Beruflich Dokumente
Kultur Dokumente
Reflections from implementing the Community Action for Health process in Tamilnadu
Rakhal Gaitonde
Society for Community Health Awareness Research and Action (SOCHARA)
Plan of Presentation
Reality check.
Alma Ata Comprehensive Primary Health Care - an approach not just a set of services
Health and Human Rights Special Rapporteur's delineation of participation as part of the Right to Health. Democracy moving from representative to deliberative democracy. Warmi, Manandhar, EKJUT, IMAGE, CLICS.
Competing meanings...
Multiple perspectives...
NGO / Civil Society Perspectiv
Rights / accountability
Communities
Health System
Lower level Staff Reaching targets Ensuring people Access Government services Health System / higher levels Control over lover level staff CAH as it is Grievance Redressal Access to resources
KEY
INSTITUTIONS
Integrate
DIST
DIST
Integrate
Taluka
Taluka
Taluka
Integrate
PHC
PHC Planning and monitoring Committees Village Health & Sanitation Committees
PHC
V V V V
PHC
V V
PHC
V V V
The Tool
Good ratings for village level Health services across 220 villages in Maharashtra over 3 phases
70 65 60 55 50 45 40 35 30 Phase 1 Phase 2 Phase 3 48% 61% 66%
1050 1000 950 900 850 800 750 700 650 600 Thane district OPD per PHC per month Thane CBM OPD per PHC per month 07-08 741 08-09 679 09-10 869
767
722
35 30 25 20 15 10 5 0
1028
34% 17%
225 200 175 150 125 100 75 Thane district deliveries per PHC annual Thane CBM deliveries per PHC annual 07-08 116 08-09 175 09-10 172
120
104 172 209
100 80 60 40 48% 20 0
Increase in Thane district PHC deliveries Increase in Thane CBM PHCs deliveries
101%
Changes still is a top down process more based on higher officials diktat - the difference between people's democracy and administrative democracy Collector. What type of changes are happening an extra ambulance being posted is easier than getting the timings of the PHC, ICDS on a board. Very little freedom to respond at lower levels.
Untied funds were still not brought under the control of the committees.
Governance in general.
Irrational
Thank You!