Project : Maharashtra Health Equity and Rights Watch

Duration : November 2005 to September 2009

Project Facilitator : Nilangi Sardeshpande

Background

India is known to have poor health indicators in the global context, even in comparison to many other developing countries. However, India also bears the dubious distinction of being among the more inequitable countries of the world, as far as health status of the poor compared to the rich is concerned.

In spite of health inequities in the country, somewhat surprisingly, the issue of health inequity has rarely been studied or addressed in the Indian context, either by Public Health academics or by NGOs working in the health sector. Hence there is an urgent need to monitor health inequities and to link this monitoring with health systems reforms in a rights-based framework. This may help to ensure that the poorest and most vulnerable sections of the population enjoy basic health care and the preconditions for health.

The 'Health Equity and Rights Watch' project, which would be a three year project, is aimed at monitoring gaps in access to health care, (particularly with a focus on women?s access to health care) in a major Indian state (Maharashtra) to support equity-oriented health sector reform and advocacy for health rights, with the broader aim of laying the groundwork for an All-India Health Equity and Rights Watch.

Objectives

In the context of a major Indian state,

1. To document existing inequities in access to health care with special focus on caste, tribe, class, gender, rural-urban and regional disparities

2. To monitor, trends regarding key process indicators responsible for such inequities and to widely disseminate the findings

3. To support state-level advocacy for reduction of inequities in health care and to strengthen initiatives to establish the Right to health and health care

At an All-India level,

1. To sensitise decision makers and health advocacy groups in other Indian states, by regular dissemination of the reports and activities of the Health Equity watch

2. To explore the possibility and lay the groundwork for an All-India Health Equity Watch

Activities

1. Establishment and continuation of an alliance of Public Health experts, Social Scientists and health sector NGOs in the form of a 'Health Equity and Rights Watch' in a major Indian state

2. Monitoring of key process indicators such as indicators reflecting access to curative health services (including critical care), maternal and child health services, key preventive health services, and health care expenditure with a focus on the public health system. This shall include the following activities:

* Annual visits to Primary Health Centres and Rural Hospitals accessed by residents of studied Primary Sampling Units (a village or the Census Enumeration Block, as the case may be). Checklists to be used to take stock of the facilities available.
* Exit interviews with patients at such healthcare facilities in order to assess the quality of services received and the deficiencies therein.
* A household level interview schedule to study the type of healthcare accessed, (e.g. state run facilities or private practitioners), the costs incurred, perceived quality of care received and reasons for use. These will include access of health care facilities for illnesses as well as immunisation and antenatal care. Questions regarding availability of drugs from the public health care facilities, impact of user fee introduction, and barriers to quality health care in terms of location of the health facility, attitude of the health providers, etc, will also be asked. This survey would be conducted once in the middle of first year of project and then in the middle of the third year.
* Profile of area to know about the socio-economic characteristics and the health facilities available in the community. Such information shall be elicited with the help of a Village/Census Enumeration Block level schedule.

3. Monitoring the trend of annual and supplementary state health budgets with an equity lens: This will mean an analysis of the budget for health outlays and budgeted expenditure along regional, tribal / non-tribal area wise and rural /urban area wise dimensions.

4. Preparation and release of the report 'Health equity and access to health services in Maharashtra', and briefing of legislators, health department officials and political leadership about the key findings and recommendations of the Watch.

5. Proposing a range of specific improvements/modifications in healthcare delivery and financing based on equity considerations.

6. Regular interfacing with campaigns for the Right to health and health care to strengthen public will for health equity and health rights, with special focus on women's access to health care.

7. Disseminating the report to decision makers and health advocacy groups in all other Indian states.

8. Exploring the possibility of developing an All-India Health Equity and Rights Watch by interaction with similar groups across the country and organising an All-India conference on Health Equity and Health Rights.

National Seminar on Health Equity in India, Organised by SATHI on 2nd & 3rd October, 2008 For more details click here

A Report on Health Inequities in Maharashtra Download full document

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