PHA-Exch> Right to health in India; an update

[Claudio Schuftan]

 Download the original
attachment<http://mail.google.com/mail/?view=att&th=11ce1f57c7190744&attid=0.1&disp=attd>

*District level Jan Sunwai for Community monitoring of Health rights in
Thane*

On 6th October 08, nearly 300 people, coming mostly from adivasi communities
in various parts of Thane district, assembled for a District level Jan
sunwai in Thane. This event organised by the local popular organisations was
the culmination of over a year-long process of 'Community monitoring of
Health services' at various levels in the district. The event was notable
for the broad-based popular participation, the articulation of a range of
health system issues by grassroots activists and ordinary people, and the
emerging evidence that people's monitoring has led to some changes in the
functioning of the health system in far flung adivasi hamlets of this
district. Under Community monitoring in NRHM, perhaps for the first time,
ordinary people have been given an official role and powers to monitor the
functioning of Health department staff and doctors.

The hearing started with major uncertainty due to reluctance to attend by
any of the senior officials. The District Health Officer, who had confirmed
his coming until just two days back, suddenly went on leave while the Chief
Executive Officer (CEO) of the district also indicated that he was 'busy'
despite the programme having been fixed with his concurrence. However, due
to insistence of the activists of the people's organisations, finally after
some delay the CEO, Assistant DHO, Civil Surgeon and other officials joined
and attended the entire Jan sunwai. The panellists were senior journalist
and TV talk show host Abhay Mokashi, a local private practitioner from Thane
Dr. Jawale, and Dr. Abhay Shukla from the NRHM - National Advisory Group for
Community Action.

The hearing started with an overview of the process of community monitoring
in Thane, including the nine PHC level Jan sunwais which have taken place
over the last few months. After this, community-level activists from each of
the three blocks presented briefly some of the key issues which have emerged
during the PHC Jan sunwais. These covered issues of inadequate availability
of medicines and services, illegal charging by certain doctors, vacant posts
of staff, inadequate patient transport services and poor allocation of
certain villages with respect to PHCs. Certain persons also presented their
experiences of denial of health care. What was notable was the sharp
articulation of issues by these activists and ordinary people, which
indicated a growing level of awareness about details of health rights
entitlements. It was also positive to note that as a result of monitoring
there have been some improvements such as stopping of illegal charging by a
few doctors and improved visits by field staff to villages.

Following this, certain issues related to the functioning of the Rural
hospitals were presented. These included non-availability of power backup
leading to some women having to deliver in near-darkness, inadequate
availability of medicines based on analysis of recent drug stocks,
inadequate beds compared to number of patients, non-availability of
ambulance in certain cases, vacant posts of specialists and lack of
cleanliness in the premises.

The officials including various PHC medical officers and Civil surgeon
responded to several of these issues. While they admitted of certain
deficiencies, they claimed that there have been improvements over the last
year. The CEO claimed that medicine availability was 'adequate' despite the
evidence of persons not getting all medicines from PHCs. Another interesting
piece of information given by the CEO was that 'biometrics' is now going to
be used to monitor the daily attendance by field staff, wherein the thumb
impressions of each staff member will be recorded on special machines and
thumb impressions will be checked everyday to confirm individual attendance!


The panellists concluded by reiterating the major issues that had been
presented. One of the panellists noted that at least 90% of the complaints
being made appeared to be genuine, and should be addressed. The initiative
of the grassroots activists in carrying out monitoring as well as the
commitment of health staff working in peripheral areas was appreciated.
Another panellist asked the CEO to develop a time bound action plan to
tackle the issues that had been raised. The need to ensure adequate
availability of medicines was re-emphasised, along with the need for all
health department staff to be actively involved in community monitoring. It
was noted that community monitoring has improved dialogue between people and
health service providers, and that this process needs to be continued and
expanded. It was emphasised that although there are differences of
perception between people and providers, these need to be addressed through
active dialogue and concrete improvements, since there is a shared the goal
of improving the public health system which belongs to us all.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20081010/9bb4022e/attachment-0001.html>