Presentation on theme: "“Towards Social Justice in Health”"— Presentation transcript:
1“Towards Social Justice in Health” Dialogue on Health of the Urban Poor in BangaloreFocusing on Persons with Mental Illness,Disabilities and Senior Citizens18th December 2012SOCHARA – CHC – Madiwala, BangaloreThelma NarayanCentre for Public Health and Equity, SOCHARA,Bangalore
2With a review of health policy (NUHM + 12th Plan) and NGO initiatives, and engagement in practice, with a Comprehensive Primary Health Care approach …we can together make a difference to Equity in Health in Bengaluru!
3Policy Process and the Politics of Health Tracing the development of ideas and institutions that impact on the Health of Communities and on certain sections in particularLocal, National and Global interconnectednessBLIND SPOTSAbsence of Space and of functional programs with dignity and respect for persons with mental illness, disability and senior citizens
4Plan of PresentationAfter an Introduction, the first set of slides trace the history of the idea about health and related rights and participation –Together they highlight the nature of the challenges,The second set of slides are a snapshot of responses by the community, civil society, governments and academics over the past decade indicating critical pathways and partnerships to address health inequalities
5How do we engage with politics and policy? From the 1970s and before there were stated efforts towards:“Promoting sustainable, equitable, participatory development, community health and social justice.”What drives the health and development agenda? LPG, science, technology, capital, management.Do the social majority have a say?Are there inclusive mechanisms?How can we create them?
6Health, Wellbeing & Development in an era of Globalisation Inequalities, vulnerabilities, trends,Underlying determinantsContradictionsPATHWAYS‘Globalisation of Solidarity from Below’ – eg the PHM/ other initiativesAddressing the social determinants of healthResearch for Health, Development and EquityRights, responsibilities,Accountability systemsSystems, convergenceSociety wide participatory , inclusive mechanisms
7Inter-connected Rights and Pathways towards Social Justice and Equity in Health – Waves of Change….. “A Globalisation of solidarity from Below”Social mobilisation and a Peoples Health Movement with constructive, critical engagement between civil society and the State…. since 2000Revitalising Health for ALL and comprehensive primary health careAddressing health determinants – CSDH Knowledge Networks and Report, 2008; Rio Conference 2011The Bamako Inter-Ministerial Conference on “Research for Health, Development and Equity”
8Change in a Generation, WHO – Commission on Social Determinants of Health, 2008 Tracing the development of the ideaDo we believe it is possible?How do we go about it?What is our role – as individuals, organisation’s?Can we join with larger collectives in today’s interconnected world
9Right to Health: Is this new? The World Health Organization (WHO) Constitution“ Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.”“ The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, political belief, economic or social condition”Source: WHO 1946
10The right to health: in-dissociable and inter-dependent right The Universal Declaration of Human Rights (UDHR), UN 1948the basis of all human rights and the primary human rights instrument in force, mentions the right to health in article 25, in connection with other economic, social and cultural rights:“Every one has the right to a standard of living adequate for the health and well being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
11The Right to Health An individual inalienable right The States parties to the International Covenant on Economic, Social and Cultural Rights ( ICESCR), recognize:“the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” Article 12.1For the committee on Economic, Social, and Cultural Rights (CESCR) the main body at the international level monitoring the realization of the right to health,“Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity” CESCR
12Fostering Action…..in Solidarity “ Since human development also means solidarity, the need to work with the family, neighbourhood and village and the practice of community medicine was considered necessary. Health personnel should “listen and learn” and should be “more concerned with fostering action than undertaking it themselves”.Source: CBCI Memorandum, 1971
13WHO and UNICEF Study, 1977 - II Principles to achieve Primary Health Care Communities should be involved in designing, staffing, & functioning of local primary health care centres & in other forms of support.Primary health care workers should be selected by the community itself or at least in consultation with the communityRespect for cultural patterns and felt needs in health and community development …..
14For a mass movement post Alma Ata Health for All –A Prescription by the ICMR and ICSSR, 1981For a mass movement post Alma Ata“Reduce poverty, inequality & spread educationOrganise poor & underprivileged to fight for their basic rightsMove away from the counter productive Western model of health care and replace it by an alternative based in the communityProvide community health volunteers with special skills, readily available, who see health as a social function”
15National Health Policy 1983 Drew some inspiration from the HFA goal and approachLarge scale transfer of knowledge, simple skills and technologies to health volunteers, selected by the communities and enjoying their confidence.The success of the decentralized primary health care system would depend on the organized building up of individual self reliance and effective community participation.The NHP 2002 has a different perspective and approach
16Placebo Policies – Be Aware and Beware! Those with no intention of being implemented.Keeps people happy and hopeful.Masks the situationAllows for capture of policy space by eliteOccurs with a passive population, disempowered.What should be our response?16
17Social relevance and orientation of health efforts Is there need for a paradigm shift? Biomedical, old public health, to a societal approach built on human agency, participation, inclusiveness
18Community Health“ Increases individual, family and community autonomy over health and over the organisation’s, means, opportunities, knowledge and supportive structures that make health possible.”Community Health Cell, 1987
19Tackling the Social Determinants of Health through society wide action “There is an urgent need to address the root cause of inequalities in disease, disability and health.Social conditions in which people live and work or the social determinants of health.”Source: WHO- CSDH,This was followed up by the Rio Declaration in 2011 in which governments, civil society and academic and research organizations pledged to work together to bring about change …? in a generation.
20Poverty, Inequality, Discrimination Health Development Health is a determinant of Development – UNDP 2005Development is a determinant of HealthThe deeper determinants of both need to be addressed as a priority at global, national and local levels
21Healthy Public Policies The National Rural Health Mission, IndiaAnd other policies
22National Rural Health Mission 2005-2012 Evolving through the politics of engagement Goalavailability …access …quality health care, rural poor, women and childrenPrinciplesimprove access to equitable, affordable, accountable, effective primary health care.female health activist in each village; a village health plan prepared through a local team headed by the village health and sanitation committee of the panchayat.panchayati raj institutions to own, control and manage public health service.COMMUNITIZATIONHUMAN RESOURCESGOVERNANCEFLEXIBLE FUNDINGMANAGEMENT
23NRHM OBJECTIVES Reduce child and maternal mortality. Universal access to public health care and public services for food, nutrition, sanitation.Prevention and control of communicable and non communicable diseases.Access to integrated comprehensive primary health care.Stabilize population with gender and demographic balance.Revitalize Local Health Traditions and mainstream AYUSH.Health Promotion.
24Accredited Social Health Patient Welfare Committee COMMUNITISATION COMPONENTSVillage Health andSanitation Committee(VHSC)Citizens Charter forPHC and CHC’sNGO-Civil SocietyinvolvementAccredited Social HealthActivists (ASHA)+ASHA support systemsNRHMCOMMUNITISATIONCOMPONENTSVillage Health PlanRogi Kalyan Samiti(RKS)Patient Welfare CommitteeArogya Raksha SamitiPRI Role
25Community Monitoring & Planning Advisory Group on Community Action for the NRHM (AGCA)Pilot tested in 9 statesExpansion through Project Implementation Plans/ Central fundPosters, pamphlets survey formsMedia fellowships
26Community Planning & Monitoring of Health Services/Community Action for Health Places people at the center of the process of regularly assessing the fulfillment of their health rights and needsIs one of the three proposed accountability frameworks of NRHMSeen as important to promote community led action in HealthSource: Manual on Community based Monitoring of Health Services under NRHM, AGCA.
27Community Action A three way partnership Health SystemPanchayat Raj Institutions (PRI)Community, Community Based Organisations (CBOs) and NGOsSource: Manual on Community based Monitoring of Health Services under NRHM, AGCA.
28Other Relevant Policies Right to EducationRight to InformationMGNREGADraft National Health Bill, 2009Draft Mental Health Bill, 2010Persons with Disability Act (Amended)Mental Health Policy and revised DMHP…
29Pathways of Change Recognising the crises in India in the 1990’s Retreat of the StateLack of inter-sectoral action for healthInadequate mechanisms for community participation in decision making …..etc
30With people back into the centre of primary health care Meeting Challenges in the New Millennium: with a Person Centric Approach together with a societal and policy perspectiveWith people back into the centre of primary health careThe public back into public health and health systemsand community voice and power back into health policy discourse & decisions,As subjects & co-creators not objects
31Towards the first PHA, 2000 AD. An alternative to the WHA THE G 8 OF THE PHAAsian Community Health Action Network (ACHAN)Consumer International (CI)Dag Hammarskjold Foundation (DHF)Gonoshasthaya Kendra (GK)Health Action International (HAI)International People’s Health Council (IPHC)Third World Network (TWN)Women’s Global Network for Reproductive Rights (WGNRR)
32The People’s Health Resource Books, India, 2000 “These books are the best expressions of primary health care concepts and its politics that I have ever read. They are the bible of primary health care, a glorious milestone on the tortuous road to primary health care….”Halfdan Mahler, 2000,DG Emeritus, WHO.
33Globalization of Solidarity for Health From Below Jan Swasthya Sabha, Kolkata 2000 Over 2000 participants in 5 peoples health trainsMobilization across 19statesAdopted 20 point IndianPeople’s CharterLaunched the JanSwasthya Abhiyan,Campaign forHealth for All NowHealth as a FundamentalHuman Right
34The People’s Charter for Health “Health is a social, economic and political issue and above all a fundamental human right.”
35Challenges & Opportunities Realizing health rights & entitlements within a time frame.Achieving equity in health through public policy & actionAddressing inequalities in access to the distal determinants of health
36Right to Health Movement : India 2001 Primary Health Care and Health for All
37Redefining Community Participation by Civil Society in India 2000-2008 Right to health campaignRightEquityGenderRight to InformationPeople’s TribunalsOn Right to HealthRegionalUrbanNationalPeoplesRuralHealthWatchPEOPLE’S HEALTH MOVEMENT-JAN SWASTHYA ABHIYANCommunity Monitoringof National RuralHealth MissionPre-election dialogue withPolitical parties:Health in the ManifestosRight to Food&Right to Water campaignsPeople’s TribunalOn World BankPolicies - India
38Asian Social Forum, January 2003, Hyderabad JSA members organized workshopson:The Right to Health CareEnvironment and HealthTobacco and HealthThe People’s Health Movement
39Asian Social Forum January 2003, Hyderabad - INDIA
40World Social Forum, January 2004, Mumbai Workshops on health rights & determinants by JSA and PHM
41Health Policy Dialogue and Action Adopted by Karnataka StateCabinet in 2004Interim Report in April 2000Final Report in April 2004Accepted by Govt of KarnatakaHigher Level Implementation Committee setup
42MAINSTREAM DEVELOPMENTS IN PUBLIC HEALTH WITH ALTERNATIVE SECTOR PARTNERSHIPS – 1998-2008
43Second National Health Assembly Bhopal- India 2007 People’s Health Rural WatchCommunity based monitoring of NRHMDialogue with other social movementsRevitalising the MovementRight to essential drugsDialogue with health policy makersState unit strengtheningTowards a people’s health planCampaign against coercive population policies
44Community Monitoring and Action for Health Social audits and more regular forms of community driven monitoring of programs are essential, and should be universalized and integrated with community action for all programs.Increasing citizen responsibility and capacity to addressing health determinants eg gender, caste, class, stigma and discrimination .
45Together …we can make a difference to Health in Bengaluru!
46BE PART OF THE CHANGE PROCESS! THANK YOU Health for All, Now !BE PART OF THE CHANGE PROCESS! THANK YOU