third Sector
Non-governmental organisations have a vital role to play in motivating people to manage
their own resources better
P V NARASIMHA RAO
I AM happy that a large number of
leading non-governmental organisa
tions (NGOs) are meeting for a consul
tation with key development min
istries. I had addressed a gathering of
NGOs in December, 1991, where I had
offered to withdraw the government
from certain areas altogether, provided
the NGOs take over the responsibility
of implementing all development programmes in those
places.
Our goal of uplifting the poor can bo achieved only if
the government and the NGOs work together, despite the
differences in our work and style. 1 don’t see any difficul
ty provided we understand how to harmonise our respec
tive roles. What is clear to me is that the early eradica
tion of poverty is not possible unless all the resources
available to us — human, material and
organisational — are mobilised and effi
ciently directed to areas and programmes
which need them most.
We have to remember that the people
must occupy the centrestage. They
should be the focus of all that we aim to
do. Therefore, when I talk of a participa
tory approach to development, what I
have in mind is an approach where the
people would be'helped to help them
selves. If a particular area is taken up by a
NGO, a time should come when the peo
ple are fully mobilised and empowered to
deal with their own problems. In other
words, the NGO should withdraw after i
the task is done.
As far as the government is con
cerned. the concept of withdrawal is equally imponant.
The formulation of policies, initiating programmes and
schemes consistent with such policies and the provision
of adequate resources for the programmes — all this is
the legitimate duty of the government. However, the flex
ibility required to take initiatives is sometimes lacking.
This quite often defeats the very purpose of the pro
grammes designed for the people.
Agents of delivery
We are changing all this but we need the assistance of
the NGOs in some areas. NGOs. being the agents of deliv
ery. need not make things better for the people. What is
important is to prepare the people, which is what the
NGOs can do most effectively. It is this preparation
which is going to be the most important aspect of the
NGOs’ programme. They are also better equipped to give
the government feedback. So, a meaningful dialogue
between the NGOs and the government is necessary
before the state launches any programme. The central
issue in all development is social mobilisation —
enabling and empowering the people to fully receive
what is intended for them. The NGOs have a crucial part
to play in this task.
We now have the Constitution (73rd Amendment)
Act, 1992, under which we would have self-governing
panchayats elected by the people. As many as 29 areas of
development, including agriculture, watershed develop
ment, small-scale industries, rural housing, drinking
water, primary health care, fuel and fodder, public distri
bution system and education would be in the hands of
the panchayats. This is a revolutionary step that we have
taken. Here, the NGOs have a crucial role to play as
external catalysts.
Don’t ask me what the NGOs have to do when the
panchayats come. Motivating the people, working among
them, not getting into a clash with anyone — that is the
crux of the whole thing. The sarpanch, who has some
power at the village level, should be able to appreciate
the work of the NGO. Otherwise, he will say, “This is
another parallel sarpanch coming and
interfering with my work.” I am warning
all the NGOs that this is going to happen
more often in the villages. Please be clear
as to where the panchayat's power ends
and the persuasive power of the NGOs
begins so that the panchayat does not
misunderstand the NGOs as meddlers.
Already, the panchayati raj institutions
are likely to clash with the legislature.
Seen in the local perspective, the
sarpanch is more powerful in his own
field than the Prime Minister of India.
The challenge before the NGOs,
therefore, is clear. The question is how to
take full advantage of the environment
that the government has created through
formulation of policies and schemes that
are helpful to the poor, particularly the rural poor. They
also have to takq advantage of the decentralised institu
tions created at grassroot levels and work in harmony
with them to empower the poor.
I am aware that we have a few thousand voluntary
organisations in our country. At the same time, I am also
aware that the spread of these is indeed limited. While
commending the work being done by all these organisa
tions, I would like to take this opportunity to invite more
and more people of goodwill to come forward to work in
the rural areas.
Tomorrow, the nyaya panchayats are coming. Let me
tell you that the panchayat is a very powerful body
because it is a combination of the legislature and the
executive and also the judiciary in the nyaya
panchayats. Now, how are the NGOs going to interact
with this very, very powerful body? ■
This is abridged from the Prime Minister's speech to the
Conference on Collaborative flelationship between
Voluntary Organisations and the Government, held in
the Capital in March this year.
45
DOWN TO tlRTH APRIL 30. 1994
NIWS
Poverty alleviation
One goal, two roads
Non-governmental organisations are taking the government's proposal for cooperation in
poverty alleviation with a healthy pinch of salt
AT THEIR most convivial. Indian
NGOs tend to keep a wide no-person's-land between themselves and
the government. So when Prime
Minister P V Narasimha Rao called
for voluntary organisations to cooper
ate with the government in order to
eradicate poverty, they considered
the possibility with lips pursed in
doubt. They made their trepidation
clear at the two-day NGO-government meeting, organised by the
Planning Commission on March 7
and 8 at the PM’s behest.
The meeting was also attended by
Union minister for human resources
Arjun Singh. Union minister for
health and family welfare Sitaram
Kesari. and minister of state for
health B Shankaranand. Rao stressed
the need for the government and
NGOs "to understand one another so
as to arrive at workable methods
of cooperating closely at the grass
roots level and perhaps all other lev
els". The Deputy Chairperson of the
Planning Commission. Pranab
Mukherjee, emphasised the need to
prepare a network of NGOs to sup
plement the work of the government.
Where the twain shall
meet
The meeting between the NGOs and I
the government identified the follow
ing key areas for NGO participation:
«
*
♦
*
«
•
*
*
*
*
«
*
*
«
Watershed development
Sanitation and drinking water
Integrated Rural Development
Programme
Family welfare
Education
Health
Women and child development
Welfare
Labour
Forests and environment
Science and technology
Non-conventional energy sources
Urban development (dealing with
problems of urban slum dwellers,
street children)
Development of women and chil
dren in rural areas
i
I
P V Narasimha Rao: calling all NGOs
But NGO representatives, hackles
raised, iterated as they have often
done before that the government
should keep its hands off the Third
Sector.
Rao replied that in 1991 he had
offered NGOs free rein to develop
any administrative system of their
choice, but had received no response.
He requested them to keep the peo
ple informed of government pro
grammes and stressed the need for a
meaningful dialogue between the
government and th? NGOs to ensure
feedback. "The role of NGOs is both
as agents of delivery and agents of
change," Rao said.
He. nevertheless, warned that
with the 73rd amendment and the
empowerment of panchayats, con
flicts could arise between them and
NGOs. He advised NGOs to develop
an appropriate interface with the
panchayats and not appear as “med
dlers".
It was agreed upon that every
ministry would set aside a part of its
annual budget for NGOs and involve
them in the planning process.
Mukherjee added that a single-win
dow clearance for all NGO projects
was being set up.
Participants at the meeting
observed that many NGOs were being
formed to avail of grants from min
istries. “This trend is going to
increase," says Anil Singh of the
Voluntary Action Network of India.
Participants also decided that NGOs
will mobilise the poor by educating
them and implementing rural devel
opment programmes, with the assis
tance of the government or govern
ment-approved external agencies.
But the meeting, says Singh, was
unsatisfactory. Lalit Pande of the
Uttarakhand Seva Nidhi of Almora.
Uttar Pradesh, says that by asking
NGOs to help in poverty alleviation
the government has admitted its fail- ’
ure in delivering its promises to the
poor.
He flayed the concept of the gov
ernment, the panchayat and NGOs
working together. “Already, politi
cians are unhappy with the autono
my of the panchayats. If NGOs are to
work in the scenario proposed, it will
get worse," he said. Pande was also
critical of the role of “contractors"
that the government visualises for
NGOs. “What does the government
mean by’ NGOs ’preparing the people
for its programmes'? We don’t want
to be the government’s spokesper
sons," he said.
P R Mishra of the Chakriy’a Vikas
Pranali of Palamau. Bihar, who has
undertaken pioneering environmen
tal regeneration work, felt that the
meeting did not achieve much. “It
ended in a farce." he said. “There are
lots of seminars like this which make
no impact." ■
9
DOWN TO EARTH APRIL 15. 1994
/NATIONAL POLICY ON THE VOLUNTARY SECTOR 2004
Preambie
a>~_/
cDrD/y
Recognising the high status and respect accorded to voluntary action by Indian
traditions and cultures, and the wide prevalence of the spirit of voluntarism
among people of this country;
Acknowledging the significant contribution voluntary action has made to the
country by fostering participatory development through local initiatives, local
resources and social action;
')
Realising the limitations of governmental systems and institutions in raising the
level of awareness among people about social and environmental issues and
problems, in effectively delivering economic and social services to all segments
of society, and in policy advocacy;
Taking note of the potential of the voluntary sector to supplement the efforts
made by government and to provide alternative channels for economic, social
and environmental development, and to improve the levels of governance in
terms of accountability and transparency of public institutions;
Having due regard for the necessity of harmonizing the actions of public, private
and voluntary sectors for realizing potential synergies and obtaining optimal
effects in terms of economic and social development of all sections of the people
especially for the poor;
Deciding that there is a need to provide an appropriate policy and institutional
framework to consolidate and expand the voluntary sector and to empower it to
act as an instrument of social mobilization, community action, societal and
national integration.
The National Policy on Voluntary Sector 2004 is enunciated as
follows:
1. Vision
To create conditions in India whereby the innate urge of human beings to
selflessly contribute to the betterment of their society can find full expression
through a variety of roles and alternative institutional channels, and their
contribution to the nation be given all due respect and recognition and regard-.
Dp
V
2.
Objectives
In pursuance of the above vision, the objectives of this policy are to.
2.1
Create an enabling legal environment to promote voluntary action, in
general, and voluntary organizations, in particular.
2.2
Promote the involvement of the voluntary sector in the design and delivery
of economic and social services to the people, especially the poor, the excluded
and the disadvantaged.
2.3
Enhance the role of. the voluntary sector in advocacy, awareness
generation and social mobilization.
2.4
Consolidate and expand the capacity of the voluntary sector to act as a
partner of the State in disaster management and preparedness and in building
societal capacity at grass roots level.
2.5
Enable the voluntary sector to effectively discharge the role of watchdog of
the Operation of public institutions and to function as conscience-keepers of
public functionaries.
2.6
Provide a framework for adequate flow of financial resources to the
voluntary sector for it to carry out its functions without undue hindrance or
compromises.
2.7
Improve the capacity of the voluntary sector to act as a medium for the
transfer of entrepreneurship, technologies and skills.
2.8
Indicate measures through which the reputation and image of the
voluntary sector can continuously be enhanced in the public eye.
3.
Definitions and concepts
3.1
Voluntary action is strictly defined as an activity or function undertaken by
a person or persons for the benefit of others without any personal financial or
material returns. The livelihoods of persons so engaged are expected to be
generated from elsewhere or from other activities. The main sources of livelihood
of persons who have formed the VOs are expected to be generated from
elsewhere or other activities. The VOs engaged in providing services in
specialized areas such as health and education, etc. are however, not precluded
frorrTpayihg^suitable compensation to professionals to maintain the quality of
) service.
3.2
A voluntary organization (VO), therefore, can be defined as an association
of persons: (a) established to organize and facilitate the exercise of voluntary
action; or (b) assuming such functions in addition to its regular activities.
3.3
In the main, non-partisan and non-profit or non-profit-distritxuting
organizations established for the purpose of attaining social objectives or general
public good and where the office bearers/members do not receive remuneration
from the organization are recognized as VOs.
3.4
In recognition of the fact that social entrepreneurship has emerged as a
valuable vehicle for transfer of technological and management skills to rural and
backward areas, such organizations too will be treated as VOs provided that the
remunerations and/or returns are significantly lower than those in comparable
public sector or commercial organizations as the case may be.
3.5
In cases where voluntary action is carried out by individuals in their
personal capacity, such individuals will be treated as a VO in persona.
3.6
Any other form of organization which undertakes social and community
work or assumes social responsibilities and where the owners/members do not
get additional remuneration from such activities will also be classified as a VO for
the purpose of carrying out such specific activities.
3.7
Networks', associations and federations of VOs shall be recognized as
VOs as well.
4.
Legal and operating environment
4.1
Formal or statutory recognition of VOs is presently governed by the
Societies Registration Act (1860), the Indian Trusts Act (1882), the Charitable
and Religious Trust Act (1920), Section 25 of the Indian Companies Act (1950),
and by similar legislations of the States. Recognizing that many of the provisions
of these laws including the laws relating to receipt of financial support from
foreign sources and requirements under the Tax Laws have become obsolete or'
redundant and that today there is greater need for promotion of voluntarism than
for its regulation, all such laws shall be reassessed and suitably amended after
due consultation with the stakeholders of the voluntary sector and
representatives of VOs.
4.2
For non-corporate private commercial organizations, such as
proprietorships, partnerships, cooperatives, etc., appropriate provisions will be
made in the laws governing their operations for facilitating them to undertake
voluntary activities.
3
4.3
Informal groups or associations undertaking voluntary work, whether as
their principal activity, such as community associations, youth clubs, mahila
mandals, etc., or as a subsidiary activity, such as self-help groups, may be listed,
if they so desire, at the level of local governments with appropriate linkages with
higher tiers of government. Care will be taken to ensure that such registration is
user-friendly and non-regulatory if public funds are not accessed.
4.4
To promote the involvement of individuals in voluntary action, rosters of
interested persons will be established at the level of local governments, which
will be freely available to all government and non-government institutions
engaged in economic and social development activities.
4.5
Networks, associations and federations of VOs shall be encouraged and
supported to strengthen the voluntary movement in the country and to give it a
larger voice. Such organizations are expected to be formally registered.
4.6
For ensuring that all volunteers receive due respect and cooperation, a
model Charter of Volunteer Rights, Duties and Privileges shall be drawn up for
adoption by all arms of government and by public institutions.
4.7
Rules and procedures for engaging VOs in publicly funded action shall be
streamlined by adopting simplified formats and tools of e-governance.
4.8
Joint Machinery or Consultative Forums for collaboration with the
voluntary sector shall be set up in all States/UTs as well as in the Planning
Commission at the Central Government level.
4.9
Coordination mechanisms shall be set up at the Ministry/State department
and the District levels to redress the grievances of VOs and to resolve all issues
pertaining to their work, particularly implementation of projects.
4.10
The registration/rostering process of VOs shall be computerized and the
Planning Commission shall make provision for a nation-wide meta-data base on
the voluntary sector.
4.11
The Government, both Centre and State, shall institute mechanisms for
recognition and reward of outstanding work by the voluntary sector, and for
publicizing success stories and working models for generating policy debate and
promoting replication and improvement of such efforts.
5.
Partnerships in development
5.1
Partnership entails the notion of jointly agreed goals shared among the
participants, and that the participants have an obligation to actively work together
in the spirit of common interest and common ownership.
4
5.2
In order to improve the quality of public services both through the
availability of additional manpower and through greater commitment and
sensitivity, the government shall encourage involvement of volunteers in public
service delivery institutions such as schools, vocational training centers, family
welfare centers, PHCs, hospitals, etc. Particular attention will be paid to utilizing
the knowledge and experience of retired persons and elders. Guidelines for such
involvement of volunteers shall be drawn up by the States and local bodies for
mandatory implementation in relevant public facilities.
5.3
In order to improve the utilization of public and community assets, the
government shall draw up guidelines for permitting, and indeed encouraging, use
of government facilities by VOs for undertaking voluntary works as a supplement
to the normal functioning of these institutions.
5.4
In view of the familiarity of the voluntary sector with local concerns and
common needs, the involvement of VOs shall be encouraged in planning at the
district, block and village levels.
5.5
VOs shall be encouraged and supported in developing and maintaining
local databases for the purposes of advocacy and planning.
5.6
The Ministries/Departments of Centre and State governments shall draw
up representative lists of VOs and network organizations of proven capacity for
regular consultations on matters relating to economic and.social policy, planning
and design of development interventions.
5.7
State and local governments shall be encouraged to involve VOs in the
management and operation of various public service facilities and welfare
schemes with suitable delegation of power and authority.
5.8
VOs shall be encouraged to mobilize and organize people for preparation,
implementation and maintenance of projects at the local level.
5.9
VOs shall be the preferred vehicle for undertaking suitable local public
and/or community projects in a spirit of public-private partnership. Guidelines for
this purpose will be framed and notified.
5.10
Involvement of VOs in monitoring the operation of public facilities and
implementation of government projects and schemes in social sectors shall be
institutionalized in a phased manner on the actual performance and capacity of
VOs unless there are compelling reasons to do otherwise. Care will be taken to
ensure that there is no conflict of interest between the monitoring function of VOs
and their direct participation in implementation.
5
5.11
All government schemes and programmes, especially those which are
beneficiary-oriented, shall necessarily involve VOs in providing the widest
possible publicity about their objectives, targets and nature of the benefits. All
relevant information shall be made available for VOs to carry out this function
effectively.
5.12
The government shall actively engage with the voluntary sector, including
provision of financial support, to generate mass awareness about pressing social
and economic issues, and shall institute mechanisms for receiving and
processing the feed-back.
5.13
In order to enhance mutual understanding and empathy between the
government and the voluntary sector, the government shall encourage
government/public sector employees to participate in voluntary action and make
appropriate provisions in the service rules.
6.
Financing Issues
6.1
In the main, VOs are expected to generate resources from the community
and from donations from charitable or commercial organizations. Extent and
continuity of community support would be a key indicator of the reputation,
acceptability and dedication of the VO.
6.2
In situations where the voluntary sector complements and/or supplements
the on-going activities of public institutions (such as those mentioned in paras
5.2, 5.3, 5.4, 5.6 and 5.7 above), suitable provision shall be made in the budgets.
of the concerned institutions for defraying the costs incurred by or incidental to
the VO.
6.3
Where public funds need to be transferred to the VOs for carrying out the
specified activities, accreditation procedures are inescapable. Recognizing the
diversity of VOs, the government shall evolve a graded system of accreditation
for different tiers of government with different financial’limits in consultation with
representatives of the voluntary sector.
6.4
In order to leverage the flow of funds to the voluntary sector, the
government shall evolve a modality for providing access by VOs to bank/financial
institution funds on the basis of either accreditation or group guarantees.
Servicing of such loans could be made from recurring revenues of VOs or from
releases from the government in the case of government sponsored
programmes.
6.5
The scope of various existing schemes operated.by the government and
its autonomous agencies for providing support to the voluntary sector, such as
6
those., under .CAPART, shall be strengthened and extended after suitable
amendments to reflect the intentions of this Policy.
6.6
In view of the decision taken by Government of India to encourage
channelisation of external bilateral aid funds towards non-governmental entities,
modalities shall be established by the government to facilitate this process,
including, if necessary, the provision of adequate comfort through a formal
government interface. VOs shall be given preferential consideration for such flow
of funds.
6.7
FCRA rules shall be suitably amended to require only first point clearance.
6.8
Stability and predictability in the flow of funds are essential to ensure that
the pace of implementation is not adversely affected and the viability of VOs is
not compromised. Central and State Vigilance Commissions shall set up fasttrack procedures for addressing cases of extortionary behaviour or deliberatedilatoriness by concerned public functionaries.
6.9
There should be no change in either the terms or structure of funding
without prior consultation with the concerned VO and other stake-holders.
7.
Capacity Building and Training
7.1
The government will endeavour to promote institutions, especially those
sponsored by VOs and network organizations, for providing professional training
to aspirants who would like to engage in voluntary action or social
entrepreneurship as a career and for assisting them in forming VOs.
7.2
The government shall encourage and support VOs in organizing training
workshops for imparting organizational, managerial and technical skills and for
disseminating best practices to other VOs.
7.3
The government shall encourage and support VOs in organizing training
to build local capabilities and for upgrading the capacity of PRIs.
7.4
The government shall provide all assistance in forging linkages between
the voluntary sector and public S&T institutions for wide dissemination of
appropriate technologies.
7.5
The government shall provide appropriate training to volunteers working in
public institutions in order to enhance their capabilities.
7
7.6
Arrangements shall be made to familiarize the voluntary sector with the
major current and emerging economic and social issues on a regular basis to
raise their capacity for participation in policy discussion. All important government
Ministries/Departments will be encouraged to make familiarisation workshops a
regular part of their activity calendar.
Governance
8.
8.1
Accountability and transparency are key issues in governance, and the
voluntary sector is expected to set benchmarks in this regard. Accountability to
funding sources, though important, is not enough, and greater emphasis should
be placed on social accountability to the stakeholders.
8.2
Recognising the diversity of entities comprising the voluntary sector and
the undesirability of specifying uniform standards for all, VOs shall be
encouraged to evolve their own codes of conduct and governance standards.
These should be appropriately notified and given publicity by the federating or
network organisations along with disclosure and reporting procedures.
8.3
All VOs will be expected to formally subscribe to one or more of such
accepted codes and standards.
8.4
A key element in transparency is the accounting standards that are
followed by VOs. Two essential characteristics which need to be reflected in the
accounts of VOs are:
•
•
Extent of voluntarism, say as measured by the ‘cost to the organization' of
members, office bearers and key employees
Extent and continuity of community support.
8.5
Formal voluntary organizations, i.e. those which are registered under the
various acts mentioned in para 4.1 and possibly para 4.2, are expected to comply
with the accounting norms laid down in the statutes. In most cases, these norms
are inadequate from the point of view of transparency and shall be reassessed
and suitably amended in consultation with representatives of the voluntary^
sector.
8.6
In the case of all other forms of VOs, suitable accounting standards will
have to be developed, which would have to be at once adequate and non
demanding. Care would also need to be taken to ensure that such accounts are
acceptable to government and other public organizations. The government shall
endeavour to develop model accounting standards in consultation with the
Institute of Chartered Accountants, the Comptroller and Auditor General of India
and representatives of the voluntary sector.
8
8.7
Provision shall be made to assist small, resource-poor VOs in adopting
governance and accounting standards.
8.8
Network or federating organizations of VOs will be expected to develop
their own systems to validate and accredit VOs for membership. They will also
be expected to monitor and discipline VOs not functioning properly or bringing
disrepute to the voluntary sector.
8.9
Notwithstanding anything contained in the formulation of the Policy,nothing shall be done to compromise the autonomy of the Voluntary Sector.
. This National Policy on the Voluntary Sector 2004 is the beginning of a process
to evolve a new partnership between Government and the voluntary sector in the
economic and social development of the nation. The Policy will be periodically
reviewed by the Government and the voluntary sector jointly in light of the
experiences gained and problems encountered.
9
_ YN GiO-S
3lcf f^TFRT TK^TFf
nipgp]
NATIONAL INSTITUTE OF PUBLIC COOPERATION AND CHILD DEVELOPMENT
Dr. Usha Abrol
Regional Director
NI/SRC/CS/3/2002-2003/^
.85
1.5.2003
The Co-ordinator
Community Health Cell
#367, Srinivas Nilaya, 1st Main,
Jakkasandra 1st Blk, Koramangala
J
B'lore - 34
Jr
"
Sir/Madam,
Sub: Survey of Counselling Services in Karnataka- Reg.
The Institute is conducting a Survey of Counseling Services in the State of
Karnataka, through which it is intended to collect and compile information on
counseling services in terms of number of institutions engaged in, infrastructure
available in the institutions, details of services rendered and, the training facilities
available in the area of counselling. Based on the information collected, a
Directory of Counselling Services in the State would be prepared.
In this connection, please find enclosed a questionnaire, through which we
request you to furnish the details of the counseling services rendered by your
esteemed institution. We request you to kindly provide us the information in the
same format and send it to us so as to reach on or before 23.5.2003.
We solicit your kind co-operation in making this exercise a fruitful one.
Thanking you,
Yours faithfully,
Regional Director
H 18, *1 cfeon, MH-I'K, 41^4cv1l<ji'< nrd,
- 560 064.
No. 18, New Town Yelahanka, Doddaballapur Road, Bangalore - 560 064
an : GfHarcnTI Grams : NIPCHILD fi?:8462818/8461355/8461793 Fax:080-8461793
E-mail: nipccdbl@bgl.vsnl.net.in
SURVEY OF
COUNSELLING SER VICES
IN KARNATAKA
O i_rE ST IO 1STNzK I RE
a.
Government Institutions
b.
Government Aided Institutions!
c.
Private Institutions
National Institute of Public Cooperation and Child Development
Southern Regional Centre
No. 18, Doddabailapura Road, New Town Yelahanka, Bangalore 560 064.
18462818, 8461355 da 8461793
e-mail: nipccdbl@.bgl.vsnl.net.in
2
identifica rioisr data
1.
Name and address of the counselling centre (parent body)
Telephone No.
Fax No.
E-mail
Website
Mobile no.
Person/Official to be contacted and contact address
Year of Establishment
4.
Year of Registration (Reg.No.)
Main objectives of the organisation
6.
Place where the counselling services are delivered
(Please give complete address with telephone number of all centres)
Activities of the institution other than counselling services
8
Please send a brochure/report/any other literature about your organisation
9.
Counselling centre mentioned above (in question no. 6) is attached to which of the
above activities
10.
Since when the counselling centre is functioning (year)
PART- II
:
c
of teje cocnseeeeng centre
Nature of Building
b. Tiled I
a.
RCC
d.
Any other, please specify
|
|
Temporary shed I
I
I
j
Ownership of Building
12.
c.
d. Any other |
13.
|
Location of the centre
a.
Rural
Free/donated by parent body
14
15.
b.
Urban
c.
City centre
d.
Semi urban
e.
Slum area
f.
Near to railway station/bus station/market area
Please mention about the Curniture/equipment available in the centre
a.
No. of chairs
b.
tyo.of tables
c.
No.ofbenches
d
No. of cupboards
e.
No. of racks
Please provide details on facilities and provisions made to ensure privacy and
confidentiality in conducting counselling sessions.(please tick the appropriate)
a.
Reception counter
b
Separate room/space for telephone
c.
Separate office room for registering complaints
d.
Record room
e.
Staff room/rooms for counsellors to sit
f.
Rooms/place for relatives/friends of the coinplainers/clients to sit
g.
Any other, please specify
5
16.
STAFFING PATTERN
Please furnish the following details:
a. For Counsellors
1
1
Designation of ■
Qualification
| Sl.No. i
the Staff
i
I__
i
j
I
I
3.
i
4-
I
5-
Part
time
Full
time
No.of
years of
service
Salary
Honorarium
Paid
1
i___
1
|
1
L
b. For Administration and Clerical Staff
i Sl.No. '
Designation of the
Staff
Qualification
Full / Part
Time
Salary /
|
Honorarium 1
Paid
Remarks
1.
1
2.
■
1
1
3.
I
5.
__
4’
1
1
c.
1
•
i
Please give details about Resource persons/guest faculty
Serial no. [ Designation of the resource person
12
4. .
5-
Number of resource persons
6
(PI.EASE NOTE : Trained here refers (o whether the counsellor has been (rained in conducting
counselling sessions in terms of obtaining a degree or diploma course in counselling, or attended
some orientation courses wherein (hey were exposed to practical sessions) Please give details
about their professional training, exposures, etc.
Please give details of training undergone by counsellors (individual wise details)
d.
Name of
Counsellor
SI.No.
Title of
Trg.Prog.
Duration
Trg.
Sponsored
by
Trg.
Organised
by
Certificate
/degree /
diploma
awarded
1.
1
2.
!
3.
4.
i
5.
e.
Quality of training: mention the course of trainers, how are you supervised/trained? Give
details.
a.
No. of theory classes:
17.
b.
No . of practical classes:
c.
No. of cases handled independently:
Give details about source of funding for the counselling centre (please tick the
appropriate)
SI.No.
a.
Funding Agencies
Central social welfare advisory board
b.
State social welfare advisory board
c.
State government
d.
Central government
e.
National private funding institution
f.
International funding institution
g.
Fee collected from the clients
h.
Any other, please specify
7
Please give information about networking activities, specifically on type of agencies with
whom you are networking, and areas of networking.
18.
SI.No.
Name and Address of Networking Agencies
Area of Networking
1.
2.
3.
4.
5.
19.
Any problem faced in running the centre? Please give details
8
DESCRIPTION OF COUNSELLING SERVICES
Please furnish details about the Following:
Presenting problems of clients (please tick the appropriate)
20.
HIV/AFDS persons
a.
21.
b.
Mental patients
c.
Marital problems
d.
Domestic / family problems
e.
Scholastic problems/Academic problems
f.,
Alcoholic /Drug related issues
g.
Sexual abuse of children/adolescents
h.
Dowry related problems
i.'
Divorce/separation
j
Old age problems
k
Any other, please specify
Counselling Services provided
Please list the counselling services delivered in your counselling centre (tick mark the
appropriate)
g] ,^0
List of Services given by
your centre
a.
Case work
b.
Marital counselling
c.
Family counselling
d.
Individual counselling
e.
Group counselling
f.
Vocational counselling
g.
Educational counselling
h.
Diagnostic psychometry
i.
IQ Assessment
j.
Any other, please specify
Profile of clients. Majority of the clients come from (please tick the appropriate)
a.
Higher socio-economic strata
b.
Middle socio-economic strata
c.
Low socio-economic strata
d.
Any other
Please describe how clients/people in problem can avail your services?
24.
Please provide data on the following.
Total number of cases registered, year wise, since last 3 years
a. 2000
'b. 2001
c. 2002
Whether your organization is charging any fee or not. Please give details.
PART- IV
TRAINING
(This part is applicable only for centres/institutions where training on counselling is given)
Profile of the Training Centre
26.
Address of the training centre
Telephone No.
Fax
E-mail
27.
Person/Official to be contacted and contact address
Mobile no.
10
28.
Date of starting the training centre
29.
Objective of the training centre
Please mention the following:
30.
Duration of the training (If it is more than one, please specify)
a.' One week
b.Two weeks
c.Three weeks
d. One month
e. Three months
f. Six months
One year
h. Two years
i. Any other
8-
31.
Nature of training (please tick the appropriate)
a. Orientation programme
e. Post graduate
b.
Diploma course
f. Certificate course
c.
Refresher training
g. Degree course
d.
In-service training
h. Any other,specify
i.
Total no. of persons trained since inception :
j.
Total no. of training programmes organised since inception, year wise
1)
2000
2)
2001
3)
2002
Curriculum followed:
(Please enclose a copy of the curriculum followed and prospectus)
11
Specifically mention the following:
33.
Curriculum prepared by:
a. Your own centre
Prepared by other professional bodies and followed by your centre
b
c. Curriculum offered by professional bodies
34.
Since how many years the curriculum is being followed
Same curriculum since the beginning
a.
35.
b.
Changed in the recent past (specify year)
c.
Some modifications are effected to the old one
d.
Details about total no. theory classes and practical
DETAILS OF TRAINEES
a. Total number of trainees in a batch:
h.
Minimum qualification for Admission:
1)
SSLC Passed
2) Intermediate
4)
Post graduation
5) Any other, please specify
3) Graduation
c. Selection criteria
d.
•
Based on marks in the qualifying exam
•
Based on marks obtained on writing exam/entrance exam
•
Based on Viva voce/interview/group discussion
•
All the above
•
Any other criteria
Medium of instruction:
1) English
2)
Kannada
3)
Hindi
4)
All the above
5)
English and Kannada
6)
Any other, please specify
36.
DETAILS OF TRAINERS
Please furnish details as stated below
Sl.No.
12.
3
4.
5.
|
Full/part
time
Number
Designation
Qualifi
cation
Salary /
Honorarium
per month
Experience
Clinical
Field
|
!
'
1
I
1
1
1
1
1
1______ !
37.
Please give details on Examination / Assessment criteria
38.
Please give details on follow-up of training
39.
Please give details on linkages with placement institutions
40.
Please give details about the fee charged for training programmes/Trainees
41.
Problems faced in conducting/organising training programmes
42.
Please give any other information that you desire to furnish.
_
N&o - 2-
Rethinking the Power of Aid
The Crisis of Humanitarian Action
medico international Report 25
english supplement
Die vorliegende Textsammlung ist eine Beilage zur Dokumentarion dcr Konferenz
von medico internatonal, Institut fur Erziehungswissenschaften Universitat Frankfurt/Main und Heinrich Boll Stiftung »Macht und Ohnmacht der Hilfe«, 28. und
29. Marz 2003 in Frankfurt am Main.
Die Dokumentarion ist auf Deutsch erschienen, diese Beilage umfasst die wichtigsten
Bcitrage im englischcn Original oder in cnglischer Obersetzung.
The present collection of speeches and texts is a supplement to the conference do
cumentation »Rethinking the Power of Aid”, held by medico international, Institute
of Pedagogics Frankfurt University and the Heinrich Boell Foundation on March,
28th and 29th 2003 in Frankfurt/Main.
The documentation was published in German, the present enclosure covers the most
important contributions, either in their original version (in English) or translated
into English.
medico international e.V.
Obermainanlage 7
60314 Frankfurt/Main
Tel. (069)944380
Fax (069)436002
Email: info@medico.de
www.medico.de
Spendenkonto 1800
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BLZ 50050201
Content
The Saving Idea is yet to be Conceived
Thomas Gebauer
4
The Crisis of Humanitarianism
David Rieff
12
Our Problems - Their Gains!
Nuruddin Farah
20
About Loneliness and Radicalism
Dr. Ruchama Marton
25
Focusing on Unconditional Humanity
Ulrike von Pilar (Medecins sans Frontieres, Germany)
..........................
29
Aid between Humanitarian Services and Social Intervention
Cornelia Filllkrug-Weitzel
32
Rethinking the Power ofAid
Programni
36
Thomas Gebauer (Executive Director of medico international, Germany)
The Saving Idea is yet to be Conceived
Notions towards a New Definition of Humanitarian Aid
Relief organizations tend to muster sup
res of the aid organizations, rhe images
port for their work on huge billboards:
of white 4x4s and aid workers not shir
»A thousand questions, one answer: Aid«.
This is a wonderful a magnificent pro
king away from any risk to be right on
mise in a world which threatens to drown
victims.
The world - a global village of those
in violence and misery. A promise that
is refreshingly self-confident as it claims
the scene of terror in order to help the
in need of help and their helpers? »Hu-
to have the solution for so many uncer
manitarianism« as the last hope for sal
tainties. It is therefore no surprise that,
vation? - The unique success story
in the English-speaking world, people do
written around »humanitarianism« over
no longer speak of humanitarian enga
rhe last decades has been in for some
gement when talking about aid, but use
criticism lately. Some commentators, like
the term »humanitarianism«.
US-writer David Rieff are talking about
a crisis of »humanitarianism«. »Relief«,
History tells us that humans have al
ways helped each other in times of need.
Today it seems, however, as if feeling a
as he concludes, »is a saving idea that in
moral concern for fellow human beings
has turned into a veritable philosophy. A
ates
One thing, however, is for sure: the
philosophy that is omnipresent in the
precarious state of the world, calls for
current public debate like no odier and
relief everywhere. There can be no doubt
the end cannot save but can only allevi
that has developed its own very specific
that, without the humanitarian assistance
practices. For, these days, almost every
body cares for human rights and aid for
provided by relief organizations over the
the poor: politicians, celebrities, industry,
reds of thousands of people more would
trades associations, rhe media - and, yes,
have died in wars or from starvation.
last decades, thousands, or maybe hund
even the military like to lend themselves
It is also true, however, that the num
an aura of charity contending that their
ber ofwars and the gulf between rich and
future interventions will be humanitarian
poor has been growing over all these
rather than military. It is certainly true
years. The miserable state of the world
that providing practical help to people in
has long since arrived at the suburbs of
need is highly acknowledged in the pu
the wealthy northern hemisphere. There
blic. And, nearly every day, we can see
how successful such aid is. See the gla
is no reason to disparage first aid, indivi
dual asylum or food aid - they are small
morous charity galas on TV, the brochu
improvements frequently helping indi
vidual people co survive. Nevertheless,
ancestors, is perceived as omnipotent and
we should not ignore rhe fact that even
coming from without, and which renders
the most successful humanitarian aid has
us so helpless that we cannot help but
not been capable of containing the di
mythologize it.
sastrous development let alone having
In a seemingly paradox way, narrow
provided a solution. Violence and po
ing our perception to individual, par
verty are the result of the powers that
prevail; they do not reflect a lack of hu
ticularly blatant cases of disaster appears
manitarian assistance but the failure of
unbearable reality. Focusing on a spec
government policies whose aim it should
have been to create conditions fit for
tacular eardiquake, a dramatic flood, the
to help us to cope with an otherwise
human beings.
war against what we take to be the powers
of evil, we lose our awareness for »com-
Disaster
monplace« emergencies and terror faced
by humans allover the world every day.
In fact, dramatizing individual, seemin
Only a few decades ago, Jean-Paul Sartre
concluded that there was no such thing
gly inevitable horrors seems to liberate
us from feeling ashamed for die fact that,
as natural disasters, because ultimately all
in view of the level of development
disasters were man-induced. Since then,
achieved in the world, we could easily
the consequences of human action have
prevent displacement, diseases and star
vation for millions of people.
kept backlashing on us with brute force.
Pollution, animal epidemics, mass mig
ration, displacement or wars come un
Victims
announced, sneak up from behind and
seem numb to all attempts at remedying
At the same time, we have whole li
them.
We cannot even say there is a lack of
braries providing information on who
knowledge of what is going on in the
of these vicdms? Do they even have some
world. Nobody would seriously claim
kind of social role to play?
the victims are. What is the significance
that it makes sense to destroy the envi
In the mid-80s, the press officer of the
ronment, uproot people or wage war. It
International Monetary Fund explained
is strange, however, how the awareness
of impending dangers goes hand in hand
that it was not only an inevitable fact but
the intention that there would be losers
with a growing feeling of despair. Is it
and that, in order to continue to reap the
benefits of the prevailing economic order,
possible at all to prevent the misery? Has
it nor become inevitable for a long time,
just like a natural disaster? Outrage and
sympathy are mingled with feelings of
it would have to be rid of all the shackles
according to the credo of neo-liberalism.
He added that consistent liberalization
fear and shame. There are signs of a di
of the market forces was the only way to
saster which, like in the times of our
ensure wealth and well-being and that
this would be taking its toll of victims.
Aid
The interventions following this an
nouncement were monstrous. One third
Aid in the emphatic sense does no longer
of the world’s population was socially
seem to be an issue these days. People still
uprooted and excluded from the formal
seem to pay lip service to the concept of
exchange on world markets; there was
providing helpful assistance with the aim
even talk about a »redundant« popu
lation. And even those who were the al
ofovercoming poverty and powerlessness
leged winners had to make huge conces
but this idea has lost all its practical re
sions: nowadays humans are controlled
levance. Fading hopes for emancipation,
and assessed right down to their biologi
the disillusionment with the failure of
in order to create and restore autonomy,
cal substrate, the social dimension has
rigid revolutionary approaches have had
been completely dissolved or is being
a detrimental effect on rhe idea of social
measured by mere economic standards.
development. The good maxim of »give
Suffering such losses calls for denial or
a man a fish; you have fed him for today;
at least for compensation. What seems
teach a man to fish, and you have fed him
to help us in this context is co regularly
recall those who are even worse off, that
for a lifetime® — which used to be very
is to say chose who fell viccim co our ef
popular until recently, seems strangely
behind-the-times, almost obsolete.
forts to secure our own privileges. Giving
For wanting to challenge the status
aid to the disadvantaged can be compa
quo is no longer deemed a credible un
red co a carnival situation where prevai
ling conditions are reinforced by a peri
dertaking by the public. The modern
heroes of the civil society movement do
odical reversal of all norms that is limited
not indulge in political deliberations,
in time and strictly controlled. There is
indeed a trend in the wealthy part of this
they just knuckle down on it. In rhe past
world ro link empathy and charity with
that motivated people to act; now it is
selected situations in order to legitimize
it was the concept of a different world
mere apolitical pragmatism, non-inter
and declare as normal their absence in
ference, impartiality, just making sure the
everyday life. Moral impulses triggered
at the sight of human plight are safely
greatest hardship is relieved without,
however, questioning the powers that
channeled into sporadic fund-raising
be.
events. Justice is transformed into the
This approach to aid has long since
good deed consoling us for the lack of
established its own iconography. The
justice as the prevailing norm. »Lct us do
white helicopter pilot rescuinga newborn
something good for a change«, confessed
African child from an almost inundated
Helmut Kohl sticking a note in a collec
tree is emblematic of»humanitarianism«
tion box when he attended the first Africa
and epitomizes the kind of »inter-
Day in the mid-80s.
ventionist® aid floating in from the
outside (and very likely to disappear
fy
soon, too), which is stripped of any
are ignoring the relevant political and
context or social relevance. It is restricted
cultural conditions, cannot respond to
to rescuing individuals, while the catas
such crisis in an appropriate way.
trophic world order, which would be in
During the Kosovo crisis, for example,
heavy need of rescue, seems as if it was
it was the massive presence of foreign aid
cast in concrete and unchangeable.
Incidentally, the increasing impor
structures that totally ostracized rhe re
tance of private relief organizations does
had escaped Milosevics expulsion policy.
maining part of the local civil society that
not necessarily reflect the fact that demo
Independent intellectuals, human rights
cracy is on the rise, rather the opposite.
activists and health experts turned into
gps As those in need can no longer resort to
drivers, translators and workers in the
employ of the relief organizations.
]egal rights usually granted by a state
government, because their social welfare
aThat’s OK, the important thing is that
now depends on the philanthropic
we have provided aid« — said a German
..goodwill™ of charity organizations or on
the efforts of multinational corporations
politician, for whom it was apparently
to polish their images, we may rightly use
alleviating the hardship of real human
the expression of »re-feudalization« to
beings, turned into an end in itself.
describe the development we are wit
nessing.
no problem that aid, originally meant for
Indeed it does not seem an obstacle
for the members of relief organizations
to know very little about the people they
Depolitization
are dealing with. Their aid projects obey
technical and economic criteria and do
While the approach to aid was being
not even pretend that the victims of war
stripped of its political components,
and poverty are more to them than ob
pragmatism defeated idealistic visions,
jects that they provide with supplies with
and mere acceptance of a given situ
ation triumphed over hopes for eman
cipation.
In fact, determining the political root
■-■s’
rhe greatest possible efficiency. Most re
lief workers do not consider wars politi
cal or historic events but rather humani
causes or the historic circumstances lea
tarian crises requiring relief. And even if
it sounds bitter: if Auschwitz were to
ding up to a plight almost always comes
off worst. Suddenly, those asking for the
occur today, the mass media and appeals
of relief organizations would be likely to
reasons of the famine at the sight of a
merely call it a »huge humanitarian cri-
starving child are reproached for being
sis«.
inhuman. Reducing war and crises to
their humanitarian consequences, how
Capitalization
ever, has considerable implications.
Those who are incapable of developing
an understanding of a crisis, because they
Such pragmatism easily associates with
business interests. The many billions
of US-Dollars raised for humanitarian
Instead of dealing with the nature and
activities in the world have made "hu
inherent dynamics of aid and its effects,
manitarianism* an interesting industry
the capitalization of aid offers the possi
recently expanding at high growth rates.
bility to make those aid programs fail
The market even has its own trade fairs,
which are unwanted for political reasons
where foodstuff, lifeboats, mine detec
by simply stamping them with a negative
economic assessments. No profit, no aid.
tors, tents, body bags, gas masks, water
purifying plants and other aid products
But how can you economically assess an
and services are on display.
The extent to which aid has been
approach to aid that is not only aimed at
successful is measured less and less by
social criteria. Econometrics seem much
ensuring they can return some day? And
providing relief to refugees but also at
is it possible to develop at the drawing
more important, like the number of
board, without involving those affected,
people reached, the volume of supplies
something like a "result-driven* plan for
dispatched, the efficiency ofaid logistics,
the process of rebuilding an organic social
the speed in which an organization gets
community in which victims of violence
to the scene of the emergency. It is the
and poverty feel secure again?
operative capacity that counts, not the
There is a risk that degrading aid to a
mere "product* is only the beginning of
human relationship to the victims. The
Humanitarian Aid Office of the Euro
a far-reaching structural change of aid.
pean Union (ECHO) says that solidarity
Within the EU rhe demand was voiced
with those who suffer is no evidence for
to withdraw tax advantages from chari
the quality of humanitarian aid but
table institutions, in order to avoid
rather an obstacle.
competitive distortion and to allow pri
Gradually, aid has been removed from
its previous social context and trans
vate companies access to humanitarian
aid markets.
formed into a "product* which, just like
Many companies, among others the
any other product, does not necessarily
German private TV station RTL, have
correspond to the needs of the recipients
founded their own relief organizations,
any longer. Donor interests are pushing
in order to secure their share of the aid
their way to the focus of attention or,
business. They can be seen as the harbin
what is worse, the act of providing aid
gers of a self-referential "humanitarian
increasingly depends on the extent to
industrial complex* threatening to evolve
which it can be exploited by the media.
in the future. The medium places the
Governmental donors, but also the relief
topic on the agenda, mobilizes support
organizations themselves, insist on their
and raises funds, translates all this into
rigid target figures and "Controlling* that
projects supplying the images which
is supposed to improve the aid’s "output*,
ensure a convincing media-based "cont
rolling*.
although social action is neither pre
dictable nor does it obey a business logic.
8
Instrumentalization
victims and those providing aid. The
impartiality emphasized quite rightly by
Stripping aid of its social context expo-
the relief organizations must not result
ses it to the control of central authorities
in indifference in the face of political
and instrumentalization in many ways.
reality. It is part of this reality, for in
The depolirization of aid has exacerba
stance, chat new players appear on the
ted the humanitarian paradox. The more
scene who are utterly unscrupulous about
smoothly uncritical aid works, rhe better
misusing aid for their own purposes.
can it be instrumentalized for political
and military purposes.
Force Protection is the name NATO uses
for humanitarian aid programs that mi
Indeed, aid has turned into an eco
litary forces carry out simultaneously
nomic and political resource much
with military operations in order to raise
sought-after by the parties to a conflict.
their public acceptance.
Be it taxes on goods imported as aid, or
In the course of economic globa
extorting, robbing or plundering the
population fed from outside - there are
lization, the old East-West axis ofconflict
many ways for parries to a war to get
has shifted and now runs North-South,
between a rich global north and a global
there share of the billions of Dollars
south drowning in poverty. The peace
worth of aid provided to the victims
strategies practiced in international crisis
management efforts resemble those of
annually. In countries like Angola, Libe
ria or Afghanistan, humanitarian aid has
the 18th and 19th century. Like in Vic
taken on such an importance that it has
torian times in England this is about a
to be considered an integral part of the
repressive kind of poverty relief where
there are good victims and bad victims.
vicious circle of violence.
Aid is also the perfect means to over
come a lack of political legitimation.
The »good victims** who deserve every
support for their good political behavior
Warlords or political elites who can
- as happened in Yugoslavia only recently
hardly legitimize their authority by pro
— receive so-called »conditioned aid**,
per governmental structures, obtain alle
giance by combining tyranny with a
while so many »uncomforrable victims**
are dragging out a miserable existence in
minimum of social welfare for their peo
refugee camps, sometimes over gene
ple, this welfare being ensured by foreign
rations, or are exploited and disciplined
aid. Public acceptance of military measu
in export zones, which are the work
houses of modern times.
res increases when relief organizations like in the Kosovo war - draw the atten
Striving for social justice has been
tion of the public to a refugee emergency
denigrated into an early warning sign, an
indicator of system disruptions which
by staging large-scale campaigns.
These dilemmas cannot be resolved
need to be contained in order to maintain
by applying the axiom that aid is to be
rhe existing gulf between the rich and the
restricted to the relationship between rhe
poor, the powerful and the powerless, rhe
privileged and the humiliated. Appar
ving for justice as an ethical principle of
ently the end justifies every means: the
society is relegated to the sidelines. Ulti
first strike, state-authorized torture, the
mately, the aesthetic exaltation of the aid
abolition of democratic legal principles,
heroes perpetuates the disaster.
It is high time relief organizations
the continued development of long-since
banned chemical weapons, and the mi
became aware of rhe dilemmas of their
suse of humanitarian aid.
Within the evolving .‘global civil war
activities. They will certainly have to
rewrite a number of myths, one of them
order«, aid is bound to fall hostage to a
being that humanitarian aid serves the
security policy whose only objective is to
victims while the helpers stay impartial.
perpetuate the status quo. This is why
Those who want to help others cannot
humanitarian aid’s terms of reference are
actually be neutral, but must interfere,
likely to change completely over the
taking a stand for the victims and against
coming years. There are more and more
the perpetrators. Any other course of
signs suggesting that humanitarian aid
action would be highly immoral. Those
may become part of a complex set of
who help others to overcome an emer
policies aimed at bringing about peace
and acting like a “foreign social welfare
office** to the outside while striving for
gency and enable them to take action
legitimation at home. In this case, private
relief organizations will run the risk of
actual aid was provided.
turning into mere sendee providers to
served wherever relief organizations do
government institutions.
not restrict their work to short-term in
themselves, leave marks that will remain
far beyond the moment in which the
How powerful such aid is can be ob
terventionist “missions**, but rather try
Prospects
to provide an aid that is tailored to the
needs of the partner and the context.
True, many attempts are made to defend
humanitarian activity against its instru-
Humanitarian crises cannot be elimi
nated by implementing purely huma
mentalization in the ongoing process of
nitarian solutions. Whoever wants to
destruction. Some observers, like Rupert
help must fight for democracy and social
Neudeck, demand that aid be purely self-
development - standing by the victims
referential. In his view, those providing
of poverty and tyranny.
aid are like modern Sisyphuses who are
incapable of bringing about a change,
Conclusion
but cannot help but help time and again.
This is how those providing aid move to
I
owe the idea of comparing aid to poetry
the foreground rather than the intended
to the Palestinian writer Mahmoud Dar
effect of aid. »Love thy neighbor and
wish. My intention is not to aestheticize
act accordingly** is cherished as a moral
aid, but rather to illustrate its political
attitude upheld by each individual. Stri
contents.
10
Aid can never be an ally of war and
However, aid has come under tre
violence. Just like poetry, aid, in its sub
mendous pressure allover the world lately.
stance and nature, serves peace and the
defense of freedom and solidarity. It
When societies persist in the status quo
springs from mutual empathy and social
ultimate goal of aid, aid will turn into an
island of solidarity and empathy in
ethics. Although aid cannot be a party
faithful to political reality, it will never
be neutral. There is no neutrality between
war and peace, between oppression and
freedom, unfairness and justice.
and frustrate any renewal, which is the
undated by increasing irrationality, or it
becomes part of what will eventually be
renewed: the security machinery installed
to protect the status quo.
Translation: Julia M. Bohm
David Rieff (Journalist, USA)
The Crisis of Humanitarianism
Not only the CNN-Effect is bringing Humanitarian Aid
into Crisis
I would like to not only talk about Iraq.
There are a hand full of aid workers
You may think that that is a bit of special
who are actually free to move about in
pleading on the part of an American, but
Iraq, even to the extent they’re free to
really it is a special pleading on the part
move about, it is by no means clear what
of someone who spent about ten years
of his life in Africa and is worried that
communications they have with each
other and therefore what kind of con
rhe emphasis on Iraq, even for the best
fidence assessments can be made, either
of political motives, is from a strictly
of needs or of the potential for harm. So
humanitarian point of view, something
we are blind, to a very large extend
of a mistake. Let me be much blunter: a
blind.
This is obviously not the first time this
great mistake.
Because one of the many perversities
has happened. Cosovo was a perfect ex
of the humanitarian system, and it is a
system, it may not be a business, as some
ample for this. During the bombing part
of the Cosovo war, what was remarkable,
of its critics, I think, rather unjustly say,
and I am a someone who covered the
but it is certainly a system. One of the
Cosovo war as a journalist and was sitting
perversities of it is that crises are picked
for most of it on the Albanian-Cosovo
more on the basis of some nexus of po
border, what was interesting was that we
pular concern in the West, western poli
tical interest and what we call for a lack
didn’t really know what was going on in
of a better word the »CNN-effect«, that
the refugee camps, we knew something
is ‘what is on Television’, than for the
about the mass deportations, we also
actual content of the crisis.
knew something, despite the ways in
As Ulrike von Pilar tried to point out
Cosovo. We knew what was going on in
which both NATO and the Serbs tried
last night, the most interesting thing
to lie about it, about the course of the
about the humanitarian situation in Iraq
at this moment is that we don’t know
war, but we did not know, really, what
the humanitarian emergency was. And
anything about it. We have no idea, if
it’s the same thing in Iraq.
this is one of the major humanitarian
Whereas we do know that in Angola
catastrophes of this period in human
there is famine. We do know about the
history in this early part of the 21st
century, or whether in humanitarian
Al DS epidemic, not just in Sub-Saharan
Africa, but 1 would remind you in the
terms it is actually a comparatively minor
Caribbean, they are my own country, and
event. We simply don’t know.
now in Eastern Europe, in the former
12
Soviet Union very close to this country.
up a feeding center, let alone, systematic
We know about that. And I think the
programs of relief in conflict areas, unless
first thing, if we want to think lucidly
you’re properly funded. And yet last night
and not sentimentally about what we are
we talked as if rhe money either wasn’t a
confronting is to start actually being
problem or wasn’t even an issue, when
it’s in fact the principal issue.
modest about what we know and trying
to separate things out.
Let’s talk about Iraq. The British Go
One thing that struck me about the
vernment, which has actually one of the
discussion yesterday was the degree to
largest contingency funds within its
which humanitarian issues in their own
humanitarian structures for human
terms were barely addressed. In other
itarian action, a fund of app. lOOMio
words, we talked a lot about the rights
pounds, that about I50mio Euro, has
and wrongs of the Iraq war. And as an
now pledged 70Mio of it to Iraq. Now
American I am perfectly going to take
that means, there is 30Mio Pounds left
the heat from you on this issue. I don’t
in rhe fund for all other humanitarian
think that it is only as an American, that
emergencies anywhere in rhe world,
makes me say, that you in rhe audience
unless the British government pushes
may consider, that the Iraq war is one of
through in parliament a supplemental
the worst political events to happen in
appropriation, which given the nature of
the last period, but it is by no means clear,
politics is probably months away. It
that it is one of the worst humanitarian
doesn’t seem very likely, knowing what I
know of the way that works (I used to
events.
The Iraqi government for example is
live in Britain), that parliament is likely
claiming 500 dead. That is not on the
simply to appropriate in general funds
standards of the horror of the world. I’m
more money for overseas development.
sorry about this malign calculus. I apolo
So what you are looking at, for example,
gize for engaging it. But I think it’s im
is in this Iraq-crisis, and I tried to say in
portant because resources are limited.
my preceding remarks, that it is not clear
One other thing that struck me very
this is rhe worst humanitarian crisis
forcefully last night is that 1 didn’t hear
around. The humanitarian funding
any discussion about money. And yet,
sources are being drained away, like water
going down the sewer.
money is inseparable from the pursuit of
humanitarian action. Humanitarian
agencies without money are just people
Maybe again, I can see, maybe the
humanitarian crisis in Iraq will be as se
who issue press releases. It’s as simple as
vere, as people say it is. It is certainly the
job of humanitarian agencies to be alar
that. There is no humanitarian action
without proper funding. There is politi
mists and I am not one of those critics of
cal symbolism, there may be political
aid who criticises agencies for making
activity, but there is no emergency relief.
statements that a lot of people will die
You cannot break a cholera epidemic, set
and then people don't die, it’s their job
to be alarmists, it is correct that they arc
So I consider first of all the fusion of
alarmists. It is much better to be alarmists
development and emergency a huge
and then be pleasantly surprised by the
mistake. If think the moral hazards of
fact that ones anticipations have not
development which again Nurudin Far-
taken place than it is to be calm about
rah explained great and subtle and cor
things. The humanitarian workers relief
rect, are such that one must be at best
are absolutely right to behave, to work in
extremely sceptical and I think one is
that register.
legitimately allowed to be more than
But having said that, simply rhe dis
sceptical. Whereas I consider humani
tortion of what Iraq is going to bring is
tarian aid for all its weaknesses, all its
amazing, impossible. If I may go back for
paradoxes, all its dilemmas to be an un
a moment, to take only one agency: when
mitigated good thing. Now, that may
the Cosovo crisis broke out, the world
sound strange to you from someone who
food programme took one official from
is supposed to be a fierce critic of aid.
But from my point of view emergency
every one of its programmes in Africa
and seconded them to Cosovo. In other
words, every single programme in Africa
lost a single person. Given rhe famines
relief is one of the few activities in this
in Africa, and I remind you there was no
world about which one can be quite
unambiguously proud. Having said that,
that doesn’t mean, that it shouldn’t be
famine in Cosovo, this was a catastrophic
criticized, viewed sceptically, or that its
blow to African Programmes.
There was some young people stan
own fantasies about itself shouldn’t be
ding outside yesterday who belong to the
its own hubris. Again I want to raise a
German Attac, who were handing out
questioned. And may I go even further:
point, that was raised in a question last
leaflets saying »in the middle of Iraq,
night, which is the issue of competence.
don’t forget about Africa«. 1 think Nu-
We heard a great deal yesterday about
ruddin Farahs remarks yesterday are
how humanitarian aid needed to be a
absolutely correct. I don’t want to single
vehicle for peace. The first sentence of
out Africa, there are other places not to
forget about in terms of emergency relief.
English translation, reads: »Aid can never
the conference document, at least in the
When I speak about relief work, I am
talking about emergency relief, relief in
be an ally of war and violence. Helping
times of war and natural disaster. I am
us to overcome poverty and dependency.«
not talking about development aid. I am
very admiring of what relief workers do
in emergencies.
I am probably almost as sceptical as
Nuruddin Farah about what develop
each other requires empathy and enables
But I believe almost every word in that
is false. Let me be very blunt. Why can
aid never be an ally of war and violence?
ment has done which in my idea is less
Again in its practice. In its ideal fine, it’s
perfectly fine to say, »we aid workers or
than nothing.
we who give money to aid the world, we
want to put an end to war and violence.
We see humanitarian assistance as part
the Bundeswehr, the floods have to be
ofa larger peace process, a larger questing
coped with by the GTZ«, because you’re
not thinking in this highly moralized
towards justice. A larger part of the good
discourse. You are actually thinking
people versus the people who want to
about how to do something about the
continue the neo-imperial order, or
floods. You don’t say, the GTZ or the
whatever political vision of the world
German Red Cross has a monopoly on
suits your fancy." That may be true. But
dealing with this floods, a moral mono
may I submit that’s about us not about
poly and rhe Bundeswehr can never do
the people who get the aid. That’s about
it because it as a military arm is by defi
what may make a person in Oxford or
nition an ally of war and violence, that
Frankfurt or Lyon or Madrid give money
after all is what armies are in their es
to an aid agency. That is not what aid
sence, however much Europeans may
does.
fantasize otherwise (the American shows
Again, what is the competence, ifwhat
the sting in his tail).
you get from an aid worker is food; 1
The fact of the matter is aid comes in
submit to you that the issue is not the
all shapes and forms. That is the histori
motives of the person giving you food,
cal truth. It comes for example histori
but the amount of food and efficacy of
cally in the shape of Christian missionary
the delivery or that food that counts for
charity, a form that is anything but dead
you. Again in this discussion it’s all about
today in the poor world. Ifyou know the
intention, it’s not about competences.
My friend Rony Brauman, who is one of
American and now worldwide orga
the leading figures in "Doctors Without
aid quite effectively in many contexts, it
nisation »World Vision®, which has given
Borders«, France has always said, emer
is also a prospertising organisation. And
gency relief groups do not have a mono
indeed, its former operations head is now
poly on giving relief. Relief is something
the head of the US agency for inter
that was given long before aid agencies
national development, which after
ever came into being and I submit to you
ECHO is the largest single funder of aid.
that may be given long after aid agencies
It comes in the form of the Red Cross.
have be so transformed that in their
No one in his or her right mind would
present form they are no longer recog
say that the Red Cross is an ally of war
nisable to us.
An army can give food. Armies have
and violence. On the other hand every
always given food. On the domestic level
you know this perfectly well. Do you say
it’s outside the competence of the Ger
one I have ever worked with in the Red
Cross has said to me: »We work in the
context ofwar«. The Red Cross takes the
existence, the purenity, the permanence
of war for granted, as a great Red Cross
man Army to cope with the floods here
recently? Of course you don’t. You don’t
official said in Rwanda: »Our aim is to
say, »the floods can’t be coped with by
bring a measure of humanity, always
15
insufficient, into situations that should
says in half of the windows I pass in
not exist.« That’s another vision of aid.
Berlin where I’m living at the moment.
And in many ways the ICRC, the inter
national committee of the Red Cross
And you may think »now that he has
remains the most coherent of all aid
movements.
revealed himself to be a true antibalacist,
Gerhard Schroder is a prince of a man.«
You are certainly entitled to that view.
There is the tradition in my own
But don’t let the fact that you may like
country, which in its secular version tends
your government and hate mine confuse
to be quite narrowly governmental.
you about the degree to which aid agen
American aid agencies have a long tradi
cies and governments are in a state of
tion dating back actually to the period of
really intense cooperation and linkage.
the Russian revolution, where the United
Nor should you think, that the mili
States mounted a very large and compli
tarisation of aid is simply a phenomenon
cated aid effort in Siberia in 1919 and
In my own country the tradition of
of the United States.
I remind you, that in the European
Rapid Response Force that went into a
fact in 2003, the mission of that force
aid is one that ties relief groups to go
was peace enforcement and humanitarian
vernment. It is true, that there is a Euro
assistance. In other words, you latest
pean tradition, dating back probably to
attempt at having a military collective
security explicitly links military action
1920. At the same time that it intervened
militarily - shades of the present.
Doctors without Borders, to Mddicins
sans Frontieres, at the time of the Biafra
war and after, that has a notion of inde
pendent autonomous aid. And also aid
that does come closer to what is written
in this conference document about aid
with humanitarian assistance. So again
the idea that somehow aid is sitting out
there on its moral high horse refusing
steadfastly to be an ally of war and vio
lence while the wicked Donald Rumsfeld
never being the ally of war and violence.
subjugates Iraq. I’m afraid it is rather a
If you will its aid as a social movement
fantastic vision of reality.
as well as a deliverer of goods and ser
vices, an alleviating machine.
Let me again try and make it even
more complicated. What is the core
That tradition is one of the traditions
of aid. But it is just a verbal slate of hand
competence ofaid? What do aid workers
to pretend, that it’s rhe only tradition, or
frankly, even the dominant tradition. The
you want to go to for political analysis?
Should Oxfam, or MSF, or dare I say
know about. Is an aid worker the person
fact is, that the relations between govern
medico.de be rhe people to whom one
ments and aid agencies are very intense,
applies for wisdom about the proper
very close and not only in the United
outcome of conflicts.
States.
You may like your government, you
may think »George Bush fuck you«, as.it
16
I heard yesterday someone say that the
war must stop on humanitarian grounds.
That tells me nothing. Perhaps this is an
unjust war. I in fact am opposed it, but
to say that war involves hideous huma
a bit more modestly than most of the
nitarian consequences. If you are not a
people in this room I think, and probably
pacifist, the issue of whether you think
by the standards of most people in this
that humanitarian issue should rake
room my opposition would constitute
priority depends entirely on the justice
little more than a sort of quibbling.
of the war. There is nothing new about
Having said that, think about it for a
this idea. But to say simply it’s fine, op
moment. Lets say the Iraq war is as most
pose the war, say »the Americans want to
ofyou think ofit, a barbarous, colonialist
re-colonise the Middle East«, say »no
injustice. Is that why the humanitarian
blood for oil«, but don’t say that it’s be
criterion should be invoked? What about
cause of the humanitarian imperative.
a just war? Do you think, that the war in
Because on that basis you must oppose
Rwanda should have been stopped? Do
all wars.
This brings me back to the level of
you for example think that instead of
Kigali we should have intervened and
competency - core competence. It is
right for humanitarians to talk from a
stopped it in place? Do you think WW1I
humanitarian perspective. There is
allowing the Tutsi army to take back
should have been stopped on huma
nothing wrong with that. You don’t want
nitarian grounds?
In other words, it is in the nature of
our perspective is this, but looking at it
the humanitarian position to want to
medico or MSF, or Oxfam to say: »Well
from the point of view of, I don’t know,
stop all wars. It tells us nothing about
Minister Fischer, we have another point
their justice. What it tells us is that war
of view.« That would be silly. Of course
is, always has been, and always will be
humanitarians have to argue the huma
about the slaughter of innocents. That’s
nitarian case. That is right and proper.
what war is. It’s other things, too, unless
you’re a pacifist. If you’re a pacifist war is
What is not right and proper, I think, is
to accept the premise, that humanitarians
only about the slaughter of innocents.
are necessarily the only or the best source
But if you are not a pacifist, war can also
ofwisdom about politics or war, anymore
be just, it can also be necessary; you can
than you should accept that journalists
make various arguments. But war is
about the slaughter of innocents. That’s
are. We are in the field, too. Are we the
what war is. So if you’re working from
best source? I doubt it.
The question is core competency.
your humanitarian perspective, all wars
Why should a water and sanitation en
should be stopped on humanitarian
gineer, and here I come back again to
grounds.
The reasons to oppose the war in Iraq
Nuruddin Farah’s very astute remarks
about how people in the poor world often
surely are political and moral. Because to
oppose them on humanitarian grounds,
sweeping in his account of aid workers.
again, unless you are a pacifist, is simply
I think there are plenty of aid workers
view aid workers, perhaps he was a bit
17
who don’t conform to this kind of bour
aid workers should appropriately make,
geois Europe and North America explo
what I consider extraordinarily hubristic
iting the poor world. But there are cer
tainly more than enough examples of
claims, that »aid can never be the ally of
such people to make what he says entirely
anecdote we know suggested that they
appropriate and well and apt in the con
have been, they are and they will conti
text of such a conference — again neces-
nue to be.
Is there a possibility of an independent
But why should 1 take the political
aid? Absolutely! I think there are groups
views of an American water and sani
that really are holding out for an inde
tation engineer who arrived in Burundi
pendent vision of humanitarian relief.
three weeks ago. Seriously - why? It isn’t
One that might incarnate the kinds of
ideals that are contained in the confe
graven in stone, that Oxfam is the source
war an violence«, when every historical
of funds and ergo of wisdom about the
rence statement and in Thomas Gebauer’s
crisis, in which, I remind you, it delivers
speech yesterday. I particularly think of
services. It helps out, it alleviates, that's
what aid does. Aid is this marvellous
the MSF movement, which I think has
come as close to exemplifying that view
thing. It’s an extraordinary thing.
My idea is, that despite all the talk
as any group of humanitarian relief wor
kers. Having said that, again, they have
been very successful at fundraising, they
about the Global Village, the media, the
internet, and all the rest, we are in fact
have private sources, which has made
as human beings not very good at sym
pathizing with people we don’t know. I
them less dependent on government. It
is by no means clear, that that kind of
think actually that’s quite difficult. So I
think the success of the humanitarian
fundraising can be done by many groups.
It may very well be that a few groups will
movement in precisely getting people to
succeed in doing this and most will not.
sympathise with people they don’t know
In any case the MSF movement is at least
at rhe moment part of the humanitarian
and going out and trying, however in
aptly, to do something, is a remarkable
if you like to use the famous phrase of
Walter Benjamin’s ‘document of civi
lisation’. But if I may quote the Benja
min-aphorism in full, he did after all say
system which contains all kinds of other
groups, that don’t take this road.
Again, yes, there is an independent
world of relief, that thinks about the
independent ‘humanitarian space’, to use
»every document of civilisation is also a
the term of art, but it is by no means
document of barbarism«. And it’s that
dilemma, that you need to think about.
clear, that it’s dominant. And it’s certainly
by no means clear that you can clean up
It’s the question of whether an alleviating
the kind of moral posture of huma
idea, noble as it absolutely is, can be
nitarian assistance by pushing it through
the UN.
come, as it were, the moral center for
thinking about the world. And whether
18
I am very struck, I think Thomas
And I actually think, people in Europe
Gebauer talked about this last night, by
are being misinformed, in some sense
the degree to which the debate at rhe
distracted by the debate about the UN,
moment is whether the United States will
when the real debate should be elsewhere.
run Iraq unilaterally or the UN will, i.e.
The recent debate about the UN is fun
the UN- Security Council, i.e. the five
mentally a way of saying: » We’re not
been granted for reasons no one can now
going to talk about politics, we do talk
explain control over the political actions
about humanitarian aid and we are going
of the world, legitimating control.
0
damentally humanitarian. It’s funda
victorious powers of WWII, who have
to talk about our good intentions.«
I don’t agree with much the Iraqi go
I know this is a post-christian con
vernment says, bur I must say I thought
ference, but as a citizen of a Christian
the Iraqi embassador to the UN’s remarks
country let me just close by saying: »The
in the open media on the Iraq crisis where
road to hell is paved with good inten-
he said: »Why are we talking about hu
tions.«
manitarianism when we should be tal
king about the justice of the war?«, was
Translation: Esther Kleefeldt
absolutely correct. And indeed unassai
lable as a position. It seemed to me he
had it exactly right.
19
Nuruddin Farah (Writer, Somalia /South Africa)
Our Problems - Their Gains!
Considerations about Colonialism and Aid
I have a vague memory of a conversation
Europe, the USA and Africa. As it hap
I had recently with a Nigerian academic
pens, we, in Africa, worry our vexed
visiting Cape Town. We were in limb
rapport with the developed world in the
time, because we were at the wake of a
same way the weak worry the troubled
mutual friend who had just died. I was
relationship they have with the strong,
there that evening with a specific assi
who impose their will on them without
ever bothering to pay them a moment of
gnment: to formalise the proceedings of
the funerary arrangements at the chapel
at which I had been asked to officiate.
their attention.
Everyone was busy with one thing or
another, and there were a great deal of
later in the same week I sat at my desk
to write my talk, soon after accepting to
comings and goings, with friends and ac
participate at this symposium, the phra
quaintances joining us and then drifting
ses kept badgering me time and time
away after listening to our arguments or
making their contributions. Of all the
again and without a letup, until I agreed
things that were done or said, however,
I remember only a couple of phrases that
have remained sharp at the edges in the
way words spoken in a delirium are.
Which perhaps explains why, when
to use them.
Our Problems, Their Gains,
indeed!
I recall going away, getting into my
car and driving home, all the while mul
Africas history is a shop-soiled one in
ling over the phrases »Our Problems,
are a damaged people on account of the
continents centuries old contact with the
Their Gai ns!« I have no idea why the
the sense that as goods go, our people
phrases struck a cord with me, or why I
kept reciting them to myself as though
impure thoughts and unclean hands of
they were a mantra whenever I revisited
reduced to a fall continent, every failing
the colonialists. By virtue of having been
rhe evenings exchange in my memory.
is blamed on us. We’ve been turned into
Nor can I identify where they came from,
a metaphor, the place where everything
or who uttered them. It may have been
has allegedly gone wrong, according to a
the Nigerian academic who had used
perverse logic in which everyone is help
them; it could equally have been one of
lessly poor, where millions are dying of
the other interlocutors who spoke them
AIDS or related ailments, where commu
in connection with our recurrent debate
nities are warring »over nothings Africa
about the vexed relationship between
is where the do-gooders go, not so much
20
to do good as to feei good, following the
we made great strides in every sphere,
balancing of their guilt accounts; it’s also
especially education and in the creation
of viable infrastructures. It was our aim
where do-badders go in pursuit of their
own self-serving ends, or those of their
to catch up with the other continents,
governments. Africa is the sewer into
which rhe donor countries’ unemployab
given that the imperialists indifference
les are conveniently drained, and where
to our well being. (Compare the number
of schools and students in the Somali
mediocre persons can acquire "expatriate
peninsula during the colonial era to those
expert* status and therefore earn far bey
who've gone to schools in the first twenty
ond their reach in their countries. A So
years after flag independence, and you
mali proverb has it that a hundred cures
will comprehend my meaning. To my
are on offer whenever one person is sick.
mind, anyone who argues that Africa is
Thar Africa is ailing is an undeniable fact.
doing worse nowadays that it did during
Many of us are concerned with the ever
the colonial era is playing hide and seek
present question as to what has brought
with the truth!) And lastly the present,
about this stymied state of affairs. Some
when Africa is, admittedly, in dire dold
of us trace Africa’s failings to the »black
rums, and when we find ourselves at the
shadows of disease and starvation* - as
Joseph Conrad puts it- these being the
lowest rung of the worlds development
ladder. Who is to blame?
consequences of the imperialist’s genoci
1 suppose that one ofour major failing
dal policies that depopulated whole areas
was that we didn’t pay heed to the age
of Africa, and sequestered her future.
old wisdom that who puts all his eggs in
Considering the time constraints, I
will give a very brief outline of why we
day and night, if only to kept track of
one basket had better stand guard over it
are where we are and how we got there.
where it is, what is happening to it, and
At the risk of sounding simplistic I will
what is going into and out of it too.
divide our vexed relationship with Eu
Rather than watch over our basket, we
rope into four main timelines: before the
turned our attention elsewhere, purpose
arrival of rhe colonialists, when the con
fully getting down to the serious business
tinent was not much different from se
of making up on lost time and lost op
veral other continents when we too ate
what we grew and didn’t feel beholden
portunities. In less than two decades, we
increased the school enrolments in our
to external influences; during the colonial
countries five hundredfold, built more
era, when, turned into chattels, we were
enslaved, sold and transported across
oceans, and when Africa became de
veloped more of our technological capa
populated, with millions of its able-bo
cities than the colonialists did in two
infrastructures to enhance the number
and quality of our institutions, and de
third stage coincides with the decade
hundred years.
Another failing was that we assumed
following our flag independence, when
we had got shot of the colonialists. But
died men and women taken away. The
21
no, our dependence on rhem rook a
tourists, they are unfamiliar with the
pathological turn. It was as though we
ways of the peoples, and are downright
couldn’t live without them -more like a
offensive to other cultures.
woman who says she has a brute for a
husband, but who won’t leave him, be
But what is my gripe?
cause she is hooked on brutality. In fact,
no sooner had the selfsame colonialists
quit our territories than they returned,
My main gripe is with my people: who
are short on commitment, but rich in
as our technical advisors on fat cheques,
the rhetoric of the mendicant, and whose
supplemented with hardship allowances,
response to our problems has been zilch.
charged with the task of working on our
Nor have we displayed a minimum of
five-year-plans of development. A few
self-regard, or made the slightest attempts
more of them arrived later as part of a
to solve some of these problems in as ho
package under rhe rubric »bilateral agree
nourable, as truthful and as scientific a
ment,« a byword for doctored falsehoods.
way as possible. Please do nor misunder
And when the purchasing power of our
stand me. I am not displeased in my peo
local currencies weakened still further,
ple or dismissive of them, because they
and we couldn’t even pay the salaries of
have relied on rhe sweat and produce
our civil servants, and couldn’t run our
of other peoples’ labour, but because
universities fruitfully, and when the
they’ve continued to abide by other
teachers of our schools had no chalk and
folks’ frames of references. What’s more,
our pupils no exercise books -and we
they have handed our problems that are
know how this came about, and can
of our making over to other economists,
name the institutions that are responsible
for the diminution of our buying capa
other scientists and other thinkers with
cities through rigging our economic
At the very least, we should have had a
potential- another term with a twist in
shot at them ourselves in the dubious
the tail became a la mode: foreign aid,
their own agendas or their governments.
hope of becoming beneficiaries of what
state-managed by men and women who
ever knowledge or experience one might
operate in the grey area between com
gain from tacking them. If the problems ;
passion for those in need and con
are ours - which no one doubts they are-
descension to the same. As a species, the
why should working the solutions out fall
men and women in the aid business are
to others, unless there is something in it
-my apology to Susan Sontag, from
for them, which they say there are not.
whom I’ll borrow the phrase- tourists in
To-date, our contribution to the exer
other peoples’ tragic realities. They fly in
cise has been limited to us providing
looking like boys and girls just out of
the paparazzi with our shock troops in
grade school, and move about showily in
the form of starving millions, many of
4x4s, talking down to everyone and
them children and women, the former
throwing their weight around. Mere
with flies feeding on their kwashiorkor,
22
the latter heavily pregnant and unable
on their haunches forever waiting to be
to move or breastfeeding and skeletal
attacked, or expecting help from some
too, and to then making appeals to the
one else. Meanwhile, the developed
international community. Our problems,
world will dispatch its aid workers and
Their Solutions!
its gunrunners, and before long we’re
Before resting my case, let me sidestep
back where we began, with the vicious
the question of foreign aid so as to frame
cycle recurring, and no peace and no
it in a way that takes account of the de
democracy on the horizon.
structive nature of the rapport between
I can think of a country, Ethiopia,
the developed world and ours. In a poem
which has never known peace and has
I titled »Modern Traveller® and published
never experienced democracy, and where
in 1898, the English poet Hilaire Belloc
famines, wars and centuries-old under
boastfully says,
development have worked hand in hand
for as long as anyone can recall. Every
» Whatever happens we have got
The Maxim Gun, and they have noth*
decade or so, there is either a war feeding
on the country, famine, for which the
world stage manages an epic performance
One is tempted to exclaim, »What ar
in a stadium, say, in London or New
rogance?" or »So what?« and, leaving
York, or a state-generated tyranny in
it at that, walk away from the entire
which several thousand students are de
scene. However, one would do well to
tained. But does anyone care, including
pause, heed and then retort that Bellocs
the so-called donor countries? Not about
arrogance is in part due to the fact dtat
peace, nor about democracy, nor about
the Ethiopian victims.
we buy these guns and use them on one
another until we raise the famines and the
No wonder the Ethiopian ruling oli
resultant starvation, and thus perpetuate
garchy go through life with the expecta
our underdevelopment.
We know that wherever there are guns
there will be dire consequences of war,
tion that even if they interfere in the
political affairs of one countries neigh
and there is famine. And where dtere is
create further havoc by attacking yet a
no democracy, and where state tyranny
is as commonplace as malaria is in the
third country, with the result that the
tropics, people will feel alienated from
bouring to it by invading it, and then
wars produce heavy casualty figures close
themselves. Being alienated and dis
to two millions dead, three million dis
placed, Ethiopia feels entitled to recei
enfranchised, we sense a false em
ving food aid for its starving millions.
powerment: that we have more guns than
I’ve seen enough African heads of state
they, and so we attack one another, razing
our villages to the ground, with third
do what they consider their foot fancy
work, blaming the weather, the World
parties selling more firearms to all the
Bank and the IM without ever explaining
sides. And those that have no guns stay
-as in the case of Ethiopia- why they need
a standing army close to a million, and
turies. But if we want our peoples to be
why their arms-purchasing bills come to
equal partners of the developed, then die
billions of dollars. You can be sure the
world must confront wars, famines and
Ethiopian Prime Minister, whose creative
anti-democratic tyrannies with equal
duplicity knows no bounds, won’t admit
venom, discourage gunrunning, and
to being even partly responsible for the
disband the amateur voyeurs who arrive
upheaval of a region with the population
of a hundred million inhabitants, where
as tourists after a disaster has struck; and
famines, wars and underdevelopments
the world must remove the agricultural
subsidies put in place to protect the
are the triplets that hold us back.
no food-giving charities please. Instead,
That Africa has survived is testament
markets that have remained closed to our
to her resilience, especially when you
tralian and the North American native
goods; and no trade embargoes please.
This way, we will be able to the redesign
our lives, own dieir problems and will
populations whose numbers dwindled
eventually come up with our solutions,
through continuous massacres over cen
and make our gains.
consider what has become of the Aus
24
Dr. Ruchama Marton (Director of Physicians for Human Rights, Israel)
About Loneliness and Radicalism
Israel - Palestine: There is no Reasonable Aid without
Political Intervention
In the context of rethinking the power of
Another option is to deal with what
aid we wish to discuss the unique, iflimited,
we in rhe human rights NGOs com
place of Physicians for Human Rights-Is-
munitycall »cases« - assisting the victims
| rael, (PHR-I): An Israeli NGO that is
' both a human rights organization and an
of specific violations - trying to solve
organization of social solidarity, based on
would need the knowledge of legal lan
professional-medical co-working.
Our basic defining experience is lone
guage, a working knowledge of the State
their individual problems. Here one
structures and authorities, and the wil
liness, both at home and abroad: cer
lingness to negotiate with the perpetrator
tainly not a characteristic global feeling.
case by case.
This is not to say that we do not find
Practical humanitarian aid does not
support from our colleagues abroad, but
belong to the human rights organization
rather to stress that loneliness is some
tradition, but rather comes from charity
thing we choose. Being part of the
orientation.
perpetrators society, there are not so
many other options opened to us.
An Israeli human right NGO can take
PHR-Israel combines case-by-case
intervention with an ongoing struggle
against the policy lying at the base of
the stand of an observer: one that docu
these violations, trying to expose the
ments and repons the violation ofhuman
processes involved.
rights. The language of »objective« docu
The character of our work is influ
mentation is one that is received well by
enced by the nature ofdoctors’ education
current western-legalistic discourse. Fur|thermore, it gives the documenter credit
that includes the specific bond or con
in the eyes of international agents that
wasted can mean death. Doctors are also
will associate it with reliability. Being
educated to be very practical - which
nection between time and life. Time
»objective«, though belonging to the oc
means dealing with the case at hand.
cupying society, is in itself admirable.
Inherent to their vocation is the sense
Reliability will be attributed to the obser
that they are as God - in their own eyes
ver also by certain parts of Israeli society
and their community as well. This bears
- first and foremost the media, which
a huge sense of responsibility. However,
finds it easier to deal with concise statistics
in PHR there is another quality - lacking
than with long complex arguments dea
in many doctors - Radicalism.
ling with processes.
Radicalism, although it is a choice to
many in our organization is not the ob
As an Israeli organization we know the
vious choice for others. Some of the
we are aware of its results as social and
physicians suffice in responding to an
individual s hardship: the patient without
historical process. It is our duty as
treatment or access to treatment, the
ledge.
Example: In the UN special delegate
tortured prisoner, the physician blocked
Israeli apparatus of the occupation, and
Human Rights activists to use this know
are following the practical aspect of me
to the OT report - Bertini’s report - one
of the demands from the IDF is to make
dicine. Gradually, many will turn to the
sure that a Palestinian ambulance will not
wider point ofview that tries to challenge
the source and processes that are at the
be delayed ar a checkpoint for more than
on the way to work. By doing so, they
origin of the individuals hardship (occu
pation, medical infrastructure level, re
source redistribution).
30 minutes. The International Com
mittee of the Red Cross demanded that
this should be no more than 15 minutes.
We cannot accept either of these de
There is a tension between the indi
mands: a 15-minute-delay at one check
vidual and the macro level in our work.
point, excessive in itself, becomes a tour
Some prefer to give the weight to the
individual level and not complicate it by
of hours as there are several checkpoints
on every route and so the way to or from
radical thought and action. This radica
medical care turns into a nightmare or
lism, they fear, is pushing us away from
in other words- a medical crime.
the consensus and thus making our in
This is why we cannot be satisfied with
fluence on that same consensus and its
collecting data on births at checkpoints,
administration scarce. Furthermore,
or on demanding that soldiers be put to
there is a great temptation in aiding the
trial. We will insist to show the process
individual, it makes good pictures on TV
by which the occupation has reached
and enables empathy and a feeling of
these depths: In the past the generally
identification with the good-doers on the
accepted norm was one in which a
part of Israeli society. We believe it is our
woman in labor would be allowed free
duty to be careful not to fall into the
passage to the hospital. In 1991, with the
warm hug of consensus, and while aiding
GulfWar, tire Gestalt of occupation took
the individual — never neglect the radical
over Israeli outlooks to such a degree,
thought that inevitably leads to strugg
that when a curfew was imposed women
ling against the causes of suffering and
in labor were no longer an exception in
oppression.
the eyes of the soldiers. Deaths as a result
In our understanding PHR-Israel is
of this approach made it necessary to
not allowed to be just an observer to the
wounds and destruction of the conflicts.
create written regulations obliging sol
diers to allow women in labor passage. It
As doctors, we must assume responsi
is fair to say that once we found such
bility to heal the sick and the wounded.
written regulations necessary (i.e., the
26
mid-90), we had in fact lost the game.
for one patient or more, whether it was
It is not enough to be an observer or
donated or purchased, whether it was in
strive for »regulation« that will assist in
a box or a bottle, what legend it bore,
our dealing with violations case by case.
who sent it and so on. The authorities
In order to achieve real change, the exis
then demanded medical documents
tence of a group that will demonstrate
proving that this specific medicine was
radical political commitment and inter
indeed required of Dr. Barghuti, as well
vention is vital. This group - so we see
as the precise name of the medicine.
PHR Israel - must not only confront the
While we were attempting to collect all
authorities with rhe violations defined in
these details - though feeling its absurd
| the legal language of international co
— the authorities informed us that the
venants but must also demand them to
people who were to come from Ramalla
to collect the medicine from rhe crossing
have the moral courage ro open their
policies to social justice and and basic
must go in a Palestinian vehicle. In Jeri
human morals:
cho, they must board a bus that would
take them to Allenby terminal. There was
We u/ill give an example
no point in their doing so, however, since
Dr. Hasssan Barghuti, a lecturer in
authorization had still not been granted
literature at Al-Quds University in Jeru
salem, suffered from cancer in deteriora
with the Medical coordinator for rhe
ting situation. A hospital in Jordan sent
Civil Administration, Dalia Bessa, were
medicine at the recommendation of his
also unsuccessful, since she also de
for receipt of the medicine. Our contacts
physician at Sheikh Zayyed Hospital in
Ramalla. A special courier from the
manded medical documents before ap
Jordanian hospital came to Allenby
Two days later, we telephoned our col
leagues at UPMRC ro update them, only
Crossing with the medicine, but was not
permitted to cross to Ramalla. He left
the medicine at the Israeli desk at the
proving the passage of the bottle - or box.
to learn that Dr. Barghuti had died. At
the same rime, a telephone call arrived
crossing. The Union of Palestinian Me-
from rhe civil administration, asking for
hdical Relief Committees contacted PHR-
yet another medical document in order
' Israel and asked us to help release the
to issue rhe permit for the passage of the
medicine for this patient. At first, rhe
medicine. We informed them that the
Israeli civil administration demanded
coordination was no longer required.
that we arrange for a vehicle to come to
the crossing to collect the medicine.
PHR-Israel insisted that there was no
point arranging for a vehicle until autho
rization was received ro release rhe me
Could it be that the real factor here
was not Israel's security, but rather the
habit of controlling the life and death of
Palestinians?
How does one report such a violation?
dicine. The civil Administration then
How do we translate into an under
asked whether the medicine was intended
standable language the sense of medical
27
emergency (»medical time
),
**
and unveil
more on the charity of foreign aid. Major
die shackles placed on each stage by the
General Amos Gil’ad, rhe Coordinator
bureaucracy of occupation? Precious
of Government Activities in rhe Occu
seconds for life are translated into hours
pied Territories has said more than once
of words procedures. How do we bring
that the Israeli policy in rhe OT is enab
the seconds back to life? How can we act
in what is by definition a system of be-
led by rhe fact that Israel allows the in
ternational community to supply rhe
aurocratic time whereas in medical time
humanitarian needs of the Palestinians.
we have no time to waste?
The economic burden of doing so is too
In our medical actions - treating the
high, so says he, for Israel to sustain (12
individual in our Mobile Clinics in the
billion shekels per annum). (Haaretz,
West Bank - which one could wrongly
July 5, 2002)
The financing of the Palestinian civil
view as humanitarian by nature - we
insist on a radical method: We refuse - as
medical staff - to ask the army for per
systems by international agencies to a
large extent funds and supports Israeli
mits to enter the WB, we refuse their
armed escort for »our security
.
**
In this,
occupation policy. In the long run it will
abolish the Palestinian economic system,
as well in the very action of crossing into
and erode its ability to recover. At the
forbidden, segregated territory, we de
same time it removes responsibility from
monstrate a protest against closure,
curfew and for freedom of movement.
accompany humanitarian aid by a con
The medical aid itself exists as a part of
the act of concrete solidarity enabled by
it.
Being an Israeli organization we refuse
to treat the crisis in the occupied territo
ries as temporary and as devoid of con
text. Unlike Israelis who begin the histo
rical account of the current situation
from where it is convenient to them (i.e.,
September 2000 and rhe breakdown of
Israel as an occupier. The demand to
stant uncompromising demand to with
draw from the Occupied Territories is
not less political than giving such aid
without this demand.
Such a demand was presented to MSF
Italy by us and also to various delegations
- UN included - that operate in the
Occupied Territories. It was listened to
seriously. Loneliness is therefore not,
complete. But loneliness is both a choice
the Camp David calles), - we are familiar
and a state of mind. It is also the strength
with, and therefore acknowledge, rhe
to recognize one’s unique place in the
struggle and use it as a tool.
long historical processes of occupation
and dispositions that brought it about.
For this reason, we cannot regard the
humanitarian crisis in the Occupied
Territories as an independent sudden
natural disaster. This crisis has led the
Palestinian community to rely more and
28
Ulrike von Pilar (Director of Medecins sans Frontieres, Germany)
Focusing on Unconditional Humanity
Neutrality Guarantees Room for Manoeuvre for
Humanitarian Organizations
I claim it is counterproductive to mix up
the different forms of humanitarian aid
The first priority - the
most needy
and to have the same demands on each
.of them with regard to their political
This is the central challenge but it recei
'positions. We should be more careful
ves for too little attention. The central
and precise when dealing with the va
point is unconditional humanity and
rious concepts and competences of aid:
the right to aid for survival. This does
Humanitarian aid is only one possible ap
proach - the protection of human rights
not come because a person belongs to a
particular party but because he or she is
and development aid are others.
a human being. This is expressed in the
The centre piece of humanitarian aid is
principle of impartiality: in situations of
the help offered to people in acute situ
urgent need there are no good or bad
ations of violent conflict - that is what
it is for and that is the responsibility of
victims. Aid must be offered according
to the extent of suffering - first of all
humanitarian organizations. They will
to the most needy. Therefore, first and
be judged by their ability to alleviate
the lot of these people. This is why
foremost humanitarian work must act
independently - only in the interest of
the history of humanitarian practice is
the victims, only according to needs. If
indeed a history of tragic failure - not
one mixes these principles, for example,
necessarily a failure of the humanitarian
with demands for human rights or for
free elections, humanitarian aid will be
organizations but rather of the internati
onal community, which stipulated at the
.Geneva Convention that human beings
nave a right to aid, but who frequently
was unable or unwilling to guarantee
this right and to impose it. There was
no help for the victims of genocide in
granted only with political strings. In this
case, humanitarian aid would be turned
into a political instrument - which it
should not be, since it can then justifi
ably be perceived as outside interference
and can lose its humanitarian character
Armenia. International relief was not
and its credibility,
provided in Auschwitz, in Cambodia,
Neutrality, on the other hand, that is, to
in China during the cultural revolution,
in the Vietnam War or the Gulf Wars, in
Kosovo and in Afghanistan at the time
of the US bombardment.
take no position in a political conflict, is
a »tool«, not a value in itself It guarantees
access and acceptance and it pursues no
nhidden agenda».
29
When one insists that all aid must be
humanitarian rights. However, in order
political because otherwise the aid be
to do this we need to reach out with per
comes an accomplice to existing power,
mission of those in power.
this must then be seen in a more diffe
Without question there can be no neutra
rentiated and clearer way. Medecins sans
lity towards human suffering. But when
Frontiers (MSF) has always emphasized
Thomas Gebauer demands that every
that aid never acts nor can take place in
aid organization must have a vision of
a non-political space, that a political
a democratic Iraq, I disagree. As MSF
analysis of that context and its respec
tive interests (including the interests of
we don’t know much about democracy
aid organizations) is essential. However,
zation have an position on this matter? .
MSF generally attempts to stay neutral.
We don’t have a public position in every
conflict and we don’t think that every
humanitarian aid and for the possibility
in Iraq, so why should we as an organi
MSF does call for access for independent
conflict situation calls for a political
to provide aid. MSF demands protection
from violence and the arbitrary use of
position. However, first of all we do
power for the people. It calls for a sys
our best to provide information about
tem that provides food, water and basic
the people for whom we work and their
medical care for all. This is the task and
reality. Secondly, we do protest publicly
the responsibility of a humanitarian or
whenever there is a massive misuse of
ganization.
humanitarian aid.
But as a humanitarian organization we
are not obliged to have a position on all
For the people in the midst
of war
political questions and on all govern
ments.
As catastrophic as the state of human
A lot has been said and communicated
about humanitarian aid but little is hap
rights was under the Taliban, humani
pening. There is plenty ofspeculation but
tarian aid was still possible to a certain
no one knows exactly what the present
extend and under difficult conditions.
As MSF we did not directly call for
situation in Iraq is, yet everyone is talking
about humanitarism. In recent years hu
womens rights - others were in a better
manitarian aid has increasingly become a
position to do that. But we were able to
document the medical consequences of
communication strategy — terrible politi
cal crises are described in the terminology
their incredible restrictions for women
of humanitarian aid, as if this were the
and children. Frequently human rights
only answer to these violence and con
flicts. This is not the case. People who are
organizations were better able to demand
their political task and mandate. It is
our task to provide practical help for the
threatened by violence need protection
from violence first rather than humani
tarian aid. This protection can only be
people on a local level and to insist on
offered by political or perhaps military
their civil rights than we were - that is
30
actors. But those increasingly offer aid
people in the midst of war. The alterna
rather than protection — aid as fig-leaf
tive would be the total war. For me this
and as propaganda to justify »force pro-
is one of the major achievements ofcivili
tcction« or to calm local negative attitu
zation: protection and aid for defenceless
des towards the military.
human beings in the midst of war. Or
It is often said that humanitarian aid
would we prefer the following scenario:
prolongs war. This might be the case
War starts and the humanitarian organi
sometimes but thorough, differentiated
zations leave? This is the solution some
studies are missing.
would prefer - but for me this would be
Humanitarian aid would humanize war
a return to barbarism.
and thereby make it more feasible, is
another reproach. But that is precisely
Translation: Keith Chamberlain
the task of humanitarian aid - to help
31
Cornelia Fullkrug-Weitzel
(Director of Brot fur die Welt/Diakonie Katastrophenhilfe, Germany)
Aid between Humanitarian Service
and Social Intervention
Towards a Critical Re-definition of the Political Role
and the Ethics of Aid
I shall refrain from making a case against
the political game and its rules; when
politics and the media. I prefer rather to
one doesn’t know what political game is
pose some critical questions to the hu
being played, what one’s role is and how
manitarian aid organizations ourselves.
effective one can or cannot be; that is
Questions to us who have committed
when one remains ignorant and passive
ourselves to the Code of Conduct, whose
and only reacts rather than being know
central assertion is: »We will take care
ledgeable and pro-active.
that we don’t become instruments of any
1)
governments foreign policy... (we) are
organizations which act independendy of
From recent developments since the
governments. For this reason we formu
Balkan Wars we have learned from our
late our own procedural and operational
western governments and the mass media
strategies. We have no intention to imp
that in such conflicts in which massive
lement government policy... nor will we
interests are involved and political-mili
allow ourselves to become agents of the
tary interventions are planned, that the
foreign policy of donor governments™.
ethical-humanitarian argument is more
This commitment involves humanitarian
and more used as a political-ethical
aid with no exclusions - it responds only
to the degree of poverty and need. Hu
justification and that humanitarian aid
manitarian aid must consciously be pro
tected from being misused to political or
jected to the political war and post-war
strategies - so to speak as publicly effec
partisan ends. Now this noble principle
is increasingly integrated into and sub
tive sub-components to ease the painful
stands in direct opposition to the pro
effects of war. Exaggerating a little, Jens
vocative title of this discussion: »Aid - a
Jessen, writing in »Die Zeit«, recently
hostage of foreign and security policies?™
and raises a number of questions.
But first it must be observed generally:
compared this to the division of labour
between a surgeon and an assisting nurse.
The former cuts and removes the malig
one becomes a hostage and an instru
nant cancer while the nurse cares that the
ment of political power when one feels
and acts like a dependent, powerless
wound doesn’t bleed too profusely.
The present situation gives rise to the
prisoner who must submit oneself to
claim that humanitarian aid organiza
32
tions are increasingly in danger of be
Are we condemned to being »inregra-
coming efficient humanitarian »service
ted« and dependent? Are we willing to
agents", who not only must submit
and able to afford to turn down money
themselves to the logic of war but are
offered by governments when it is tied
also »embedded« into concrete military
to conditions - as recently done in rhe
planning. Humanitarian aid in the en
case of Iraq by members of our own
tourage of the occupying power is char
global church network for humanita
ged with »winning the hearts and minds
rian aid ACT (Action by Churches
of the people". Recently Colin Powell,
Together) from belligerent countries?
with unusual candour, called the huma
Or done by the Diakonie Katastro-
nitarian organizations »power multipli
phenhilfe in the case of Serbia?
ers and an important part of our combat
And in any case of doubt, do we put
first our own economic interests and
forces". Accordingly guidelines are being
prepared to determine who can provide
market pressure or the principle of
help to whom in accordance with poli
humanitarian aid to which we have
tical and military strategy goals.
committed ourselves in the Code of
Conduct?
This sort of cooperation is not the result
of argumentative persuasion on rhe part
i At what percentage of back-donor
of governments. It takes shape above all
money (government money) in our
through competition and access to public
budgets has the critical limit of our
resources, favourable or unfavourable sig
ability been reached to resist a political
nals by the mass media and the immense
instrumentalisation?
money raising capacity that they provide.
The economic logic ofhumanitarian aid
■ Are we in a position to set up counter
balances and counter strategies which
favours an involuntary politicisation. The
give us more flexibility not only in
increasing number ofhumanitarian orga
Germany but also in the internatio
nal context?
nisations who are basically dependent on
government support play a central role in
these dynamics. In addition, there is an
2)
entire range of protection and coopera
Our humanitarian credo »not to under
tion offers from the military and govern
stand humanitarian aid as a partisan or
ments which enhance the motivation to
political act« has not protected us from
let oneself be instrumentalised.
the fact that in many violent conflicts
Mind you, this is not a moral claim
and wars the humanitarian aid of civi
against politics but rather an attempt to
describe the real conditions and our wea
lian aid organisations produced clear
political effects and emanated political
knesses. Consequently, we have to ask the
signals. Many of us will remember the
following questions to ourselves:
accusations from political and media
circles that local warlords and despots
were maintained and alimented with
33
humanitarian aid, thus extending sense
any longer interest in the humanitarian
less wars. Out of the USA emerged the
situation of the people — see the Balkan
concept »Do no harm« as a guideline for
and Afghanistan).
humanitarian organisations to contribute
to peaceful solutions through specific and
This also raised several questions:
deliberate aid.
Since the Kosovo War and at the latest
b
If it has become clear to us that the
action or inaction of aid organisations
following the 11th of September we
have political consequences for local
now see in a political roller coaster how
conflict parties, the affected populati
western, and especially US policy regards
ons and international policy, how do
these local conflicts as a global challenge
we see to it that our activities really
and how a military intervention is per
»do no harm® (not only in the trivial
ceived as an ethical solution. And the
sense of limiting local conflicts)?
people affected see how humanitarian
si Should we ignore all of this and,
organisations withdraw their personnel
as David Rieff recommended this
and services in the face of a pending
morning, simply limit ourselves to
military intervention only to return in
our »core competence®, deliver the
the wake of that successful intervention
aid and leave the politics to those
- under the protection of the victori
ous military forces or even as part of
responsible? I think that the Code
of Conduct would not allow this and
them. Intentionally or unintentionally,
that impartiality has its price.
humanitarian organisations in these
■ Should we deny this, or at least not
cases also set clear political signals and
mention it, because it is not good for
fund-raising? People seems to prefer
produced consequences in spite of »Do
no harm«, which proves to be obviously
inadequate.
to give money for uncomplicated
humanitarian aid precisely for this
Since then we have even seen how huma
nitarian aid activists themselves called for
reason rather than for long-term
development aid, because emergency
»humanitarian interventions®. Starting
aid seems to be less complicated as
in rhe beginning as a concept to contain
war, humanitarian aid became a legitimi-
organisations like ourselves (Brot fiir
die Welt and others) have repeatedly
sation for war through the emphasis in
called to attention the unjust econo
the so-called »humanirarian imperative®.
mic structural conditions which make
»Humanitarianism« with the public sup
port of so-called humanitarian organisa
the success of our help questionable? I
tions became a propagandistic argument
for military actions whose real reasons,
sues to uncover their abuse. Only that
is a useful prerequisite for combating
think we have to speak about these is
as we know, were quite different; and
this abuse and for the defence of the
barely had the wars begun, and even
good and urgently needed principles
more after they ended, nobody showed
of humanitarian aid.
34
Working in this enlightening way, we
relations. Being a Christian humanitarian
cannot simply name the political con
aid organisation which is under the same
sequences without assessing their value.
roof and under the same administration
But on the basis of which ethical prin
ciples shall we do this?
3)
This leads to the last point: I think that it
is time to account for our ethical princip
as the development organisation Brot fur
die Welt and Diakonie Menschenrechts-
arbeit and cooperating closely with both,
it is probably easier for Diakonie Kata
strophenhilfe to relate humanitarian aid
with other ethical principles such as, for
les as a humanitarian aid organisation, or
example, a clear peace and reconciliation
more generally: to speak about die ethical
commitment without much pondering.
principles of humanitarian aid. Who are
(This can also offer some protection from
we, the various humanitarian aid organi
the influence and pressure ofa utilitarian
sations and what are our spiritual-intel
and capricious ethic in politics)
lectual roots? Which religious or political
As part of a large organisation it is easier
convictions or economic considerations
for us to make use of the various and
influence the humanitarian evaluation
specific instruments of long-term deve
and actions or condition them? What
lopment and peace work, lobbying and
vision and overall strategy play a role in
humanitarian aid through the sharpness
our work, consciously or unconsciously?
which results from this separation, wi
This has consequences for its quality,
thout, therefore, turning blind to the
too. The Diakonie Katastrophenhilfe
(responsible for emergency aid) - as a
greater challenges and visions, as well
as for potential conflicts of objectives
church aid organisation, definitely not
without feeling politically powerless.
an zeitgeist-organisation and considered
We don’t have to realize human rights,
by some to be outdated and dismissed
peace and development work with our
like some parts of Europe by George
Bush - has never made a secret of the
humanitarian aid. But we do have the
fact that our recognition of the need for
demands of protection of human rights,
as well as peace and development policies
non-partisan and neutral aid fits into a
in mind when we plan our humanitarian
comprehensive ethical concept. This con
aid strategies. Thus our strategies gain
cept is not characterized by neutrality but
a specific quality which we consider to
rather by partisan action in favour of the
be indispensable. Humanitarian aid is
poorest, peace, religious and ethnic un
implemented under the perspectives of
derstanding, reconciliation, social justice,
sustainability, human rights and human
human rights and human dignity, parti
dignity and the promotion of peace. This
cipation and empowerment and, last but
doesn’t impinge upon its neutrality but
not least, by Christian compassion. All
is part and parcel of its Christian-ethical
this is part of our evaluation of situations
orientation.
Translation: Keith Chamberlain
and strategy of aid, as well as our public
35
I iumanintriunlsm in
Rethinking the Power of Aid
A Conference on the Future of Humanitarian Aid
March 28-29, 2003
University Frankfurt/Main
Friday, March 28, 2003, 6 pm-10pm
Opening
Humanitarianism in a state of crisis
Welcoming address
Katia Maurer (medico international)
Ingrid Spiller (Heinrich Boll Foundation, Berlin)
Prof. Micha Brumlik (University of Frankfurt)
■
The humanitarian paradox
Aid in limes ol war and poverty
Thomas (lehaucr (Executive Director of medico international, Frankfurt)
A win wm situation?
Who Is helping whom after all?
Iltiinddiii I'aiah (Writer, (ape town/,Somalia)
Ilin i tixe uf lurtiel/Pulextine
1111 * j i io t li >t io I Aid and local I luimm Rights NGO
Pliyjlt iitii>< Im I Innum Rights Israel
I It Um Ihtnui Million (President of Physicians lor I Inman Rights, Tel Aviv, Israel)
I *l|| IHsIllII
Ahl in Hun m ul wm
Uli llu piitili hulling gumi spcakeix
Saturday, March 29, 2003, 9 am-9 pm
The reality of aid
Welcoming address
Katja Maurer (medico international)
A bed for the night. Humanitarianism in crisis
David RiefF (Reporter and Writer, USA)
Panel discussion
Aid between technical pragmatism and political action
Sabine Eckart (Project Coordinator, medico international)
Dr. Ulrike von Pilar (Managing Director of Medecins sans Frontieres)
David RiefF (Reporter and Writer, USA)
Dr. Marrin Salm (Director of Caritas international),
Facilitator: Christiane Grefe (Editor, Die Zeit)
Panel discussion
Aid - hostage to foreign and security policy?
Prof. Lothar Brock (University of Frankfurt)
Cornelia Fiillkrug-Weitzel (Director of Bread for the World/ Diakonie)
I
Horand Knaup (Editor, Der Spiegel)
Claudia Roth (Representative for human rights and humanitarian aid, Federal
Foreign Office)
Facilitator: Brigitte Kols (Frankfurter Rundschau)
Satire
Brief interlude
with Matthias Deutschmann
Prospects of aid
3 parallelforums
Forum 1
Is there a legal right to aid?
Keynote: History of humanitarian aid: ethics and interests: Prof. Micha Brumlik
(University of Frankfurt)
Input: Right to aid? International law, right and moral: Prof. Dirk Fabricius (Uni
versity of Frankfurt)
Practice: Human right to aid in theory and practice. Dr. Ruchama Marton (President
of Physicians for Human Rights, Tel Aviv, Israel)
Forum 2
': Aid as social responsibility
Keynote: Social security needs to be institutionalised in society: scopes in the na
tional and global processes of designing policies: Jurgen Stetten (Friedrich Ebert
Foundation, Berlin)
Input: Participative democracy, decentralization, secondary liability - the principles
of sustainable societies are also valid in the area of social security: Barbara Unmiissig
(Board Member of the Heinrich Boll Foundation, Berlin)
Input: Techniques of aid: Dr. Thomas Seibert (medico international)
Practice: Local and regional models of social welfare: Walter Schutz (medico
international, Nicaragua)
Forum 3
i Can aid be financed?
Keynote: Financing the ‘better world’: Which ressources exist? Jens Martens (Board
Member World Economy, Ecology and Development ( WEED)
Input: The role of ecomomy. Public Privat Partnership: Albrecht Graf von
Hardenberg (GTZ, Director of the Public-Private Parnership Programme)
Who wins in win-win-games? Critical reflections on public-private interactions:
Dr. Andreas Wulf (medico international, Health Action International HAI)
38
Concluding discussion and future prospects
Aid as a challenge to the status quo
Prof. Micha Brumlik (University of Frankfurt)
Nuruddin Farah (Author, Capetown/ Somalia)
Thomas Gebauer (medico international)
Jens Martens (Board Member of WEED)
Dr. Ruchama Marton (President of Physicians for Human Rights,
Tel Aviv, Israel)
x-v David Rieff (Writer and Journalist, USA)
Barbara Unmiissig (Board Member of the Heinrich Boll Foundation, Berlin)
Facilitator: Christiane Knauf (Hessischer Rundfunk)
Closing
Katja Maurer (medico international)
39
Rethinking the Power of Aid
Aid can never be an ally of war and violence. Helping each ocher requires empathy
and enables us co overcome poverty and dependency.
This idea of aid is subject co enormous pressure these days. Eradicating the root
causes of poverty and promoting social development used to be major aims of aid,
but today nothing more seems to be left but mere pragmatic action obeying technical
and economic criteria rather than social maxims. Donor interests are pushing their
way to the focus of attention or, what is worse, the act of providing aid increasingly
depends on the extent to which it can be exploited by the media. Aid is bound to
become a commodity which is no longer directly linked co those in need, serving as
an instrument to mitigate the effects of unsuccessful policies instead. Aid - hostage
co global security policy and prevailing informal power structures? It is high* time,
particularly for aid organizations, co scrutinize their own practices and the ongoing
structural change of aid.
The conference » Rethinking rhe power of aid« hosted by medico international and
the Heinrich-Boll-Foundation intended to raise awareness for these issues. A critical
analysis was being followed by the question for potential maxims for aid in rimes of
globalisation. Because a different kind of help is possible - and necessary.
mi
medico international
t\}Go-8-
THE IMPERATIVE
OF EQUITY:
THE MISSING
DIMENSION OF
UNCED
STATEMENT OF THE
SOUTH ASIA NGO
SUMMIT
NEW DELHI
FEBRUARY 17-19,1992
Centre for Science and Environment
THE IMPERATIVE
OF EQUITY:
THE MISSING
DIMENSION OF
UNCED
o
STATEMENT OF THE
SOUTH ASIA NGO
SUMMIT
NEW DELHI
FEBRUARY 17-19,1992
Centre for Science and Environment
The South AsiaNGO Summit was organised by the Centre
for Science and Environment (CSE) in New Delhi from
February 17 to 19,1992, to discuss the agenda ofthe United
Nations Conference on Environment and Development
(UNCED).
We are grateful to the following without whose financial
help the Summit would not have been possible:
United Nations Development Programme (UNDP)
Danish International Development Agency (DANIDA)
Indo German Social Service Society (IGSSS)
Centre for Science and Environment
F 6, Kailash Colony
New Delhi 110 048
Tel: 6433394, 6420253
Fax: 091-11-6438109
THE IMPERATIVE OF EQUITY:
THE MISSING DIMENSION OF UNCED
Statement of the South Asia NGO Summit
New Delhi, February 17-19, 1992
PREAMBLE
s
outh Asia is a region that represents more than one-fifth
of the world’s human beings. It is today also a region of
acute poverty and economic and technological backwardness.
But it was not always so.
Less than 300 years ago, it was one of the world’s most
urbanised and richest regions which attracted traders from all
over the world. This wealth was built upon the sustained use
of local natural resources which was governed through
extensive management systems in which both local communities
and the state played critical roles. The extraordinary ecological
diversity of the region — ranging from the cold deserts of the
Karakoram and Ladakh to the hot sandy desert of the Thar,
from the high mountain temperate forests of the Himalaya to
the lush tropical forests and vast mangroves of India, Bangladesh
and Sri Lanka and from the sharply dissected mountain lands of
Nepal and Bhutan to the unending, flood-prone plains of Pakistan,
India and Bangladesh—gave rise to an equally extraordinary
cultural diversity which embodied within it rich traditions of
ecological management and resource use. In large parts of the
region, however, colonialism and subsequent centralised
interventions completely disrupted and transformed the local
economic, ecological and cultural systems and left the region in
a state of all round impoverishment.
Economic development of the last four decades also did not
take into account either people’s own wisdom about their
natural resources nor did it hand them back power to manage
their environment. The result has been continued exploitation
2
of the resource base without any discipline or care for future
impacts. International banks and agencies have consistently
pushed and imposed a Western model of development that is
unsuited to the ecological and economic needs of the region and
have, as a result, exacerbated pressures on the local resource
base. This model is urban elite oriented and the distribution of
resources is at the hand of urban elites and bureaucrats. Therefore,
the gap between rich and poor has widened in the past and the
process is still-continuing. The international monetary system
has further pushed the region to the brink of economic chaos
through rising indebtedness, imposition of unrealistic conditiona
lities and declining terms of trade.
The main objective oftheUNCED conference is to identify
and promote a plan of action that will make this earth a better
and safer habitat for all to survive and develop. We strongly urge
the conference to develop a truly global agenda that responds to
the present and future needs of all human beings on earth. We
also urge the conference to develop systems of global ecological
and economic management that will be equitable and fair, in
which all will have equal access to and capacity to influence
the global checks and balances that are sought to be created. A
fair and safe world cannot be built by using levers of power that
rest largely with the rich and the powerful, whose consumption
and production is the main cause of global ecological destruction
in the first place. Sustainability is not, possible or desirable
without equity'and fairness. We are also firm in our belief that
each human society on earth has the capacity to develop its own
wisdom and equilibrium and contribute richly to the growth and
development of others. An ecologically diverse global habitat
demands a multicultural world i n which all cultures and soci eties
are equally respected.
It is keepingthisinmind thatthe South AsiaNGO Summit
has endorsed the following resolutions which we urge individual
governments, the proposed Rio conference and other NGOs to
consider in all seriousness.
*1
THE EARTH CHARTER:
Both equity and sustainability must be stressed.
e call upon the governments of the world to ensure that
” *
the Earth Charter endorses the following basic mini
mum principles:
1. The right of all nations to development.
2.
The right of all human beings to a clean and healthy
environment.
3.
The right of all human beings to equality in access to and
use of the global commons like the atmosphere and oceans.
4.
The right of all human beings to any information that
threatens or affects their health and environment, whether
this information exists within or across national borders.
5.
The right of all human beings to participate in the governance
of their environment on an ongoing basis through
participatory democratic institutions, beginning at the
community levelandgoing on to higher levels ofgovernance.
a)
At the international level, new mechanisms should be
created which allow all citizens of the world equal
opportunities to participate in global environmental
management. The existing levers of power such as aid,
trade and debt, which are available mainly with the
North cannot be used as a basis for global environmental
management and should not be used to impose new
conditionalities on the South. The North should review
the indebtedness of the South which in most cases has
become an unbearable burden.
b)
6.
All nations at UNCED must take a pledge to develop a
new tier of governance within their countries — a tier of
community level governance through open, participatory
institutions with inalienable rights over their immediate
environment to care for, use and manage.
The world economic order should be built on the principle
that all human beings, and especially the rich, must pay the
full ecological costs of their past and present consumption.
AGENDA 21:
Action priorities should be set by the poor
but only after the rich agree to pay the
full costs of their consumption.
j|
__ _1
he Agenda 21 as it stands today appears to be a donor
driven mechanism for aid coordination. It fails to address
the needs of the developing world. This summit demands that
UNCED must move away from a view of global environmental
management which sees it as a question of additional aid funds
or technology transfer. The Agenda 21 should emerge out of the
rights and obligations of all citizens as enumerated in the
proposals for the Earth Charter described above. The South
must not ask for aid and charity but for a fair share of the
common global resources.
Therefore, we demand that a global consumption tax be
levied so that the rich pay for their excessive consumption of past
and present world’s resources. The tax should be determi ned and
administered by a democratic global institution where every
member will have equal voting rights. The revenues so raised
should go to poor local communities through a democratic
mechanism to manage and improve their environment since it is
they who bear the burden of the ecological costs of unplanned
development and consumption.
FUNDING MECHANISMS:
Reject the GEF and develop an
automatic and democratic mechanism.
s an instrument for transferring funds to the South for
-------- environmental management, the GEF is undemocratic
becauseits decision making mechanism is donor weighted; and,
it is also immoral in that it places control of financial resources
in the hands ofnations who have created the problem in the first
place. The GEF also falsely differentiates between what is
'global’ and ‘local’ and thereby distorts the priorities of the South.
It represents not a compensation for the environmental misdoings
of the rich, but a continuation of the old aid order. It is like the
relief support that the North generally gives to the South after
a disaster. We, therefore, forcefully reject the GEF. Instead a
new fund should be created at UNCED on the principles
enumerated earlier and administered through a democratic and
decentralised institutional setup.
POVERTY AND ENVIRONMENT:
The South must stress this
as a key issue for discussions.
T
he UNCED processhaspaid inadequate attention to the
key question of poverty in the South and its links with
environmental degradation. The poor depend heavily on their
immediate surroundings to meet their survival needs of food,
fodder, fuel wood and water. Overexploitation, expropriation and
degradation of land and water resources by powers beyond their
control force the poor to the brink of survival. They then lose their
ability to withstand natural disasters and, in sheer desperation,
are forced to exploit their natural capital beyond sustainable
limits.
For governments ofSouth Asia, poverty alleviationhas been
a stated priority. Yet they have done little to insist that the
UNCED address this crucial issue. It is essential that our
governments impress upon those of the North that poverty is a
consequence and not a cause of environmental degradation. It
becomes a cause only in extremely desperate economic conditions,
the trigger for which often lies in unequal and ecologically
unsound economic strategies. A world in which a large proportion
of the population lives in abject and dehumanising poverty can
never be sustainable. Both the national and international causes
of poverty must be clearly identified and eliminated if environmental
disaster is to be averted and the poor of the world given a fair
chance to survive as a matter of human right.
Environmental degradation and poverty in the South are
strongly linked to global processes of trade and economic relations.
Growing debt and declining terms of international trade for
mineral and biomass products make it impossible for developing
countries to incorporate the ecological costs of their production.
The rich are not even paying a fraction of the ecological costs
of their enormous consumption and are being constantly subsidised
by the global poor. In addition, the debt crisis has resulted in a
situation in which the South today actually transfersUS$40-50
billion every year to the North, lea vi ng precious little to invest in
environmental management or poverty alleviation through
development. The policies of the IMF, World Bank and other
North based financial institutions consistently devalue the natural
resources of the South and make them ever cheaper.
At the national level, poverty has increased greatly because
of:
a)
constant imports of inappropriate development paradigms,
often under pressure from international agencies like the
World Bank;
b)
a steady erosion in the rights of local communities to their
environment;
a widespread failure to develop participatory systems of
governance;
c)
d)
e)
undemocratic and inequitable distribution of resources in
the society; and,
widespread corruption and misuse of resources by political
systems that are not adequately accountable to the people
who vote for them.
If we want to eradicate poverty, then, at the international
level, the rich must be made to pay the full costs of their
consumption through an international consumption tax. Since it
is the poor who suffer most heavily from ecological degradation,
the revenues thus generated should be made available to local
communities, through a democratic and decentralised mechanism
which is accountable to the people, to regenerate and manage
their environment. An international employment programme
which guarantees survival wages to all poor people across the
world would cost only US$30-40 billion every year. But it will not
only ensure that nobody goes to bed hungry but also provide an
extraordinary opportunity for harnessing the labour power of
the poor for the ecological regeneration of their own habitat
through afforestation, grasslands development, soil conservation,
water conservation etc. Such a global programme should be
financed through a global consumption tax on all the world’s
rich both in the North and the South. The North must take the
lead to accept its share of global responsibility.
At the national level, governments must develop systems of
participatory governance that ensure that control and management
ofthe environment rests with local communities. Whereverlocal
communities have been involved in the control and management
of their resources, it has been possible to protect the environment
and regenerate its productivity. We are proud to say that NGOs
across South Asia have repeatedly shown through their work
that community self governance has invariably led to improved
environmental management. Some of the best examples are
those of the Orangi Pilot Project ,in Karachi in the urban
context; the villages of Sukhomajri, Nada, Seed, Bhusadia and
Ralegan Siddhi in India; and, the Grameen Bank in the flood.
affected plains of Bangladeshi In Nepal, rural communities
continue to manage their fragile Himalayan environment with
great care and labour inputs. The enormous labour inputs of
the poor in environmental management — such as those of
the Himalayan farmers in terracing their agricultural fields
— remain an invisible factor in national economic calculations
even though their.contribution is often far more than official
expenditures, whether they result from national funds or foreign
aid.
If investments in land, water, minerals and forest resources
are to be productive and poverty eliminated, efforts to,develop
and strengthen democractic, and participatory insti-tutions at
the grassroots is essential. The nature of effective participatory
institutions will be determined by local cultural, social and
economic conditions. .Experimentation in this area is urgently
needed so that appropriate community institutions can be
legally empowered to manage local environments.
GLOBAL WARMING:
The Climate Convention should be signed
only when equal rights of all to the
atmosphere are accepted.
1-4
xcessive burning of fossil fuels over the last century has
led to a global greenhouse effect which is largely the
result of rapid industrialisation and heavy energy consumption
in the North. In fact, the North has been able to undertake
cheap industrialisation only because it could encroach upon the
ecological space of the South without any compensation. In the
process, the North has accumulated an enormous ecological
debt. If the North continues emitting greenhouse gases in the
same way, the earth’s atmospheric processes will be further
destabilised. It has been argued by the Inter-governmental
Panel on Climate Change (IPCC) that the likelihood of global
warming is very high and, if no immediate action is taken, it
will be too late to reverse the processes of global warming later.
Though caused by the North, the effects of global warming
will be borne heavily by the South, which has hardly any
financial or technical resources to deal with the problem. With
a rise in sealevel, South Asia, which has large low-lying areas,
will become one of the most affected regions in the world. If the
sea level rises by one metre, more than 17.5 per cent of the total
land area of Bangladesh will be inundated. Some 40-50 million
people will be rendered homeless and infrastructure worth
billions of dollars will become useless. Scientists also predict that
cyclonic storms will intensify in the Indian Ocean region if sea
surface temperatures rise. Increased ice melting in the Himalaya
together with changes in rainfall patterns could inundate vast
areas of the flood plains of the Ganga-Brahmaputra-Barak
basins which will multiply the miseries and sufferings ofmillions
ofpeople. Asalarge proportion ofits population lives at or below
the poverty line, and remains heavily dependent on a biomass
based subsistence economy, South Asia will be devastated by the
dislocationbroughtaboutbyglobal warming. Poverty andglobal
warming will together form a deadly combination for the poor
millions livingin coastal, arid and semi-arid areas of the region.
10
We believe that those who have created the problem of global
warming must bear the costs of preventive and corrective
action and compensate others for the use of their ecological
space. The North must adjust its patterns of production and
consumption to mitigate the threat to the earth s atmosphere. It
is both its moral and legal responsibility to prevent and repair
any environmental damage that is likely to be inflicted upon
others. The North must also develop mechanisms to speedily
communicate the results of its researches on global warming
to the South. Developing countries should aim for net zero
deforestation through sustained use of existing natural forests
and not merely by plantations.
Any management system that is developed to limit carbon
dioxide emissions and thus stabilise world climatemust be based
on the following principles:
a)
All of us must learn to live in harmony with nature,
that is, reduce our total emissions to a level that is considered
to be sustainable in participation with scientists from the
South.
b)
All human beings should have an equal right to the total
emissions that the atmosphere can bear on a sustainable
basis.
c)
The South must be compensated for the atmospheric
space that the North has been using to date.
While we afe fully supportive of the firm stand taken by
South Asian governments thus far in international negotiations
relating to the climate convention, we believe that they must
insist upon the above principles in all negotiations. Under no
circumstances should the governments of South Asia agree to a
framework convention which would dilute the above principles
and thus mortgage our future. No framework convention should
• be signed which does not include the basic minimum principle
that all human beingshave an equal right to the atmosphere. The
governments must remember that they have to protect the
interests of both the present and the future generations of South
Asia.
The South should not be seen again as holding out the
beggingbowl for “new and additional resources” or calling for
technology transfer . Instead, the South should demand
compensatory measures from the North for errant behaviour as
a matter of the South’s right over global resources.
BIODIVERSITY CONVENTION:
Refuse to sign the convention
until major contradictions are resolved.
I
he proposed convention on biodiversity does not deal
____ only with the subject of biodiversity conservation. In
return for its support for biodiversity conservation the North
is demanding access to the world’s biological resources, which
are largely concentrated in the South. Since the convention is
attempting to deal with both these issues, it raises numerous
complex issues which must be resolved before any convention
is signed.
There can be no doubt that biological diversity needs to be
conserved both for its own sake — all living species have a right
to exist — and for the benefit of all humankind. In an ideal
world, given the fact that people all over already use biological
resources from far flung corners of the globe, these resources
should be commonly available to all to use and conserve. But
the principle of ‘common heritage’ has been misused by
commercial interests in the North to monopolise and plunder
the biological resources of the South while restricting access to
genetic materials and associated technologies based on these
resources. This Northern approach is both unfair and ecologically
unsound. While the measures taken under the proposed
convention would make access to biological resources easier, the
new life forms and technologies emerging from these resources
would be strongly privatised through powerful patents under
the proposals being pursued in the Uruguay Round. Any effort
therefore to improve access to the biological wealth of the South
would lead to an extremely inequitous situation. It is obvious
that we cannot have one set of negotiations that aim to privatise
knowledge and biotechnologies while another set seeks to
globalise the biological resources on which this knowledge and
biotechnology is based.
12
Recent legal and technological developments in fact threaten
the very biological diversity that is sought to be conserved, and
also restrict access to biological resources and associated
biotechnologies. These include:
a) Intellectual property rights, both as plant breeders rights
and patents on life forms and biological processes;
b) Commodification of biological resources for purpose of monopoly
and profit; and,
c)
Increasing genetic uniformity in cultivated/domestic species.
We also believe that there are strong links between the
proposed conventions on climate and biodiversity. Developing
countries are being asked to protect forests under both these
conventions while the North is not prepared to make any
serious commitments on carbon dioxide reductions under the
climate convention. If developing countries sign the biodiversity
convention they will legally bind themselves to a major committment
sought by both conventions without the North committingitself
to anything serious in either.
Moreover, we question the legitimacy of our governments to
negotiate access to biological resources, without consulting and
involving in decision-making, the local communities which have
customary rights to these resources. It is these communities
which have nurtured these resources and have developed a
wealth of knowledge and skills related to their use. Any process
of international negotiation must evolve through an internal
process of public debate, in particular involving local communities.
This has not been done at all in the case of the Biodiversity
Convention.
Current strategies for biodiversity conservation, often eman
ating from Northern agencies, are extremely anti-people, relying
heavily on fences and guards. Participatory biodiversity
conservation strategies must be developed urgently — an activity
that requires enormous experimentation. More of the conventional
protectionist approach, resulting from increased global availability
of funds through mechanisms like the biodiversity convention,
could severely affect local communities living in biodiversity rich
areas.
13
Considering the fact that all these critical issues have not
been satisfactorily resolved, we strongly urge upon our
governments and those of the North not to rush into signing a
convention which does not satisfactorily address and resolve the
above issues. Southern governments cannot negotiate away our
biological resources — one of our most critical assets— in such
ahurrybyJune 1992, and in the absence ofmeaningful citizens’
participation in the negotiatingprocess and oflocal communities,
especially tribal communities.
NGO Relations:
Northern NGOs must consult Southern NGOs
adequately before espousing global causes.
T
his group is acutely aware of the disadvantage that
Southern NGOs repeatedly find themselves in getting
access to and influencing international negotiations as compared
to Northern NGOs. Most NGOs working in the South have
remained uninformed about the ongoing issues in UNCED and
the related conventions, for which we hold the UNCED
secretariat responsible. The resources needed to attend these
conferences which usually take place in Northern capitals are
extremely limited. Even information flows to Southern NGOs in
terms of official documents have been extremely small. The
rapidly changing national positions make it even more difficult
for Southern NGOs to keep abreast of and analyse the developments
taking place in distant places regardless of their importance to
the national and local constituencies they work with. Northern
NGOs often form their global perspectives without adequate
discussions with and inputs from the South. We therefore call
upon Northern NGOs to recognise this inherent imbalance in
resources that Southern NGOs suffer from and ensure that
global positions are taken only after adequate discussions. A
lack of such efforts leads to confrontations which can be easily
avoided, and unnecessarily hamper efforts to build up a truly
global partnership on environmental issues.
We also call upon our own governments to consult NGOs
regularly before they adopt national positions in international
environmental, trade and economic fora. National governments
and the SAARC secretariat ought to develop mechanisms for
consultations with NGOs at the national and regional levels,
respectively. The proposed meeting of SAARC Environment
Ministers should pay attention to the conclusions of the South
Asia NGO Summit on UNCED.
SOUTH ASIA NGO SUMMIT
NEWDELHl FEBRUARYrT^li), 1992
Guest Speakers
Mr. Kamal Nath
Minister of State for
Environment & Forests
Mr. Erling Dessau
Resident Representative
United Nations Development
Programme
Mr. K.K. Bhargava
Former Secretary General
South Asian Association for
Regional Cooperation
Prof. M.G.K. Menon, MP
President
International Council of
Scientific Unions
Delegates
NEPAL
Mr. Anil Chitrakar
ECCA
P.O.Box 3923, Kathmandu
Mr. Ganesh Ghimire
Secretary, Coalition Nepal
P.O. Box 4067
Kathmandu
Mr. Binod Bhattarai
General Secretary,
Nepal Environmental Journalists
Forum
P.O. Box 5143, Kathmandu
Mr. Bharat Sharma
Nepal Environmental Conservation
Group
P.O. Box 3094 Kathmandu
Mr. Kanak Mani Dixit
Editor
Himal Magazine
P.O.Box 42, Patan Dhoka
Lalitpur
Mr. A.M. Shreshtha
P.O. Box 3094, Kathmandu
PAKISTAN
Mr. Nasir Dogar
IUCN, 1 Bath Island Road
Karachi 75530
Ms. Khawar Mumtaz
Shirkatgah
18-A Mian Mir Road
P.O. Mughalpura,
Lahore 15
Mr. Chandio Munir Ahmed
Sindh Rural Workers Cooperative
Organization
263-C, Block Z, Near Tariq Hotel
Tariq Road, PECHS,
Karachi
Mr. Asher Ali
Sindh Rural Workers Cooperative
Organization
263-C, Block Z
Near Tariq Hotel
Tariq Road, PECHS, Karachi
16
Mr. Arif Hasan
37-D, Mohammad AH Society
Karachi 8
SRI LANKA
Mr. Uchita De Zoysa
Public Campaign on Enviroment
and Development
50/7C, Siripa Road, Colombo 5
Mr. Nalin Ladduwahetty
Sri Lanka Environment Congress
No.ll, Sri Saranankara Road
Dehiwala
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Sri Lanka Environmental
Journalists Forum
P.O. Box 30,
5 Fourth Lane, Nawala
Sri Jayawardenapura
Mr. Nalaka J Gunawardane
4/10 A, Welikadawatte
Nawala Road, Rajgiriya
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Managing Director
UBINIG-Policy Research for
Development Alternative
5/3, Barabo Mahanpur Ri*g Road
Shaymoti, Dhaka 1207
Mr. Saleem Samad
Coordinator
Like Minded Environmental
Activist Group
House 62/1, Road 8A
Dhanmondi, Dhaka 1209
Mr. Monirul Qadir Mirza
Secretary General & Editor
CESR Newsletter
Centre for Environmental Studies
& Research
GPO Box 3290,
68/1 Purana Paltan,
Dhaka 1000
Mr. Anisuz Zaman Khan
Wetlands, NACHOM, Dhaka
BHUTAN
Mrs. Kamani Witarana
Environmental Foundation
Limited
29, Siripa Road
Colombo 5
Dr. M.S. Rajendra Wijethunge
Organisation to Safeguard Life
and Environment
16/5 Elliot Place, Colombo 8
Mr. Kunzang Yonten
Secretary General
Royal Society for Protection of
Nature
Thimpu
INDIA
BANGLADESH
Ms. Madhu Sarin
48, Sector 4
Chandigarh 160 001
Dr. A. Atiq Rahman
Bangladesh Centre for Advanced
Studies
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GPO Box 3971, Dhaka 1205
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Sadguru Water & Development
Foundation
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VIKSAT
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P.O.Narodi
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Pune 410 503
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Council of Professional Social
Workers
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AIR, Correspondent
D-3, Radio Colony, Old Palace Road
Jammu
Mr. Ranjan Rao Yerdoor
Federation of Voluntary
Organisations in
Rural Development
P.O. Box 2541
Richmond Town
Bangalore 25
'■>
Mr Chitta Behera
Director
Project Swarajya
Moti Bhawan, Bepari Sahi
Kesharpur Road,
Buxi Bazar
Cuttack 753 001
Mr Kishore Saint
Ubeshwar Vikas Mandal
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Udaipur 313 001
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Via Thanagaji, Alwar
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Village Setwana
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District Udaipur
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Academy of Administration
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Secretary
Delhi Science Forum
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Secretary General
National Forum on Tourism &
Environment
18/30 East Patel Nagar
New Delhi 110 008
Dr. A.T. Dudani
South South Solidarity
P-4, F.F., Green Park Extn.
New Delhi 110 016
Mr. Feisal Alkazi
President, ANKUR
S 286, Greater Kailash-II
New Delhi 110 048
Ms. Kamla Bhasin
Food & Agriculture Organisation
55 Max Muller Marg
New Delhi 110 003
Ms. C.P. Jayalakshmi
EEG, Post Bag No.4
New Delhi 110 066
Ms. Madhu Bajpai
Honorary Secretary
Conservation Society of Delhi
N-7/C, Saket New Delhi 110 017
Prof. P.R. Trivedi
Indian Institute of Environment
& Ecology
Paryavaran Complex
Maidan Garhi Road
New Delhi 110 030
Ms. Jayasree Menon
WWF-India
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New Delhi 110 003
Ms. Usha Menon
NISTADS
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Gandhi Peace Foundation
221, Deen Dayal Upadhyay Marg
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Society for Participatory Research
in India
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Mr. Ajoy Bagchi
Executive Director
The People’s Commission on
Environment & Development
India
15 Institutional Area
Lodi Road,
New Delhi 110 003
(\J GJc> -
The World Bank’s Private Sector Development Strategy:
Key Issues and Risks
Leon Bijlmakers and Marianne Lindner
ETC Crystal
2nd Draft: 6 December, 2002
Contents:
1
Chapter 1
Introduction
Chapter 2
Features of the PSD strategy
2.1
Overview
2.2
Support to private provision of health services
2.3
Output-based aid
2.4
Trends in World Bank support to PSD
Chapter 3
Key issues and risks
3.1
The context
3.2
Concepts of private sector involvement in health and health care
3.3
What’s new in the PSD strategy?
3.4
What is missing?
3.5
Why private sector development at all?
3.6
Which market?
3.7
Policy coherence at the national and international level
3.8
Risks
Chapter 4
Conclusions and perspectives for NGO action
References
Materials for further reading
Chapter 1
Introduction
The past century has seen unprecedented improvements in the health status and a reduction in
mortality rates across the world. However, since the mid 1980s the rate of decline in child
mortality rates has slowed substantially. This’has been felt most significantly in low-income
countries in Sub-Saharan Africa and South-East Asia, where mortality rates have started to
increase again in a number of countries (Simms et al., 2001). Whereas since the early 1990s
major achievements have been made across the world in the improvement of health status, such
as a halving of deaths from diarrhoea among young children and a one third reduction in underfive mortality rates in 63 countries, many targets have remained unfulfilled, especially in the
poorest regions of the world. In Sub-Saharan Africa, the region with the highest child death rates,
less than half of children under one are fully immunised against DPT, which marks a decline
compared to 60% recorded in 1990, while the total number of malnourished children has
increased during the 1990s (Hilary, 2001). The road to achievement of the Millennium
Development Goals (MDG), agreed at the Millennium Summit of the United Nations in
September 2000, calls for a dramatic reduction in poverty and marked improvements in the health
of the poor, but there is still a very long way to go to achieve these goals.1
There are various interrelated reasons for the continued ill health and the deteriorating situation in
the poorest countries. Among the most prominent ones are poor economic performance,
continued or increased poverty, health systems failure and the HIV/AIDS pandemic (WHO, 2001;
World Bank, 2000; Simms et al., 2001; Hilary, 2001). Health systems failures have been widely
attributed to public health expenditure cuts, associated with the economic crises in the 1970s and
1980s; to structural adjustment policies applied in response to those crises, including’ an even
further reigning in of social expenditure; and to a general lack of effective measures to protect the
■ poorest and ensure their access to basic social services. The debt crisis, which in the 1990s has
become increasingly an African crisis, has led to large amounts of funds being used for debt
service payment at the expense of the provision of basic social services, including health care.
Until the early 1990s the health sector was still viewed as a non-productive sector. This view has
been reversed, and it is now firmly established that improving health and health care plays an
important role in pursuing economic development and poverty reduction (WHO 2001). This is
also reflected in the key role that the Poverty Reduction Strategy Paper (PRSP) framework plays
in general development policy in an increasing number of low-income countries, and in the
recognition of the importance of increased resource allocation to the social sectors, including
health care. Nevertheless, the health care sector in low-income countries remains severely
underfunded. Average percapita public health expenditure is estimated below $10 per year in
Highly Indebted Poor Countries (HIPC), and has been substantially less than that in many of
these countries (World Bank, 1997; Simms, et al. 2001). These figures fall far short of the $12 per
capita required to finance the cost of an essential package of clinical services and public health'
ihtervenfiohsfas defined by the World Bank in its World Development Report 1993; the $13 per
capita required to cover the cost of a basic health care package in low-income Africa, as
advocated in the World Bank’s Better Health for Africa report in 1994; and the $30-40 per capita
health spending required for low-income countries as minimum financing to cover ’essential"
interventions, according to the WHOCommission on Macroeconomics and Health (World Bank
1993; World Bank, 1994; WHO, 2001). "
1 Among the MDG are the halving of the proportion of people who live in absolute poverty, and a reduction of child
mortality by two thirds and of maternal mortality by three quarters by 2015. The MDG include 17 health indicators
2
While in the 1980s the state was seen as the primary player in the health sector, in many countries
the government role as a service provider has diminished considerably. A key element in the
health sector reforms underway since the late 1980s, promoted by the World Bank and other
international organisations, involves a redefinition of the role of the state, promoting a retreat of
government from its role as provider, while increasing its role in policy making, financing and
regulation.. At the same time the share of the private sector in health care delivery has increased.
This was first articulated by the World Bank in its 1987 report on health care financing (World
Bank 1987), further elaborated in its 1993 World Development Report (World Bank 1993), and
again called for in the 1997 World Bank’s Health Nutrition and Population (HNP) sector strategy
(World Bank 1997).
The World Bank has become the largest external source of financing of HNP activities in lowand middle-income countries, with a total net commitment of $ 9.3 billion in 2000 (IFC 2002). It
has recently launched a Private Sector Development (PSD) strategy, which involves support to
increase private sector involvement in the provision of basic services, with the aim to increase
equitable access. The profile of World Bank lending can be expected to change under the impetus
of the PSD strategy and this is likely to have an effect on other lending institutions and donor
agencies that have a tradition to adopt new World Bank policies and strategies.
The main purpose of the current paper is to raise and critically assess key issues and risks with
regard to the possible effects of the World Bank’s PSD strategy on achieving equitable access to
health care for all, with a focus on the possible consequences for the poor in low-income
countries. The paper intends to provide civil society organisations/NGO’s in low-income
countries with arguments in the policy dialogue with their governments.
This paper starts from the premise that health is a fundamental human right as defined by the
United Nations in article 25.1 of the Universal Declaration of Human Rights: "Everyone has the
right to a standard of living adequate for the health of himself arid ofhis family, includingfood,
clothing, housing and medical care and necessary social services The International Covenant
on Economic, Social and Cultural Rights provides the most comprehensive article on the right to
health in international human rights law. In accordance with article 12.1 of the Covenant, state
parties recognise "the right of everyone to the enjoyment of the highest attainable'staridard of
physical and mental health", while article 12.2 enumerates, by way of illustration, a number of
examples of state parties’ obligations, The right to health is not to be understood as a right to be
healthy, but rather as a right to the enjoyment of a variety of facilities, goods, services and
conditions necessary for the realisation of the highest attainable standard of health. These include,
amongst others, timely and appropriate health services, which are accessible, acceptable and of
adequate quality; other services and conditions, which relate to the underlying determinants of
health, such as safe water, sanitation, food and housing; as well as the establishment of a
legislative framework, as one of the obligations of the state. The right to health, like all human
rights, imposes three types or levels of obligations on the state: obligations to respect^protectand
fulfil. The obligation to protect requires the state to take measures that prevent third parties from /
interfering with article 12 guarantees. It includes, amongst others, the duty of the state to adopt
legislation or to take other measures ensuring equal access to health care and health-related
services by third parties; to ensure that privatisation of the health sector does not constitute a
threat to the availability, accessibility, acceptability and quality of health facilities, goods and
services; and to control the marketing of medical equipment and medicines by third parties (UN
Economic ancfSocial Council, 2000).
After this introductory chapter, chapter 2 contains a description of the PSD strategy, with a focus
on its social sector component, which includes health. Chapter 3 discusses key issues and risks
related to the strategy. It starts with a number of general observations on two World Bank
documents that outline the PSD strategy, and a discussion of the novelty of the strategy. Next, a
review is given of the argumentation to focus on private sector development and of the evidence
from the public-private mix debate in the literature in relation to the achievement of affordable
access to quality health services. We then elaborate on the importance of making a distinction
between for-profit and not-for-profit providers, and between various forms of private sector
involvement in health care. It discusses the potential consequences of private sector involvement
for equity and efficiency, and related issues such as contracting, regulation, and targeting of
support to the poor. The discussion concentrates on health care provision more than on financing,
since this is also the main focus in the PSD strategy. We further examine the issue of national and
international policy coherence, in particular the relationship of the PSD strategy with other
international policies and initiatives, such as the PRSP policy framework, and global regulations
on international trade, such as GATS and TRIPS. Chapter 4 contains conclusions and
recommendations, which may help NGO’s strengthen their position in the dialogue with their
respective governments.
Chapter 2 Features of the PSD strategy
This chapter provides a summary of the Private Sector Development (PSD) strategy, as laid out in
the document issued in April 2002 under the title Private Sector Development strategy —
Directions for the World Bank Group (World Bank, 2002). It zooms in on the proposed PSD
initiatives in the domain of basic social services, including health and education, which seem to
concern only a small part of the entire PSD strategy document. This chapter also draws on a
document written by the International Finance Corporation (IFC) 2 under the title Investing in
Private Health Care: Strategic directions for IFC (International Finance Corporation, 2002).
2.1
Overview
The World Bank’s PSD strategy starts from the premise that private sector development is key to
promoting growth and poverty reduction, in parallel with and complementary to public sector
efforts. PSD is proposed as a strategy pursuing a good balance between the complementary
functions of the State and the private sector. “It is about judicious refocusing of the role of the
state, and not about indiscriminate privatisation.” Sound government policies that provide room
for private initiative and that set a regulatory framework which channels private initiative in ways
that benefit society, are considered critical. The PSD strategy document acknowledges that this
requires institution and capacity building and that PSD strategies for individual countries need to
be owned by their respective governments. It emphasises that country- and sector-specific PSD
approaches should build on country-driven consultation processes. The strategy comprises several
components, which are outlined in Box 1.
Box 1: PSD strategy components
A. Extending the reach of markets, by:
1. Enhancement of the investment climate
2. Provision of direct public support to private firms
B. Improving access to basic services, by:
1. Private participation in infrastructure services
2. Private provision of social services (primary education and basic health care)
3.
The use of output-based aid (OBA) schemes
Enhancement of the investment climate (A-l) would be achieved through continued deployment
of lending operations and capacity building, particularly to reduce “unjustifiable obstacles” to
private business and to establish secure property rights. In addition, investment climate surveys
would be supported. Direct public support to private firms (A-2) would be provided in terms of
advisory services and credits, involving both the IBRDZIDA and the IFC. Support for private
2 The IFC forms part of the World Bank Group, which further comprises the International Bank of Reconstruction and
Development/Intemational Development Association (IBRD/IDA) and the Multilateral Investment Guarantee Agency
(MIGA). The IBRD/IDA is the Bank’s soft (concessional) Ioans arm, while the IFC is the Bank’s commercial loans
arm. The MIGA provides investment guarantees.
participation in infrastructure (B-l) focuses on telecommunications, energy, transport and water
and sanitation. The current paper does not deal with these types of support. Below we will
summarise the main features of World Bank Group support to private provision of social services
(B-2) and the use of output-based aid (OBA) approaches in working with the private sector (B-3).
2.2
Support to private provision of health services
The PSD strategy document considers it a challenge to build, nation-wide health systems that
provide affordable quality access, especially free access to basic health care. It states that it will
be important to find the right mix of private and public provision that increases access to services
of adequate quality, which is largely determined by country- and sector-specific conditions. It
emphasises that work with the private sector will be done side by side with unabated supports
public health services. The policy, regulatory and funding role are considered clear and crucial
tasks for the state that cannot be fulfilled by private unregulated markets. Major capacity and
institution building of public sector agencies is required to fulfil this role. While public provision
of basic services is considered a key component of current national health systems, the PSD
strategy document asserts that the reality in low-income countries is that poor people often rely
on the private sector for the provision of basic services, reflecting either the absence of public
services or people’s choice to bypass such services. The document suggests that private providers
are not in all cases systematically better than public providers, but that under appropriate
regulatory regimes they can expand and provide quality services at low cost. It highlights in this
regard the clear contracting and regulatory challenges that exist in relation to private provision,
which - if not properly dealt with - harbour the risk that private markets may end up providing
low quality services.
The private sector for health care, as defined in the PSD strategy document, is a broad concept,
which comprises both for-profit and not-for profit service providers. Examples of the latter are
religious, NGO-operated and community-financed institutions. For-profit providers comprise
modem as well as traditional providers. The document indicates that clients may put a great deal
of trust in not-for-profit organisations, enabling them to make a substantial contribution to service
delivery, and possibly to out-perform for-profit providers under competitive conditions.
The PSD strategy document further underlines the need to make a distinction between financing
and the provision of health services. The government has the undisputed responsibility to ensure
that services are affordable to all layers of society and that services with positive externalities are
sufficiently provided.3 To achieve this, it needs to institute appropriate financing schemes. But
instead of trying to provide all services through its own public health institutions (hospitals,
clinics, health centres, laboratories), the government through its financing role should consider
using private institutions and firms for the provision of certain services by providing funding to
them. This would be appropriate in areas where private institutions have a comparative advantage
over public ones. It wouldjcelieye the government from some of its duties and enable it to
concentrate on its core functions, namely that of policymaking, strategy development, regulation
and resource mobilisation.
3 Externalities refer to effects on people (or agencies/institutions) that are not directly envisaged by providing a
particular service. Immunisation services, for instance, are considered to have large (positive) extemalitj.eSj since they
do not only protect the individual clients. but also the community as a whole by affecting the transmission of infectious
disease. Health education is another example of a service with (positive) externalities.
6
The World Bank sees for itself an important role in assisting governments in the assessment of
the potential role of private _sector involvement and in establishing an appropriate enabling
environment. This would include clarifying the strengths and weaknesses of alternative forms of
private participation, market structure arrangements, regulatory approaches, strategies" for
improving universal access to services and financing approaches. The Bank would focus on
developing policies, institutions and capacity to support private participation in the health sector,
and it would typically do this through programme lending and provision of advisory services,
using IBRD/IDA channels.
The PSD strategy document proposes that in certain cases it may also be possible to directly
support private firms that engage in the provision of health services. Financial investments should
preferably be provided via the IFC,. The document supports the continued expansion of IFC
involvement in low-income countries and it promotes strong collaboration with the IDA, for
example through OBA schemes (see section 2.3 below). While IDA will work with governments
to develop policies, institutions and capacity to support effective private forms of participation in
the health sector, IFC will increase its involvement in direct lending for the expansion of private
firms, in particular private for-profitfirms, engaged in the provision of health services.
The establishment of a new group4 (in April 2000) within the IFC and its transformation into the
IFC’s Health and Education Department (in September 2001) reflects IFC’s ambitions in the
social sectors. The department elaborated the above mentioned strategy document Investing in
private health care: strategic directionsfor IFC (IFC, 2002), which claims that reliance solely on
tfie public sector to address the main challenges in the quest for universal and good quality health
caire is no longer a viable or sustainable option because of fiscal constraints. The document is
more specific than the PSD strategy document, since it deals solely with health care. The desired
IFC investments fall into two categories: a continuation of already existing investment activities,
predominantly in the hospital sector; and an expansion of investment into new growth areas,
including private health insurance, pharmaceuticals, medical devices, biotechnology and health
Workers education and training. In terms of geographical distribution, the IFC will concentrate'on
specific countries in seven different regions.5 So far, IFC financed institutions have tended to
cater primarily to the lower-middle and middle classes. The ambition, however, is “... to target a
very broad spectrum of the patient population, including poor people, particularly in situations
where the private sector is the service provider for the state.”
The PSD strategy document asserts that the World Bank’s own efforts to better understand the
role of the private sector are just starting and that its knowledge is still embryonic. In this regard,
it underlines the challenges of strengthening analytical work and broadening" the options for
engaging with private forms of health service provision in a way that is consistent with overall
sector policies. The document also recognises that private participation in the health sector, while
, widespread in reality, remains “a highly contentious issue”, but remarkably it does not elaborate
i onthe possible pitfalls. Hence the World Bank does not seem to have put a lot of thought into
' how such pitfalls could be avoided. Chapters 3 and 4 of the cunent paper try to address this.
" The Global Practice Group for Social Sectors.
5 The seven regions include South and South-east Asia (with India and Pakistan) and Africa (with Cote d’Ivoire,
Kenya, Nigeria and South Africa), along with five others.
2.3
Output-based aid
The PSD strategy document proposes to focus collaboration with the private sector on
development results and on improved targeting of government funding schemes, through the
application of output-based aid (OBA) schemes. In contrast to traditional approaches whereby
support is channelled to inputs consumed by public providers, service delivery under OBA
schemes would be shifted to third (private) parties under contracts that tie payment to the outputs
or results actually delivered.6 The two approaches are presented in Box 2,
Such public funding schemes, which could be financed by aid funds (including IDA funding),
would be justified where externalities or affordability and redistribution objectives exist. OBA
could be used to address affordability concerns through subsidy schemes, which will offset the
costs of private services to low-income consumers by making these services available for free or
at reduced cost.7 OBA would shift the responsibility and performance risk to the (for-profit and
not-for-profit) private sector,8 and hence it would help sharpen the targeting of development
outcomes, sharpen incentives for efficiency, mobilise private finance, and improve
accountability.9 Subsidies should preferably go to the consumers instead of the providers.
While the IDA would support output funding, providing financing for the subsidy payment in the
form of loans or grants, along with assistance to governments in designing effective subsidy
schemes, the IFC would help fund private providers through commercial credits without
6 Where needed, the disbursement schedule for subsidies could be frontloaded somewhat to make financing more
manageable; at the same time, adequate financial exposure of the private provider must be maintained to keep
incentives to perform.
7 All forms of subsidy schemes could be supported, ranging from means-tested targeting of specific consumer groups
to broad-based subsidies to all consumers.
8 If service providers fail, investors should suffer rather than taxpayers in poor countries.
’ Public providers may also compete under such schemes; however, in this case taxpayers instead of the private
provider bear the ultimate risk of failure.
8
government guarantees. This should lead to a better division of labour between the two arms of
the Bank.
The PSD strategy document highlights the risks involved in OBA arrangements, which pose
design, contracting and regulatory challenges, in particular monitoring arrangements, contracting
processes, regulatory, supervision and financing schemes.10 As more experience with OBA is
needed and its full potential still needs to be explored, it is proposed to undertake a pilot for OBA
schemes, with special emphasis on those supporting the provision of basic public services. This
would be done in particular in the domain of infrastructure development. It remains Unclear to
what extent OBA schemes would be piloted in the health sector.
2.4
Trends in World Bank support to PSD
The PSD strategy document does not provide a clear insight in the volume of support that will be
allocated to PSD in the health sector in the coming years. Nor is it clear what the expected
relative increase will be compared to current funding levels, or the expected changes specifically
for health related interventions. From the PSD Strategy document and the IFC paper some
indications can be derived, though, about current lending volumes and past trends.
Total World Bank Group lending and guarantees for PSD (not just health related) doubled in real
terms since 1980, largely due to increases in IFC lending and MIGA guarantees. IFC investments
increased 4.5 times in real terms since 1980, and in 2000 they accounted for 56% of total WBG
lending and guarantees for PSD. IBRD lending for PSD has declined in real terms, and in 2000 it
stood at about one third of the 1980 level. In low-income countries, however, real IDA lending
for PSD doubled during the same period. In 2000, IBRD/IDA lending for PSD amounted to onesixth of WBG’s PSD-oriented lending and guarantees. The WBG’s financial support for PSD has
increased at a faster rate in recent years than total lending and guarantees, as a result of which the
share of total lending and guarantees going into PSD doubled from 16%. in 1995 toJ0% in 2000.
Although in recent years more WBG loans have included a private health care component, PSD
lending for health is still very limited compared to the Bank’s total PSD portfolio. In 2000,
IBRD/IDA project lending for PSD in health amounted to about $ 30 million11 or 0.5% of the
total project portfolio for PSD of $ 6.5 billion.12 The PSD strategy document does not provide any
figures for the amount of IBRD/IDA adjustment lending allocated to the private health sector.
IFC investment in the social sectors (health and education) grew at an average rate of 23% per
annum during the period 1996-2000, but still accounts for not more than 0.8% of total IFC
commitments. In October 2001, IFC’s total disbursed and outstanding loans in the health sector
amounted to S 77 million.13 IFC’s health care portfolio in Sub-Saharan Africa between 1993 and
2000 amounted to $ 48 million. These figures show that health-related PSD lending has been very
limited in relation to the Bank’s total portfolio for HNP in low and middle-income countries,
which amounted to $ 9.3 billion in 2000.
10 One way of strengthening monitoring capacity may be by involving NGOs or contracting out monitoring to them.
11 Most PSD lending goes to three sectors, including social protection, private sector development (support to small
and medium size enterprises) and agriculture. It is not clear to what extent support to social protection also covers
activities related to the health sector.
12 The $ 6.5 billion is 6% of total committed loans of the Bank.
13 IFC lending for PSD is concentrated in three sectors, which account for two-thirds of its lending: the financial
sector, infrastructure and manufacturing.
The PSD strategy document specifies that most of the proposed PSD interventions will be
financed from existing WBG budgets through internal reallocation. It is therefore expected that
any future increase in lending for PSD activities will be at the expense ofthe public sector.
Chapter 3
3.1
Key issues and risks
The context
Experience across the world shows that health systems generally consist of a mix of public and
private systems. Rapid private sector growth has occurred in many low-income countries, not so
much as a result of explicit policies to promote the private sector, but primarily because of a
perceived low quality of care in the public sector.
Initial research efforts on the public-private mix for health care in low-income countries began to
take place in the early 1990s (McPake and Mills, 2000). The initial picture that emerged in many
countries was of.two-tier health systems, whereby rich people enjoyed the services of wellresourced private health care systems, while the poor were surrendered to poorly-resourced public
health care systems that provided poor quality services. Evidence then started accumulating that
private provision and financing in fact played a much greater role in health care than was
suggested by the typical characterisation of health systems in low-income countries as being
dominated by the public sector. Even in countries with a small formal private health sector,
individuals ’ out-of-pocket payments for health care often exceed one-third of the national health
expenditure (McPake and Mills, 2000). World Bank estimates of private health expenditure as a
share of total health expenditures (public and private) amount to 59% for low-income countries
(as opposed to 40% for low-middle income countries and 48% for high-middle income countries)
and 52% for Sub-Saharan Africa (51%> for all countries worldwide; World Bank, 1999).
Several countries have seen their private sector proliferate in the past decade, and there is strong
evidence that the use of private health institutions is not restricted to higher-income groups. The
IFC strategy paper suggests that more than 50% of the provision of health services occurs through
private institutions in countries such as Cote d’Ivoire, Nigeria, South Africa, Egypt, India and
Thailand. Although reliable data for most countries in Sub-Saharan Africa are not available, it is a
fact that church affiliated hospitals and health centres traditionally play a prominent role in the
provision of health services in countries such as Ghana, Kenya, Malawi, Uganda, Zambia,
Zimbabwe and South Africa. In addition, commercial private clinics and surgeries are no longer
restricted to urban areas and have started to emerge in semi-urban as well as in certain rural
localities in most Sub-Sahara African countries. These facilities are operated either by
practitioners that are fully private or by medically trained staff employed in the public sector, who
engage in private activities after or sometimes during official working hours, using public
resources. While data about the exact size of the private for-profit sector are scant, there is ample
evidence that it is significant and there are strong indications that it is expanding rapidly (Hanson
and Berman, 1998). In Kenya, for example, 70% of all physicians work in fulltime private
practice (Kumaranayake, 1997). In Benin, exact figures are not available, but regulation and
control of the private sector has been identified as one of the major challenges of the Government
(Ministere de la Sante Publique, 2000).
The question therefore is not so much whether the private sector should play a role in the
provision of health services, but rather how it should be involved within a public health sector
framework so as to contribute optimally to achieving public health goals. Both the general PSD
strategy document of the WBG and the IFC paper (that deals specifically with the health sector)
start from this premise and they are right in doing so. The problem, however, is that the World
Bank uses a rather narrow concept of private sector development in health and health care.
3.2
Concepts of private sector development in health and health care
From the way in which the PSD strategy document and the IFC paper use the term private sector
development it becomes clear that they refer to programmed privatisation, which should be seen
as the result of the implementation of pro-private government policies. They ignore the
phenomenon of incremental privatisation, which is a largely unplanned response to.failures of the
public sector (Bennett at al, 1997). Many countries recognise the danger of uncontrolled
proliferation of private enterprise in the health sector, as has been the recent experience in almost
alTurban and peri-urban conglomerations in low-income countries. The technical quality of the
services rendered by private providers in a rapidly expanding market is often not up to standard,
and this may have adverse effects on people’s health. Even though some governments have
established minimum standards and regulations for the private sector, they may not have
appropriate systems in place to ensure inspection and enforce sanctions. From the perspective of
the state, which has the obligation to protect its citizens from violation of their human right to
health by third parties (see Chapter 1), the PSD strategy thus has a serious lacuna.
Programmed private sector development is a broad, generic term that merits further specification
of the various strategies that may be pursued, such as privatisation of public institutions,
outsourcing of good and/or services and granting of autonomy. Box 3 explains the meaning of
these concepts.
The appropriate public-private mix for health care, which uses some of the above strategies,
depends on the country-specific circumstances. Although the PSD strategy document
acknowledges this by explicitly saying so, it actually puts a strong emphasis on direct support to
firms and on the disbursement of public funds — under certain conditions — to private providers.
From the health care project portfolio of the IFC (presented in an annex to the 2002 IFC paper), it
further appears that the bulk of financial loans has so far gone into the construction or expansion
of private hospitals and diagnostic centres, and the production of pharmaceutical drugs and other
cKeiiiicals. These are forms of support to private institutions that may or may not compete with
other service providers in the same geographical areas, without necessarily specifying the
services that are being purchased. Outsourcing of particular services to private institutions, with
the government in the role of purchaser (as described in Box 3) thus receives little attention.
Section 3.7 will revert to the experiences and in particular the key assumptions for contracting
out, which are relevant for any form of private sector involvement in health care.
12
Box 3: Terminology and concepts
It is useful to make a distinction between different forms of (programmed) private sector development
or involvement. In principle the term privatisation should be reserved_for the transition of an entire.
functional component of a public institution - such as for instance a hospital or a central medical stores
department - into a private company, or its transfer to an already existing private company., It implies
that the Government divests itself of its existing infrastructure, as well as its managerial and financial
control of the ‘business’. This goes much further than two other distinct forms of private sector
involvement, namely outsourcing and the granting of autonomy (or quasi-autonomy) to lower levels of
the public health system.
Outsourcing refers to a situation in which one party buys/purchases goods or services from another
party that provides them. There are two fundamentally different forms of outsourcing, depending on
whether the government assumes the role of buyer/purchaser or that of provider. With the government
in the role of buyer/purchaser of services from the private sector, it can eitherprovide subsidies (for
instance for organising a particular campaign or for the provision of preventive services) or buy
services directly (such as maintenance, hospital catering, laundry or security services). With the
government in the role of provider, one can think of private pharmacies buying drugs from government
medical stores, or industrial companies obtaining health services from government hospitals against
payment. The latter arrangement (government in the role of provider) is less contentious, unless the
services are provided at a highly subsidised price. The PSD strategy paper seems to focus mainly on the
former arrangement, i.e. government in the role of purchaser.
Outsourcing of services with a public benefit to the private sector has been experimented in many low■ income countries, often in the form of contracting out, a modality through which the services to deliver
:and the conditions of exchange are defined in a contract (McPake and Ngalande-Banda, 1994).
.^Financial benefits of contracting out of services to the private sector are expected on the basis of a key
.* economic principle, namely that competition between providers increases efficiency.
^ The granting of autonomy is basically a phenomenon internal to the public sector that is usually
preferred to as decentralisation. It involves either the deconcentration of management responsibility by
the Ministry of Health headquarters to_specific government departments (such as research institutes,
hospitals or medical stores) or to regional or district health office level; or the devolution of
management responsibility to local government institutions (such as district councils or city councils. It
usually involves budgetary autonomy, financial autonomy and/or human resources management
autonomy (‘hiring and firing’). The modalities of such forms of decentralisation are usually laid down
in written service agreements that are concluded for a specific period of time. Many national
governments in Sub-Sahara Africa have implemented decentralisation as part of larger health sector
reforms, aimed at increasing health sector performance. The private dimension comes in, when
provisions are made for the participation of non-govemment representatives in local decision making.
In Zambia, for instance,-district health boards, which manage public funds (district health baskets)
made available by the central government and a number of donor agencies, are made up of
representatives from civil society. NGO representatives, in particular representatives from church
affiliated health institutions may be members of district health boards and district health management
teams, which are responsible for the smooth delivery of health services in their respective districts.
Uplekar(2000) suggests that programmed privatisation, although much described in theory, is not very
widespread. When documenting the purchaser-provider relationship many authors use the NHS of
Great Britain as an example (e.g. McPake and Hongoro, 1995; McPake and Mills, 2000; Palmer, 2000).
Where they were tried, contractual relationships often work out differently and tend to develop into
durable partnerships (Palmer, 2000). Waelkens and Greindl (2001) suggest that this is because some of
the initial assumptions in relation to contracting out of services proved wrong (section 3.7 will elaborate
on this).
13
3.3
What’s new in the PSD strategy?
Overall, the PSD strategy document does not contain many new elements where it concerns
interventions in the health sector. It builds on World Bank policy outlined in earlier health
strategy papers and should rather be seen as the continuation of a trend of increased World Bank
support to private sector involvement in the provision of health services, which started in the late
1980s.’4 '
Nevertheless, the PSD strategy involves a stepping up of private sector involvement in the health
sector. This will also include increased support through IFC lending. It is relevant to note that the
World Bank emphasises a general change in the role of the state towards policy making. But it is
ambivalent about the role of the state as a health service provider. On the one hand, the PSD
strategy document proclaims a continued role of the public sector in service provision
concomitantly with an increased role of private provision. On the other hand, an earlier version of
the IFC paper (issued in March 2002) was very sceptical about the capability of the public sector
to ensure good quality health services.14
15 Similarly, the PSD strategy document itself is not
consistent While in one paragraph it asserts that "... the WBG will continue to provide unabated
support to public services in health ...”, another paragraph says that "... most of the (PSD)
actions proposed are to be covered from existing budgets in IFC, MIGA and the Bank through
internal reallocation.” This suggests a shift of emphasis from public to private provision of
services.
OBA schemes are not new either. The PSD strategy document suggests that pilots of OBA
schemes be undertaken under IBRD/IDA project lending, which would provide the opportunity to
learn more about the usefulness and pitfalls of this method before considering further expansion.
The emphasis for OBA schemes is put on the infrastructure sector (energy, transport, water
supply), and it remains unclear to what extent OBA schemes will actually be applied in the health
sector. Several countries, however, have experience with OBA-type approaches in the domain of
health. Ghana, for example, has introduced the Budget Management Centre (BMC) concept,
whereby church-related hospitals, along with government institutions, receive and manage public
funds for the provision of a certain package of services (Government of Ghana, 2001). In Zambia,
the Central Board of Health (which is a central purchasing agency, separate from the Ministry of
Health) concludes annual contracts with Hospital Boards and District Health Boards on the basis
of annual plans and budgets (Bijlmakers andNyarang’o, 2002).
The novelty in the PSD strategy is the shift in the nature and volume of.World. Bank lending with an explicit focus on basic social services and on new countries, in particular low-income
countries - as well as the institution and capacity building activities that the Bank intends to
undertake.
‘ ‘
“
3.4
What is missing?
Meanwhile, three important issues remain pending. Firstly, the PSD strategy document suggests
that affordable access to private health services by the poor will be ensured through targeting of
subsidies^but it does not address the problems commonly experienced with targeting resources to
14 See for instance Akin et al. (1987) or Griffin (1989).
15 The tone of the final version of the IFC paper, issued in June 2002, was less negative after several phrases about the
performance of the public sector were altered or deleted.
14
the poor. History shows that there are no easy solutions. For instance, programmes aimed at
protecting poor people against the negative implications of structural adjustment programmes many of which were supported by the World Bank itself- have not been very successful.16
Secondly, the document does not adequately address the issue of regulation of the private sector
and adherence of private forms to existing regulation. We have argued above^in 3.2) thatit_is not
sufficient for any government to establish minimum standards and regulate the private sector:
systems to ensure inspection and enforce sanctions are required as well.17
And thirdly, it does not address the issue of ‘market failures’, which is not uncommon in the
health sector. Hsiao (2000), for instance, argues that macro-economists tend to overlook that the
supply side has a far greater impact on health care efficiency, quality and spending, than the
demand side. There is plenty of evidence, for instance, that physicians have the market power to
induce demand, over-prescribe and practice price discrimination, The notion of market
competition thus Jooses importance, in particular in the setting of low-income countries where the
number of suppliers (service providers) is often limited. This then calls for a more prominent role
of the public sector so as to answer to these market failures.
Box 4: Experiences with contracting out ofservices
The most common form of involvement of the private sector in the provision of health services has
been through contracting out of specific services to private institutions. Waelkens and Greindl (2001)
discuss the evidence in relation to five key assumptions in relation contracting out of services:1
5(a) Management in the private sector is more effective
-(b) A sufficient number of providers allows for competition
"(c) Provider competition enhances efficiency
<(d) The benefits of a new system that involves contracts exceed the costs of its introduction
-.‘.(e) The Ministry of Health has the capacity to design contracts and to manage the contractual
s.relationship.
■ The authors review recent findings indicating that these assumptions are not necessarily valid and that
sometimes the reverse is true. As a result, the emphasis on public-private collaboration has shifted from
the initial strategies towards the recognition of improving management skills among public health
authorities, amongst others to equip them with the knowledge and skills required for the management of
contracts and service agreements. While the notion of competition looses importance, the role of the
public sector to answer market failure becomes more prominent. Thus, governments tend to make funds
available to promote service delivery in underserved areas, and to stimulate the inclusion of preventive
services (e.g. vaccination) into existing private facilities.
Furthermore, collaboration with NGOs, in particular church related health institutions, has become
more important than with the for-profit private sector. Since NGOs often specifically target vulnerable
population groups or underserved areas, and their objectives are closer to those of the government, the
publicsectpr has. turned towards contracting out to the not-for-profit sector. In fact, the nature of the
relationships has changed towards partnerships. characterised by mutual trust'and of which the
obligationsare ideally described in a memorandum of understanding rather than a contract.
16 The case of Zimbabwe demonstrates this very clearly. See: Bijimakers (forthcoming).
17 See the example of Benin, to which section 3.1 refers. For evidence from Tanzania and Zimbabwe, see
Kumaranayake et al. (2000).
15
The PSD strategy document does not make a clear distinction between for-profit and not-forprofit service providers. While it does recognise that both categories operate in the health sector,
sometimes side-by-side, it does not acknowledge the fundamental difference between the two.
And hence it does not consider the implications for the manner in which governments and the
World Bank itself should engage in public-private partnerships. Not-for-profit providers, such as
church-related hospitals and community based NGOs, usually have strong developmental
objectives that may strongly overlap with the objectives of the government. For-profit providers
are mainly guided by business objectives, and are generally less concerned with development.
Developmental and business objectives are not incompatible, but the potential areas of conflict
need to be recognised. Box 4 describes some recent trends in relation to contracting out, which
the PSD strategy document does not address. It further illustrates that it is far from sufficient to
say that the government’s regulatory role should be strengthened in order to streamline private
sector development.
Another weakness is that the PSD strategy says very little about monitoring and evaluation
(M&E). It is too simplistic so say (in relation to output-based aid) that "... public funds will be
disbursed when results are achieved, for example when water and electricity are flowing to
customers”. The reality in the health sector is more complicated, since access and in particular
quality of health services cannot easily be measured. The IFC paper claims that for the education
sector significant progress has been made in developing baseline indicators that would adequately
measure whether the objectives are being achieved. For the health sector work is said to be in
progress at the level of the WBG. What is required, though, is that each country adopts its own
M&E framework that relates in a very clear fashion to the country’s overall health policy and the
preset objectives of private sector development/involvement, before any further steps are taken.
Only then will it be possible to genuinely assess whether PSD has any public health benefit.
3.5
Why private sector development at all?
While the World Bank admits that support to PSD in health remains “highly contentious ”, it does
not discuss the reasons why this is so. In fact, the PSD strategy document does not even explicitly
mention the issues that are at the heart of the public-private mix debate. Some pros and cons of
private versus public provision of health services are mentioned in a rather casual manner, but the
exact areas of contention and the evidence are not reviewed.
A range of theoretical arguments have been put forward by neo-liberals, including World Bank
representatives, in favour of expansion of the private health care sector. Bennett (1997) has
summarised these into four main arguments:
(i)
Efficiency and quality
The private sector is often considered more technically18 efficient than the public sector. Due
to the profit incentive, private providers tend to produce services at lower costs for a given
level of output. At the same time, they have an interest in maintaining or raising the quality of
services. In a competitive market, firms that do not operate efficiently will incur losses and
will eventually be driven out of the market. An expanded role for markets and the private
sector would increase efficiency in the provision and financing of care. More recently, the
emphasis of the neo-liberal argument shifted to the suggestion that there will be gains in
” Technical efficiency refers to the optimal relationship between the inputs (resources) and outputs of a particular
(health) service (Green, 1999).
16
allocative efficiency-1’from private sector..growth. If the private sector is able to provide nonessential services, then the resources freed in the public sector can be targeted to priority
health interventions, such as public goods and goods with large externalities, and highly costeffective clinical services.
(ii)
Equity
Growth of the private sector and the transfer of demand for services by the rich from the
public to the private sector have the potential to increase equity in health care provision
because they free, up public resources that can be directed to the poor.
(iii)
Increased resources for health
A larger private sector implies an overall increase in the total resources available for health
care, and hence less pressure on government resources.
(iv)
Consumer choice
Increased private provision leads to increased consumer choice.
The PSD strategy document tacitly uses these arguments as an underpinning for the proposed
interventions. However, these arguments have been heavily criticised and continue to be the
subject of intense debate in the international literature and in public fora.
Bennett (1997) examined the empirical evidence in relation of each of the above four arguments
and came to six well-founded conclusions:
1.
The evidence on standards of efficiency and quality in the private sector relative to the public
sector was inconclusive, but suggested that private not-for-profit providers may be more
efficient and offer a higher quality of care.
2.
Damaging failures in the market for health care services may occur as the result of problems
of imperfect information.
3.
Promoting the private sector may increase accessibility to services and/or quality of care for
the poor in absolute terms, but differences in access and quality of care provided to rich and
poor are likely to increase.
4.
Government commitment to maintaining existing public funding levels is critical if total
health sector resources are to increase.
5.
Private providers are likely to bid up certain factor prices, thereby decreasing public sector
purchasing power, and possibly adversely affecting standards of care in the public sector. A
concomitant shift in inputs from public to private sector will occur.
6.
Consumer choice normally increases with privatisation, but with ambiguous implications for
consumer welfare.
In the same journal article, Bennett asserts that governments are generally unlikely to be able,to
fully determine three of the most important contextual factors that affect private sector behaviour,
although they do have considerable influence. The three factors are: the .market structure, the
regulatory framework in which the private sector would develop itself, and the socio-economic
environment More importantly, though, governments need to be aware of existing conditions that
will affect the way in which private sector providers operate and they need to adapt their policies
accordingly. These conditions include:
(a)
The existence of a sub-section of the population who are able and willing to pay for private
care;
(b)
The absence of great inequities;
(c)
Appropriate incentives and regulatory structures for health care providers;
(d)
Strong professional ethics;
19
Allocative efficiency refers to the optimal balance between the allocation of resources in view of the existing health
problems and disease patterns (Green, 1999).
17
(e)
(f)
Informed consumers and active consumer organisation; and
Relatively high standards of care in the government sector.
It would appear that most of these conditions are not fulfilled in poor countries. The logical and
inevitable conclusion would then be that the chances for a successful privatisation programme in
these countries are very limited. The suggestion in the PSD strategy document that the Bank
would focus on developing policies, institutions and capacity to support PSD in the health sector
therefore seems by and large inadequate to render private provision of health services effective
and useful.
3.6
Which market?
The PSD strategy document does not specify which markets are targeted for private sector
development. The few examples that are given suggest a focus on the provision of hospital
services or of specific curative services. It would appear that the IFC concentrates its support on
tertiary hospitals and industries that have a longstanding private sector involvement, such as the
pKaffriaceutical, biotechnology, medical supplies and medical equipment industries. But in its
strategy paper the IFC shows interest in other markets as well, including primary and secondary
levels of care (whether preventive, curative or rehabilitative), private health insurance, support
services in areas of patient management and information systems, and new markets such as
waste water treatment and medical waste management systems. So far, the IFC has supported a
wide range of private initiatives, ranging from hospital management and infrastructure
development (outpatient departments, diagnostic imaging and haemodialysis) and the provision
of laboratory services to the production of pharmaceuticals, medical equipment, ‘managed care’
projects and health care information technology and e-health.
The PSD strategy does.not prioritise any of these markets, suggesting a rather opportunistic
i approach and a ‘We-can-do-it-all” mentality within the Bank. It would appear that a careful
analysis of the experiences gained so far, not only with World Bank supported initiatives, would
shed more light on which markets are fit for private sector involvement and under what
conditions.
3.7
Policy coherence at the national and international level
The PSD strategy would obviously not be implemented in a vacuum. The PSD strategy paper
itself elaborates on the relationship with the Poverty Reduction Strategy Paper framework
(PRSP), but_not on the relationship with global regulations on international trade, such as the
General Agreement bn Trade in Services (GATS) and the Trade-Related Intellectual Property
Rights (TRIPS). Cognisance should also be taken of other international initiatives and new
funding'arrangements, such as the Global Fund to fight AIDS, TB and Malaria (GFATM), and
the recommendations of the Commission on Macro-economics and Health (CMH), which makes
a plea for massive financial injections in the health sector in low-income countries
PRSP
According to the PSD strategy paper, the. PRSP remains the main framework, into which PSD
strategies need to be incorporated. The World Bank and the IMF jointly introduced the PRSP
framework jn 1^99, .as an. overall development policy framework for at least 78 low-income
countries and as a requirement for these countries to be eligible for soft loans from the IMF and
the World Bank. Countries participating in the Highly Indebted Poor Countries (HIPC) initiative
18
■:
were targeted first.20 A large number of other donor agencies, including the European
Commission, have indicated that the PRSP will be the basis for their own contributions. 21
The PSD Strategy document indicates in which ways the WBG can further the treatment of PSD
issues in the PRSP process: for example by building capacity among domestic stakeholders to
carry out the required analysis; by sharing of knowledge, cross-country studies and best practices;
and by commenting on PRSP-related documents prepared in-country. Implicitly, the PSD strategy
paper suggests that PSD issues have so far not been adequately addressed in already existing
PRSPs. It is not clear, though, whether any specific efforts will be undertaken to ensure
integration of PSD issues into existing PRSPs. Neither is it clear whether individual countries are
expected to develop their own PSD country strategy papers, separate from the PRSP, and, if so,
through which process this would be pursued.
Several citizens’ groups in developing countries are of the opinion that their governments collude
with the World Bank behind closed doors on the privatisation of services, often in parallel to and
without the knowledge or consent of citizens involved in formulating national development
strategies, such as PRSPs. These groups feel that decision making on service provision should be
the domain of domestic constituencies instead of external actors. They also feel that the World
Bank interferes with domestic processes through the medium of public information campaigns,
which it undertakes to persuade countries and their citizens of the benefits of private sector
participation (Globalisation Challenge Initiative / Citizen’s Network on Essential Services, 2002).
GATS
Services first came under the rules of the world trading system in 1995, when the World Trade
Organisation (WTO) came into effect. As part of the General Agreement on Trade in Services
(GATS) negotiations, the WTO has been drawing up proposals for international trade laws that
would imply severe restrictions for the design, funding and provision of public services, including
health care. It is thus creating extra pressure for privatisation of public services. The legal tests
under consideration would outlaw the use of non-market mechanisms, such as cross
subsidisation, universal risk pooling, solidarity and public accountability as being anti
competitive and restrictive to international trade. The domestic policies of national government
will be subject to WTO rules, and if declared illegal, could lead to trade sanctions. Critics believe
that an acceleration of privatisation in health care systems will bring disproportionate advantages
to multinational corporations in the USA and the European Union and that it will undermine the
ability of low-income countries to implement their own public health priorities.22
TRIPS
The WTO agreement on Trade-Related Intellectual Property Rights (TRIPS) grants extensive
patent rights to pharmaceutical companies. The agreement has been much criticised, amongst
others for denying developing countries the right to manufacture or buy generic versions of
brand-name drugs, which would undermine the ability of developing countries to provide their
population with affordable medicines. More generally, the TRIPS agreement would make
governments vulnerable to extraneous political pressure from economically powerful states.23
20 As of October 2002,22 countries had their PRSP finalised, of which 15 in Sub-Saharan Africa; 45 countries had
drafted an interim PRSP (I-PRSP), of which 25 in Sub-Saharan Africa.
21 For more background information, see Verheul and Cooper (Wemos briefing paper; 2001) or Laterveer et al.
(2001).
22 See for instance Pollock and Price (2000), Hilary (2001) and Sexton (2001).
23 For more details see Hilary (2001).
19
Commission on Macroeconomics and Health
The report of the Commission on Macro-economics and Health (CMH), chaired by Jeffrey Sachs
on behalf of the WHO, does not elaborate in an extensive manner on private sector involvement
in the provision of health'services. In order to scale up health interventions and address the health
needs of the poorest people in society, the Commission advocates for the development of closeto-client systems (health services as closely as possible to the'clients), involving a mix of state ad
non-state health providers, with financing guaranteed by the state (WHO 2001).
“The government may directly own and operate service units, or may contract for services with forprofit and not-for-profit providers. Since public health systems in poor countries have been so weak
and underfinanced in recent years, a considerable non-govemmental health sector has arisen, that is
built upon private practice, religiously affiliated providers, and non-govemmental organisations. This
variety of providers is useful in order to provide competition and a safety valve in case of failure of the
public system. It is also a fait accompli in almost all poor countries.”
The Commission does not touch upon the conditions or the policy requirements for development
of private practice in the health sector. It recommends the establishment of a National
Commission on Macroeconomics and Health in each country, which would be chaired jointly by
the Ministers of Health and Finance, to organise and lead the task of scaling up the provision of
health services. If adopted, such a national commission could assume the task of outlining the
areas of private sector development and defining the legal framework and the support systems
that would be required. The PSD strategy paper, however, does not explore such possibilities and
concentrates rather on internal Work Bank dynamics.
It is evident that national governments, including those in low-income countries, need to explore
the possibilities how best to make use of the private sector in order to achieve public health goals
and to incorporate their views into policy and strategy documents. From the above examples, it is
not so evident though, whether national governments should specifically ensure the inclusion of
PSD strategies as outlined by the World Bank into their domestic policy frameworks. Neither is it
straightforward how they should do that, if at all. Policymaking and strategy development are
tedious processes, especially in low-income countries with limited human capacity, and ideally
they involve consultation of various stakeholders, both from government and outside government,
at different levels. Experience has shown that many national governments have great difficulty in
keeping up with the international debate and incorporating new international initiatives into their
domestic policies' and strategies. The PSD strategy, which is one of many international initiatives,
. harbours the risk of linking funding modalities to the priorities of the world’s major lending
institutions (including the World Bank Group), which may be guided largely by the type of
^—activities, and services that private providers are prepared to engage in. These activities and
services are not necessarily those that are needed most, and may lead to an undue focus on urban
localities, hospitals and on a selected number of diseases and specialist services, rather than on
nationally defined, integrated policies.
3.8
Risks
The World Bank may go ahead with increased PSD lending without verifying whether adequate
regulatory and monitoring.-capacitY. is in place at the level of the client countries concerned or
whether appropriate measures have been taken to ensure effective targeting of the poor.
Implementation of the private- sector development strategy as laid out in the World Bank
documents reviewed in this paper thus implies a number of risks, in particular for low-income
countries.
20
□
A shift in lending arrangements from support to health service provision by the public sector
towards service provision by the private sector may not increase the total resource envelope
available to the health sector as a whole, which would undermine the position of the state.
□
Increased emphasis on private sector development may lead stakeholders to shy away from
public health interests and give undue priority to hospitals and specialist medical care to the
detriment of primary health care.
□
The PSD strategy as laid out by the World Bank may unduly draw away the attention of
national governments from the need to bring under control the proliferation of private
enterprise in the health sector.
□
The PSD strategy is likely to further accelerate the formation of a two-tier system, whereby
rich people enjoy the services of a well-resourced private health care system while poor
people are surrendered to either a poorly-resourced public health care system that provides
poor quality services or an unregulated private health care system, that provides equally poor
services. Hence, the strategy is bound to lead to increased inequity in the access to quality
health care.
□
Overall, the PSD strategy will hamper national governments in fulfilling its obligation to
protect the right to health of large segments of their populations; as a result, the gap between
poor and rich people within one and the same country may widen further; and the gap
between poor and rich countries may widen as well.
21
Chapter 4
Conclusions and perspectives for NGO action
The PSD strategy as laid out by the World Bank for low-income countries has some serious
limitations for the development of the health sector and the protection and promotion of people’s
health, in particular the poorest groups in low-income countries. Several conclusions can be
drawn on the basis of the argumentation and the evidence presented in the previous chapter.
□
The PSD strategy document concentrates on programmed privatisation, leaving out the
widespread problem of incremental privatisation. Some countries might benefit more from
assistance to put mechanisms in place to regulate and control the private sector than to invest
in programmed privatisation. Regulation and capacity building for improved regulation - as
suggested in the PSD strategy document as an accompanied measure for programmed private
sector development - is not sufficient Regulation, inspection and enforcement/sanctioning
must go together.
□
The development objectives of the PSD strategy are clear; however, the precise objectives of
any PSD initiative will depend on country-specific or even local circumstances and requires
carefill definition. The current PSD strategy is too general to allow an evaluation after some
time. A framework for monitoring and evaluation is required, with a clear specification of
possible key indicators. This could be used by individual countries to develop their own
system for monitoring and evaluating any progress in private sector involvement in health
care.
□
The four basic arguments in favour of private sector involvement in the provision of health
services are not explicitly mentioned or discussed in the PSD strategy. They are rather taken
for granted, despite the fact that they are highly controversial. As a result, the ‘areas of
contention’ that are at the heart of the public-private mix debate, and that have been
articulated so well by analysts like Sara Bennett, have not been discussed either. This
suggests that either the World Bank has not done its homework properly or it has chosen to
disregard scientific evidence. It is a serious omission not to review the experiences already
gained and the lessons drawn by others, especially those that do not belong to the neo-liberal
school of thought that predominates at the World Bank.
□
The PSD strategy has the ambition to contribute to better private health service coverage
worldwide, including in poor countries. However, the PSD strategy document does not
attempt to refute the well-documented claim of several analysts that the conditions for a
successful privatisation programme (see a. to f. in section 3.5) are not fulfilled in the poorest
countries.
□
The PSD strategy has the ambition to extend private health service coverage to people of all
layers in society. Past experience has shown that well-functioning targeting systems are a key
element in ensuring that the poorest have access to (private) health care. The PSD strategy
does not address the problems that have been encountered in targeting assistance to those
who are most in need, yet most deprived of such support.
□
The PSD strategy seems to target all health care related markets for private sector
development. Before implementing the strategy in any country, a thorough analysis would be
22
required to clarify which markets are fit and which ones are less appropriate for private sector
involvement.
□
The PSD strategy does not make a clear distinction between for-profit and not-for-profit
providers. Yet, there is a fundamental difference between the two categories and the
opportunities for a fruitful public-private partnership of the government with not-for-profit
providers seem much bigger than with for-profit providers. In this regard, applying OBA
schemes in relation to not-for-profit providers could have clear merits and contribute to the
goal of increasing equitable access to health care by all.
What can NGOs do?
Non-governmental organisations concerned with the plight of low-income countries and
especially the health situation of the poorest layers in society could undertake action in several
ways. Where possible, they should work in close collaboration with public health specialists and
researchers/analysts to do the following:
1.
Analyse what national health policy frameworks and strategies say about private sector
involvement in the provision of health services. Are there any intentions to change the public
private mix in health care? In what direction and with which objectives, in mind? Similarly,
local health policies and strategic plans (e.g. district health plans) should be scrutinised:
verify whether the intentions for private sector involvement, if any, are made explicit and
what type of involvement is pursued at this level.
2.
Document the experiences with (programmed) private sector involvement; evaluate these
against the four objectives outlined in this paper (efficiency & quality, equity, increased
resources, consumer choice); verify whether the basic conditions are fulfilled for effective
private sector involvement in the provision of health services; and evaluate the experiences
against national/local health policy and strategic frameworks.
.
-
3.
Question national or local authorities about their intentions with regard to development of the
private sector for health service provision; ask them for indicators of success. Provide them
with concrete experiences (positive and negative) from the field. If applicable, advocate for
the establishment of a focal point within the Ministry of Health (preferably close to the
Planning Department or the Secretary for Health).24
4.
Monitor the plans of the World Bank and other lending and aid agencies in relation to private
sector development; demand participation in any new initiatives right from the planning
phase onwards and ask critical questions as to the exact purpose, the intended or unintended
effects on the poorest people in society and how these will be measured.
5.
Exchange the experiences acquired (positive or negative) in national fora or through the
appropriate coordinating bodies; among the NGO’s, designate a focal point, if appropriate, so
as to facilitate the exchange of information.
24 Ghana could serve as an example: in 1997, the Ministry of Health established a private sector unit within the
Planning Department.
23
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24
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Materials for further reading
Bayliss K, Hall D (Public Services International Research Unit) (2001), A PSIRU response to
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Bayliss K, Hall D (Public Services International Research Unit) (2002), Another PSIRU
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International Development Association (2001), Note on IDA 13 and private sector
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Sexton S (The Corner House) (2001), Trading health care away? GATS, public services and
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Verheul E, Cooper G (Wemos) (2001), Poverty Reduction Strategy Papers (PRSP): What is at
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World Bank (1999), Investing in Health: Development effectiveness in the Health, Nutrition and
Population Sector. World Bank Operations Evaluation Department. Washington, D.C.
World Bank (May 2001), Review of private sector development in EDA 10-12, World Bank
Operations Evaluation Department. Washington, D.C.
25
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