PHM-Exch> PHM Maharashtra, India: State Convention on Accountability of Health & Social Services

[Claudio Schuftan]

*State Convention on Accountability of Health & Social Services*

*22-23 November 2011, TISS, Mumbai*

On 22nd and 23rd November 2011 in a vibrant atmosphere and with a shared
vision to ensure accountability of the social sector, over 270 delegates
from more than 23 districts across Maharashtra participated in the *State
convention on accountability of Health & Social services*. The convention
was co-organised by People’s Health Movement-Maharashtra, Centre for Rights
and Governance, School for Rural Development, Tata Institute of Social
Sciences and organisations implementing Community based monitoring of
health services across Maharashtra state* <#_ftn1>. The key theme discussed
was how to ensure accountability of social services like health care,
education, food security, water supply, nutritional services. The positive
experiences emerging from *Community monitoring of health services, *being
implemented as part of the National Rural Health Mission in Maharashtra
since 2007, were a key reference point in the presentations and
discussions, in which national and state level resource persons
participated along with Panchayat members, representatives of Health sector
employees unions and civil society organisations.

    In the inaugural programme, representatives from about 30 different
blocks where presently Community based monitoring is being implemented,
presented posters sharing briefly the key positive changes brought about by
Community monitoring of health services, interspersed with slogans. A short
yet powerful film on Community based monitoring in Maharashtra and a song
on health rights were presented.

 *Abhay Shukla* noted the widespread positive impacts of Community based
monitoring (CBM) in form of improved presence of doctors and staff, check
on local corruption and increased utilization of PHCs in CBM areas.  With
this background he emphasized that there is a need to take up Community
monitoring not just as a project but as a social process across the state,
expanding this within the health sector and working to strengthen similar
accountability processes for other social services like food security,
nutrition, education and water.  He noted that CBM is emerging as a strong
bottom-up complement to accountability mechanisms, and CBM can help in
checking corruption with people’s active involvement.

Key insights from Maharashtra also need to be replicated in other states of
India. Although the CBM process was originally initiated in nine states of
the country, only in a few states like Maharashtra it  has continued in an
effective way and is leading to various positive impacts.

  Issues like caste often need to be kept in mind while doing community
based planning combined with monitoring. The need became clear to address
the wider social determinants of health and to work with a broader
social-political approach. The example of the Cuban health system based on
social justice and equality was highlighted.

Sessions were also held on the role and future involvement of Panchayat
members and Public Health employees in the Community based monitoring
process. There were interventions by nearly twenty PRI members from various
districts, all of whom recounted experiences of how the CBM process has led
to positive local impacts and urged that this process be continued with
involvement of PRI members. The need to effectively plan, based on people’s
priorities, regarding large scale untied funds under NRHM was stressed.



A session with representatives of Maharashtra Government Medical officers
association, Nurses federation, ASHA union and other Health sector employee
unions was held and the need to combine struggles for better working
conditions for staff with delivery of improved health services for people
was stressed.



The key to an accountable public system is a clean and transparent
information system. If people have access to information they can monitor
the availability of facilities at each level. Setting up a separate,
autonomous department for the social audit helps. Training young people for
the processes of social audit was highlighted. Through this process in AP
they have lodged 1600 cases of corruption and unearthed corruption of more
than millions of rupees. For the process of social audit one needs to do
capacity building. Redressal mechanisms need to come to the doorstep of the
citizen, rather than the exactly opposite scenario witnessed in the entire
social sector.

Community involvement in all public services is needed. There is an erosion
of the traditional resources for adivasis in India and this has
catastrophic impact on the livelihood of such communities. Empowering and
informing communities to take decisions about issues concerning them is
key. It is essential that there is decentralization and devolution of power.

In parallel sessions activists working on urban health, water supply,
public distribution system, ICDS and primary education discussed their
experiences of working for rights and the possibilities of community
accountability systems in the above contexts. The session on food security
and urban social services talked about the emerging Food security Act in
India and the need to ensure pro-people provisions in this context; a
dialogue with political representatives at various levels to improve
delivery of food security schemes is needed. Community based monitoring is
necessary in urban areas also; accountability tools like complaint boxes
need to be used more widely. There is an urgent need to improve ICDS and
more attention must be given to the conditions of frontline workers.
Committees which are supposed to monitor functioning of staff do not meet
regularly, which needs to be ensured. The session on water and education
talked about School monitoring committees and parents meetings, which have
helped to increase the sense of ownership of parents in functioning of
schools, and has made teachers accountable. Inequitable distribution of
water in large cities like Mumbai and denial of water connections to people
who have settled in Mumbai after 1995 is rife. In this context to increase
accountability, it is essential to build awareness about water as a right
among people, and to develop participatory dialogue between Municipal
decision makers, employees and citizens about various options for improving
supply of water.



In the next plenary session using the Right to Information Act and Social
Audit process was explained; this, to enable people to demand their rights
and ensure greater accountability of the administrative system.  A proper
devolution of power is key, as ell as a grievance redressal system.

Transparency and accountability are also needed in the Employment Guarantee
Scheme. We need to think of models of ‘people friendly information display’
for the all social services. As regards grievance redressal system, if
people have to access it optimally, it must operate from the District level
upwards. Although people are the real ‘owners’ of public resources, they
have been marginalized from these resources. In fact the public servants
have taken control of public resources and services. This situation needs
to be reversed and people must now assume control as the real ‘owners’. Any
grievance redressal system must ensure some prompt remedial action in
timely manner, so that the complainant gets some relief immediately. A set
of suggestions about how to make grievance redressal participatory and
locally accountable, with involvement of civil society organisations, was
presented.

In the last session, representatives from networks such as Right to Food
campaign – Maharashtra, Child Rights campaign, Movement for Peace and
Justice, coalition of mass organizations PHM-Maharashtra discussed about
possible further activities to promote accountability of social sector
services. A set of resolutions demanding development and widening of
Community based monitoring and accountability of health services were
adopted, and further combined actions including a protest on 15th December
on health policy issues during the upcoming State Assembly session were
planned. Overall the State convention has enabled sharing of the effective
approach of Community based monitoring of health services with a large and
diverse audience, has taken forward the emerging discourse on
accountability of public services, and has furthered the debate on how to
develop such mechanisms for each service in the social sector.



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* <#_ftnref1> Maharashtra is the second largest state of India with a
population of 112 million.
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