COVID-19 had multi-dimensional impacts on the urban poor. Beside job losses and the lockdown effect on the informal sector, people experienced significant financial and mental distress while dealing with the healthcare sector. Two trends seen in urban areas during the COVID epidemic were-
The project aims to rejuvenate the public healthcare system in selected districts, and streamline and restore provision of essential health services in the post-pandemic period, through capacity building of local committee members and a cadre of health communicators. The intervention focuses on three tribal/rural areas (Pune and Nandurbar) and one urban area (Pune city), and covers socially excluded, marginalised and underserved communities in the intervention areas.
Rural health intervention (component A)
Urban health intervention (component B)
Technical support to victims of COVID related overcharging (component C)
Background
This project aims to Strengthen agency group’s understanding on delivery of RCH services aimed at increased access to maternal health services and schemes. Strengthen key maternal and child health entitlements and services and track post-COVID shifts in public health services to support community-based action. The grassroots level intervention will lead to mobilised communities and beneficiary women for maternal and child health services and related schemes. Grassroots experiences and findings regarding RCH services will be shared with frontline workers and local elected representatives, to strengthen maternal health services. Further, mobilised communities successfully relay ground level feedback regarding health and nutrition services to enable a system level dialogue with decision makers regarding monitory schemes. This set of interventions will constitute a vertical integration approach to health system reform, focused on maternal and child health services amongst tribal community in Maharashtra.
Project area-Amravati, Nandurbar, Thane, Yawatmal
Key activities-
Background
The COVID-19 pandemic has acted as a powerful ‘MRI scanner’ helping us to scrutinise India’s health system, starkly revealing the architectural weaknesses of the under-resourced, atrophied public health system, along with exposing the predatory nature of unregulated, commercialised, hypertrophied private health care. During this period poorly staffed public hospitals proved insufficient compared to the population’s health requirements resulting in inadequate facilities for COVID-19 patients, while many corporate and large private hospitals engaged in massive overcharging and profiteering.
Within India, Maharashtra state has suffered from not only the largest number of COVID cases and deaths compared to any other state, but strikingly also had one of the highest case fatality rates (among COVID cases, the proportion who died) compared to major states in the country.
The cross-state differences in COVID outcomes among major Indian states seem to be primarily related to differences in effectiveness of public health systems; Maharashtra with one of the highest COVID case fatality rates among Indian states has a highly privatised health system, with inadequate public health services. Compared to this, Kerala has much lower COVID case fatality rate, associated with a robust public primary healthcare system.
With such catastrophic impact of the pandemic, the stage has been set for healthcare and health systems to emerge as an agenda for urgent policy attention. In this setting, on one hand regressive solutions are being promoted by the establishment focussing on further privatisation, corporatisation, private sector oriented transnational investments, and securitisation of healthcare. On the other hand, there is high degree of social receptivity for progressive proposals centred on major strengthening of public health services, regulation of private healthcare providers, and fulfilment of health rights through a democratised healthcare system, based on public-centred universal health care. There is no doubt that the COVID-19 pandemic can become a critical turning point for the health system in India, and especially in states like Maharashtra. This is an opportune time to reimagine health systems and powerfully build socio-political will from below for comprehensive, people centred, rights-based health system change.
Given this context, SATHI proposes to conduct activities on two complementary fronts during the COVID recovery situation, which can help shape the policy discourse in the health sector in a pro-people direction. The first component would focus on studying and deconstructing official transnational development investments in the health sector, with focus on German development agencies, to understand the impacts which these influential investments have on health systems and access to healthcare for deprived and marginalised populations in India. The second component would be focussed on the state of Maharashtra (the second largest state in India, which has suffered the worst during the COVID pandemic), towards shaping policy discourse to promote major strengthening of public health systems and operationalisation of Right to Healthcare.
Key Inputs
Expected outcomes
Background
People in India experience a fragmented and commercialised health care system which is dominated by for-profit private healthcare, responsible for around 70% of healthcare utilisation. With a mere 1.15 % of the GDP being invested in health, India has among the world’s highest levels of out of pocket expenditure on healthcare, leading to around 5.5 million people falling into poverty annually due to catastrophic healthcare expenses. A weak public health system, coupled with lack of accountability and regulation of private healthcare, results in frequent unethical, medically inappropriate practices, substandard and unaffordable healthcare, and exploitation of vulnerable people seeking treatment.
Maharashtra has been one of the worst affected states in the COVID-19 epidemic, with people experiencing major hardship in seeking healthcare from overwhelmed public hospitals and exploitation and overcharging in private hospitals despite the governments efforts to provide free and affordable healthcare to its citizens through extending coverage of central and state public insurance schemes to all citizens, capping of costs of treatment in private hospitals. However, reports of denial of treatment to vulnerable communities, discrimination, inflated billing, abuse of patient’s rights continue to be highlighted in media reports and documented by civic society.
The COVID 19 epidemic has underscored the urgent need for a strong and well-equipped public health system along with expansion and strengthening of urban health services, especially primary healthcare. Given the high degree of dependence on private healthcare, there is a need to ensure patients’ rights and regulation of the huge, unregulated private healthcare sector. This includes the need for social accountability of publicly funded health insurance schemes like PMJAY / MPJAY which are supposed to provide hospitalisation coverage to the entire population of Maharashtra by involving private hospitals.
Objectives
Background
Two unmissable trends in the Maharashtra vaccination coverage are- vaccination coverage is unequal and highly skewed towards urban areas; secondly, vaccination in less developed rural and tribal areas is particularly lagging. Among a range of issues causing poor coverage, one that needs to be addressed with urgency is the overall coordination of the vaccination initiative at the PHC level.
Objective-100% coverage of vaccination in selected PHC’s population.
Background
The National Rural Health Mission (NRHM) was launched for the period 2005 to 2012 with the goal of improving the availability of and access to quality health care for people, especially for those residing in rural areas, the poor, women, and children. Community Based Monitoring and Planning was introduced as important component in order to ensure that the services reach those for whom they are meant. It was an outcome of consistent effort taken by Jan Swasthya Abhiyan. Community Based Monitoring is also seen as an important aspect of promoting accountability & community led action in the field of health. The monitoring process also includes outreach services, public health facilities and the referral system. It is assumed that, the most important input on what, where and how health services are needed and should be provided or improved, can be given most efficiently by the users/ beneficiaries of the services themselves. Community based monitoring places people at the centre of the process. Community Based organisations (CBOs), people’s movements, non-government organisations and Panchayat representatives monitor demand/need, coverage, access, quality, effectiveness, behaviour and presence of health care personnel at service points, possible denial of care and negligence as well as directly give feedback about the functioning of public health services, including giving inputs for improvement. This has enabled people’s participation in monitoring health resources and direct dialogue with health officials. The platform ensures accountable as well as transparent practices.
Objectives of Community Action for Health
Scope and structure of Community Action for Health
Community Based Monitoring and Planning process has been implemented as a pilot in selected nine states of India of which Maharashtra is one state. Five districts are selected from Maharashtra in first phase. In the second phase of CBMP, this activity has been expanded to Eight districts. Now, it has successfully implemented in Thirteen districts namely Aurangabad, Beed, Nandurbar, Osmanabad, Pune, Palghar, Gadchiroli, Nashik, Kolhapur, Solapur, Sangli, Thane & Yawatmal. The representatives of Health Officials, Panchayat Raj, Community Based Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
Key Activities
SATHI as State Nodal NGO
SATHI- Action Center ofANUSANDHAN TRUST has taken the responsibility to work as a state nodal NGO for this project, providing training material like guidebook, posters, tools for data collection and state level coordination with Government of Maharashtra as well as 13 districts and 28 Blocks nodal NGOs for implementation of Community based monitoring and planning activities.
Background
The second wave of COVID has its onslaught with very virulent spread. For example, In Pune the daily count of the cases coming COVID positive were around 2200 in the first wave. In the second wave as on 3rd April 21 the daily count of COVID positive patients was 5720. The count is rising. THE SITUATION is not as encouraging as in Mumbai, but continuous decline in active cases for the last one week has raised hopes that the worst in the second wave might be over in Pune as well. Unlike Mumbai, Pune is still reporting more than 10,000 cases a daily, this number dropped below 6,200, the lowest this month. But during the past one-week, active cases in Pune have come down by more than 25,000. It peaked on April 19 when the city reported 1.25 lakh Covid-positive people. On Monday, this figure was just about one lakh, though still the second highest in the country after Bengaluru.
At the same time, rural areas in Maharashtra facing unique challenges as they are particularly vulnerable, with poor access to healthcare facilities. With all state efforts focused on epidemic containment, disruptions are being reported in provision of essential non-COVID related health services in rural areas, along with difficulties in accessing relief measures. The vulnerable rural population needs support to access even basic healthcare. The COVID and non-COVID patients in these areas would need support and facilitation to access healthcare facilities.
In urban India, in Big cities like Pune the public healthcare system is virtually at the same scale as was thirty years back. And at primary healthcare level there is big gap and neglect. Not surprising that in this situation, the poor and working class living in slums and low-cost housing, that comprises nearly 50% of the urban population is suffering to get access to quality healthcare that is affordable or free COVID has exposed this harsh skeleton of nearly non-existent public healthcare in cities like Pune. COVID also has compelled the government to push its many schemes for poor and vulnerable and also out of compulsion the Maharashtra State Government has made the scheme like Mahatma Phule Jan Arogya Yojana – a scheme for nearly 900 secondary and tertiary procedures available to whoever asks for it, expanding the scheme to cover the entire population, beyond the normal eligibility criteria for poor people with Keshari Ration Cards only (BPL and above BPL).
Objectives
BackgroundAccountability Research Centre and Anusandhan Trust- SATHI (Support for Advocacy and Training to Health Initiatives) are collaborating on a project with research and action components, for developing an advanced model of community accountability of health and health related services and programs in Maharashtra, India.
This project builds upon both the foundation of Community Based Monitoring and Planning (CBMP) in Maharashtra, facilitated by SATHI with support from the National Health Mission over the last decade, and ARC’s substantial research and training expertise in the sphere of social accountability and participatory governance.
Objectives
Building robust evidence base regarding the impacts of community-based monitoring and planning (CBMP) efforts in Maharashtra’s public health system, through action linked research including both quantitative and qualitative components.
Background-
SATHI proposes to address the challenge of pervasive malnutrition in Maharashtra, specifically targeting the tribal communities. While the preceding sections have clearly established that fully addressing malnutrition requires a comprehensive multi-sectoral approach, SATHI is proposing to contribute to reducing malnutrition among pregnant and lactating women and children up to six years of age in tribal communities by focusing on the core interventions of direct nutrition services and immediately related health care services.
SATHI will focus its efforts on two components of AAY, namely the nutritional services and the public health care services necessary to complement towards improving the nutritional status of women and children. To work on both aspects simultaneously will be too much for the short period for which initial funding support is being requested. So, SATHI is finally proposing that the full project concept is implemented in two distinct yet related phases.
The Objectives of this project will be in two phases-
Phase 1 Improving the delivery of direct nutrition services
Phase 2 Ensuring Core Public Health Services needed to Complement Nutrition Services
Background-
In the last phase of project intervention an attempt was made to build capacities of activists from around 10 Civil Society Organisations (CSOs) towards ensuring community action for Health in Maharashtra. All these were involved in generalised Community Based Monitoring and Planning (CBMP) process on voluntary basis since last 3-4 years. Based on technical inputs from SATHI, various community processes were implemented in totally new selected districts and blocks of Maharashtra. In each block, these organisations have facilitated generalised CBMP process such as health rights awareness activities, community-based data collection, documentation of cases of denial of health care and preparation for Jan samwads (Public dialogue programs). All these processes have contributed to initial improvements in health services.
The objectives of this programme will be as follows –
In the last phase of collaboration during the period October 2017 to March 2018, SATHI has significantly contributed for strengthening the ‘Healthy Start’ campaign in the form of building the capacities through national level convention and visiting the field of WaterAid network partners from Odisha, Telangana, Madhya Pradesh and Uttar Pradesh; provided ongoing technical and strategic inputs to WaterAid partners; contributed in developing various documents such as concept note and operational framework of intervention, awareness material etc. It is clearly evolved that there is need for continuation of this collaboration in order to consolidate the efforts are being taken for capacity building of WaterAid network partners; deepening and expanding interventions with regards to improve WASH facilities in Health institutions.
Expected outputs-
Objective
Scope and structure of Community Based Monitoring
Community Based Monitoring process has been implemented as a pilot in selected nine states of India of which Maharashtra is one state. Thirteen districts are selected from Maharashtra – first phase districts namely Amaravati, Nandurbar, Osmanabad, Pune and Thane. In the second phase of CBMP, this activity has been expanded to Aurangabad, Beed, Chandrapur, Gadchiroli, Nashik, Kolhapur, Raigad and Solapur districts. The representatives of Health Officials, Panchayat Raj, Community Based Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
SATHI continues to work as State Nodal NGO
providing training material like guidebook, posters, Aarogya Hakka Calendar, tools for data collection and state level coordination with Government of Maharashtra as well as 13 districts and 29 Block nodal NGOs for implementation of Community based monitoring and planning activities.
Objectives-
Background
The National Rural Health Mission (NRHM) was launched for the period 2005 to 2012 with the goal of improving the availability of and access to quality health care for people, especially for those residing in rural areas, the poor, women, and children. Community Based Monitoring and Planning was introduced as important component in order to ensure that the services reach those for whom they are meant. It was an outcome of consistent effort taken by Jan Swasthya Abhiyan. Community Based Monitoring is also seen as an important aspect of promoting accountability & community led action in the field of health. The monitoring process also includes outreach services, public health facilities and the referral system. It is assumed that, the most important input on what, where and how health services are needed and should be provided or improved, can be given most efficiently by the users/ beneficiaries of the services themselves. Community based monitoring places people at the centre of the process.
Objectives of Community Based Monitoring
Scope and structure of Community Based Monitoring
Community Based Monitoring process has been implemented as a pilot in selected nine states of India of which Maharashtra is one state. Thirteen districts are selected from Maharashtra – first phase districts namely Amaravati, Nandurbar, Osmanabad, Pune and Thane. In the second phase of CBMP, this activity has been expanded to Aurangabad, Beed, Chandrapur, Gadchiroli, Nashik, Kolhapur, Raigad and Solapur districts. The representatives of Health Officials, Panchayat Raj, Community Based Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
SATHI continues to work as State Nodal NGO
Providing training material like guidebook, posters, Aarogya Hakka Calendar, tools for data collection and state level coordination with Government of Maharashtra as well as 13 districts and 29 Block nodal NGOs for implementation of Community based monitoring and planning activities.