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

Duration : 3 Years (2007- 2010)

Project Facilitator : Abhay Shukla

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.

Objectives

With the above background, the objectives of SATHI Phase III project are as follows-

* To facilitate the institutionalization of citizens health rights, service guarantees and accountability/ monitoring mechanisms in the context of NRHM.

* To establish a credible model of community based monitoring as envisaged in the NRHM in certain areas of Maharashtra and Madhya Pradesh.

* To facilitate the implementation of the new rules in the amended Bombay Nursing Home Regulation Act, organising and supporting civil society action in certain areas in Maharashtra, with focus on the provision relating to the Patients Rights.

* To mainstream the SATHI methodology and training material for ASHAs; and to create an appropriate niche for less educated / functionally literate women as ASHAs in specified remote areas of Maharashtra and Madhya Pradesh .

Activities

Institutionalization of citizens health rights

At both National and State level, SATHI team members are playing an important role in facilitating institutionalization of health rights mainly by using the various provisions under NRHM.

A SATHI team member is part of the National resource group to facilitate Community monitoring of health services and has played a central role in shaping up of the overall Community Monitoring component in the larger NRHM framework. SATHI team members are part of the national level committee constituted to give overall direction and specific technical inputs for facilitation of the CBM pilot project and have played a central role in preparing prototype of tools for the Community Based Monitoring.

The SATHI team as part of Jan Aarogya Abhiyan has been raising the issue of ensured availability of essential drugs in Primary Health Care facilities. In some areas, where our Partner Peoples Organisations are involved in monitoring availability of drugs, there has been some improvement in this availability.

SATHI team has been conducting intensive trainings on Community Monitoring of Health Rights for both regular partner organisations and also some other organisations who have shown interest in doing this activity. SATHI team played a central role in facilitating JSA collaboration with the National Human Rights Commission (NHRC) for the Right to Health care campaign during 2004-5. Presently SATHI team along with other JSA constituents in collaboration with the NHRC is involved in planning of the next phase of Right to Health care campaign. In this phase of the campaign SATHI team members would contribute to the process of preparing protocols for survey, western region and State level coordination of the activity and facilitation with the National Human Rights Commission. These hearings would provide us important space for addressing the pertinent issue of the Private Health Sector regulation. In addition to these broad areas of action for Health rights, the SATHI team is continuing to give inputs to collaborating organizations on specific issues with a health rights dimension, for example health rights of certain vulnerable sections like women, HIV positive people.

SATHI has taken a lead in the Jan Aarogya Abhiyan, Maharashtras efforts to put pressure on the Maharashtra Govt. to adopt the Intra Dermal route for giving the anti-rabies vaccine to those suffering from suspected rabid dog bite.

As part of the Aarogyaseva Khajagikaran Virodhi Samiti SATHI is playing an important role in opposing the privatization of the Dalvi Hospital in Pune.

Credible model of community based monitoring

In the present phase SATHI is systematically promoting health rights in partnerships with six organisations in Maharashtra and two organisations in Madhya Pradesh. Our overall strategy is to empower community for demanding Health Rights on the basis of Service Guarantees, Citizen Health Charters and the Community Monitoring framework, as envisaged in the National Rural Health Mission. With the help of our inputs our partner organisations are making effective community level interventions for improvement in the Public Health System. Specific community level interventions for promotion of health rights are through activities like Jan Sunwais, Jan Samvad, Community level dialogues, posters exhibitions etc. We are hoping that these activities would generate sustained activity around health rights issues in multiple areas in these two states. This is a significant and innovative development and could serve as a model at the national level.

Availability of essential drugs: This is an important issue because shortfall of essential drugs is one of the most important reasons for dissatisfaction about PHCs and its underutilization. SATHI and its collaborating partners are involved in monitoring the availability of essential drugs in PHCs and to demand adequate supply where there is shortfall. Medicines for vulnerable groups like women, HIV positive people are especially being monitored.

New rules in the amended Bombay Nursing Home Regulation Act

As a result of ongoing advocacy by Jan Aarogya Abhiyan in which SATHI team played a leading role, new rules are in the process of being prepared for the amended Bombay Nursing Home Regulation Act. The Draft Rules prepared by CEHAT include patients rights and these new rules have been approved by the Health and Family Welfare dept. In July 06, these rules have been put up on the Maharashtra Govt.website (maha.arogya.gov.in) for suggestions from the public. But for unknown reasons, these rules have not received final official approval. SATHI, as part of JAA is continuing to do advocacy for this final official approval as well as for further amendments to this Act.

Mainstreaming the SATHI methodology and training material for ASHAs

SATHI teams objective of Public health system supported, generalized, upgraded CHW programme in Maharashtra and Madhya Pradesh was partially fulfilled after the launch of NRHM, in which a provision of hamlet level health worker called ASHA has been made. SATHI team has utilized this newly created space by preparing a pictorial manual for less educated ASHAs in Marathi and Hindi on the basis of the curriculum and guidebook prepared at the National level by the Ministry of Health. These pictorial manuals for ASHAs are based on SATHIs decade long experience in training of less educated Community Health Workers and preparing pictorial training material for them. Presently these manuals are widely used in Maharashtra and also in one district of Madhya Pradesh. In Maharashtra, this pictorial manual prepared by SATHI was initially meant for less educated ASHAs. However, now 9000 copies of the Volume-I in Marathi, designed by SATHI, have been printed to give a copy each to all the 9000 newly trained ASHAs in Maharashtra. This is because the concerned officials were very much impressed by the quality and utility of this pictorial manual. SATHI has also been entrusted to prepare in similar fashion, the remaining four volumes.