The Health Rights Projects (SATHI Phase II Project)
From 2005, we decided to further broad base our work further, focusing on fostering of health rights in by enhancing the capacities of like minded NGOs by conducting orientation, training for them. We continued our collaboration with the three Peoples' Organizations by focusing on the health rights issues in their areas as they had entirely taken over the management of the CHW programme in their respective areas. This focus on health rights was needed in view of the broader scenario of neoliberal globalization. We believe that Community Health initiatives and campaigns are needed to reclaim the space for Public Health in this new era of market oriented globalisation. These campaigns would be multi-pronged. One thrust of the campaign would be to resist the withdrawal, weakening of the state health care services and to demand strengthening of the public health services in a clear rights-based framework.
By its very nature, advocacy for health rights has an important broader, national component. However, local and state level advocacy are also required to take care of local specificities and to convert the concessions and gains that may be achieved at the national policy-level into real changes in practice; to move from 'change on paper' to 'change for people'. All this multi-level work of advocacy for health rights, by its very nature has to be a collaborative one, involving a range of like-minded organisations and individuals.
Pro-people changes in the National Rural Health Mission
Based on this collaborative work, the SATHI team contributed substantially to many Policy and Practice Changes on the health-care front. This was possible because of a distinct change in the govt. policy after the parliamentary election in 2004. The newly elected United Progressive Alliance declared a Common Minimum Programme (CMP), which amongst other things commits itself to increasing the Public Health Expenditure from 1% to 2-3% of GDP. Accordingly, for the first time since the nineties, for the last three years Central Govt?s budget for Health increased by over 20% each year. Though this is far less than what is required if the Public Health Expenditure is to increase to 2% of GDP by 2010, there is some beginning in the right direction, given the background that this expenditure had reduced from 1.3% of GDP to 0.9% during 1988 to 2003. This increased allocation is mainly due to realization by some policy makers, politicians after the parliamentary elections in 2004 that people will not vote for those who do not bring any relief in their daily ordeal. Jan Swasthya Abhiyan's continuous advocacy for a substantial rise in Public Health Expenditure being included as part of the election manifesto of some mainstream parties, as well as the recommendations of the National Human Rights Commission after the joint NHRC - JSA Public Hearings in December 04 played a role in this budgetary increase.
Along with this budgetary rise, the Union Govt. launched the National Rural Health Mission from April 05 with the objective of strengthening the rural health care system. Thanks to very energetic, timely and high quality inputs by JSA or by its constituents, (SATHI has played a leading role in this) some undesirable strategies being brought in under NRHM have been pushed back and NRHM strategies have now included some pro-people elements due to this JSA advocacy.
The NRHM now includes strengthening of the PHCs (earlier there was a proposal of downsize the role of the PHCs under NRHM under the guise of strengthening the CHCs!); a Community Health Worker in each village in the 18 focused EAG states; adoption of Indian Public Health Standards (IPHS) in all rural public health facilities including display of charters of health rights; commitment to provide guaranteed health services and the Community Monitoring framework to put pressure 'from below' on the Primary Health Care system with a formal inclusion of civil society organizations as one of the major stakeholders in this Community Monitoring.
Thanks to the initiative of Gujarat JSA, the Gujarat Public Health Act has been drafted and is likely to be passed in the Legislative Assembly. SATHI has given substantial inputs in this whole process including the actual drafting of this act. A background is thus being created in a neighbouring state of enactment of a comprehensive Public Health Act, which would cover mandatory steps to move towards ensuring health and health care as a right.
The SATHI team has been able to intervene in available spaces, and has catalysed or significantly contributed to the following Policy and Practice Changes. The main focus has been in shaping certain aspects of NRHM and it?s implementation.
During the two years (2005-06) of the SATHI Phase-II project following Policy and Practice Changes were achieved in NRHM in which as part of JSA SATHI team played a leading role:
* Formulation of a National civil society response to the NRHM by facilitating discussion and circulating draft position document by JSA. This culminated in publication of 'Action Alert on NRHM' as a major independent civil society national response to NRHM.
* Conceptualization, shaping, arrangement of funding and launching of National People's Rural Health Watch by Jan Swasthya Abhiyan as a National independent initiative to audit and hold accountable the NRHM in eight States and at the National level.
* Shaping of NRHM components through active participation by SATHI team members in various national taskforces, such as National Task Force on ASHA programme; taskforce on strengthening of PHCs and CHCs; taskforce on District Health planning, and task force on Indian Public Health Standards for District and Sub-district hospitals. These interventions have led to inclusion / modification of the following key points in various NRHM documents -
# Citizen's charter of health rights to be displayed in all CHCs included in national guidelines on strengthening of CHCs and IPHS
# Inclusion of the section on ?Community Action for Right to Health Care? in the document National framework for implementation of NRHM;
# Incorporation of section on Patients Rights in Indian Public Health Standards (IPHS) for District and Sub-district hospitals
# Modified and elaborated section on Guaranteed health services in NRHM framework document, including full coverage for minor illnesses and injuries, full coverage for secondary care services and safe abortion care.
# Detailed section on ?Community Based Monitoring of Health Services? with NGO / CBO representation at all levels added in National Framework for implementation of NRHM which includes amongst other things, Periodic Public Hearings to be conducted at PHC, block and district level to ensure accountability of health services in rights based framework
# Approval by Union Health Ministry for a national pilot for Community Based Monitoring of Health services; to cover 8 states, 30 districts and 90 blocks. The Implementation of this pilot would be coordinated by a task force of the Advisory Group on Community Action, with SATHI as one of the coordinating members
Acceptance in principle by the Union Health Ministry that less educated ASHAs may be selected and may be given training according to a modified methodology; acceptance of SATHI manuals for non-literate workers as a model training material.
The SATHI team has been able to intervene as part of JSA to lobby with National Human Rights Commission (NHRC) to catalyse the following initiatives by NHRC -
* NHRC circulated to all states for action it?s National action plan for Right to health care
* NHRC directed all state governments to report on action taken by them concerning national action plan; responses given by eight state governments (Jul. 2005).
* A National review on Health Rights conducted by NHRC in March 2006. Here JSA representatives presented the actual situation vis a vis the claims made by the state in the presence of the NHRC officials and state health officials.
* Based on a JSA suggestion formulated by the SATHI team, NHRC decides to organise an annual review of Health rights; the recent most such review conducted on 6th March 2007 with facilitation of JSA participation by SATHI team.
* Based on inputs by the SATHI team, NHRC takes up the issues of Universal access to anti-rabies vaccine, adverse impact of Pulse Polio on routine immunisation, and initiation of steps to prevent Silicosis.
SATHI helped in shaping certain Policy Practice Changes in Maharashtra State -
* Modifications in Pada Swayam Sevak (Hamlet health worker) scheme.
* Based on advocacy led by the SATHI team, state government takes decision to appoint exclusively women as Pada Swayam Sevak throughout the tribal hamlets of the State; for the first time over nine thousand women appointed as Pada Swayam Sevaks in 2005.
* Based on intervention by SATHI team in high court case, the Mumbai high court orders state government to give upgraded training to all Pada Swayam Sevaks; State government commits in court to carry out such training.
* Based on continuing advocacy by SATHI team, acceptance in principle that less educated women (often from poorer adivasi households) may be given training as ASHAs with use of distinct materials and methodology, using substantial inputs of the SATHI team.
* Advocacy for usage of low cost intra-dermal rabies vaccine leads to a consultation being held by State government and acceptance of this option in principle; issue also highlighted by national TV channel interviewing SATHI members on this topic. Action pending decision by Union Health Ministry, to which JSA has made a relevant representation; also complaint submitted to NHRC. SATHI team members played an important role in this process.
* Combined inputs by CEHAT and SATHI members lead to inclusion of a broad set of Patients rights in the BNHRA rules for regulation of private medical sector being enacted by the Health department.