Project : Arogya Hakka Sahayog Prakalp (SATHI Phase IV Project)

Duration : April 2010 - March 2011

Project Facilitator : Dhananjay Kakde

Background

Major new challenges have arisen, new spaces and opportunities have been created during the last two years both in Public and Private health care. Since 2005, we have entered a phase during which the emphasis of our activities has changed from making interventions at National Policy making level to utilization at the local level, of the spaces created due to the earlier policy interventions so that these policy-changes do not remain on paper. Hence during the SATHI Phase III Project we plan to concentrate more on strengthening accountability and facilitating implementation at the ground level in Maharashtra, MP and beyond, related to certain progressive, pro-people policy changes that have been achieved so far. We would continue to operate at the National Policy making level, to contribute to building continuous pressure for making further progressive changes and to prevent rolling back of pro-people provisions.

As peoples access to health care improves substantially from its current abysmal situation, the issue of mainstreaming the issue of access to health care for HIV positive people can be taken up; something for which the overall health care situation was not conducive so far.

The work of the SATHI team in remote areas of Maharashtra and MP has contributed significantly in conceptualizing and concretizing specific pro-people measures in the National Policy making. Thus for example, the monitoring of the Primary Health Centres and Rural Hospital in the Aajara area and efforts at independent audit of PHC Ganjad in Dahanu area of Maharashtra, and the experience of concretely building pressure on the functioning of the PHCs in the Pati area in MP have contributed to the concrete conceptualization of the National Framework of Community Monitoring. SATHI's experience of working in remote hilly areas in Maharashtra and MP and of training non-literate Community Health Workers was crucial in advocating for a distinct space for recruiting non-literate/functionally literate women as ASHAs when appropriate candidates with minimum educational qualification of 7th standard school education are not available from the deprived sections. The specially designed training manuals for non-literate CHWs and the experience of preparing these manuals was crucial in designing a new manual for non-literate candidates selected as ASHAs in the Pati block in MP. Such a new manual in Hindi can be developed and finalised, and used throughout the Hindi belt (including states like U.P., Rajasthan, Bihar) as no such manual for less-educated / non-literate ASHAs exists today. The Ministry of Health has bought 100 copies of our Swasthya Sathi manuals and have distributed to different state health authorities so that they can prepare accordingly manuals for non-literate ASHAs in the state or get in touch with SATHI for a ready manual specially prepared for ASHAs in view of their specific job responsibilities.

The point is - the ground level work of the SATHI team in Maharashtra and MP continues to have significance beyond these two states and the grassroot work and national policy advocacy have been integrated and deeply complementary.

Aims and Objectives

The overall aim of the next project would be to consolidate health rights activities and community based health capacities in areas covered by SATHI in Maharashtra and West Madhya Pradesh. This would be achieved by further development of the Health rights partnerships with existing partner organisations in defined areas, value addition to Community based monitoring, strengthening social support to selected ASHAs who have now been trained by SATHI and partner NGOs, and supporting advocacy especially on Patient’s rights.

Specific objectives would be as follows-

  1. Consolidation of health rights activities being done by partner organisations by continued development of grassroots work and alliance building at district level.
  2. Generalised implementation of Community Monitoring in further districts of Maharashtra with value addition by SATHI team members; orientation of certain large networks regarding community based monitoring
  3. Strengthened Health system and community support for selected NGO trained ASHAs and linkage between these ASHAs and the Community monitoring process
  4. Orientation of activists in a few areas of Maharashtra regarding Patient’s rights in the private sector and regulation of the private sector.
  5. Strengthened pro-people advocacy (in collaborative manner) on specific national health issues

Activities

  1. Consolidation of Health rights activities in multiple areas of Maharashtra and Western Madhya Pradesh
  2. Value addition to generalised implementation of Community Based Monitoring of Health Services in Maharashtra.
  3. Advocacy and follow up to strengthen Health system and community support for selected NGO trained ASHAs.
  4. Workshops for orientation of activists in Maharashtra regarding Patient’s rights and regulation of the private sector.
  5. Inputs for pro-people advocacy on specific health issues at National level
  6. Library and Publications

Expected Outcomes

1. Consolidation of Health rights activities in multiple areas of Maharashtra and Madhya Pradesh-

In the State of Maharashtra-
i.Systematic capacity building of activists from six partner organisations for carrying out district level advocacy and to follow up unresolved issues emerging from local level health rights actions.
ii.In each district by involving other appropriate organisations/forums in their district, partner organisations would conduct at least one district level event and would engage in dialogue with district level officials.
iii. In the area of partner organisations, dialogue between community representatives and private practitioners regarding issues concerning patient’s health rights would take place.

In the State of Madhya Pradesh-
i.In Barwani district of M.P., Health rights actions would take place to address unresolved issues emerging at the PHC and CHC level.
ii.In addition to this, health rights action would be undertaken at the District level with focus on improving functioning of the District Hospital
iii. Training of VHSCs in about 15 villages with focus on support to ASHAs and consolidating community based actions for health rights would be conducted.


2. Value addition to generalised implementation of Community Based Monitoring of Health Services in Maharashtra

  • Key monitoring related innovations would be publicized towards promoting replication in new areas.
  • Orientation of certain large civil society networks would be conducted regarding CBM to facilitate involvement of their constituent members in the districts where CBM is being implemented.
  • At least two partner organisations would conduct orientation of PRI members on community based monitoring to elicit their involvement in the process of monitoring.


3.Strengthening Health system and community support for NGO trained ASHAs

  • In the areas of two or three organisations, synergy between VHSCs and community supported ASHAs would be promoted through training and interaction sessions along with community level follow up
  • In these areas, dialogue would be held between the facilitating organisation and the local public health functionaries to address problems affecting the work of ASHAs


4.Orientation of activists in Maharashtra regarding Patient’s rights

  • Three workshops on Patient’s rights would be conducted in specific areas of Maharashtra.
  • Around 50 activists would be oriented on Patient’s rights to conduct related activities in their respective areas.


5.Inputs to National level advocacy

  • Maharashtra based inputs would be fed into the process of civil society scrutiny of PIPs in NRHM AGCA (National Advisory Group for Community Action)
  • Strengthened advocacy on the National health bill as part of Jan Swasthya Abhiyan


6. Publications SATHI would organise publication of the following materials in this project-

  • Partner organisations in consultation with SATHI would publish small reports in Marathi concerning health rights activities conducted
  • Based on all five ASHA trainers guidebooks, a compiled Marathi trainer’s manual for training of less literate ASHAs would be published.
  • A booklet concerning Patient's Rights in private and trust hospitals would be published.