Rakesh Chandoore CHLP 2006 -1-FR 18.pdf
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CONTENT
Acknowiedgement
1. Concept and Background
2. Objective
3. Orientation at CHC.
4. Attended training on Right to health and health
Care 28-30 Sep 2006.
5.
Meeting cum discussion on water privatization
And JN-NURM in Indore
6. Water testing in 3 sites
7.
Preparation of health profile of 4 slums
8.
National tour linking the urban poor
9. Jan Swasthya Abhiyan meeting
10 Indian Social Forum 9-13th Nov 2006
s
11 Jan Swasthya Sahayog
12 Conclusion
1
jd-
Acknowledgement
I am heartily indebted to Dr. Thelma Narayan and Dr. Ravi Narayan
and all the staff team of the CMC for providing me an opportunity to
explore my carrier in the community health.
I would like to thank Dr. Yogesh JainjPr. Anurag Bhargav for their
guidance and support during the stud^of malnutrition and the village
health team who helped me a lot to understand the issues and
situation in the fieid.
I would also like to thank village health workers and the care taker at
the Phulwari centers in the villages.
Thanks to all of them
Rakesh Chandore
2
1.Concept
For the last three years I have been working in Indore slums
among the rag-pickers. During my work, I realized that health status
and facilities for the slum (urban poor) people is worse than rural
areas. Since then I have had a desire to work on health issues of the
urban poor.
Though many agencies like Government / NGO's / trusts etc are
working in the field of urban health but their intervention is only up to
the organizing the awareness sessions, health camp, immunization
camp and RCH based activities. These activities were mainly carried
out through a service-based approach.
So there is a need to do interventions with a rights based
approach and bring health on the agenda of local groups and NGO's.
So that people become capable to ask about their rights and services
by the government institutions and they can also think in the direction
of health as their right.
Background
After 53 years of independence the Government has gradually given
up the trend of people friendly development. The current trend of
development by corporate is causing people to loose control over
productive assets like land forest water etc. There is increasing
tendency of concentration of resources in fewer hands. While more
and more people are getting disposed and displaced, these policies are
pushing people out of villages into urban areas. In the town and cities
also land is being taken over for development of multiplexes, widening
roads, flyovers etc - there is no space for the poor. The basic services
like water, sanitation, education and health are being privatized and
priced.
In today's context community level health services is still far from the
people and not able to meet the need in the context of increasing
urbanization and growth of slums. As of now health services in urban
areas are mainly based on hospital based services, and there was very
less focus on community level health care services, as strategies for
developing health care for urban poor are often framed but
implementation is a big challenge for all of us.
3
State Profile of MP1
MP is considered as one of the backward states of India with a
large Tribal population, which comprises 1/5 of the total population
(20.3%). The total population of the state is 6.04 crores as per 2001
census. Area wise the state is 2nd largest in India. Administratively the
state has been divided into 48 Districts and 313 Developmental Blocks
(89 Tribal Blocks). The state has 73.3% of its population residing in
52143 villages and the rest in 394 towns and cities. Out of the total
urban population 24.31% resides in slums as against all India figures
of 14.1 %. The percentage of the population reported to be below the
poverty line is 37, as against the all India figure of 27%. The overall
literacy rate is 64%, female literacy rate is 50%. While the Gender
Ratio is 920 female as against 1000 male but the Juvenile sex ratio is
much higher at 929.The life expectancy is 55.2, Infant Mortality rate is
89.5 as against the all India figure of 70.
Western region of MP
Western region of M.P. comprises of Nimar region with 5 districts
(Districts-Barwani, Khargone, Khandwa and Burhanpur) and Jhabua.
This region is Schedule V area and are economically underdeveloped
inhabited by Bhil and Bhilala Tribes and has been suffering from
repeated droughts. The area has also been an area of constant neglect
with very poor penetration of Govt, schemes, including very poor
health and education infrastructure. The people of this area do not
have sustainable livelihood options they seasonally migrate every year
in neighboring states of Maharashtra and Gujarat and are exploited by
the contractors and moneylenders. Studies have also shown that due
to poverty, lack of adequate nutrition and health care facilities the
people suffer from chronic hunger and malnutrition. It is also the
region where big dams on the Narmada are being built.
Indore is the regional center of this region. In the present situation
migration to urban areas especially Indore has increased substantially.
There are two trends regarding displacement and slum growth:
a) From rural areas because of Push-Pull factors;
b) From urban areas in the name of urban renewal mission and
beautification of the city.
Besides this with increase trend of capital intensive technological
development and mechanization, the organized labour is coming down
' Profile has been written on the basis of HDR 2002 and www.mp.nic.in
4
and more and more trend is towards casual unorganized labour
employment, with very little social security and proper housing.
The slum population in 2001 is estimated to be close to 60j
million comprising 21% of the total urban population. However this
may be an underestimate. In Indore the total population is reportedly
2.6 lakhs, in Jan 2002. Rapidly growing population in cities is a major
constraint for govt, institutions to provide basic infrastructure and
amenities for both rich and poor.
Access to health services and facilities for the slum dwellers / poor in
Indore is a big challenge. The major and basic problem is to access of
primary health services and facilities available for the people in the city
and also the quality of services. Overall health indicator of Indore is in
bad shape and if we analyses the situation of slum dwellers it is very
worse.
Past work and present linkage
I had my first exposure in working in peoples' health issues at
Jhabua where I was attached with a doctor of the organization, the
Adivasi Sevaashram Trust to help out in health education and training
of peoples on health. The exposure in health was continue in my next
placement with Adivasi Mukti Sanghatana where I learnt little bit about
health as a peoples right and about the Jan Swasthya Abhiyan (JSA)
and about its activities and ideology.
For last three years I have been intensively working with slum
dwellers of Indore city. While working with rag-pickers I developed
interest on working with people's health intensively.
The approaches made by the different agencies in the slums
have stimulated my thinking to take different path of right-based
initiatives in this particular area
Support group in Indore
In Indore we are also trying to build a support group for people's
movements. I and the other group members would be playing a
supporting role for the people's movement in the future already the
group has some presence in the area and by staying in Indore I
personally feel that this support would continue and expand.
5
2. My Objectives are: 1. To enhance the knowledge and skills on Rights based work on
health
2. Prepare a database of 2-3 slums for develop a health programme
for these communities and develop a health profile of slum dwellers in
Indore city.
3. To understand the issues of women's health and child health and
nutrition
4. Develop linkages between health and its determinants (water,
nutrition and sanitation.)
5. Participate in JSA activities, meetings, seminar, public hearings etc.
6. Document the experience and learning.
6
3. CHFS Orientation Programme at CHC
07/08/06
It was the first day of six month fellowship scheme at CHC. Dr. Thelma
gave the introduction of CHC and about its functioning. After that we
had a introductory session with all the CHC staff.
Dr. Ravi took session on learning methods in the scheme. He talked
about two methods.
1) Banking Method: generally it is one way method with power
relation, lots of theory includes and less discussion in it.
2) Interactive participatory:
this is also called problem solving
method. Participatory approach is main part of method, he also
taught about the looking inside and looking outside. I also find
this theory very important for evaluating ourselves. Discussion,
slide show, Focus group discussion, case study, films are the
main processes.
08/0/06 RN
f *
Exploring health / Community health / Primary health /Public heath:
HEALTH: - According to the WHO "Health is a state of physical,
mental and social well being and not only the absence of disease".
Though the medicine is the important part of health but not enough,
health is much more than medical. It depends upon many things and
we call it - "Determinants".
Some main determinants of health are
1) Poverty
4) Agriculture
7) Employment
10) Economic
2) Education
5) Water
8) Housing
11) Cultural etc.
3) Nutrition
6) Sanitation
9) Environment pollution
7
These are the basic determinants of health. We can't think about the
health without these determinants.
The human being required three basic things, which are Roti, Kapda
and Makan, and for poor (Urban/Rural), to meet these things are
challenge. These three things are the bases of all the determinants.
If the people don't have regular employment they will not get food,
housing, safe drinking water etc, means they will not get HEALTH".
Public Health: One of the key principles of Public Health that the state is responsible
for the health of its people. What the government made provide for
the better health like, safe drinking water, employment clean
environment, Education, disease control programme like Malaria, TB,
HIV/AIDS and all the national programmes comes under public health.
In public health a population-based approach is taken focusing on
disease pattern, distribution funds of disease and risk factors. Public
health interventions are organized usually through government as
larger collective action required. The scope is wide and includes health
protection, promotion, disease preventions, cure and rehabilitation.
It is the combination of services, skills and beliefs that are directed to
the maintenance and improvement of the health of all people through
collective actions.
Primary Health Care: -
It is the first level of contact of individuals, the family and the
community with the public health system bringing health care as close
as possible to where people live and work constitute the first element
of health care process.
The primary health care approach as a strategy to attain the
international goal of health for all by 2000 A.D was articulated and
accepted at a WHO-UNICEF conference in Alma Ata in 1979. There are
four underlying principles of Primary Health care, these are:
1) Equity 2) Appropriate technology
3) International Action
4) Community participation
1) Equity: Equity through equitable distribution of health resources
means health care services should be accessible to all,
irrespective to their capacity to pay specially to the
marginalized/ disadvantaged/ poor people or family.
2) Appropriate Technology:
use of appropriate technology for
health. There is no need of CT scan machine and EMI in PHC's,
8
because it will not sustain and maintenance of this Machine is
difficult for PHC & its staff.
3) Intersectoral Action: Intersectoral coordination should be there
between health and development. Your intervention should not
be fully based on medical cure but more than that in terms of
water, wages food employment etc.
4) Community participation:
Community participation and
involvement is the most important thing of these structures.
Without community participation it is difficult to provide
successfully Primary health care to the society.
In today's
context all the planning and schemes/ programmes completed
by buearocrates/ politicians and people don't have their voice in
these activities. The natures of this entire programme are top
down rather bottom up. Community involvement is the base of
this entire programme because all these for the community but
unfortunately does not have any role in the structure.
Community Health: Community health is more than Primary health care and more than
Public health. Community health is a concept for achieving the goal of
health for all. Community health is a process to enabling people to
exercise collectively their responsibility to their own health and to
demand health as their right. But in this process people has to take
some responsibilities of services provide by government and of Health
factors like cleanliness etc.
In this process involvement and
participation of the community, family and individual is necessary and
essential part to achieve the goal of Health.
This process/ approach also include an attempt to integrate
development activities including education, agriculture extension and
income generation programme with the health.
It also involved local, indigenous, health resources like traditional
healers, folk medicine practitioners etc.
Reorganization of these
individuals and group is also a part of process of community health. It
involves training and involvement of village health workers, dais and
an attempt to organize the community through farmer's, youth and
women's groups.
This is a process, which includes increased involvement and
participation of community through formal and informal groups,
organizations, health committees etc., in decision making for health
action including Planning finance and evaluation of health actions.
This approach must be a democratic, decentralized, participatory,
people building and empowering the community.
Community health includes primary health care and public health with
people's action and initiative to attain the goal of health for a
9
Urban Health
We had a session on urban health by Mr. Chander. Through two
case studies we started discussion on the urban health and we came to
know the urban health situation. Specially we learnt how the poverty
and health are interlinked.
Expenses
Poverty
<
\
\
Disease
Malnutrition
F
Illness
Rural Poverty Migration over crowing is the Major challenges for urban
health.
ARSA
Afternoon we went to APSA. It was quite a good experience.
The main thing about APSA which we learnt from them is their
10
approach to handling the issues at different levels. As they providing
the services to the needy children and the same time they are working
at the community level to solve the problems. Especially through child
labor free self help groups. They also adopt the intersectoral right
based approaches as well. We also had some discussion on campaign
against Water privatization and land issues.
29.08.2006
Today morning we discussed about the Environment health and
challenges. The main thing about this issue that we learnt how it
affect health and how difficult to prove its consequences mainly we
discussed about the industrial pollution and pesticide pollution and
complicity of the issues.
Mobility India
Afternoon we visited the Mobility India. This visit was based on
information about the Mobility India and discussion on CBR was not
enough. Dr.Thelma and Dr.Rakhal gave some information on the issue
especially about the DRC, VRC, PMR & RCI.
30.08.2006
Today we had a session on alternative approach to health. We
learnt about it like participatory decision making, Awareness building,
Accountability, Community audit, building social analysis people
oriental and physical dimension of health.
After that we had a session on Gender. It was quite and sensible
session. The main thing about the gender which I realize that gender
is not social issue but it start from personal level and gender is
relationship of mutual understanding and equal opportunities.
PUCL
Afternoon we went to Prof. Hassan Mansur's house, where we
discussed about the human rights and they are violated. It was quite
a good visit. He also shared his personal experience in the campaign.
The main thing about their rights we learnt that state has no right to
recall this rights whether its matter of emergency, independence or
security etc. We also came to know that how different Act came in
power like Preventive detection act, Maintenance of Internal Security,
National security act and Armed force special court in name of
security.
11
Communalism and fundamentalism is the greatest threat for Human
Rights.
Mental Health
Mr. Mohan Isaac delivered his lecture on Mental Health in a very
simplest way and it was good to understand the issue initially. He
classified the mental health in three types 1) Severe mental disorder
2) Common mental disorder
3) The group of substance use/ personality disorder.
Mental health is inner sense of comfort and wellbeing and to make
other people happy.
Mental health is concept of who I am?
Basic Needs
Afternoon we visited the Basic Need. Where we got some idea
about the mental health and how to intervene at community level. We
also visited the slum where Basic Needs working through APD and also
did the family visit. The main thing we like that is their approach.
They are working on four levels.
1) Individual 2) Family level 3) Community level 4) Research,
Documentation and advocacy.
We also discussed about the traditional healer and their practice and
we realize that purely rational approach doesn't work.
01.09.2006
The CHESS Initiative - Promoting lay Epidemiology:
This morning we had a session on CHESS and CHESS Initiative.
Dr.Ravi Narayan gave the background of CHESS and how it works,
when Bhopal tragedy happened and government suddenly introduced
the "Official Secrecy Act". After that we discussed CHESS Initiatives
especially in Kaddalur Industrial pollution, Kasargod Pesticide spray
and Tea plantation in Iduki district of Kerala. The main thing we learnt
about this issue is how to study the effects on health of pesticide,
Chemicals etc, and importance of community level information
gathering.
We also understand that these issues are more political and there are
more involvement of capitalism, because its matter of globalization.
12
4.Right to health and health care.
Health Right Training Organized by Sathi Cehat
Indore, 28-30th
Objective of the training
1. To make understanding about the Health Rights
2. To develop perspective to see health right as a human right.
3. Ways to implement health rights.
4. Coordination with different movements on health issues.
Need of the health rights
To understand the need of the health rights we have to analyze the
health situation. We can classified it into two parts
1) Negative Conditions
2) Positive Conditions
1) Negative Conditions: In these section we specially analyze the situation during the
1990s and afterwards. It's the period of Globalization, Privatization
and liberalization.
The Alma Ata commitment did the lead to some renewed attempts at
achieving this goal. Soon after this, the Indian government passed in
parliament a national health policy in 1983. In this policy all the
process element of primary health care as understood at Alma Ata was
highlighted. The National Health policy went further to talk of large
scale of transfer of knowledge and skill to health volunteers. It talked
of a nationwide chain of sanitary cum epidemiological station. It also
13
talked of decentralization in health care and referral system. It talked
of inter- sectoral cooperation and even a better utilization traditional
Indian medicine. It even explicitly promised to phase out private
practice by medicos in government.
Unfortunately it was all only talk.
Still we have very poor indicators in health like as
•
22 lakhs infants died every
•
3 children die (U-5) every minute.
•
5 lakhs deaths due to T. B. every year
•
increase in Malaria, Dengue, Leptospirosis etc which can be
generally controlled
•
3 lakhs deaths due to cancer (Tobacco related)
Condition of primary Health Centers:
•
Only 38% PHC Have adequate staff
•
Only 31% PHC have enough infrastructures etc.
Inequalities in health services:
•
IMP in BPL families is almost 2.5 times in comparison to rich
families.
•
U-5 mortality is 1.5 times in girls in comparison to boys.
•
Hospitalization of poor patients 6 times less than others.
•
Per capita expenditure in rural areas on health is 7 times less in
comparison to urban areas.
•
Expenditure on public health is only 0.9% of the GDP.
2) Positive Conditions:-
There are some positive changes were taken place in the field of
public health, like:
14
• Justice Anand and the IMHRC accept that health right is the
people's right.
•
Launching of National Rural Health Mission.
•
Health Budget increased by 22%.
•
Central Government listed the minimum guaranteed health
services at PHC level.
•
Community
monitoring
of
the
health.
(l/3rd
NGO
representative, l/3rd Govt and l/3rd Panchayat representative.)
•
Public health act in Gujarat is in process.
Failure of policies, schemes and to reach the peoples are enough
reason to raise the issue of health rights. In these process people
should be in the centre of public health, they should be involved in
management, monitoring etc means the whole process will be
decentralized like in Kerala there is 40% of budget channelized
through the Panchayat. We have to also monitor the Rogi Kalyan
Samiti.
Health and all the services like PDS (public distribution system)
and others should be free from BPL criteria.
Right of Health and Health Services:
We would try to understand the issue of health Right under the
following points
1. Service Based Approach
2. Right Based Approach
I would like here to put a question that what is the difference
between rights based and service based attitude. Is right based
attitude means to be away from the services. There is lot of
institutions, groups and individuals who are full filling unseen and basic
needs of vulnerable and marginalized group of the society. Like Baba
Amte, mother Teresa who comes first when we think about it. In our
15
society there are social beliefs to fulfill the needs of vulnerable groups
but if we continue to provide the services in the same way then
somewhere we are not able to address the actual cause for the
lagging. Second thing is that service based work has many limitations
in providing, means we can provide the services to the very limited
population and for very limited time also. But the actual thing is that
we can't depend on the well wishers are providers rather we have to
work in the direction that basic health services should be available for
every one as their basic right.
Third thing is that right based approach is base to address the basic
reason for the inequalities. The success in this approach is does not
matter it's depend upon many things.
And lastly every individual, institution and group can develop their
own model of service and can demand for universal implementation.
Healthy Conditions: - Getting health services is not the only
indicator of healthy society. We can't think of it without healthy
conditions. There are some necessarily condition
1. Safe drinking water
2. Enough Food, Nutrition and Housing,
3. Safe and healthy Environment,
4. Safe working place
5. Education for all
6. Provide health information to all
7. Employment
Now we can easily understand the difference between the right to
health and right to health services. Right to health means, every
person has right to get all the necessary conditions and services for
the health.
Health Right
I
16
Right of healthy condition for all
Right of health services
Patients Rights: Every patient has right whether he is getting the treatment in
public hospital in private hospital. He has the right to know his illness,
diagnosis and regarding the treatment etc. Especially in the private
sector provider should disseminate all the information about his
services, rates of services and other conditions so that everyone can
get the information same as at government sector all the information
about the services at different level should disseminate so that people
can demand for the same.
Apart from these patients has some other rights like
•
Right of confidentiality
•
Non Discrimination in behavior
•
Right of human values
•
Right of second opinion
•
Right of complaint.
Private Health Services and Health Right:Right of health services comes under the subject human
rights and to protect this right is responsibility of both the public and
private sector. Here we are especially talking about the private sector,
why public sector is responsible for it, because:
•
Entitlement provided by the government
•
Expenses on students of medical colleges
•
Many institutions are registered under society registration so
they are getting tax exemptions. For these exemptions they
have to provide free services to 20 -30 % patients of weaker
17
section of the society. But most of the times these institutions
are ignore the conditions.
Standardization of private health services and social
control:Today in our country private sector is major part of
our health sector and they are providing services at large scale but
quality of these services is not satisfactory. In this concern it's
consider that there should be some rules, regulations and standards.
Standard
regarding the
resource like infrastructure, equipments,
operation theatre, beds, medicines, diagnosis, treatment etc. So that
people can get the appropriate and scientific treatment. National
Health Policy had decided in 2002 that such type of measurement and
standards will be implementing to the entire nation upto 2003 for
private sectors. Under the National Rural Health Mission the formation
legal structure is in the process for implement this measurement and
standard. It will ensure that as we have the rights of health services in
public sector in the same we are having rights in private sectors. Now
it is needed to give a legal framework to save the right of community.
There is also a need of social control on private sector. It will be
possible through a committee of doctors, peoples and representatives
of NGOs or other social groups.
In brief we can write
•
Provision for basic facilities for patients like place, electricity,
sanitation, water etc.
•
Trained and enough staff.
•
Health services related facilities like X-ray, sonography, blood
test.
e
Appropriate mechanism of diagnosis and treatment of illness.
•
Standard rates for services.
18
•
Communication mechanism between doctors and patients to
solve problems.
•
Price controlling on essential drugs
•
Ban on unscientific medicine
•
Social control on advertising of pharmaceutical company
Primary Health Services for all- what does it mean:Primary Health for all is what we want. We want
•
Availability of Health resources.
•
Trained human resources.
National Health Program
Facilities for treatment and services.
Control of communicable disease.
Services for pregnant women and children.
Services related to nutrition.
Health education.
Means of family planning.
Services with respect.
Participation of public in health services.
Provision
for
complaints
and
grievance
redressal
and
compassion.
•
Sensitive
health
services for women
like
women's
illness,
domestic violence, rape, female feticide and issues related to
miscarriage.
•
Include men in family planning.
Public Health Services at different level
A civil hospital district level
Community Health Centre
(For 4-5 Primary Health centre)
19
Primary Health Centre
(One PHC - at every 20000 population for tribal and hilly areas, and 30000 for
rural areas.)
|
Health sub centre
(One PHC - at every 3000 population for tribal and hilly areas, and 5000 for
rural areas.)
Health workers/providers at village level with govt,
structure.
ANM / MPW
Anganwadi
ASHA Worker/ Trained Dai
Community monitoring on public health services
We have to monitor at two levels
a. Inside monitoring of public system
b. Outside monitoring of public system
1 Inside monitoring of public system: - In National Rural
Health Mission there is a national advisory committee on
community
action
(AGCA).
Through
the
AGCA
mechanisms for community monitoring of primary health
care have been developed. This is one way of monitoring
the public services including primary health care. There is
some other ways also for inside monitoring like using of
Right to Information Act.
20
2 Outside monitoring of public system: - In this the
community monitors the services or system through active
participation in implementation. There are many ways of
monitoring
like through Panchayat,
Community based
organizations, people movements etc. monitoring through
committees is also an effective way, and this consists of
Panchayat representatives, NGO representatives, health
officers and representatives from the communities. These
committees will organize public hearing at least once in a
year.
National
Rural
Health
Mission:
Information
and
Critique
After the 1990s there is a stagnation ( and a fall for sections of
society) in health indicators. To improve the health situation Govt
started the R.CH II programme and after that they also committed to
achieve the millennium development goal. In 2004 Jan Swasthya
Abhiyan
organized
public
hearings
with
National
Human
Rights
Commission. In addition to the campaign on Right to Health Care by
JSA with NHRC, JSA decided to go with political parties just before the
election to advocate the issue of health at national level. JSA met
many political parties like Congress, CPI, and CPM etc and put the
agenda before these parties. Agenda includes health worker in every
village, to increase health budget, health guarantee etc. UPA alliance
took this agenda in their common minimum agenda after formation of
government they launched National Rural Health Mission (NRHM).
One of the important component of NRHM is ASHA program. The first
draft of NRHM comes in Dec 2004 it was based on family planning.
Again JSA took initiative through dialogue to correct the approach.
21
After many changes this program was launched on 12th April 2005 with
a focus on primary health care and public health. But in this program
content is not clearly defined such as the nature of ASHA. The unfair
condition about selection of ASHA is she should be 8th pass.
Main Content of NRHM
1 ASHA program: accredited social health activist. She should from the
village, selection of the ASHA will do by gram Sabha. She should be at
least 8th passed. But there is clear indication about her duties.
2 To improve the quality of services at PHC / CMC level. For this there is
provision of untied fund RslOOOO/. It will be channelised through sarpanch
and ANM.
3 CHC /PHC should fulfill the criteria of IPHS.
4 provision of decentralized planning at dist level. There will be a
dist health planning unit and dist health society.
5 promotion of AYUSH.
6 provision for public private partnerships. This concept is based
Rogi Kalyan Samiti. To receive the untied fund first we have to register
the Rogi Kalyan Samiti. There is also provision for contract services of
health services.
5. Meeting cum discussion on water privatization and
JNNURM
On
5th
Oct.
2006
I
had
organized
a
discussion
in
collaboration with Jhuggi Basti sangharsh Morcha on water
privatization and Jawaharlal Nehru Urban Renewal Mission
at Visarjan Ashram Navlakha Chauk Indore.
22
First
session
started
privatization,
Mr.
with
discussion
Shripad
Dharmadhikari
on
water
was
the
resource person.
Process of water privatization was started three years
before in Indore with Asian Development Bank. This was
mentioned by Asian Development Bank in their annual
report
2003.
Though
these
whole
processes
like
privatization and liberalization was started in India in 1991
with
new
economics
policy
as
structural
adjustment
programme. That was the time when gaps between rich
and poor being started increased.
The logic behind the privatization and liberalization given
by government was that government system is corrupt,
system is destroyed, the services given by govt, are very
cheap that's why govt is in debt and due to all these
reason Govt is unable to provide all the services so these
all the welfare and basic responsibility should handed over
to private companies.
At the same time international agencies wanted to spread
their business in the developing countries because these
countries have big market. Because of this pressure these
process of the privatization started in early nineties in
these developing countries.
In India privatization of electricity was the first area of the
privatization.
In this process some parts of the govt
services got privatized, like meter reading, collection of the
bills, etc. privatization of the water is directly affects to
every section of the society. In this process govt, adopt
very moderate way to privatized water.
23
The loan from the Asian Development Bank was taken on
following conditions:
a. Water supply should be done by the companies only
b. To close down all the public resources
c. Reducing the staff
d. Those who are not able to pay will not get the water.
Though the privatization of water is not an easy thing it's a very
sensitive
issue,
so
govt go
in
slightly
different way
which
is
marketization of water. Reducing subsidy or completely withdraw from
it, increasing in the rate of supply all these things were done in the
name of reform means Govt prepare a ground for the private
company.
The main stated goal of every loan of Asian Development Bank is to
reduce poverty but the contract between Asian Development Bank and
Municipal Corporation directly said that services will provide in the
outskirt of the slum periphery. About the public sources contract says
they will continue if the community take responsibility to pay or they
can take prepaid billing system otherwise connection will cut down.
We can easily understand the principle of the Asian Development
Bank.
The cost of the whole project is 1300 cr. but for the slum area they
allocated only 30cr while 40 % population of the city is residing in the
slums and 77cr allocated for the consultant.
Jawaharlal Nehru Urban Renewal Mission
24
The ground for this mission was prepared in tenth five year plan.
This plan was launched in Nov 2005. The main objective of the mission
is to reform infrastructure based on public private partnership.
> Population growth rate in the urban India 2% and in the mega
cities 3% but growth rate of the urban poor is 4.5-5 %. Mission
says in its first Para there is high pressure on infrastructure and
governance due high increasing in urban poor population but no
poverty alleviation funds in the first round of the JNNURM project
approvals. The govt of India approved many projects for 23
cities in the initial lists but only infrastructure development and
no allocation made for poverty alleviation.
JNNURM Mission & Objectives
> An Rs.50, 000 crores initiative with a stated objective to improve
urban governance, service provision and alleviate urban poverty.
The 2005-06 budgets allocated an initial 5500 cr. (which was
partially disbursed end of March 06)
>
JNNURM funding will provide seed money to kick-start other
forms of commercial funding and project development in 63
cities are now subsumed under JNNURM and linked to reforms
>
Conditionalities: City government must submit city Development
plans to the non-elected designated parastatal agency to receive
for JNNURM
funds,
state
will
have
to
enact and
modify
legislation,
Municipalities
will
have
to
undergo
several
institutional
reforms, other reforms such as public -private
partnership, will encouraged.
>
JNNURM consists of two parts: 65% of the fund for urban
infrastructure and Governance (Under the ministry of Urban
Development -MoUD) and 35 % of the fund to basic services to
25
the urban poor (under the Ministry of Urban Employment and
Poverty alleviation - MUEPA).
>
Under Urban Infrastructure and Governance, the main thrust
will be on water supply including sanitation, sewerage, solid
waste management, urban transport, road network and re
development of inner (old) cities. The focus will include -
Integrated development of and adequate investment in urban
infrastructure service.
Planned development of cities to scale up the delivery of civic
amenities.
Urban renewal program: re-development of inner (old) cities
area to reduce
Congestion.
> Under the basic services to the urban poor, previous Gol scheme
will be consolidated and funds will cover programmes like slum
improvement,
rehabilitation,
environment,
night
shelters,
community toilets and housing at affordable prices for economic
weaker section and low income group categories.
JNNURM adversely impacts Urban Poor and their livelihoods:
>
The entrepreneurial approach underlying JNNURM signals an
unconditional surrender to corporate interest.
> Disempowers municipal
government by financial
conditions,
unconstitutional decision making removing almost all possibilities
for effective poverty removal and livelihood generation.
> Places at severe risk, poor and chronically poor groups who
might be evicted by regressive master planning and repressive
zoning regulation.
> Opens political and administrative spaces for the elite to usurp
valuable public resources and high cost infrastructure at little or
no cost.
26
> JNNURM promotes e-governance and land titling which reverse
the gains made hitherto by more progressive ways to strengthen
de-facto tenure.
Private Finance Driven Investment Model
JNNURM
funds
will
be
as
allocated
grants;
States
/
ULBs
contribution; and loans from financial institutions / commercial banks
in the following ratios
7 mega cities (> 40 lakhs),
35:15:50
28 metro cities (10-40 lakhs)
50:20:30
25 other cities
80:10:10
Little Scope for Social projects or welfare orientation
>
No funding for Health or Education related support activities.
>
No funding for power or telecom projects.
>
No wage employment programme and staff component.
6. Water Testing Report
S.No.
Name of the
parameter
Test Result
Sample 1
Sample 2
Sample 3
1
PH Value
8?2
8.4
8.1
2
Turbidity in NTU
06
04
05
3
Total Alkalinity as
240
425
250
CaCo3 in mg/l
4
Phenolphthalein
20
27
alkalinity as CaCo3
in mg/l
5
Total hardness as
50
110
130
25
95
105
25
15
25
30
105
50
CaCo3 in mg/l
6
Calcium hardness as
CaCo3 in mg/l
7
Magnesium
hardness asCaCo3
in mg/l
8
Calcium as chloride
in mg/l
9
Total solids in mg/l
155
461
210
10
Total dissolved
127
448
190
28
13
20
240
226
235
Below 1.5
Below 1.5
Below 1.5
7.2
7.3
7.0
00
00
00
solids in mg/l
11
Suspended solids in
mg/l
12
Sulphate as So4- -
in mg/l
13
Fluoride as F- - in
mg/l
14
Dissolved Oxygen
(D.O.) in mg/l
15
M.P.N. index /100ml
(presumptive Test)
28
7. Preparation of health profile
1 Ramabai Nagar:
Majority of the population are the followers of Baba saheb
Ambedkar. Majority of the population are Buddhist and Balai, they are
migrated from Nimar region of MP and Buldhana & Akola dist of
Maharashtra. Their main occupation is rag picking and domestic work.
Men are mainly involved in fruits selling and catering.
Firstly they had evicted from Krishnapura Bridge to CP Shekhar
on 24th May 1995 in the name of beautification of the lake and again
they evicted from this place to near Bicholi Hapsi road on 15% reserve
land for weaker section. There are no basic services available like
school, anganwadi, water and sanitation, cards. Still they are trying to
get Patta. Only 32% households have ration card.
70% people have
voter ID card and 25% have health card. Only three widows are
getting pension, six people are getting old age pension. Water supply
is not enough they are bringing the water from a kilometer far.
The near by Govt school is 3km far from the community and
across the ring road. Only 25% children are going to the school. Only
5% children are going to the Govt School and 20% children are going
to private school and they are paying lOOrs per month. The near by
Govt hospital is 6km far from the slum. Generally people goes to
private clinic or private practitioner for treatment. ANM visit the once a
while for immunization, ANC, Family planning promotion etc. the
immunization rate is very low it is nearly 36%. Still they are living in
threat of eviction.
2. Ishwarchandra Vidhyasagar Nagar:
They are evicted from Bangali Chauraha to near Piplyahana
Talab in the year 2003 during the rain. Presently there are no basic
29
facilities
as
well
as
services
available
like
school,
anganwadi,
sanitation, immunization facility, ration card, voter Identity cards and
still they are trying to get Patta.
Only
18%
households
have
cards, llpercentage
ration
households are having health cards but they do not about use of
cards. 26% households are having BPL card. Nobody is receiving any
kind of social security. There is no Govt school within community. The
nearest Govt School is 2.5km far from the community and nearly one
private school is there. Total 35% children are going to school but the
only 8% children are going to the Govt School, rests of 27% children
are going to the private school. The behavior with children in private
school is not good. The monthly fee of this private school is 70 per
month. The nearest Govt hospital is Maharaja Yashwant Rao Hospital
but people generally go to the private clinics or they get treatment
from the local practitioner. For serious cases they go to the M Y
Hospital. Malaria and Diarrhea are the prevalent disease in the slum.
ANM visit the slum once a moth. She comes under routine tour and
she does the immunization but the very few children getting the
immunized because the dwellers are unaware about her visit. The
immunization rate in this slum is nearly 30%.
Pregnant women only
get the immunization not Iron and folic acid tablets.
The
community comprises
with
different caste
like
tribal,
schedule caste and others, mainly they are daily laborers.
They are still facing the false cases filed by Corporation during
eviction.
3. Vidur Nagar:
The
residents
of this slum
were
evicted
from
piplyapala
chauraha, asharam bapu chauraha and ashok nagar on 17th June
30
2003. The community comprises with different caste like tribal,
scheduled caste and others, mainly they are daily laborers and
domestic servant. This resettled site is in outskirt of the city there is
no other source of livelihood and no basic services available like
school, anganwadi, water and sanitation, ration card, voter Identity
cards. Still they are trying to get Patta.
4. Piplya Rao Nai Basti:
They are evicted on 28th May 2000 from professor colony,
Bhanvar kuna. This resettled site is also in outskirt of the city.
Presently there are no basic facilities available like school, anganwadi,
sanitation, immunization facility. Few dwellers have ration card and
voter Identity cards. Mainly they are from Scheduled caste (Balai),
Women are mainly involved in domestic work and rag picking
and men are engaged in daily laborers.
Profile of Slums
s
Slums
War
N
name
d
o
1
Caste
Occupatio
No. of
Residentia
School
Health
r
n
family/
I status
availabilit
facility
C!
no.
Ramabai
36
pop
Mahar
Nagar
Balai,
e
y
rag
155/701
15%
3km far
pickers,
Male -
reserve
across the
domestic
358
land
ring road
workers.
Female-
Fruit
321
sellers,
Boys-
catering
161
none
b
v\
Girls-
31
139
2
Ishwarcha
Kumh
daily
85/283
Resettlem
2.5 km
ndra
ar,
wage
Male-89
ent
far across
Vidhyasag
Banjar
labour
Female-
the ring
ar Nagar
a,Bhilz
83
road
Dhobi,
Boys-57
36
none
n
none
r-
none
r'
Girls-54
3.
Vidur
69
Nagar
Balai,
Rag
145/668
resettlem
Bhil,
pickers,
Male
ent
daily
341
wage
Female
workers,
327
domestic
Boys-
worker
161
Girls-
139
4.
Piplyarao
69
Balai
nai Basti
Rag
280/
pickers,
1400
Domestic
Male
workers,
334
labour
Female-
Patta
296
Boys-
416
Girls-
354
Profile of Indore City
1-
Total area of city
2-
Total population of city
130.17 Sq Km
16,37,461
32
3-
Population Density
12579 p/SQKm
4-
Sex Ratio
901
5-
Percentage of urban poor
6-
No of wards
69
7-
No. of Zone
11
8-
Water supply
42 MGD
9-
Solid waste generated
10-
Education level
25.57 (Govt.)
476 T
89% (M), 74% (F)
Health Profile in Indore District
Ante
I.F.A
Institutional
Natal
tab
Delivery
No ANC
only
13.6%
Immunization
Diarrhea
Pneumonia
only 25%
12-35
20.3%
22.8%
39.8%
delivery in
months
Children
Children
taking
govt
-49.65 Full
Regular
hospital
immunization
Check
up
tab
33
R.T.I
Govt
Govt
services
Services Post
during
delivery
complicated
complications
delivery
36.4%
26.7%
44%
8. National tour linking the urban poor
On 18th Oct I coordinated the Indore meeting of the NAPM
organized national tour linking the urban poor, with the help of
support group in Indore.
A meeting was organized at Manasi clinic with tour team and
representatives from different organizations. Meeting started with
introduction. After the introduction tour coordinator Mr Maju gave
the information about the tour and purpose of the tour. The main
purpose of tour was to strengthen the fight against different forces
and integrate the different initiatives around the India and create
awareness about the JNNURM and SEZ.
Mr. Basant Sinthre gave the brief information about the situation in
Indore. Especially about the master plan that how the master plan
is going to affect the urban poor in Indore and forthcoming eviction
which will in the name of the beautification of the city. At the
meeting there was a sharing by participants from different towns/
cities eg Bhusaval, Nasik, Mumbai
After the meeting I had organized field visit in the community
named Naya Basera. We entered in the slum in form of rally. There
we discussed the situation of the urban poor in Indore and in the
other cities of the India.
34
9. JSA meeting
I had attended the meeting of Jan Swasthya Abhiyan held
on 1st oct 2006 at BGVS office Bhopal. The main agenda of
the meeting was to finalize the issues for NHA II.
Many issues discussed in the meeting like health services
at PHC and CHC level women health, occupational health,
urban health mission, Rogi Kalyan Samiti,Organizational
capacities of JSA, network with other campaign, follow up
of denial cases etc.
After that discussion was held on the peoples rural health
watch survey.
10.Indian Social Forum 9-13 Nov 2006
Campaign issues on child health 10/11/06
This was the first session which I had attended and it was on
child health issues in campaign. Different people present their views
on different aspect of child health. The first presentation was on
street children. She talked about the two types of children on the
street and
off the street children.
Juvenile justice act is a
progressive act but it also talk about the institutionalization of the
children but the
best place for the children
is their home.
Institutionalization means you are keeping the children away from
the home which is not good for rehabilitation for the children.
These children are very soft target for abusing for anyone either it
will be police, mafia or somewhere else. Girls are not seen on
platform or on street. The railway staff also uses these children for
picking up death bodies from the railway lines.
These children are facing the sexual harassment; drug mafia uses
these children for drug supply.
35
There is urgently need of change in our approach. For example we
have to open the centers close to the railway stations. To provide
health services we have to organize health camps, clinical health
facilities.
Health of migrant Children
To provide health services to the migrant population is really a
challenging task. The nature of group is their mobility and because
of this nature they are not getting regularly any kind of services.
Mobile camps / medical camps are the short term solutions but
there is urgent need for long term solutions or campaign. For that
there is need to revamping the existing health services, regular
mobile outreach program. Other main problem with group is
identification so the state govt should provide the ID card to each
migrant. Because of no identity there is no registration facility for
this group. The children of these groups are also not getting
education and other recreation facility. Migration is basically related
with livelihood issues so if we want to solve the problem we have to
concentrate the root cause of this problem means livelihood issues.
We have to talk about their rights, fight for bill for unorganized
sector.
Health of SAHARIYA children
The health of the SAHARIYA children
is in
bed condition,
malnutrition rate among these children are 93%. They live in
outskirt of the village. They are getting exploitation from the local
landlords. Their livelihood based on forest after forest stone mines
as an alternative. There is high prevalence of T.B. in these groups
because of their working condition in stone mines. They are also not
getting minimum food security.
36
Parents are giving thick roti to their children so that
chewing the whole day. They aren't goes out in search of their
livelihood, and hunger effects adversely
on their health and result
of this they are very prone to disease, infections, skin disease.
Health services are totally unavailable for this group. There is no
special quota for the health services of SAHARIYA tribes. So there is
need of campaign at large scale to advocate the
issues of
SAHARIYA tribes at state and policy level.
Pulse Polio Campaign
Mr Rajeev
Dasgupta of JNU gave the
information about whole issue. He stared with polio virus infection and
its three main outcomes. He shared that in 92-95% cases there is sub
clinical infection and only 1-2% cases facing major illness. 1% of total
paralytic polio reached 10% deaths. 50% recover and 40% permanent
paralyzed.
Polio is water born disease but in the whole campaign this was
never addressed at all. He also explain the meaning the word
eradication. Through some intervention there should be removing and
new cases will be zero and there is no further need of any additional
measures but we are still having polio cases. He adds that the children
having polio virus have more chance to get polio if he got injection.
He also discussed the data of polio cases. If we are not taking
epidemic cases of polio there are huge number of cases. In 1959 there
was an epidemic in USA at that time near about 20000 people are
paralyzed and 400 were dead. He said after a huge campaign we are
still having significant cases of polio. According to the November 2006
data there are 1400 cases identified globally and in India near about
37
490 cases are identified and nearly 75% cases from the Bihar and
Uttar Pradesh and 72 districts are affected from polio all over India.
Ms Indira added that this pulse polio campaign basically a WHO
program which is implemented by Government of India. It was started
in 1988 by WHO (world health organization). The rational behind the
campaign was that routine immunization is not enough for eradication
of polio so there is intensive need of intervention and this was pulse
polio campaign. Immunized all the children together are main principle
of this program.
In
this
campaign
whole
the
intervention
was
based
on
immunization but there is no focus on other issues like malnutrition
social issues etc. malnourished children are more prone to get polio
there are 30% more chances of conversion of polio because in these
children defense mechanism are weak. According to Dr.Shridhar 50%
children
are
malnourished
and
100%
children
are
are
partially
malnourished.
The major failure of this program that it is never been the part of
people.
Seminar
on
Urban
Health
in
Context
of
Globalization
10/11/06
The
session
starts with
Mr.Dunu
Roy's
presentation.
This
presentation was focused on JNNURM. This talks especially urban
reform. The total budget of this scheme is nearly 1.5 thousands crores
for 60 cities. Under this production process is closing in the pollution
and shows it's dangerous for health. It talks about reducing the labor,
reducing the work etc. The whole planning was based on the cost of
poor. Its strongly talks about the eviction of slums in the name of
beautification of the city. After the implementation of this program
every service will be paid and every thing will be the marketized like
38
water, housing, health services etc. the basic concept of this program
is privatization. On the one hand there is many problems like poverty,
hunger, safe drinking water, food etc but on other hand this program
include nothing for this it talks about super specialty hospitals and
medical tourism.
In 2001 their 40 lakhs labor in Delhi and it is estimated that three will
be 80 labor in 2021 in Delhi itself but master plan says that we will not
do anything for employment generation at large scale. Nobody wants
that this group will come under formal sector. We can easily imagine
the future of this targeted group.
Mr. Rajeev Dasgupta focused his presentation on water access
and water borne disease. In 1988 cholera was the major epidemic but
the cases identified of water borne disease in 1994 were much more
than in 1988. It does clearly indicate the approach towards community
health. This type epidemic was repeated in vulnerable colonies.
Dr. Mira Shiva talked on malaria and chikanguniya. Today the
nature of this type of disease is different from the earlier but we not
doing any research. Still we fail in diagnosis. So we also demand for
diagnosis facilities and research and development should be based on
needs of public health.
Right to Education Bill: Myth or Reality
11/11/06
Why today we are taking about the right to education and of
Need of right to education bill. As Indian citizens it is basic right and
Constitution also provide the right to education to all the children
without any kind of discrimination. But today we are struggling to get
this right as our right. This is responsibility of states to provide free
and compulsory education to all the children between the age group 6-
14 years. But there is lack of political will to provide the education to
all the children.
39
water, housing, health services etc. the basic concept of this program
is privatization. On the one hand there is many problems like poverty,
hunger, safe drinking water, food etc but on other hand this program
include nothing for this it talks about super specialty hospitals and
medical tourism.
In 2001 their 40 lakhs labor in Delhi and it is estimated that three will
be 80 labor in 2021 in Delhi itself but master plan says that we will not
do anything for employment generation at large scale. Nobody wants
that this group will come under formal sector. We can easily imagine
the future of this targeted group.
Mr. Rajeev Dasgupta focused his presentation on water access
and water borne disease. In 1988 cholera was the major epidemic but
the cases identified of water borne disease in 1994 were much more
than in 1988. It does clearly indicate the approach towards community
health. This type epidemic was repeated in vulnerable colonies.
Dr. Mira Shiva talked on malaria and chikanguniya. Today the
nature of this type of disease is different from the earlier but we not
doing any research. Still we fail in diagnosis. So we also demand for
diagnosis facilities and research and development should be based on
needs of public health.
Right to Education Bill: Myth or Reality
11/11/06
Why today we are taking about the right to education and of
Need of right to education bill. As Indian citizens it is basic right and
Constitution also provide the right to education to all the children
without any kind of discrimination. But today we are struggling to get
this right as our right. This is responsibility of states to provide free
and compulsory education to all the children between the age group 614 years. But there is lack of political will to provide the education to
all the children.
39
4th draft of right to education bill was come in 2003 and it was
rejected by everyone because this bill was promoting discrimination.
In the next draft few good things was there
but it was not
implemented and in this year 6th draft came out but this draft has also
many
irrational
things in
it.
Through
this draft all
the
major
responsibility handed over to State government and their no provision
for free education for children form weaker section of the society.
There is also no provision of residential school where their any school
available because of this disabled children will
not able to get
education easily so its directly attempt for this group to keep away
from education.
There is also lacking of to fight for barriers like
economic, cultural and social but in 5th draft few provision was their.
There is no provision for nursery education.
This draft also legalizes the capitation fee. But this bill says
school, neighborhood school, residential school, transport etc will not
be providing by the government.
This draft does not have any space for working children or child labor.
This draft also says Government will not open new school where there
are private school is available but dept will give support through
vouchers for selective population. We may call this approach is silent
promotion of privatization of education.
In the entire situation if children will not get the education then
parents will responsible for the same but not Government and have to
ready for punishment.
Girl Child Education
The situation of the girl child is worse in backward areas. There
are many girls working as a bonded labor but the works which they are
doing not comes under the child labor. Girl children are out of child
labor definition. The jobs they are doing also not recognized as
40
hazardous work. There is no special provision for education of these
girls.
A study was conducted by Child Right Protection Forum in
Nalgonda on child marriage. The results of the study are
> Two girls came to suicide.
>
Five cases of miscarriage.
>
75 girls were suffered with abortion.
> 20 girls facing mental health problems or ill health.
> Seven girls were return to parents home.
> The husband of six girls made second marriage.
> One girl got natural death.
We can easily imagine the situation child marriage especially of the
girls.
Education of Dalit Children
In the ancient period there were four section of society Brahmin,
Kshatriya, Vaishya and shudra (Dalit) and that time dalits were not allowed
to get education. After the independence every citizens has got the right to
equality constitutionally. But till today the dream of equality for a special
section of the society is very far. In the some feudal and religious state like
Gujarat, Rajasthan the situation of the dalits are worse. Earlier the budget
for education of this group was little bit high but from the early 90s there
were significant downfall in budgeting.
In the remote area of the Rajasthan the condition of the Dalit children
in school is very bad, they still facing the discrimination. In these area
children have to sit alone they can not sit with general class students.
Drinking water for these children is also kept separate. In these areas Dalit
students are doing the cleaning the school, surroundings etc. they called by
41
caste in role call. The ministry of education of Rajasthan is largely in the
hands of elite people right from the beginning.
Saving India's Public Healthcare system 11/11/06
This session was organized by Jan Swasthya Abhiyan. Public
health care system is only system to serve the services to the people.
But today main challenge is to get the service from these institutions,
they becomes more bureaucratized and not functioning well.
The
national
common
minimum
programme of the
united
progressive alliance (UPA) govt, identifies health as an important
thrust area. At 0.9% of the GDP, which translate into Rs. 200 per
capita, the total investment on health in India is among the lowest, in
the family of the world nations. In fact the allocations for health have
decreased from the level of 1.3 % of the GDP in 1990 to o.9% in
1999. Even this outlay is not being effectively
utilized and access to
health care services are not uniform due to inefficiencies of the public
health system, poor maintenance of the public health infrastructure,
manpower problems, lack of accountability, unregulated private sector
health care cost and multiplicity of vertical programmes, dissipate
energies at the operational levels.
Despite the impressive public health infrastructure, it is cause of
concern that only about 20 % services are being provided by the
public health sector, while the private sector provides almost 80 % of
the health care services. Studies demonstrate that curative services
largely favor the rich over the poor.
It is estimated that health
expenditure is the major cause of the rural indebtedness.
The govt, of India has launched National Rural Health Mission (NRHM)
on the 12th April 2005. The mission covers the entire country with
42
especial focus on the most vulnerable 18 states where the challenges
of strengthening weak public health system and improving key health
indicators.
Jan Swasthya Abhiyan has played an important role in NRHM through
various ways at different levels.
Different stages in the development of the NRHM are as follows:
pre national consultation
ii.
national consultation phase
ill.
post national consultation phase
JSA was involved at different level like meeting with Govt officials,
works as a task group and action for redrafting the NRHM.
1st draft of NRHM came in Oct 2004 this was mainly based on
family but the other areas of the health were absent. That was the
main cause of reaction on it. One of the main focus areas of the NRHM
is ASHA. The concept of rural health worker basically brought from
barefoot doctor of China. This model program is being implemented.
But mobilization not has done.
NRHM said PHC, CHC should be improved according to the Indian
Public Health Standard (IPHS) but IPHS mainly concern about the
infrastructure. There is discussion about the services. There is no
clarity about the citizen charter. There is also lacking of other health
determinants like water, environment, nutrition etc. its also promotes
public private partnership in the form of contracting, franchising,
recognition to the private clinics and paid services from these clinics.
But NRHM
is
not talk about the
regulation
of private sector.
Infrastructure is essential but there is no explanation of patient's right,
standard of services.
43
Some positive indicators are also their like district level planning,
community monitoring with involvement of NGOs and other local
institutions like panchayat, gram Sabha etc and public hearings at
every district, block level once in a year.
State wise presentation on NRHM
Uttar Pradesh by Dr. C. S. Verma
National Rural Health Mission was launched in Uttar Pradesh in
September 2005. The officials are not willing to give the information
about the progress of mission though they are demanding the under
the Right to Information Act.
There are many irregularities in selection of ASHA like bribe, non
democratic selection, misguiding the ASHA about the remuneration
etc.
Selection of monitoring committees is done till November 2005.
Shortage of doctors is another main problem their. Contract
basis appointments are taking place in hospitals on call duty.
The training of ASHA was held in only five districts with junior
doctors only. They are working as assistant of ANM; she is also
working for routine immunization campaign.
The two selected ASHA from Raibareli were come and shared
their experience. According to both of them after the selection and
training no meeting was held. They are still confused about there
works. They don't know what to do. Even ANM and MPW are not much
sure. They also shared about corruption in selection process.
Madhya Pradesh by Dr. Shailendra Patne
Dr Patne started with health infrastructure in M.P. there are
5 medical colleges
2 private colleges
178 CHC
1194 PHC
44
8835 Sub Center
8 doctors per lakh population (on doctors in remote areas)
After that he presented the draft report of study rural health watch.
The study was conducted in 11 district of MP. Some main findings are:
73% CHC are situated under the range of 5 KM.
27% CHC are situated far, beyond the 5 KM
Selections of ASHA were done by ANM, MPW, Panchayats, no
involvement of community.
44% selection of ASHA were done by Anganwadi
20% selection of ASHA were done by health workers ANM/ MPW
About the duties and responsibilities she is confirmed.
They have less information about Janani Suraksha Yojna.
Tables, chairs, mattresses, torch were purchased from untied fund.
Health committees exist in every village but involvement in planning.
There is no gynecologist.
Bihar
Black listed NGOs are involved in planning. 29 were selected in
Bihar but presentation from ST, SC and other weaker section are
negligible. The breakup of ASHA according to the class is
Defending
2
Brahmin
1
General
1
landless
19
Other backward classes
3
schedule caste
3
minorities
the
Health
Rights
of
People
in
the
era
of
Globalization 12/11/06
This was organized by ISA. In this event the campaign
themes of national health assembly were introduced. Four themes
45
were introduced and are Globalization and Health, Health System in
India: Crisis and Alternatives, Women's Health, Campaign in Child
Health.
Globalization and Health:
In period of time funding of public sector in health are
reduced and private sector still spreading his hands and covering
almost 80% of services in health. In this period expenses on health
are increased. There is increase in hunger. In 1991per capita food
availability were 178 kg it reduced up to 154 kg in 2000. The
conditions of half of the population are worse than the South African
poor countries.
According to studies conducted in health services there are
huge increase in private hospitals and are 55- 57%. There is also
increase in out care patients and it gone up to 80%. The increase in
expenditure of rural patients on health by 142% and in urban areas is
increased by 150%.
Expenses in government hospital are also increased three times.
Now Government is talking about the improvement in health
services but their efforts are limited to RCH or in AIDS and it is only up
to the primary level. For this government is saying there is not enough
fund but if we on other hand there significant downfall in money
collected through. In 1991 the amount collected through taxes was
13% of our GDP but it reduced in 2001 up to 9%, decline of 4% which
four times our health budget.
Globalization and Women's Health
Health is a state of physical, mental and social well being and not only
the absence of disease. Women's health is integrally linked to women's
access to available resource and Women's productive and reproductive
role in our society.
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11 Experiences with Jan Swasthya Sahayog (JSS)
I spent one month with JSS ,Ganiyari. Objective of the working with
the JSS were
1 To understand the community health with practical experiences.
2 To conduct the study on malnutrition in the children between the age
group of 6month to 36 month.
3. To understand the Jan Swasthya Sahayog
About the Study- the study was conducted in 30 villages of Kota and
Lormi block of Bilaspur district. I examine the 478 children at the
phulwari centers and in villages.
Intensive examination was done by the fellow and it is found that
nutritional condition of the children is not good.
12. Conclusion
This whole period of fellowship was full of learning through discussion,
visits, and exposures. This fellowship also helped in build up personal
capacities in terms of knowledge, skill, confidence, technical etc.
Through the intensive efforts at Jan Swasthya Sahayog in the field
gave me a reach experience in term of practical, knowledge and about
the community.
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Annexure-1 Survey Form
HEALTH PROFILE OF SLUM DWELLERS
(A) General Information
1.
Name of the Slum.
2.
Name of the Ward.
3.
Ward No.
4.
Population
of
Slum.
Adult:
Male.
Female.
Children: -
Boys
Girls
5.
Total No. of houses/huts.
6.
Present residential Status
7.
Religion (%)
With / Without Patta
48
8.
Casts (%)
9.
Details of common Property recourses of the dwellers
1. Community Hall. 2. Temple 3. Garden 4. Open Place. 5. Other
Details.
10. Percentage of household having —
1) Ration Card
2) BPL Card
3) Any other Govt, given Card.
11.. Where do you buy Ration from —
1) Ration Shop
12.
2) Other
Social Security Pension
(B) Basic Needs
13. Source of water
14. Availability of water
daily/weekly/every 2-3 days.
15. Drainage System.
Present/Absent
16. Toilet facility: -
1) Individual 2) Shared 3) Public 4) Open place
(C) Education.
17. Near by School: Public
Distance from Basti
Fees
Private
Monthly
Distance from Basti
Monthly Fees
18. Percentage of School going Children.
(1)
Boys
(2)
Girls
49
I
19. Anganwadi
Balwadi
facility
Present/Absent.
20. If Present, No of Children regularly attending Anganwadi.
21. under whose management.
22. Literacy Rate
(1)
Male
(2)
Female
(D) Health.
23.
Nearly hospital/health post.
Govt.
Private
Others
24. Diseases prevalent in Slums
(1) Malaria. (2) Jaundice. (3) T.B. (4) Diarrhea (5) Others.
25.
Where do the dwellers usually go for treatments?
26. Does any health worker visit your home?
(l)Yes.
(2) No.
27. If Yes. Who.
?
28. How frequently do they visit the slum?
1) More than once a month
2) Once in 2-3 month
3) Other.
29. What do they come for?
50
30. Does anybody provide you education concerning prevailing
health problems?
1. Yes
2. No.
31. Where were the children Immunized.
a
32. Percentage of Immunization in Slums.
4
33. Did the women receive ante-natal care?
1. Yes
2. No.
34. If yes what type of services they get?
4
c,
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