varsha Gaikwad CHLP 2008-3-FR 30.pdf
Media
- extracted text
-
Community Health Learning Programme
Cl
i
2008
CHL?-2£)0&>Z/FK3d
Community Health Learning Programme
June 2008 to February 2009
REPORT
varsha Gaikwad
intern, community Health Cell
Acknowledgment
This programme has given me a special opportunity to know about my self thru the
special care and guidance of Dr Sukanya, my mentor in this course. Without her
valuable guidance I would have not come across the vast world of knowledge and
esteem which was under cover due to my personnal family problems. She was the
guiding lighthouse to change my view to live independently and take my own
decisions through various means. I am also grateful to Mr Premdas who always
encouraged me to go for tire new avenues in life without taking care of other worldly
tilings on my own even with sacrificing my own personal family life. Dr Rakhal who
also was a inspirational lamp and his valuable guidance was very much practical from
time to time. All the friends', interns, who were with me through out the programme
at the various points taking care of each other and shared the views at various point in
their happy moments.
I am very much grateful to the whole staff of CHC for their ready to help attitude and
kind nature without which it would have been not possible for me to achieve this small
drop of knowledge from the ocean.
This learning programme would not have been possible without Dr Ravi Narayan and
Dr Thelma Narayan whose vision gave rise to the idea of CHC where there is fusion of
knowledge and values from various fields which provides a platform to an individual
to groom up his/her knowledge and change the view of life.
2
Introduction
I am Varsha, President of Positive Womens Network, Maharashtra, and Vice-President
of Positive Womens Network at the national level. I had completed my Master's in
social work. We started the state level Positive Women Network of Maharashtra
(MPWN+) in the year 2007 and are working in the field of HIV/ AIDS and are affiliated
to the Positive Women Network (PWN+), Chennai, a national body of women living
with HIV in India. The members of MPWN+ are also offering their services through
counseling and treatment adherence programme of the Government Medical College,
at the ART centre in Nagpur. Besides, there is our counseling centre close to the
Government Medical College where the PLHAs are counseled with regards to the
nutrition.
MPWN+'s purpose is to change the existing situation of all women living with
HIV/AIDS and infected/affected children in the State of Maharashtra. We build
women's capacities to increase their access to rights, develop partnerships and
advocate for programmes and policy changes to address concerns of women living
with HIV/ AIDS.
As a leader, I was not capable to handle all responsibilities of leadership. I was
completely unaware about the national health policies, health movements and the
related NGO's who were working in this field. I got a great opportunity to learn the
various aspects relating to the policy making in respect to health and the NGOs who
are pioneers in the respective fields, I honed my skills for efficient leadership to lead
my Organization, The Positive Women's Network of Maharashtra in Nagpur.
From childhood I am very ambitious, always to ready to learn new things, to meet new
friends and different thoughts of people, When I opened website SOCHARA, on seeing
the contents I was puzzled. My first question for myself was that what is community
health? I gathered the related information on the matter to understand that this
fellowship will be of help to me to show a new path in future.
Reflections of the fellowship programme
There were many questions in my mind before joining CHC. What and which type
of learning can I acquire? In CHC, I came across a very unique way of learning, which
was the active participatory method of the volunteers, by self learning groups, critical
thinking and adult learning process. I acquired more knowledge by observation and
group discussions. When I had earlier read the WHO definition of health, I merely
understood the meaning, but from the CHLP I came to know the real sense of health, it
is not only related to disease and illness but it is also affected by social determinants
like class, caste and gender.
Dr. Ravi had given us space to express our feelings, experiences and facilitated self
awareness for the first time I had asked myself what will I learn, what I like and don't
like. I recalled some pleasant and unpleasant memories in my life. We learnt skills and
values required as community health worker. I learnt that participatory skill,
communication, nonjudgmental attitudes are important for leadership. The sessions on
the epidemiological triad and primary secondary and tertiary prevention of
Tuberculosis;
3
Alma Atta Declaration - Health for All concept; the Public health system, policies
and programmes. Implementation of services, regulation and monitoring were very
useful. Now I am aware about what is primary and public health care , structure of
PHC, duties and responsibilities of ANM.
Through stories, I deeply understood the concept of then People's Health
Movement. The life journey of Dr. Ravi and Dr. Thelma, in the community health
movement is an inspiration for me.
Through the group work assignment on structure of public health system in respective
states, I learnt more about how geographical position and population affects
community health.
In group discussions I got a clear idea about positive and negative impact of
globalization and how globalization, liberalization and privatization has eventually
increased the gap between rich and poor.
All the interns from different background, shared their experience on issues
from grass root level to global participation these discussions have been instrumental in
increasing my confidence.
Exposure visits were really an interesting learning experience for me. In Hannur,
the Holy Cross Comprehensive Rural Health Project (HCCRHP) are taking initiative to
protect the children from child labour and provide platform to enjoy their childhood
and education through day care bridge schools and residential and join them to the
main stream. The bridge school Satvidya, bridge school, is a great example of the first I
have seen. When we saw vast areas in Arbgare covered under water shed project, I
really felt happy that with help of organizations and fund's acres of wasteland has been
cultivated. I visited a PHC for the first time in my life. We observed what health
facilities were provided, the health workers attitude and also their limitations due to
the limited facilities available in PHC. Then I concluded that every PHC must be
having similar problems. Meeting with Jaddejamma a health worker trained by a Holy
Cross project was unforgettable moment in my life. We learnt lot of things ( use of
herbal medicines ) when she had shared her experiences with us.
In Hospet, we met Dr. Bhagya of SAKHI. This organization is running a hostel for
SC/ST girls and provides scholarship for higher studies. Here I came to know the real
meaning of globalization or capitalization. Due to the increasing illegal mining projects,
life of people had been changed, as they had lost their land. Agricultural land has
become infertile. Unemployment has increased leading to addiction of drugs and
alcohol. There were also cases of sexual abuse and rape, and Sakhi also fights for
justice for the victim.
We also had a chance to visit Hampi, it was a memorable trip, cannot be described in
words. We all fully enjoyed the scenery and even forgot the tension, worries and
regained our energy.
The visit to Jagrutha Mahila Sanghatan (JMS) in Raichur was a very interesting
experience. JMS is working for empowering the Dalit women and organizing the
women to fight for their rights. Their continuous effort of 8 years, got them tire success,
that women have come forward and have made 42 SHG groups and are running a
school for poor, orphan and helping working children to get back to schooling. Women
groups are running many income generating programmes like making terracotta
jewelry, herbal medicine and neem fertilizers.
4
We stayed for four days with these children, sang songs, danced and played games
with diem. I was surprised to see the way they maintain discipline throughout die day
.Early morning they did yoga, exercise, homework, got ready for school and all the
daily chores. Jeyapaul had taught them many songs widi actions. We all had seen
simple hardworking village life. We also learnt how to make terracotta jewellery and
preparation of herbal medicines from medicinal plants and which disease it can be
used. Chinamma shared her experiences of successfully treating many people.
The field visits which were carried out were personally very interesting for me as I
came across many situations where the community had found solutions to their
problems and I was also able to help them with some.
Our CHC mentors are like friends and guides for each fellow. When I came to
CHC, I was very upset and unhappy due to my family problems but when I met with
all the staff of CHC , then I forgot all my problems due to the lovely behavior of all.
Dr.Sukanya always provided me help in my personal problems. Due to my health
problems I was worried about traveling. Through email and phone we were always in
touch. My Mentor always showed me the way whenever I needed.
Learning objectives
1.
2.
3.
4.
5.
6.
Improve my leadership skills to be an efficient leader for the movement.
Learn National level HIV AIDS policies and NACP III in relation to women and
children.
Understand different health and women related movements and network for
collective advocacy.
Understand and learn more on alternative medicines that help in improving the
health of an individual
Development of personality skills.
Improve writing and documentation skills.
Plan of action
1 a) Visit and talk with various leaders in movements.
2. b) Collect and read the NACP III document and the related programmes.
c) Visit MSACS and collect state's action plans on HIV and women & children.
d) To visit MASUM, CEHAT and other women movements and network within the
state
a) To visit and document activities of PHM and its structure.
b) Visit PWN+ Chennai and strengthen Maharashtra PWN+.
c) Participate in training programmes related to reproductive health, HIV AIDS and
advocacy.
4. a) To collect literatures on alternative medicines for women's health.
b) Compile a booklet for HIV positive women on alternative medicines to maintain
good health.
c) Participate in future in the related trainings, to work towards the betterment of
the community.
3.
5
Time line of activities:Time Period
Activity
13th to 18th July
National workshop for planning
for strengthening national and
state level Networks
From 22nd to 30th Advocacy
training
on
July
reproductive Health and Rights
at Naukuchiatal in Uttarakhand
On 1st to 3rd Aug
meeting
for
advocacy
programme
4th to 8th Aug.
Orientation course on prevention
of micronutrient malnutrition
22nd to 26th August 1st
National
Consultation
2008
Workshop
From 1st to 7th Mid term review of CHLP
September
16th
and
17* meeting with D. G.
September
21s1 September TO Field work and attending public
7* November
hearing in 4 district
Organisation
PWN+Chennai
SAHA YOG ,CHSJ,PLP
DPWN+
NIPCCED Delhi
New Delhi DPWN+
CHC Bangalore.
NACO New Delhi
SATHI
Pune.
CEHAT
1st to 8th October 2nd
National
consultation
New Delhi
workshop
2008
Revised training for trainer
PWN+Chennai
29th to 2nd Nov
MPWN
Signature and quilt campaign
15 th Nov
3rd
National
Consultataion PWN+ New Delhi
1st to 4* Dec 2008
Workshop
Alumni workshop
• CHC Bangalore
5th to 6* Dec 2008
Project work
• MPWN
Jan and Feb
Presentation of work with respect to Learning Objectives
National workshop for planning for strengthening national and state level Networks
We were 22 women leaders from nine different states who participates in the 3 days
workshop.
On day one, we interacted with each other, shared our state wise concerns and
strength's and weakness of the National secretariat office.
On day two, Ms. Geetha from engender health took a session on understanding the
situation of women's movements in India. The state level network's shared their work.
We reinstated the PWN+ vision (see Anexure V) and came up with ideas and solutions
to strengthen our network.
On day 3 we went to Mahabalipuram where a three days National conference of project
directors on HIV/AIDS was going. We, all the 22 WLHIV state leader's met Dr.Sujata
Rao Director General of NACO .We gave her the memorandum on why, Drop in
Center's exclusively for women are required.
6
I gave a short note in AIDS INDIA about Railway concession for PLHIV which is
available only in the general class which created interest and a long discussion was
needed on this issue.
On 21st July I went to 1CRW (International Counsel for Research Welfare ) office and met
the project director, to seek technical support for documenting the research
undertaken on the current landscape of involvement of WLHA and the results of
training workshops and a national consultation on involvement of PLHA. The 1CRW
was also given the responsibility of documenting (print and film), the history of PWN+
to commemorate its tenth
anniversary.
*
1 attended a ten days
training
programme
on
advocacy for Reproductive
Health and Sexual rights in
Nainitaal which was organized
by SAHAYOG ,CHSJ, and
population
Leadership
programme from July 22 - July
30, 2008.
Objectives of the Training Programme
Build conceptual clarity on rights-based approach to sexual and reproductive health
(including maternal health and safe abortion) within an overall human rights
perspective
1. Develop an in-depth understanding of the present scenario in sexual and
reproductive health and rights: policies, evidence and debates - globally and
locally
2. Understand the role of rights based advocacy in the context of social change,
what factors/actors are involved to change opinions, practices, policies
3. Develop understanding of the components of essential advocacy
• analysis of the political, economic, social context
• identification of problems/advocacy issues/rights violations
• stake-holder analysis
• mobilization, organization-building, networking, alliance building
• communication, negotiation, conflict-resolution
• campaign planning, influencing specific groups of opinion makers, working
with media
• using and building evidence, developing information and advocacy
materials
7
4.
Apply the above in developing strategic advocacy plans including identifying
process indicators and intermediate outcomes
Modules and Contents
1.
Sexual and Reproductive Health and Rights (Two and half days)
• Gender, Power and Reproductive and Sexual Health
• What are Rights? Introduction to Human Rights.
• Reproductive and Sexual Rights - Tehran, CEDAW, ICPD, Beijing, MDG
• Health and Human Rights - UN system and India, AAAQ framework
• SRHR and Population Facts and Myths
• Rights based approach
• Introduction to NRHM and RCH2
Understanding Advocacy (3 days)
i. What is advocacy - advocacy and social change
ii. Rights based and evidence based advocacy
iii. Identifying key advocacy issues - Using evidence
iv. Identifying actors and factors - stakeholder analysis
v. Advocacy Experiences - community based advocacy, policy
advocacy, legislative advocacy, legal advocacy, media advocacy
3. Planning for Advocacy (One and half days)
4. Developing an advocacy plan
I met the Facilitators Dr. Abhijit, Ms.Jashodhara and Ms.Renu Khanna.
I shared my views and got them refined by Ms Renu, who was very cooperative and
explained each and every point that was raised in a very easy to understand way. Total
25 participants came from different NGO,s all over the country.
2.
In this training I came across some technical points related to advocacy. I was able to
distinguish between advocacy and activism. I came to know that many women suffered
from genital T.B. and it has an affect on their fertility which is a cause of social stigma. I
also learnt full forms of abbreviations like:
CEDAW- Conventional Elimination of all forms Discrimination Against Women
UDHR- Universal Declaration of Human Rights.
The training helped me significantly in my work. I learnt about the analysis of stake
holders networking of the NGOs, the media power and how to utilize it best for the
advocacy of a cause.
* I stayed four days in the Delhi Positive Women Network state level office.
Here we had a meeting and fixed an agenda for a one day advocacy programme to be
held on 6th August in Delhi to raise issue on widow pension scheme.
* I met with Ms. Freya who was providing her voluntary services from VSO (Voluntary
Service Organization). She gave training on improvement of computer skills, how to
access internet and many other things to our WLHIV in DPWN+ office. I had a
8
discussion with her about the VSO strategies and capacity building programmes for
state level network.
* I attended the orientation course on prevention of micronutrients, malnutrition at
NIPCCED New Delhi from 4-8 Aug, 2008.
The National Institute of Public Cooperation and Child Development designed this
course especially for executive and middle level functionaries associated with health
and nutrition programmes for women and children. The main objective of this
programme was to sensitize the participants about the magnitude of the problem of
micro-nutrients, create a awareness about policies and programmes for control of
micronutrient deficiencies, highlight causes and consequences of micronutrient
malnutrition, and evolve the strategies for prevention of malnutrition of micronutitient.
The contents of the programme had been covered through a combination of training
method including lecture cum discussions, group discussions, case study analysis,
group exercise, films, with emphasis on participatory approach to learning. Besides
faculty of the institute, programme faculty comprised of experts from technical
institutions, government and non govt organizations working in the field of nutrition
and health. I learnt that MM is a serious problem in adolescents and the programmes
that are run by the govt to reduce micronutrient malnutrition. I enjoyed participating
in group discussion and exercises.
* A three day workshop on introduction to GIPA, its structure and functions and the
role of gender was held from 22nd to 26th August 2008. The sessions were as follows:
Workshop One Day 1 Understanding GIPA
Introduction
and
background to GIPA
Day 2 - Structures and Day 3 - Gender and
GIPA
Functions
Structure of NACO, Gender and HIV
SACS, district units and
their
programs
on
prevention,
treatment,
care and support
Benefits of GIPA for Understanding the role Gender and GIPA
PLHA,
NGOs
and of networks and NGOs
government.
Involvement
and Why women should be
meaningful involvement involved
- case studies
Overcoming barriers to
involvement
During the workshop I was introduced to GIPA, explored its structure and functions
and developed an understanding of the role of gender in GIPA.
9
Another three day workshop was held for exploring national policies and the role of
GIPA. The sessions are listed below:
Day 1 - GIPA
national level
GIPA revisited
at Day 2 - Policies
Day 3 - GIPA Draft Policy
and training for own
research
Exploring GIPA draft
policy
NACP-III
Structure and functions UNAIDS "Three Ones" Training on participant's
of
national
level principles
own field observation on
stakeholders
the prevalence and quality
of women's involvement
at the state level
Global Fund
Coordinating
Mechanisms
Country
This workshop developed my knowledge on national and international level policies
including NACP-III, UNAIDS "Three Ones" principles and the Global Fund Country
Coordinating Mechanisms.
One the final day of the workshop, 15 participants were trained on how to undertake
their own research on the prevalence and quality of women's involvement in their own
states.
I got the GIPA draft Policy translated in the local language and in our MPWN+ I took a
complete session on GIPA and NACP-III for our members.
* National consultation was organized with the support and involvement of Global
Coalition on Women and AIDS (GCWA), NACO, UNAIDS, UNIFEM, UNICEF, UNDP,
VSO and other national and international organizations working on women and HIV
and AIDS in December 2008 at Delhi.
The 110 women attending the consultation were divided into three groups, focusing on
national, state and district level functioning of government bodies and NGOs. During
the consultation participants who undertook research, had discussions on the results of
their field observation on levels of involvement of WLHA and barriers to involvement.
The groups began to develop recommendations to improve involvement of women
living with HIV with input from stakeholders. UNAIDS "Three Ones" principles and
the draft GIPA policy was analyzed and further recommendations developed. WLHA
had been given the opportunity to share their thoughts and experiences with
stakeholders and discuss the barriers to involvement that they have experienced and
the ways that these can be overcome. The recommendations for improving
involvement presented followed by a panel discussion. Feedback was obtained from
stakeholders through an open discussion.
10
The National Consultation had
given the, supporters and
stakeholders an opportunity to
commemorate
the
tenth
anniversary of Positive Women
Network. And to present the
achievements of PWN+ over the
last ten years, the challenges we
faced and the challenges we have
to overcome in the future. We
had launched our ten year
commemoration
document,
screened
the
accompanying
documentary film and honored
our supporters and network members.
The 30 women who attended the training workshops travelled from their states. 15-20
women attended a the preparatory training workshop two days prior to the
consultation to develop skills to enable them to facilitate sessions and share knowledge
during the consultation. The first two days of the consultation involved discussion and
development of recommendations with stakeholders. Stakeholders and supporters
invited to attend PWN+ 10 year commemoration event on the final day of the
consultation.
NationalConsulta tion Sessions are as follows
Day 2
Dayl
Two day
preparatory
workshop
Presentation from - Analysis of draft
15
participants G1PA policy and
Ones"
who
undertook "Three
own research on principles.
Further
the
prevalence
and quality of development of
recom me nd a tions.
women's
involvement
at
the state level and
barriers
encountered
- Discussion on - Presentation of
of
the functioning of testimonies
WLHA
and
government
bodies and NGOs recommendations
at district, state to stakeholders.
Forum
for
and national level
and
and the barriers discussion
Q&A.
to involvement
- Development of
recommendations
Day 3
Commemoration of
PWN+ tenth year
anniversary
- Launch of booklet
and
video
documentary
commemorating
PWN+ anniversary
Launch
of
research report on
women's
involvement
11
as to how women
can
become
involved.
Honoring of PWN+
partners
and
supporters
Celebration of past
ten
years
and
looking forward to
future of PWN+
* My fieldwork was in SATHI (Support for Advocacy and Training to Health
Initiatives) SATHI is the action centre of Anusandhan Trust evolved from CEHAT.
SATHI envisages a society, which has realized its right to health and health care-
•
•
•
A society which has eliminated health inequities, by removing the structural
barriers which today prevent the majority from accessing healthy living
conditions and quality health care;
A society which instead of the current pathological model of development, has
adopted a developmental path which fosters health of both the people and their
environment;
A society where people, are not appendages of the health care system but; are its
prime movers and have universal access to appropriate health care as a human
right-
To realize this long term goal, SATHI's strategy is to contribute as a team of pro-people
health professionals, to the movement and initiatives towards such a society, by
focusing on the aim of realization of health and health care as fundamental human
rights.
SATHI's origin is traced to a small action-team in CEHAT, which since 1998, pioneered
a collaborative Primary Health Care project with three People's Organi-zations. During
the last 10 years this work has developed considerably and, has moved beyond it's
initial focus and now consists of many components.
A. Collaborative health initiatives with four people's organizations in Maharashtra and
Madhya Pradesh.
B.
Advocacy at broader level for Primary Health Care and Health Rights
C.
Training on Health Rights and in Community Health Initiatives
D. Action-research related to Health Advocacy
During the field placement of two months with SATHI, I attended 4 district level
Jansunwai and one state level Jansunwai (Public Hearing). In this process I
encountered the positive angles of Community Based Monitoring of Health Services.
12
Under the NRHM programme, nine states were selected to be part of the first phase of
CBM Maharashtra wss one of the state. In Maharashtra this community based
monitoring process started in 5 districts, i) Amravati ii) Nandurbar iii) Osmanabad iv)
Pune v) Thane. Three Talukas were selected in each of the above districts, and three
PHCs in each taluka and 5 villages under each PHC were undertaken. As a State
nodal organization SATH1 CEHAT Pune, undertook the above said programme for the
period of April 2007 to January 2008. [see Annexure IV J
My observation
•
People were very actively involved with greater enthusiasm in the process.
The people were getting aware of the health services which are available at PHC,
sub center, and about the rights to avail them.
People at grass root level were coming to know about the amount of funds
which was made available to their village/taluka/district/state. Awareness was
seen on ascending trend for the services provided on paper and in physical state.
Provision of health services improved at sub center PHC and RFI level after the
public hearings.
The mothers were getting there dues under the Jannani Suraksha Yojana without
any delay from the concerned authorities.
Various vacant posts at different levels were filled in due course and fresh
appointments and tenders were issued for future programmes.
The people's health rights charter was displayed in each PHC and RH
prominently and was given wide publicity.
All the essential medicines will be provided across the counter on a cashless
basis and with the provision of local purchase if not available on hand at the
time of requirement.
Free transportation will be provided to and from the referral services if it is not
available
arrangement will be made through the 1PH funds
•
Signature and quilt campaign on 15th November 2008: Women Voices &
•
•
•
•
•
•
•
•
•
MPWN+ organized a signature and
quilt campaign (Quilt made by the
belongings of people living with HIV
and few those no more with us) to
enlighten the masses and to bring
greater awareness about the SHGs, and
NGOs working in the field of
HIV/AIDS or those voicing the various
issues pertaining to women.
The Objectives of the Campaign were -
•
To impart knowledge to the general public on how to reduce Infection rate
among women.
13
•
To help the community to be aware of how they can help tire positive women. (
Both Emotionally as well as by Economic Support)
* In December 2008, with the experiences of women living with HIV AIDS in areas of
sexual and reproductive health, I developed a proposal for MPWN+ with the following
goals and activities and submitted to ITPC. The goal of the project was Empowering
women living with HIV as peer educators and activists in responding to women's
specific opportunistic infections in three districts of Maharashtra
1. Developing 30 master trainers / educators in three districts of Nagpur, Gondia and
Gadchiroli as prevention ambassadors for women specific opportunistic infections
1.1 Selection of 10 WLHA master trainers from each district based on prior
experiences and background knowledge on HIV and ART
1.2 Developing a Flip Book on prevention and treatment referrals on cervical and
breast cancers among WLHA
1.3 Three day training for master trainers in Nagpur and training on how to use the
Flip Book in community
1.4 Organising and sharing information through support group meetings of WLHA
in respective districts
1.5 Mobilising 300 women living with HIV in three districts and encouraging them
for screening tests on cervical and breast examinations
2. Networking with health care providers in public and private sector to improve
referral services on women specific illnesses like cervical and breast cancers among
WLHA
2.1 Individual one to one meetings with public and private health centers that
provide treatment on breast and cervical cancers
2.2 Organising quarterly meetings among heath care service providers to strengthen
the referral systems
2.3 Recording information and encouraging WLHA to access cervical and breast
cancer tests
2.4 Documenting the results and preparing status paper towards treatment
advocacy for women specific illnesses
3.
Advocating with SACS and other service providers to include prevention of specific
OI among WLHA
3.1 Develop advocacy IEC materials (Poster and an information Brochure) on
prevention and treatment of Women specific Opportunistic infections
3.2 Organise one day advocacy event involving district and state level HIV AIDS
stakeholders in highlighting the need and further action on needs in women
specific Opportunistic infections in the state.
Though we submitted with the detailed list of activities and plan, unfortunately our
proposal was not accepted. Hence the same concept I am using with CHLP support to
implement some components of this proposal.
14
* One day health training programme on 14th February 2009
The main objective of this health training programme was to empower women living
with HIV as peer educators and activists in responding to women specific
opportunistic infections.
This programme started at 12 pm in the premises of the Positive Women Network of
Maharastra office. Near about 30to 35 participant had registered.
In introduction session every one gave their introduction and why they participated in
this training programme and their expectations.
A small questionnaire was given to them for pre evaluation.
Mr. Riyaz Quazi, project co-ordinator of H1V+T.B. cordination project, gave
information on causes, etiology , signs and symptoms and treatment of Tuberculosis.
After tea snacks break I took a session on Opportunistic infections and how to manage
them. Availablity of treatment In the
session on I focused on women specific
O.Is like breast cancer and cervical
cancer available screening test like
paps smear.
Mr. Sanjay, counsellor of Ashirwad
Kanti,
gave
information
about
government schemes
like Sanjav
Gandhi Niradhar yojana , children
hostel and day care school by their
organistion .Health check up camp and
health facilities was available free of
cost.
Dr. Amabade, of A.R.T center, made a short visit from his busy schedule.
He provided valuable knowledge about ART and management of its side effects and
also on the importance of adherence.
Looking Inward - What did I learn about myself?
I was very narrow and fixed minded, and also short tempered. After attending the
orientation in CHC, a total change has occurred in my behavior as observed by friends,
colleagues and family members. As I attend programmes , training and various
workshops, 1 am finding it very' easy to make present, with a high level of confidence
which I was unable to do earlier
Looking Outward - What did I learn about the community?
•
•
During the programme I came across many NGOs and social workers who are
pioneers in there own fields or have attained a place of respect in the
community. It was a great opportunity to meet them and learn about their way
of working and the process they followed. This gave me vision to cany out my
new ventures in future.
In the advocacy programme I experienced discrimination. When my room
partner came to know my HIV status, she felt uncomfortable and left the room.
This incidence taught me a good lesson not to disclose my HIV status before
15
unsensitised people. During counseling I always tell my clients to disclose their
status to sensitized medical health care providers.
During field placement in SATHI CEHAT I learnt about coordination,
networking and team work which are the essential ingredients to carryout a
successful project.
I met Dr. Satish Gogulwar who started a project called -Aamhi Amachaya
Arogyasathi which motivates women in the villages to come together and form
'bachat gat'. They have become confident and having dairy decoration and
herbal medicine. Aamhi Amachaya Arogyasathi whose vision statement is to
build healthy capable and equity based global society. Believe in initially several
concept and get them implemented from local people after their empowerment.
I went to Nandurbar district with the sathi-cehat team. Personally it was a great
experience for me. We stayed in Dr. Dhananjay's native. I met his parents his
mother was so kind and active .She shared her experiences with me and I gained
a lot of knowledge from her .
After attending the three workshops national consultation of the Positive
Women Network, I learned the gender policy, GIPA (Greater Involvement of
People Living wit HIVAIDS) and NACP III (National AIDS Control
Programme).
During the workshop in New Delhi of PWN, I got the opportunity to visit
NACO head office and meet the director general Ms Sujata Rao, I also visited the
UNODC, the UNICEF and UNIFEM offices which gave me a golden
opportunity to gain knowledge about big structure of ournational and
international health policy.
I have learn the meaning of community health which is a process of improving
physical, mental and social well being of the community and all component
members. Health services must be available, and equally shared with the whole
community, It is not merely the absence of illness, sickness and disease but
related with the social determinants geographically, economically, and class,
caste, gender. Practically what I saw was that common people do not get access
to treatment according to their needs .Government has made many health
policies but due to corruption, lack of awareness, gap between health care
provider and common people, lack of coordination between public health
system and Panchayati Raj and political leader health programme, it is not
successfully implemented. Any public service can be improved only with active
participation of the local people. Social action can improve health. Community'
health can be improved by participation of people in decision making, for
example for the GIPA policy, there was PLHIV at decision making committees
with gender balance
The people need to enable themeslves to maintain their health, exercise thenresponsibilities collectively and also demand health as their right.
Due to community monitoring process in the pilot project districts people were
aware about their health rights through display of health charter. People got
platform to solve their problems in public hearing at PHC, district and state
level.
As a counselor I am trying to implement all these principle in my work. In the
ART center I counsel every new client with information about HIV/AIDS,
respective tests, treatment and their health rights.
16
Looking Ahead - Where do I go from here?
With all the learning's I received I will be able to work with a stronger position and the
weapon of skills achieved from tire programme to strive for the betterment of the
community at the grass root level and also take tire grievances of the community to
appropriate position to solve them.
17
Annexure
Annexure I
NATIONAL AIDS CONTROL POLICY -PHASE III
Excerpt from NACP III document
To halt and reverse the epidemic in India over the next five years
Specifically reducing new infections by
> 60% in High Prevalence States
> 40% in Vulnerable States
Objectives:
• Prevention of new infections (saturation of HRG coverage and scale up of
interventions for General population)
• Increased proportion of PLHA receiving care, support and treatment
• Strengthening capacities at district, state and national levels
• Building Strategic information management systems
• Three Ones
• Equity
• Respect for the rights of the PLHA
• Civil society representation and participation
• Creation of enabling environment
• Improved access to services
• Effective HRD strategy
• Evidence based and result oriented programme implementation
• Prevention
• Saturation of HRG
• Targeting of Bridge Population
• Focusing on Women, Youth and Children
• Blood Safety
• Access to STD Care
• Condom Promotion
• Comprehensive Communication Package
• Advocacy
• IEC (Mass Media & IPC)
• Social Mobilization
Ila
Care and Support
> Community Care Centers
• OI Management
• Drug Adherence
lib
Treatment
> ART
■ Adult
■ Paediatric
He
Impact Mitigation and Stigma Reduction
• Implementation Strategies
18
> Shift of focus from states to district based on evidence
> Decentralization
> Capacity Building - Infrastructure and Training
> Setting up procurement systems
> Convergence with health systems
> Mainstreaming
> Partnership with Civil Society and Private Sector
Annexure-II
The meaning of 'Greater involvement of PLHIV'
In December 1994, at the Paris Summit, 42 nations declared their support for the greater
involvement of people living with HIV/ AIDS (PLHIVs)l in prevention and care, policy
formulation, and service delivery. Signatory governments to the Paris Declaration
undertook to "support a greater involvement of people living with HIV/ AIDS through
an initiative to strengthen the capacity and coordination of networks of people living
with HIV/AIDS and community-based organizations. By ensuring their full
involvement in our common response to the pandemic at all national, regional and
global-levels, this initiative will, in particular, stimulate the creation of supportive,
political, legal and social environments (Paris Declaration, 1994)."
Since the Paris Summit, GIPA has been endorsed in numerous international statements,
most recently by the UNGASS Declaration of Commitment on HIV/AIDS, which
acknowledges "the particular role and significant contribution of people living with
HIV/AIDS, young people and civil society actors in addressing the problem of
HIV/AIDS in all its aspects and recognizing that their full involvement and
participation in design, planning, implementation and evaluation of programs is crucial
to the development of effective responses to the HIV/AIDS epidemic (United Nations,
2001, paragraph 33)."
The PLHIV movement in India
From a handful of selectively open PLHIV in the mid 90's, the PLHIV movement has
steadily grown in size, visibility and capacity. In the late 90's the first National network
of PLHIV was formed which has since grown to have many state level networks and
district level networks. New leadership has emerged; women living with HIV have
increasingly become part of this growing group of articulate and informed advocates.
Alongside, collectives of men who have sex with men, sex workers and Intravenous
drug users have also benefited from the experience of those among them who live with
the virus. These collectives have specifically contributed to the advocacy on creating
enabling legislative environment, reduction of stigma and challenging discrimination.
Consistently, they have represented their concerns at international, national, state and
district levels. They have been at the forefront of treatment advocacy in India, played
the important role of being the eyes and ears of the national AIDS programme,
ensuring that quality services are provided. Many PLHIV have stood shoulder to
shoulder with Presidents and Prime Ministers of India, ministers and legislators at
19
different levels, sensitizing them about the key HIV issues. Their fearless presence on
print and electronic media has contributed significantly to reduction in stigma.
However, the involvement of PLHIV and those directly affected can become more
meaningful, consistent and systemic, thereby benefiting the national HIV response by
accelerating its impact.
Purpose/objectives of the policy
The National AIDS Programme of India defines the involvement of PLHIV and affected
communities as a specific expression of the right to active, free and meaningful
participation in all aspects of the HIV/AIDS response.
The application of the principle of GIPA is an organic and ongoing process that
demands different levels of readiness. This policy aims to effectively harness the
meaningful involvement of PLHIV in order to reduce the spread of HIV and mitigate
the impact of the virus in India.
Guiding Principles of the GIPA Policy for HIV Programmes
The national AIDS programme of India recognizes that involving PLHIV and affected
communities in the HIV response makes a powerful contribution to the pandemic by
enabling individuals and communities to draw on their lived experiences; thus
contributing to reducing stigma and discrimination and to increasing the effectiveness
and appropriateness of the HIV/AIDS response.
The advantages of GIPA at the policy level flow beyond the immediate concerns of
prevention, care, and treatment issues and can improve the capacity of various sectors,
such as education and employment, to respond to HIV/AIDS.
To effectively ensure that PLHIV and affected communities are actively involved in
responding to the pandemic it is essential that PLHIV fulfill a diverse range of roles
that include policymakers, activists, healthcare workers, educators, scientists,
community leaders and public servants, as may be applicable in a given situation and
setting.
Meaningful inclusion of voices of PLHIV who are marginalized because of gender,
sexuality, age and behaviors in the HIV response is key to the success of the
programme.
PLHIV leadership is also central to establishing a voice in the policy process. PLHIV
leaders generally have to accept the heavy burdens imposed by the physical and social
experience of living with HIV & AIDS. Leaders often emerge because they are among
the first people in their country to speak openly about living with HIV. The limited
number of openly positive people creates huge demands on those who have taken the
step to be public about their status. A critical element in sustaining such public
leadership remains the provision of ARVs and OIs treatment and diagnostics including
second line for those who lack sustainable access.
To ensure that PLHIV and affected communities are meaningfully involved in all
aspects of the HIV/AIDS response it is essential that we all work together to advocate
for and with PLHIV. Effective advocacy requires that:
• The voice of PLHIV is heard
• PLHIV obtain their rights
• The interests of PLHIV are represented
• PLHIV have access to necessary services and support in an enabling and conducive
environment
20
Policy Guidelines
PLHIV will be recognized as important providers of information, knowledge and skills;
their participation will be on the same level as professionals in the design, adaptation
and evaluation of interventions.
PLHIV will be facilitated to carry out real and meaningful roles in HIV interventions
such as acting as caretakers, peer educators and/or outreach workers.
PLHIV will be active spokespersons in campaigns to change behaviors and will be
meaningfully involved in sharing their views at meetings and conferences.
PLHIV will be meaningfully involved in contributing to public awareness raising
activities and act as role models in the HIV response.
PLHIV will be actively involved in tire development of HIV information, education and
communication (IEC) resources, and provide important feedback that will influence the
ongoing development of IEC initiatives
NACO, SACS and all partner agencies will promote the active and meaningful
involvement of PLHIV and affected communities within the organisation — in
partnership with organizations and networks of PLHIV and affected communities; this
is essential for implementing the GIPA Principles.
NACO, SACS and all partner agencies will have an organizational environment that
fosters non-discrimination, and values the contribution of PLHIV and affected
communities.
The national AIDS programme will recognize and encourage the involvement of a
diverse range of PLHIV and affected communities in all HIV work.
All implementing partners of NACP3 will define the roles of PLHIV in our organisation
and their associated responsibilities, including supporting the capacity of individuals to
fulfill those roles, and provide the necessary organizational and financial support to
those people.
All implementing partners of NACP3 will ensure that organisational policies and
practices provide timely access to information so PLHIV and people from affected
communities work in an environment that fosters non-discrimination, and values their
specialized contributions.
All implementing partners of NACP3 will ensure that workplace policies and practices
recognise the health and related needs of PLHIV, and create an enabling environment
that supports their involvement in our organisation.
All implementing partners of NACP3 will ensure that PLHIV and affected community
organization/network representatives that work with organisations are supported to
be accountable to their members, and we assist them to establish processes that enable
them to represent the views of their membership.
AU implementing partners of NACP3 will give resources and support to capacity
building within PLHIV and affected community organisations and networks.
AU implementing partners of NACP3 will fund and/or advocate for funding for
PLHIV and affected community organisations to ensure they have the resources to
build their capacity and empower others within their own networks.
TO include:
- include the perspective of PLHIV
- involve PLHIV to feed into the programs on prevention and care programs on
HIV
21
all implementation agencies of NACP3 to involve PLHIV as watchdogs to
evaluate and monitor the program progress
involvement of PLHIV towards bridging the gap between service providers and
community
PLHIV are the best advocates for tire issues
Involve PLHIV to reduce stigma and discrimination and impact mitigation
efforts
Preferences to be given to PLHIV during recruitment of staff and as and when
required PLHIV experiences be replaced with educational qualification
At least one PLHIV be recruited in each intervention sites supported by
NACO/SACS. This will help reduce stigma
Promoting GIPA at the management level- involvement of PLHIV at decision
making committees with gender balance
Investment in GIPA (capacity building, network formation and strengthening,
sustaining networks)
-
Annexure-III
Positive Women Network
Positive Women Network (PWN+) is the only national self-help organization focusing
entirely on issues of women living with HIV. PWN+ was initiated in 1998 to address
the need for a support mechanism for women and children living with HIV. With the
organizational goal of improving quality of life by providing an enabling environment,
PWN+ envisions a better life for women living with HIV. Positive Women Network
seeks to empower women and children living with HIV/AIDS to access their rights
and live a life of dignity, free from stigma and discrimination.
PWN+ functions as an information centre, organising workshops and sensitising
groups on positive living and issues of women living with HIV/AIDS. Its activities
include networking, advocating for issues affecting women living with HIV,
counselling, training and the initiation of self-help groups of WLHA.
For the last ten years, PWN+ has been committed to building the capacities of women
living with HIV and campaigning for equality and justice. It has conducted numerous
capacity building workshops for WLHA, including gender training and visioning
sessions and legal literacy workshops designed to create awareness among WLHA of
their rights and the existing laws and policies which can protect them. We have also
conducted advocacy training to empower WLHA to advocate for women's rights in
HIV-related policies and programs put forward by government and other stakeholders.
pyyjq+ has also campaigned tirelessly against stigma and discrimination and for the
recognition of the rights of WLHA.
In 2002, PWN+, with the support of UNIFEM, UN agencies and NACO, organized a
national consultation, Positive Faces and Voices of Women, the first of its kind in India.
The consultation was the outcome of a felt need for a platform to address the special
needs, concerns and issues of women living with HIV/AIDS in order to bring about
tangible improvements in the quality of their lives.
22
In 2003, PWN+ alongside the National Commission for Women organized public
hearings in Karnataka, Kerala and Tamil Nadu to address concerns of women living
with HIV. The public hearings were organized in response to 'Positive Speaking', a
study undertaken by PWN+ and the Centre for Advocacy and Research (CFAR) which
indicated high levels of stigma and discrimination against people living with
HIV/ AIDS in the three states.
Organized in 2004 with support from UNIFEM, UN agencies and NACO, Shaping a
New Reality': for Women Living With HIV/AIDS, which promoted a gender-sensitive
multi-sectoral approach to HIV/AIDS was the second national consultation organized
by PWN+. The consultation was preceded by training-workshops undertaken over a
six-month period which addressed mainstreaming concerns of WLHA in existing
schemes of the Government. Following the training, women were able to develop local
goals and strategies to access government programs, which they advocated during the
National Consultation. During the consultation, recommendations were developed for
Government ministries including the Ministry of Social Justice and Empowerment,
Ministry' of Rural Development and Ministry of Youth Affairs and Sports on how
various government schemes could be extended or adapted to better involve WLHA.
Out of the consultation came a declaration by members of the Positive Women
Network to shape a new reality.
In 2006, PWN+, in partnership with UNICEF organized The National Consultation for
Children Affected by HIV/ AIDS in India. The consultation brought together children
affected by HIV/AIDS and created a platform for their voices to be heard by high-level
policymakers in the Indian government and NGO community. Through this forum,
children from all over India articulated many concerns - being orphaned, being denied
services, lacking access to education - and offered suggestions to improve the quality of
their lives.
Significance
Improving involvement of people living with HIV/AIDS is recognized as 'critical to
halting and reversing the epidemic'1. However, despite being officially on the agenda
in the response to HIV/AIDS since the Paris AIDS Summit of 1994, it is widely
recognized that the principles of involvement are rarely fulfilled.
At the 2001 UN General Assembly Special Session on HIV/AIDS it was agreed by over
180 countries that gender equality and women's empowerment are fundamental to
reducing girls' and women's vulnerability to HIV/AIDS. India's National AIDS
Control Organization (NACO) has renewed its commitment to improving involvement
of people living with HIV/AIDS in its NACP-III guidelines in recognition of the failure
of NACP-II to adequately address the issue. UNAIDS also supports the principles,
calling for 'all actors to ensure that people living with HIV have the space and the
practical support for their greater and more meaningful involvement'2. Similarly, the
1 UNAIDS Policy Brief (GIPA)
23
Global Coalition on Women and AIDS have made improving involvement of women
living with HIV a priority in its Agenda for Action of Women and AIDS.
PWN+ wishes to be at the centre of the renewed commitment to involving people
living with HIV/ AIDS to represent the voices of women and children living with HIV.
Annexure IV
Key issues emerging from various District level Jan Sunwais Related to
Community monitoring of Health services in Maharashtra
This note briefly lists the key issues that were presented in various District level Jan
Sunwais in five districts, as part of the Community monitoring process under NRHM.
Not all the issues and cases of denial of health care have been listed here, however
major issues, especially those requiring district level or state level intervention, have
been outlined.
It should be noted that Community monitoring has led to a number of improvements
in all of these districts, and this process has led to increased dialogue between people
and public health providers. However these improvements have not been covered in
this note.
District Nandurbar
Key issues:
Availability of medicines
Representatives of the Block Nodal NGO in Akkalkuwa and Dhadgaon have
shown that most of the PHCs do not have adequate medicine availability
(especially ASV, TT inj, and disposable syringes).
Specific issues observeda. Participants in the Jan Sunwai have unequivocally said that many times
syringes that are used in the PHC are autoclaved, although these are
disposable syringes.
b. Mechanism of local procurement of medicine was not revealed to community
monitoring agencies inspite of repeated requests.
A. Ambulance availabilityOut of the nine PHCs monitored, only four PHCs have a functional ambulance.
Issues observeda. It has been claimed time and again that wherever ambulance is not available
people can hire a private vehicle for which reimbursement would be given.
However in practice it is rarely done citing various rules.
b. Though the untied fund is supposed to be used for hiring private vehicle
wherever ambulance is not available, many people have reported that for one
or the other reason this service has been denied. Hence patients are often
denied ambulance facility.
B. Vacant Posts-
24
It has been pointed out that there are large number of Health posts which are
lying vacant for last few years, mainly posts of ANMs and MOs.
Issues observeda. One interesting phenomenon that has been observed in Nandurbar is
simultaneous appointment of single doctor at two places, e.g. Kusumvada
PHC doctor also happens to be ADHO. Because of this arrangement though
on paper PHC MO post in Kusumvada appears filled, in practice the MO is
never present in the PHC. It should be noted that arrangement like this also
hides real number of vacancies in the District.
b. ANM posts have been vacant for last many years; even the monitoring
agencies are convinced that the present ANMs are simply overburdened.
C. Construction of new PHCs and location of the present onesa. One of the issues which has been repeatedly stressed by community' level
activists is the poor location of certain PHCs. In Dhadgaon block most of the
PHCs become inaccessible during monsoon, including the one which is
designated as 24x7. Similarly in Akkalkuwa, location of some PHCs is
inconvenient to the people residing in the PHC area.
b. In some areas though the new PHCs have been sanctioned, due to non
cooperation of Panchayats and also because of the vested political interests
these PHCs could not be constructed.
D. Incentive based schemes- (Janani Suarksha Yojana and Matrutva Anudan
Yojana)Delay in the payment, partial payment, asking for number of documents which are
difficult to arrange are some of the general problems that are observed in Nandurbar.
Issues Observeda. In some cases payment was delayed for more than three months. According to
the DHO, at the District level itself there was delay in receiving the money.
b. The range of paperwork that a potential beneficiary of JSY or Matrutva Anudan
Yojana (Maharashtra specific maternal benefit scheme) has to perform is simply
overwhelming for the ordinary Adivasi person. This leads to lapse of benefits.
c. Incentives are provided only at the service points like PHC and RH. There were
instances where woman who has delivered at home, with a newborn baby has to
go to these service points within 10 days of her delivery for seeking benefits of
the mentioned scheme.
District Pune
Key issues:
Taluka Khed
PHCs
•
•
PHC Wada and Kadus do not have drinking water leading to lower utilization
by people
The planned new PHC should be operationalised at Vashere (which is more
centrally located) instead of Vetale (less convenient location for most villages)
25
PHC Khed does not have proper quarters for doctors, hence doctors and staff are
not staying at PHC. Similar problem of quarters for PHC Kadus
RH Chandoli - Serious issue of demand being made by doctors in the range of Rs. 5000
to Rs. 7000 for performing operations, including cesarean operations
•
Taluka Velhe
PHCs
• Sub-unit at Panshet is insufficient to provide full range of health services to
surrounding villages. This must be upgraded to PHC at the earliest
• Quarters for staff inadequate, leading to non-residence of PHC staff
• Vacant posts of ANMs and MPWs
• Almost all of the PHCs do not have functioning laboratories, lack of lab
technicians
• Most of the PHCs do not have functional ambulances or patient transport
vehicles
RH Velhe
Not a single specialist doctor. Entirely run by general MOs. No cesareans or operations
performed.
Serious problem of electricity supply leading to some deliveries being performed in
near-darkness. Inadequate water supply.
Ambulance exists but no proper driver. Peon is driving vehicle but charge of Rs. 5 per
Km. taken from all patients.
Inadequate number of indoor beds.
Taluka Purandar
PHCs
• Belsar PHC does not have its own building, lack of proper space leading to
serious deficiency in provision of services. Adequate building needs to be
arranged at earliest
• Till recently doctor at PHC Malshiras was frequently prescribing medicines for
purchase from medical store
• Quarters for staff inadequate, leading to non-residence of PHC staff
• Vacant posts of ANMs and MPWs
• Almost all of the PHCs do not have functioning laboratories, lack of lab
technicians
• Most of the PHCs do not have functional ambulances or patient transport
vehicles
RH Saswad
• Expired drugs have been found in the pharmacy, which were kept for being
dispensed
• Pharmacist is on leave (period not known) leading to problems in dispensing of
medicines
• Pregnant women are asked to have Ultrasound performed from a private
facility, have to make payment for this
• Patients required to have HIV and Widal tests performed from private labs
• Inadequate specialist doctors and staff
26
Cases of denial of Health care at various Rural Hospitals • Serious complaints were voiced by certain women patients concerning RH
Chandoli (Tai. Khed), who accused the surgeon of having demanded large
amounts of money for performing cesarean operation. It was alleged by two
women that Cesarean operation was denied when they refused to pay the illegal
bribe of Rs. 5000 that was demanded.
• Similarly another woman who had undergone sterilization in RH Chandoli one
and half years back, became pregnant (a clear case of sterilisation failure) yet
when she approached the same RH for D&C (abortion), Rs. 1500 were
demanded by the doctor. It was only after the intervention of a local journalist
and the threat of media exposure that this demand was withdrawn and the
abortion was performed.
• Complaint was voiced by a woman who approached RH Saswad (Tai. Purandar)
during labour, and was asked to get Ultrasound performed from a private clinic
as a precondition for the delivery being done in the RH. This was despite an
earlier, normal U/S report for the woman being presented when she approached
the RH. Ultimately delivery care was denied and she had to undergo delivery in
a private hospital
Some cross cutting issues noted by the panel:
• Lack of availability of medicines is significant and in some cases medicines are
being prescribed for purchase - this must stop and all essential medicines must
be made available from the PHC stock itself.
• Certain commonly required medicines found deficient include Inj. Methergin,
Syp. Paracetamol and Syp. Co-trimoxazole
• Large number of PHCs do not have functioning laboratories; serious shortage of
lab technicians needs to be addressed
• Charter of Citizen's health rights needs to be displayed in all PHCs with name
and mobile numbers of Medial officers
District Amaravati
Key issues:
A. Inadequate infrastructure and humanpower at PHCs Issues observeda. Vacant Posts of ANMs and MOs for last many years in certain PHCs.
b. Unavailability of certain essential medicines.
Upon checking the indent register in some of the PHCs it has been observed that
there is inconsistency in medicine supply, most of the medicines that are
supplied are less than what has been demanded.
c. In one PHC upon checking the medicine stock it has been observed that lot of
medicines are still stocked though their expiry date has already passed.
B.
Referrals of delivery casesa. It has been observed that in many PHCs the tendency of referring women in
labour without even examining the patient is growing. There were at least
27
three instances where a woman was referred to the Rural Hospital or tire
private hospital citing complications. However all these woman had normal
delivery after reaching the referral hospitals. (In every PHC there should be
clear guidelines about referral, in case it is observed that the referral was
unwarranted an enquiry should be conducted)
b. Another significant problem that has been noticed is access to ambulance
services in Rural Hospital. It has been observed that in some of the PHCs
ambulance services are available, however these services are available only
till the rural hospital; for subsequent transfer from RH to the sub district or
district hospital people have to approach the Civil surgeon. This arrangement
is creating lot of problem for patients who need ambulance services in RH.
c. Almost all PHCs do not have stretcher or wheel chair facility, upon enquiry it
was told that there is no provision of budget to buy these essential
commodities. However if needed PHC officials were told to buy it from
untied fund.
C. Anganwadi Servicesa. In Melghat it has been observed that there are some Anganwadis which are giving
services to as many as seventy children, with limited man power and resources.
There has been consistent follow up of this issue by the district nodal NGO
however no action has been taken on it.
b. Though there is a guideline by the state Government that whenever a grade m and
IV child is admitted in the hospital, the mother accompanying a child should also
be given adequate food and also monetary incentive to take care of loss of daily
wages. However this rule is not at all followed by the Public Health Department.
D. Arbitrary transfer of PHC MO at Dhamangaon Gadhi In spite of large scale community protest, the DHO and other officials at the district
level are adamant on transferring a PHC MO, Dr. Mrs. Miraj Ali, in Dhamangaon
Gadhi. This is despite the fact that she has significant community support since she has
been regularly providing services while being based at the PHC. (separate letter has
been sent by panellists to MD, NRHM in this regard).
E.
There has been a long standing demand by many activists working in this area
that every PHC and RH should have a counsellor, who knows local dialect, who
would facilitate communication between local Adivasis and Public Health
functionaries. This would lead to better access to health services and better
awareness amongst Adivasis about various Government schemes.
District Osinanabad
Rural Hospitals
There were two main issues that need follow up at higher levelI)
Availability of Essential Medicines Gross shortage - for example, out of minimum eight commonly required
antibiotics that should be available, five were totally missing in Ter and six were totally
missing in Tuljapur RH respectively. Out of 14 medicines examined, 9 were missing in
Ter and 10 were missing in Tuljapur RH respectively.
28
II)
Vacant postsIn Tuljapur and Kalamb RH • Only one or two of the four posts of specialist doctors have been filled.
• The post of Medical Superintendent was vacant in both RHs.
Primary Health Centres
Because of Community Monitoring, number of visits of the staff to villages has
improved but home visits have not improved.
As regards supply of essential medicines, out of 8 PHCs surveyed, the situation was as
follows:
Good - 3 (37%)
Fair - 2 (25%)
Unsatisfactory - 3 (37%)
There were some discrete examples of highly unsatisfactory services • In Naldurg PHC, people complained that even simple delivery cases are referred
to a nearby private hospital, routinely. One concrete case was reported wherein
the woman who had come for delivery at 4 PM was asked to go to the private
hospital. She was in no position to do so and was delivered by a nurse, who was
on leave but had come to PHC for some other work. The doctor did not do
anything in this case. After the delivery, the mother and baby were left alone in
dark in the PHC at night.
• Jaagji PHC is supposed to be 24x7 PHC. But only 8 deliveries were conducted in
this PHC during last 1 month. One of the nurses conducts deliveries at home and
charges fees for it. She was suspended, but has been reinstated.
• Staff does not visit Dalit bastis in Pohner PHC area in Osmanabad Taluk.
There was a strong suggestion that the system of trained dais being paid some
honorarium per delivery conducted should be revived.
29
is lk<? seco^ pk^f
oj lk<? comuMiltj ^^Hk ^4bw$ki|? ^kew (AOOJ-WO/)
<xv\4 iv
Sir RaUh IaU 'Iha^I,
Position: 571 (10 views)