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Follow up of Civil Society Charter of Demands on Budget for better Health Outcomes 

 In the State level convention on Government Budgets and Better Health Outcomes organized jointly by Mumbai based organisation CEHAT, Human Rights Law Network (HRLN)- Bhubaneswar, Bharat Gyan Bigyan Samiti (BGVS) Bhubaneswar and Network for Social Accountability (NSA)-Bhubaneswar, held on 10th April 2009, many citizen groups, academicians, students, and civil right organizations expressed their discontent in the collapsing public health scenario in the State. As an outcome of the consultation process, a People’s Charter of Demands on Public Budgets for Better Health Outcomes was prepared with specific demands on health related issues with a focus on improving the assess and combating exclusion in health service delivery. Network for Social Accountability (NSA) was entrusted with the responsibility of facilitating the activities related to the following tasks.

Tasks Identified and Progress Made (As on 20th July 2009)

(a)    A consultation meeting with around 40-50 MLAs can be organized to discuss with them the charter of demands developed and to orient them for taking forward the demands to the Legislative Assembly. PROGRESS MADE– A delegation went and discussed with the individual MLAs on the Charter of Demands and the health issues pertaining to the state. So far, 71 MLAs could have been contacted. A few MLAs have shown interest to form a taskforce on the issues and requested to classify the charter of demands in terms of rolling targets for advocacy so that efforts can be streamlined. Formation of taskforce is under process and demands have been classified accordingly. The specific demands around which NSA in consultation and participation of the larger civil society shall advocate for are presented in Annexure-1. A consultation meeting with MLAs shall be held once the task force is formed.

(b)    A campaign shall be launched at the bureaucracy level and suitable strategy shall be evolved for the same on the “civil society charter of demands on health”. PROGRESS MADE -Limited progress has been made so far. Larger civil society participation required to take forwards the process. For more details and participation in the process please contact media@nsa.org.in or info@nsa.org.in

(c)    A massive signature/postcard campaign shall be launched on the charter of demands to make the people aware of these demands on health. It was suggested that for the present purpose around 100000 signatures collected and 10000 post cards sent shall be a sufficient number to conclude the awareness building process. –Process yet to start

(d)    A delegation of civil society shall meet the health minister and the finance minister to submit a memorandum around the civil society charter once sufficient signatures are collected over the demands and sufficient numbers of post cards are sent through the people. PROGRESS MADE –The taskforce comprising of MLA representatives, political party representatives and Civil Society Representatives shall form the delegation.

(e)    Zonal level consultations of civil society organizations shall be organized to highlight the issues raised in the charter of demands. In the context of Orissa, such zones may comprise a set of districts located in different geographical regions. It is suggested that at least four zonal consultation meetings shall be organized within a time frame of one year. PROGRESS MADE –In the planning process.

(f)     Extensive media advocacy shall be undertaken by writing numerous small write ups on health related issues in Orissa and getting them published in the news papers. Efforts shall be made to assist the media teams of the electronic media to highlight local issues in delivery of health services. PROGRESS MADE –NSA activists with the help of other civil society representatives have written numerous articles and short write ups on budget and health services for the poor in Orissa. Several of them are already published in the Oriya Press. Several media houses have shown interest in regularly bringing out such articles and writings in the interest of the people.  Please click here to read the articles already published in the Press.

(g)    Extensive Public Expenditure Tracking Surveys shall be conducted and public hearings shall be conducted on performance monitoring of health service at the Block level. Public hearings shall be organized on the findings of such performance monitoring. It was suggested that 100 public hearings shall be organized in the coming year by forming a network of groups working on health related issues. PROGRESS MADE –This initiatives require substantial resources. Initial progress has been made to build an understanding with CEHAT –Mumbai to organize 2 public hearings with financial support and partnership from CEHAT Mumbai. However, unless such a process is undertaken in large scale (in 100 blocks as decided in the consultation) just two public hearings can not create adequate pressure on the issue. Civil society participation is solicited for supporting public hearings on health services in the rest 98 Blocks. Please contact please contact media@nsa.org.in or info@nsa.org.in for more details.

 

 

ANNEXURE-1 

ABRIDGED CHARTER OF DEMANDS FOR STRUGGLE DURING 2009-10 & 2010-11

(I) Overall Demands on Health Sector Budget in Orissa

 

·                                 100 % Utilization of Budgetary Resources Available for Health Services  

·                                 The government of Orissa to take appropriate steps to bargain with the government of India for more autonomy and abolition of the concept of matching grants in the Centrally Sponsored Schemes which is discriminatory against the poorer states like Orissa.

·                                 Revolving fund support to each self help group (SHG) in the state for establishment of Community Based Drug (CBD) Centers.

·                                 The Civil Society urges the Government of Orissa to take a proactive role in providing self appraisal reports and information (data) on its performance in achieving the outcome targets for improving the health situation in Orissa. Annual rolling targets must be set for making assessment on the progress towards the MDGs in health sector in Orissa. The achievements and hurdles should be made public for wider awareness on the issues.

·                                 The number of mobile health units be raised to 314 over next few years in order to maintain one MHU in each block, as promised in the manifesto of the ruling political party (BJD) during elections. The civil society demands that on an urgent basis, at least 139 new MHUs should be provided to the specific districts with immediate effect and the rest can subsequently be provided during the five year rule of the present government.. The districts that need immediate attention for Mobile health units are as described in the table below.

Sl. No.

Name of the District

G.P

Village

 Existing MHUs

Additional Demanded by the Civil Society

 

 

 

 

 

 

1

Angul

209

1922

1

7

2

Balangir

285

1794

1

13

4

Baragarh

248

1208

1

11

6

Boudh

63

1156

0

3

10

Gajapati

129

1576

2

5

15

Kalahandi

273

2205

1

12

17

Keonjhar

286

2127

2

11

20

Malkangiri

108

928

1

6

21

Mayurbhanj

382

3945

2

24

22

Nawapara

109

659

0

5

23

Nawarangpur

169

897

0

10

25

Kandhamal

153

2515

2

10

29

Sonepur

96

959

0

6

30

Sundargarh

262

1744

1

16

 

Total

6234

51061

14

139

·                                 It has been considered by the civil society that in the context of prevalent diseases in Orissa, even non-specialist doctors and health workers are extremely useful in many areas. A cadre of rural doctors may be trained and developed to provide health services in many common diseases. While it is understood that the non-specialist doctors can not work as substitutes to doctors in the state, given the urgent necessity of doctors in the state, it is deemed that such a process be developed in true spirit.

·                                 In proper coordination with the Department of Higher education, efforts should be made to provide compulsory foundation courses and ancillary courses in primary health care at the Graduation level for all students. Course materials should be developed by professionals, experts, artists and language specialists in a manner that those are comprehendible even for the students coming from arts and commerce streams.  This, the civil society believes will bring in scientific approach towards health care among the masses in rural areas and shall be helpful in solving many related issues which do not necessarily need intervention of specialist doctors.

·                                 The medical education system in the state should be reformed in a manner that money does not remain as a criterion for admission, even in private medical colleges.  

II. Demands Specific to Women

 

·                                 In order to check the declining sex ratio in the state, strict action is required against sex determination of the fetus. There is also a need to wage a battle at the level of awareness building of the masses for stopping sex determination of the fetus. Civil society demands that a special cell should be formed in the department of health and family welfare with qualified doctors, representatives of teachers and legal experts to initiate a mass campaign against sex-determination.  In the light of the above, the civil society demands for strict  implementation of Pre-Conception and Pre-Natal Diagnostic Techniques Act 1994 (PC & PNDT Act) in all the districts of Orissa, Adequate provisions should be made for capacity building, awareness creation, engagement with civil society and women’s organizations etc. Specific allocations should be made for the enforcement of Pc & PNDT Act.

·                                 Adequate allocations should be made for programmes related to child survival and safe motherhood. There is a need for increasing the number and quality of local dhais/TBAs through a massive training programme in the state. Adequate funding should be provided for the purpose.

·                                 The civil society demands that at least 30 percent of all expenditure under the ministry of health and family welfare be earmarked for women beneficiaries and for improving the health situation of the women. Monitorable indicators of progress should be evolved for the purpose.

·                                 Institutionalizing the women component plan with the health sector without any further delay.  

 

III. Demands Specific to Dalits and Adivasis

 

·                                 As per the norms of Scheduled Caste Sub Plan and Tribal Sub Plan, at least 39 percent of the total allocations for the public health sector should be earmarked for the targeted benefits of the SC and ST sections in Orissa.

·                                 Sufficient care should be taken to ensure that students from marginalized sections such as SCs and STs get an opportunity to get enrolled for medical education.

 

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