Since the inception of Community of Practitioners on Social Accountability and Social Action in Health (COPASAH), the East and Southern Africa (ESA) member institutions have registered achievements as individual initiatives owing to the knowledge acquired from Facilitated Learning Exchange Visits. However, the COPASAH ESA membership has experienced limited engagement among members thus affecting further growth both in terms of membership and ideas for advancement of the network.
The Coalition for Health Promotion and Social Development (HEPS UGANDA) Uganda is successful in implementing the Citizen’s Engagement initiative to Stop Medicine Stock Outs (COME) that aims to fostering action, engagement and participation of the community. This initiative which was kick started in March 2014 has today shown that the community engagement can increase social accountability. Community leaders are forging a path towards advocacy of health rights for all. This includes ensuring every citizen has access to essential medicines in every public health facility, where the availability of essential drugs is adequately provided and above all health care services are improved to serve the community.
The focus of the initiative was to get the public health facilities in Lira and Kiboga districts up to health care standards. Citizen Report Card (CRC), a social accountability tool was used to provide feedback received from the users of public services to the public health agency. The feedback was received through the sample surveys that were conducted on different aspects of service quality. This enabled the public agencies to identify strength and weaknesses in their work. The CRC was further used to identify key gaps, with a way-forward, a plan to fix the gaps that came up during the discussions between the community, service providers and duty bearer.
A woman drops a suggestion in the suggestion box that was provided during the implementation of the community action plan. This resulted in community dialogues and interface meetings at Katwe HCIII, Dwaniro Sub County, Kiboga District.
The Uganda Government recognizes the importance of community involvement in the successful fulfillment of the right to health. The National Development Plan (NDP), the overall Government development strategy, sets and prioritizes the empowerment of individuals and communities for a more active role in health development and the implementation of the Uganda National Minimum Health Care Package (UNMHCP).
During the project life-cycle, it was heartening to see collective action at work, especially when a community gets together to demand for their entitlements. Such is the chronicle of the residents of Dwaniro Sub County, Kiboga District, who observed that a lack of adequate and standard infrastructure compelled them to lobby for a positive change in the status of their health centre, eventually achieving 50% of service enhancement of what was originally targeted.
In Kiboga District, inadequate infrastructure is affecting access to services in all the health facilities. For example, the district hospital is a 100 bed capacity but the intake of patients is over 150 which puts the pressure of hospital management at risk. This means that the current ward capacity which has limited capacity cannot match with the volume of admissions. It is often a common sight to see patients sleeping under beds, or in the veranda. Male and female patients are put-up in the same ward. These are reasons to believe that the health consumers are shunning away from public health facilities as they lack adequate care. The community work experience in Dwaniro Sub County is an ideal example to showcase how monitoring service delivery can yield positive outcomes through the process of social accountability and community participation. During the interface meetings facilitated by HEPS Uganda between the health workers, community leaders and community members in the last quarter 2014, Katwe community members identified issues that were affecting their health centre and these were prioritized in the community action plan. The health centre lacked a clear complaint and redress mechanism, a placenta pit, and had poor accommodation facilities for staff. The General ward and OPD department were of substandard, a situation that had affected the access to services in this health facility.
The community members of Dwaniro Sub County in collaboration with the health unit management committee members and the health facility in-charge agreed to submit a proposal to the sub county, district headquarters, politicians and development partners to solicit for support to improve the health facility infrastructure. In addition, community fundraising conferences were held to supplement the development works at the health centre.
The district councilor Nelson Agaba, informed community members of Dwaniro Sub County during a quarterly community action plans review meeting that due to the lobbying, the staff quarters were included in the district work plan for the year 2015. In this regard, through community fundraising meetings, the community members also contributed money, bought building materials to help in the construction of the health workers staff houses.
The health centre beefed up its health education programmes to keep to the goal of information dissemination, now to include health rights and responsibilities of clients and the use of rational medicines among others.
In Uganda, the range of health services varies with the level of care in public and private health facilities. Public health facilities up to Health Centre III (HCIII) offer basic services as per the minimum health care package. HCIIIs in particular the lowest facilities accessed at village level render a comprehensive health care package. At HCIIIs there are provisions for laboratory services for diagnosis and it is the first referral cover for the sub county as the third lowest unit of local government. But, access to services in these health facilities is limited due to a number of factors such as sub-standard health care facilities, unavailability of drugs and lack of awareness of community about their rights and standards of service.
Healthcare promotion in Uganda is strongly dependent on availability of adequate infrastructure, facilities, and technology. To a large extent, the infrastructure, equipment, furniture and vehicles define the capacity of a health centre to deliver health services to the population. However the state of the current infrastructure is below the standard of the adequate infrastructure set by the Ministry of Health.
Joan Esther Kilande holds a bachelor’s degree in Social Sciences and majored in Gender Studies. She has a certificate on Primary Health Care. She has certificates in Reproductive Health and Human Rights, Policy advocacy and Social media campaigns. She has been working with Journalists for the last 5 years in various health and human rights campaigns and has skills and experience in using social accountability approaches specifically the Citizens Report Card (CRC), Community Score Card (CSC) and the HEAR model.
Wakabi Eric is an all-round communication specialist and journalist with more than three years of experience in, health policy advocacy and communicating development issues to various Newspapers, Magazines, and Internet Productions, NGOs in Uganda and South Sudan. He holds a B.A Mass Communication degree of Makerere University and currently pursuing Bachelor of Laws at the same University. He’s currently a communications officer at HEPS –UGANDA
The Training and Research Support Centre (TARSC) and Zimbabwe Association of Doctors for Human Rights (ZADHR) has reported on different platforms of COPASAH and in the COPASAH Communique earlier, as how Participatory Action Research (PAR) was used in the Cassa Banana community to explore, analyze and take action on priority health problems faced by the community. PAR activities led to the formation of a Community Health Committee (CHC) and the development of a community action plan that prioritized lack of clean water and poor sanitation as the key health problem in the area. Initially, the CHC focused on clarifying the confusion in roles and responsibilities between two district councils, both of whom denied responsibility for supporting Cassa Banana. More recently, the CHC has focused on organizing community actions and engaging with the relevant duty bearer in demanding the delivery of basic services, including access to health services, waste collection, and the improvement of sewage and water supplies.
Cassa Banana is one of many informal settlements that have sprung up around Harare, the capital of Zimbabwe, over the last 20 years or more. In most cases, these unplanned urban settlements are overcrowded, lacking in basic infrastructure and services, with poor environmental conditions for health. Residents are facing a range of other social and economic challenges common throughout the country, including rising urban poverty, falling access to improved water and sanitation, and lack of overall growth in the economy, employment or household incomes post 2013 (TARSC and MoHCC Zimbabwe Equity Watch 2014). The current Public Health Act has provisions for addressing water and sanitation but these are poorly implemented with an underfunded public health system. Diarrhea, intestinal infections and periodic outbreaks of cholera are not unusual in settlements such as Cassa Banana.Despite these challenges, there are opportunities for health and social accountability. The right to health care, water, food and shelter was included in the new Constitution of 2013.
Zimbabwe has seen improvements in the Human Development Index mainly due to better health and HIV outcomes, as there is sustained gender parity in education. Improvements in health and well being in Zimbabwe depend, among other things on engaging with the strong social assets within and improving dialogue between communities, state and private sector, in raising and addressing barriers to resources and services for health, and in supporting community efforts to define and act on problems in order to transform their own environments.
An aerial view of Cassa Banana © L. Dhumukwa 2015
Within this context, the work in Cassa Banana is building a body of knowledge on strategies to support community efforts to take action and on how to hold duty bearers accountable. As part of this process, in October 2015, nine community members were trained as community photographers using a PAR tool called Photovoice.
-COPASAH at the Learning Exchange: Transparency/Accountability Strategies & Reproductive Health Delivery Systems- Accountability Research Centre, School of International Service (American University), Washington DC
A Learning Exchange on Transparency/Accountability strategies and reproductive health delivery systems was recently held on June 27 and 28, 2016. This learning exchange was convened by Accountability Research Center, School of International Service, American University along with the Evidence Project, International Planned Parenthood Federation and Reproductive Health Supplies Coalition, Advocacy and Accountability Working Group. COPASAH was represented at the learning exchange meeting by two Steering Committee members including Walter Flores (CEGSS, Guatemala) and Renu Khanna (SAHAJ, India ) – and E. Premdas Pinto from t h e COPASAH Global Secretariat, Centre for Health and Social Justice(CHSJ, India
The learning exchange was convened in the background of systemic weaknesses, vulnerabilities and biases which at different points in health systems form bottlenecks for the reproductive health (RH) supplies to reach the last mile. Practitioners, researchers and persons involved in the field of Transparency, Participation and Accountability (TPA) participated in the learning exchange. The goal of this learning exchange was to inform and identify practical strategies to address unidentified and unmeasured bottlenecks in the process of procuring and moving commodities through the supply chain into health facilities at different levels as well as the barriers that impede citizens’ enacting of full, free and informed contraceptive choices. One key proposition for discussion was the issue of public monitoring which can inform problem solving and policy advocacy, while problem-solving or advocacy strategies can in turn inform monitoring strategies.
The objectives of the learning exchange were set as follows:
- Share analytical insights, key concepts and practical developments both from transparency, participation and accountability and the reproductive health systems, including commodity security;
- Learn from experiences by addressing issues of supply chain challenges in various sectors
- Identify research gaps and/or questions for addressing the monitoring challenges involved in tracking the determinants of access to contraceptive services;
- Contribute to practical research agendas;
- Discuss possible strategies for improved monitoring through collaboration and sharing between RHSC and TPA sectors.
Presentations: COPASAH members made presentations on various experiences of practice of citizen empowerment and monitoring. In the session ‘Key concepts and lessons from the emerging field of Transparency, Participation and Accountability’ which was chaired by Kelsey Wright, Evidence Project, E. Premdas Pinto from COPASAH Global Secretariat, CHSJ, made a presentation and shared the experiences of COPASAH strategies of bottom up accountability practice, networking of practitioners, using ICT for networking and advocacy for the citizen centric accountability practice. This session introduced some key concepts and lessons emerging in the TPA field and used concrete examples of how they have been applied in different sectors and to what effect. This included approaches to advocacy, problem solving and policy monitoring.
E. Premdas Pinto, COPASAH Global Coordinator, in his presentation highlighted the issue of bottom up knowledge generation from practice to countervail the top-down model of knowledge making and policy making. The contributions of COPASAH in terms of issue papers, case studies, stories of practice from various countries were highlighted. COPASAH knowledge products were also distributed to participants.
Renu Khanna, COPASAH Steering Committee member, from SAHAJ Society for Health Alternatives (India) presented her reflections on challenges faced in independent monitoring of maternal and reproductive issues. These challenges were encountered in initiatives dealing with social autopsies of maternal deaths, monitoring negligence and denial of services to women through various community based efforts. This presentation was made as part of the session on ‘Challenges of independent monitoring and advocacy’. The session aimed at sharing experiences and reflections of practitioners who have been combining monitoring and advocacy to advance health rights. This session was chaired by Sono Aibe, Pathfinder.
Walter Flores, COPASAH Steering Committee member, from Center for the Study of Equity and Governance in Health Systems (Guatemala) presented the citizen monitoring and community ethnography undertaken in Guatemala. The process was presented through a documentary followed by a presentation. Both visual presentations brought out the centrality of citizen empowerment, forming collectives and strengthening citizen voice as a sine qua non for monitoring and people centred advocacy. They also highlighted that when citizens voice critical questions, the system is likely to resist and also that there is possibility of back lash.
Conclusion: The small group discussions from the learning exchange deliberated on the critical research that would bolster the monitoring of reproductive health care and access to services. The themes of power, the research questions to be asked, various strategies that could be combined both at the grass roots as well as policy making level for improving access to reproductive health care, were also discussed.
About the Authors
- Premdas Pinto coordinates the Global Secretariat for COPASAH.
Renu Khanna and Walter Flores are the Steering Committee members of COPASAH Global.
The health and nutrition accountability sector in South Asia is a rich and vibrant field, with a great deal to offer in terms of innovation and best practice – but it still performs relatively poorly on health and nutrition indicators.
A range of accountability initiatives have been implemented in the health and nutrition sector, including techno-managerial, transparency oriented, participatory and collective or social accountability initiatives, but there is little work yet that is taking both a comparative and theoretical perspective to ground existing and future initiatives on accountability, and accountability in health in particular.
In March 2016, in partnership with the Community of Practitioners on Accountability and Social Action in Health (COPASAH), the project convened an online expert discussion which brought together 49 practitioners involved in improving health and nutrition services in South Asia. They shared their experiences on community participation and engagement, negotiating with the state, private sector accountability, and how to define and measure impact.
The learning they shared included the following:
- A ‘culture of questioning’ is crucial to mobilising communities around social accountability in healthcare.
- The effectiveness of social accountability tools – online or offline – depends on the way they are used. Part of their value is that they create an environment where people can sit together and start talking about healthcare issues.
- Clear, attainable goals are essential to ensure community participation.
- When locally-collected data are used to push for better service delivery at ‘higher’ levels of government, the voice of community members becomes more legitimate.
- Lack of regulation in the private sector means there is no effective framework for accountability in service delivery.
- It is essential to put politics and power at the centre of the accountability discourse, to make sense of the changes we seek to create.
Strengthening Mutual Exchanges and Solidarity in East Southern Africa Region – Community of Practitioners on Accountability and Social Action in Health
An initiative in Family Planning Services from Khyber Pakhtunkhwa , Pakistan suggests that citizen led performance monitoring employing community scored cards is leading to improvement in health services.
Improving Family Planning Services through Community Score Cards in Khyber Pakhtunkhwa – Community of Practitioners on Accountability and Social Action in Health
Pakistan is one of the fastest growing countries on the globe with a population of over 180 Million at an annual growth rate of 2.03 percent. Based on current trends, Pakistan stands to double its population by 2050. The latest figures released from Pakistan Demographic and Health Survey (PDHS) 2012/13 point out that fertility rate stands at 3.8 with highest amongst rural poor women with low levels of literacy and education. Contraceptive Prevalence Rate (CPR), though slightly improved but hugely behind the anticipated targets, reflects 0.5% increase since the start of family planning programme in 1964. CPR has remained stagnant in 2000-11 and this has raised several questions about the efficiency and effectiveness of the Family Planning (FP) initiatives. Challenges identified in variety of reviews pointed out demand and supply constraints (Karim and Zaidi, 1999: Rukanuddin, 2001; TAMA, 2008). This has led to the argument that FP programmes could not perform as anticipated.
Poor performance of the FP sector is attributed to the structural inefficiency, weak demand and poor supply side response. A plethora of evidence based studies have come up with variety of reasons including poor management, inadequate coverage, low quality of services, inadequate oversight and weak governance, staffing gaps, poor human resource management, inappropriate stock management, and weak implementation of devolution in subordinating units.
Sukhi Ghar Mehfil at Khazana
As I sit down to write about the role of social movements and grassroots organizations for state accountability, I’m drawn to reflect on the significance of today, January 25, 2016. Five years ago, thousands, and eventually millions, of Egyptians took to the street to protest a corrupt and illegitimate regime. Tahrir Square became the epicenter of this movement, and in a few short weeks Egypt’s strong-man resigned and a democratic opening began.
If only the story ended there. Unfortunately, it did not, and Egypt is today under another military government, one that has learned the lessons of the past and has sup-pressed civil society with renewed vigor. What lessons should we draw from this experience? In my own reflection on the Tahrir Square movement, I highlight the need to build grassroots organiza-tions, not just bring people into the streets with social media-enabled mobilizing.
The broader point is that we need to have a more sophisticated understanding of the role of mobilizations, social movements, and membership based organizations in promoting more democratic and ac-countable governance. What can we learn from historical experiences? And what insights need to be captured from the day-to-day struggles and decisions made by organizations? What can external actors do to support citizen centric organizing for accountability? These questions were raised in a 2014 workshop organized by the TALEARN community of prac-tice, with COPASAH members Walter Flores and Premdas Pinto among those leading the call.
Over the next two years, a working group of COPASAH and TALEARN members has served as a space to explore the role of popular movements and organizations for state accountability. I’ll briefly highlight the lessons and insights that have emerged from this engagement and where we might go from here.
The TALEARN community of practice brings together funders,researchers and civil society organizations that share a common interest in strengthening learning about how to improve our efforts to ensure more transparent, participatory and accountable governance. The working group on grass-roots organizations and movements saw an opportunity to generate a more robust conversation in the TALEARN group, as well as among a broader set of actors. The first step was a set of three think pieces around the title Mobilizing Accountability, to frame the issues and provide new insights and ideas.
These think pieces focus on moving beyond narrow understandings of citizen engagement as either professional NGOs or individual/ community participation in exter-nallysponsored processes. The think pieces argued instead for increased attention to the forms of mobilization and organization the citizens undertake to bolster their collective agency. Finally, the think pieces offered suggestions for how to support, not just financially, these more diverse forms of grassroots organizing. The engine room collaborated on the second two notes in the series.
The think pieces were generally well received as useful resources for a range of actors trying to engage with these issues, comple-menting other recent papers making similar arguments. To follow up on this base, TALEARN and COPASAH cohosted a small roundtable to shape a learning agenda around social movements and grassroots organizing.
Participants deliberating in a group exercise in TALEARN and COPASAH collaborative roundtable
The meeting brought together re-searchers, NGO representatives and activists with broad experience in social movements, particularly in the Indian context. Over the course of two days we had a wide-ranging conversation about the experiences of movements, hard-won lessons, and questions that remained. These questions formed the basis for a movement-centric learning agenda. This learning agenda raises questions about lead-ership, mobilization and how movements and grassroots organizations engage with wider govern-ance systems. The round-table participants were particularly interested in pursuing these questions through action research, case studies and real time learning methods. We hope the learning agenda will be a resource both for movements and organizations themselves, to orient their internal learning, and the wider community of organizations interested in citizen engagement and accountable governance. Please feel free to make use of it if you find it interesting.
Reflecting on the discussion on learning with, from and for move-ments, I was struck by the rich experiences of the participants as well as the need to have a more systematic focus. Indeed, most of the lessons coming from the move-ments and grassroots organizations reinforced ideas from the concep-tual framework that T/AI and oth-ers have been proposing for ‘Ac-countability Ecosystems’. Think-ing about the systems of actors and mechanisms for promoting ac-countability focuses our attention on the multiple pathways, points of engagement, tools and tactics, and contextual factors that must be addressed to get at the root causes of unaccountable governance and corrupt practices.
Late last year, at the most recent TALEARN workshop, we brought these perspectives together, sharing lessons learned from the working group on social movements/ grassroots organizations and presenting ideas about strengthening accountability ecosystems. The workshop highlighted five key challenges for the TALEARN community, as well as the broader set of organizations working for more open and accountable governance. Most of these five issues spoke to the experiences and chal-lenges of citizens movements and grassroots organizations, such as the need for political analysis, to strengthen connections between actors and movements, to leverage a diversity of tools and tactics, and to learn and adapt as we go. Much of this is instinctive for activists around the world, but more project -oriented efforts may find it difficult to incorporate these elements in their work. Thus, TALEARN serves as a frank space for conversation about how funders and NGOs can work to enable more strategic approaches, and ones which take into account and sup-port the efforts of broader movements and mobilizations.
As participants reflected on the TALEARN workshop, they demonstrated a more nuanced under-standing of the value and chal-lenges of learning, both within organizations and across stake-holder groups. There seems to be a growing consensus that practice-oriented learning can enable the kinds of nimble, adaptive approaches that seem to be more effective than pre-determined, linear projects, particularly in the challenging terrain of politics and governance. But learning is not a silver bullet, and it must be combined with more strategic approaches, including more active engagement with movements and grassroots organizations. Learning about ef-fective and strategic NGO-movement coalitions is an area of particular need, as some of these have shown great promise in ena-bling strategies that work at multi-ple levels (e.g. local and national) and leverage both pressure tactics and evidence-based advocacy, for example. Movements, grassroots groups, and membership-based organizations must be part of a holistic approach to strengthening accountability ecosystems, and although we have more evidence than ever, we are all still learning how best to build partnerships,capacities and strategies that reflect these insights. There are tentative steps in the right direction, particularly with a shifting focus from ‘open government’ to ‘open governance’, but we need to get better at putting our insights into practice.
- Halloran, B. (2016). Politics, Governance and Development blog.https:// politicsgovernancedevelopment.wordpress.com/
- Halloran, B. (2015). Strengthening Accountability Ecosystems: A Discussion Paper.London, Transparency and Accountability Initiative.
- Halloran, B. and W. Flores (2015).Mobilizing Accountability: Citizens, Movements and the State.London, Transparency and Accountability Initiative.
- Joyce, M. and T. Walker (2015).A Movements Perspective on Transparency and Accountability.London, Transparency and Accountability Initiative
- Joyce, M. (2015).Watering the Grassroots: A Strategy for Social Movement Support.London, Transparency and Accountability Initiative.
- Stephan, M., et al. (2015). Aid to Civil Society: A Movement Mindset. Washington, D.C., United States Institute of Peace.
- Transparency and Accountability Initiative.www.transparency-initiative.org
About the author:
Brendan Halloran is Program Officer – Impact and Learning with Transparency and Accountability Initiative. He is leading the T/AI’s work stream on Impact and Learning. Brendan coordinates TALEARN, a community of practice involving individuals from the different groups, all working on T/A work from all around the world. He also leads T/ AI’s involvement in supporting new research and other learning efforts around transparency and accountability issues, ranging from social accountability to international multi-stakeholder initiatives. For more information on Transparency initiative please visit http://www.transparency-initiative.org
Moving From New Knowledge to New Practice*
For about ten years now, my team and I have been working on strengthening the accountability of public services for rural indigenous populations in Guatemala. During this time, we certainly have seen an evolution in the theory and practice of accountability. We started with an aim to strengthen the democratic governance of public polices and services in a post conflict context with historical inequity and social exclusion. To us, it was clear we were aiming at a relatively long process of engagement. The emerging frameworks and tools on social accountability and legal empowerment were useful to understand how to implement, monitor, and evaluate our interventions, which included improving working relationships among rural indigenous citizens, authorities, and public service providers and improving access to public services.
In addition to the increased interest from donors in accountability, we also witnessed a mushrooming of “social accountability projects,” which technocratic interventions were attempting to solve highly complex citizen-state interactions through two- or three-year projects. Fortunately, it seems these types of projects are much less frequent now.
In terms of the theoretical advance, in the past couple years we have seen the research by scholars who take an explicit approach to the politics of accountability, including power relations (Fox, Tembo, Joshi and Halloran). For us, practitioners working in post conflict contexts with high levels of impunity, this theoretical advance speaks better to our experience than the technocratic view that dominated the past decade.
Despite the theoretical advance described above, we have yet to move forward on our operational tools and implementing frameworks. For instance, although many donors and large international NGOs recognize the complexity of accountability and the politics involved with it, they still work through self-contained projects and logframes. Projects would not be a problem per se if they were cycles in a broader agenda rooted in a strategic framework. But usually they are not.
I would highlight three current challenges and opportunities.
Going From Knowledge to Practice
In my organization, we follow the principles of action research, which hold that learning occurs when one changes his or her own practice. I would say that we have accumulated very important knowledge in the accountability field but are only just starting to learn (demonstrating changed practices).
Building a Genuine Collaboration between Researchers and Practitioners
Most of the research in the field has consisted of top-down initiatives by donors and academic researchers. There are very few examples in which a research agenda has been developed and implemented with the active collaboration of practitioners. In 2015, I participated in two international meetings in which this situation was broadly recognized and there was a true interest in developing effective collaboration. To make this intention a reality, donors can help by supporting a continuous engagement between researchers and practitioners (going beyond one single meeting) and even supporting the development of a strategic research agenda that would be developed by interested researchers and practitioners together.
Connecting the Accountability Field with the SDGs Movement
There is an interest in the SDGs community to implement citizen participation as a way to ensure national and subnational accountability. However, many calls from within that field are referring to “citizen voice” as the key driver. The past decade of research and knowledge from the accountability field has shown us that citizen voice is not sufficient to affect the behavior and decision making of those in power. This means that the accountability field has much to contribute to the SDGs movement. I see a unique opportunity to build collaboration between both fields. T/AI could develop a specific stream of work to support those researchers and practitioners who are building in-country and international collaboration about SDGs accountability, including citizen-led accountability.
I feel strongly that there is a need to continue advancing the theoretical work, frameworks, and tools related to the politics of accountability. At the core of citizens’ demands for transparency and accountability lies the need to build and strengthen democratic institutions. These efforts are for the medium and long term. It would be good therefore to have explicit goals in this regard and the framing of an action plan.
- This short essay is part of the process, to assess the achievements and opportunities for the Transparency and Accountability Initiative (T/AI) several academics, researchers and activists, were invited to produce short essays responding the question: “Based on your understanding of how the field of transparency and accountability has evolved in recent years, what issues or areas of work would be especially important and fruitful for T/AI’s funders to address in the next several years?” Walter Flores was one of those invited to give opinion.
The link to the complete set of short essays is: http://ceip.org/1UsUe7r
Citizens of V K Salagar, Aland Taluk, Kalburgi district, Karnataka (India) reclaim their Primary Health Centre
Following the state government’s decision to take back all the Primary Health Centres (PHCs) from NGOs and other private entities, the people of VK Salagar in Aland taluk of Kalburgi district in state of Karnataka (India) held a public dialogue recently with the district administration to discuss the urgent measures required to “clean up the mess and undo the damage done by Karuna Trust”, the Bangalore-based NGO which had been managing the Primary Health Center in VK Salagar for the past 10 years.
Led by the Kalburgi district committee of Karnataka Janaarogya Chaluvali (KJC)*, the public dialogue was attended by 50 people (mostly women) from 4 villages that come under V K Salagar PHC. The district administration was represented by the Taluk Health officer (THO) Aland taluk, and the medical officers and other staff of the PHC. People brought up several issues that needed to be addressed by the district administration on a priority basis. These were long-pending issues that had been raised by the people with Karuna Trust in the past but there had been no response from them.
Discussions between people and the district administration focused on 10 key issues:
- All 14 vacant posts in V.K.Salagar PHC have to be filled immediately : PHC staff on deputation or on contract basis is not acceptable to the people.Ravi from V.K. Salagar demanded to know what steps the district administration had undertaken to fill the vacant posts and wanted the THO to commit to a clear-cut deadline for the same. The THO said that the district administration had already written twice to the Director of Health and Family Welfare to fill in the vacant posts in V.K.Salagar PHC. As a stop gap measure he introduced the two doctors deputed to V.K.Salagar PHC (one MBBS(allopathic) and one AYUSH(Indian System of Medicine). He also took cognizance of the fact that women complained that the MBBS doctor had not been seen in the PHC even once.
- The Doctors and staff quarter for V K Salagar PHC which is under construction has to be completed immediately within a month and all the PHC staff appointed has to stay in the quarters. Ambika, an elderly woman from V K Salagar fondly recalled the selfless services of Dr. Muktha Saheb who worked in V K Salagar PHC before Karuna Trust took over the PHC. Explaining the sacrifices and commitment of this Government doctor, she said the people of V K Salagar want doctors and all PHC staff to stay in the Government quarters. In response, the THO said that persons like Dr. Muktha Saheb were truly selfless and assured that the all PHC staff would stay in the headquarters.
- All drugs in the essential drug lists for the PHC has to be made available free of cost for the patients at the PHC. The practice of writing prescriptions outside has to be stopped immediately: Women said that the AYUSH (Indian System of Medicines) doctor was seeing all patients including the antenatal women. People questioned the rationale of the AYUSH doctor treating patients with allopathic medicines and demanded that the AYUSH doctor need to prescribe their medicines and those medicines should be made available at the PHC. Women gathered showed the prescriptions written outside by the medical officer. Several of these prescriptions included substitutes for IFA tablets and pain killers and multivitamins. The THO then gave a strict warning to the medical officers not to prescribe any drugs outside. He also admitted that V K Salagar PHC had not been indenting drugs. He said that he would need one more month to ensure supply of drugs directly to the PHC and promised that by June 1, 2016 onwards V K Salagar PHC would get its own drug supplies.
- All neonatal deaths in the last one year in V K Salagar PHC have to be immediately audited and it has to be made public and immediate actions to be taken to correct the errors: Indubai, of V K Salagar shared how her daughter had lost her first born baby two weeks ago due to delay in referring her to the General hospital, following which there was a discussion on how the PHC had failed to pick up high risk pregnancies even in the past. The THO said all neonatal deaths will be audited and remedial actions undertaken immediately. People demanded that the audit report and Action taken Report be made public.
- PHC staff collecting money after the delivery has to be stopped immediately and necessary actions to be taken against the staff involved in such practice:Ujala Lengti, brought the issue of rude behaviour by staff nurse and collecting money for deliveries. THO confronted the concerned staff nurse and gave his telephone number to the people and asked them to call him directly on such issues.
- Running water facility to be made available at the PHC immediately: Women complained that for the past 10 years, families had been bringing water from homes for drinking and cleaning up after delivery. Complaints to Karuna Trust had fallen on deaf ears. Women demanded running water facility in the PHC immediately. The public works engineer from V.K.Salagar, Mr. Swamy said a borewell connection had been provided to the PHC 10 years ago. After the PHC was taken over by Karuna Trust, this water source was poorly maintained and been destroyed. He said that Zilla Panchayat had sanctioned money during the Karuna Trust period for re-boring. However no one knew what had happened to the funds. As an immediate measure, the THO said arrangements would be made with the Gram Panchayat to supply water through tankers.
- Abdomen examination has to be done for all pregnant women in the PHC. Writing scans to private scanning centers to be stopped immediately and has to be done to the district hospital if necessary:Women complained that abdomen examination of the pregnant women is not done in the PHC. The medical officers complained that they don’t have a fetal stethoscope for abdomen examination. The THO ordered that the fetal stethoscope will be obtained immediately. Further the doctor examined women only if they had a scan report and the doctor referred women to private scanning centres in Kalaburagi town. The THO said that all women should not be referred indiscriminately for scans and he strictly instructed the doctors to refer women only to the district hospital.
- Drugs for RTIs and STIs to be made available at the PHC. Large -scale hysterectomies in the villages to be investigated and actions taken immediately: Jyothi Pawar from V.K.Salagar Tanda raised in just two small lambani tandas that comes under V.K.Salagar PHC, 38 women have undergone hysterectomy. Many of these women were under the age of 30 years and had first approached the PHC but had not received any treatment. Women demanded good and effective medicines at the PHCs for RH issues of women. Women also said that there had no awareness / education session on issues related to women and child health in the PHC for the past 10 years.The THO agreed to initiate IEC activities related to RH issues immediately and sought people’s cooperation in these efforts. He also promised that all medicines related to RTI/STI treatment will be available in the PHC in one month’s time.
- Ambulance facility to be made available for the PHC immediately:People reminded THO about the public hearing last year where the issue of ambulance service for VK Salagar PHC was discussed. They said even now V.K.Salagar is in a very pathetic situation and neonatal deaths take place due to lack of emergency transport. One of the women attending the meeting had brought her daughter-in-law for her first delivery. She told the THO that the doctor had called for an ambulance and was told that it would take 2 hours to reach. In response, the THO immediately called Narona CHC and arranged for an ambulance. He promised to post a government ambulance to V K Salagar PHC immediately within 3 days.
- All national programs to be undertaken in full swing with immediate effect: People of VK Salagar will be closely monitoring the implementation of above actions by the district administration over the next one month. As committed by the THO, Aland taluk, they are expecting a fully functional PHC by 1st June 2016. They plan to hold another public meeting in the first week of June 2016 to constitute the Arogya Raksha Samiti at the PHC level with representations of women from various villages to ensure continued monitoring of the PHC in the coming days.
About the author:
*Karnataka Janaarogya Chaluvali (KJC)- Karnataka People’s health movement),Karnataka(India);comprises of progressive social movements, community collectives, informal sector and other workers’ unions, women’s collectives, doctors, filmmakers, public health practitioners and lawyers. KJC is a people’s struggle to protect marginalized communities’ health rights and defend the public health system against the onslaught of commercialization and privatization in health care.