<p style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" class="MsoNormal" align="center"><b style="mso-bidi-font-weight: normal"><span style="FONT-FAMILY: Arial; FONT-SIZE: 11pt">PHM-Maharashtra (Jan Arogya Abhiyan) state convention on 5-6 March 2011 </span></b></p>
<p style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" class="MsoNormal" align="center"><i style="mso-bidi-font-style: normal"><span style="FONT-FAMILY: Arial; FONT-SIZE: 11pt">Critique of state health policies; decision to launch campaigns and strengthen network.</span></i><b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal"><span style="FONT-SIZE: 11pt"></span></i></b></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Marking ten years of activities by the health movement coalition, PHM-Maharashtra state, India organised a <b style="mso-bidi-font-weight: normal">State Health rights convention</b> on 5-6 March 2011 in Pune. Over 160 representatives from health sector and social organisations drawn from 27 districts across Maharashtra attended the convention.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The convention was inaugurated on 5<sup>th</sup> March morning with a collective song ‘Let the right to health for all, be attained and sustained’. </font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">This was followed by a brief introduction given by Abhay Shukla, tracing the evolution of the People’s Health movement in the state over the last ten years (2000 to 2010), various phases of activities and campaigns, the modified situation created by launching of National Rural Health Mission (NRHM), and the current challenges in the health sector as well as within the movement. It was shared that the idea of a state level convention had emerged from the participatory review last year, where the need for organizational strengthening and revitalization of Jan Arogya Abhiyan (JAA) had been stressed.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Subsequently, four major thematic sessions were conducted on the themes identified for the convention: Right to Rural health services, Right to Urban health services, Patients rights and regulation in private and trust hospitals, and Right to Social determinants of health.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The session on <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">Rural health services</i></b> outlined key policy level issues and deficiencies concerning the rural public health system in Maharashtra, especially since launching of NRHM in 2005. These included continued low state government health budget, lack of guaranteed health services and medicines, poor support to staff, lack of inter-departmental coordination, and urgent need to form the state level monitoring committee as a part of community based monitoring activity under NRHM. Organisation of Community based monitoring of health services was noted as a positive development which had contributed to improvements in services in concerned areas, but was tending to draw away energies of health activists from movement activities, a situation that needed to be changed.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">It was then suggested some key campaign strategies to be adopted by JAA such as large scale community assessment and dialogue in campaign mode to demand guaranteed health services; demanding availability of essential medicines in public facilities along with suggesting implementation of a Tamil Nadu type procurement and distribution system; need to reverse recent hike in user fees and to abolish such fees at all levels; stressing need to appoint staff on a regular basis rather than contractual appointments leading to better retention of staff and less corruption; regular honorarium and medicines to comm. health workers (ASHAs) along with their providing basic care at village level; social audit of utilisation of Village untied fund at all levels, and demand for generalization of community based monitoring. About twenty ASHA-activists from the Maharashtra state ASHA workers union had attended the convention, and their representatives emphasised the need to ensure improved support and working conditions for ASHAs.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The next session on <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">Urban health services</i></b> outlined the challenges given the context that Maharashtra has numerically the largest urban population in the country, with about 45% people living in cities and towns. These include lack of primary health systems, major deficiency in number of urban health posts, lack of clearly shared responsibility and coordination between urban local bodies and state governments, and recent hike in user fees in Medical college hospitals. The poor plight of health services in smaller towns, which often lack even basic health care institutions was emphasised. Then the wide range of vulnerable and excluded groups in urban areas was mentioned – including street children, migrant and unorganised sector workers, homeless people, people living in slums including ‘unauthorised’ settlements, and people living in institutions. The need for strengthening the Municipal corporation health system was stressed and some campaign areas were suggested such as initiating community monitoring of health services in urban context, campaign for withdrawal of fee hike in public hospitals and suggesting special provisions for vulnerable groups to be included in the Urban health mission.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The further session on <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">Patients rights and regulation of Private and trust hospitals,</i></b> began by outlining the current situation of total lack of regulation, extremely weak political will for regulation, and official tendency towards ‘inspector raj’ rather than participatory regulation, vocal private doctor’s lobby and growing corporatisation of the private medical sector. At the same time the new opportunities created by growing popular interest in patients’ rights, High court order to ensure free beds for poor patients in Trust hospitals, and central ‘Clinical establishments regulation act’ were mentioned. Experiences were shared of the ‘Patients rights forum’ formed in a smaller town, where doctors have been effectively brought into dialogue around issues of patients rights. A union worker from Pune shared experiences of how union activists have been fighting for the right of woman waste-pickers with insurance cards to receive free care in large Trust hospitals, and despite resistance from such hospitals have managed to obtain free care in several cases, which could become an example for others. </font></span></p>
<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The need to press for implementation of the High court order on free beds in trust hospitals, to build a large scale campaign including possible legal intervention on legally enshrining Patients rights under existing rules, and the suggestion to form Patients rights forums or ‘Patient-doctor dialogue committees’ across the state were shared as possible further steps.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">In the next session on <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">Social determinants of Health</i></b>, an overview was given about the current status of food security and PDS, anganwadi services, drinking water, environmental conditions, education, and social exclusion as key determinants which were affecting people’s health. She stressed the political nature of the demands and need for health activists to actively support and engage with campaigns and struggles on this spectrum of issues. Some concrete campaign actions were suggested such as organising multi-sector meetings at block or district level through collaboration of various concerned networks, and the need for multi-sectoral community monitoring of all social services. The issue of health impact of GM foods was raised and some participants expressed the need to include it in JAA’s agenda.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Following these thematic plenary sessions, the delegates divided into four sub-groups according to the already discussed themes, to work out specific campaign strategies and plans. In these groups, based on already suggested actions, district wise or city wise activists stated the activities they would take up in their particular areas. In addition, a few specific areas were identified to be taken up by the entire coalition as state level campaigns.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">On 6<sup>th</sup> March morning, representatives from each sub-group presented the key campaign actions that had been decided upon in their group. </font></span></p>
<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Key campaign decisions included:</font></span></p>
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<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 1.25in; mso-list: l0 level2 lfo1; tab-stops: list 1.25in" class="MsoNormal"><span style="FONT-FAMILY: 'Courier New'; FONT-SIZE: 11pt; mso-fareast-font-family: 'Courier New'"><span style="mso-list: Ignore">o<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Urgent <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">reversal of sharp hike in user fees</i></b> at Medical college hospitals, moving towards abolition of user fees in all public health facilities </font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 1.25in; mso-list: l0 level2 lfo1; tab-stops: list 1.25in" class="MsoNormal"><span style="FONT-FAMILY: 'Courier New'; FONT-SIZE: 11pt; mso-fareast-font-family: 'Courier New'"><span style="mso-list: Ignore">o<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Basic overhaul in medicine procurement and distribution policy to ensure <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">guaranteed availability of all essential medicines</i></b> in all public health facilities</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.5in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The Marathi text of the signature campaign letter was read out and all present delegates signed this letter, which was subsequently sent to the CM. It was further decided that large numbers of signatures of Village health committee members, Panchayat representatives, CBM committee members and representatives of NGOs and Community based organisations would be obtained in the coming month and would be collected in each district and <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">would be sent to the Chief Minister and</i></b><i style="mso-bidi-font-style: normal"> <b style="mso-bidi-font-weight: normal">released to media across the state on 7<sup>th</sup> April – Health rights day</b>.</i></font></span></p>
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<p style="TEXT-ALIGN: justify; TEXT-INDENT: 0in; MARGIN: 0in 0in 0pt 0.45in; mso-list: l1 level1 lfo2; tab-stops: list .5in left 54.15pt" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">In parallel, a campaign was planned to demand <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">immediate adoption of rules for the Bombay Nursing Homes Registration Act to ensure protection of Patient’s rights</i></b> in private hospitals. Since successive Chief Ministers, including the current Minister, have not been able to sign on the pending rules to finalise these (five years would be completed in April this year), each JAA organisation would symbolically send the campaign letter along with a pen to the Minister, urging him to sign on the rules with provisions for protection of Patients’ rights. Thus scores of pens would be sent to the Health Minister from across the state, and this campaign would be publicized in the media. Along with this, appropriate legal action to ensure passing of the rules would also be seriously explored.</font></span></p>
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<p style="TEXT-ALIGN: justify; TEXT-INDENT: 0in; MARGIN: 0in 0in 0pt 0.45in; mso-list: l1 level1 lfo2; tab-stops: list .5in left 54.15pt" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Based on the response from the State government on various issues, a meeting of JAA representatives with the Chief Minister would be sought in May to communicate the entire range of demands and to press for action on the issues which have been raised in campaign mode.</font></span></p>
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<p style="TEXT-ALIGN: justify; TEXT-INDENT: 0in; MARGIN: 0in 0in 0pt 0.45in; mso-list: l1 level1 lfo2; tab-stops: list .5in left 54.15pt" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Various organisations working in rural areas (in at least a dozen districts) would carry out monitoring of public health facilities in campaign mode and wherever possible, would organise local dialogue or mass actions on health rights. Similarly, JAA groups working in 12 cities / towns across the state would carry out assessments of urban health services and would publicise the need for a comprehensive urban health system.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Following the adoption of these campaign decisions by the convention, a presentation was made on need for a <b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal">‘System for universal access to health care’</i></b>, that outlined the current situation of predominant private sector where vast majority of doctors are located, and the need to regulate and bring under public management a section of private services to ensure access to health care for all. Key issues raised in the recent Medico Friend Circle annual meet, the need to ensure that strengthened and expanded public health services would be at the core of any such system, and the threat of current outsourcing type ‘PPPs’ which are siphoning off public funds to private providers without any larger framework of regulation, rationalisation of care, social planning or accountability were stressed. The overall direction of a publicly managed and funded universal access system based on strengthening the public health system, and public regulation and socialization of a section of the private medical sector, was emphasised. Given the need for detailed discussion on this large and complex topic, it was suggested that JAA would organise a separate workshop for activists on this issue where all aspects could be deliberated upon in detail.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">In the final session on organizational issues, the need for strengthening of JAA as a campaign network was emphasized. Many suggestions were discussed and the need for organized district level JAA units was strongly raised. Some key decisions were as follows-</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Processes would be carried out to form District level JAA units in most districts of Maharashtra in the next two months. Discussing district by district, activists from each of the concerned 27 districts who were present took up responsibilities to form such units. In some districts, where presently only one organisation is involved in JAA, they would act as ‘contact persons’ and would contact further organisations to help from a district unit.</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Regional level co-conveners would be finalised during regional level JAA meetings in next three months.</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The State coordination committee was expanded. Besides the current members (existing regional convenors), representatives from various state level networks were incorporated in the state level committee. New regional co-convenors would be included in the coordination committee.</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The State level committee would meet on a six monthly basis. The next meeting would be held in July 2011 at Nagpur or Pune.</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">State level JAA conventions would be organized periodically. </font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Updated booklets on the People’s Health Charter would be prepared in Marathi, Hindi and English.</font></span></p>
<p style="TEXT-ALIGN: justify; TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l2 level1 lfo3; tab-stops: list .75in" class="MsoNormal"><span style="FONT-FAMILY: Symbol; FONT-SIZE: 11pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><span style="mso-list: Ignore">·<span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span style="FONT-SIZE: 11pt"><font face="Times New Roman">Specific campaign material especially on urban health services and provision of free beds in charitable trust hospitals would be developed for wide circulation among JAA activists.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The accounts of expenditure and donations related to the JAA convention were shared with all participants; the entire expenditure for this large convention could be met through small organizational contributions and individual donations without any institutional funding.</font></span></p>
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<p style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt 0.25in" class="MsoNormal"><span style="FONT-SIZE: 11pt"><font face="Times New Roman">The convention was concluded with the collective song ‘Health is our Right - all of us together will obtain it’!’.</font></span></p>