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RF_NGO_26_SUDHA
2-9-1993
12:93
Dr. Amar Jesani,
CEHAT,
310, Prabhu Darshan,
31, S.S.Hagar, Amboli,
Andheri (West),
Bombay - 4GO 058.
Dear
tS.-eA'-
Greetings from Community Health Cell!
Thanks for your letter dated 23-7-1993. We were quite busy in early
August preparing for Thelma's trip to Canada. She went to present
two papers from our study at the Conference of the International
Network of Community Oriented Health Sciences at Sherbrooke and also
attend a meeting at Mci'aster. Some of the groups I had met during
my earlier trip to Canada have arranged meetings for her as well
and sc she will have a busy time and return on the Sth.
You should write to Hr. George Krause and Er. Ulrich Dornberg of
i isereor, Postfach 1450, D-52015, Aachen, Germany, about CEHAT and
its evolving studies. One or both of them are likely to be visiting
India in November for the CHAT Jubilee: meeting in Secunderabad from
31st October to 7th November, 1993. They could probably discuss
further at that time and would need to put Bombay on their
itinerary. I had been to Aachen in May to facilitate a workshop on
State of India's Health and many of the issues you want to do
studies on, emerged as key issues for 1990s - womens health, violence/
human rights violation etc. : rause has been travelling in India for
nearly two decades or more and has a very good understanding of
grassroots realities and issues. They are keen to fund secular
groups and are not imposing in their relationship. Presently they
fund our library and documentation unit.
I was not very sure what sort of fun s - levels - over what sort of
time etc., you are exploring. Also a more detailed study proposal
around specific hypothesis may get more easier funding than
monitorinc vaguely the overall focus and ofcourse depending on the
study methodology, the funds needed could be very varied.
2
2.
If you write to Hisereor, mark a copy to us so that we too could
follow it up when we meet them in Kovember, 1993.
* Cur plans after December, 1993 are still uncertain but we may
have some further clarity when Thelma return.
Best wishes to you, Vibhuti, Lara and mfc-Bombay friend
Yours sincerely,
T^'Ravi narayan
*rn/vnnr
14.
47:93
1993
Tear
Greetings from Community Health Celli
1.
This is in response tn your letter of 13th July, 1993 (Kr/pk 321/ft.l
re. the CMA1
rim ary Health Care Newsletter proposal,
n the rush
of completing many items of work in preparation for handing over
coordinatorship in July, I misplaced this letter for a while. It
resurfaced recently as I was looking through piles of paper and I
have just managed to show it to Dr. C.;-. Francis, who now works with
us as a part-time consultant and also to other team members. As
you have indicated i:l is is a ’desk reaction’ to the venture from us.
X always prefer to discuss the matter out with the partners
concerned so that the cc-rments are seer, as ’questions’ for
reflection to improve or modify the project proposal rather than
an outside consultants' view of whether it is C.t. or not C.K.
However since CHAI is by now quite used to cur critical perspectives
I am sending this note to you based on our intra-toam discussions.
2.
have you all written anything u>-. as a sort of summary report or
list of issues for follow up after the Aachen workshop? I would
love to have a copy so that one is clearer about how the group
responded to the perspectives shared etc. I wrote a very short
note about the workshop and trie trip for our Executive Committee
and this is enclosed in a spirit of partnership. It is not
comprehensive just a few salient points!
3.
Thelma has just returned from her Canadian trip which vias most
interesting in terms of meetings and sharing perspectives. The
Canadian proposal is evolving at a rather slow pace partially
because of the ’funds* problem. '.-.e have also now decided to
explore the London School connection more actively since the
phase is scheduled to begin January 1994. For the present, we
feel we shall have enough to consol idate/write up based in
Bangalore itself till around
1994 - so we hope to move
if at all
1994 or thereafter, >-.e presume one or both of
you will be visiting India later this year - so hopefully there
will be more to report by then and perhaps to explore as well!
2
2,
4.
7. group of mfc colleagues - serious rosearchers/activists nave
recently moved beyond J'RCr.-Bombay and sot up their own group
called CLEAT. A pamphlet is enclosed and in a recent letter to
. i. Amar Jesani (copy enclosed) I have requested them to approach
you for support since their areas of enquiry are very relevant
for the evolving current situation. ho follow it up during your
next visit - especially if Bombay is on the itinerary.
5.
It feels nice to be able to sit back and see CHC evolving, gradually
towards newer directions and initiatives. The new team is forming
up and while we have been helping >?r. Shirdi Prasad Tekur in
planning and orienting it is from a position of ’not being in
charge*"which is a new experience, efeourse the Research Project
pnblications/reports are still taking up much of the time since
these have to be completed definitely by December, 1993 when we
phase out fully.
Lest wishes from both of us and the CHC team,
Yours sincerely.
£ncl: 1. note on CMAI’s project proposal;
2. R'.’s letter to Cr.Amar Jesani dated 2.9.93
Project Proposal; Support for relevant Primary
Health Care Newsletter for India.
Seme comments
1.
There is no doubt that a newsletter on PHC which is practical, and
links experience with evolving theory in India and abroad would be
a great stimulus to Health care.
already one such.
The FIONA Newsletter of CHAI is
Similarly Health for the Millions of VHAI and
Health Action of CHAI also provide some stimulus in this direction
2.
while the attempt to amalgamate FIG/A, and Indian edition of art
and diarrhoea Dialogue may seem a laudable objective - ariving at
a need by reviewing existing NCG communications and identifying
lacunae which need to be met in a 'new newsletter’ may be a more
sensible way of arriving at identifying the need.
3.
Also ARI and
iarrhoee dialogue are typical of the selective
primary health care approach and though they do provide practical
information regarding these two problems the new newsletter should
be more integrated towards Comprehensive Primary Health Care and
perhaps also strongly emphasise the Community Health perspective
relevant to the Indian situation especially since the mandates of
CMAI and CHAI now endorse this broader view and more comprehensive
basis for action.
This is not adequately spelt out in the
objectives.
4.
The proposal seems to be a collaboration between CMAI and AHRTAC.
CHAI seems to have been an after thought!
I
With Health Action,
Catalyst and a member oriented newsletter (post jubilee) being
already on the CHAI anvil what wil’ their real contribution to
this contribution actually operationalise? is VHAI involvement
in the thinking through'of the focus and objectives a practical
possibility.
Since CHAI and CMAI members form the core of VHAI
itseli and VHAI has initiated so many other publications that
are also now practical oriented apart from HPM - various wall
papers etc., is their participation in planning feasible?
2
2,
5.
The editorial group has not been spelt out. It is crucial to select
appropriate persons and especially those that have ’practical'
experience or atleast grassroots contact so that 'praxis' is
emphasised not 'theory'. To reduce travel expenses, persons in and
around Delhi may get selected but an attempt to tap experience of
different and remote parts of the country are required and this
needs some creative planning and establishing of linkages with
'doers' and not only 'thinkers’.
6.
The amount seems huge.
It is presumed that it is a monthly.
This
would mean the cost comes to ‘ .7-00 per copy. This seems too much.
It is said to be a 12 page publication with 20,000 copies. The
cost will be much less unless there are multiple colours involved
and or use of art paper.
7.
It is difficult to got into the details of the budget.
The overall
impression seems it is high though whether this is a reflection of
costs in the capital city, one cannot say. e.g., for postage and
distribution Rs.2.2 to 3.2 lakhs is provided.
If the newsletter is
registered (which can be done in 3 months), the postage will be
very low.
8.
So also for many items the provision seems rather high.
In the covering letter, there is a mention of a more comprehensive
application.
May be that would provide more details of the
objectives, methodology, process and evaluation of effectiveness since these need to be spelt out in greater detail to help the
project get started on a much firmer base.
9.
There is a lot of practical field experience, creative adaptation,
appropriate technology and alternative ways of doing things towards
empowerment of people, demystification and creating autonomy in
health care. It would be a challenging task to reach this experience
and share it around. Many of the existing newsletter are too topdown, theoretical and prescriptive of uniformity rather than
representing the rich diversity that abounds. But getting to 'feel
see and hear* this needs perhaps a little more grassroots oriented
journalistic skill rather than relying on expert editorial boards.
Can the newsletter introduce this dimension in the planning/
management process?
—x—x—x-x
CEHAT_____________________
519, Prabhu Darshan, 31, SwatantryaSainikNagar, Andlieri West, Bombay 400058, India
INST/MISE/95/21 efT
November 24,1995.
Speed Post
Drs. Ravi and Thelma Narayan,
Community Health Cell
367, Srinivas Nilaya, Jakkasandra, I Main
I Block, Koramangala, Bangalore 560 034.
Deal- Ravi and Thelma,
Greetings from friends here.
It was nice knowing that you people are here. The Cehat is doing well. We had some fmacial
problems in last two months as the FCRA misplaced some papers of our application but that
has been sorted out and the prior permission given. This project is in line with Ravi’s Jalgaon
studs' titled “Cost of Health Care” but would concentrate on the reported morbidity,
practitioners utilised and cost of women’s health. All household expenditure studies done so
far have substantially missed out on cost of women’s health. Ulis is going to be a very difficult
study, and thus makes us very excited about it. If you are interested in its progress, I will ask
Sunil Nandraj to write to you from time to time.
One of our MFC friend from Kanpur, Dr. Abhay Shukla has settled down in Dahanu (in Thane
district where Kashtakari Sanghatna works) to begin a primary' health care project in tire
tribal people’s movement. I am sure this would remind you of Dhruv/Anant’s views of doing
health work as apart, of people’s movement. Yes, Anant is involved, he will be conducting the
first camp for training women health workers from villages in the first week of December,
1995. The Cehat has submitted a proposal for funding this project to the CAPART. The
CAPART representative has done its appraisal last week and we hope it would be processed
fast. But, as ususal we are not waiting for the funds. If the funds come we will establish a
modest medical/health centre in one of the villages to provide first level referral services with
a doctor to provide support to women health workers’ work. With this, our community level
work has taken off In the next phase, we intend to establish primary health care work in
Bombay slums. Of course this would take one more year to take shape, but it is on the agenda
On the research side, situation is equaally good. We have completed two studies (Study of
physical standards for care in private hospitals in Satara district, it is a study of 49 nursing
homes, and a study of legal aspects of health care) for the UNDP/GOL We also did a
substantial database report on state health expenditure, 1952-95, which has been published in
the EPW, April 15 and 22, 1995 issues in two installments. These data are on the computer, so
go through these statistics in EPW and if you have any special need for data, national or
statewise, please write to Sunil. He would send them to you. Besides, we are doing two
chapters (on Medical Ethics and Private Sector) for the Independent Commission on health of
the VHAI. And a study of state financing (national and all states) of major. disease, control
programmes, 1986-1995 (if Thelma is interested in such data, please ask her to write to Sunil)
Telephone/Fax'. (91) (022) 625 0363
E-Mail: cehat @ inbb.gn.apc.org
(Fax. received only from Monday to Friday, between 10 a.m. to 5 p.m., Indian Std. Time)
CEHAT is a Research Centre of Anusandh/ui Trust tegd Under Bombay Public Trusts Act Regd No E-13480
CEHAT - Centre for Enquiry into Health and Allied themes
2
for flie UNDP/GOL A major study on social aspect of abortion will be completed in Pune by
March next year and a book on it will be ready by September 1996. An edited book titled
“Market, Medicine, Malpractice: Issues and Case studies" published by the CEHAT is in
press and should be available in January.
We have worked like donkeys in last two years to establish the Cehat as a reliable and good
research institute. Personally, I am quite satisfied, and the results have started showing. The
Cehat has stalled getting recognised for its expertise and we are finding it difficult to honour
invitations we are getting. Ravi and Sunil are now invited to the US to present their critique of
world bank’s India papers on family planning. They are going there for a week from December
10,1995.
hi this rush, I had kept my plans of developing work on violence on hold. Thus, I could not
follow up what I had promised to the MISEREOR. Now, I feel less insecure about the Cehat
and so I have decided to get out of my health service research by December end. From January,
I will have no project to work on. I have applied for a fellowship from the Times Fellowship
Council, to work on the health services response to epidemic of violence but I am not sure
about getting it If I don’t get it, I will have to make lots of efforts to get some support to myself
and that was wiry I called up in case Misereor is interested in supporting something. To be
frank, I have lost, interest in most of the issues on health except violence, ethics and
malpractics. That limits my choice but that is also a good incentive to develop those areas.
Early in this month (November) I attended a meeting at Amsterdam on human rights and health
and also visited Paris where I have several friends working at the treatment centre for violence
victims (Primo Levi). One of them (Francoise Sironi) has visited India several times, spent
lots of time at Cehat and closely observed work I have been doing with the victims and they
also provided support when I was undergoing crisis due to the experience of violence. They
have established their own centre with the support of Amnesty and other groups. They have
given their full commitment to provide us support whenever needed. If they get finance, a team
from their organisation might visit Bombay early next year to make a report on the need for
such a centre here. We felt that since we would need large funds, such a report would help in
raising finances. We have also made a proposal for creating an alternative international
network ofNGOs involved in providing treatment to violence victims with a community based
and culturally sensitive approach. Whi le the biggest network in this field is sponsored by the
IRCT, Copenhagen, there are many community based and or socially oriented groups involved
in such work on violence and not part of that network due to its high emphasis on medical
model and so called value free approach.
Anyway, in short, this is the direction I intend to take from January, 1996. Thus, I have
enclosed proposals for the consideration of Misereor. I have apologised to them for not
contacting for so long, and I have no explanation to offer except that I was too busy in
establishing Cehat (and of course helping Medical Ethics, RJHand MFC}.
Of the five proposals, the first one is sent to the Times Fellowship Council. If I get the
fellowship, I may be working on torture in police custody. For Misereor, I am interested in
undertaking a study of health system’s response to communal violence in Bombay and if enough
CEHAT - Centre for Enquiry into Health and Allied themes
hinds are made available, then in Ahmedabad or Surat, too. If Ahmedabad is included, I would
like to persuade our MFC friend Dr. Hanif Lakdawala who is presently working most of the
time on mobilising liberal Muslim opinion on communalism, to help in the work. I would be
the happiest person if the Misereor show interest in the second proposal which is about
establishing medical centre for treatment of victims of violence. But it needs big funds, about 3
million rupees a year. The high funds will be needed as we will need rent for a separate place,
for library documentation, remunerations for doctors and nurses and for undertaking actions to
prevent further occurrance of violence to treat and rehabilitate victims. If they can’t, I will
continue with my efforts elsewhere.
There are two other proposals, one on medical malpractice and another on PDIC, both are
known to you as for the former, much was reported in the MFC and for the latter, Anil
Pilgaokar has written in the MFC bulletin.
I know that giving several proposals at a time might confuse the funding agency. But voluntary
work on each (except proposal on child abuse) is already on. The funds are needed to
institutionalise them as many of us are fast burning out due to spending long working days and
also for doing wotk on week ends. We have no choice but to get funds to support some salaries
and other expenditures so that work is made more effective, efficient, and some relief is
provided to volunteers.
Lastly, we would be happy to have collaborative work on any of tire project mentioned with
you or CHC or both. I strongly feel that organisations which have evolved from the MFC
influence should be collaborating at the national level to make our intervention very effective. I
do not believe in doing work in a comer without concern for influencing larger processes for
change at national level. The collaborations have their peculiar problems, but unless we learn
to amicably manage such problems there is no possibility of making a greater impact. Thus, I
will be interested in undertaking something that could be done multicenfric or as a part of a
loose collective or network of friends. I leave it to your discretion by saying that I will be
open to newer ideas. So go through the papers enclosed for the Misereor and let me know.
I am also enclosing a letter for Dr. Francis. We will be very disappointed if you decide not to
come for the MFC meet. Believe me, although certain things can never change in the MFC,
there are also many things which are changing. The tempo for the meet is building up, and we
expect 50 to 75 persons. I have also written to Dr. Francis about the meet and requested him to
attend, more so because it is on ethics. We expect the January issue of Medical Ethics to be
ready by December 25, so that it is made available at the meet.
I am sure reading this bundle of papers would take your day, my advance apologies for that. I
do feel that I am burdening you a lot, more so as it relates to the funding and to the development
of research areas. My apologies for that too.
Our best wishes and regards to all friends there.
Yours sincerely,
Amar
J
A k
ojiK.
^*—7
__
.
,
PUBLICATIONS
CEHA T
Research Centre of Aitusandhan Trust
519 Prabhu Darshan, 31 S.Sainik Nagar
Amboli, And her) West, Mumbai 400 058, India
Fax: (91) (022) 620 9203, lei: 625 0363,
Email: adminfg'cehat.llbom.ernet.in
(A)
Health care services and financing
Studies, reports and books:
(RA.04) Patient satisfaction in the context of socio-economic background and basic hospital
facilities: A pilot study of indoor patients of tlie LTMG hospital, Mumbai, Iyer Aditi, Jesani
Amar, Kuimarkar Santosh: Mumbai: CEHAT, October 1996, pp.56.
(RA.03)Financing of disease control programmes in India, Nandraj Sunil, Duggal Ravi; Mumbai;
(.'EHAT, February 1996, pp.53.
(RA.02)The private health sector in India: Nature, trends and a critique, Duggal Ravi: Mumbai:
CEHAT. January 1996. pp.47.
(RA.01) Special statistics on health expenditure across states, Duggal Ravi, Nandraj Sunil,
Vadair Aslia: Economic Political Weekly, Vol. XXX, Part I in No. 15, April 15, 1995, pp.834844. and Part U in No. 16. April 22.1995. pp.901-908.
Papers and essays:
(PA.25) Physical standards in the private health sector, Nandraj Sunil, Duggal Ravi, in Radical
Journal ofHealth (New Senesl, Vol IL No. 2-3, April-September 1996, pp.141-164.
(PA.24) From philanthropy to human rights: A perspective for health activism in India, Jesani
Amar (Paper presented at the Diamond Jubilee Conference on “Social Movements" organised by the
Tata Institute of Social Sciences. Mumbai on November 3, 1996): Mumbai: CEHAT, November
1996: pp.24.
(PA.23) National disease control programmes: Recent trends in financing, Nandraj Sunil,
Duggal Ravi: Radical Journal ofHealth (New Series), Vol. II, No. 1, January-March 1996, pp.
(PA.22) Cost of medical care: Issues of concern in the present scenario, Nandraj Sunil (Paper
presented at the All India Peoples Science Network. Seminar on Health For All Now. New Delhi,
November 1995): Mumbai: CEHAT. November 1995, pp. 13. '
(PA.21) Medicos’ strike: Relevant issues, Jesani Amar: Radical Journal of Health (New Series),
Vol. 1, No. 4, October-December 1995, pp.247-50 (Editorial).
(PA.20) Market reforms in health care, Jesani Amar: Radical Journal of Health (New Series),
Vol. LNo. 3, July-September 1995, pp. 171-3 (Editorial).
(PA. 19) Public health budgets: Recent trends, Duggal Ravi: Radical Journal of Health (New
Series). Vol. I. No. 3, July-September 1995. pp. 177-82.
(PA.18) Beef up the health budget, Nandraj Sunil: The Metropolis (Anniversary Special), February
4-5. 1995, pp.l.
(PA.17) Health expenditure patterns in selected major states, Duggal Ravi: Radical Journal of
Health (new scries), Vol. L No. 1, January 1995, pp.37-48.
(PA.16) The number game. Duggal Ravi: Huntanscape, November 1994, pp.20-22.
(PA. 15) The great divide, Duggal Ravi: Humanscape, October 1994, pp. 14-15.
CE/Z-trFublfcaHons
1
(PA. 14) Population meet: Poor impact of NGOs, Duggal Ravi: Economic and Political Weekly,
Vol 29 No 38. September 17. 1994, pp 2457-8
(PA. 13) Population and family planning policy: A critique and perspective, Duggal Ravi (Paper
presented at International Conference on Population and Development. Cairo. September 1994):
Mumbai: CEHAT, August 1994, pp.6.
(PA.12) New moves: The Indian drug scene, Pilgaokar Anil: Voices, Vol.: U, No. 3, 1994, pp.2224.
(PA. 11) Health finance of the Brihan-Mumbai Municipal Corporation, Duggal Ravi, Nandraj
Sunil (Background paper for Medico Friend Circle. Mumbai Group’s Workshop on Improving
Public Hospitals in Mumbai, June 1994): Mumbai: MFC - Background papers, May 1994, pp.37-44.
(PA. 10) Peoples economy: context and issues from India, Duggal Ravi (Paper presented at
Seminar on “Market Economy Also for the Poor”, Berne, Switzerland, May 1994), Mumbai:
CEHAT, May 1994, pp. 14.
(PA.09) For a new health policy: A discussion paper, Duggal Ravi (Paper presented at the study
circle organised by the MFC/FMES/ACASH, Mumbai, on August 21, 1994): Mumbai: CEHAT,
August 1994. pp.13.
(PA.08) Health manpower in India, Duggal Ravi (Paper prepared as National Consultant on WHO
project, for the Ministry of Health. New Delhi): Mumbai: CEHAT. August 1993, pp.20.
(PA.07) Health care utilisation in India, Duggal Ravi: Health for the Millions, Vol., No. |
pp.10-12.
(PA.06) Resurrecting Bhore: Re-emphasising a universal health care system. Duggal Ravi:
MFC Bulletin, No. 188-9, November-December 1992, pp. 1-6.
(PA.05) Trends in FP policy and programmes, Duggal Ravi (paper presented at seminar on
“Trends and perspectives for FP in the Nineties”, Mumbai Union of Journalists, August 1992):
Mumbai: CEHAT, August 1992, pp. 15.
(PA.04) Cost and concern in primary health care, Duggal Ravi: Health Action, Vol. 5. No. 8.
August 1992, pp.
(PA.03) Regional disparities in health care development: A comparative analysis of
Maharashtra and other states, Duggal Ravi (paper presented at the national workshop on health
and development in India, NCAER,Harvard University, Delhi. January 1992), Mumbai: CEHAT,
1991. pp.20.
(P/V02) Ending the undeiTinancing of primary health care, Duggal Ravi, MFC Bulletin No. 177178. November-December 1991. pp.7-9.
(PA.01) Private health expenditure, Duggal Ravi, MFC Bulletin, No. 173-174, July-August 1991,
pp!4-6.
4
(B)
Health legislations, etliics and patients’ rights
Studies, reports and books:
(RB.D3) Medical ethics: For self-regulation of medical profession and practice, Iyer Aditi,
J ,'^am Amar: Mumbai: CEHAT, January 1996, pp.39.
(RB.02) Laws and health care providers. Jesani Amar. Mumbai: CEHAT. January 1996. pp. 135.
(RB.01) Physical standards in the private health sector: A case study of rural Maharashtra,
Nandraj Sunil. Duggal Ravi: Mumbai: CEHAT, November 1995. pp. 133.
Papers and essays:
(PB.24) Cross practice at the cross-roads, Jesani Amar: Issues in Medical Ethics, Vol. 4. No. 4,
October-December 1996, pp.103 (Editorial)
CEHAT Publications
2
(PB.23) Medical ethics and professional seif-regulation: Some recommendations, Jesani Amar:
Health for the Millions. Vol. 22 No 4, Julv-August 1996, pp. 24-9.
(PB.22) Crisis of credibility: The talc of Medical Councils, Iyer Aditi. Health for the Millions,
Vol. 22 No. 4, July-August 1996, pp 17-20.
(PB.21) Editorial, Jesani Amar (As guesl editor): Health for the Millions, Vol. 22 No. 4, JulyAugust 1996, pp 2.
(PB.20) Physical standards in the private sector: A case study of rural Maharashtra, Nandraj
Sunil, Duggal Ravi: (Accepted lor publication in Radical Journal ofHealth, New Series). 1996.
(I’B.19) Law, ethics and medical councils: Evolution of their relationships Jesani Amar.
Medical Ethics. Vol. 3, No. 3, July-September 1995, pp.C-IX-XII.
(PB.18) Medical ethics: General principles, Pilgaokar Aiul: Medical Ethics, Vol.. 3, No. 2, AprilJune 1995, pp.C-V to C-VUI.
(PB.17) Self-regulation or external control?, Jesani Amar: Medical Ethics. Vol.: 3, No.: 2, AprilJune 1995, pp 18 (Editorial)
(PB.16) In the pink: Need for asserting patients’ rights, Jesani Amar, Pilgaokar Anil: Keemat,
Vol.: 24. No: 3. March 1995. pp 12-4
(PB.15) Ethics of professional bodies, Pilgaokar Anil: Medical Ethics, Vol.: 3, No: 1, JanuaryMarch 1995, pp. 2 (Editorial).
(PB.14) Assessing the need for and designing an accreditation system: Situation in India.
Nandraj Sunil (Paper prepared as consultancy for Institute of Health Systems, Hyderabad, July
1994): Mumbai: CEHAT. August 1994. pp. 10
(PB.13) Beyond the law and the Lord: Quality of private health care, Nandraj Sunil: Economic
and Political Weekly, Vol.: XXIX. No: 27. July 2, 1994, pp. 1680-5.
(PB.12) Medical ethics. Jesani Amar: Medical Ethics. Vol. 1. No: 3, May-July 1994, pp.8. (Book
Review).
(PB.ll)The unregulated private health sector. Jesani Amar. Nandraj Sunil' Health for Million,
Vol. 2. No. 1, February 1994. pp.25-28.
(PB.10) Patient’s autonomy: Throwing it to the winds?" Jesani Amar. Pilgaokar Anil. Medical
Ethics. Vol. 1 No. 1, August-October, 1993, pp.6-7.
(PB.09) Patients’ rights: A perspective, Jesani Anar, Nadkami Virnla: The Indian Journal of
Social Work. Focus Issue: Patients’ Rights. Vol.: LIV, No: 2, April 1993, pp.167-71. (Guest
editorial)
(PB.08) User charges and patients' rights. Duggal Ravi: The Indian Journal of Social Work.
Focus Issue: Patients’ Rights, Vol.: LIV, No: 2, April 1993, pp. 193-97.
(PB.07) Medical ethics and patients' rights, Jesani Amar: The Indian Journal of Social Work.
Focus Issue: Patients’ Rights, Vol.: LIV. No: 2. April 1993, pp. 173-187
(PB.06) Consumers and the medical community, Jesani Anar: Christian Medical Journal of
India. 1992. pp 5-7.
(PB.05) Medical ethics: Awaiting a patients' movement, Jesani Anar, Duggal Ravi: VHA1, State
ofIndia's Health iBook): New Delhi: 1992. pp. 365-77.
(PB.04) Private nursing homes: /V social audit. Nandraj Sunil (report submitted to the committee
appointed by the Mumbai 1 ligh Court to regulate nursing homcs/hospitals in Mumbai City, July,
1992), Mumbai: CEHAT.
(PB.03) Regulating the private health sector, Duggal Ravi, Nandraj Sunil: MFC Bulletin, No.
173-4. July-August 1991. pp.5-7.
(PB.02) Educational intervention in medical malpractice, Jesani Amar: FRCH Newsletter, Vol.
V. No. 4. July-August 1991. pp.4-5 (and 8).
(PB.01) Medical malpractice: What it is and how to light it (Report of a workshop, MFC
Mumbai Group): Jesani Anar. MFC Bulletin, No. 171-2, May-June 1991, pp. 1-3.
CEHAT Publications
3
(C)
Women’s health
Studies, reports and books:
(RC.01) Garbhapal: Samaj ani Adhikar, Gupte Manisha, Bandewar Sumta, Pisal Hema, (Slide
Show, in Marathi). Mumbai: CEHAT.
Papers and essays:
(PC.14) Abortion needs of women : A case study of rural Maharashtra, Gupte Manisha.
Bandewar Sunita. Pisal Hemlata (Paper presented at the conference organised by Stimezo, a Dutch
Foundation of Abortion Clinics in the Netherlands in March 1996): Mumbai: CEHAT. December
1995. pp.16.
(PC. 13) Women's perspectives on (he quality of health care and reproductive health care:
Evidence from rural Maharashtra. Gupte Manisha. Bandewar Sunita, Pisal Hemlata (Scheduled
for publication in a book to be brought out by the Ford Foundation): Mumbai: CEHAT, December
1995. pp.28.
(PC. 12) Umaltya kalayan ch e prashna, Gupte Manisha, Pisal Hemlata (article for AFARM):
Mumbai. CEHAT. December 1995. pp.4. tin Marathi)
(PC.11) Jant: Prasar ani laxane, Pisal Hemlata: Mumbai: CEHAT, September 95, pp.8. (1^
Marathi)
(PC.10) Saad sharirachi. Gupte Manisha: Palakneeti. Vol. 65. Diwali 1995. (In Marathi)
(PC.09) Our health costs little, Duggal Ravi: in Karkal Malini (Ed.) Our lives, our health, (Book)
New Delhi. Coordination Unit. World Conference on Women. Beijing, 1995. August 1995. pp.5459.
(PC.08) Abortion: Who is responsible for our rights, Jesaiu Amar. Iyer Aditi. in Karkal Malini
(Ed.) Our lives, our health. (Book) New Delhi: Coordination Unit. World Conference on Women,
Beijing. 1995, August 1995. pp. 114-130.
(PC.07) Women, health and development. Gupte Manisha. Karkal Malini, Sadgopal Mira:
Radical Journal ofHealth (new series), Vol.: l,No: 1, January-Marell, 1995, pp.7-8.
(PC.06) Violence against women and children: The role of media and health care
professionals. Jesani Amar (Paper presented at Xavier's Institute of Communication’s seminar on
Health Communication held in Mumbai on November 17, 1994). Mumbai: CEHAT, November 1994,
PP?
(PC.05) New approaches to women's health: Means to an end?, Prnknsh Padma: Economic and
Political Weeklv. December 18. 1993. pp.2783-6. ( A background paper for the MFC meet on "Soci^*
construction of reproduction” at Wardha, January 13-15, 1995).
(PC.04) Women and abortion. Jesani Amar, Iyer Aditi: Economic and Political Weekly, November
27. 1993. pp 2591-94 (A background paper for the MFC meet on “Social construction of
reproduction" at Wardha. January 13-15, 1995).
(PC.03) On being normal (whatever that is), Gupte Manisha: MFC Bulletin. No. 197-201. August
1993, pp.4-6. (A background paper for the MFC meet on “Social construction of reproduction”, at
Wardha, January 13-15. 1994).
(PC.02) Sexism in medicine and women’s rights, Prakash Padma. George .Annie, Panalal
Rupande: The Indian Journal of Social Work, Focus Issue: Patients' rights, Vol.: LIV, No. 2, April
1W3 pp. 199-204.
(PC.01) Nurses as women, Jesani Amar: Economic and Political Weekly, March 2-9, 1991, pp.493.
(Book Review i
CEHA T Publications
4
(D)
Investigation and treatment of psycho-social trauma
Studies, reports and books:
(RD.04) Mumbai riots: January 1993: A selected documentation from a section of the print
media, Jesani Amar, Alphonse Mary, D’Sa Aloysius; Solidarity for Justice, Mumbai March, 1993,
pn. 180.
(RD.03) An enquiry by the fact finding team into the police firing that led to the lulling of a
tribal and caused injury to others in Dahanu Taluka, Thane District, Maharashtra, Oza
Bhushan, Jesani Amar and others. Mumbai: Fact Finding Team, July 1992, pp.17.
(RD.02) Human rights issues from investigation into the murder of Sr. Sylvia and Sr. Priya,
Jesani Amar. Mumbai: Solidarity for Justice. November 1991. pp.27.
(RD.01) Will truth prevail? A report of the investigation team on the murder of Sr. Sylvia and
Sr. Priya at Snehasadan, Jogeshwari, Jesani Amar and others. Mumbai: Solidarity for Justice,
April 12. 1991. pp.31.
Papers and essays:
(PD.15) Violation of medical neutrality in India, Jesani Amar (Paper presented at the international
Congress on ‘Violation of medical neutrality'’ organised by Johannes Wier Foundation at Utrecht,
the Netherlands, on November 8. 1996): Mumbai: CEHAT. November 1996. pp.5.
(PD.14) Report from India: Post-graduate diploma course on human rights, Jesani Amar: PST
Quarterly (The Philippines), Vol. 1. No. 2. July-September 1996, pp.30-1.
(PD.13) Directory of persecuted scientists, engineers and health professionals, Jesani Amar;
Issues in Medical Ethics, Vol. 4. No. 4. October-December 1996, pp. 135 (Book Review)
(PD.12) PST’ Quarterly inaugural issue, Jesani Amar: Issues in Medical Ethics, Vol. 4, No. 4,
October-December 1996, pp. 135 (.Review of Journal)
(PD.ll) LNHHRO conference of health, human rights, ethics, Jesani Amar. Issues in Medical
Ethics, Vol. 4, No. 1, January-March 1996, pp. 27.
(PD.10) Health of child labourers in India. Sinha Roopashri; Mumbai: CEHAT. December 1995.
PP 6
(PD.09) Police, prison and physician, Jesani Amar: Medical Ethics, Vol. 3, No. 4, OctoberDecember 1995. pp.58 (Editorial).
(PD.08) Supreme court judgement violates medical ethics, Jesani Amar: Medical Ethics, Vol. 3,
No. 3. July-September 1995. pp.38 (Editorial).
(PD.07) The doctor’s dilemma: A supreme court judgement on death by hanging violates
medieni ethics. Jc:;:ini Amin. Viidini zVilm HtiiiiuriMiiye, Mnich 1905, pp 12-3
(PD.06) Violence and the ethical responsibility of the medical profession, Jesani Amar. Medical
Ethics, Vol.: 3 No: 1, January-March 1995, pp.3-5.
(PD.05) Medical Ethics: In the context of increasing violence. Jesani Amar (Presented at the
Indian Medical Association workshop on "Medical Ethics and Ethos in Cases of Torture, at New
Delhi from November 25 to 27. 1994): pp.7 (Published in the Workshop Report. New Delhi: IMA.
pp.52-56).
(PD.04) Slippery slopes of Nazi medicine, Jesani Amar: Economic and Political Weekly, Vol.
XXIX. No 43. October 22. 1994. pp.2805-2807. (Review Article).
(PD.03) When medicine went mad: Bioethics and the Holocaust, Jesani Anar: Medical Ethics,
Vol. 2. No. 1. August-October 1994. pp 10-11. (Book Review).
(PD.02) Doctors and hunger strikers, Jesani Amar: Humanscape, June 1994, pp.7-9 & 29).
(PD.01) Repression of health professionals. Jesani Amar: Economic and Political Weekly, October
* 1991. pp.2291-2
CEttA T I’.
Jlcallons
CEHAT_____________________
519, Prabhu Darshan, 31, Swatantrya Sainik Nagar, Andheri West, Bombay 400058, India
October 9,1995.
A Brief Report for the Network meeting of Health and Human Rights Groups.
WORK OF CEHAT ON HUMAN RIGHTS AND HEALTH
About CEHAT: The Cehat is an institution in the non profit voluntary sector involved in the
research and action in the field of health. It is in existence since 1992.
The Cehat has a long term research and action programme on the violence and psychisocial
trauma This programme has been undertaken, so far, without any systematic funding from any
agency. However, the quantum of work done purely on the voluntary basis is substantial.
Library Documentation:
The Cehat has established a fairly good collection of books (3000), journals (25 received
regularly) and documents (3500) on health and health care. Of them, 25% are on the
psychosocial trauma, human rights investigation reports, medical ethics and violence in general.
We consciously and systematically promote the use of our library and documentation by
scholars, activists, media persons and individuals from other NGOs. The utilisation of this
centre by such concerned people is fairly good. On several debates that took place in the national
media in last two years on public health, medical ethics and human rights issues, the media
persons responsible for such reporting had used the information available with us.
Our day-to-day documentation on human rights violation is still not systematised due to lack of
funds. However, selected clippings from newspapers, journals and popular magazines are
maintained in order to prepare comments by our staff in the scientific journals and for the media
from time-to-time.
Problems and future plans: While we have good collection and contacts for dissemination of
information, we are handicapped by logistical and financial problems. (1) We do not have a full
time professionals to manage our library and information system. (2) We need to computerise
our library and information system, as the users do not have sufficient time to dig out documents
and other information (3) We would also like to have a publication officer who could analyse
information collected and makes our efforts at publication of material efficient so that the
documents prepared could be easily disseminated to a wider audience, particularly to people
outside Bombay.
Telephone/Fax: (91) (022) 625 0363
E-Mail: cehat @ inbb.gn.apc.org
______ (Fax received only from Monday to Friday, between 10 a.m. to 5 p.m., Indian Std. Time)
CEHAT is a Research Centre of Amtsandhan Trust Regd Under Bombay Public Trusts Act Regd. No:E-134SO
CEHAT- Centrefar Enquiry into Health and Allied th ernes
2
Research, Education and Training
This has been the strongest part of our work so far. This work is carried out by our staff purely
on voluntary basis within the CEHAT as well as with other organisations and associations of
which they are individually members. Three such organisations need mention: (1) Indian
Medical Association, (2) Forum for Medical Ethics Society, and (3) Medico Friend Circle.
(1)
Research: No project based systematic research was undertaken. What we have been doing
is to continuously collect information, maintain selected documentation of clippings from
newspapers and magazines, and purchase necessary books and documents for research. On three
subjects substantial work has been done and part of it published: (1) Custodial deaths in
Maharashtra state in 1980s. (see publication nos. 10 & 11) Its findings were presented in an
International Seminar organised by the Indian Medical Association in New Delhi. (2) Doctor’s
role in the death penalty (see publication nos. 8 & 9), and (3) Doctors role in the force feeding of
hunger strikers (see publication nos. 15 & 16)
Future Research Plans: The research has been done informally so far. It is now time to
systematise it by getting financial support The CEHAT is at present looking for financial support
for its research The following topics are identified for further research: (1) Force Feeding:
Hunger striking is the commonest form of political protest with a history of over a century. The
forced feeding of hunger strikers and doctor’s participation in it have been equally common. We
would like to undertake historical and sociological research in this field so that advocacy for
stopping doctors participation in force feeding could be strengthened. (2) Torture in the
Ancient and Medieval India: With the rise in the religious fundamentalism, all practices of
torture are conveniently laid at the doors of “outside” forces like Muslim invaders and Christian
colonialists. This kind of arguments are used for minority community bashing. There is however
strong irrefutable evidence that torture was systematically practiced in India before these
“aliens” came to India. Historical research on the subject would help in showing that the
systematic violence has been part of Indian culture for centuries. It is no use blaming so called
alien forces for its existence. What is required is the will and sincerity to stop it (3) Violence as
a public health issue: The Cehat is presently planning collaboration with various agencies for
studying epidemiology of violence.
(2)
Education: The educational work is a very regular feature of the Cehat It is done in three
ways. (I) Providing information to mediapersons and legal professionals, a number of media
persons and legal professionals have used our library documentation services, have interviewed
the Cehat professionals to prepare their news reports and also participated in the meetings,
workshops, seminars organised with the help of Cehat staff We have also got published in the
newspaper interview of visiting professional from other treatment centres. (H) Organisation of
meetings, workshops and seminars: The Cehat has helped other organisations, such as Medico
Friend Circle, Committee for Protection of Democratic Rights and Forum for Medical Ethics in
organising seminars, workshops and lectures on various subjects. For instance, the Medico
Friend Circle, a nationwide organisation of health activists is organising its 22nd annual
conference from December 27-29 in central India on “Ethics in health care”. The Cehat staff
members will be conducting a workshop on ethical responsibility of health professionals in
cases of violence. (HI) Publication of Papers, articles etc. in various Journals: So far,
CEHAT - Centre for Enquiry into Health and Allied themes
3
SEVENTEEN papers and articles have been published in various journals, magazines and
newspapers. (See papers listed from no. 8 to 24). The Cehat staff members are on the editorial
boards of two scientific journals, Medical Ethics (a journal of medical professionals) and
Radical Journal of Health (social science health journal). In addition, the Cehat has on its
governing board the senior assistant editor of the largest circulating and prestigious social
science journal, Economic and Political Weekly.
(3)
Training: The Cehat staff is regularly invited at the Tata Institute ofSocial Sciences (T1SS)
a deemed University for the post graduate training of Social Workers. We have also been
regularly called as visiting faculty for delivering lectures on Human Rights to the refresher
training courses for the officers of Indian Administrative Service (IAS) and Indian Police
Service (IPS). In addition, we also organise or participate in the training programmes for the
grass roots level paramedical workers and social workers in which a part of the training is on
human rights and ethical issues.
Investigations
The health professionals of Cehat have regularly participated in die investigation of human rights
violation. They were parts of the investigation teams appointed by human rights organisations.
So far we have participated in FIVE such investigations and their reports are listed below (nos.
3 to 7).
Networking and Advocacy
We are now making concerted efforts to establish good network with other organisations in
order to make our advocacy for policy changes more effective and of course also for
strengthening our work in other areas.
Recently, our staff prepared for the “Forum for Medical Ethics Society” and presented a
memorandum to the “National Human Rights Commission’’ on issues such as (1) Role of health
professionals in the custodial deaths, (2) Violation of medical ethics during judicial death
penalties, (3) Prison health services, (4) Hysterectomy on the medically handicapped women,
(5) Ethics of sex selection and (6) Violation of ethics and human rights in medical
experimentation. A copy of our submission is enclosed herewith.
Future Plans: The Cehat would like to organise a meeting of NGOs and professional
associations interested in human rights issue in order to create a loose network at the national
level. Such a network could facilitate information sharing and initiation of common campaigns.
The Cehat is looking for funds to support such networking activities.
Treatment and Rehabilitation
At present this is the least developed activity of the Cehat We have one partially trained but out
of touch medical professional who has been providing counselling to the survivors of various
forms of violence. We also have a nurse who does not work with the Cehat but is giving some of
her time in this work.
CEHAT - Centre for Enquiry into Health and Allied th ernes
4
However, in the absence of a formally established medical centre this work is still at die low
key. From 1996 we intend to establish a separate medical centre for treatment and rehabilitation
of survivors of violence.
LIST OF Cehat PUBLICATION ON “HUMAN RIGHTS AND HEALTH”
Books, Investigation Reports and Memoranda’s:
(1)
"Submission made to the National Human Rights Commission on September 25, 1995" by Forum
for Medical Ethics Society, Bombay, pp. 4 + 9.
(2)
Amar Jesani, Mary Alphonse, Alyosius D’Sa, “Bombay Riots: January 1993: A Selected
Documentation from a Section of the Print Media", Bombay: Solidarity for Justice, March, 1993, pp.
180.
(3)
"An Enquiry by the Fact Finding Team into the Police Firing that Led to the Killing of a Tribal
and Caused Injury to Others in Dahanu Taluka, Thane District, Maharashtra ", Bombay. Fact Finding
Team, July 1992, pp. 17.
(4)
"Human Rights Issues from Investigation into the Murder of Sr. Sylvia and Sr. Priya", Bombay
Solidarity for Justice, Nov. 1991.
(5)
“Will Truth Prevail? A Report ofthe Investigation Team on the Murder of Sr. Sylvia and Sr. Priya
at Snehasadan, Jogeshwari", Bombay. Solidarity for Justice, April 12,1991.
(6)
"Another Lock up Death : An Investigation", Bombay Committee for the Protection of Democratic
Rights, July 1990.
(7)
“The Jogeshwari Rape Case : A Report", Bombay Medico Friend Circle, YUVA, CPDR etc., July
1990.
Papers, Articles etc. Published in Journals and Books:
(8)
Amar Jesani, “Prison, Police and Physician” (editorial), in Medical Ethics, VoL3, No.4, October,
1995.
(9)
Amar Jesani, “Supreme court judgment violates medical ethics”, (editorial) in Medical Ethics, VoL3,
No3, July-September, 1995, pp 38.
(10)
Amar Jesani, Asha Vadair, “The Doctors Dflcmma: A supreme judgment on death by hanging
violates medical ethics”, in Humanscape, March, 1995, pp. 12-3.
CEHAT- Centre for Enquiry into Health and Allied th ernes
5
(11)
Amar Jesani, “Violence and the Ethical Responsibility of the Medical Profession", in Medical Ethics,
Vol 3 No: 1, January-March 1995, pg. 3-5.
(12)
Amar Jesani, “Medical Ethics : In the context of increasing violence", (Presented at the Indian
Medical Association workshop on "Medical Ethics and Ethos in Cases of Torture, at New Delhi from
November 25 to 27,1994, and published in the IMA document on the workshop), pp. 7.
(13)
Amar Jesani, “Violence against Women and Children : The Role of Media and Health Care
Professionals”, (Paper presented at Xavier’s Institute of Communication’s seminar on Health
Communication held in Bombay on November 17,1994), pp. 3.
(14)
Amar Jesani, “Slippery Slopes of Nazi Medicine” (Review Article), in Economic and Political
Weekly, VoL XXIX, No. 43, October 22,1994, pp. 2805-2807.
(15)
Amar Jesani, “When Medicine Went Mai Bioethics and the Holocaust” (Book Review), in Medical
Ethics, VoL 2, No. 1, August-October, 1994, pp. 10-11.
(16)
Amar Jesani, “Doctors and hunger strikers”, in Humanscape, June 1994, pp. 7-9(and 29).
(17)
Amar Jesani, Anil Pilgaokar, “Patient’s Autonomy: Throwing It To The Wmds?” in Medical Ethics,
VoL 1 No. 1, August-October, 1993, pp. 6-7.
(18)
Amar Jesani, Ravi Duggal, “Medical Ethics : Awaiting a Patients’ Movement”, in VHAI, State of
India*s Health, New Delhi: 1992. pp. 365-77.
(19)
Amar Jesani, “Repression of Health Professionals” in Economic and Political Weekly, Oct 5, 1991,
pp. 2291-2.
(20)
Amar Jesani, “Medicine at risk : Health Professional as Abuser and Victim”, in Economic and
Political Weekly, July 1989, pp. 1633-7.
(21)
Amar Jesani, “Health Professional as Abuser or Victim”, in FRCH Newsletter, VoL 3, No. 1,
January-February 1989, pp. 4.
(22)
131.
Amar Jesani,"Ruins of War", in Radical Journal of Health, VoL I, No. 4, March 1987, pp. 130-
(23)
Amar Jesarri, "Health in Nicaragua: Epidemiology of Aggression", in Radical Journal ofHealth, VoL
I, No. 1, June 1986, pp. 3-10.
(24)
Amar Jesarri, "Doctors and Torture" in Socialist Health Review (now called Radical Journal of
Health), Bombay, VoL H, No : 4, March 1986, pp. 177-178.
CEHAT__________ __________
519, Prabhu Darshan, 31, Swatantrya SainikNagar, Andheri West, Bombay 400058, India
INST/MISE/95/
5
November 24,1995.
Mr. Ulrich Dornberg
MISEREOR
POSTTACH 1450, 52015 AACHEN
MOZARTSTRASSE 9, 52064 AACHEN
(Through Dr. Ravi Narayan, CHC, Bangalore)
Dear Mr. Dornberg,
Geetings from friends at Cehat.
It is a year since we met I have been feeling guilty and uneasy for not communicating with you
and for not following up ideas we discussed last time. I know that an apology is not enough for
you were very kind in showing interest in our work and for considering support for it I know
at the end, the loss is ours only, and that makes me very guilty. I unfortunately got sucked in so
many things that although we have devloped work on the issues we had discussed, I did not
write to you about it.
Dr. Ravi Narayan’s letter has brought me back to the track. Ravi wrote that you people will be
in Bangalore and meeting him, and the positive thing coming from the delay is that he may also
be interested in linking up with us in undertaking some work of mutual interest. So I am taking
liberty to send you few proposals for you consideration. Let me explain the present status of
each proposal.
On Violence and Human Rights:
(1)
“Response of health professionals and services to the epidemic of violence”: This
proposal has been prepared by me for the Times of India fellowship. Thus, upto the objective
section, it covers all issues on which we intend to do work- in the methodology, the scope is
kept modest as it is an idividual fellowship, and so I cannot to do a large survey of the
situation. I am not sure whether I will get this fellowship as the subject matter is unlikely to be
on the priority list of the Times fellowship council. Secondly, it is highly competitive, the
journalist standing better chance than a doctor researcher like me. In any case, even if 1 get it,
its scope will be limited to Bombay and would address to only one or two of the several
issues identified. Therefore, we would need funding support for undertaking research and
action based work on the remaining issues. If you find the proposal of some interest to you
deserving funding support, please let me know so that I can send it to you with revised
methodology. The budget would depend on the scope and methodology finalised. There too,
your suggestions are welcome.
(2)
“Establishment of treatment and research centre for survivors of violence”: This is a
preliminary note on tire subject. It was prepared in order to link up with a treatment centre
Telephone/Fax.'. (91) (022) 625 0363
E-Mail: cehat @ inbb.gn.apc.org
(Fax, received only from Monday to Friday, between 10 a.m. to 5 p.m., Indian Std. Time)
CEHAT is a Research Centre of Anusandhan Trust Regd Under Bombay Public Trusts Act Regd. No E-13480
CEHAT - Centrefor Enquiry into Health and Allied th ernes
2
called “Association Primo Levi” located in Paris. The Primo Levi was created this year
primarily by doctors and psychotherpists who left another treatment centre called AVRE. The
Primo Levi is an association of Amnesty International (French Section), Medecin du Monde,
Action des Chretiens pour 1’Abolition de la Torture, Juriste sans Frontieres and the staff of the
Primo Levi centre. In early November this year I had an oppotunity to visit this centre and
found it having elements of collective functioning and sensitivity to the specificity of the reality
of underdeveloped countries.
As the note explains, this project would need large funding support and collaboration with
some centres for training the staff and for other technical inputs. The Primo Levi centre has
agreed to have such collaboration. However, the funding support will have to be raised by us
or by Primo Levi and us together.
I am note sure whether the Misereor would be interested in supporting such big project or a
part of it In case the Misereor is interested, please let me know as the full proposal with
details of budget will be available by the end ofDecember 1995.
In case you would like to get in touch with the Primo Levi, please write to Dr. Francoise
Sironi, Coordinator, Association Primo Levi, 107 avenue Parmentier, 75011 Paris, Tel: 43 14
88 50, Fax: 43 14 08 28.1 am also enclosing a copy of its brochure for information.
(3)
“Need to study and confront child abuse”: This is a note explaining what we want to do
on child abuse. It involves both research and action. It is prepared by my collegue Ms Manisha
Gupte.
Action research projects on health:
(4)
“Social accoutabQity of medical practice”: This proposal is based on work we have been
doing for last six years in helping victims of medical malpractice. It is self-explanatory. An
edited book on the work done so far in this field is under publication by the CAHAT. It is
titled “Market, Medicine, Malpractice: Issues and Case Studies”. It contains articles on
various topics related to the operation of market in health care, the lack of regulations, ethical
and legal issues and five case studies of victims of medical malpractices. It should be
available for distribution by end December 1995 or early January 1996.
(5)
“People’s drug information centre”: This proposal has evolved from our experiences in
the rational therapeutics movement and has been formulated by Dr. Anil Pilgaokar, former
Convenor of the Medico Friend Circle. It is an ambitious project for empowering the patient
by providing rational information on drugs.
We have already received Rs.75,000 (seventy thousand) for continuing this work which was
started with the help of volunteers few years back. Dr. Pilgaokar will be donating Rs.25,000
some time next year. Thus, out of about Rs. two million needed to achieve the objective, we
have hundred thousand with us. We have continued work with this money and looking for more
support If the finances are made available, it would be accoplished within the time frame
mentioned, otherwise it would take considerably longer time.
CEHAT - Centre for Enquiry into Health and Allied themes
3
I hope, these five proposals would provide you sufficient material to let us know your interest
Personally I am interested in projects on violence and human rights. However, as a coordinator
of the institute, I will be taking responsibility, along with other researchers, for the successful
implementation of other projects, too.
About CEHAT:
The CEHAT is a research centre of Anusandhan Trust which is registered as a public
charitable, non-profit organisation. The donations made to it are given tax exemption under
Section 80G of Income Tax Act It does not have permanent registration under file Foreign
Contribution (Regulation) Act, but so far three projects have been given prior permission to
receive foreign contribution-cleared by the FCRA. Our application for the Permanent
registration is also awaiting clearance.
The Trust has nine trustees and they also constitute governing board of CAPIAT. In addition, in
order to make the work of the CEHAT socially accountable, a Social Accountability Group
(SAG) consisting offive individuals having a public standing been constituted. This group had
its first meeting in October. It has worked out its own achedule of overseeing the CEHAT.
Accordingly, in 1996 it will be meeting twice (in May, to review accounts and work, and in
December to undertake annual review and give a report for publishing it in the Annual report
of CEHAT) and would make its views on our work publicly known.
I am also enclosing a (1) Names and addresses of Trustees/Goveming Board. (2) Names and
addresses of SAG members (3) Report of CEHAT (Anusandhan Trust) for the years 19^94.
(4)
A brief report on CEHAT’s work on Violence and human rights. (5) A brochure on
CEHAT.(6) List of CEHAT publications, 1991-1995. (7) The CVs of few of us working here
(Sunil Nandraj, Ravi Duggal, Amar Jesani). (8) Audited statement of Accounts of Anusandhan
Trust for the year 1994-95. (9) A copy of registration certificate of the Trust
I hope, the above project proposals and information on our organisation would be sufficient for
you to let us know whether MISEREOR would be interested in providing financial support for
any of the project We would like to know about your views at the earliest so that we could
plan our work for the next 2-3 years. In case you are visiting Bombay, we would be happy to
meet with you people.
With best wishes and regards.
Yours sincerely,
CEHAT
Centre for Enquiry into Health and Allied Themes
310 Prabhu Darshan,
31, S. S. Nagar, Amboli,
Andheri (W.),
Bombay-400058
Tel. : 6230227
October 22.,
1993
Drs Ravi and Thelma Narayan
Community Health Cell
Bangalore
Dear Ravi and Thelma,
I am sorry for my prolonged silence. I have been following up issues we
discussed in Bangalore, but bit hafa?:ardly .
(l)
Ravi Duggal knows the person in the Ministry in charge of leprosy. If
your project has come through please let Ravi know, he will give you the
name of the person and will also write him directly on the subject. Ravi's
address is: Staff Quarters, Barrack No 6, Raj Hans'School, Bhavan's
College Campus, Bombay 400 058. I have also told Sunil at FRCH about your
requirement ahd you can depend on his help if you need anything from
FRCH.
(2)
I have sent a letter to Misereor as per the discussion we had. It has
gone bit late but by speed post and by now they must have received it.
A copy is enclosed herewith for you. Please follow it up when you meet
them. I will appreciate it very much if we could meet them during their
visit to India.
(3)
Padma was attending a meeting today in Delhi where Thelma was likely
to participate. I have discussed with Padma about the Network and asked
her to speak to Thelma about how to organise MFC's contribution at the
1995 meeting. Hope they will finalise that part. In the meanwhile I have
talked to Aditi and she has shown reddiness to contribute an article
on ANNS for the Network,
kith beast wishes
^ours sincerely
rt.
CEHAT is a Research Centre of Anusandhan Trust;
JeaBdtjisiered under Bombay Public Trust Act, 1950, Registration No. E-13480 (Bombay)
<,4l.vr
(2^
—
Che.
CENTRE
FOR
ENQUIRY
INTO HEALTH
(CEHAT)
AND
ALLIED
THEMES
310 Prabhu darshan, 31 S.Sainik Nagar
Amboli, Andheri West, Bombay 400 058, Tel: 623 0227
14 October 1993
Mr George Krause^
Mr Ulrich Pohnberg
Misereor/'
Postfabh 1450
D-52015, Aachen
•iermany.
Dear Mr Krause and Mr Dornberg,
Greetings and best wishes from friends at CEHAT!
Dr Ravi Narayan
from Community
Health Cell,
Bangalore
introduced us to your organisation. He and Dr Thelma Narayan
are our friends from a larger voluntary organisation Medic’o
Friend Circle and so we share many ideas and values. For last
several years we have been very concerned about the increasing
violence and rising
religious fundamentalism and fascist
forces in our country. As health activists we often intensely
^discussed these issues and every time .realised that there was
Aneed for us to make an intervention in the situation both by
studying epidemiology of violation and by involving in the
relevant action at the community level. However various other
commitments and uncertainty about getting support for such
work did not allow us to actually undertake such systematic
work though individually many of us continued to participate
in various voluntary actions against such forces.
This year some of us in Bombay and Pune decided to leave our
jobs as we were not satisfied with the hind of social research
in health care we were doing for last many years and we
established CEHAT. This is a new organisation which wants to
undertake socially relevant research and action useful to
progressive people oriented causes and movements. We thought
that now we were free of other constraints to begin work on
‘that now we were free of other constraints to begin work on
the above subject and told our friends about our intentions.
Apparently in his last visit to Germany Ravi found that issues
of our interest were identified in a workshop as key issues
for 1990s and he therefore suggested that we should contact
you.
Some of the areas in which we want to
action work are as follows:
evolve our research and
(1) We are greatly concerned about the increasing violation in
the civil society and by the state on the citizens. The events
of last -December and January have clearly shown that there is
increasing participation of common people in such violation
and that minorities (Muslims in particular and. all other
iorities in general) are
feeling highly insecure. The
fecist and fundamentalist forces have gained in strength so
much so that they are making serious bid to come to power. If
this happens, the situation would worsen and from their
utterances it is clear that minorities would face serious
threats of ethnocide and even genocide, a phenomenon becoming
increasingly common in many parts of the country.
«
In view of this we want to work in the following two ways:
First, we would like to study epidemiology of violation in
last one or two decades. We believe it will have educational
value. However its usefulness would not stop there. We would
like to do this in such a manner that we can at the end of the
study formulate certain parameters/criteria for continuous
^pnitoring of
the situation to predict ethnocide and/or
g^pcide. Setting up such a monitoring mechanism, in addition
to disseminating findings to sensitise people against the
horrors of violence,
is necessary to warn the national and
international community of impending holocaust in India. Such
warning supported by facts would provide material to people
all over the world to campaign to prevent such eventuality.
Second, the violence of last December and January in Bombay
has convinced us that as health workers we should provide
necessary
help
to
the
survivors
to
overcome
their
psychological and emotional wounds. To this end few doctors of
us would like to set up a small medical centre in a suburban
slum in Bombay which provides such medical help to all
survivors of communal violation as well as to battered women,
rape victims, survivors, of torture etc.
(2) The second area of our interest is Medical Ethics and help
to victims of medical malpractice. As members of Bombay Group
of Medico Friend Circle we have on a purely voluntary basis
helped (counselling, guidance as what was wrong and how to
proceed to punish the guilty etc) more than 50 such victims
and we are helping to build a Forum for Medical Ethics (which
has now started publishing a bulletin). I will not write more
on this subject as you may get our views from the chapter on
Medical Ethics we did in VHAI’s "State of ' India’s Health".
Suffice to add that such work of monitoring medical practice
and helping victims will have to be systematised through the
infrastructural support from CEHAT.
It is difficult to explain in more detail these ideas in a
^ter. It would be really of great help if you could meet us
citing your forthcoming visit in November so that in the
course of a day or two we could share our concerns and ideas
with you.
Lastly, I can’t resist from telling you that I really felt
very happy when Ravi wrote to me that there are people like
you who are interested in helping work in the above areas. I
therefore sincerely request you to make it possible to meet us
in your forthcoming visit.
With best wishes.
Yours sincerely,
Dr Amar Jesani
Coordinator.
cc to: Dr Ravi Narayan, Bangalore
12:95
10-11-1995
Dr. Amar Jesani,
310, Prabhu Darshan,
31, S.Sainik Nagar,
Amboli, Andheri West,
Bombay - 400 053.
Dear
Greetings from Bangalore!
We returned to India in the third week of September; having had a
very meaningful break at the LSHTM and experiencing complete
recovery from the 'burn-out' feeling ,at the end of CHC's first
intensive decadal experience in 1993-94.
Thelma completed her M.Phil in August and continues on with the
Doctoral Programme. She is busy operationalising the TB Control
Policy Projects which includes field work in Mysore District and
also coordinating CHC temporarily, since Shirdi proceeded on
three months leave,to recover from work exhaustion.
My sabbatical continues till December 31st (completing our 10 year
report and the monographs) and I then propose to rejoin CHC on a
part-time basis, following up on Medical Education,- CH training
policy projects and providing part time for short term assignments
that will focus on BIMAROU area - perhaps Madhya Pradesh more than
the rest as a 2 year transition, process to shifting to the North
by the time Thelma finishes the Ph.D. This will perhaps be a
CHC - Northern initiative but we shall gradually build up the
framework and decide a base (parthenium.free small town in the
North if such a place exists!!) over 2 years. A more definitive
framework will evolve in consultation with all our friends and
contacts after we return to CHC more actively in January, 1996.
Your letter written to us on 14th September - the day we left
London arrived recently in a packet, a friend posted to us. If
you are writing to Sanjay and Abha let them know about this.
Thelma will return for a year again from end August 1996 to
August 1997 (same address). Both the boys and I are not inclined
to go back again, at the present - but we shall see.
Hope you receive a prompt response from Antony. He is a good
chap but a bit preoccupied with both personal and professional
demands - so though we are all on the same same wave length - we
could, not interact adequately around the issues of common interest
during this year - which was a bit disappointing. He and others
were associated with a radical medical group in South Africa and
during 1986-87 when he was doing M.Sc. Epidemiology with Thelma
2
2
we got to know all of them and they formed a Health and Development
forum like mfc which organised lunch time discussions, etc.
I found your offer interesting and perhaps you could send me some
papers about what you want to do and I could respond and start up
an interactive process. After January 1996 I could include it on
the agenda of my BIMAROU focus. The Misereop team are visiting
Bangalore between 1-4th December so if the material came before
that, I may also be able to get them interested. In a report,
we prepared for them last year - we have suggested victims of
■communal violence and ethnic conflicts' as a priority area which
has received little attention. They are visiting us to discuss
this report as well.
I had been in touch with Dhruv and Shyam during the year and also
since we returned6Ve are really concerned about Dhruv and I hope
we can all be specially supportive of him - till he recovers
completely. Probably he needs a replacement immediately and we
have suggested to him that should be the focus of efforts. A
couple known to us from Hyderabad are in touch with him.
Have seen the announcements and preparations for the mfc meeting.
One of our team members is working on a bibliography of materials
other than Medical ethics forum and mfc-bulletin. Shall send it
to you when it is ready in case you are interested in any
particular papers. The CMC Network of medical colleges had
discussed this issues on two occasions and various clinicians
had presented papers. You probably also know of the large meeting
which MCI/IMA etc., organised on this theme a few years back.
Also Dr. Francis (whose book you had reviewed last year) made a
presentation in a seminar in the US on 'Transcultural issues in
Ethics' presenting a point of view from the Indian situation/
ethos. It has now been published in a book on Transcultural
issues. We shall send a copy tof/the paper to you.
An American student has contacted us indirectly to work on
Cross-cultural issues. Her fax is enclosed. In our response,
we have suggested that she get in touch with you and / forum.
Her request is enclosed, since she wants to work with a
practicing doctor .- a link with CHC would be unsuitable. Would
your forum be interested.
Best wishes from both of us and the CHC team to you, Vibhuti,
and ba"J a.
Yours sincerely,
Ravi Narayan.
Encl:
1.
*rn/vnnr
CEHAT_____________________
519, Prabhu Darshan, 31, SwatantryaSainikNagar, Andlieri West, Bombay 400058, India
PER/ACJ/95/
September 14,1995.
Dr. Ravi and Thelma Narayan
623 Elysium
William Goodenough House
Mecklenburgh Square
London WC1N 2AN, (UK).
Dear Ravi and Thelma,
I had received your letter of April 6, 1995 and I do not remember whether I replied or not If
not, my apologies, I was totally lost in my work here and there is no respite as yet. hi case I did
not reply, let me cover those points first I haven’t heard from Shirdi about the email, modem
etc. Perhaps he is already in it The MFC meet is as scheduled, Dec 27-29 on “Ethics in health
care”. Any possibility' of you two attending? I am enclosing the second announcement of the
meet (minus papers mentioned in it, if you want me to mail them to you, please let me know).
Doesn’t the list look impressive? Lastly you had enquired about the list of articles in EPW, I
don’t think such list is available barring the one that Padma had prepared and circulated in the
MFC.
We have run into some trouble with the FCRA for no fault of ours. Till that is over, our
temporary financial crisis will not be over. But that is a part of the problems in institution
building.
There are two other things: Firstly, I came to know that your friend Anthony Zwi is
coordinating an international network on violence as a public health problem. I had written to
him to enquire about work of the network. He has responded positively and suggested that we
should plan some collaborative work. So I have sent him a long letter giving a number of areas
on which such research could be conducted. If this works out, we should be able to undertake
in a formal and systematic way the work on epidemiology of violence, the subject we have
discussed so often. I do not know what you are doing now-a-days. But if you would like to get
involved in this collaborative venture, we will not only feel happy but more confident as your
inputs would give a focus to the work. If it is possible, please discuss with Anthony and let me
know. I am sorry that due to my own fault, I haven’t been able to follow up this part with
Miserior, and now I feel miserable in writing to them after not sending proposal as promised.
Will they still be interested? I am sending a letter to them. As far as I am concerned, I have
decided not to take any work other than on the issue of violence from Dec. So I should be able
to concentrate fully on this subject
Secondly, friends of ours, MFC as well as one of editors of Medical Ethics, Dr. Sanjay and
Abha Nagral are going to be in London for a year. Both of them are from KEM Hospital.
Sanjay is leaving next week while Abha will join him in a month’s time. They will be at the
following place:
Telephone/Fax: (91) (022) 625 0363
E-Mail: cehat @ inbb.gn.apc.org
(Fax received only from Monday to Friday, between 10 a.m. to 5 p.m., Indian Std. Time)
CZHAT is a Research Centre of Anusandhan Trust Regd Under Bombay Public Trusts Act Regd. No: B-13480
CEHAT- Centre for Enquiry inioHealth and Allied themes
2
Drs. Sanjav and Abha Nagral, Liver Transplantation Surgical Service, King’s College
Hospital, Denmark Hill, London SE5 9RS, Tel: 171-737 4000, Fax 171- 346 3575.
I have given them your address and they might contact, or if you get an opportunity, do get in
touch with them. Four of you may be able to form London group of MFC! (Minimum
requirement for forming a group in MFC is three).
Lastly, if I remember correctly, you had told me that you were planning to visit India in this
month. Is your trip still on? Let me know and do visit us when you are here. In Bombay you can
stay with us. In fact, on Oct 7 & 8 some of our MFC friends (Anant, Dhruv, Manisha, Anil,
Padma, Ravi etc) who are also our trustees will be at CEHAT.
Dhruv is much better now. I am sure somebody must have written to you about his illness. It
happened in March, when he had bleeding in his brain due perhaps to malaria We were really
scarred, but fortunately for him and all of us, Mohan and Sham were with him and they could
shift him to Pune on time. It was very close and he has lost part of his vision (peripheral) and it
has affected his memory. He was depressed for awhile but now he seems to be much better.
Added to this, he lost his father a few months after. We keep in constant touch. I am sure you
must be in touch with him, but ifnot, please do write to him.
As you know the political situation here is very fluid and I only hope that I am not getting into
my work on violence too late.
Vibhuti and Lara are fine and have sent their love and regards. How are Lalit and the second
one (I keep forgetting his name, but not Lalit’s as I have seen him often at the MFC)? Our love
to them and if they are visiting India with you, do bring them here.
With regards and best wishes.
Yours sincerely,
Amar Jesani.
CURRICULUM VITAE
NAME
: Ravinder Singh Duggal (Ravi Duggal)
DATE OF BIRTH
: 5th December 1957
RESIDENTIAL ADDRESS
: Hansraj Morarji Public School, Staff Quarters No. 6,
Munshi Nagar, Andheri West. Bombay 400 058.
Phone : 22 - 628 6865
FOR CORRESPONDENCE : CEHAT, 519, Prabhu Darshan, 31 SS Nagar, Amboli,
Andheri West, Bombay 400 058
Phone :22 - 621 0145 / 625 0363 (office hours)
Fax : 22 - 621 0145 / 625 0363 (office hours)
E-mail: cehat@inbb.gn.apc.org
ACADEMIC QUALIFICATION :
1.
Schooling : ICSE from St. Mary's, Bombay : 1st class 1963-1973.
2
Graduation . BA(Hons.) in Sociology from SI. Xaviers. Bombay 2nd class, 1974-
3.
Postgruduation : MA in Sociology from Bombay University : B+ 1978-79 -1979-80
4.
Certificate Courses in Computer Programming and statistical applications from
Bombay University (16 weeks, 1980).
5.
Certificate Course in Planning and Evaluation of Health Programs from the
Indian Council of Medical Research (7 weeks, 1982).
6.
Diploma in Business Management of the Indian Merchants Chambers, Bombay:
2nd class, 1979-81.
7.
Diploma in Communications Arts from Xavier Institute of Communication,
Bombay : A-, 1978-79.
75
1977 78
•
LANGUAGES KNOWN :
Excellent written and spoken English and good fluency in Marathi and Hindi.
WORK EXPERIENCE :
1.
Lecturer in Sociology for two years at Vivekananda College, Bombay (1981 and
1982)
2.
Researcher in Foundation for Research in Community Health from June 1982 to
March 1993, between 1982 and 1986 as Research Officer and subsequently, as
Senior Research Officer. For details of research work done see Annexure I.
3.
at
WHO fulltime Consultant for Health Policy and Planning and Health Economics
the Ministry of Health and Family Welfare. New Delhi from March 1993 to
Sept. 1993
4
Presently working as Country Representative of SWISSAID in India since
Oct 1993. Also associated with CEHAT as a Consultant on research related to
quality of health care, health databases and health economics
WRITING AND RELATED EXPERIENCE :
I
Since 1984 I have been part of a working editorial team that brings out the
journal 'Radical Journal of Health', it is the only one of its kind in India that looks
at health issues from a social, e<. 'iiumiu and political perspective.
2
Since I9l>? I have been leyukiily uullioiiiig monugi<iph:i, <nlni.lc-:> nnd pupuis lui
various journals, magazines and newspapers and making presentations a!
conferences and seminars on a wide range of health and related issues. See
Annexure ii for a list of publications.
. 3.
In the past few years I have helped various International Funding Agencies,
Official Funding Agencies and NGOs in reviewing and evaluating projects and
research/project proposals.
International Conferences Participation :
1. World Congress of Sociology , New Delhi, 1985 : Participated actively in sessions on
Health Issues.
2. World Congress on Health Economics, Zurich, 1990 : Made a presentation on the
Political Economy of Health Care Underdevelopment.
3. International Seminar on Market Economy for the Poor, Berne, 1994 : Made a
presentation on Peoples' Economy and Local Resources.
4. International Conference on Population and Development, Cairo,1994 : Conducted a
workshop on Population Policies and Underdevelopment at the NGO Forum.
CONSULTANCIES AND OTHER ASSIGNMENTS :
Major Consultancies
1.
Jan. 1992 - April 1992 : Consultant to the World Bank Mission on Health
Financing in India for three and a half months. Apart from assisting the Mission in
various field and desk tasks I prepared a background document for the Mission
titled ‘Health Care Services and Financing in India’.
2.
June 1992 - May 1993 : For two days every month (totally 24 working days) as a
Research Consultant on an Urban Health Education and Community
Organization project of the National Addiction Research Centre, Bombay. My role
was to help them design the study, advise them on organisational dynamics and
monitor the progress of the research project.
3.
March 1993 - Sept. 1993 : Fulltime National Consultant with the World Health
Organisation, New Delhi, for six months to advise the Policy and Planning
Division of the Ministry of Health and Family Welfare, Govt. Of India. The work
done has been compiled as an internal document titled "Health Policy and
Financing” and it fed into the 1993 Annual Conference of Health Ministers and
Secretaries (Joint Council of Hearth and Family Welfare).
4.
Jan. 1994 - May 1994 : 8 days in a month (totally 40 days) as head of a team at
the Centre for Enquiry into Hearth and Allied Themes (CEHAT), Bombay, to
design and compile a database on health care services and financing. The
pieliiinimiy wotk done is being published in the Economic and Political Weekly in
April I995. The database includes timeseries data from 1950-51 to 1994-95 on
expenditures on major health programs of the public sector, data on health
infrastructure and personnel in both the public and private sectors and data on
health indicators. The data is accompanied by a detailed analytical note.
5.
June 1994 - Dec. 1995 : Six days every month as Research Advisor in CEHAT
on project on "Quality of Hearth Care Services' - a field based study enquiring
into physical standards and qua’ity of care in private nursing homes and
hospitals and of private practitioners. My role has been to design the study and
monitor its progress, and presently help in analysis of the findings as they
become available.
Other Assignments :
#
#
#
it
#
During 1986-87 I have taken occasional teaching courses in rural sociology at
the Dept, of Sociology' Univ. of Bombay
During the last five years I have taken occasional lectures on hearth sector
development and health financing at the Tata Inst, of Social Sciences
Have been a consulting resource person on hearth financing and hearth
economics for the Planning Commission, Ministry of Hearth, Indian Council of
Medical Research and the Voluntary Health Association of India
Evaluation of Project on Health Economics (2 days) for IDRC-Canada
Consultant on Evaluation Methodolgy for ACTIONAID project VACHAN
3
#
#
Member of panel of Catholic Hospital Association of India on National
Consultation on Impact of Structural Adjustment on Health
Visiting Faculty at the Indian Institute of Health Management and Research,
Jaipur during 1993
Areas of Expertise :
Health Sector: Health Care Planning and Poacy, Health Economics, Financing and
Expenditures, Health Services Development, Private Health Expenditures,
Comparative Health Sy: 'ems, Quality/Standards of Health Care, Medical
Malpractice and Regulahon Evaluation of Health Programs, Health Care
Databases
Other Areas : NGO sector, Rural Development, Local Economies, Resources and
Sustainable Development, Consumer and Human Rights, Ecology and
Environment Issues, Employee Benefits and Social Wages, Program /
Project Evaluation and Impact Assesment in Social Sectors
GENERAL BACKGROUND:
Since school days I have been actively involved in various action programs that have
exposed me to the realities of the underpriviledged classes both in rural and urban
areas: rural development and reconstruction, development programs for slum dwellers,
democratic rights issues, health services and health care issues, womens issues and
other campaigns in support of the underpriviledged.
I am an active member of the Medico Friend Circle (MFC), a natipnal forum of socially
committed health workers. The main focus of MFC is Community Health and inis is
expressed through its monthly bulletin and annual conferences on issues related to it. In
Bombay the local MFC group is campaigning against Medical Malpractice and violation
of human rights by doctors and medical institutions in the interest of consumers. I am
actively associated with these campaigns and actions of MFC. Since April 1994 I am
MFCs National Convenor.
My current area of research interest is health policy, the NGO sector, health economics
and financing, quality of health care and health databases. Besides the various
research studies undertaken by me in this area I have also been networking with others
working in these fields in India especially from the NGO sector. I have also been
interacting with the Ministry of Health and the Planning Commission on these issues in
official meetings, working groups and conferences.
DATE :2b~ b'^5
RAVI DtJGGAL
4
ANNEXURE I
Research Work Done by Ravi Duggal
1979-80 : As a Master's student in the Dept, of Sociology, University of Bombay, I participated
in a research project titled 'Corporate Sector in Rural Development', directed by Prof. Manorama
Savur This study critically evaluated the role of the corporate sector in IRDP programs of the
government. This report was published by the dept, as a monograph. Besides the field work
and participation in part of the data analysis ! wrote the section pertaining to "tax expenditure"
in this report
1982 to present: Since 1982 all the research undertaken by me has been at the Foundation for
Research in Community Health (FRCH) where I have been employed during the period.
(A)
The following research projects we; . undertaken by me independently as part of a core
research team. I was the principal investigator of studies at numbers 1,2,3 and 5.
1.
Study of Health Services and the Community in Uran Taluka: This was a
field based study using group interviews to get an understanding of the people's
perception of health care services available to them. It also evaluated the
participation and impact of a non-govemment organization in health care in that
area. This document is a mimeograph publication of FRCH
2.
Critical Study of Health Services Projects in Maharashtra: This was a field
based study carried out over a three year period (1983-1986). This study made
a historical analysis of 45 health and development non-govemment organization
run projects in rural Maharashtra. Subsequently in lhe second pari of study.
four of these projects and four government run primary health centres were
studied in greater detail through a household-survey-based study to look at
health services utilisation patterns in a comparative perspective. The first part of
the study was published in 1986 and the second part is presently under
publication.
3.
Social Aspects of Leprosy in Rural Maharashtra: The focus of this
study was to evolve an understanding of stigma of leprosy in a historical
perspective. The field work of this study wag carried out in 22 villages of
Maharashtra over 2 years. The concept of stigma was placed in (he
context of a stigmatized society which is a structural problem and not a
behavioural one. The study findings were published in 1988.
4.
Health Status of the Indian People : This is an information database
publication about the health sector in India based on extensive research on
various aspects of health. I was responsible for the sections on "environment
and health" "population and health" and "health financing and
expenditure". This document was published in 1987.
5.
Health Expenditure in a District: For one year a household survey was carried
out in Jalgaon district to record consumption and health expenditure. Besides
providing data on health services utilisation patterns and cost of health care this
5
study provides an analysis of methodological issues in the area of "health
expenditure studies". The study report was published in 1989.
(B)
(C)
The following studies were carried out under my direction.
1.
State Sector Health Financing In India: A historical analysis of heallh sector
development and financing in india that seeks to provide a critique of the
development of health services in the country and why they have remained
underdeveloped. This study for the first time in the country has come out with a
comprehensive time series health finance database The study was published in
1992.
2.
Study of the Private Health Sector: This exploratory study critically explores
private general practice and private nursing homes and hospitals with a view to
finding out the dynamics of investment, user charges and a cost analysis of such
practice. It is presently under completion.
3.
Study of Corporate Schemes and its Financing: This study too is exploratory
in nature as it aims to provide an overview of health benefits provided by
employers to their employees. This study provides analytical data on employee
benefits in over 130 companies (with a turnover over Rs. 50 million) all over the
country through a mailed questionnaire as well as personal interviews. The
study was published in 1994.
4
Health Financing and Costs. A comparative study of health system of
capitalist, socialist and underdeveloped countries: This is an international
study that is looking at the various health care systems globally under different
economic structures. It's focus is to evolve an analytic understanding of recent
bonds world-wide in tho health sector, especially so in the context of
privatization. The draft report is at present ready dhd awaiting editing and
publication.
5.
Health Services Utilization and Expenditure in Madhya Pradesh: This study
looks at health services utilization and expenditure by households in an area
which has an intensive program approach by the government in collaboration
with an international bilateral agency.Tt was published in 1994.
6.
Health Research Studies in India: This is an analysis and a compilation with
detailed annotations of over 300 research studies done in the country by various
research institutions. It was published in 1994.
Since October 1988,1 am registered for my Ph.D. studies with Prof. Manorama Savur. I
was a recipient of an ICSSR National Fellowship in Medical Sociology for three years
The title of my doctoral work is "The Political Economy of Health Policy making in
India". The study aims at a historical analysis of health policy and programs in India
with a special focus on the role played by various international agencies in shaping
these health policy and programs. At present about half the chapters of the thesis are
ready.
6
ANNEXURE II
PUBLICATIONS OF RAVI DUGGAL.
RESEARCH MONOGRAPHS AND BOOKS.
NGOs in Rural Health Care : A Comparative Study with PHC's, Vol. II,
(co-authors Amar Jesani and Manisha Gupte) FRCH - ICMR Pune, forthcoming.
Health Policy and Financing : Papers and Notes, Document prepared as a WHO National
Consultant to Ministry of Health and Family Welfare, New Delhi, 1993.
Employee Medical Benefits in the Corporate Sector, FRCH - ICMR, Pune, 1993.
State Sector Health Expenditure : A Database - All India and States. (Co-authors Sunil Nandrai
and Sahana Shetty), FRCH-ICMR, Bombay, 1992.
Health Care Services and Financing in India, Background Document, World Bank, New Delhi
1992.
Cost of Health Care : A Household Survey of an inoian District, (Co-author with Suchetha Amin),
ICMR-FRCH, Bombay, 1939.
NGOs in Rural Health Care Vol. I: An Overview (co-author with A Jesani and M. Gupte), FRCH
ICMR, Bombay, 1986.
Health Status of the Indian People : A Supplement to the document ’Health For AH’ (research
contributor) Ed. Sonya Gill. FRCH-ICMR. Bombay. 1987
Social Aspects of Leprosy : Findings from Rural Maharashtra (Co-author with Amar Jesani and
Manisha Gupte), FRCH-Damien Foundation, Bombay, 1986.
Corporate Sector in Rural Development under IRDP (co-author with M. Savur et.al.), University
of Bombay, 1985.
PAPERS AND ARTICLES (1982 -1992) OF RAVI DUGGAL.
Health Infrastructure and Woman - Systems, Trends and Budgets, Chapter in Forthcoming
edited book fo the International Womens’ Conference, Beijing (Editor • Malini Karkal)
Health Sector Database : A special compilation on behalf of CEHAT for.the Economic and
Political Weekly’s (EPW) special statistics section. Co-authors Sunil Nandraj and Asha Vadair,
EPW, Vol. 30, Nos. , April 45-and 22,1995.
Health Expenditure Patterns in selected Major States, Radical Journal of Health (new series)
Vol. I, Jan. 1995.
The Number Game, Humanscape, Nov. 1994.
The Great Divide, Humanscape, Oct. 1994.
7
Po>. ...non Meet: Poor Impact of NGO's, Economic and Political Weekly, Vol. 29. No.38, Sept
17. 1994
Population and Family Planning Policy : A Critique and Perspective, Paper presented at
International Conference on Population and Development, Cairo, Sept. 1994.
Health Finance of the Bombay Municipal Corporation , (Co-author Sunil Nandraj), background
papei fot Medico Friend Ciicie Woiksliop on impiuving Public Hospitals in Bombay, June 1994,
mfc Bombay Group. Bombay.
Peoples Economy Context and Issues from India, Paper presented at Seminar on Market
Economy Also for the Poor, Beme, Switzerland, May 1994.
Health for All in India. FRCH Newsletter. July-Aug. 1993. Pune.
The Impact of NIP-NEP on Labour, paper presented at seminar on Impact of New Industrial
Policy on Labour, MILS/AILS/MKI, Bombay, Jan 1993.
Health Care Utilisation in India, paper presented at seminar on Rural Medical Practitioners,
SRRi-iMRB/UNICEF, New Delhi, Jan. 1993.
Resurrecting Shore ; Reemphasising a Universal Health Care System, tvicajiuv
Ethics ■ Awaiting a Patients' Movement ^coauthor Arr‘?r J^sanO in AJok M’.’khonadhvav
fed) State of Undia's Health, VHAI. New Delhi, 1992
User Charges and Patients' Rights, paper presented at workshop on Patients' Rights, TISS,
Bombay, August 1992.
Trends in FP Policy and Programs, paper presented at seminar on Trends and Perspectives for
FP in the Nineties, BUJ. Bombay, August 1992.
Piimaiy Health Care under NEP - Does ii ealiy mallei? repei piesenled al CHAI National
Consultation on Ths Impact of NEP on Health Care, March 1992, Hyderabad," also as Cost and
Concern in Primary Health Care in Health Action Vo!,5, No.8 .August 1992
Health Care in China - A model in Transition, (co-author Sonya Gill), FRCH Newsletter, VI : 1,
Jan-Feb 1992.
Regional Disparities in Health Care Development - A Comparative Analysis of Maharashtra and
Other States, paper presented at the National workshop on Health and Development in India,
NCAER/Hav'ard University, Delhi, January 1992.
Ending the Underfinancing of Primary Health Care, Medico Friend Circle Bulletin 177-178, Nov.Dec., 1991.
Private Health Expenditure, Medico Friend Circle Bulletin 173-174, July-August, 1991.
Regulating the Private Health Sector (Co-author Sunil Nandraj), Medico Friend Circle Bulletin,
173-174. July-Aug ,1991.
8
Health Care in Underdeveloped Countries Under Imperialism and a Historical Case-study of
Undet development of Health Care Services in India, Paper presented at Second World
Congress on Health Economics, Zurich, September 1990.
State Health Financing and Health Care Services in India, Paper presented at workshop on
Health Financing, Simla May 1990, VHAI/Ford Foundation, also in Health for the Millions, XVI:3,
June 1990.
Health Care Services in India - Facts Revealing Gross Maldistribution (coauthor Amar Jesani), a
paper for a meeting on health services, Planning Commission, April 1990.
A Review of the Shore Committee - 1946 and it’s Relevance - 1990, FRCH Newsletter IV 1-2,
January-April 1990, also in Indian Journal of Pediatrics, 58:4.
Health and Related Statistics - compilation and critique, (co-author Sunil Nandraj and
Saraswathy A) FRCH Newsletter, III 6, September-December, 1989.
Planning for Whose Development? FRCH Newsletter III 6, September/December, 1989.
Exploding the Population Bomb Myth, MFC Bulletin No. 152 and 153 June-July, 1989.
Medical Education in India : Who Pays?, Radical Journal of Health Vol. Ill, No. 4, March 1989.
Privatisation and New Medical Technology, FRCH Newsletter Vol. 2, No. 5, SeptemberDecember, 1988 (Part I) and Vol. 3, No 1, January-Febn.iary, 1989 (Part in
Medical Services. Medical Technology and Privatisation. Paper oresented at XVth Annual Meet
of Medico Friends Circle at Alwaye, January, 1989.
Health Care, Health Policy and Underdevelopment, Radical Journal of He’alth, Vol. Ill, No. 1,
June, 1988.
Health, rinancing in inaia : Keview or investment, Research and issues for further research
(Papoi pies>anied at National Workshop On Health Financing in India Organised by Opeiaiiun
Research Group and Ford Foundation at Surajkund, Haryana) 23, April 1988. (Co-author N. II.
Antia), also in Peter Berman and M. E. Khan (cd.) Paying For India's Health Caro, Saga
Publications, New Delhi, 1992.
Vaccines : Panacea or Palliative, FRCH Newsletter Vol.ll, No. 1, Jan-Feb 1988.
Why Population Won't Fall, Indian Post, June 13,1987.
You Can't Blame the Third World All The Time, Indian Post, May 30,1987.
Financing Family Planning, Medico Friend Circle Xlllth Annual Meet
Paper, 1987.
Seminar Background
Health Personnel in India, FRCH Newsletter, Vol. I, No. 4, June, 1987.
Why We Must Ban EP drugs, Indian Post, August 6, 1987.
XYZ of Sex (feature on practice of Sex determination and sex-preselection in Bombay) (Co
author Manisha Gupte), Indian Post, May 31, 1987.
Political Economy of State Health Financing. Radical Journal of Health, Vol. I, No. 3, December.
1986
NGOs, Government and Private Sector, Paper presented at Seminar on Health For All: Concept
and Reality (FRCH/ICSSR), November 1986 - also in Economic and Political Weekly, Vol. 23
(13). March 26, 1983
Health Expenditure in India, FRCH Newsletter, Vol. I, No. 1, November, 1966.
Health in the Seventh Plan : Boost to the Private Sector, Radical Journal of Health, Vol. I, No. 1,
I. .no long
Did Manda Padwal Die in Vain (feature on consequence of Population target approach)
(coauthor with Manisha Gupte), India Express Magazine. June 19,1986.
The Ericsson Technique : A new way to eliminate woman (feature on sex-preselection) (co
author with Manisha Gupte), India Express Magazine, June 29, 1986.
Mental Health and Society, Socialist Health Review, Vol. II, No.4, March 1986.
iiis or the Health Industry, Socialist health Review, Vol. II, No.1, June 1965.
Population, Health and Development, FRCH, 1985.
Health and Population in Tribal Villages, paper presented at Seminar on Tribal Demography and
Development. IASP. October, 1984: also in Ashish Bose et.al.(eds) Demography of Tribal
Development. B.R Publishing. New Delhi, 1990.
Politics of III Health and Health Care. Economic and Political Weekly. Vol £IX, No. 24-25, June,
198-1
Health Services and the Community - A field study of Uran Taiuka, FRCH, 1982.
Rural Development
critical analysis of policy and implementation, with special emphasis on
the health delivery system, FRCH, 1982.
Environment and Health, FftCH, 1982.
Air Pollution and Health, FRCH, 1982.
Water and Food Contamination and Health, FRCH, 1982.
Workplace Environment and Health, FRCH, 1982.
Tax Expenditure and Rural Development, Dept, of Socio. Univ, of Bombay, 1982.
10
The Unregulated Private Health Sector, Amar Jesani and Sunil Nandraj, Health
for the Millions, Vol. 2, No.l February 1994.
Private Health Sector in India : A Need for Regulation, Sunil Nandraj.
Background paper for the Workshop on the World Development Report 1993, held
at ICSSR, Bombay, July 10th 1993.
State of health care in Maharashtra, Alex George and Sunil Nandraj, Paper
Commissioned by WHO/Government of India/VHAI,
Economic & Political Weekly,
Bombay, Vol XXVIII Nos 32 and 33, August 7-14, 1993.
Regulating the private sector, Ravi Duggal and Sunil Nandraj, Medico Friend
Circle (MFC) Bulletin, 173/174, July-Aug., 1991.
Health Policy in the Five Year Plans : A Critical Overview,
FRCH Newsletter, Vol. V (3), May-June, 1991.
Sunil Nandraj,
Health and related statistics, Ravi Duggal, S. Anahtharam, Sunil Nandraj,
FRCH Newsletter, Special Number, Vol. Ill, No. 6, Oct.-Dec. 1989.
Penal Institutions, health professionals and human rights, R. Raghav and
Sunil Nandraj, Medico Friend Circle Bulletin, No. 164/165, June/July, 1990.
REPORTS :
An Assessment for the Meed for Designing an Accreditation system in India,
for Institute of Health Systems, Hyderabad, Nandraj Sunil, July 1994.
State Sector Health Expenditures - A Database : All India and States, 19511985, Ravi Duggal, Sunil Nandraj, Sahana Shetty, FRCH/ March, 1992.
Private Nursing Homes : A Social Audit, Sunil Nandraj, July 1992, report
submitted to the committee appointed to regulate nursing homes/hospitals in
Bombay City.
Health Research Studies in India, Vol 1 : A Review & Vol 2 : An Annotated
Bibliography. Part of the Research Team.'Report submitted to the Ministry of
Health and Family Welfare, New Delhi, 1993.
A Study of Household Health Expenditures in Madhya Pradesh, George A, Shah I,
Nandraj S. FRCH, 1994.
Nawipapmr articles :
Beef up the Health Budget, Sunil Nandraj,
Special),Bombay, February 4-5, 1995.
,
The Metropolis
(Anniversary
AREAS OF EXPERTISE:
Health Sector: Health Care Planning and Policy, Health Economics, Financing and Expenditures,
Health Services Development, Private Health Expenditures, Quality/Standards of
Health Care, Medical Malpractice and Regulation, Evaluation of Health Programs,
Health Care Databases
Other Areas : Disaster Management, Rural development, Socio economic programs for weaker
sections. Implementation of
PARTICIPATION IN SEMINAR'S, WORKSHOPS, CONFERENCES, TRAINING PROGRAMS :
Clairvoyance-95 at TISS, All India Seminar on Health care managment - Future
challenges and opportunities, organised by Dept. Of health services USS,
Bombay, 4th & Sth Feb, 1995
Expert group meeting on Health Financing Stratergies for strengthing Primary
health care organised by WHO/MQH/IIHMR at Jaipur, March 3-4 1995.
Medico Friend Circle, Annual meet on Reproductive Health at Wardha, 12-15
January 1994.
Indian Institute of Managraent, Ahmedabad, Training Programme cum workshop on
Health Policy Analysis and Development Programme on Policy Formulation
Process, August 29 - September 3 1994.
Workshop of select experts for Development of Training materials on Ecohealth for workers in slum areas held at Jagruti Kendra in 17th November 1994
Improving Public Hospitals in Bombay Medico Friend Circle (Bombay Group),
Seminar in Bombay, 25th June 1994. (Background paper for seminar with Mr.
Ravi duggal)
Private Sector in Health care : Need & Means for regulation MFC Annual meet,
Bombay, 5-6 Sept, 1991.
Workshop on Health Economics Jointly organised by TISS and Ford Foundation,
TISS, Bombay, Oct 28th to Nov 2nd 1991, Bombay.
RELIEF WORK EXPERIENCE
19B2-83 in Orissa for Flood affected victims
1984 in Bombay for Communal riot affected victims
1984 in Bhopal for Gas Victims
MEMBERSHIP IN ORGANIZATIONS
Medico Friend Circle - Co-ordinator of Regulation Cell of Bombay Group.
Co-ordinator of Bombay Group (1989-1991).
Steering group member of National MFC (Jan-Sept 1991) .
MEMBERSHIP IN COMMITTEE
Appointed by the Bombay High court on the committee to oversee and
supervise the functioning of private hospitals and nursing homes in
the city of Bombay and make recommendations therein.
EXTRA CURRICULAR ACTIVITIES
1981 - 1982
: Student’s Council member in S.I.E.S College.
Representative of S.I.E.S College in Bombay University
Students Council.
1982 - 1983
: Public Relations Secretary in TISS Students Union.
1985 - 1986
: Executive Committee of the TISS Alumni Association.
(Also a member of editorial committee of the Newsletter).
OTHER RELEVANCIES
Since the beginning I am involved in activities and action programmes dealing
with social issues. This has attributed social sensitivity to me and has
worked as the motivating force behind my engrossment with issues related to
underprivileged people, rural development and reconstruction, development
programmes, democratic rights, health sector, women, children and the like.
The preoccupation of this nature has been not only direct but also indirectly
in the form of support to various NGOs and individuals working in the field
having somewhat the similar concerns.
CURRICULUM
VITAE
: Sunil Wandraj
KAME
SEX
: Male
NATIONALITY
: Indian
RESIDENTIAL ADDRESS
.- WL 5/9/14
Sector 3,Phase I
Nerul,New Bombay 400 706
DATE OF BIRTH
: 21st,January,1961
ACADEMIC QUALIFICATION :
1.
Graduation : BA In Economics & Political Science from University of Bombay, Bombay, 1982.
2.
Postgraduation :M.A. in Social Work (Urban & Rural Community Devlopment) from Tata
Institute of Social Science,Bombay, 1984
LANGUAGES KNOW
: English,Hindi,Marathi,Tamil,Telugu,Kannada.
PROFICIENCY IN COMPUTERS
: SPSS,LOTUS 123,WORDPERFECT, HPG,ISIS.FOXPRO,
WINDOWS based packages.
SCHOLARSHIP AWARDED
: Sir Dorabji Tata Scholarship in 1983-84.
WORK EXPERIENCE :
Employer
Year
Post Held
Nature of Activity
July 1984Nov. 1984
Project
Coordinator
Coordination and
implementation of the
project programs
related to social issue
United Nation
University
(Tokyo) Project
at TISS, Bombay
Dec. 1984July 1987
Social
Worker
Dealings with tribal’s/nontribal’s covering issues
like socio-economic, cultural
health and exploitation.
Pariwartan-84
Maharashtra
July 1987Oct. 1988
Social
Scientist
Evaluation of Primary Health
Health Centers in Maharashtra
Indian Council
for Medical
Research, Bombay
Oct.1988April 1994
Research
Officer
Health Research
The Foundation
for Research
in Community
Health, Bombay
May.1994presently
Research
Officer
Health Research
Centre for
Enquiry into
Health & Allied
Themes, Bombay
Consultancy
Consultancy
to
Maharashtra
:
prepare
A
a
background
comparative Analysis
India, September 1992.
paper on State of Health care
for Voluntary Health Association
in
of
Consultancy to Review Health Research Studies In Xndia, November 1993 - March
1994, FRC'H, Bombay.
Consultant to prepare paper on An Assessment for the Need for Designing an
Accreditation system In Xndia, for Institute of Health Systems, July 1994,
Hyderabad.
RESEARCH EXPERIENCE :
Title of
the Project
Nature of Project
Nature of Bork
Carried Out
Sponsoring
Agency
State Sector
Health
Expenditures
in India
Critical analysis of the
development and
financing of health
sector in India from a
historical perspective.
Data collection
computerized
data analysis
Indian Council
for Medical
Research,
New Delhi.
Study of
Corporate
Sector
Exploration of the
health benefits provided
by employer in corporate
sector, at India level.
Data collection
computerization
of data
Indian Council
for Medical
Research,
New Delhi.
Health
Services
Utilization &
Expenditure
Nature of health services
utilization and
expenditures incurred by
households.
Data collection
DANIDA,
Training and
New Delhi.
supervising of
investigators/
research associates.
Data analysis,
Report writing,
Health
Investment
in a District
Exploration of health
care resources available
in a district and their,
investment pattern.
Data collection,
analysis and
report writing.
Ford
Foundation
New Delhi.
Review of
Research
Studies in
India
To review health
research studies
undertaken in India.
Data collection,
analysis of
Research
studies and
Report writing
Ministry
of Health
and Family
Belfare
New Delhi.
Quality of
care provided
by the private
Health Sector
To Study the standards
available in the private
health sector, (Nursing
homes & GPs)
Data collection
analysis and
Report writing
Government of
India & UNDP
Creating, updating and dissemination of Database on Health & Allied themes
PUBLICATIONS
MTTCUS8
:
Special Statistics on Health Expenditure Across States. Ravi Duggal and Sunil
Nandraj,Asha Vadair, Economic & Political Beekly, Bombay Vol XXX No 15 & 16
April 15th and 22nd,1995.
Beyond the Law and the Lord : Quality of Private Health Care. Economic &
Political Beekly, Bombay Vol XXIX No 27, July 2, 1994.
Health Finances of the Bombay Municipal Corporation. Ravi Duggal and Sunil
Nandraj, Background paper at the seminar on Improving Public Hospitals in
Bombay, June 26th, 1994.
CURRICULUM VITAE
CURRICULUM VTIAE.
Name : Dr. A5AR JESANL
Sex : Male.
Age : 41 years.
Educational Qualification:
MJL.B.S. 1978Medical College, Baroda. M.S. University.
Current Affiliations :
Coordinator, (EHAT(Centre for Enquiry into Health and Allied Themes), Bombay.
Principal Irtve&galor and Consultant, FRCH (Foundation for Research in Community Health), Bombay,
on the project, '‘’Educational and Training Support for the Auxiliary Nurse Midwives in Madhya Pradesh
and Maharashta".
Member, Healthcare Panel, the Task Force Constituted by the Technology Information, Forecasting and
Assessment C«ek3 (TIFAC), Department of Science and Technology, Government of India.
Member, Editoial Committee. "Medical Ethics", A quarterly journal of the Forum for Medical Ethics,
Bombay.
Consulting Kdlor, Radical Journal of Health, a quarterly journal on Social Science and Health published
from Bombay.
Member, Me'diocFriend Circle, Vice-Chairperson: Forum for Medical Ethics^Sodety, Bombay.
Research Experience:
At CEHAT, Baabay:
1994- , "Stityof Legislations and Legal Aspects of Health Care Services in India", as Principal
Investigator, the project sponsored by the United Nations’ Development Programme (UNDP) and the
Government dfisdia (GQI).
1995- “Strengthening Medical Ethics for SelfRegulation ofMedical Profession and Medical Practice", a
report for the hfcpendent Commission on Health in India.
At FRCH, Bor&ay/Pnne:
1993- , "Eduction and Training support for ANMs in Madhya Pradesh and Maharashtra", as Principal
Investigator andSonsultant, the project sponsored by the DANIDA
1992-93, "Studyof Utilisation and Cost ofDrugs and Pharmaceuticals at District and Cottage Hospitals,
CHCs andPHCsin a District in Maharashtra", as Principal Investigator (was involved in only first part of
the study), the paject sponsored by the Ford Foundation.
1988-92, "Study f Doctors and Auxiliary Nurses at the PHCs and Subcentres’, as Principal Investigator,
the project sponsred by the DANIDA
Dr. Aauw Jeraai. Cxrrtcxhuu rAu_
2
1989-90, "Study of Private Sector and Privatisation in Health care Services", as Senior Researcher, the
review paper commissioned by the Joint Panel of the Indian Council for Medical Research and the Indian
Council for Social Science Research.
1989-90, "Study of Community Participation in Health care Services", as Senior Researcher, the review
paper commissioned by the Joint Panel of the Indian Council for Medical Research and the Indian Council
for Soda! Science Research.
1987-88, "Study ofPrimary Health Centres in Maharashtra", An anthropological and qualitative study of
PHCs, as senior researcher, the project sponsored by the Government of Maharashtra.
1985-86, "Social Aspects ofLeprosy : Findings from Rural Maharashtra", as research officer, the project
sponsored by the Damien Foundation.
1983-85, "Critical Study of Voluntary Health Projects in Maharashtra", as research officer, the project
sponsored by the ICMR.
1980-81, "Urban health in a slum of Bombay", A Community activation project for health and other
developments in Lal Dongar slum, Chcmbur, Bombay, as community organiser, file project supported by
the FRCH, Bombay.
1980, "Integration ofleprosy in the general health care work", a study of integration of leprosy work done
by the Mandwa Project of the FRCH, in Raigarh district of Maharashtra covering 30,000 population, as
research officer, file project sponsored by the Research Society, J. J. Group' of Hospitals and the Medical
College, Bombay.
1979-80, "Health For All: an alternative strategy", the Study Group Jointly set up by the ICSSR and the
ICMR (also known as HFA Committee or Dr. Ramalingaswamy Committee), worked in its secretariat as a
research officer helping the committee in drafting its report.
Publications
Books and Published Reports:
(Ed. With Singfai P.C), "Market, Medicine, Malpractice: Issues and Case Studies", Bombay: CEHAT, pp
160 (under publication, expected date of publication, November 1995)
(with Iyer Adin) "Walking A Tightrope:Auxiliary Nurse Midwives in Rural Health Care" Bombay:
FRCH, pp 131 (under publication, expected date of publication, December 1995)
(with Anantharam Saraswathy), "Private Sector and Privatisation in Health Care Services", Bombay:
FRCH, 1993, pp. 97.
(with Ganguly Shilpi), "Some Issues in the Community Participation in Health Care Services", Bombay:
FRCH, 1993, pp. 30.
(with Alphonse Mary, D’Sa Aloysius), "Bombay Riots: January 1993: A Selected Documentation from a
Section ofthe Print Media", Bombay: Solidarity for Justice, March, 1993, pp. 180.
Dr. Acaar Jared. Casr&a&3cs wfise—
3
“ANMs al Primary Health Centres in Maharashtra", Bombay FRCH, 1989, pp. 124.
"Drugs and Pharmaceuticals at the PHCs", Bombay FRCH, pp. 64,
(with Duggal Ravi, Guptc Manisha), "Social Aspects of Leprosy: findings from Rural Maharashtra",
Bombay: FRCH, 1988, pp. 124.
(with Duggal Ravi, Guptc Manisha), "MJOs in Rural Health Care: Vol. I:An Overview ", Bombay: FRCH,
1986, pp. 176.
"Integration of Leprosy in general health care: A report on Mandwa project", Bombay FRCH. 1980.
Other Published Reports:
(as a member of investigation team), "An Enquiry by the Fact Finding Team into the Police Firing that
Led to the Killing of a Tribal and Caused Injury to Others in Dahanu Taluka, Thane District,
Maharashtra", Bombay Fact Finding Team, July 1992, pp. 17.
“Human Rights Issues from Investigation into the Murder ofSr. Sylvia and Sr. Priyd", Bombay Solidarity
for Justice, Nov. 1991.
(as a member of investigation team), “Will Truth Prevail? A Report of the Investigation Team on the
Murder ofSr. Sylvia and Sr. Priya at Snehasadan, Jogeshwari", Bombay Solidarity for Justice, April 12,
1991.
(as a member of investigation team), "Another Locle up Death : An Investigation", Bombay: Committee
for the Protection of Democratic Rights, July 1990.
(as a member of investigation team), "The Jogeshwari Rape Case : A Report", Bombay Medico Friend
Circle, YUVA, CPDR etc.. July 1990.
Articles Published in Journals and Books:
"Law, Ethics and Medical Councils: Evolution of their relationships" in Medical Ethics, VoL3, No.3,
July-Sept 1995. pp C-IX-XIL
"Self-Regulation or External Control?", in Medical Ethics, Vol: 3, No:2, April-June 1995, pg
18.
(With Pilgaokar Anil) "In the. Pink: Need for Asserting Patients' Rights", in Keemat, Vol: 24,
No: 3, March 1995, pgs 12-14.
(With Vadair Asha) "The Doctors Dilemma: A supreme judgement on death by hanging violates
medical ethics", in Humanscape, March, 1995, pp 12-3.
“Violence and the Ethical Responsibility of the Medical Profession ", in Medical Ethics, Vol: 3
No: 1, January-March 1995, pg. 3-5.
Dr. Amar JerarkCarrtcabua
4
"Medical Ethis : In the context of increasing violence", (Presented at the Indian Medical Association
workshop on Medical Ethics and Ethos in Cases of Torture, at New Delhi from November 25 to 27,
1994), pp. 7.
"Violence aganst Women and Children : The Role of Media and Health Care Professionals”, (Paper
presented at Xsier’s Institute of Communication’s seminar on Health Communication held in Bombay on
November 17,1994), pp. 3.
"Slippery Slops'ofNazi Medicine ’’ (Review Article), in Economic and Political Weekly, Vol XXIX, No.
43, October 22.1994, pp. 2805-2807.
“When Medicos Went Mad: Bioethics and the Holocaust ” (Book Review), in Medical Ethics, Vol. 2. No.
1,
August-Octcicr, 1994, pp. 10-11.
“Doctors andsmger strikers”, in Humanscape, June 1994, pp. 7-9(and 29).
"Medical Ethis ” (Book Review), in Medical Ethics, Vol: 1 No : 3 May-July, 1994, pp. 8.
(with NandrajSUml), “The Unregulated Private Health Sector", in Health for Million, Vol 2, No. 1,
February 1994pp. 25-ZS.
(with Iyer Adfit “Women and Abortion", in Economic and Political Weekly, November 27, 1993, pp.
2591-94.
(with PflgaokarAnl), “Patient’s Autonomy : Throwing It To The Winds?”in Medical Ethics, Vol 1 No. 1,
August-October.1993, pp. 6-7.
'
“Consumers ardthe Medical Community”, in Christian Medical Journal ofIndia, pp. 5-7.
(with Duggal R«i), “Medical Ethics .-Awaiting a Patients’ Movement", in VHAI, State ofIndia’s Health,
New Delhi: 19<t pp. 365-77.
“Repression ofiealth Professionals” in Economic and Political Weekly, Oct 5,1991, pp. 2291-2.
“Educational h&rvention in Medical Malpractice", in FRCH Newsletter, Vol V, No. 4, July-August
1991, pp. 4-5 (ai8).
"Medical Malpractice : What it is and how to fight it: Report of a workshop”, Medico Friends Circle
Bulletin, May- Jkc, 1991, pp. 1-3.
“Nines ps Wonvt”,Qsoak review) in Economic and Political Weekly, March 2-9,1991, pp. 493-4.
“Limits of Emplacement: Women in Rural Health Care”, in Economic and Political Weekly, May 19,
1990, pp. 1098-IMM.
“Medicine at rit: Health Professional as Abuser and Victim ”, in Economic and Political Weekly, July
1989, pp. 1633-7
Dr. Amar Jextuti. Cminbua vitae—
5
"Degraded Breadwinner and Harassed Health Worker: Socio-economic Background and Problems of the
Auxiliary Nurse Midwife”, in FRCH Newsletter, Vol. 3, No. 3-5, May-Scptcmbcr 1989, pp.7-10.
"After Bangladesh, the Philippines Show the Way", in FRCH Newsletter, Vol. 3, No. 2, March-April,
1989, pp. 2 (and 8).
"Health Professional as Abuser or Victim ", in FRCH Newsletter, Vol 3, No. 1, January-February 1989,
PP- <
“Health for All: For Women’s Empowerment or Further Subjugation?”, (Paper presented for the Working
Group Committee for the Seminar Empowerment of Women: Multidisciplinary Perspectives), December,
1988, pp. 8.
“Hands off the MTP Act I", A response to Nflima Dutta’s comment on the law relating to Prenatal
Diagnosis, in The Lawyers, October 1988 pp. 22-3.
"Eradicate Tuberculosis, Not TB Beds", in Economic and Political Weekly, Vol XXm. No. 39, Sept 24,
1988, pp. 1995-1997.
"Fee for service in Maharashtra Hospitals", in Radical Journal of Health , Vol H, No. 4, March 1988,
pp. 99-100.
"Scope and Limits ofMaharashtra Legislation: Banning Prenatal Sex Determination" in Radical Journal
ofHealth, Vol H, No. 4, March 1988, pp. 88-90.
“Target Orientation in Health Care”, in FRCHNewsletter, May-June, 1988, VoLU, No.3, pp. 1-2.
(with Duggal Ravi), "Penacea or Palliative?” (on Universal Immunisation Programme), in FRCH
Newsletter, Vol 2, No.l, January-February 1988, pp.8-9.
"Pesticide Poisoning", in FRCH Newsletter, Vol I, No. 5, July-August 1987, pp. 7.
"Technology in Medicine" in Radical Journal ofHealth, Vol n, No. 1-2, June-Sept 1987, pp. 1-2.
“~'e New Drug Policy in Nigeria”, in FRCHNewsletter, Vol I, No. 4, May-June 1987, pp. 3.
‘Ruins of War", in Radical Journal ofHealth, Vol I, No. 4, March 1987, pp. 130-131.
"Use and Abuse of Bio-medical Technology - Amniocentesis - a Case Study", in Medico Friends Circle
Bulletin, New Delhi, January, 1987, pp. 1-3.
"Health in Nicaragua: Epidemiology ofAggression", in Radical Journal of Health, Vol. t No. 1, June
1986, pp. 3-10.
"Doctors and Torture" in Socialist Health Review (now called Radical Journal ofHealth), Bombay, Vol.
n, No : 4. March 1986, pp. 177-178.
(with Prakash Padma), "Political Economy of Health Care in India : An outline" in Socialist Health
Review (now called Radical Journal ofHealth), Bombay VoLI, No:l, June 1984, pp.29-44
Dr. Amar JtratL Corricatam rttat-
6
Participation in Seminars, Workshops, Conferences:
International:
•“Sex Seiectisn Conference” in London, organised by die British Medical Association (BMA) and the
European Conmission Research Project, University of Swansea, on April 23,1993.
‘The Internatonal Conference on “The Third World Debt” in Brussels, Belgium, in April 1993. Made
presentation <n India in the session, "AIDS and the Health Situation in the Third World".
•Delivered albcture on the “Violence and the role of Health Care Professionals in India”, in Paris in a
meeting orgariscd by the Medical Division, French Section of the Amnesty International, September, 1992.
‘The Intemiional Conference on “Elimination and Terror: International Conference on Political
Killings and‘disappearances’”, in Amsterdam, the Netherlands, organised by the Dutch Section of the
Amnesty Intmational, in September, 1992.
•Training Setanar on “Treatment and Rehabilitation of Torture Victims” in Copenhagen, organised by
RehabilitarionGentre for Torture victims (RCT), Denmark, in April 1992.
‘The Intemiumal Conference on “Medicine at risk : Health Professional as Abuser and Victim”, in
Paris, France,organised by the Medical Division, French Section of the Amnesty International, in January,
1989.
National: (inl993-94 only)
‘The Intemiipaal Workshop on “Medical Ethics and Ethos in Cases of Torture”, organised by the
Indian McdicJiAssociation, November 25-27, 1994 in Delhi. Presented a paper, "Medical Ethics in the
Context ofbtreasing Violence”.
‘The National Seminar on “Health Communication”, in Bombay, organised by the Xavier Institute of
Communication Bombay, on November 17, 1994. Presented a paper, "Violence against Women and
Children rTiteRole ofMedia and Health Care Professionals ~.
‘From 1991tn 93, conducted training sessions as an invite-d faculty at the Tata Institute of Social
Sciences, Boniiay, far the IAS and IPS officers on “Human Rights”.
•National Wofeshop on “Joint Action by District Officers and Non-Governmental Organisations in
Social Welter-Sector”, organised jointly by the Tata Institute of Social Sciences, Bombay and the L.B.S.
National Acadany of Administration, Massooric, August 5-6, 1994, in Bombay. Participated in the
discussion on the draft of “Source Book for District Officers to Work with the NGOs and other
Organisations™ the District”.
•Seminar on“isues in Reproductive Health in India”, at Delhi, organised by CHETNA, Ahmedabad,
on May 4 aiuJS, 1994.
•“Male Gendr Workshop”, at Bandipur, Mysore, organised by Sakti, Bangalore, March 19-21,1994.
•Conference W “Service Delivery System in Induced Abortion” at Agra, organised by Parivar Seva
Sanstha (MarieStopes), New Delhi, on February 22 and 23,1994.
•Workshop ob “Social Security”, at fee Indira Gandhi Institute of Development Research, Bombay,
organised by tk UNDP/Govcrnmcnt of India’s “Research Project on Strategies and Financing for Human
Development”,Buccmber 8-9,1993.
‘Workshop on “Aeneas, to and Financing of Health in India” at the Gujarat Institute of Devt Research,
Gota (Ahmedaiad), organised by the UNDP/Govemment of India’s "Research Project on Strategies and
Financing for Htrnan Development”, November 1 and 2,1993.
•“Discnsrion Betting on Health Economics - Research and Training”, at the Christian Medical College
and Hospital (CMCH), Vellore, organised by the World Health Organisation (WHO) and the CMCH,
November 30 te December 3, 1993.
‘International Workshop on “Evolving Cultural Identity of Bombay, Nineteenth and Twentieth
Centuries”, at fie SNDT Women’s University, organised by the Department of Sociology, SNDT
Women’s University, December 16-20,1992. Acted as discussant on a paper presented by Ramasubam
Radhika and Cook Nigel, “Political Economy of Health in the City of Bombay”.
Tel: 363-4
3617
SACHIN P. MULGAOKAR & CO.
CHARTERED ACCOUNTANTS
Veer Bhuvan 36-A Hughes Road Bombay 400 007
REPORT OF THE AUDITORS
Name of the Trust : ANUSANDHAN TRUST
Registration No.
F.-13480
dt. 30.8.91
We have audited the annexed accounts of the ANUSANDHAN TRUST for the year
ended 31st March 1995 and we report as under:
1. The accounts are maintained regularly' and in accordance with the provisions of the
Act and the Rules.
2.
The receipts and disbursements are property and correctly shown in the accounts.
3.
The cash balance and vouchers in the custody of the Manager or Treasurer on the date
of audit were in agreement with the accounts.
4.
All books, debts, accounts, vouchers or other documents or records required by us
were produced before us.
5.
The trust does not own any immovable property.The trust has maintained registers in
respect of moveable property.
6.
The Treasurer or any other person required by us to appear before us did so and
furnished the necessary information required by us.
7.
No property or funds ofthc Society were applied for any object or purpose other than
•the object or purposes of the Trust.
8.
There are no amounts which arc outstanding for more than one year and no amount is
written off.
9.
No tenders were invited for repairs or construction as there was no such expenditure in
excess of Rs. 5000 during the year.
10.
I’he moneys of the Society have not been invested contrary to the provisions of
Section 35 of the Act.
/'ll. The Trust does not hold any immovable property and as such the provisions of
Tel: 3634
3617
SACHIN P. MULGAOKAR & CO.
CHARTERED ACCOUNTANTS
Veer Bhuvan 36-A Hughes Road Bombay 400 007
12.
So far as it is ascertainable from books of accounts and according to the information
and explanations given to us there were no cases of irregular, illegal or improper
expendihire, or failure or omission to recover moneys or other property belonging to
the Society or of loss or waste of money or other property belonging to the T rust.
13.
The budget required to be filled under Rule 16-A is filed.
14.
The maximum and minimum number of the members of the Managing Committee is
maintained.
15.
The meeting arc held regularly.
16.
The minute books of the proceedings of the meeting is maintained.
17.
None of the Trustees has any interest in the investment of the Trust.
18.
No Trustee is debtor or creditor of the Trust.The Trust has taken loans from Trustees.
19.
No irregularity has been pointed out by us in our previous report.
20.
There is no special matter which we think fit necessary to bring to the notice of the
Deputy or Assistant Charity Commissioner.
BOMBAY
For SACIDN P. MULGAOKAR & CO.
Chartered Accountants
Dated: 25th May, 1995.
SACHIN P. MULGAOKAR
(Proprietor)
BOMBAY PUBLIC TRUSTS ACT, 1950.
SCHEDULE VIE (Vide Rule 17 (1)],
Regn. No: E-13480, dt. 30-08-91
Name of the Public Trustj ANUSANDHAN TRUST
BALANCE - SHEET AS AT 31 st MARCH 1995
FUNDS &LIABHJTIES
Rs.
Rs.
TRUST FUND OR CORPUS:
Rs.
Rs.
FIXED ASSETS:
Balance as per last Balance Sheet
105.00
LOANS (Secured or Unsecured)
(As per Annexe. H forming part of Balance Sheet)
1,45,202.50
ADVANCES FOR EXPENSES:
From Trustees
3,415.85
OTHER EARMARKED FUNDS:
For Expenses
20,280.80
Deposits
6,000.00
CASH & BANK BALANCES:
(as per Annex. I forming part of Balance Sheet)
3,20,356.50
INCOME it EXPENDITURE ACCOUNT;
Balance as per last Balance Sheet
PROPERTIES & ASSETS
Short term Deposit with :
(I) HDFC
(2) Bank of India
(-71,303.85
1,00,900 00
5.000.00
LO5.OOO.uO
Add: Surplus as per Income &
Expenditure Account
32,856.30
31,552.45
Savings Account with;
Bank of India
17,603.30
Shamrao Vithal Co-op Bank I
58.540.20
Shamrao Vithal Co-op Bank n_________________
__ 2,803.90
78,946,50
_
THE BOMBAY PUBLIC TRUSTS ACT, 1950
SCHEDULE Vin [Vide Rule 17(1)]
Regn. No. E-13480 dt. 30.08.91.
Name of the Public Trust: ANUSANDHAN TRUST
INCOME AND EXPENDITURE FOR THE YEAR ENDING 31st MARCH 1995
EXPENDITURE
Rs.
INCOME
To Email Charges
2,300.00
To Bank charges
27.00
Rs.
By Donations
14,675.00
By Consultancy
7,000.00
1,559.75
To Miscellaneous Expenses
2,234.00
By Miscellaneous Receipts
To Depreciation
2,792.45
By Bank Interest
1.764.00
To Excess of Income over Expenditure_____
32,856.30
By Interest on SDR
15,211.00
TOTAL__________
40,209.75
40,209.75
fl MEy . 7_
THE BOMBAY PUBLIC TRUSTS ACT, 1950
SCHEDULE Vffl [Vide Rule 17 (1)]
Regn. No. E-13480 dt. 30.08.91.
Name of the Public Trust: ANUSANDHAN TRUST
EARMARKED FUNDS AS AT 31st. MARCH 1995
PARTICULARS
Opening balance
as on 1-4-94
FORD FOUNDATION
n)S(AIDS)
Grants received
during the year
Total
Expenses
Transfers
Closing Balance as
on 31-3-95
6,96,097.15*
6,96,097.15
4,41,454.85
-
2.54,642.30
15.563,00
15,563.00
UNDP (GOI)____________________ -_____________ 3,62,000.00
TOTAL
* Includes Bank Interest Rs. 6442.00
BOMBAY
Dated ill;
10,73,660.15
THE BOMBAY PUBLIC TRUSTS ACT, 1950
SCHEDULE VUI [Vide Rule 17(1)]
Rcgn. No. E-13480 dt. 30.08.91.
Name of the Public Trust; ANUSANDHAN TRUST
FIXED ASSETS AS AT 31st MARCH 1993
GROSS
PARTICULARS
As on
31-3-94
BLOCK
Additions dur-*nStheyear
NET
Total
Deprivation
for the year
BLOCK________
W.D.V. as on
31-3-95
ANUSANDHAN
a)
Furniture & Fixturds
8,943.00
8,943.00
447.15
8,495.85
b)
Fax Modem
12,500.00
12,500.00
1,562.50
10,937.50
5,740.20
CEHAT
a)
Furniture & Fixtures
6,378.00
6,378.00
637.80
b)
Vehicle (Bicycle)
1,450,00
1,450.00
145.00
1,305.00
29,271.00
29,271,00
2,792.45
26,478.55
30,165.50
30,165.50
3,016.55
27,148.95
650.00
650.00
162.50
487.50
FORD FOUNDATION
a)
Furniture & Fixtures
b)
Eqipment
c)
Computer
1,21,450.00
1,21,450,00
30,362.55
91,087.50
1,52,265.50
1,52,265.50
33,541.55
1,18,723.95
GRAND TOTAL
1,81,536.30
1,81,336.50
36,334.00
1.45,202.50
- '
As per our report of even date
yr
BOMBAY
Dated at;
-----------
Chanered Accountants
Auditors
BOMBAY
Dated at
TRUSTEED
(Spl.—CCBPT2
n?
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1_
CEHAT Publications, 1991-95
1995
Health Expenditure Patterns in selected Major States, Duggal Ravi, Radical Journal of Health (new
series) VoL I, Jan. 1995.
Violence and the Ethical Responsibility of the Medical Profession, Jesani Amar, in Medical Ethics,
Vol: 3 No: 1, January-March 1995, pg. 3-5.
Ethics of Professional Bodies, Pilgaokar Anil, in Medical Ethics, Vot3, No: 1, January-March 1995, pg.
2 (Editorial).
Beef up the Health Budget, Sunil Nandraj, The Metropolis (Anniversary Special), Bombay, February 45, 1995.
In the Pink: Need for Asserting Patients’ Rights, Jesani Amar, Pilgaokar Anil, in Keemat, Vol: 24, No:
3, March 1995, pgs 12-14.
Death Penalty : Medically Designed and Legally Executed Killing, Jesani Amar, Asha Vadair,
Humanscape, March, 1995.
Special Statistics on Health Expenditure Across States. Duggal Ravi and Nandraj Sunil, Vadair Asha,
Economic & Political Weekly, Bombay Vol XXX No 15 & 16 April 15th and 22nd,1995.
Medical Ethics: General Principles, Pilgaokar Anil, in Medical Ethics, Vol: 3, No: 2, April-June 1995,
pgs. C-V to C-VHL
Self-Regulation or External Control?, Jesani Amar, in Medical Ethics, Vol 3, No2, April-June 1995,
Pg 18.
“Law, Ethics and Medical Councils: Evolution of their relationships” Jesani Amar in Medical Ethics,
VoL3, No.3, July-Sept 1995, pp C-IX-XIL
“Market, Medicine, Malpractice: Issues and Case Studies”, Jesani Amar (Ed.), Singhi P.C Bombay:
CEHAT, pp 160 (under publication, expected date of publication, November 1995)
“Walking A Tightrope: Auxiliary Nurse Midwives in Rural Health Care” Jesani Amar, Iyer Aditi)
Bombay: FRCH, pp 131 (under publication, expected date of publication, December 1995)
1994
The Unregulated Private Health Sector, Jesani Amar, Nandraj Sunil, Health for Million, VoL 2, No. 1,
February 1994, pp. 25-28.
Peoples Economy Context and Issues from India, Duggal Ravi, Paper presented at Seminar on “Market
Economy Also for the Poor”, Beme, Switzerland, May 1994.
“Medical Ethics” Jesani Amar (Book Review), in Medical Ethics, VoL: 1 No : 3 May-July, 1994, pp. 8.
Doctors and hunger strikers, Jesani Amar, Humanscape, June 1994, pp. 7-9(and 29).
Health Finance of the Bombay Municipal Corporation , Duggal Ravi, Nandraj Sunil), background
paper for Medico Friend Circle (Bombay Group) Workshop on Improving Public Hospitals in Bombay,
Bombay, June, 1994.
Assessing The Need For And Designing An Accreditation System, Situation in India, Nandraj Sunil,
Paper prepared as consultancy for Institute of Health Systems, Hyderabad, July 1994.
New Moves: The Indian Drug Scene, Pilgaokar Anil, in Voices, Vol’ H, No. 3,1994, pgs 22-24.
Medical Ethics Jesani Amar (Book Review), Medical Ethics, Vol: 1 No : 3 May-July, 1994, pp. 8.
Beyond the Law and the Lord : Quality of Private Health Care, Nandraj Sunil, Economic <i Political
Weekly, Bombay Vol XXEX No 27, July 2,1994.
When Medicine Went Mad: Bioethics and the Holocaust Jesani Amar (Book Review), Medical Ethics,
Vol 2, No. 1, August-October, 1994, pp. 10-11.
Population Meet : Poor Impact of NGOs, Duggal Ravi, Economic and Political Weekly, Vol 29.
No.38, Sept. 17,1994.
Population and Family Planning Policy: A Critique and Perspective, Duggal Ravi, Paper presented at
International Conference on Population and Development, Cairo, Sept. 1994.
Slippery Slopes of Nazi Medicine, Jesani Amar (Review Article), Economic and Political Weekly, Vol
XXIX, No. 43, October 22,1994, pp. 2805-2807.
The Great Divide, Duggal Ravi, Humanscape, Oct 1994
Violence against Women and Children : The Role of Media and Health Care Professionals, (Paper
presented at Xavier’s Institute of Communication’s seminar on Health Communication held in Bombay on
November 17,1994), pp. 3.
The Number Game, Duggal Ravi, Humanscape, Nov. 1994
Medical Ethics : In the context of increasing violence, Jesani Amar (Presented at the Indian Medical
Association workshop on “Medical Ethics and Ethos in Cases of Torture, at New Delhi from November 25
to 27,1994), pp. 7. (Published in the Workshop Report, New Delhi: IMA, pgs 52-56).
1993
The Impact of NIP-NEP on Labour, Duggal Ravi paper presented at seminar on Impact of New
Industrial Policy on Labour, MILS/AILS/MKI, Bombay, Jan. 1993.
Health Care Utilisation in India, Duggal Ravi paper presented at seminar on Rural Medical Practitioners,
SRRI-IMRB/UNICEF, New Delhi, Jan. 1993.
2
Bombay Riots: January 1993: A Selected Documentation from a Section of the Print Media, Jesani
Amar, Alphonse Mary, D’Sa Aloysius, Solidarity for Justice, Bombay, March, 1993, pp. 180.
Patient’s Autonomy : Throwing It To The Winds?” Jesani Amar, Pilgaokar Anil, in Medical Ethics,
Vol 1 No. 1, August-October, 1993, pp. 6-7.
Women and Abortion, Jesani Amar, Iyer Aditi in Economic and Political Weekly, November 27, 1993,
pp. 2591-94.
Health Policy and Financing : Papers and Notes, Duggal Ravi Document prepared as a WHO National
Consultant to Ministry of Health and Family Welfare, New Delhi, 1993.
“Private Sector and Privatisation in Health Care Services”, Jesani Amar, Anantharam Saraswathy),
Bombay: FRCH, 1993, pp. 97.
“Some Issues in the Community Participation in Health Care Services”, Jesani Amar, Ganguly
Shilpi, Bombay: FRCH, 1993, pp. 30.
1992
Regional Disparities in Health Care Development - A Comparative Analysis of Maharashtra and
Other States, Duggal Ravi paper presented at the National workshop on Health and Development in India,
NCAER/Havard University, Delhi, January 1992.
User Charges and Patients' Rights, Duggal Ravi, paper presented at workshop on “Patients’ Rights”,
organised by the Medico Friend Circle, ACASH and TISS at TISS, Bombay, August 1992. Also published
in The Indian Journal of Social Work, Focus Issue: Patients’ Rights, Vol LIV, No: 2, April 1993 pgs. 19397.
Patients’ Rights: A Perspective, Jesani Amar with Nadkami Vimla, in The Indian Journal of Social
Work, Focus Issue: Patients’ Rights, Vol LIV, No: 2, April 1993, pgs.167-71. (Editorial)
Medical Ethics and Patients’ Rights, Jesani Amar, paper presented at workshop on “Patients’ Rights”,
organised by the Medico Friend Circle, ACASH and TISS at TISS, Bombay, August 1992. Also published
in The Indian Journal ofSocial Work, Focus Issue: Patients’ Rights, Vol: LTV, No: 2, April 1993 pgs. 173187.
Sexism in Medicine and Women’s Rights, Prakash Padma with George Annie and Panala Rupande,
paper presented at workshop on “Patients’ Rights”, organised by the Medico Friend Circle, ACASH and
TISS at TISS, Bombay, August 1992. Also published in The Indian Journal of Social Work, Focus Lssue:
Patients’ Rights, Vol: LTV, No: 2, April 1993 pgs. 199-204.
Private Nursing Homes: A Social Audit, Sunil Nandraj, report submitted to tire committee appointed by
the Bombay High Court to regulate nursing homes/hospitals in Bombay City. July, 1992.
Trends in FP Policy and Programs, Duggal Ravi, paper presented at seminar on “Trends and
Perspectives for FP in tire Nineties”, BUJ, Bombay, August 1992.
3
Primary Health Care under NEP - Doer ft really matter? Duggal Ravi, Paper presented at CHAI
National Consultation on The Impact of NEP on Health Care, March 1992, Hyderabad; also as Cort and
Concern in Primary Health Care in Health Action VoL5, No.8 August 1992.
Consumers and the Medical Community, Jcsani Amar, in Christian Medical Journal of India, 1992,
pp. 5-7.
Resurrecting Bhore : Reemphasising a Universal Health Care System, Duggal Ravi, Medico Friend
Circle Bulletin, No. 188-9 Dec. 1992.
Medical Ethics : Awaiting a Patients’ Movement, Jesani Amar, Duggal Ravi in VHAI, State of India’s
Health, New Delhi: 1992. pp. 365-77.
1991
Nurses as Women, Jesani Amar, in Economic and Political Weekly, March 2-9, 1991, pp. 493-4. (Book
Review)
WUl Truth Prevail? A Report of the Investigation Team on the Murder of Sr. Sylvia and Sr. Priya
at Snehasadan, Jogeshwari,, Jesani Amar and others, Bombay: Solidarity for Justice, April 12,1991.
Medical Malpractice : What it is and how to fight it, (Report of a workshop), Jesani Amar, Medico
Friends Circle Bulletin, May- June, 1991, pp. 1-3.
An Enquiry into the Police Firing that Led to the Killing of a Tribal and Caused Injury to Others in
Dahanu Taluka, Thane District, Maharashtra, Jesani Amar and others, Bombay. Fact finding Team,
July 1992, pp. 17.
Regulating the Private Health Sector, Duggal Ravi, Nandraj Sunil, Medico Friend Circle Bulletin, 173174, July-Aug., 1991.
“Educational Intervention in Medical Malpractice”, Jesani Amar in FRCH Newsletter. Vol V, No. 4,
July-August, 1991, pp. 4-5 (and 8).
Private Health Expenditure, Duggal Ravi, Medico Friend Circle Bulletin 173-174, July-August, 1991.
Repression of Health Professionals, Jesani Amar in Economic and Political Weekly, Oct. 5, 1991, pp.
2291-2.
Human Rights Issues from Investigation into the Murder of Sr. Sylvia and Sr. Priya, Jesani Amar,
Bombay Solidarity for Justice, Nov. 1991.
Ending the Under-financing of Primary Health Care, Duggal Ravi, Medico Friend Circle Bulletin 177178, Nov.-Dec., 1991.
4
/V6)'o-
ABOUT CEHAT (ANUSANDHAN TRUST)
ENCLOSURES
Governing Board, CEIIAT I Trustees, Anusandhan Trust
Names and Addresses
.
(1)
Dr. Anil Pilgaokar, TRUSTEE.
34B, Naushir Banicha Road, Grant Road West
Bombay 400 007. Tel: 368 8608.
.
(2)
Ms. Padma Prakash. TRUSTEE.
19, June Blossom Society, 60A Pali Road, Bandra (West)
Bombay 400 050. Tel: 642 1 265
.
(3)
Dr. Mohan Deshpande, TRUSTEE.
2.
Surabhi, Old Gangapur Naka, Gangapur Road
Nasik 422 005.
.
(4)
Mr. Ravi Duggal. TREASURER.
Barratk No. 6. Hansraj Morarj i School, Bhavan’s College Campus,
Andheri (West), Bombay 400 058. Tel: 628 6865
.
(5)
Dr. Vibhuti Patel, TRUSTEE.
310, Prabhu Darshan, S.S.Nagar, Amboli
Andheri (West), Bombay 400 058. Tel: 623 0227.
.
(6)
Dr. Dhruv Mankad, TRUSTEE.
Vasundhara, Shivaji Nagar, Opp. Vijay-Mamta Talkies
Nasik 422 006. Tel: 62 520
.
(7)
Dr. Anant Phadke, TRUSTEE.
50 LIC Quarters, University Road
Pune 411 016. Tel: 345728
(8)
Ms. Manisha Gupte, TRUSTEE.
11,
Arcliana Apartments, 163, Solapur Road, Hadapsar
Pune 411 028. Tel: 67 5058.
(9)
Dr. Amar Jesani. MANAGING TRUSTEE.
519 Prabhu Darshan, S.Sainik Nagar, Amboli, Andheri West
Bombay 400 058. Tel: 625 0363.
The “Sodal Accountability Group” (SAG) of CEHAT
Names and Addresses of Members
(1)
Dr. S. L. Shetty
Director, EPV' Research Foundation
212 C Wing. Akurii Industrial Estate
Akurii Road, Kandivali East
Bombay 400 101.
(2)
Dr. Sunil. K. Pandya
Head. Department of Neurosurgery'
KEM Hospital, Pare!
Bombay 400 012.
(3)
Dr. Ashwin Patel
Director, TRL’ (Trust for Reaching the Unreached)
21 Nirman Society
Alkapuri, Baroda .390 005.
(4)
Dr. Ravindra Soman
Professor, National Institute of Virology'
43/9, A, Gumpha
Income Tax Office Lane
Erandwana
Pune 411 004.
(5)
Dr. Neeraben Desai
Director (Rtd), Research Centre for Women’s Studies
Head (Rtd), Department of Sociology
SNDT Women’s University
Jai Kutir, Taikalwadi Road
Mahim PO
Bombay 400 016.
rt &o-
People’r Drug Information Centre (FDIC)
1
Title of the Project I
People’s Drug Information Centre (PDIC)
1. Need for Drug Information Centre
For quite some time now, those of us involved with the movement for rational use of drugs, as also
others, have been very uncomfortable-with the rampant misuse of drugs (medicines) in our country.
Drugs are double edged weapons - put to right use, they are a valuable tool in therapeutic but
wrong choice of drugs, or wrong advice on drugs by healthcare providers or wrong intake of drugs
by end-users (patients) can and does (very often) end with unnecessary and avoidable harm (at
times causing grievous damage to patients). Information on drugs is vital both for the prescriber as
also the end-user, the patient It is tragic that though it is always the end-user who suffers, drug
information designed for end-users is not made available to them. We felt it right and necessary
that drug information is provided for patients. Since there was no such facility existing in the
country, we felt we should take it up ourselves. PDIC Project takes its roots from this.
Yet another reason (for starting the project) is that we believe that it is important for patients to
play an 'active and informed role1 in remission from diseased state (along with healthcare
providers), rather than be relegated to the passive, hapless position. Active role entails an
adequate understanding of the therapy which we believe should enhance compliance of the patient
to the therapy. We believe parentalization in medicine should be gradual!}’ replaced with a respect
for patient's autonomy and drug information and comprehension (of the end-user) serves as a first
step in this direction.
In our country, the drug scene is one of plethora of irrational and even harmful drugs- drugs which
have long been discarded on "more harmful than beneficial" basis, in developed countries. The
State’s effort in correcting this situation is painfully slow. It is imperative that the consumer is alert
to the consequences of taking such drugs. Drug information in a format that is designed with end
user needs in mind is, therefore vitally important
2. Utility of Drug Information Centre
There are over 60 to 80 thousand drug formulations in the country (no one, not even tire Drug
Controller ofIndia, knows the exact figure), produced and marketed. An average doctor anywhere
routinely prescribes less then 50 drugs. Thus, the prescription habit is formed by the education
s/he receives from the medical representatives and not from what he or she learns in the medical
college. Very often s/he prescribes drug combinations (over 50% of formulations are all kinds of
combinations). Given the situation of almost non-existence of independent continuing education
proeramme for doctors in our country, the doctor often get unduly influenced by propaganda and
advertisements on drugs rather than the scientific facts.
The information provided by the drug information centre, while making the patient more informed,
would also motivate patient-to ask question to doctors, a-healthy practice conspicuous by its
virtual absence in our country. The questions of informed patients and the knowledge that the drug
information centre can also provide doctors foil scientific information on most drugs in the market
would motivate doctors to seek reliable scientific information. We expect that such a process
CEHAT Project Proporal.
People’* Drug Information Centre (FDIC)
2
would in long term change the prescription behaviour of doctors by making prescriptions rational,
it would empower patients by motivating them to become active participant in their own treatment
and over and above everything, it would create public and professional opinion for the
pharmaceutical company to provide full and scientific information on their drug products and not
to make exaggerated, unscientific or vague claims.
3.
Objectives of Drug Information Centre
From tire above analysis flows the following specific objectives and tasks for establishing and
running the Drug Information Centre:
(1)
To create a database of scientific and technical information on about 700 allopathic drug
substances. (These 700 drug substances should cover about 95% of the 60 to 80 thousand
formulations in the market)
(2)
To create database of simple understandable information for use by patients/people on the
above drugs.
(3)
To create database' of the formulations available in the market (brand names, the drug
substance, quantity).
(4)
To translate the above data base in vernacular languages (to begin with Marathi, Hindi and
Gujarati)
(5)
To computerise the database with preparation of appropriate software so that the quick
retrieval of information on drugs for various users is possible. The software created should be
user-friendly so that it could be widely used after training.
(6)
To pretest the material prepared in urban and rural settings, modify the information content on
the basis of responses received and to disseminate the software with database to interested
individuals and organisations.
(7)
To do regular updating of the database by including new formulations produced or marketed,
add more drug substances and modify patient information on the basis of feed back received from
patients and others
t
This centre would provide unbiased, objective drug information, in a form and formal that would
(hopefully) serve every end-users need for actively participating in remission from a diseased
state.
4.
Phases of Programme:
It is obvious from the objectives and tasks narrated above that lot of work needs to be done in
order to actually take scientific mfonnationjnjhejaaguage people can understand. Thus, the work
would be divised into four distinct phases.
~
'•
CEHAT Project PropoiaL
People’i Drtit Information Centre (FDIC)
3
Phase I: Database Preparation, Computerisation and Software Design: This would involve (1)
Preparation of data information sheets on each drug substance (700 of them to begin with). Two
types of sheets will be prepared: i. Patient Drug Data Sheets and ii. Technical Drug Date* Sheets.
(2) Simultaneous computerisation of these data sheets. (3) Programming for the preparation of user
friendly software for the retrieval of information or database. (All information in this phase will
be in English).
Phase 11: Pretesting the Software and the Patient Information in English: This phase will be of
short duration and would primarily test the software and English information with the educated
patients in Bombay. This work would provide us with some kind of assurance that we are going in
the right direction. The phase I and II will be completed in THREE years time.
Phase 111: Preparation of Vernacular Database, its Field Testing and Modification in the
Information Content: This phase would last about two and half years. In this period the English
database will be translated into three languages (Marathi, Gujarati and Hindi), field tested with at
least 1000 patients (users) in the rural and slum areas. The information contents will be modified
without compromising die scientific facts. This phase will take about TWO years.
Phase IV: Dissemination of Database, Translation in more Languages and Continuous
Updating: This phase is that of maintaining end continuously upgrading the work of the Centre.
Tne CEHAT would also network with like-minded non-profit organisation to establish drug
information in various parts of the country. In this phase, we may undertake research to monitor
changes brought about in the consumer and provider behaviours due to the availability of
information.
5.
Work Already Completed
Although no institutional funds has been received for making this centre a reality, our colleagues
have made voluntary efforts in last few years to complete a part of phase I work. The impetus for
the project came through Mr. Kisan Mehta, member of ACASH which is a consumer organisation
in the field of health. Few years back, Mr. Kisan Mehta’s wife, Mrs. Mehta, was treated with
'methotrexate', a drug used in cancer treatment, and suffered from adverse side effects of the drug
and finally succumbed to it Both Mrs. Mehta & Mr. Mehta were very literate and could have
responded appropriately if drug information (of methotrexate) designed for the patient was
available to them. In the first two years, inspired by him, and under the auspices of ACASH we
tried cut our floundering steps into-wildemess, trying to understand how to create such information
system. We could, with the help of friends abroad, get information on such systems tried out in
some advanced countries. In last three years we could collect individual donations from several
persons m the country to begin preparation of data sheets on the drug substances.
Due to long hours of voluntary labour, using students and pharmacists at token payments, we have
been able to prepare drug information sheets on 635 drug substances. Of these, the information on
nearly 50 drugs has been supplemented with "judgmental" clinical responses to "what if
Equations.
CEHAT Project Propotal.
People’! Drug Infcreation Centre (PDIC)
4
In preparation of above work a number of individuals and organisation provided moral and
technical support. Since the preparation of database, software and other ligistical requirement
needs an institutional support structure, the ACASH has kindly passed on the work accomplished
under it to the CEHAT.
6.
Liability
(1) The drug information database prepared and used, will be done as a voluntary work and will
be on the principle of no-profit
(2) Since database will be prepared by the CEHAT, all legal and other responsibility or liability
of it will be that of CEHAT. The individuals or institutional funders of the project will not be in
any way responsible for its content, format and use.
<-
7.
Financial Support Required
..
.
.
. H
Although it is always good to get financial support for the full project at a time, we feel that given
long duration of time required in operationalising the work and in order to keep scope for
voluntarism, the funding should be sought to support phases of the project Moreover,
accomplishment of each phase would give us a concrete outcome in hand, it would be field tested
and the experience gathered would go in enriching the next phase.
Of the four phases described above, the fourth phase is that of dissemination, maintenance and
updating. The first three phases on the other hand needs research and experimental input Of the
first three phases, phase one and two will be taken together.
Of the three years required for completing first two phases, we have already completed work of
one year (technical and patient information sheets ,on 635 drug substances completed). We
therefore need financial support for the remaining two years work for the phase I& E.
The outcome of two years proposed work would be (1) computerised drug information database,
(2) user friendly software for retrieving drug information for patient and (3) pretesting of this
information with English knowing patients.
Personnel Required: We would need full time professionals to work on the project Ltd a support
group of experts to help them. The professionals required are: (1) Two, pharmacists (or
pharmacologist or doctor), (2) One or two computer programmers. The support staff required are:
(1) Data entry operators cum secretaries (two), (2) An office attendant to help in routine work
Capital: The capital expenditure will be primarily for Two computers (Pcs) along wit. ..ec. ssai,,
perioral s and fiimiture.
' . Other Expenditure: _This_wonld be on_photocopying,-stationay, book»?-eemptiter consummriries
and maintenance, pest, fax and emsitrexpendHure on doing pretesting'with the Ent>Iis7T£ho-..ins
patients, etc.
.
—
—
~
CEHAT Project Proporal.
People’! Drug Information Centre (PDIC)
5
Budget for Two Years:
(1) Salaries of full time staff and honorarium to experts
(2) Computers, peripherals & furniture
(3) Other Expenses
(4) Overheads
Total for 24 months: Rs. 19,50,000.
First year: Rs.9,50,000.
Second Year: Rs.10,00,000.
CEHAT Project Proposal.
Rs.13,00,000.
Rs. 1,50,000.
Rs. 3,50,000.
Rs. 1,50,000.
Title of the Project
Social Accountability of Medical Practice
The work by individuals associated with the CEHAT in this field is of long duration. About
seven years back a retired IAS officer of Rajasthan government approached Medico Friend
Circle, a loose association of socially conscious doctors and non-doctors of which most of
our staff persons are members. His problem was gross negligence and arrogance of a
topmost specialist of Bombay while treating his wife who allegedly died in great pain
following the medical negligence. While making efforts to understand his plight we got
exposed to a large number of such complaints from patients. We were told by patients about
the arrogance of doctors, their disinclination to give information on illness and the line of
treatment adopted, about unnecessary investigations, cut practices, non-issuance of receipts
for the payments made and so on.
R.evcalation of this face of medical practice made us to explore further. A letter with several
questions to people on their experiences with medical practice was submitted to newspapers
which published it as letter to editor. In no time we were flooded with more than 300
responses to questions. These responses showed that while there was lot good in the way an
average doctor is doing, much of it is getting overshadowed by the negative aspects of their
behaviour and ugly features of openly commercialised medical practice. We also realised
that all those w^shave had bad experience of medical practice needs extensive counselling
and support, moral and legal.
Since then, for last five years we have been helping such “victims” of medical practice or
malpractice. Most of them have approached us because of lack of proper communication
from the doctor. When such persons got full understanding of what had happened during the
■treatment, most of them felt satisfied. Ver^few cases have gone into litigations as people are
not inclined to go to court so easily duey heavy toll our courts take in terms of time and
finances. Those who did not go to courts have acquired better understanding of the way
medicine is practiced and they would be more conscious about their rights when they
approach doctor again. Those who have gone into litigation would in few years create new
legal precedents as this area of law has not been sufficiently developed in India
This w'ork is also generating rich information on the way medicine is practiced and on the
condition of our private and public hospitals. The information thus gathered so far is being
published by CEHAT in a book titled “Market, Medicine, Malpractice: Issues and Case
Studies”. One of the editor of the book is the person who sensitised us to this issue.
Objectives and Tasks:
i •, erall aim of this work is
(1) to sensitise medical practice to needs and dignity of patients, (2) to impress upon the
profession to have good self-regulation, (3) to make people' aware of their rights and
responsibilities while receiving medical care, (4) to make consumer aware of the trends,
good as well as bad, in medical practice.
The tasks involved are:
(1) To help patients who have suffered due to negative outcome of medical practice or due to
negligence on the part of medical professional, (2) To sensitise as many number of doctors
as possible to come forward to help such patients or their relatives by carrying out
educational campaigns in the profession, (3) to document, collate, analyse and publish
information gathered from patients or otherwise on the trends in medical practice and by that
create a public opinion for more humane and rational medical practice.
Work:
In order to accomplish above objectives and task, a small unit comprising of one para-legal
worker or social worker, one researcher and an assistant will be formed. All of them will
work foil time and will be paid salaries. They will be assisted by 15 doctors hailing from
three voluntary organisations, namely Forum for Medical Ethics Society, ACASH and
Medico Friend Circle. These doctors have already agreed to provide such voluntary
assistance.
The unit will be housed in the Andhcri office of CEHAT or will be available at Dr. Manohar
Kamath’s clinic in Mahim from 12 noon to 5 p.m. every day. The aggrieved patients or their
relatives will approach them while the social worker w’ould compile foil history of the
problem and obtain necessary medical record. This will be referred to one of the volunteer
doctor who would study it and provide his objective scientific opinion on the case and the
same wall be communicated to the client The additional work that some of these doctors
might be doing for the clients would be to provide their opinion in the affidavit format for the
client to use it in the court of law and even to appear in the court as independent expert
witness.
Financial Support Needed:
The financial support needed is mainly to support salary of two persons and expenditure on
travelling and documentation.
Budget for Two Years:
Salaries: 3 persons for two years: Rs.3,50,000.
Eonoraruim & Consultancies:. - Rs. 40,000.
Other Expenditures:
Rs. 50,000.
Total Budget for Two Years: Rs.4,40,000.
Budget for One Year:
Rs.2,20,000.
CEHAT: Centre for Enquiry into Health and Allied Themes, Bombay.
NOTE ON THE NEED TO STUDY AND CONFRONT CHILD ABUSE
In the nineteen seventies, before the women’s movement took up the issue of
rape, it was widely believed that rape was an act of the psychopaths and that
such things didn’t exist in our society as a rule. Many myths regarding rape
were challenged by women and a change in the law regarding custodial rape
was brought about. Being able to name the crime gave women the strength
to speak about it, and to seek redressal. Even though most attitudes
regarding the crime have not changed at societal level, atleast a
beginning has been made to understand the politics and power
relations within the act of rape. A woman-centered perspective was
evolved.
On numerous occasions, women friends have shared with each other their
personal experiences regarding abuse- physical, emotional and sexual, during
their childhood years. One has also seen children of friends being sexually
abused by trusted or casual acquaintances. The scars of physical and mental
battering as well as those of sexual abuse stay for long and it is quite possible
that they adversely affect our perceptions of sexuality, relationships,
childbirth, self-confidence and so on. Worse still, there is no space to
speak about child abuse and so most of us carry these^guilty burdens
alone. In a sense we remain the frightened and lonely child forever.
The sharing of friends regarding childhood abuse led us to believe that child
abuse exists extensively in our society. It is not an imported perversion. It
carries on furitively within the environments that children believe to be the
safest- the home, school, institutions for child care and state run homes such
as remand homes, prisons, asylums and so on. The crime is committed
more often than not by people children love, trust and/or fear. When
the criminal is a custodian (either permanent or temporary), children
are forced to keep quite for reasons of survival. The tiny minds are sick
with fear that they may be the cause of breaking up the family and they keep
silent for'the same reasons that grown-up women do in violent homes.
Furthermore, very few-people would believe the child if she or he were to talk
about abuse. Since disciplining of children through coporal punishment is
accepted in society, what exactly would constitute abuse is a grey area. Being
born as a daughter itself would lead one to be emotionally abused, either
through discrimination or through taunts or negative attitudes of family
members. If children were to identify this behaviour as abusive, they would
at best be counselled by adults to be more obedient and at worst, would be
targeted for further abusive treatment.
CEHAT: Centre for Enquiry into Health and Allied Themes, Bombay.
The problem of sexual abuse is more severe and complex. In most households,
sexuality - even that which is considered ‘normal’ is hardly discussed. Rarely
would parents consider it their duty to talk to children about menstruation,
intercourse, conception, childbirth, pleasures in sexuality, contraception and
so on. To talk of rape, dangers, abuse and violence in a rational and realistic
fashion is unheard of, in most homes. This ignorance, stigma and
irrational fear of sexuality that parents harbour prevents them from
communicating with their children about mature and responsible
sexual behaviour and also exposes the children to abuse from adults.
In a household that considers sexuality harmful and speaking about t
perverse, the child cannot confide in any loving adult about abuse. Receiving
negative signals about sex, the child may feel that the adults would
disbelieve her/him, resulting in loss of face and tensions at home. This
dilemma would be aggravated in a household where a abuser is a close
relative residing in the same house. Many studies and observations all over
the world have shown that mothers tend to keep quite when the daughters
are abused by the father and watch the humiliating act helplessly. When the
daughters grow up, they hate the mother more than they hate the father.
Two victims are thus pitted against each other.
Growing up abused has serious consequences for the survivor. The limits of
privacy and body sanctity are lost in hostile touch, either of battery or of
sexual abuse. Pain is equated with love and sex becomes either an act of
power or of seeking security and self-worth. On the one hand, unnatural
fears of sexuality may result in fear of mensrtruatioji, childbirth and
building stable relationships, whereas on the other hand physical
and sexual abuse may precipitate a dangerous adventurism that pre
disposes the individual to further abuse, rape and battering. The
vicious cycle of lack of self-esteem and further abuse is generated.
Some psychologists have now accepted that childhood abuse results in
various disorders in adulthood. Eating disorders, sexual disorders, allergies,
addictions, mental ill-health and so on may be precipitated or aggravated by
unconscious memories"of childhood abuse. Even in ‘normal’ individuals, the
inability to build loving relationships and the inability to get out of abusive
once may have some connection with harmful experiences in childhood.
For innumerable reasons, the silent crime that kills the innocence of
thousands of children has to be confronted. Children’s rights to security, love
and to a nurturing environment cannot be violated at any cost. Battered and
abused children would have a liard time trying to blossom into creative,
fearless and well-adjusted adults. Who gives adults the right to maim a
' CEHAT: Centre for Enquby into Health and Allied Themes, Bombay.
child’s body and mind or to destroy a child’s present and future? Protecting
children from abuse is thus nothing short of a human rights issue.
Areas of Work and Methodology:
The entire problem of child abuse would have to be tackled through a long
term and sustained effort of many individuals and groups. To name and
identify the crime, to acknowledge that child abuse is far more prevalent in
society that we would like to admit, to help children to resist abuse, to counsel
parents and teachers, to offer help in crisis situations, to teach children to
avoid dangerous situations, to develop a positive attitude to the body and to
sexuality - the list is endless. Some of the work will also have to be done
with adults, either survivors or parents or abusers.
At the Centre for Enquiry into Health and Allied Themes (CEHAT),
we would like to develop the area of looking into, understanding and
confronting child abuse. We are seeking funding partners who will assist in
research and service project related to the issue. Undoubtedly, one would
have to start from a couple of projects in the beginning; but that would be
done with the overall child-centered perspective towards abuse.
The first task would be to place child abuse in the Indian context. This would
include research as wells as documentation of primary and secondary
evidences/experiences and coping mechanisms of victims and survivors. This
work would be carried out in schools, neighbourhoods, child-care institutions
as well as meeting adults in different walks of life.
)
,
'
Another task involved is actually providing as well as sharpening and
adapting counselling techniques for victims, survivors and their
supporters, and preparing manuals for children, parents, custodians and
teachers. Abusers would also have to be counselled and/or confronted. This
experience would help us in the setting up of sensitive and childoriented services in the form of education, counselling, legal advice,
temporary shelter, placing in foster homes or in state care if necessary, and
providing institutionalized, specialized services such as psychiatric,
medico-legal, psychological help and so on. Training facilities to NGOs and
child-related institutions (mainly schools) could also be a meaningful service
to provide after sufficient expertise has been generated.
Time Frame:
The type of work that needs to be done in the form of research,
documentation, service provision, manual preparation, education, training
etc. is undoubtedly massive and we are committed to do sustained work in
CEHAT: Centre for Enquiry into Health and Allied Themes, Bombay.
this field on long term basis. At the same time we are aware that there is lot
to be learnt and social obstacles to be overcome before we could make a. real
dent in the situation.
Keeping this in mind, we propose to make a modest beginning in both the
research, documentation and in providing help to the abused children in
Bombay. This will be done in several public and private schools, in a slum
and neighbourhood and in some of the child care institutions like orphanages,
street children’s homes etc.
This first phase of work will be for two years.
Financial Support Required:
In two years, the total financial support required is: Rs.10,22,000.
Salaries and Consultancies: Rs.6,72,000., Contingencies: Rs. 2,75,000., Misc.
and other expenses: Rs.75,000. And the overheads.
Le nom de 1'gcrivain Primo Levi a ete
choisi en raison de sa valeur symbolique : refus des traitements inhumains, cruels et degradants, refus de
la violation organis^e de la dignity de
1'homme, refus de 1'exclusion au titre
de 1’origine.
"Vous qui vivez en toute quietude bien
au chaud dans vos maisons (...),
N'oubliez pas que cela fut,
Non, ne 1'oubliez pas1'.
Primo Levi. Si c'est un homme
« Le Centre observe une inddpendance
d'action et d'expression par rapport aux
organisations politiques, syndicales, religieuses, qu'elles soient frangaises, dtrangdres ou intemationales...
« Compte tenu du secret qui pdse sur Vutilisation de la torture et de I'aggravation
des positions ndgationnistes, les person
nels du Centre peuvent Stre amends a tdmoigner des souffrances et des cruautds
infligdes aux victimes soigndes au Centre,
avec leur autorisation ; cette fonction de
tdmoignage s'exercera auprds de toutes les
instances et de tous les publics qui nous
solliciteraient ou que nous solliciterions.
Transmettre ou ddnoncer ce que nous
voyons et entendons, fait partie de notre
engagement dans la lutte pour le respect
des droits de l'homme.«
Extraits de la Charte
Pour toute information
sur
VAssociation Primo Levi
et le Centre de soins:
PRIMO LEVI
107, avenue Parmentier
75011 Paris
POUR L'ASSISTANCE
Tel.: 43 14 88 50
AUX VICTIMES
Fax: 4314 08 28
metros: Goncourt et Parmentier
ASSOCIATION
DE LA TORTURE
ET DE LA VIOLENCE
POLITIQUE
Responsable medical du centre :
Dr. Nathalie Monbet
Groupement interassociatif
cree et anime par:
Amnesty International
Section fran$aise
Medecins du Monde
Action des Chretiens
pour 1'Abolition de la Tbrture
Juristes Sans Frontieres
Consultations uniquement
sur rendez-vous
Treve - Personnel soignant
Des moyens pour Vaction
Le Centre PRIMO LEVI:
un centre de soins a Paris
pour les victimes de la torture
et de la violence politique,
qui, en partenariat avec les
ONG fondatrices :
• con^oit et realise des mis
sions a 1'etranger aupres de
populations victimes de traumatismes collectifs ;
• offre un soutien psychologique aux expatries d'ONG
qui ont ete confrontes a des
situations de stress au cours
de leurs missions ;
• elabore et realise des forma
tions sur la specificite des
soins aux victimes de torture
ou de repression politique ;
• soutient les victimes appelees a temoigner devant les
juridictions internationales
creees pour sanctionner les
crimes centre 1'humanite et
les genocides.
Une equipe pluridisciplinaire
Un Conseil d'administration
et un Bureau
IVIedecins, psychothera-
Des responsables qui
peutes, psychiatre, kinesitherapeute, interpretes, assistant
social et juristes, forment une
equipe pluridisciplinaire au
service des victimes de la tor
ture et de la violence politique
- ainsi que leurs families.
Dans une approche globale de
la personne ; avec le souci de
respecter les valeurs, les cul
tures, les traditions, des personnes traumatisees. Son objectif est d'aider les victimes a
revivre, apres un passe traumatique, dans le pays d'accueil, a temoigner si elles le
desirent - ou a temoigner pour
elles a leur demande.
sont 1'expression d'un groupement de partenaires :
President:
Hubert PREVOT
ACAT
Michel DRAVET *
Bernard LEDESERT
AISF
Michel FOURNIER*
Bernard JOMIER
JSF
Philippe RYFMAN*
Georges PERIDIER
MDM
Claude AIGUEVIVES *
France ARRESTAT
TREVE
Diane KOLNIKOFF*
Sibel AGRALI
Secretariat administratif:
Catherine Pinzuti-Thomas
Marie-Therese Petraz
* Membres du Bureau
Establishment of a Treatment and Research Centre for Survivors of Violence
The land which produced world famous proponent of non-violence, Mahatma Gandhi who led a
largely non-violent independence movement of India, is in the grip of unprecedented epidemic of
violence to day. This does not mean that the Indian society has otherwise been a non-violent
society. Far from it. The caste and gender violence, and interspersed events of large scale political
violence let loose by the ruling tyrants and invaders, have been constant feature of violence since
time immemorial. The communal (the violence on religious lines) is also as old as two centuries. It
was the violence so deep rooted in the Indian reality that perhaps motivated Gandlti to direct the
national movement on the concept of non-violence and create a counter force against tendencies
of violence.
What is new in the over last two decades old epidemic of violence is that various political
processes and movements have brought much of the reality out of the closet, made it sharply
visible. These movements have exposed the hypocricy of Indian elite preaching non-violence in
the atmosphere of all pervading violence in the society. Thus, in last two decades, while the
intensity of violence has increased and newer facets added to it, there have been more movements
and actions against the violence. One such area in which the movement against violence taking
shape is health care.
Gender Violence: The modern feminist movement in India emerged and took shape on the issues
related to violence against women in the early 1980s. Indeed,, in the early 1980s the feminist
consciousness spread along with large scale women’s mobilisation against rape, dowry deaths
(women burnt, hanged, killed by in-laws and husbands demanding more money as dowry from
women’s parents) and wife battering. This movement not only spearheaded changes in the rape
laws and laws related to dowry deaths, it also created support structures for providing counselling
and shelter to the victimised women. A number of such women’s centres have been established
and run by women in almost all big cities of India.
Caste Violence: After gender, the caste violence is the oldest form of violence in India. India is a
caste divided society. Though caste is the specific feature of India’s dominant religion, it is not
restricted to Hinduism alone. All other religiouns also have their caste hierarchies. Further, the
caste division and violence is also related to the class structure. For the caste positions of High
and Low castes groups also often correspond with their class or economic position in the society.
In last two decades there has been great assertion by the low and lower middle castes in the social
and political arena. The caste violence has intensified also due to the backlash from the high castes
groups. Noteably, the students of medical colleges in the western Indian state of Gujarat triggered
and were at the forefront of an agitation in ealy 1980s against providing reserved seats in the
medical education to the low caste people. This agitation took a violent turn with mass scale
attacks on dalits (the low oppressed castes).
Communal Violence: The communal violence is indeed a modem phenomenon started about
two centuries ago as a part of “divide and rule policy” of the colonial government, and its
CEHAT, Bombay: Establishment or a Treatment and Research Centre for Survivors of Violence
2
ideological menifestation ulitimately resulted into the division or partition of India in 1947. The
partition also witnessed one of the massive violence between Hindus and Muslims. The post
partition communal violence has got intensified in last one decade. The communal violence is
expressed in the street fights, in which the state machinery either goes to sleep for few days or a
few weeks, or sometimes help fomenting violence. During these days and weeks, the innocent
citizens, particularly those who are marked out for attack, experience real terror producing great
amount of traumatic stress. From all empirical evidence it is very clear that the minority religious
community has suffered the worst during the recurrent communal violence. The traumatic stress
produced by such violence is such that it has completely changed the psyche of the sufferer
community and in the absence of significant psychosocial relief privided, the sufferers have
continued to be haunted by the trauma.
State, Terrorist and Political Violence: From the late 1960s, when the peasant rebellion rocked
several slates of India and produced a violent backlash from the state to repress it, this form of
violence has only increased. The traumatic 19 months (1975-6) of suspension of democracy under
the state of emergency, produced a strong democratic movement and created many human rights
organisation all over the country. The custodian violence, torture and deaths in police lock ups
and prisons, the encounter deaths (killing of individuals in the so called encounter with the police)
etc have been well documented by now due to the relentless work done by the human rights
organisations in last two decades. In last one decade the issue of violence unleashed by armed
dissident groups has been increasingly reported.
Role of Health Care Professionals:
The health care professionals occupy an unique place in the situation of violence. They are
considered neutral agency', providers whose primary concern is healing. Thus, the survivors of the
violence at some stage in their suffering do seek help from the health professionals. Similarly, in
cases of deaths, the health professionals are also brought in the service for examining the dead
bodies and in conducting autopsies. Indeed, the ethically oriented health professionals could do a
lot in treating the survivors of violence and through meticulous autopsy and medical records
could assist survivors and victims’ relatives to get justice.
However, the record of health professionals so far in this regard abysmally poor. This has
happened due to ignorance on the part of health professionals as well as due to negligence which
have most often gone unpunished by the courts and the professional associations. In our
interaction with victims, for instance with the battered women, we have found that the doctors
have failed to elicit history’ of battering, and even when women volunteered on their own, have
deliberately nated it as an accidental injury on the medical record giving an excuse that such
battering was normal and was internal matter between husband and wife or that the doctor wanted
to avoid his/her duty to go to courts to give evidence. Often, the perpatrators of rape have gone
scot free because the medical examination of the rape victim conducted by the doctor was
inadequate or left inconclusive. In cases of torture in police custody we found during the
investigations that the doctors did not take priliminary precaution of taking history of patient after
sending the police out of his or chamber. A number of investigations of human rights violence,
including those done by the Amnesty International, Human Rights Watch and Physicians for
CEHAT, Bombay: Establishment of a Treatment and Research Centre for Survivors of Violence
3
Human Rights have found the deficient or some times even patently false autopsy reports
prepared by doctors.
Treatment of Survivors of Violence: In the treatment of survivors of violence the health
profession has acted in a conservative way. That is, most of the reports suggest that treatment of
physical injuries has been carried out in a reasonably efficient way. For instance, during the
communal riots in Bombay city and the bomb blasts that followed the riots, the public hospitals
were overloaded with patients with grevious injuries. Although it was noted that the health care
system was not properly geared to respond such disaster situation, the health workers rose to the
occasion and provided reasonably good care to the injured people. Only in last few years some
reports of some doctors discriminating against patients from certain communities have come out
showing that the prejudices taking roots in the society may be getting reflected in the practice of
maedicine. Nevertheless, on the whole, the performance of health professionals in such violence
has been commendable.
However, the failure on the part of health professionals is noticeable when one considers
diagnosis and treatment of the long term psychological problems suffered by the survivors due to
the severe spychosocial traumatic stress. This failure is glaring even amongst the otherwise highly
enlightened professionals. For instance, one is not surprised to get a self referred case of post
torture traumatic stress who was otherwise well treated by public or private health professional
but was not at all examined for his or her state of mind. Partly this indifference to the
psychological stress is due to the less importance given to the psychological problems, particularly
of common people, in general, or lack of motivation and time.
Prevalence of Psychosocial Stress Among Survivors of Violence:
A Case study, findings of one research and some observations derived from our work would
illustrate the problems faced by the survivors of violence:
(1)
A 25 years old semi-skilled worker working in the maintenance division of a lift (elevator)
manufacturing firm was picked up by the police when the workers of his company went on strike.
He was neither the leader nor even a vociferous activist of the union which had organised the
strike. He suffered this fate because he was close friend of some the union leaders and was often
noticed in their company. Besides, due to the police crack down on the unionists, the leaders had
gone underground, so he became an easy target. He was taken to a police station close to his
sister’s residence which he used to visit frequently. Here, in an interior room, he was surrounded
by the 8-10 police constables and a sub-inspector who started beating him. The next thing he
knew was that liis closes were taken off and he was standing at the centre of circle of policemen
laughing at him and pushing and hitting him all the time. This continued for about half an hour. He
was repeatedly asked to tell them the whereabouts of his union leaders but he could not provide
the answer as he had no idea about their whereabouts. His pleas about his ignorance were brushed
aside by the police. They took him beside a small electrical machine mounted on a table. The
naked parts of the cables coming out of the machine were first put on his fingers and toes and
they told him that they were going to electrocute him. The electricity was switched on, and he
shouted out in pain. In response he heard deafening laughter. His face was taken close to the
CEHAT, Bombay: Establishment or a Treatment and Research Centre for Survivors of Violence
4
machine and shown how the electric cunent was increased by pressing a switch. Then they kept
on increasing the intensity of the cunent amking him to face more and more pain. Then, suddenly
a policeman came very close to his face and asked him, “Are you married?" He failed to
understand the meaning of the question writhing in pain all over his limbs. The policeman asked
again, this time he replied in negative. “OK, then we will see that you never gel married as we will
now do something that will make you permanently impotent." He was shaking and crying loudly,
with folded hands be told them to release him. But the electrodes were put around his penis in no
time. All policemen started laughing and told him, “Here goes one man permanently " He felt pain
on his genitalia, ii was unbelievable that they could do such thing to him. This electric torture
continued for awhile, he had lost count of the time. After doing all these things when the police
could not get the information they wanted, he was transferred to the lockup while threatening all
the time that they will do worse to him as soon as they were able to lay their hands on him.
He was eventually released on bail. When he came out, his collegues took him to the public
hospital for the treatment of injuries. He was meticulously treated, a medico-legal case paper
describing in brief the torture was also prepared. He also filed a complaint against the policemen
responsible for his ordeal. A departmental inquiry by an inspector was ordered but a year and half
after the incident, no report has been made. In the meanwhile, his problems continued. First of all,
he started having sleep disturbances, hallucinations and so on. He was so scared of the police that
as soon as he heard the siren of the police car at the distance, he used to hide under the bed. He
found it difficult to walk on the same side of the road where a policeman stood. Further, while
visiting his sister's residence, he started avoiding walking in front of the police station where he
was tortured And he genuinely believed that he had gone impotenf and would not be able to
marry. Further, when the strike was withdrawn and he started working, he found it difficult to
work on his job as he was so afraid of electricity. Being a maintenance person, this affected his
work drastically and that brought him to us for treatment.
(2)
A study of 104 villagers in a state in the north eastern region of India, who were tortured by
the army revealed that after 22 months of the experience of torture, it was found that 24 of them
showed the visible physical marks of the torture on the body, but as many as 101 out of 104 were
found to be menially unwell, while 35 showed severe mental symptoms due to the trauma
suffered. The study also found the relationship between the type and nature of torture reported
with the symptoms suffered. It was found that 39% suffered from recurrent dreams of torture,
66% from disturbed sleep, 55% were incapable of enjoying village festivals, food, sex and even
friendship. One third of them had lost their self confidence and believed that they were ruined
physically although the medical team found no physical disability on examination.
The medical team of investigators also found that most of the tortured villagers were not provided
any medical treatment either in the detention centre or after their release. 22 months after the
torture, so many of suffering from the severe psychological problems were not treated by any
agency and they continued suffering.
(3)
As against the psychosocial problems suffered by the torture victims, what are the features of
problems suffered by the survivors of communal and caste riots? There is very little clinical and
research material available on the subject. Our study reveals that the survivors receive three
CEHAT, Bombay: Establishment of a Treatment and Research Centre for Survivors of Violence
5
intense forms of traumas at the time of riots: Firstly, there is trauma due to general terror. Here
the victims are in their own houses, or have taken shelter in somebody's house, are expecting
murderous attack on them at any moment. Secondly, the trauma is due to witnessing violence.
This is common to both who are marked as victims and vulnerable as well as for those who are
otherwise safe but forced to witness gruesome violence as it is taking place in the close vicinity.
However, the degree of immediate traumatic effect created by witnessing violence appears to be
different for those who are actually endangered and under the fear of suffering similar fate (for
being of the sufferer's community) than those who witness but are not under threat or believe that
they were not likely to suffer (for being members of the attackers’ community). And Thirdly,
there is trauma of those who actually get violently attacked, suffer but survive. Needless to add
that their suffering, physical as well as psychological, appears to be greater.
It is really unfortunate that although few psychiatriasts were involved in treating a sizeable
number of cases of post-riot psychosocial conditions, the follow up of the cases doesn’t seem to
be so adequate. From our own experience of voluntary work in this field, we have come to realise
that it is very difficult to make patients of such condition to complete the treatment. Further, the
health professionals in the public sector are overburdened with work and they have little resources
and time to make rigorous follow up. This only emphasises the fact that there is a dire need to
establish a medical centre which makes a concentrated effort to treat the patients suffering from
psychosocial stress.
Objectives of the Medical Centre:
The Treatment and Research Centre for Survivors of Violence will be established with the
following five objectives. All five objectives make a comprehensive whole and they would be
addressed to in totality.
(1)
To provide medical and psychotherpeutic treatment to the patients/clients suffering from the
psychosocial stress brought about by the trauma due to any form of violence.
(2)
To rehabilitate such clients through appropriate and sensitive support services.
(3)
To document traumatic stress produced by violence in the individuals and in the society.
(4)
To undertake clinical and social research to understand causes of violence, ins impact on
individual's and society's mental health and to find ways and means for treatment of individuals
and for eradication of violence from the society.
(5)
To inform people, the leaders, the media and all those who care on the effect of violence and
to aid the campaigns for eradication of violence in the society.
As suggested by the above objectives, the proposed medical centre will not be a passive agency. It
would undertake systematic research and documentation, it would make foil efforts to disseminate
information, it would undertake public education campaigns, it would contribute in the processes
CEHAT, Bomba*: Establishment of a Treatment and Research Centre for Survivors of Violence
6
of getting justice for the victims and above all it would strive to upholding rights of people and
the independence of health professionals. Further, given the varied forms of violence prevailing in
India, their different effects and menifestations, and the multicultural melieu from which the
sufferers come from, the centre would provide an essential basis for the extensive clinical research
in psychothrapy, counselling etc. Thus, apart from meeting needs of the suffering victims, it would
give inputs for enhancing understanding of the national and international medical and psychologist
community on the traumatic stress.
Both as a necessity for rehabilitation of the sufferers and for creating wider awareness, the centre
will network with humanist NGOs, legal community, medical associations, the media, women’s
groups, human rights groups, trade unions and so on. Such networking will also enable people to
understand what to expect from such a medical centre.
Further, the centre would make efforts to cater to all forms of violence, such as survivors of riots,
battered women, dowry harassments, abused children, torture by the state agencies as well as
private agencies and so on Thus, this endeavour would aim at creating holistic understanding and
treatment methods relevant to various forms of violence. Secondly, it would not use only modem
medical methods of treatment, but integrate the relevant methods from the indigenous systems.
And thirdly it will try to provide complete treatment to survivors of violence by offering medical,
physiotherpeutic, counselling and psychotherapeutic help.
While inculcating the norm of professional excellence, the centre would be very sensitive and
responsive to three other issues: (1) The institution advocating eradication of violence and
oppression cannot be run on the rigit oppressive hierarchy within. The oppressive hierarchy and
lack of participatory and democratic functioning is a major problems with most of the institutions
and in the way profession is organised in the country. Thus great care will be taken to inculcate
participatory democracy and respect for the clients. (2) There is a great erosion of ethics in the
profession and medical practice in India. The centre must have strong, functional ethics committee
comprising of medical and non medical individuals with impaccable integrity. (3) Such a centre
cannot remain insensitive to the needs of the local community within which it will be existing. In
that area at least it will make some efforts to help the community in meeting its health care needs.
Such effort could be in training health care workers, undertaking health education campaigns etc.
Requirement to be Met for Establishing the Centre:
There are four major requirements to be fulfilled in order to establishing such centre, they are, (1)
Personnel selection, (2) Their orientation and training, (3) Library and documentation, and (4)
Investing in the physical structure and meeting financial requirements.
(1)
The personnel selection: This part of the work is very important as getting medical, nursing
and other personnel with right kind of commitment to work for the victims would mean half battle
won. This is difficult, too. There is a lure of money in the private practice, and the income of
medical people in private practice is very very high. The centre obviously cannot pay so much to
its staff. Yet, the payments at the centre cannot be so low as to fail in attracting individuals with
good competency in work. At the same time the individuals shuold possess impaccable ethical
CEHAT, Bombay: Establishment of a Treatment and Research Centre for Survivors of Violence
7
character. Given the great erosion of etliical norms in the medical practice in India, one must
adequately stress this point. For, the health professionals would be dealing with a very sensitive
issue, some indiscretion on the part of them could lead to great harm. They must have unshakable
commitment, moral and political, to the welfare and safety of the survivors of violence.
At the moment we have only a few individuals with such motivation and commitment
collaborating with us in this work. When we systematise our work, of course we will be able to
get more individuals to work with us.
(2)
Orientation and Training: This is a must as our work so far in the field is episodic and
experience minimum. We infact have no experience in systematic work on the subject. Besides,
we feel that the initial nucleus of the health professionals formed by us at the centre will not have
relevant professional expertise, or formal training in the work we intend to undertake. Thus, some
of us may need a crash course of training in the basics of say, psychotherpeutic methods. And of
course we would need training at the centre(s) where such work is already underway. Since at
present there is no such centre working in India, it is imperative that few of us undergo training at
a centre where such work is already on so that we could adopt some of such work to our
understanding and needs in India. Although we have no idea as to how we would actually do the
adaptation of such work, we do strongly believe that it would not be correct and useful to blindly
duplicate what is done elsewhere. This means we will have to work hard, be innovative in our
work and keep our feet firmly rooted in the indian reality. We believe, that is how it should be.
This would only mean that we will have to pay great attention to the details of the clinical aspects
of psychology and psychitry in our work. Without that it would be impossible or messy
(3)
Library and Documentation: This would be collection of information, preparation of library
databases for use by people, lawyers, media persons etc, analysis of information and wider
dissemination of information to people and professionals. The information would pertain to the
larger social information on the incidence, trends etc of violence as we as to the databases for
clinical work and research.
We feel that this work should be initiated at the earliest so that by the time the medical centre
actually starts offering services we already have some amount of information base ready.
(4)
Investment and financial implications: Although we have been voluntarily working on this
subject for fairly long time, the task of systematising the work and establisliing a medical centre
not attempted due to the lack .of financial support. In order to do this work few of us may have to
leave our current work and devote full time in estblishing the medical centre, undergo necessary
training and also build up credibility for the centre. That means few professionals will have to be
supported full time from the beginning of the work. In addition, we have to take, initially on rent
at least 2000 sq.ft place and furnish it, in the suburb of Bombay to establish a functional medical
centre.
CEHAT, Bombay: Establishment of a Treatment and Research Centre for Survivors of Violence
Of
8
K
The financial requirement would be (rough estimates) about US $ !OO,OO0per year (in the first
year it may be little more as there will be establishment cost) and to begin with we must ensure
that the finapal support is committed for at least for three years.
/
PROJECT PROPOSALS
Amar Jewab Project Proposal: "Rerponee ofhealth profetrionali and terbcei to the epidemic of violence “
5
Propoial
Response of Health Professionals and Services to the Epidemic of Violence
(A) THE PROBLEM
The mainstream social sciences in India have largely ignored the fact that India is a very violent
society. Although the investigation and documentation of political violence was started in a
systematic manner by many small voluntary groups and the media much earlier (the 19 months of
Stale oflnternal Emergency in the mid 1970s provided impetus to it), the mainstream social sciences
had not taken sufficient interest in the phenomenon. The other forms of social and political violence,
viz. gender, caste, communal etc. were also analysed inadequately.
However, the decade of 1980s has heralded some change. For example, three edited volumes by
Prof AR. Desai (1986, 1990, 1991) and in his recent study of Gujarat (with D’Costa, 1994) have
brought together collection of documents and writings on the political violence and violation of
democratic rights which would have otherwise found less recognition in the social science
discourse. Similarly, social scientists have also started paying attention to the communal violence
and violence against women. For example, the works of Asgharali Engineer, Veena Das (1992),
Flavia Agnes (1990, 1992), Chhaya Data? (1992), Vibhuti Patel and many others have done much
needed conceptual and empirical work on the subject Due to their work certain types of violence
which suffered from social taboos, such as rape, wife beating, child abuse etc have now found a
place in the social science discourse end in the campaigns of concerned organisations. In fact, these
concerns have altered the political agendas of many social and political movements. At the same
time this has brought in its wake more concern for the victims and survivors of violence.
Violence as a public health issue:
In this regard, the health care professionals have fared even worse than the social scientists. In the
medical discourse in this country the concern for violence is conspicuous by its virtual absence. In
much of the medical research, discussion and publications, the mention of the victims and survivors
of violence, and their special medical needs and rehabilitation, is rare. Is this because fte health
care workers do not come in contact with the victims and survivors of violence? Answer is
categorical “No”. Violence invariably inflicts physical or psychological trauma and in any violence,
the victims and many’ survivors come in contact with the health care workers. Survivors approach or
are taken to health care services, for the treatment of their physical injuries and psychosocial trauma
suffered The dead victims of violence are examined for autopsy’ by the doctors. In fact, the medical
record of violence on the survivors and victims constitute one of the important evidences for the
police investigations and legal processes for punishing the offenders and compensating victims and
survivors.
The figures quoted by the media and social science researchers from the various sources on die
incidences of all types of violence and the estimated numbers of sufferers are indeed shocking. What
is also shocking for the health care providers is that there is hardly any mention in our scientific
journals and in the health policy documents on the implication of such a phenomenon for the health
care services. While one doesn’t want to sensationalise and exaggerate ‘he phenomenon of
increasing violence in our society, one also can’t resist saying that for health care services it is a big
but ignored epidemic of the present time. Its size needs to be assessed, but sa
our public health
Amar Jesanl: Project Proposal: ’Rerpome ofhealth profettionali and lenicei to the epidemic ofviolence “
6
experts have done little in this direction. Information quoted by us in the later part of this document,
albeit insufficient, point to an epidemic which is bigger that most of the well known diseases
identified as public health problems. No doubt, therefore, the violence is a public health problem. It
is absolutely essential that our health policy makers and the health care providers accept this fact,
estimate the health care needs of the sufferers, train health care providers for their treatment and
above all, reorient the health care providers in such a way that their work could become an
important social instrument for preventing violence, for punishing offenders and for properly
rehabilitating victims.
Unfortunately, the conscious response of the health professionals to one of the bigger epidemics of
violence in recent times in our country has been grossly inadequate. They have either shown plain
indifference or clumsy and adhoc crisis management attitude when faced with the situation of
violence. This does not auger well for a profession claiming to have scientific basis for its practice.
The implied failing in discharging social responsibility raises ethical questions for the profession at
large in the country.
Violence and the Health Professions:
The science of medicine incorporates sociological and epidemiological understanding. The
medicine, and for that matter any science, not geared to the real social and epidemiological issues
ofien loses its humanitarian content As stated earlier, the social scientist have of late started
responding to the phenomenon of violence. What is the reaction of health professionals? The
violence does not leave the health professionals completely unaffected. Afierall, doctors also come
from the social milieu which has varied and conflicting standpoints on'the violence. To what extent
is the attitude of doctors to violence shaped by their social positions and ideological orientation in
our country? Answer to this question is not easy as there has been very’ little empirical research
conducted to find out health care providers’ attitude on the subject and the extent to which individual
biases get reflected in the medical practice. However, some indication on what is happening at the
ground level within the profession is available from the investigation reports of various local,
national and international groups, and some research studies.
(a)
Autopsy': The way autopsies are conducted, the reports written, the access to the reports etc
have been a bone of contention for long. There have been reports in the press about the pressure
exerted by the police on the doctors to give favourable findings. The famous case of police custody
death of Dayal Singh made the Resident Doctors’ Association of the AILMS (New Delhi) protest
against such pressure is mentioned in the Amnesty- International (Al, 1992) report titled "Torture,
Rape and Deaths in Police Custody” which generated lots of controversy only a couple of years
back. Similarly, the autopsy reports of two nuns murdered in a Bombay suburb and doctors’ role in
unscientific interpretation of its findings created great furor (Solidarity for Justice, 1991). In
addition to the autopsy reports of these nuns, I also had an opportunity to go through a sizable number
of autopsy reports of the custody deaths and the so called encounter deaths in last few years.
hi general I found several disturbing issues which have great implication fog 8? ethical behaviour of
the doctors involved in conducting autopsies. For instance, autopsies in custody deaths are normally
conducted by the police doctors in police hospitals or departments in pubhi hospitals to which lay
people and other doctors have no access. An independent medical audit of work being done there is
unheard of This situation is neither conducive for good science nor for good ethics; and should make
Amar Jesanii Project Proposal; "Response ofhealth professionals and services to the epidemic ofviolence “
7
the profession at large suspicious of the standard of ethics practised, unless such suspicion is
disproved by an independent body of the profession. Further, a study of autopsy reports of the
violence victims would probably show that normally they have incomplete and often unscientific
documentation. It is significant to note that the Supreme Court had to pass an order in 1989 that all
postmortem examinations held at the AHMS be standardised. However, this High Court order has
remained inadequately implemented. This is observation is corroborated by the way autopsy’ (not
once, but three times) was conducted on the charred remains of Naina Salmi in the well known
gruesome murder case involving a politician. While legal implications for such autopsy were
highlighted, nothing has been written about the doctors involved. (Jesani, 1995).
(b)
Torture and rape: There have been numerous official denials that the so called third degree
methods of interrogation or torture are practiced by our police and security personnel. However, the
evidence accumulated so far do not support such a claim. Some of the retired and senior police
officers, “reared in the old school of correct policing” have publicly criticised the “new methods of
policing” which are “supposed to be firm, unorthodox, effective and harsh, and they condone the use
of torture, illegal detention and tempering with records, end in worst cases even condone execution
by police officers of hard core criminals” (Rustamji, 1992).
The above mentioned 1992 report of the Al cites 13 cases of custody deaths due to torture in the
period 1985-89 in Maharashtra. However, a Bombay newspaper (The Independent, 1991) reported
a study by the prestigious Karve Institute of Social Work, Pune giving the toll of custody deaths in
Maharashtra to 155 in 1980-89 period. On inquiry’, I (Jesani, 1995) found that of these 155 deaths,
102 (20.4 per annum) had taken place in the five year period of 1985-89 for which the Al had
reported only 13. On analysing the causes of the 155 custody deaths, I found that only 9.7% (15)
were admitted as due to police action, 44.5% (69) were attributed to suicide or acts of the accused,
7% (11) to acts of the public, 22.6% (35) to disease and illness, 13.6% (21) were termed natural
deaths and in 2.6% (4) the cause was not known or record not available. I was further astonished to
learn about some specific causes mentioned, viz. alcohol consumption (9 cases), hanging (45),
jumped in well (3). jumped under the train (2), jumped under the auiorickshaw (3), jumped under the
bus (1), fell from the coal or bed (1), skin disease (1), giddiness (1), unconsciousness (1) end so on.
Given the norm that every death in the custody ought to be investigated end proper autopsy’ done,
such causes are not only incomprehensible but they' create suspicion that a larger proportion of them
were due to torture. The role of doctors doing such autopsies therefore need to be investigated by
researchers and the media
In one ofthe investigations (CPDPS 1990) of the police custody death in Bombay (of which I was a
member ofthe investigation team along with two journalists and a lawyer), we found that the young
victim accused of a petty theft was, in the course of interrogation, brought to a public hospital in
serious health condition which included (as per hospital records), typical torture inflicted injuries' on
his wrists and thighs, bloody vomiting, pain in the region around kidney etc. He was given routine
treatment and asked to go back to his torture cell by the doctor. It was also found that the doctor had
taken case history and done medical examination in the presence of the police officer who had
accompanied the victim. The doctor did not consider presence of the police in the doctor pa'jenl
relationship unusual but termed it as routine and yet insisted that he did not suspect torture as th?
victim never reported it to him. The victim went back and later died. Similar thing was found b as
in an investigation (YUVA, MFC et el, 1990) of a gang rape wherein, inspite of the visible sigm of
injuries in regions which could make any medical person suspicious of rape, the male doctor hr-sed
Amar Jetank Project Proposal' "Rerponie ofhealth profeirionab and tervicet to the epidemic ofviolence “
6
away die patient with routine treatment of injuries simply because the woman could not tell him that
she was raped. In this particular case the woman had reported rape to the nurse on duty but could not
communicate the same to die male doctor. In another case of custodial gang rape and torture of a
tribal woman by police in Gujarat (Al 1988), the commission of inquiry constituted by the Supreme
Court found that two doctors at die government hospital were guilty of shielding the policemen and
also for issuing a false certificate.
These examples, I have reasons to believe, only represent a tip of the iceberg. It is not that the
doctors who often come into contact with the survivors and victims are always conscious
accomplices in covering up the cases. A section of doctors involved are plainly ignorant about
this aspect of medical work. Another section is indifferent to the plight of sufferer due to their
own social biases against the victims end survivors. Such indifference is also produced by social
pressure- to conform to die dominant belief Thus for instance, in cases of torture inflicted on persons
labeled as terrorists, doctors often faithfully treat the injuries but show great reluctance in
mentioning torture due to the fear of being seen as opposed to state’s efforts at fighting terrorism,
separatism etc. Besides, the psychosocial trauma inflicted by torture is completely ignored, often
because there is no training imparted to them for managing such trauma and also due to low
commercial value of such medical work A third section simply believes that being in the
employment of the government, the police department or the prison, they are bound by the orders of
their superiors and the code of their service did not allow them to “blow the whistle”. Another
reason for doctors’ apathy to these issues is that they consider themselves as mere technicians (as
some doctors have often remarked, “we are doctors, we treat illness, we are not interested in torture
or rape”) and therefore they do not make necessary efforts to explore the causes and history. This is
both inadequate science as well as inadequate understanding of medical ethics.
(c)
Family Violence: The great surge of women’s movement in the 1980s brought issue of violence
against women on the political agenda of the country. Yet, a survey of violence against women in the
less developed countries has shown that it is a grossly neglected public health issue (Heise, Raike et
el, 1994). The family violence involves violence against women and children.
The violence against women and children is tire most common form of family violence and it has
social, cultural and religious sanctions. The studies done by Flavia Agnes in the 1980s in Bombay
and other studies have shown that it cuts across the class and class barriers. These social variables
only change the form of violence, not the high prevalence of it In a study of 120 families done at the
NIMHANS, Bangalore, Bhatti (undated) found that some form of violence against women was
prevalent in all families, the physical and verbal violence being the highest (88%) in the low income
•families while in the middle income (43%) and higii income (35%) families those forms were less
prevalent However in the latter groups, there was higher prevalence of social and emotional
violence. In a large study of 230 women from urban middle and upper classes, Sathyanaraymi Rao
and his collegues (1994) from the department of psychiatry in the Medical College at Mysore,
studied the pattern and causes of psychological violence against women in the family and came to the
conclusion that psychological aid emotional torture ar- highly prevalent in the middle class families.
In a study by Mahajan A, Madhurima (1995) of 115 women in the lower caste households in one
village at the outskirt of Chandigarh in Punjab, it was found that as many as 87 (75.7%) women
reported physical violence against them by their husbands. Further, of these 87 women, 58 (66.7%)
said that they' were beaten regularly. Similarly, the dowry deaths and their increasing numbers
despite changes in law, point to the pernicious prevail.xe of family violence.
Amar Jetanl: Project Proposal: "Reiporud ofhealth profetnonah and eervicei to the epidemic ofviolence “
9
While women’s movement has brought the family violence out of the closet and made it a social and
political issue, the violence against children in the family and outside is still not properly
recognised, except in the campaigns against child labour and the problems faced by street children.
The studies on child abuse in India are difficult to find although our experiences suggest that the
violence against girl child, including sexual violence, is as highly prevalent as the wife beating.
The role of health care professionals is highly ambiguous in cases of family violence. Although
batterred baby syndrome as a cluster of signs and symptoms for battered children was medically
recognised in the early 1960s, very little work on it by health professionals in India is available.
Similarly, the battered wife syndrome is almost unheard of in the medical discourse in our country.
A practical implication of such indifference of health professionals is felt by women’s groups in
their cases in the family court In our discussion with women activists we were repeatedly told that
in the cases filed in the Family Courts though the cruelty by husband is tire biggest reason given by
w’omen for separation and divorce, they normally do not have any documentary evidence in the form
of medical records to support their claims. This does not mean that such battered women never
approached doctors for treatment when severely beaten up, but the medical record invariably
showed the injuries as accidental. In many cases women had not reported correct cause of injuries
due to social fears, in some cases when such reporting was done they had found the doctors
uncooperative. The studies done so far on this problem have normally not paid much attention to the
response of health professionals and health services. For instance, in the stud}' by Mahajan and
Madhurima (Ibid, 1995) neither in the survey conducted nor in the case studies, die response of
health professionals and health services to whom many of these battered women must have
approached from time to time for treatment is even explored. The child abuse while being a health
problem in itseff it is also a public health problem in the adult life. For the abused children suffer
from multitude of psychological problems crippling some parts of their lives when they grow to be
adult
(d)
Communal and Caste violence: Most of the sociological studies have shown that the doctors
hail from upper caste and class strata of the society (Ommen T.K, 1978, Venkatratnam R., 1979).
With the phenomenal increase in the number of private medical colleges, the dominace of these
strata is on the increase. It is interesting to note that in the anti-reservation agitations of 1980s,
particularly of Gujarat in mid 1980s, the medical students played a very prominent role. For that
matter, in the communal and caste mobilisations, a significant support has come from the
professional classes which include doctors. Our personal experiences with doctors at professional
level and in our interaction with them in several health service studies in urban and rural
Maharashtra, we have found the health professionals highly coloured by the caste and communal
ideologies. •
While day to day discrimination against women and lower castes in the provision of health care is
prevalent and unethical, the role of health professionals during the large scale caste and communal
violence has remained unexplored. During the communal violence in Bombay in 1992-3, we came
across many doctors in public and private hospitals who justified the violence against minorities, but
we also came across some who showed heroism at that time to take care of victims, although the
number of the latter wm> much less as compared to the former. To what extent the caste and
communal biases amongst doctors get menifested into overt discrimination in the treatment? This
subject needs more exploration and research.
AmsrJesani: Project Prepo«al: "farponie ofhealth profetnonalt and tereicet to the epidemic ofviolence “
10
Treatment, RehabEtation and Documentation:
All types of violence produce traumatic effect on the victims. The trema could be on the body or on
the mind. In a famous case of mass torture of villagers by the security forces in Manipur, although
there were official denials, a team of doctors which also included psychiatrists visited and examined
104 survivors in that area after 22 months of the incident They found that a very high number of them
were suffering from the post-torture traumatic stress. They found that 36.6% were suffering from
recurrent dreams of torture, 66.3% of disturbed sleep, 54.4% were not able to enjoy village
festivals, food, sex and even friendship, 37.6% showed loss of self confidence, developed a sense
of foreshortened future, etc. (Biswas, Das et el, 1990),
There is extensive work done on the treatment and rehabiitalion of survivors of violence in many
countries, it is conspicuous by its absence in India The survivors of violence are special types of
patients, and they would be missed, continue to suffer if not treated. While there is no doubt about
their individual <nrffbrings, they also add into the socio-political problem. Thei* rehabilitation also
has a socio-political dimension as the medical documentation could be a formidable evidence to get
justice for them. An indepentden^ conscious and trained health professional thur while treating cases
of violence can also become a source of deterrence and prevention ofviolence.
OBJECTIVES OF THE PROPOSED STUDY
The problem narrated so far is based on my own experiences and work done as a volunteer while
doing my research on health in various institutions. It is infact a summary of voluntary work done in
last six years. The issues raised therein are those which were actually experienced in the course of
work. The conclusion arrived at and assertions made are also based on experiences and study of
work done by others, and are therefore tentative. Unfortunately, in my project based research in other
aspects of health in last 15 years, I could never afford to give full time concentration on this aspect
of work. Unless one is able to concentrate solely on this task, a systematic exploration of this subject
will never be possible.
Overall aim: The aim of my study is to explore violence as a public health issue md the role played
by health professionals (doctors and nuraes)^m&e situations and cases cfvicJeme.
Specific Objectives:
(1)
To collate information on the incidences of violence from the secondly sxirces in order to
understand the violence as apublic health issue in last one decade (198-'--95i mSfemrav.
(2)
To analyse such ir’onnation to understand changing pattern, if any, eft;
(3)
To stud}' attitude :: health professionals to die impact of violence o. .
and communities in Bv.nbay.
v:c?.ace.
?f individuals
Amar .U mV Project Props raL 'Rerponie ofhealth profetrionab and terwtet to the epidemic ofviolence "
(4)
To study role played by health professionals in cases of violence in Bombay.
(5)
To formulate concrete practical suggestions for educational and training needs of healt
professionals, for changes in the protocols for medical records and mangement of victims and
survivors of violence, for changes in codes of medical ethics etc..
METHODOLOGY
Approach:
(i)
The objectives and the narration of problem make it clear that we treat issue of violence from t
human rights perspective. However, our perspective does not narrow down human rights issue to the
political violence or violence perpetrated by the state agencies. Since such an approach makes the
coverage of human rights issue too wide and thus perhaps unwieldy for a research to last for only a
year.
However, at the same time it is not possible to specify’ particular types of violence that the study
would cover. For, there are difficulties in gathering hard data on certain forms of violence,
particularly medical records. The data to be gathered from the victims and survivors would,
however, not create such problem, as such group of people will be accessible to me or the research
assistant who would work with me. Thus, in the micro study, two of the following four types of
violence would be taken up for indepth exploration:
(1)
Torture and deaths in police custody. (2) Communal violence. (3) Violence against women in th
family, including deaths. (4) Rape.
(ii) While the violence will be necessarily explored to understand its cuases, the focus would be,
through01^ the study, on its implication to the health of individuals and community to which they
belong. Their problems, expectations and the actua’ assistance received will be viewed in relation
to the role played by the health professionals, particularly doctors and nurses.
(in) The above issues will be explored keeping in mind the following research questions:
(1) What are the levels of involvement of health care professionals in the instances of violence?
(2)
What is the knowledge and attitude of health professionals, and their professional associations
on the role expected of them?
(3)
What actual role the health professional are found to be playing at each level?
(4)
What are the reasons for the kind of role that presen'iy health professionals are playing?
(5)
What is the opinion of victims and suivi’-ors about the role of health professionals?
(6)
What are the specific areas where inputs and changes a- e i equired for the health professionals t
play an ethical and sensitive role in cases .. •. iolence? How?
Amar JetanL- Project Proposal: "Retponse ofhealth profetiionale and tervutet to the epidemic of violence "
12
Study Design:
L Collation and analysis of information from secondary sources: Some amount of work has
already been done by me in putting together available information. More information will be
collected in the first three months of the study.
(1) I do not have full documentation of data pertaining to the instances of violence. For such data,
hospital and police sources will be approached. (2) More information will be collected from the
newspaper clippings and reports of various concerned organisations active in Bombay.
IL Collection of primary information:
Method:
Chiefly, the qualitative method for data collection will be used. The techniques of case studies,
observation (if permitted) and analysis of documentary evidences will be carried out. Such
qualitative methods will provide indepth data on what is happenning at the ground level. Although
such data will not enable use to do quantitative estimates, they will provide material for
understanding trends and patterns; and to an extent make it possible to do theoretical generalisations.
*
Study units?
The case studies of a select number of doctors, nurses,survivors or victims of violence and the
concerned individuals or representatives of organisations involved in helping victims will be
carried out.
(1) 5 case studies of doctors who are working in the public hospital, coroner’s court etc and who
receive cases of violence will be done.
(2)
5 case studies of nurses working in the similar situations.
(3)
5 case studies of police officials selected from the constables to higher officials will be
conducted.
(4)
15 case studies of survivors of violence will be undertaken.
(5)
10 individuals involved in helping survivors of violence will be interviewed.
Thus, totally, at least
ko
and if necessary more, case studies will be done.
Documentary data: From the organisations involved in helping victims, lawyers pleading such
cases and other sources, the medical records of about 30 victims on the subject selected for indepth
study will be obtained. An effort will also be made to get records Horn public hospitals, police and
coroner’s office, etc.
Observations: The onservation of doctor patient relationship, with the permission of attending
doctor and the patient, will be done at
of the public hospitals Bombay. If such permission is
not given, detailed information obtaineu -rbout the process from tire patient and doctors in their case
studies will be used
Amar JeianI: Project Prop oral: "Retpome of health profeteionab and eervicet to the epidermic ofviolence "
13
Instruments:
Case Studies: For the case studies, an interview guide for each set of unit will be prepared keeping
in mind the study questions given in the previous section (approach) and the newer one as I give the
final shape to the methodology immediately after commencing the study1. Each case study will be
done in at least two lengthy sessions.
Documentary data: First of all, using medical scientific books and manuals, a guide for analysing
madical and autopsy reports will be prepared. The documents will be examined to understand
whether the protocol or formal for recording information is scientific, whether the! are complete, fee
information lacking is vital or not, the medical procedures followed, investigations carried out, and
so on.
Data analysis:
I have experience in using computer packages for analysing qualitative data I also have my own
laptop (notebook) compter with the necessary packages installed. Using appropriate packages, the
content analysis of case studies will be carried out The observational and documentary data will be
meshed with the case study’ data while preparing reports.
Report:
The final report will be in the form of monograph or book of 100 pages or more.
In addition, two scientific papers based on the study* will be prepared for publication in the
medical, nursing or social science journal(s). Three essays or articles for publication in popular
newspaper or magazine will also be prepared, in the style that suits for such publications.
PRACTICABILITY AND SIGNIFICANCE
Although while dealing with the problem, literature review and methodology, we have emphasised
the significance and practicability' of the proposed work, some, of those ideas are brought together
here to make them explicit
Significance:
As it is pointed out by many* social scientists and media personalities, the violence has been a
significant feature of the Indian society. In last one decade this problem has only intensified and its
character has changed. This development is so serious that many commentators have felt compelled
to warn again and again that if no serious effort is made, it would have detrimental effect on the
larger process of deveolpment, so much so that the unity and integrity of the country' might get
jeopardised. Further, the epidemic of violence has also made the human rights situation in the
country worrisome. Although the National Human Rights Commission (NHRC) has shown much
more initiative than was expected of them, if various responsible strata of the society do not
Amar Jesaab Project Prop oca!: "Rerponie ofhealth professional! and sendees to the epidemic of violence “
14
contribute in such initiatives, there is a possibility that might remain a paper tiger as it does not have
sufficient powers to put into action its pronouncements.
The health professionals and health services occupy a very crucial position in the situations and
cases of violence. They not only provide much needed services to people who have suffered from
violence, but their medical records could be essential evidences to get justice for the sufferers.
It is indeed unfortunate that inadequate attention is paid by the researchers to the health professionals
and health services in relation to violence. The health professionals, a great proportion of them
(over 80%) busy in commercialised private practice, have also not shown necessary social
responsibility in creating independent and effective space for themselves in order to provide care to
victims and ensure justice.
Thus, it needs no further emphasis that it is now high time to pay more attention to this sector and
professionals working there. Our aim is, by highlighting the present lamentable situation in general,
by giving due recognitions to those who have made sincere efforts to uphold professional ethics and
help victims, and by arriving at concrete, practicable suggestions, to orient the health professionals
and services for making solid and positive contribution in society’s efforts for combating violence,
the agressors and get justice for the victims.
The proposed study, if undertaken, will be perhaps the first or one of the few, of its kind in our
country.
Practicality:
My narration of the problem would have given an indication that I have not arrived at tire study ofthe
problem purely from intellectual work. I am a medical professional involved in social science
research and my formal research assignments at the institutions I have worked had very little
connection to the issue of violence. My voluntary’ practical work outside office hours, in
collaboration wife health activists groups, women’s groups, human rights groups etc brought me face
to face with the violence and made me acutely aware of die shortcomings in the response of health
professionals and services. I also find myself in a unique position to fall back on my medical
background, experience of social science research and of course network of contacts formed while
participating in social activism to accomplish the task of proposed research.
References:
(1) Agnes Fiavia, "Journey to Justice: Procedures to be followed in a rape case" Bombay: Majlis, 1990, pp 68
Agnes Fiavia, 'Give us this day Ow daily bread: Procedures and case laws on maintenance", Bombay: Majlis.
1992, pp 170. Also her works on the Fnr.ly violence and communal violence.
(2) Amnesty International, "India: Allegations of rape by police: The case of a tribo! woman m Gujarat,
Guntaben", London: AL March 19SS (Al Index: ASA 20/04/88).
(3) Amnesty International (Ad), "Terr-:, rape and Deaths in Police Custody”, London: AL 1992, pg 73.
(4) Asia Watch, Physician for Hun— ...rdr.s, "The Human Rights Crisis in Kashmir: A Pattern of Impunity ",
Boston and Washington. PHR and HLW, June 1'993.
Amar Jesani: Project Proposal: "Rerponse ofhealth profeinonab and >truces to the epidemic ofviolence “
15
(5) Bhatti Rznbir Singh, "Sociocultural dynamics offamily violence ", Bangalore: NIMHANS, (Mimeo, undated and
unpublished)
(6) Biswas Eipasa, Das Sujit Kumar et el., "Post torture state ofMental Piealth: Report of a medical study on the
delayed effects oftorture on Nagas tn Manipur", Calcutta: Drug Action Forum, West Bengal, July 1990.
(7) CPDR (Committee for the Protection of Democratic Rights), “Another Lock up Death : An Investigation".
Bombay:, July 1990.
(8) Das Veena (Ed), "Mirrors of Violence: Communities, Riots and Survivors in Struth Asia", Bombay; Oxford
University Press, pp 407.
(9) Datar Chhaya (Ed), "The Struggle against violence ", Calcutta: Stree, 1992, pp 198.
(10) Desai AR. (Ed), "Violation of Democratic Rights in India", 1986, "Repression and Resistance in India",
1990, "Expanding Government Lawlessness and Organised Struggles" 1991, Bombay: Popular Prakashzn. And
Desai AR, D’Costa Wilfred, "State and Repressive Culture ", Bombay: Popular Prakashan, 1994.
(11)
Heise Lori L, Raike AJanagh, Watts Charlotte H., Zwi Anthony B., “Violence against women: A neglected
public health issue in less developed countries”, inSoct'al Science Medicine, Vol.39, No.9, pp 1165-1179.
(12)
Jesani Amar, “Police, prison, physician", (Editorial), in Medical Ethics, Vol.3, No. 4, October - December,
1995, pp 58.
(13)
Jesani Amar, “Violence and ethical responsibility of the medical profession”, in Medical Ethics, Vol. 3, No.l,
January-March, 1995, pp 3 -5.
(14) Mahajan A Mdhurima. "Family violence and abuse in EidicT, New Delhi: Deep and Deep Publication, 1995,
pp. 178.
(15) Omvedt Gail, "Violence against women: New movements and new theories in India", New Delhi: Kali for
Women, 1990, pp 42.
(16) OmmenT-K, "Doctors and Nurse: A study in occupational role structures "Bombay: MacMilllan, 1978.
(17) Rao Sathyanarayana, Rao Vasumathy ct el., "A Study of Domestic Violence in urban middle doss families",
Mysore: Department of Psychiatry, JSS Medical College and Hospital, 1994, (mimeo, unpublished)
(18)
Rustamji K.F, “Passion of the fanatic: Hie government’s response has been a confused one” in The Afternoon
Despatch and Courier, Bombay, February 18, 1992.
(19)
Solidarity for Justice, “Human Rights issues emerging from Investigation into the Murder of Sr. Sylvia and Sr.
Priya”, Bombay: Solidarity for Justice, 1991.
(20)
The Independent /State has one lockup death every month” by staff reporter in Bombay, December 16,1991.
(21)
United Nations, “Manual on the Effective Prevention and Investigation of Extra-legal, A-bitrary and Summary
Executions”, New York: United Nations, 1991.
(22) Venkatratnam R, "Medical soa t-iogy in an Indian sett',ng ”, Bombay: MacMillan, 1979.
(23) Yuva, Medico Friend Circle, Women's Centre et el., "The Jogeshwari Rape Case- A report", Bombay: MFC,
1990.
REPORT
(1992 - 1994)
ANUSANDHANTRUST
(Registered Under the Bombay Public Trust Act, 1950. Registration No: E - 13480, Bombay)
519 Prabhu Darshan, 31 S. Sainik Nagar, Amboli, Andheri West
Bombay 400 058, India
Anusandhan Trust is an educational public charitable Trust registered under the Bombay
Public Trusts Act, 1950 (Bombay Act No.XXIX OF 1950). It was registered with the
Charity Commissioner, Bombay on August 30, 1991. Its registration number is E - 13480
(Mumbai). The primary objective for which Anusandhan Trust is established is to
conduct educational, research, training and service activities in the field of Health and
related areas for the well being of the disavantaged and the poor.
A Modest Beginning:
In 1992, we began work for the fulfilment of the objectives of the Trust In January 1992,
the office of the Trust was set up in the residence of one Trustee. However, soon another
Trustee offered an exclusive 850 squarefeet place at the above address to house the
office. It was decided to begin work with educational and research activities. In persuance
to the decision, a library and documentation unit and a research centre were established at
the above address in April 1992.
Library and Documentation:
For establishing library and documentation unit, we made an appeal to our Trustees and
well wishers to make generous donations in cash and kind. We needed books, documents
and furniture for the library. In no time, donations, mainly in kind, started pouring in.
Within few months, we acquired more than 2000 books and equal'number of reprints
(documents) from our Trustees and well wishers. We also received from them necessary
furniture for keeping books and for the users to sit and work. The books and documents
were further divided into two different library set ups, one primarily for children and
another for researchers, academicians, media persons, activists etc.
Children’s Library: Our office is located in an area where there is no public library for
the citizens. The private circulating libraries are too expensive for the kids to utilise. The
schools in this area do not have library for the kids to take books home and aread. We
invited few kids to come and see our collection. They were very excited on looking at the
collection of books and journals, like National Geographies with the Trust. We wanted
children to run the library on their own. Some children volunteered to work in their spare
times, accession all the books, keep the library for a few days in a week, lend books to
children, keep record and ensure that books were returned by the borrower in a specific
time period. Thus a children’s library managed by them in the Trust office was bom.
The children have named their library as “Kidds’ Nook” and it is run by their own
commitee of volunteers and its use by chilren is totally free of any cost. Presently there
are about 800 books and numerous old issues of educational journals at the Kidds’ Nook.
Health and Allied Themes Library and Documentation: Simultaneously, we
established a specialised library on Health and Allied Themes for researchers, media
persons, health activists and others This library has now about 1500 books and about
2000 documents which are regularly used by our own staff and by the people from
outside
Research Centre:
The Trustees of Anusandhan Trust had decided in July 1991 to establish, own and operate
a research, education and training centre in the field of Health and Allied Themes at the
Trust office It is named as Centre for Enquiry into Health and Allied Themes, or in
short, CEHAT (which in Hindi means Health). Project proposals for undertaking relevant
research were prepared in the late 1991 but there was a great delay in receiving funds.
Objectives of CEHAT: The research centre is established with three major objectives: (1)
To identify relevant research priorities in health and allied fields at local, national or
international levels and to formulate problems based on these priorities. (2) To conduct
research and action research on topics of importance for the benefit of the poor and the
disadvantaged, and of interest of people’s movement in the country. (3) To interect with
progressive individuals and organisations active for the betterment of and in defense of
rights of the disadvantaged people and provide research inputs and access to relevant data
base.
CEHLAT’s Mode of Functioning: On principle, the Anusandhan Trust does not regard
society either as a ground for experimentation or as unexplored terrain for data gathering
for intellectual exercises. Given this, as a policy of the Trust, the CEHAT’s research
projects endeavour to create space for the participation of populations under study
without compromising on academic rigour. All CEHAT’s projects have ethics committee
and are committed to return to study population the results of research in an appropriate
form.
The Trust has created institutional structures in the research centre for ensuring
democratic and participatory mode of decision making. The research centre is supervised
by a Governing Board made up of nine Trustees In addition, it is periodically evaluated
by an external Social Audit Group The Social Audit Group examines CEHAT’s
performance in collective management, relevance of research projects undertaken and so
on.
Reseach Projects Presently on at the Trust’ Centre:
From April 1, 1994, the Anusandhan Trust has commenced its research work in Bimbay as
well as Pune. The Trust has also established a branch office in Pune at 11 Archana
Apartments, 163 Solapur Road, Hadapsar, Pune First Project on Women and Abortion,
funded by the Ford Foundation, received approval of the Government of India in March
1994 was commenced from April 1, 1994. Two more projects, funded by the UNDP and
Government of India on the Legal aspects of Health Care Delivery and Quality of Health
Care in the Private Sector were started from June 1, 1994. From August 1, 1994 the
fourth research project on Preparation and Application of Sensitive Health Education
Material on AIDS Awareness funded by India Development Service was also commenced.
All in all, the Trust’s research centre is presently working on four research projects.
In order to undertake these projects and for managing library and documentation centre,
presently there are five researchers and two secretaries (total Seven persons) working
full time in the Trust’s offices at Bombay and Pune. Of the seven, four are employed at
Bombay and three at Pune. Inaddition, we have two senior experts helping in research as
consultants.
Women and Abortion Project: This project is to understand poor women’s abortion
needs and to study social aspects of abortion in rural areas. We have selected villages in
Purandar Taluka of Pune district for this study. Using methods of case studies and focus
group interviews, we are studying abortion needs, abortion seeking behaviour and the
social, economic, cultural factors influencing their choices. The abortion provides in those
villages are also being studied.
The objectives of women and abortion projects are: (I) Abortion Behaviour: (a) To
understand social attitudes and practices on abortion in the context of the position of
women in their families and work situations, their sexuality and contraceptive practices
and values that motherhood holds for them, (b) Factors influencing choice of abortion
provider, (c) Role of men in influencing the decision to abort and on choice of provider.
- (d) Medical and psychosocial consequences of abortion as known as well as experienced.
(D) Abortion Providers: (a) To study providers available in women’s immediate
surroundings and in the official public-private helth care services, (b) To study providers
of abortion services from the point of view of quality of services offered, their
background, qualifications, accessibility and their legal status, (c) To study types of
services provided by them, (d) To document the experiences of women who utilise these
services.
This project is for a duration of 21 months. It is financially supported by the Ford
Foundation and has a budget of US $33,200 or Rs. 10,26,850.
Project on the Study of Physical Standards of Health Care in Private Sector: Several
studies have brought out that the private sector is the main provider of health care to
patients in India. Although it was assumed so far that the private sector provided best
quality of care, recent revelations have shown that many private hospitals and nursing
homes even it city like Bombay do not conform to minimum standards and that
malpractice is rampant. This study explores the physical standards of care as obtaining in
the private sector in the rural areas of a district.
The objectives of the study are: (1) To document and review various guidelines available
in the Government, NGO and Private Sectors for the minimum physical standards
necessary for the provison of reasonable quality of health care of various kind. (2) To
study the existing Physical Standards of health care in rural areas of a district and at
different levels of health care provision (GP, Consultant, Nursing Home, Hospital, etc..).
(3) To compare the findings of the study with the guidelines for minimum physical
standards at different levels of health care delivery and to understand reasons for
adequacies or inadequacies in fulfilling such physical in the private sector.
The information collection on the private sector for this study is being done in two
Talukas of Satara District in Maharashtra. This district is selected as it is an averagely
developed district in the country.
This project is for a duration of 18 months. It is financially supported by the United
Nations Development Programme and the Government of India and has a budget of
Rs.2,68,000.
Project on Study of Legal Aspects of Health Care Delivery: It is now being
increasingly realised that although the private sector overwhelmingly dominates the health
care delivery system in our country, there are inadequate laws and regulations to monitor
its work It is also argued that private health care delivery sector in India is one of the least
regulated sector in the world. As a consequence, the consumers are suffering from the
arrogance and malpractice of the practitioners and often fleeced at a time when he/she
needs more care and support.
The objectives of the study are: (I) The overall objective: To document, collate, critically
-examine, and to study legislations and regulations applicable to individuals and institutions
involved in the delivery of health care services. (II) The Specific Objectives: (1) To
collate the existing legislations and regulations applicable to individuals and institutions
involved in the delivery of health care services in India. (2) To study gaps, inadequacies in
the existing legislations and regulations and to make recommendations for changes and
also, to identify areas where new legislations and regulations are needed, with a view to
increasing efficiency, improve quality and access of services and to empower people. (3)
To compare legislative and regulatory mechanism as existing presently in India with that in
a developed country.
This project is for a duration of 15 months. It is financially supported by theUnited
Nations Development Programme and the Government of India and has a budget of
Rs. 1,86,100.
The Project on AIDS Awareness: This project is for preparation and application of
sensitive health education material on AIDS awareness.
The objectives of the project are: (1) Collection of health education material on AIDS
awareness, both in India and elsewhere. (2) Preparation of sensitive health education
material (a slide show, a booklet and a mobile poster exhibition) on AIDS awareness in
the community. (3) Continuous field testing of all our material in three areas of Pune
district in Maharashtra.
This project is for a duration of three years. The field testing of the material prepared will
be done in various rural and urban areas of the Pune district. This project is financially
supported by India Development Service and Vikas, Chicago, USA and has a budget of
US $ 6000.
rVGo -
CEHAT
Centre for Enquiry into Health and Allied Themes
m2*,
Prabhu Darshan, 31, S. Sainik
N a g a r, Amboli, Andhcri (West),
Bombay - 400 058
V«|
o'itl ■
io
The process and purpose
The Centre for Enquiry into Health and Allied Themes, CEHAT,
is a non-profit research collective / organisation set up with the
primary objective of conducting research on topics of relevance to
the health and well-being of the disadvantaged and the poor. It will
function as an interface between progressive and pro-people
movements and academic expertise.
CEHAT represents the outcome of a long process of debate and
discussions on the increasing need to create a structure which
could in a disciplined manner enquire into the many troubling
questions thrown up by and within peoples' movements and
provide a data base and well-substantiated answers. Some of these
topics may involve quantification and estimation such as, for
instance, the volume of resources wasted on irrational drugs.
Others may extend, deepen and influence currently applied norms
of medico-legal jurisprudence, such as research on domestic
violence, torture or rape. Some may impinge on medical ethics and
may raise further questions as in explorations of the responsibility
of the medical community towards patient. Studies and surveys on
women's experience with abortion or contraception, or their
perceptions of health and illness will seek to inform mainstream
analyses, while those on psycho-social trauma of populationsj
forcibly displaced, or the concept of social wage and what i"
implies, will reveal what is hidden even as they influence the
process of change towards a more sustainable and equitable
society.
How we function
On principle, CEHAT does not regard society either as a ground
for experimentation or as unexplored terrain for data-gathering for
intellectual exercises.
Given this, all CEHAT's projects
endeavour to create space for the participation of populations
under study without compromising on academic rigour. All
CEHAT's projects will include ethics committees and are
Committed to return to study population the results of research in
an appropriate manner.
OBJECTIVE
1.
Conduct research and action-research on topics of
importance or interest from the point of view of
peoples' movements in the country.
2.
To interact with progressive movements in related
areas, such as women's groups, trade unions and
campaigns or organisations involved in human rights
issues and provide research inputs.
3.
To identify research priorities in health at local,
national or international levels, the findings of which
will be of use to progressive groups or movements and
which will directly or indirectly benefit oppressed
sections in society.
The emphasis in CEHAT is on a democratic and participatory
mode of decision-making. An external social audit group will
periodically evaluate CEHAT's performance in collective
management and will evaluate the relevance of research directions
of the centre.
At present CEHAT functions on a project to project basis. A^
some point in the future, a corpus fund will be raised to ensure a
degree of continuity in the institution. At all points of time
CEHAT will aim to provide its staff with a just pay on scales
comparable to UGC scales, and a participatory and conducive work
environment
CEHAT is a research activity of ANUSANDHAN TRUST whose
trustees are: Amar Jesani (who will coordinate the activities of
CEHAT), Anant Phadke, Anil Pilgaokar, Dhruv Mankad, Manisha
Gupte, Mohan Deshpande, Padma Prakash, Ravi Duggal and
Vibhuti Patel. The CEHAT team is multidisciplinary with
academic training and experience in the fields of medicine,
economics, sociology, journalism, biochemistry and microbiology.
Most of them are currently engaged in full-time research in health
and related issues and women's studies.
Anusandhan Trust is registered under the Bombay Public
Trust Act 1950. Regd. No. E -13480, Bombay
Perspective and organisation
CEHAT
Centre for inquiry into /Teal th and Allied Themes
Research Centre ofANUSANDHAN TRUST
519 Prabhu Darshan, S. S. Nagar, Amboli.
Andheri West, Mumbai 400 058, India
Tel: (+91)(022)625 0363, Fax: (+91)(022) 620 9203
E-mail: adinin@cehatilbom.ernetin
ABOUT ANUSANDHAN TRUST
Anusandhan Trust is a non-profit educational trust registered on August 30, 1991, under the
Bombay Public Trust Act, 1950 (Registration No: E-13480). Donations made to the Anusandhan
Trust are given exemptions under the Section 80G of the Income Tax Act. Anusandhan Trust is
permited to receive contribution from the Foreign sources. It is registered with the Ministry of Home
Affairs, under the Foreign Contribution (regulation) Act, the registration number: 083780565
Goal:
The long term goal of the Trust is to establish and run democratically managed institutional structures
undertaking research, welfare, services, education, training and advocacy in various fields and
locations for the well being of the disadvantaged and the poor, and to collaborate with organisations
and individuals working with and for such people.
A
Multi-disciplinary character:
The Anusandhan Trust was established by coming together of nine friends who have been active in
health and allied fields for last two decades. Each one has in the course of her/his work, contributed
extensively and intensively in those fields. The formal educational and training background of the
trustees is in biomedical and social sciences, representing Medical Science (four of them), Sociology
(two), Economics (one), Biochemistry (one) and Microbiology (one). The multi-disciplinaiy
character of the board of trustees is reinforced by the fact that each trustee has acquired expertise in at
least one field other than the one in which he or she was formally trained.
The Board of Trustees:
The following nine individuals constitute the Board of Trustees of the Anusandhan Trust. In that
capacity, they also constitute the Governing Board of CEHAr.a
(1) Ms. Manisha Guptc.
(4) Dr. Dhruv Mankad.
(7) Mr. Ravi Duggal.
(2) Dr. Anant Phadkc.
(5) Dr. Anil Pilgaokar.
(8) Dr. Mohan Deshpande.
(3) Dr. Vibhuti Patch
(6) Ms. Padma Prakash.
(9) Dr. Amar Jesani.
Establishment of CEHAT:
To begin its march to achieve the goal, in July 1991 the Anusandhan Trust decided to establish first
institutional structure for undertaking activities in the field of Health and related areas. Thus, the
CEHAT (which in Hindi means health) or Centre for Enquiry into health and Tllied Themes came
into being.
2
Objectives of CEHAT
The main objective of CEHAT is to undertake Research, Xction, (Service and Advocacy (RASA) in
the health and allied fields. The advocacy and action also involves education, training and information
dissemination. Specifically, it endeavours to do the RASA in the following manner:
(1)
To identify relevant priorities themes in health and allied fields at local, national or international
levels and to formulate problems based on these themes.
(2)
To conduct RASA for the benefit of the poor and the disadvantaged, and in the interest of people’s
movements in the country.
(3)
To interact with progressive individuals and organisations active for the betterment of and in
defence of rights of the disadvantaged people and provide inputs and access to relevant information
and data base.
CEHAT’s approach to work
Evolution of a collective voluntary effort is a process. A non-profit voluntary institution demands a
strong commitment to the cause as well as the high standard of professional inputs. The research and
other efforts made by a voluntary institution for the well being of disadvantaged people and their
movements ought not to be of low standard. In fact, such work needs to be of as good quality as, if
not of higher quality than, done by the institutions supported by the government and the private
agencies. Strong commitment and the high quality of process and output are indispensable for a non
profit voluntary institution to bring the well being of the disadvantaged and the poor to the local,
national and international agenda.
On principle, CEHAT does not regard society merely as ground for experimentation or as unexplored
terrain for data gathering for intellectual exercises. While the methodology used for each work shall
meet high academic standards, it is also kept in mind that it is only a tool for the advancing the social
commitment. The social relevance of work is therefore given the crucial importance it deserves. In
order to ensure social relevance, sensitivity and responsibility to participant people, the following three
important ingredients are made inseparable part of all research projects involving information gathering
from people:
(1)
Ethics Committee:
In social science research in our country, the ethical issues are almost never talked about and
documented, so much so that in such research reports it is assumed that no such ethical issues existed
or were ever encountered. Even in large national surveys involving collection of sensitive data from
people, we normally do not find a mention of an independent or institutional ethics committee which
monitored the research process. While work in provision of health care involving not-so-conventional
experimental research and service is very popular among highly committed or no-so-committed health
NGOs, they are also normally found to be indifferent to need for instituting ethical safeguards.
We are aware that it is easier to criticise the present social science research than to provide an
alternative. However, a new and good beginning in research must be made, and CEHAT has been
doing it by making it mandatoiy for each research project involving information gathering from people
to have an ethics committee comprising of individuals having background in academics and pro-people
activism, and such individuals from the area where tire study is conducted. While we recognise that the
3
most important thing in respecting ethics is high level of consciousness and commitment on the part of
the research team, we believe that observance of ethics must not be left entirely to them. We have
observed in research everywhere that the best of the research team is highly susceptible to the
exigencies created by the pressure of research. Having an separate body of individuals to monitor the
ethical aspects is only one of the ways to prevent the such exigencies going unnoticed and uncorrected.
The ethics committee of CEHAT projects normally meets twice or thrice, depending on the size and
duration of the project. The first meeting is when the draft methodology with instruments and
sampling are completed, second when the preliminary findings and draft plan of analysis are ready and
third when the draft report or book is ready. In projects of shorter duration, second and third meetings
are combined. The subjects providing information, if not each individually then at least in the meetings
organised in the village or neighbourhood, are informed about the individuals on the ethics committee.
The reports also give names and addresses of the ethics committee members, and
the ethics
committee desires to give a written report on the ethical issues encountered, respected or violated in
the process of research, it is appended without any change to the report.
(2)
Informing subjects and participants:
This provision applies all works involving primary data collection and provision of service. We believe
that people answering questionnaire (“respondents”), providing information for qualitative researew
utilising conventional service provided or service provided as a part of research or experiment, have
inalienable right to know about it. All works of the CEHAT respect this right and efforts are made to
use various methods to put it in practice. Some of the methods used are as follows:
When surveys are conducted using service of investigators, before starting the canvassing of
questionnaire the investigators along with the members) of research team spends at least a day in the
community to explain the purpose of research. This is done by otganising village, basti or
neighbourhood meetings, by giving simply worded written material the language people understand or
by both. The information normally has (1) purpose of research, (2) who is doing it (about CEHAT
and research team), (3) others associated with it (consultants and ethics committee), (4) why that
particular community, and within that only certain people, have bee selected, (5) the individuals or
households selected for the survey have a right not to respond, (6) that no benefit would directly
accrue to anybody responding to the questionnaire, (7) what use of the information thus gathered
would be made and (8) that a summarised and simply worded findings in their language will be sent to
each person responding to the questionnaire.
In the qualitative and other researches, in addition to providing the above information, longer duration
of time is allocated for direct interaction with the community. For collecting information as participant
observer, even at the risk of disturbing their normal pattern of behaviour, our purpose of being their
and participating in their community life is made known. In researches and works involving longer
duration of interaction, if we do not intend to stay with the community at the completion of such work,
the same is made known. Similarly surveys or works involving medical examinations and diagnosis are
undertaken only if we have resources to provide primary health care level treatment to those who are
found suffering from ailments.
Needless to add, all community level works must be sensitive and respectful to the culture, belief
systems and other aspects of the community. The researchers are encouraged, if they so desire and are
able to make adjustment with their work commitments, to keep in regular contact with the people with
whom they completed a study or work.
4
(3)
Taking findings to subjects and participants:
We believe that respecting right to information of subjects and participants necessarily extends to their
right to know the results of work they participated in. Accordingly, findings of work are communicated
to them either in printed form or by sitting with them in a meeting or both. For an institution sustained
primarily on projects, there is a real problem of resources and time as the concerned individuals move
on to the work on the next project. Thus, care is taken to integrate time and finances needed for this
into the proposal itself, but in the event of that being not feasible, the CEHAT takes the responsibility
to raise, spare funds to accomplish this work. Even if there is delay in communicating results, as a
policy it is not allowed to be used as a pretext to dispense with this task. As soon as resources and time
available, work is accomplished without fail.
Organisational structure and functioning
The objective of making CEHAT a democratically managed institutional structure is also more difficult
to achieve in practice. There are not many living examples of such institutional functioning for us to
follow. However, we are learning from our own and of others’ experiences and making sincere efforts
to avoid pitfalls of highly bureaucratised structures on one hand and the loosely structured personality
dominated organisations on the other.
The functioning of the CEHAT is structured on the following five principles:
(1)
The institutional democracy, while vesting formal rights to participants, demands responsibility,
sincerity of work and optimum efficiency from them. (2) Creation and effective working of the formal
bodies to facilitate democratic participation, decision making and implementation of decisions. (3)
Accountability of each person, irrespective of his/her position in the institution, to such bodies, and the
larger social accountability of the institution. (4) Maintenance of informal and respectful interaction
within the hierarchy of position and tasks. (5) Periodic rotation of Coordinatorship and encouragement
with training to deserving and interested individuals to make this possible,
Coordinator:
The Coordinator is the director of the institution. The change in the nomenclature is to reflect change
in the manner of exercising authority, method of work and temporaiy character of responsibility
assigned to an individual. The idea behind it is that as a core group of committed individuals evolve,
the “directing” should give way to “coordinating”. This indeed heavily depends upon increasing
number of talented individuals giving long term commitment to the institution and their readiness to
undertake greater responsibility of collectively building and running the institution. Further, the
coordinator exercises authority as vested by the Working Group (WG) in daily administration, has
discretionary power when the WG fails to reach a consensus, and in the event of his/her over-ruling of
the majority decision of WG, the same is brought up within a specified time for discussion with the
Governing Board (GB) or Trustees.
Working Group(WG):
The WG is the core forum for executive decisions, such as identification of work/research areas,
obtaining funding support, fund allocations, external reporting, project administration, growth
planning, staff recruitment and development etc. The WG appoin ts a coordinator from within and
decides his/her tenure. Thus, the WG is also a place for training the future coordinators. The WG is
collectively accountable to the GB and the Social Accountability Group (SAG). The membership to
WG is on the basis of aptitude and talent of individuals, and is given on the consensus decision of the
existing members of the WG. In course of time, as the more number of individuals decide to give long
5
term commitment to CEHAT, we intend to effect a periodic tum-over in the membership by a
proportion of members retiring every one or two years and new ones taking their place. The optimum
size of the WG is not less than 10% and not more than one third of the total staff of the institution.
The WG meets at least once in a month.
Governing Board (GB):
The Trustees of the Anusandhan Trust constitute the GB of CEHAT. Thus, they are finally and
legally responsible for the institution. We believe that trust in order to make a balanced and healthy
development of the institute possible, tire trust should neither be concerned with the day to day work,
nor it should be completely aloof, looking only at the balance sheet at the end of the year. Thus, in
addition to having the statutory responsibility, the trust undertakes two functions: (1) Interacts with the
WG and L . staff for framing the basic policies related to work and its development, and (2) Acts as
the final forum for resolution of disputes within the institute. The GB meets at least three times in a
year.
Social Accountability Group (SAG):
While all NGOs are supposed to be public endeavours, except meeting the requirement of the law»
there is little transparent attempt made for showing public accountability. The CEHAT is makin™
sincere effort to inculcate a sense of public and social accountability in the individuals associated with
it and in its work. The SAG represents a mechanism for the CEHAT to undergo such accountability
and to make the results of it known to people. The SAG normally meets twice in a year.
The SAG consists of the following five individuals having long standing experience in public work:
(1)
Dr. Sunil Pandya, Head, Dept of Neurosurgery, KEM Hospital, Bombay, and Chairperson,
Forum for Medical Ethics Society. (2) Dr. Neera Desai, Head (Rtd), Dept of Sociology and Director
(Rtd), Research Centre for Women’s Studies, S.N.D.T. Women’s University, Bombay. (3) Dr. S. L.
Shetty, Director, EPW Research Foundation, Bombay. (4) Prof. Ravindra Soman, National Institute
of Virology, Pune. (5) Dr. Ash win Patel, Director, Trust for Reaching Unreached, Baroda.
The SAG was constituted and the first meeting to define its role took place in October 1995.
Accordingly, the SAG would obseive the progress as compared to the aims and objects, assess the
social relevance of the work done and the general social relevance of the CEHAT as an institution^
From the year 1996 onwards, the SAG will prepare its own report on these aspects and the same will*
be published, without any change by the CEHAT in its annual reports.
In order to facilitate this task of the SAG, its members regularly receive, (1) Minutes of the Trust/GB
meetings, (2) Copy of all internal discussion documents, (3) Summary of reports of the work done,
and (4) Any other material desired by the member.
Financial support and salary structure
Core fund and core staff:
The CEHAT began with high social objectives but without any core fund to provide financial support
to the work and the staff. In the first three years all work was done by the concerned individuals
making non-paid voluntary efforts. However, as the scale of work increased, the corresponding need
for finances increased too. From 1994 onwards, this is being met by making tire major aspects of our
work into well defined and time bound projects on which the staff take temporary employment. Thus,
all individuals working at the CEHAT ar e employed on a project-to-project basis. This basis financial
6
constraint is a big hurdle in ensuring long term commitment of the core staff to the institution, and is
therefore, also a potential disrupter of the internal democratic process. We are acutely aware of the
necessity to overcome this difficulty so that in a course of time, at least the core staff is provided
relative employment security. The following three efforts are being made in this direction:
(1) We are looking for agencies which would like to provide basic stability to our endeavour by giving
corpus funds and endowments. We also make efforts to persuade individuals and agencies to give
generous donations for the objectives of the institution.
(2)
We generate small funds by undertaking consultancy and specific tasks for various agencies and
institutions.
(3)
We are also looking for a permanent office space in Bombay as well as in Pune.
Salary’ structure:
Although at present the CEHAT is run on project-to-project basis and employment of all staff
members is temporary, we try to pay reasonable salary to the staff. For this the CEHAT has taken the
following steps:
(1) All full-time employees and regular part-time employees are put on a salary scale.
(2)
The CEHAT salary scales are kept as close to the University Grant Commission scales for the
university teachers as possible.
(3)
As a good tradition, the employees are covered under the social security, irrespective of whether
given the size of the institute the relevant laws for it are applicable or not. Thus, provident fund (till we
have a staff of 20, tire payment of employer’s contribution in the PPF account), Graduity (given the
project based employment, made applicable at one year’s service), termination allowance (when
employment is terminated by the institution due to completion of project or other constraints), etc. are
paid as social security.
(4)
A care is taken to ensure that no regular employee is paid less than the minimum wages as
applicable in Bombay.
(5)
The ratio of the emolument received by the lowest level regular employee to that of the highest
level employee is maintained at less than 4.
CEHATs priority themes
After intensive debates, creation of a body of literature and involvement in research and action, the
CEHAT has identified four prioroty themes for its work in Research, zlction, Service and Advocacy
(RASA). These themes are of course not fixed categories, they are evolving as we gain in experience
and expertise. These themes are:
(A) Health services and financing, (B) Health legislations, ethics and patients’ rights, (C)
Women’s health, (D) Investigation and treatment of psycho-social trauma.
The individuals working at and associated with the CEHAT have contributed in evolving perspective
and a body of literature consisting of published papers, resear ch studies and databases on each theme.
Some of the studies completed or presently on are also encompassing subject matter of more than one
themes. In last five years, a core team of researchers and activists having expertise on each theme has
been consolidated at the CEHAT.
7
1
ACTION TAKEN BY THE ANUSANDHAN
TRUST ON THE SAG REPORT
Dhruv Mankad
Managing Trustee, Anusandhan Trust
Ravi Duggal
Coordinator CEHAT
At the outset we.thank the SAG members for their interest and concern with the wotk of CEHAT
and giving their time over the last three years, despite their very busy schedule. This being our
own first experience with trying to understand social accountability'of CEHAT's work, we have
both learnt and unlearnt a great deal We acknowledge the courage and efforts of the SAG
members to be a part of this process about which all of us were still tn ing to learn and gather first
hand experience. It has indeed been an enriching experience from which we can now take the
process of social accountability (SA) forward with greater confidence.
As mentioned at the beginning of the report, we acknow ledge that there is indeed a need to seek
further clarity on the concept of social accountability and setting better defined criteria, tools and
modus opcrandi for it. Having gained some experience we arc definitely in a better position to
develop a more appropriate framework and guidelines, and if need be we will seek consultation
from an expert on SA.
As regards various comments and suggestions by the SAG we are giving a serious thought to
these. Certain steps being taken to full'd the expectations expressed by SAG are outlined below. It
-may be pointed out that after the last SAG meeting, in which ("ehal's work was presented, certain
developments have already taken place in this direction. They are refected in the paragraphs
below:
I.
The SAG Report mentions that wc need to have in place a specific plan as to how we address
specific nccds/conccms of oppressed and disadvantaged people. In projects like the ‘data-base
project’, though they arc socially quite relevant in changing policies in favour of the oppressed.
such direct linkage with the immediate needs of the oppressed people would not be possible.. But
in choosing other projects, wc will pay more attention to this aspect, as this is a central concern of
Cehat. Further, the SAG Report also speaks about the use of outcomes of the research towards
this aim. CEHAT during the last year has become increasingly active on the advocacy front
influencing policy and planning at one level and collaborating with peoples’ movements, human
rights groups, NGOs. public institutions, academia etc., at the local, regional, national and
international levels. Research being planned in the near future will be strengthening this aspect
further.
2.
With regard to staff orientation, decision-making processes, devolution of responsibilities the
SAG has complimented our achievements but we feel a lot more needs to be done. Even though
we have a democratically elected Working Group (WG). its confidence and strength in taking
over greater responsibilities in decision making and carrying a larger burden of administrative
and organisational accountability needs building up. Towards this end. at one level, a process of
staff development has been enhanced and will be carried forward Research skill development
through an epidemiology workshop was conducted in which nine researchers from CEHAT
participated; researchers were encouraged to participate and make presentations in conferences at
regional, national and international levels; researchers and staff were encouraged and supported
to volunteer time in various development initiatives, etc. At another level a lot of discussion has
taken place as to how to strengthen the WG so that it becomes the decision making body of
CEHAT. In the next couple of years we should be moving much ahead on this front. One
immediate action we have taken is that at least twice a scar the Trustees and WG would have a
joint meeting making the governance structure further transparent, accountable and democratic.
3.
The SAG has also suggested that we have a greater collaboration with peoples' movements,
other NGns etc. This is already a growing strategy in CEHAT's work. We arc training health
workers
people’s organisations, in slum communities. We arc bringing together NGOs and
academia to address concents like ethics in social science research and development work; we arc
collaborating with local governments in cities and rural areas in strengthening public health and
reorienting it to felt needs of local communities. In collaborative research; we arc working on an
action research program along with the Bombay Municipal Corporation to help them set up a
Onc-Stop-Crisis Centre in one of their larger hospitals, w hich will help victims of violence. We
are documenting and disseminating dossiers on issues of public concern - the first one on
domestic violence has been completed and others on private health sector, abortion, quality of
care etc. arc being planned.
4.
For reaching out to people apart from the dossiers mentioned above strengthening of the
CEHAT library is high on our priority list. We have offered our infrastructure for becoming a
clearing-house for information and documentation on issues of public concern in health. We have
set up a web-site also to fulfil this objective. The concern expressed by SAG about reaching out
to people with literature in Marathi and Hindi languages is shared by all of us. And efforts arc
being made in this direction so that in the next few years a much larger proportion of
documentation coming out of CEHAT will be in Marathi and Hindi.
5.
Finally we would like to respond to the concent of the SAG with regard to future stability of
CEHAT and linked to it questions raised about funding sources. We share their concern and
would like to point out that this has been a constant debate within Anusandhan Tmst and
CEHAT. We have now reached a juncture in our growth where this concent has acquired a
greater significance since we have reached a more or less optimal size. We have to now'
consolidate and stabilise. This means a more serious look at financing sources, which arc not
projectindent. We arc presently negotiating with one of the donor agencies a more
comprehensive grant, which includes a strong component of institutional development. In this
context acquiring our own place becomes quite crucial and we arc working towards that.
Similarly we are diversifying our base of funding sources. Senior researchers arc taking up
consultancy assignments, which bring in direct incomes for the Tmst and this is helping us build
our own resources. As suggested by the SAG we have to plan to raise resources within the
country in innovative ways. We have to work out an action plan for this at the earliest.
The SAG's concluding remarks in the paragraph relating to funding about CEHAT maintaining
its freedom to publish and being independent from donor doctoring of our work are highly
appreciated by CEHAT. In fact, this is the main concern when negotiating with any funding
agency for a new research proposal. Several donor agencies have acknowledged this.
,
2
SOCIAL ACCOUNTABILITY OF CEHAT
A REPORT
Dr. Nccralrcn Desai
Dr. Ravindra Soman
Dr. S. L. Shetty
Dr. Ashvvin Patel
Dr. Sunil Pandya
(Facilitator: Dr. Molian Deshpande)
October 1999
We, the members of SAG (Social Accountability Group) arc happy to present the first and the
much-awaited report on Social Accountability of CEHAT. What follows docs a combined effort
on our part to understand and give justice to the very concept of Social Accountability and to
apply it to this organisation. While we began the task, we soon realised how complex the concept
is in the actual operational terms and how difficult it is to deal with, even though it is generally
appreciated as a value to be cherished.
The Concept, Areas and Scope of Social Accountability
The terms, ‘evaluation', ‘social audit' and 'social accountability' look quite synonymous. We
would at the outset like to differentiate these concepts from each other and then assign to
ourselves a more specific task of social accountability Evaluation is a generic phenomenon which
measures processes, impact etc. vis-a-vis objectives, norms and envisaged impact stated by the
programme under evaluation. Social audit is a specific kind of evaluation which is guided by the
notion of social accountability, and aims to examine whether the programme and the processes
involved in operationalising it and its impact are socially relevant, and useful. Tools used for such
social audit arc usually devised externally by social auditors. Social accountability (SA) on the
other hand is more of a continuous process, evolving constantly by the programmc/organisation
itself guided by internal need, and which wants to be socially accountable. This is true even when
the tools of social accountability are not consciously designed by the organisation. In such a ease,
it is necessary to locate tools in tire stated objectives and in the actual functioning of the
organisation. .
We felt that certain areas as regards SA should be considered in the context of CEIIAT and its
work so far:
• Relevance and Utility of research conducted (content of themes, and outcomes for the society
or tire section of society for which it claims to have worked).
•
Processes involved in operationalising the research programme.
•
Functioning of the programmc/organisation: Norms and Values (ethical norms while
selecting themes, sources of funding, devising methodology, democracy, transparency.
simplicity, interaction with other organisations etc )
The quintessential aspects of social accountability are just three: (a) the democratic functioning of
the organisation; (b) upholding of social concerns in conceiving and reporting research projects;
-and'(c) ensuring ethical standards in selecting sources of funds for the organisation and its
activities.
The scope of social accountability of CEI1AT is determined by its objectives, which are:
• To conduct research and action research on topics of importance or interest from the point of
view of people's movements. .
• To interact with programme movements in related areas, such as women's groups, trade
unions and campaigns or oiganisations involved in human lights issues and provide issues for
•
research.
To icc.tify research priorities in health at local, national and international levels, the findings
of winch will be of use to progressive groups or movements and which will directly or
indirectly benefit oppressed sections of the society.
Obviously, one would like to see whether these objectives are reflected in dcciding/sclccting
research themes and in follow-up actions with people's movements, progressive groups, deprived
sections of the society and with advocacy groups. It is also equally important to see whether the
norms and actual functioning of CEHAT are congruent with these norms and values which the
progressive movements and groups cherish and try to practice.
Though as SAG we arc not expected to evaluate the research projects per sc from academic point
of view, we feel that the focus of research and broad mcthodologv need to be evaluated
particularly when we contend that the respondents arc not mere ‘samples' in the studv.
A very crucial issue in social accountability is the sources of funding. This has been dealt with at
the end of this report.
Limitations
Lack of adequate interaction with CEHAT team: The SAG could not spare enough time for
interacting with CEHAT staff members for the purpose of social accountability.
There was not enough clarity as regards criteria to understand the actual functioning of CEHAT.
This was partly due to the lack of time on the part of the Sz\G members and partly due to inability
to evoke modus operands for such interaction
Only one tool i.e. a questionnaire evoked by SAG was used. The questionnaire w'as
I'llled/answcrcd by the concerned CEHAT teams quite meticulously and it helped us a great deal
in understanding various facts of CEHAT and its work. But this in fact highlights the need for an
in-depth interaction with researchers that would have certainly brought out a better result.
Methodology
Since the entire concept was new and our experience as SAG was fresh, having no blue-print at
hand and with the above limitations, no explicit methodology was devised, except the
questionnaire so laboriously answcied by CEI lAT-lcams Besides this, following meetings and
materials contributed fruitfully.
•
A number of SAG meetings at the CEI 1AT office.
•
Reports of Staff meetings.
•
•
•
•
•
Minutes of Trustees meetings.
Document containing rules and regulations of CEHAT.
Meetings with the staff at Khandala.
Reports of WG (Working Group).
Auditors' reports.
Report of evaluation of the Co-ordinator of CE1IAT.
Workshops organised by CEHAT
CEHAT’s Publications.
We have been receiving these documents regularly since the time we accepted our present role.
One remarkable and praise worthy tradition nurtured by CEHAT is the transparency and that of
sharing information by sending all document, reports of meetings, publications etc. to us. It shows
sincerity and willingness for honest social accountability. While reading/through these documents
and questionnaires we witnessed genuine efforts to develop and stabilise democratic traditions.
CEHAT also shared with us the problems (and their probable solutions) encountered in such
democratic functioning.
We distributed the areas of research projects among ourselves in one of the SAG meetings and
began examining each of the CEHAT projects through questionnaires. The areas were i) Women
and Health ii) Health Services and Financing.
Our findings and recommendations
The projects arc generally in line with the objectives of CEHAT. Most arc related to social
science research. There is a conscious effort at incorporating social accountability in the project
itself.
There appears to be a keen awareness at the senior level about the importance of the perspective
of the research team.
Most of the projects arc selected as a follow up of previous studies or assessed needs of larger
society, rather than specific campaigns or movements. A specific plan should be worked for
identifying the felt needs of the movements and the oppressed sections. Study proposal should be
reviewed critically regarding specific use of findings for the disadvantaged.
So far as the use of outcomes of various projects in concerned. CEHAT needs to work out a plan.
'Strategies to influence the policy, strategies to reach out to people’s movements and oppressed
sections, follow-up action in the Target group, and the use of the findings by other groups - all
need to be emphasised more than what it is today.
For the purpose of realisation in practice the above stated goals of CEI IAT. we are of the opinion
that it is imperative for CEI IAT to have a stable, continued and assured existence. Onlv this will
enable the organisation to carry out necessary extension programmes, fellow up actions etc. based
on the results obtained through various present investigations.
Enough has been said earlier about the norms, values and functioning of CEHAT. ‘They’ are
evident from the documents and what we saw and experienced through the limited interaction.
The values are pro-people research, participatory and democratic functioning, accountability,
efficiency and competence.
There arc a number of mechanisms and dynamics for participatory and accountable intraorganisational functioning that have been consciously evolved in CEI IAT. These arc:
• Clear personnel policy.
•
Delegation of power and responsibilities to the WG (Working Group) which also has many
pow ers of decision-making.
•
•
•
•
•
•
•
Grievances Redress forum.
Decision making systems and processes are outlined without ambiguity.
Responsibilities of indiv iduals and teams arc specified.
Methods of evaluation of the members and teams have been clearly outlined.
Information showing with SAG (an outside group) and the WG (inside group) remarkably
efficient.
Evaluation of the functioning oftlic Co-ordinator of CHI IAT.
Organising workshops for critical review of the projects at various stages.
The projects arc generally well designed, showing keen awareness about professional acumen
required to design especially the methodology part of it. However CEHAT need to pay more
attention to action and advocacy after the projects bring out significant results. Though there has
been some effort at preparing material in Marathi/Hindi, we suggest that for reaching out to the
community at large, more concerted efforts arc required. For this and also for advocacy on
various health and health related issues and about the role of the state. CEI IAT will have to plan a
policy - "working with other NGOs and groups
Ethical Issues as regards funding
In the context of globalisation and the pursuit of liberal economic policy, the issues of selfreliance and indigenously based development have lost their earlier significance. Yet it still
remains too important an issue for an institute like CEHAT to gloss over. It may now appear
more difficult than in the past to apply any cut-and-dry yardstick in choosing the source. Even so,
it should be possible to lay down some broad rules for accepting funds.
It is necessary to get a profile of the funding agency, its history, objectives and priorities hidden, written and spoken.
Priorities and interests of the funding agencies have to be juxtaposed with those of CEHAT and
Anusandhan Trust, to ensure that there is no violation of the mandate while accepting the funds.’
'This is applicable even to the public/govt. agencies in India.
The objectives of the specific funded project should be acceptable to CEHAT and they should
help build the organisation.
It is necessary to insist on freedom to publish research results on our own, without they being
doctored by the funding agency, flic publication rights should cover both the primary results and
that of any offshoots of the research endeavour that the project may generate.
We arc happy to say that tire broad principles stated above arc generally observed by CEHAT.
The trustees are quite aware of the ethical issues and they seem to have debated on these issues
very often. Individual professionals have undertaken many projects without expectation of
rewards or remuneration. But the existing knowledge about ethical issue and principles of
accepting funds is not adequately reflected in some of the responses given by the project-chiefs.
(Ontfof them has raised doubts of the validity of the question itself!) It is necessary for the senior
members of the institution to share their thoughts on these issues with other staff members and
the new entrants as well.
4
Anusandhan
A note for (potential) Social Accountability Group (SzXG) members for CEIIAT.
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,
|o 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 dial initially there could be a centre for research, but if die need
arose, Anusandhan would initiate other centres as well.
CEI IAT (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 die past six years CEHAT 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 (vn) social accountability in all its units. When CEHAT was started,
structures for implementing these values were gradually put in place.
Plie Trust Board of Anusandhan - since the very beginning - realised that merely constructing structures
was not cnuuji to ensure their effective purposes.. Anusandhan believes that just as featuring of financial
audit report is mandatory' in a company's report to die public, social audit report must also be a
responsibility of an organisation in its report to the society in w hich and for which it exists. Nonetheless,
Anusandhan also is alive to die ground realities. While norms for financial audit arc tangible and
quantifiable and by and large universally accepted, diose 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 are difficult, if not
impossible to quantify and measure.
Rather than wait until such proceduics 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
intcj^itv, sensibilities and ability to critically review all tfrai went into the work oj its centre and along
with it the output of its work, it would be mandatory to include (attach) report of SAG along with llip
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 who 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'/'datc). the first SAG - comprising of
Dr.Ashwin Patel, Dr. S L Shctty
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 the Trust's centre in the way the SAG deemed it fit.
For this purpose,
CEHAT provided extensive material that was generated in the centre (c.g. all papers / reports published
and unpublished , minutes of the Trust Board Meetings, the Staff meetings, rules & regulations & salary
structure of CEHAT, etc.).
Reviewing the exercise of SAG
now. the 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. This 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.
At present, CEHAT 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 I She has duties &
responsibilities towards (a) the Trust, (b) the administrative wing (accounts / personnel etc.).
the research wing, the external contacts. I Ic / 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 invoked 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 the wage structure are made, a meeting
with staff is organised and the subject is throw n open to debate.
4.
In order to nurture collectivism, democratic practices and effective space for communication
within personnel and to evolve leadership qualities within the staff, the Centre has instituted
a Working Group (WG). WG has elected representatives fiom both the Mumbai and Pune
offices. The WG meets once a month.
flic Co-ordinator is an ex-officio member of the
WG. Expenses (travelling etc.) arc borne by the Centre. Elections to the WG arc held every
2
year and any member of the stall’ is eligible for this.
I he 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 are 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. 1 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 the staff, changes in
administrative / accounting as also the hurdles and difficulties in the procedures etc. And any
other personnel matter. Often the 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
k
of die staff.
It also can (and hopefully does) provide space for harmonising personnel
matters.
6.
The Centre has put in place the Grievance Rcdrcssal 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 die duties
of the accounts wing.
8.
Research Projects are submitted by the Centre for funding.
These projects are drawn out by
the Principle Investigator (Pl) and discussed within die staff and the WG. For every’ research
I
project (involving primary data collection) setting up of
Ediics Committee (EC)'is
mandatory. This EC reviews the work at die 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. CE11AT sends the minutes of
the Staff meetings to SAG and the Trust Board Members. CEHAT also sends the minutes of
GRS to SAG members and the Trust Board
10.
The Trust Board Members and the SAG members are encouraged to meet the staff.
.Trust Board and the constitution of new SAG.
Tmst 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 die 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. 1 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 CEI1A F
•
On transparency of CEHATs work within the Centre and with the outside environment.
•
On Worthiness of the output of CEHAT - preferably with respect to individual projects and
administration
•
•
On honouring cdiical concerns
On the aspect of CEUATs
provision of space for nurturing excellence and leadership
qualities of individuals on the Staff.
•
•
On CEUATs interaction with other Organisations
On die space and nurturing of democracy and collective functioning within the Centre and
between Trust Board and Centre.
•
•
On CEHATs growth and development
the Gricvcncc Rcdrcssal mechanism and functioning and effectively of it
•
On the quality of research and shortfall in the area
•
Odicr areas diat SAG may diink pertinent and important.
Anusandhan believes dial with a written request to SAG. it may facilitate the SAG to include the items in
its report to the Trust on die one hand and to die Public on the other. It will be a binding for Anusandhan
Trust to publish (as attachment to its own Report) the SAG report and to state its response to SAG report
in form of ATR and what is not taken up for action widi explanation to the Public.
Facilitating the functioning of SAG.
For facilitating the functioning of SAG, CEIL\T had been furnishing to SAG (on a regular basis) (a)
reports ofthc research work published and unpublished (b) die minutes of Stall'Meeting and any request
diat SAG makes. The minutes of WG arc not sent (because these take place every month and arc mainly
relevant to the staff co-ordination) (cbcck’if thisiscorrect) 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 the deliberations
at Trust Board meetings.
CEHAT helps SAG in organising venues for SAG meeting and rp-imburscs 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 CEHATs funds. Also to facilitate administrative work of the
SAG, - particularly in the 3,J year (when die written report of the SAG is sought) the Trust will provide
funds for a secretariat (of one or two persons) tliat 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 CEHA1
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 CEHAT 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 the end of which a social
audit report will be produced.
The SAG will get all secretarial assistance needed by them from CEHAT. 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 CEHAT and discuss amongst
themselves. Also they should meet and hold discussions with all staff members at this meeting. The SAG
members may choose to review the work of CEHAT selectively as per their area of interest etc.. This the
SAG merr.be: s must decide at their first meeting. At this 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 their annual meeting must be sent to the Trustees. The
members arc also free to send feedback to the Trustees as and when they desire. At the end of three years
the SAG should earn' 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 die next Annual Report of CE11AT / AT.
Ravi Duggal
24,h Oct. 2000
Social Accountability and Social Audit of NGOs
Some loud thinking for an approach to conduct it.
NGOs (or Voluntary OrganisationsfVO], 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 lacking1 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 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
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 are 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 Tor 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 practice(s) has (have) also carved out
ingenious methods for 'hiding' / or camouflaging / or colouring fiscal picture. Auditor's work
(in this area) is to 'monitor* '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 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 is. 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 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. I 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. I do not know for sure, but for brain storming I am enlisting some
'heads' and elaborating on these wherever 1 can. (See below)
•
•
Worthiness Indices
l_n.ve.stment_w’orthi.ncss index
»
In an Organisation like CEIIAT 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 increment in
'worthiness ' Again the more investors would mean a signal for greater perceived
worthiness by that investor segment. A. 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
constiucled. This index could be liom the investors tingle. Likewise theie could be those
from the point of view of (1) 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 / support
Debt : Equity ratio (A little diversion for the moment)
This is a thumb rule popular within the Corporate circles. "If the Share-holders are 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 efforts (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 product of 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.
Does this mean everything that goes on within the
Organisation is out on display? 1 think not. There arc 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 he 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 miormation (even if that calls for a payment of a fair fee) about CEHA T 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)
In Hospital accreditation programme - a new approach to zero-in segments from varied
"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)
This is yet another innovation to defeat copy-right madness.
This 'value' could be
subjected to 'scoring'
o
Outreach accessibility
i
To be worked out.
Internal democracy - How much? How effective exercised? How fruitful in nurturing
0
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 stall) 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 1-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 developmentjndex.
(In house poll Entrance poll / Exit poll) The entering stall' 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 eooliny period, say of 6-months This
score (it is believed) is useful..
Intra-Organisation personality gradient. - Space score / involvement score / belonging score
5
In house value nurture index - ethics-ethos / social justice index / empathy index I openmindedness 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
and 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 not dose, 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 score for each. It is expected that
scoring of individual evaluators follows a (^)~ctt^ve
If it happens to be olhcrwisc'\^y/the
evaluators need to be changed -
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.
'1 here are 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
•
to peer Organisations
7.
Slippery slopes and Iceberg technique.
It is important to be aware of areas with slippery slopes and Iceberg technicpie 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.
- 2-6 •
VOLUNTARY HEALTH ASSOCIATION QF KARNATAKA
Place: Conference Hall
St.Martha's Hospital
Nrupathunga Road
Bangalore - 560 001
Date: Sunday 21, July 2002
Time: 10.00 a.m. to 1.00 p.m.
SEMINAR
THEME: INTEGRATION OF DIFFERENT SYSTEMS OF HEALTH CARE
PROGRAMME
9.30 to 10.00 a.m.
Registration
10.00 to 11.00 a.m.
INAUGURATION
- Invocation
- Welcome
- Lighting of the lamp
- Inaugural address
Dr.A.B.Malaaka Raddy
Hon'ble Minister for Medical Education
- Keynote address by
Dr.R.M.Varma
Emeritus Prof.of Neuro Surgery, NIMHANS
- Vote of thanks
TEA BREAK
11.00 to 11.15 a.m
11.15 to 1.00 p.m.
Panel discussion
Chair Person - Dr.R.M.Varma
Ayurveda
Dr.K.SJayashree
Prof. Govt. Ayurvedic College, Bangalore
Homeopathy
Dr.B.N.Prakash
Principal, GovtHomeopathy College, Bangalore
Allopathy
Dr.K.S.Gopinath
Bangalore Institutte of Oncology
Unani
Dr.Roohizaman
Lecturer, Govt.Unani College
Yoga
Dr.Shamanthakamani Narendran
OPEN HOUSE
Concluding remarks
Dharmadarshi N.C.Nanaiah
President, VHAK
VOLUNTARY HEALTH ASSOCIATION .OF KARNATAKA
Date: 22nd June 1998
VHAK/98/C-1/Prog.
Dear Sir/Madam,
fae are grateful to Member Organisations who co-operated in
materialising VHAK Programmes during , the previous’ years.
Some of you have not participated and we do not want to
keep you out of.it.
'A'e are very much concerned about your
involvement.
This year we are taking up the following programmes which
may be, your area of interest.
The details of the programmes
are given below for your kind co-operati»n to organise and
conduct the same.
S.l.No.%
Programmes
Duration
1.
Traditional Systems of Medicine
3 days
2.
Village Health worker's Training
10 days
3.
Health for Non-health
(for Developmental workers/ ■
Gram panchayat members)
3 days
3 days
5.
School Health iJrogramme
(Schools Teachers)
Training of Traditional Birth
Attendants
(for Dais)
6.
STD and AIDS Training
4 days
7.
Women & Health
5 days
4.
5 days
FxOxjrawjaesi would he f i na 1-i c od on first, come first serve
basis.
Please specify the programme you are interested to take up
from, the above mentioned and fill in the enclosed format
and send it back to us by 15th nf July 1998to enable us to
finaljse the calender of programmes.
We solicit your kind co-operation in realising the above
programmes. Please feel free to write back to us for any
further clarifications;
with kind regards,
Yours Sincerely,
(t.n^fraJjakshl)
Promotional Secretary
encl: as abovp
VOLUNTARY.HEAL TH. ASSOCIATION.OF KARNATAKA
TRAINING ..PROGRAMME APPLICATION
NAME OF THE ORGANISATION
:
POSTAL ADDRESS
:
TEL.CODE:
FAX:
TEL.NO;
TELEGRAPH
CODE:
PERSON IN-CHARGE OF THE PROGRAMME.
DESIGNATION
VENUE OF THE PROPOSED PROGRAMME
:
DURATION & DATES OF THE PROGRAMME:
NO. d. NATURE OF PARTICIPANTS
TRAINING NEED IDENTIFIED (tick
one)
Health for Non-Health / Training for Traditional Birth
Attendant's / Women & Health / Traditional System of Medicine /
Mental Health / Communicable Diseases / Family Welfare
Education / Environmental Sanitation /'HIV & AIDS Awareness /
School Health Programme / Any other (Specify)
WHAT DOES THE PROPOSED TRAINING PROGRAf/iME ENVISAGE? .
(brief statement)
SUBJECTS CONCERNEDf
a
■
;r
1 .
3.
4.
5.
6.
7
RESOURCE PERSONS
(give maximum information)
3
- Commiting any expenses other than those specified
above will be subjected to the availability of
resource with the concerned organisation. Most of
the organisations have their own designated resources
for such causes.
- Food provided should be akin to people's day to day
consumption, befitting the local traditions.
- In addition to VHAK personnel, assistance of locally.
available resource persons may be availed in order to
be able to nurture and enhance local participation and
to ensure effective communication.
- VHAK does not encourage honororium and the such to
resource persons; however would consider minimum
local conveyance expenses.
VOLUNTARY HEALTH .ASSOCIATION. OF .KAR.r4ATAKA
MINUTES OF THE .ANbUAL.GENERAL BODY MEETING
HELD ON.
SATURDAYx THE.23RD JUNE. 19.9.8 AT VI'SHRANTHI ...ILAYAM*,
INFANTRY ROAD,.. BAi'vGALORE - 560 001..,
The Annual General Body Meeting started at 2.30 p.m. with the
1 ^-iluvvxiiy
1.
2.
ayeilua,
.Invocation
Roll Call
3.
Welcome address
4.
Presentation of minuses of the previous Annual General
Body Meeting held on 19th July 1997 and adoption.
5.
Presentation of Annual Report for the period 1997 - 93
6.
Presentation of Annual Audited Statement of Accounts
for the period 1997 - 98.’
7.
Appointment of Auditors for the year 1998 - 99
8.
Presentation and adoption of Budget for the year
1993 4 99
9.
Policies 8 vital issues:
10.
Any vther matter
Nursing Home Bill
The President Dr.H.Sudarshan took the Chair and called the
meeting to order after observing one minute silence.
There were 24 members representing 21 Member Institutions.
The President welcomed the members of the Executive Committee
and the representatives of the organisations.
The minutes of the previous General Body Meeting held on
19th July 1997 at St.John's'Medical College, Bangalore;
was presented by the President and accepted by the General
Body.
It was proposed by Mr.Venkatesh, RLHP and was
seconded by Mr.R.3.Hiremath, I.D.S.
The Hon.Secretary, Dr.S.M.Subramanya Setty presented the
Annual Report, Highlighting the calender of events and
various programmes organised by the VHAK.
He gratefully
acknowledged the co-operation extended by the Government
and Member Organisations in making the programmes
successful.
Commending the success of the Training in Traditional
Systems of Medicine, he underlined the need for VHAK''to
assume the responsibility to co-ordinate the RCH
Programmes.
. . . .2
2
He also called for greater participation of the Member
Organisations to make the programmes of the VHAK more
meaningful.
This report was
proposed by
Fr.Sebastian Qusepparampil, Administrator, St.John's Medical
College Hospital and seconded by Mr.Neelaiah, PMSR and the
Annual Report was accepted by the General Body.
The Audited Statement of Accounts for the year 1997-98 was
presented by the Treasurer, Mr.Kumar.
An ambiguity under allowances for conveyance and travel was
satisfactorily clarified by the Treasurer.
The Hon.Secretary explained the need for additional financial
requirements and'sought the Mem.ber Organisations to suggest
ways and means to mobilise local resources.
Increase in
membership and prompt settlement of subscription dues Were
identified as ideal measures.
Appreciating the commendable contribution made by the
: Treasurer in systematising and•presenting the accounts, the
I President suggested the need for appointing a part time
| accountant.
The President ‘-as eApressed his concern about the inadequacy
fcf space and such other amenities fer the VHAK and stressed
the need for a own office premises.
Towards this, he
suggested mobilisation of grants and loans from.appropriate
sources and called on all the Member Organisations to
contribute their best. The audited statement of accounts
for the year 1997-98 was accepted by the General Body
after it was proposed by Mr.weelaiah, PMSR and seconded
by Ms.Lily, Sandeep Seva Nilayam.
Discussing over the appointment of Auditors for the year
1998-99 it was unanimously decided to continue with the
present Auditors viz: M/s.Charles Prabakar & Associates.
Further it was decided to conduct a mid-term audit in the
VHAK ^remises by the Auditors to ensure better financial
management.
This was duly accepted and it was proposed
by Mr.Joby Jaccb Vargheese, Vision India
> j
and
Mr‘7Neelaiah, P.M.S.R. seconding the same.
3
3
i-resenting the budget for the year 1998-99;
the Promotional
Secretary Ms.T.Neerajakshi said that the budget was already
approved and accepted by the funding partners.
However,
she focussed on the need for additional resource requirement
for the programmes on Traditional Systems of Medicine.
She
also offered to share with all the Member Organisations.
The study materials on vital themes such as 'Safe
Motherhood' shortly.
Besides, she explained the need for
considering programmes on a regional basis involving more
organisations, to facilitate to cut down the cost and time
effective on each programme.
This was proposed by Mr.Neelaiah, PMSR and seconded by
Mr.Venkatesh, RLHP and the budget was accepted.
Discussing on the policies and vital issues; Fr.Sebastian
Ousepparampil made a preliminary presentation of the
impending Nursing Home Bill and highlighted the magnitude
of the problem that it might pose for the Voluntary Agencies
involved in health care delivery services in remote rural
areas and slums.
Supplemented with several pertinant points
by Dr.P.T.Abraham, Mr.Emerson Samuel and Dr.S.M.Subramanya
Setty;
the General Body was enabled to foresee the positive
and negative factors of the bill.
It was resolved to:
* Constitute a Committee comprising of Fr.Sebastian
Ousepparampil, Mr.Emerson Samuel, Ms.T.Neerajakshi, Dr.Shoba
Yohan and Sr.Elise Mary in consultation with Dr.C.M.Francis
and such other experts to study the bill in depth and
pxescJtt their observations to the Executive Commit tee.
.£he .Suggestions are:.
,* To net work
Coxd.4
with CMAI, CHAI and IMA and initiate a
/
hs M
dialogue with the Health Minister.
CerwdL^cLe J
* To refer, compare and to review the policies Of other
States in this regard in order to understand the implica
tions better.
Against the observation of the Hon.Secretary that the
buaget allocation of the State for health was comparative^/
too less;
the President, quoting the Health Minister and
the provision of World Bank felt it was fairly good.
4
4
He suggested that the VHAK and all its Member Organisations
to play more dynamic role in Health Care delivery system.
The President requested .:
the Member
Institutions to play
more active participation and more dynamism on the part of
the VHAK staff in order to enable VHAK become an alternative
Health Force in the State of Karnataka,
He appreciated the
VHAK team for their collective work.
After proposing vote of thanks by the President, the meeting
came to a close by 4.30 p.m.
(DR.S.M.SUBRAMANYA SETTY)
Hon* Secretary
QxJf4!
t
"2—6 •
VOLUNTARY HEALTH. ASSOCIATION OF ...KARNATAKA
Report of the Seminar on ’Integrated Approaches towards
Health and Development’ held in connection with AGBM
on 23rd May 1998 at Vishranthi Nilayam, Infantry Road,
Bangalore - 560 001,
,
Programme started with an invoca’tibn song by Baby Kruthika,
Deepa & Vidya.
5'1 representatives from Member Organisations
were present for the programme.
Dr.H.Sudarshan, President, Voluntary Health
.Association of Karnataka welcomed Dr.M.C.Modi, renowned
Bye Surgeon, Mr.Alok Mukhopadhyay, Executive Director,
Voluntary Health Association of India, New Delhi,
Dr.P.S.Prabhakaran, Director; Kidwai Memorial Institute of
Oncology,
Bangalore and Dr.H.C.Mahadevappa, Hon.ble Minister
for Health 8. Family Welfare Services, Govt, of Karnataka.
Dr.M.C.Modi inaugurated the S.eminar by' lighting the lamp.
He said that this type of theme
is very important in the
present context for those who are working in the field of
promoting health and wished all the best for success of the
programme.
This was followed by the presentation of the summary of the
Seminar by Dr.H.Sudarshan. He said that earlier,mere
..emphasis was given curative aspects, now the trend has
changed to promotive aspects.
In India Health was of low
priority.
If we neglected health we cannot progress,
hence importance should be given to health.
If the status
of health of an individual improves definetely the country
4 will becoming progressive in all aspects.
so health and
-/development were two faces of the same coin; they are
interlinked and co-related. He stressed Govt, to provide
life saving drugs for rural poor.
x. Dr.P.S.Prabhakaran, Director, Kidwai Memorial Institute of
‘■‘^Dncblogy was of the opinion that'the barriers between the
u- Govt, and private hospitals and Voluntary Organisations
.^-•should go and -they should compliment each
others activities.
Voluntary help for public health care did count if health for
all was to become a reality.
Finally he assured that all
possible help from KIDvJAI would be extended for the promotion .
of health of the rural people.
2
Dr.H.C.Mahadevappa, Honourable Minister for Health & Family
welfare released the report 'The Independent Commission on
Health in India' brought out by Voluntary Health Association
He said that a new scheme under which
of India, New Delhi.
the poor would be provided with life-saving drugs free of
cost from Government Hospitals would so«n be implemented
in the State. He said that a large section of the
population lived below the poverty line and found it very
difficult to purchase medicines.
Under the new scheme the
poor would be provided medicines including expensive life
saving drugs free of cost. He said that Rs,8QQ----- oro_r.e_has
been, alloted
by the Central Government’and other
agencies to the state fur developing the necessary
infrastructure for health^care,
The state has already
achieved a record by reducing the infant mortaliry rate
from 62 to 53 per&e-nt
10000 live births,
that no-other state has achieved this.
he pointed out
The Minister
observed that under the India Population Project VIII and
I/v ils.47 crore has been earmarked to be utilised in the
US
state,
-He said that a Health Policy was required at the
state level for which he-is going t_o__qa 11. all the NGOs to
“Sc
UK
discuss the possibilities , at the earliest and he would try
his best for the implementation wf the same,.
I'vO/'vCcI!.
Dr.Mahadeyappa pointed out that unless illiteracy was
eradicated from the country it was very difficult to achieve
health for all by the year 2010.
Education is essential to
create health awareness among the people which inturn
improve the health status of the people.
can
Mr.Alok Mukhopadhyay, Executive Director, Voluntary Health•
Association of India, and also convenor of the Independent
Commission on Health In India briefly presented the gist
of the report.
The Repirt attempts to look at the
variations and disparities in health achievements prevelant
in different states, and regions in.the country. He
lamented that none of the reforms, progress or development,
have reached 30 percent of the population in the country.
The commission also studies the modern trends
and forces responsible
for them.
in Health Care
It also probed
into
health facilities’ available in rural and urban areas in the
aftermath
of globalisation, liberalisation of Medical Care.
If has recommended solutions to problems encountered by the
Health Care Sector.
Dr.(Sr)Aquinas, Member, VHAK Board
proposed vote of thanks to dignitaries and participants.
. . .3
- 3 After Tea a panel discussion on Integrated Approaches to Health
development was held.
The panelists were Mr.Alok Mukhopadhyay,
Dr.H.Sudarshan and Dr.Mohan Issac.
Dr.H.Sudarshan requested the
participants to share their experiences before the commencement
of plenery discussion.
This was.followed by Mr.Alok's views on
the Theme. He emphasised that Health is an integral part of Devt.
Development cannot,c§nsidered as a separate identity; the role
c
Health Workers was very important.
changing the societal problems.
They are the pioneers in
He quoted that in Rajastan the
Local Panchayats, now a days is represented by more & more Health
Workers and they are taking tremendous decisions regarding health
r lated issues. -He called upon that in this regard^,
health
worker needs to work as a catalyst or awareness creater in the
community.
Dr.Mohan Issac from NIMHANS shared his experiences and said that
health cannot be fragmented. It is-an overall development. Health
is having different components, without Health, Development
cannot be achieved and he highlighted the different dimensions of
Health i.e., health is . part of development.it relates to
economic development the goal of development, activities was
health.
The.
consequences of.health and development should be
looked from both qualitative and quantitative level.
Increase '
in sophostication of health technology has burgen on health care
activities by people.
The important thing here is to identify .
the objectives which are qualitative for well being and the
vulnerable group who do not have the capacity to improve their
^onomic status.
Mr.Gopinath from Association of People with-Disability , Bangalore
Mr.Siddartha of MYRADA, Kamasamudram Project and Dr.P.T.Abraham
CMA Hospital, Ankola shared their experiences in the field.
Dr.H.Sudarshan, President, VHAK expressing his views regarding
health issues was of the opinion that there was a lopsided
approach by Government to health care.
Subsidies were given
for tobacco growers and for beedi rollers.
also spent on Cancer hospitals.
While money was
The liquor industry
also encouraged as the Government needs excise revene.
amounts were spent on dams and reservoirs
water
was
Huge
and their back
is a breeding site for mosquitoes which cause Malaria.
A better and broad based approach to health care was needed
he said.
Dr.Sudarshan thanked the representatives frjm all over
Karnataka for actively participating in the Seminar.
Position: 1798 (2 views)