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Govt-civil society partnerships hailed for welfare schemes

Nov 11, 2014

India’s well known social activist Aruna Roy underlined the importance of public engagement for various schemes.

New Delhi: The health sector received a great compliment from the former Comptroller and Auditor General of India, Vinod Rai during a National Consultation on Community Action for Health.

He said the health workers had scripted a great success story over the last eight to nine years; they had transformed the sector. He commended the partnership between the government and civil society, which is without any profit motive, and is helping the government deliver.

The National Consultation on Community Action for Health, organised by the Ministry of Health and Family Welfare and Population Foundation of India as the Secretariat for the Advisory Group on Community Action (AGCA), which comprises civil society and public health experts.

Elaborating on his statement, he said the government can at best come up with a programme, but civil society organisations can modify and adapt it to the region as they know the people well and also act as vigilantes. Rai called upon the participants to take forward the success story, keeping in mind that they were in a glass house and the public would hold them accountable.

India’s well known social activist Aruna Roy while giving her keynote address at the consultation had stated that though the public health had come a long way over the decades, there is still a lot to be done. There was the need to work on ethics and accountability.

She underlined the importance of public engagement, with people feeling a sense of ownership about the system. Health governance is not just the business of the government, but it is people’s business. We have to understand it is our system that has to deliver for us. A rights-based legislation, therefore, is critical for better delivery.

She illustrated this by saying that when she had asked a group of young Dalit men what kind of a health system they wanted to see, they had listed out five critical components --  information, accountability, participation, redressal of grievances,  and security.

The two inspiring speakers -- Vinod Rai and Aruna Roy, leading public health experts of the country, senior officials of the Ministry of Health and Family Welfare, Mission Directors and nodal officers of the National Health Mission from different states, and AGCA members deliberated over two days on how to take forward one of the most unique components of the National Health Mission – Community Action for Health.

This component of the National Health Mission engages with the communities, enabling them to plan and monitor the public health services they receive.

Among the recommendations that emerged at the consultation was the need to set up an effective grievance redressal mechanism, a simplified and a long-term funding mechanism with a fixed percentage of funds being allocated for community action with a significant role for NGOs.  Guidelines, a user manual and a film developed by the AGCA to help in the roll out of community action were released by Mr Vinod Rai and the Additional Secretary and National Health Mission Director C K Mishra.

Mishra said the process of consultation guides the government and policy makers. The learnings would help in taking the strategy of community action forward. Manoj Jhalani (Policy) Joint Secretary, Ministry of Health and Family Welfare, said the proposed National Health Assurance Mission, would take forward the National Health Mission and calls for greater accountability with an assured set of services, diagnostic tests and drugs provided free at government facilities. If, for example, a certain drug was not available, the facility would have to procure it from the open market and provide it to the patient.  There would also be an assured redressal mechanism.

The Ministry of Health and Family Welfare had constituted the Advisory Group on Community Action (AGCA) in 2005 to provide guidance and technical support on community action under the National Rural Health Mission. The AGCA had worked on a pilot in nine states, and based on the learnings, had refined the model for scaling up all over the country.

The advisory group has been helping in organising visioning meetings and giving technical support to initiate and scale up community action for health. It had helped in building the capacities of the state nodal officers appointed by the Ministry of Health and Family Welfare in all the states, as well as the NGOs working with the communities.
Till date, over 20 states and Union Territories have included the Community Action component under their Programme Implementation Plans, which are under varying stages of implementation.

One of the objectives of the consultation was to look at scaling up community action in states that had started work on it, and get the others to introduce it.

Community Action for Heath empowers communities, especially the poor and the marginalised, to demand their rights and entitlements. The process involves the training of local leaders on ways to assess, plan and monitor health services. It also gets communities to identify the gaps and cases of service denial and take them up with the authorities during a public dialogue. Some cases do get resolved at this stage, while others are sent forward to higher authorities for redressal.

This challenging process of empowering the communities is done by local level NGOs in collaboration with the government. The results have been found to be dramatic: health services improve, people start accessing them, corruption levels fall and with it out-of-pocket medical expenses which the poor can ill afford, come down dramatically.  Best of all, the authorities and the public begin working together for better health.

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