Action research and related activities of SATHI cell
The SATHI team has been involved in a range of action research initiatives as relevant to the emerging advocacy activities. Rather than being only Academic research, this has directly strengthened initiatives for people’s rights to health care and food security.
Some of the reports
1. Right to food Survey report (English –Survey in Maharashtra)
2. A summary report of Right to food Survey (Marathi –Survey in Maharashtra)
3. Right to food Survey Report (Hindi- Survey in Madhya Pradesh)
4. A Hindi Report about Food security schemes in MP.
5. Hindi Report about Food security schemes in Badwani District
6. A study of existing public health services in 3 blocks of Badwani District
7. Status of Public Health Services in Badwani District of Madhya Pradesh – a study report in English
8. Status of Public Health Services in Badwani District of Madhya Pradesh – a study report in Hindi
9. The Nutritional crisis in Madhya Pradesh- A Report in English
10. Hindi Report about Nutritional crisis in Madhya Pradesh
11. A Hindi Report about Health Services under SJSGY (Swasthya Jeevan Sewa Guaranty Yojana) in M.P.
12. A Hindi Report about SJSGY in Sendhwa block
13. Summary report about PHCs, Rural Hospital’s health services status in Badwani District
14. A study on the health care utilization and preferences in the tribal villages of Jhabua district in Madhya Pradesh
15. Maharashtra Report based on the Denial of right to health care survey in the Maharashtra State- Status of public health Services in Maharashtra state
A. Studies based on primary data collection
Study of undernutrition and suspected starvation deaths in Badwani, MP
Baseline surveys -
1. To understand the health related knowledge, attitudes regarding gender-related health issues and expenditure among village people in selected villages of Sendhwa block.
Sendhwa is the new area in which health worker programme was initiated during SATHI cell period. Thus a baseline survey was conducted in 4 villages of Sendhwa with the objectives of collecting information on health related knowledge, awareness, attitudes regarding significant gender-related health issues and expenditure among village people in this new project area.
Role of SATHI cell -Since it was part of SATHI cell project, SATHI cell team did everything from conceptualization to report writing of this survey.
Application of survey findings for advocacy- the survey has served as base document giving an idea about the then existing pattern of health care utilization, expenditure and awareness on key health issues in this project area.
2. To assess the status of implementation of various food security schemes in Madhya Pradesh.
Implementation of eight schemes related to food security was assessed in this survey. Total 202 villages form 12 districts of MP were covered in this survey.
Role of SATHI cell -SATHI cell members did data collection for two blocks in Badwani district viz. Sendhwa and Pati. SATHI team members independently did analysis and preparation of report for these two blocks. Also the team has significantly contributed in the state level analysis and report writing stages. Later on the findings of the survey were translated in Hindi and the findings were shared with the community from which the data was collected
Application of survey findings for advocacy- The report of this study has been an important input to right to Food campaign in MP. On 7th April 2002, a programme on Health Rights was organised by MP JSA in which SATHI Cell members were centrally involved. The findings of this survey were presented in this programme. Another health dialogue with state level officials about the findings of the survey report was organised by Jan Swasthya Abhiyan, Madhya Pradesh in May 2002 at Bhopal, which was also facilitated and attended by a SATHI Cell member.
3.To study existing Public Health Services being provided under Swastha Jeevan Seva Guarantee Yojana (SJSGY) in Sendhwa Block.
Under the SJSGY scheme of MP government, a core set of basic health services were guaranteed by the state government within a specified time frame. The survey was conducted to see the extent of the fulfillment of this guarantee at village level.
Role of SATHI cell- Initially, the survey was conducted in six villages under three PHC areas of Sendhwa block. For the initial survey in Sendhwa block, SATHI cell team did everything starting from the conceptualization of survey till the report writing. An intern of Karve Institute of Social Work did actual data collection in Sendhwa block and also contributed significantly in all other stages.
4. To study existing Public Health Services being provided under Swastha Jeevan Seva Guarantee Yojana in selected districts of Western Madhya Pradesh
Subsequently, the survey was replicated in four other districts of western MP by other JSA organisations.
Role of SATHI cell- SATHI cell members gave orientation to the activists of other JSA organisations to conduct the survey in other parts and also helped in analysis and report writing.
Application of survey findings for advocacy- Findings of the survey served as a basis for the state level Public Audit of the ‘Health Guarantee Scheme’, a programme held in Bhopal in December 2002. SATHI Cell members presented the report and made presentations during this programme, which was attended by the senior Govt. official responsible for the Scheme. This was a unique public dialogue, which was widely covered by the Press and TV.
5. To assess the status of implementation of eight food security related schemes in Maharashtra.
The schemes regarding which data was collected during the survey conducted in September and October 2002 were –
In this survey, data from total 91 villages of 8 districts of Maharashtra were collected by various organisations, which are part of Right to Food campaign in Maharashtra.
Role of SATHI cell- SATHI team translated the protocols prepared by right to food campaign groups and circulated to various other organisations of right to food campaign of Maharashtra. The local organisations did the data collection. Then the SATHI cell members did the collation of data, analysis and report writing. SATHI cell members also translated the important findings of the survey into Marathi.
Application of survey findings for advocacy- The report has been quite useful in the Right to Food campaign in Maharashtra. It was used during the dialogue with Chief Secretary and other senior officials in the state. It was also sent to the Commissioners appointed by the Supreme Court.
6. To study the availability of the health care services and facilities in Alirajpur tahsil of Jhabua district.
The objective of the survey was to understand the different health care preferences of the tribal people in study area, to know about the availability of different health care facilities within the village and outside the village, and the trends in the use of herbal medicines by the people and traditional healers in the study area. The survey was conducted in 3 villages in Alirajpur tahsil.
Role of SATHI cell- the actual survey was conducted by an intern of Karve institute of social sciences placed in CEHAT. Team members helped in the design of the questionnaire / checklists, guided and supervised him during the study period and gave substantial inputs during the report preparation process.
The survey was basically conducted as the need for such documentation was expressed by the local organisation Khedut Majdoor Chetana Sangh.
7. To study the status of Public Health Care Services in Barwani District of Madhya Pradesh.
The objective of the study was to assess the level and limitations regarding availability of the health care services in the government health facilities and to recommend improvements in organisation and delivery of public health care services. To fulfill this objective, data was collected from all the 5 Community Health Centers (CHCs), all the 31 Primary Health Centres (PHCs), and the District Hospital from Barwani District.
Role of SATHI cell- A student placed with CEHAT for fieldwork conducted the actual survey. For this study too, guidance was provided by team members at all the stages ranging from conceptualizing the study, to guiding data collection to actual report writing.
Application of survey findings for advocacy- The survey findings were of use in the public hearing organised on the issue of denial of health care in Badwani district. Also cases where health care was denied were documented and presented in this programme.
8. To assess the availability of the staff, infrastructural facilities and health care services in the public health facilities in selected districts of Maharashtra.
Data from total 144 PHCs and 18 rural hospitals from 18 districts of Maharashtra were collected for this survey.
Role of SATHI cell- SATHI cell has given significant inputs in preparing checklists for PHC and RH based on the norms about the staffing pattern, infrastructural facilities and services to be provided by these facilities. The data collected by various other JSA Maharashtra organisations were then collated by SATHI cell. SATHI cell members also did analysis of data and report writing.
Application of survey findings for advocacy- a Maharashtra level report, which also included secondary data analysis of health services and other issues like women's health and mental health was prepared with inputs from JSA organisations. This report was presented in the Western region public hearing organised in Bhopal and has been submitted to NHRC.
12. Documentation and analysis of cases of denial of health care
Around 70 cases from all over the country were collected for the national level public consultation on right to health care organised in Mumbai on 6th September 2003. The protocol for documenting such cases was prepared by SATHI cell members. Besides this, SATHI cell members have given orientation to activists of various JSA organisations in Maharashtra for documentation of cases of denial and data collection. Subsequently these cases were analysed by SATHI cell members.
13. End project surveys to see the impact of health worker programmes on the availability of affordable and accessible first contact care in the village itself
One of the potential results expected due to the work of the SATHI Cell is substantial decrease in medical expenses in project areas, where direct implementation takes place. In this context, provision of affordable and accessible first contact care by the Swasthya Sathis (Community Health Workers) was expected to result in decrease of medical expenditure. To assess this, a sample survey in all project areas was conducted in July-August 2004, to determine the treatment utilization pattern and expenditures on various treatment providers in all the field areas.
B. Tools prepared by SATHI cell to facilitate action research
14. Guidelines for investigating suspected hunger related deaths & assessment of malnutrition in the community
SATHI cell members have been involved in facilitating the formation and coordinating a pioneering initiative in the form of the National Level ‘Hunger Watch’ group. The Hunger watch group has been organised to arrive at a scientific protocol to investigate and document hunger related mortality. A draft ‘Methodology for investigating hunger related deaths’ has been developed by the Hunger Watch Group of Jan Swasthya Abhiyan. SATHI cell team members have been facilitating the meetings of this group, and have authored various chapters of this booklet. Team members played a major role in organisation of a two-day workshop to orient the grass root level activists to use this methodology. The team members then incorporated the inputs received during the workshop on the draft methodology to investigate the hunger related deaths. SATHI cell members have given substantial editorial inputs and at present the draft is in almost final stage.
15. Handbook for documentation and presentation of evidence concerning “Denial of Right to Health care"
This handbook has been published as booklet by CEHAT. It was mainly drafted by the members of the Sathi team with help of other JSA constituents. This booklet provides essential guidelines, questionnaires and protocols to the activists working in the RTHC campaign in various parts of the country, and participating in the survey of denial of health care.
C. Papers based on secondary data analysis
16. " Notes on the politics of health care in M. P. -Towards a critical analysis of the situation of health and health care"
This paper is based on the secondary data related to various health indicators like life expectancy, Crude death rate, IMR, Child mortality and maternal mortality rates and indicators related to status of healthcare services of Madhya Pradesh. It also discusses the status of nutrition related indictors like malnutrition among children and women, prevalence of anaemia. The paper gives lucid picture of the health status and trends related to the people of Madhya Pradesh. The paper also discusses the health care financing trends in MP. This paper has been quoted extensively in the chapter on Health and Nutrition in the Human Development Report of Madhya Pradesh for year 2002.
17. "The Nutritional Crisis in Madhya Pradesh"
In this paper, while commenting upon the nutritional status of the population of M.P., some aspects of household food expenditure and food security have been briefly reviewed. This is followed by examining food intake in certain vulnerable groups, and then various parameters of the nutritional status of the population have been examined. A special focus has been given to the tribal population of the state, given its unique socio-economic characteristics. A brief micro-study on drought, malnutrition and starvation is also included. Subsequently there is a brief review of key nutrition supplementation measures. Finally, there is an attempt to integrate these aspects to gain an overall perspective about the key issues, which emerge, regarding nutrition of the people of the state. Based on this paper, a presentation was made by a SATHI cell member in a programme on Health Rights organised by MP JSA on 7th April 2002.
Similarly, a detailed study of the status of public health services at village level provided under Swastha Jeevan Seva Guarantee Yojana (‘Health Guarantee Scheme’) in Sendhwa Block was done in June 2002. This study was further replicated in other four other districts of western MP, based on the questionnaires and protocol developed by the SATHI team. Members of the SATHI team guided the analysis and report writing of the study. The studies revealed a dismal state of ‘Guaranteed’ health services and formed a central input for the state level 'Public audit' of the Health Guarantee scheme of the M.P. Government organised in December 2002.
A survey of food security schemes in a sample of 3 villages each of Pati and Sendhwa block, has been an important input for a state level survey and campaign on the Right to Food issue taken up by the Jan Swasthya Abhiyan, MP. The SATHI team also played a central role in the entire data analysis and report writing for the JSA State level ‘Right to food’ survey in Madhya Pradesh, covering 203 villages.
Similarly a major survey on ‘Status of Implementation of various Food Security Schemes in Maharashtra’ was guided by the SATHI team and carried out by constituents of Anna Adhikar Abhiyan (Right to Food campaign, Maharashtra) during September to December 2002. In this survey, the data collection was done in 91 villages by various organisations involved in Anna Adhikar Abhiyan. The SATHI cell did dissemination of protocols, complete data analysis and the report writing. This report has been sent to the Commissioners appointed by the Supreme Court and has been submitted to the Chief Secretary and other senior officials in the state as part of the campaign initiative.