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Past Projects

Promoting participatory action on local Health budgets and medicine distribution in Maharashtra

Project Duration - 1st June 2014 - 31st July 2016 

Goal
Responsive district health planning and effective medicine distribution in Maharashtra to ensure significantly improved primary health care service delivery with a broader framework of community accountability.

Objectives
  • Central role played by RKS members and CBMP committees in local need based health planning and budgeting, leading to more effective and appropriate functioning of health services. Strengthened spaces for participatory planning and accountability related to health services.
  • Active involvement of CBMP committees in monitoring expenditures of Program Implementation Plan (PIP) budgets, ensuring effective utilization of these funds and improved service delivery.
  • Demand driven and adequate medicine distribution in rural public health facilities based on key changes in medicine distribution system.
  • Effective state level collaboration and advocacy with the help of the CBMP network for ensuring greater responsiveness of district health planning and medicine distribution processes.

To achieve these objectives, SATHI would collaborate with five partner organisations to conduct project activities in an intensive manner. Further, capacity building related to various activities would be carried out with 24 CBMP implementing organizations in 13 districts. The project would consist of a three pronged strategy to achieve these objectives – action oriented research and evidence building, capacity building of key stakeholders, and advocacy at various levels.

To move towards attaining the stated objectives, we propose to carry out the following activities in this project -
  • Activity 1 - Study of pattern of utilization of RKS (Patient welfare committee) funds in 6 selected PHCs and 3 Rural Hospitals from 3 districts of Maharashtra, linked with participatory interventions in planning of RKS funds by CBMP and RKS committee members, leading to more appropriate use of flexible funds.
  • Activity 2 - Capacity building of  24 civil society organisations from 13 districts on PIP related issues, for ensuring budget accountability and monitoring of district and block health plans
  • Activity 3 - Tracking implementation of community oriented and innovative components of PIPs as well as local level advocacy for its effective implementation in 2 Districts.
  • Activity 4 - Action oriented analysis of medicine distribution system linked with advocacy for more responsive supply system in 3 selected districts of Maharashtra
  • Activity 5 - State level networking and advocacy to influence the public health system, towards more participatory local health planning and effective medicine distribution systems

Nutrition Rights Project

Project : Promoting a comprehensive and rights based approach to address malnutrition in Maharashtra
Duration : November 2012 to Sept 2015
Funded by : Narotam Sekhsaria Foundation

Background
It is an accepted fact that nutrition is one of the most important determinants of health and well being of any population. This fact is especially relevant in the Indian context, not only in less developed states, but also in ‘developed’ states characterized by major inequities like Maharashtra where it has become clear that Maharashtra’s human development is not corresponding with its economic growth.

A broad and comprehensive approach to malnutrition is needed for identifying not only immediate but also intermediate, underlying and fundamental causes, and hence the need for major changes at multiple levels including large scale socioeconomic changes.

It is also imperative that whatever nutritional services Government is offering to tackle malnourishment should be accountable to the community if at all they should be effective.

General Objectives
To create an enabling environment for the reduction of malnutrition in Maharashtra through making nutrition services accountable and responsive, through generation of appropriate knowledge, reshaping relevant policies and programs, and promotion of the Community monitoring approach for improving health and nutrition services.

Specific Objectives
1. To promote community action towards making nutrition related programs [ICDS] accountable, responsive and effective in the intervention areas
2. To influence state level nutrition related policies and programs towards making these community oriented and responsive to accountability processes
3. To facilitate action research and innovations regarding approaches to improve nutrition at community level and to develop a contextualized understanding of the dynamics of food security and nutrition
4. To strengthen the discourse on Community Based Monitoring (CBM) of social services as a key mechanism to ensure social accountability of Public services, particularly Health care and nutrition

Key Activities

A. Accountability:

  1. Implementation of community based monitoring and action processes concerning nutrition related programs (ICDS and Jijau mission ) in selected areas in the first year of the project
  2. Capacity building of the activists of Partner organizations regarding CBMP of ICDS
  3. State level TOT workshop with activists for dissemination of guidebooks and training of the tools for assessment of Anganwadi
  4. Block provider's workshop in every intervention block to enhance the knowledge level and to build capacity of the local stakeholders like AWWs, ASHA, PRI members.
  5. Community mobilization and awareness in the form of street plays, AV, Posters, flip charts as well as meetings with members of various committees and local activists – with focus on women.
  6. Formation of the expanded body of village consisting of VHSNC plus School management committee (plus JFM / CFR where applicable) members as permanent invitees, who would be involved in monitoring Anganwadis.

B. Critical knowledge generation and Research:

  1. In the first phase Situational analysis of nutritional status of under-6 children will be done in the intervening areas.
  2. In the next phases some small research studies will be undertaken on emerging issues like Take Home Ration.

C. Advocacy

  1. State level workshop for advocacy with WCD and health departments to create a space for CBMP in ICDS.
  2. State level convention in collaboration with Right to food campaign will be undertaken.

D. Promoting CBMP as an approach to health and social services

  1. District / state level events for building social-political support for CBMP as an approach to make health and social services accountable and effective.

Regulation and accountability of the private medical sector

Project : Promoting Private sector regulation and accountability through regional and multi-state processes.
Duration : April 2014 to March 2015
Funded by : OXFAM India

Objective - Promoting awareness and advocacy on 'participatory, multi-stakeholder regulation of private healthcare sector in India' at both regional and state levels. This would be furthered by the following areas of activity:

  1. Capacity building of civil society activists towards demanding social accountability of private healthcare sector by conducting regional workshops on 'Social Accountability of Private Medical Sector and Clinical Establishment Act' in Northern, Eastern, Western and Southern regions of India in the first half of year 2013-2014, one workshop in each region. It is expected that civil society organisations from 2 to 3 states in each region would participate in each of these workshops. Each workshop would be for 2 days, with the objectives of –
    A. Orienting civil society activists towards conceptual understanding of private medical sector in India and issues related to it like commercialisation, patients rights violations etc.; need for social accountability of private medical sector; and practical steps towards building such accountability mechanisms in the context of Clinical Establishment Act etc.
    B. Imparting activists with an approach to document cases of patient's exploitation and violation of their rights in private medical sector in such a way that issues emerging from these cases can be highlighted in future as basis for advocacy for regulation Providing guidance and helping pro-active civil society organisations in strategising advocacy on social accountability of private healthcare sector.
  2. Developing quality information material on contemporary issues related with the regulation of private medical sector for civil society activists: A policy brief / advocacy document would be prepared on 'Regulation of private medical sector and Clinical Establishment Act'.
  3. Multi-stakeholder advocacy meetings would be conducted at different levels in the pilot state of Maharashtra, where a civil society coalition is quite active on this issue, which in itself is a pioneering example in the country. Experiences gained through activities in Maharashtra will feed into civil society processes at national level, to actively promote patients’ rights with focus on multi-stakeholder participatory regulation of private medical sector in the context of Clinical Establishment Act. Multiple stakeholders to be involved include representatives of doctors associations and hospitals associations, socially prominent individuals and political representatives, and a wide spectrum of civil society organisations.
  4. Bringing private healthcare related issues under public scrutiny by documenting and publicizing major problematic experiences of patients and testimonies of doctors.

 

Promoting participatory action on local Health budgets and medicine distribution in Maharashtra

Project Duration - upto 31st March, 2017


Funded by - International Budget Partnership
Goal - Responsive district health planning and effective medicine distribution in Maharashtra to ensure significantly improved primary health care service delivery with a broader framework of community accountability.

Objective

  1. Central role played by RKS members and CBMP committees in local need based health planning and budgeting, leading to more effective and appropriate functioning of health services. Strengthened spaces for participatory planning and accountability related to health services.
  2. Active involvement of CBMP committees in monitoring expenditures of Program Implementation Plan (PIP) budgets, ensuring effective utilization of these funds and improved service delivery.
  3. Demand driven and adequate medicine distribution in rural public health facilities based on key changes in medicine distribution system.
  4. Effective state level collaboration and advocacy with the help of the CBMP network for ensuring greater responsiveness of district health planning and medicine distribution processes.

 

To achieve these objectives, SATHI would collaborate with five partner organisations to conduct project activities in an intensive manner. Further, capacity building related to various activities would be carried out with 24 CBMP implementing organizations in 13 districts. The project would consist of a three pronged strategy to achieve these objectives – action oriented research and evidence building, capacity building of key stakeholders, and advocacy at various levels. To move towards attaining the stated objectives, we propose to carry out the following activities in this project:

  1. Activity 1 -Study of pattern of utilization of RKS (Patient welfare committee) funds in 6 selected PHCs and 3 Rural Hospitals from 3 districts of Maharashtra, linked with participatory interventions in planning of RKS funds by CBMP and RKS committee members, leading to more appropriate use of flexible funds.
  2. Activity 2 Capacity building of  24 civil society organisations from 13 districts on PIP related issues, for ensuring budget accountability and monitoring of district and block health plans.
  3. Activity 3 -Tracking implementation of community oriented and innovative components of PIPs as well as local level advocacy for its effective implementation in 2 Districts.
  4. Activity 4 - Action oriented analysis of medicine distribution system linked with advocacy for more responsive supply system in 3 selected districts of Maharashtra.
  5. Activity 5  -State level networking and advocacy to influence the public health system, towards more participatory local health planning and effective medicine distribution systems.

A consultancy project on Strengthening accountability of Health and Nutrition services (November 2012 to March 2013)

Key activities facilitated by SATHI under the consultancy project -"Capacity building of ‘Save the Children’ partner organisations for Strengthening accountability of Health & Nutrition services" 

  • State level workshops for representatives of civil society organizations - 3 days workshop would be organized in each intervention state. The Head of organization, project coordinator and field workers (karyakartas), who are actually going to implement the processes will be the participants for this workshop. The content of this workshop would be conceptual understanding of Health Rights, Health Advocacy, sharing of experiences and processes/methods which can be used for ensuring accountability and based on discussions and inputs in the workshop, the plan of action will be prepared by participants.  
  • Mentoring of activities conducted by civil society organization in intervention areas - Mentoring of activities with the help of local resource teams/organizations within each state would be conducted. Mentoring will include regular follow up and communication with partner organization, one or two field visits as per requirement, strategic or problem solving interventions if required. 
  • Exposure visits for civil society organizations - In order to understand and learn from experiences of other civil society organizations who are working on accountability, exposure visits would be organized in Maharashtra. The representatives from civil society organizations will participate in these exposure visits. These visits would be organized after state level workshops. 
  • Review and assessment of activities and planning for next year- At the end state wise review and assessment of activities would be conducted. In these reviews, overall experience of civil society organizations will be shared as well as review of technical support and mentoring would be conducted. Based on these experiences and learning, next phase plan for each state would be discussed.

Writing research paper on Community-based Monitoring Process in Maharashtra

The objective of the research is to critically analyze community-based monitoring and planning (CBMP) related to health services in Maharashtra as a way to foster ‘publicness’, to evaluate the potential for scaling up such initiatives in India, as well as for transferability on a global scale. The study is based on secondary research to be carried out in Maharashtra state of India. It will focus on CBMP in relation with accountability, improving access to public health services, enhancing responsiveness of services and reducing out-of-pocket expenditures of people accessing public health services. 

First, it will provide international context and theory about Community monitoring of public health services, locating CBMP in Maharashtra in this context. Second, it will identify key successes and problems related to CBMP in public health services in Maharashtra, drawing upon external evaluations and SATHI experiences. Finally, it will draw out key lessons from the Maharashtra CBMP experience which might be relevant for similar accountability work in other settings, including health sector in other countries and other social services.

A consultancy project - National consultation on regulation of private medical sector and patients rights (completed)

Background

India has one of the largest private medical sectors in the world – yet this gigantic entity has remained almost completely unaccountable and unregulated until now. Serious problems in this sector include frequent financial exploitation of patients, often accompanied by sub-standard and irrational care in private hospitals and nursing homes. Costs of private medical services have spiraled, having more than doubled in absolute terms between the mid-1980s and the mid-1990s. It is estimated that Health care expenditures account for more than half of all Indian households falling into poverty, with nearly 4 crore Indian people being pushed into poverty every year due to such costs. While ordinary patients are suffering tremendously due to this situation, it should be kept in mind that due to growing corporatisation and commercialization of the entire health care sector, it is also becoming extremely difficult for the dwindling numbers of rationally practicing doctors and genuinely non-profit health facilities to practice ethically.

How can we start changing this situation? Located within the broader context of need for strengthening public health services and rolling back privatisation, comprehensive social regulation of the private medical sector is an outstanding need today. In this context, with support from Oxfam-India, SATHI has organized a series of regional workshops on regulation of the private medical sector in Southern, Eastern, Northern and Western regions of India during August to November 2013. During these workshops, experiences of patients regarding private hospitals have been shared and overall justification for regulation has been discussed, existing Clinical establishments acts have been analysed, core desirable features of a pro-patient regulatory framework have been proposed, and some state level action plans have been developed. At the same time, a range of suggestions and inputs regarding both possible campaign strategies and issues to be addressed in the regulatory process have been shared.

Further we need to keep in mind the context of the national Clinical establishment act (CEA) which has been adopted in 2010, followed by related rules in 2012. The central government is now pushing state governments to adopt this act in existing form. Although the central CEA has some positive steps like mandatory minimum standards, standard treatment guidelines, regulation of charges and consumer representatives in national and state councils, it has several major lacunae like no provision for ‘patient’s rights’ in the entire act, no provision for grievance redressal mechanism for patients, and no scope for complaints by citizens regarding implementation of the act. Since this central act is being used as a kind of ‘framework legislation’ by various states, and some states are adopting it in existing form, it is essential to develop a national consensus among civil society organisations regarding this framework and to develop an effective national advocacy strategy regarding this framework.

Keeping this context in mind, SATHI facilitated in organising a ‘National consultation on regulation of private medical sector and patients rights’ in collaboration with the Jan Swasthya Abhiyan network. 

Objectives

A.To discuss coordinated strategies for effective documentation of violations of patients rights and testimonies of selected doctors who are critical of commercialisation, in context of the private medical sector in India. 

B.To concretize national position and demands regarding the central Clinical establishments act (CEA) 2010 and related rules, and also broad approach to regulatory framework and acts in states. 

C.To develop a civil society strategy at national level and suggested approaches at state level to raise demands and deal with the evolving regulation of private medical sector.

D.To provide space for articulation of concerns of genuinely not-for-profit hospitals and rational practitioners working with lower resources in vulnerable areas, regarding standards and regulations related to CEA.. 

Expected outcomes

  • Development of coordinated strategy for documentation of violations and irrationality in the private medical sector – this could be the major input for a publication including testimonies by patients and doctors from various parts of the country, combined with policy recommendations for patient oriented regulation of the private medical sector.
  • Initiation of a national ‘Private medical sector and PPP watch’ which could be linked with an interactive website.
  • Concretisation of position and demands of health movement, regarding central Clinical establishments act (CEA) 2010, and about various state acts.
  • Further development of health movement strategy regarding Clinical establishments act and rules linked with further strategy to demand modifications in the national regulatory framework, including changes in rules and formulation of standards. 
  • Articulation of concerns of rational practitioners and genuinely not-for-profit hospitals regarding the emerging regulatory framework.

Promoting synergy between Quality Assurance (QA) and Community based Monitoring and Planning (CBMP) processes in selected areas of Maharashtra


Duration - November and December 2013

Funded by - State Family Welfare Bureau, Pune , Government of Maharashtra (State)

The Government of India launched the National Rural Health Mission in 2005 with the objective of effectively providing health care to the rural population, especially women and children and various underprivileged sections, by improving access, availability and quality of public health services. In order to achieve this objective NRHM has planned different strategies, in which establishing regular and systematic monitoring and evaluation systems for improving and ensuring the quality of public health services are core strategies of NRHM.

As one strategy in this context, Maharashtra Government has implemented a Quality Assurance (QA) programme under NRHM, with technical support from the Maharashtra State UNFPA office. QA programme activities were implemented in 18 districts of Maharashtra. The focus of the QA programme is to develop an internal system of assessment and feedback for enhancing the quality of health services, especially Reproductive and Child Health (RCH) services. QA programme is an internal feedback system, which provides an institutional platform to public health staff for understanding and resolving problems related to the functioning of public health facilities. The approach of the QA programme is to motivate public health functionaries for resolving problems within the system framework, so that they can provide good quality health services to the patients.

At the same time, the Community Based Monitoring and Planning (CBMP) process in Maharashtra provides an independent, external feedback system anchored in the community regarding availability, accessibility and quality of public health services. The main focus of the CBMP process is ensuring accountability of the public health system through community participation. This process is being implemented in 13 districts of Maharashtra. The approach of the CBMP process is to activate and motivate the community to raise demand for health services along with providing suggestions for improvement, as part of a bottom up approach.

First Phase Project : A Study of budgetary provisions, procurement and supply system concerning essential medicines in selected districts of Maharashtra

Duration - August 2009 - March 2012

Funded by - International Budgetary Partnership

Availability of essential medicines in public health facilities is one of the serious concerns regarding the quality of health care services, and also one of the major reasons for lower utilization of the public health system. Some amount of evidence is already available to substantiate this fact including preliminary findings of the household survey conducted by SATHI.

Project objectives

To improve the availability of essential medicines in primary health centers

Short term objectives
  • To understand the procurement and distribution process in the state of Maharashtra
  • To develop tools for monitoring the procurement and distribution system

Key research areas in this project are

  • To study budgetary allocations- The budgetary allocations for essential medicines in the districts/ PHCs under study.
  • Study of procurement of essential medicines in the state of Maharashtra-The procurement and distribution system of selected essential medicines in the state of Maharashtra with a view of understanding key gaps, bottlenecks and reasons for delay.
  • Study of availability of essential medicines in the selected districts -Actual availability of various essential medicines at select PHCs


Project - Arogya Hakka Sahayog Prakalp (SATHI Phase IV Project)

Duration - April 2005 - March 2011

Funded by - Oxfam

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 IV 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.


Aims and Objectives

The overall aim of the project would be to consolidate health rights activities and community based health capacities in areas covered by SATHI in Maharashtra and West Madhya Pradesh.

Specific objectives would be as follows -

  • Consolidation of health rights activities being done by partner organisations by continued development of grassroots work and alliance building at district level.
  • Generalised implementation of Community Monitoring in further districts of Maharashtra with value addition by SATHI team members; orientation of certain large networks regarding community based monitoring.
  • Strengthened Health system and community support for selected NGO trained ASHAs and linkage between these ASHAs and the Community monitoring process.
  • Orientation of activists in a few areas of Maharashtra regarding Patient’s rights in the private sector and regulation of the private sector.
  • Strengthened pro-people advocacy (in collaborative manner) on specific national health issues.


Expected Outcomes

  • Consolidation of Health rights activities in multiple areas of Maharashtra and Madhya Pradesh.
  • Value addition to generalised implementation of Community Based Monitoring of Health Services in Maharashtra
  • Strengthening Health system and community support for NGO trained ASHAs.
  • Orientation of activists in Maharashtra regarding Patient’s rights.
  • Inputs to National level advocacy.
  • Publications

Project : Developing capacities for using community oriented evidence towards Strengthening District Health Planning in Maharashtra State, India

Duration - April 2010- September 2012

Funded by - WHO

Health sector policy making in India has been highly centralized with little use of community based evidence. In principle, Government is committed to the decentralisation of power and thereby allows people to have greater say in the process of decision making. Since Districts have distinct context and specific needs as far as health care is concerned, District Health Planning is a necessary component of decentralisation. Activities and strategies mentioned in this proposal are to build capacities of key stakeholders who would be involved in the process of decentralized planning by using community based evidence as well evidence from other sources such as Health Management Information System.

One of the essential features of decentralized district health planning is use of community based evidence. This space is now available in the form of the community based monitoring of the health services which is a significant policy initiative under the NRHM.

General aim -
To build the capacity of members of Block and District monitoring and planning committees including health officials towards facilitating their use of evidence for decentralized health planning

Specific objectives -

  • By 2012, train about 30 Health officials and civil society representatives from three districts for using evidence, including community based evidence, for improved health planning.
  • By 2012, develop and implement a generalisable course on ‘Using evidence for Health planning’ which would impart the skills of using evidence for district health planning and policymaking.
  • By 2012, demonstrate a process of decentralized evidence based district health plan preparation, in at least one district of Maharashtra state.

Strategies
Strategies to be employed in three intervention districts in this project are as follows -

  • ‘Structured learning course on Health planning’, for District and block health officials and civil society representatives from the select districts.
  • At District and Block levels, practical capacity building of members of District and Block monitoring and planning committees would be carried out in the three intervention districts.
  • Facilitation of processes for inclusion of community based evidence in the district health plan and activation of the District health monitoring and planning committee.

Project - Maharashtra Health Equity and Rights Watch

Research and advocacy on aspects of access and rationality of health services and Universal access to health care; Health rights and equity fellowship programme.

Project duration (in months) - 36 months April 2011 - March 2014

Funded by IDRC
The activities in this project are in continuation of the research activities conducted in the first phase. This project uses a three pronged strategy to develop work on health equity in the state. The three complementary approaches are -

  • Additional specific research to deepen understanding regarding certain irrational practices by the private health sector (esp. in context of women’s health) as they accentuate the health inequities, this also includes studying the irrational health care expenditures in the private medical sector.
  • Concretising models and shaping public opinion and policy towards a regulated system for Universal Access to Health care, as a key strategy for reduction of health inequities and reduction of irrational health care expenditure.
  • Capacity building of younger health professionals to create a larger pool of professionals working on Health rights issues with an equity perspective

    The activities in the second phase are as follows -
    Key areas of research in this phase are
  • Investigating the phenomenon of hysterectomy in young women.
  • The quality of maternal health services and key related gaps and barriers in context of Maharashtra.
  • Inequities in health care expenditure.
  • Analysis of NFHS 3 data pertaining to Maharashtra focusing on increasing numbers of Caesarean sections reflecting irrationality of delivery care.
  • Policy proposal paper on strategies for achieving Universal Access to Health Care in Maharashtra.
    One of the important activities of the project is a fellowship programme which would help build the capacity of young professionals. The focus of the fellowship programme would be Health rights and equity

Project - Research and advocacy on aspects of access and rationality of health services and Universal access to health care; Health rights and equity fellowship programme


Project duration (in months) - April 2011 – January 2015
Funded by IDRC

The activities in this project are in continuation of the research activities conducted in the first phase. This project uses a three pronged strategy to develop work on health equity in the state. The three complementary approaches are -

  • Additional specific research to deepen understanding regarding certain irrational practices by the private health sector (esp. in context of women’s health) as they accentuate the health inequities, this also includes studying the irrational health care expenditures in the private medical sector.
  • Concretising models and shaping public opinion and policy towards a regulated system for Universal Access to Health care, as a key strategy for reduction of health inequities and reduction of irrational health care expenditure.
  • Capacity building of younger health professionals to create a larger pool of professionals working on Health rights issues with an equity perspective
    The activities in the second phase are as follows -
    Key areas of research in this phase are
  • Investigating the phenomenon of hysterectomy in young women
  • The quality of maternal health services and key related gaps and barriers in context of Maharashtra
  • Inequities in health care expenditure
  • Analysis of NFHS 3 data pertaining to Maharashtra focusing on increasing numbers of Caesarean sections reflecting irrationality of delivery care
  • Policy proposal paper on strategies for achieving Universal Access to Health Care in Maharashtra One of the important activities of the project is a fellowship program which would help build the capacity of young professionals. The focus of the fellowship program would be Health rights and equity

Anusandhan Trust

Anusandhan Trust, a public trust registered under the Bombay Public Trust Act, 1950, (Registration No: E-13480), runs two centres namely: CEHAT based in Mumbai and SATHI in Pune.
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