Report for Monday 17 March (Day Three)

Day Three Report

(Day Three Schedule)

Feedback for Day Two

The third day started by sharing of feedbacks about the yesterday’s session by Jyoti. The feedbacks shared included:

• Presentation made by Thelma was very good as it gave a good insight about the work and development of Public Health Movement and also presented a good picture of work of Jan Swashtya Abhiyan in India.
• The session on Social determinants was appreciated as it was very interactive. But participants faced problem in figuring out how to address the complexities of huge range of social determinants.
• Session on equity was difficult to comprehend for people particularly who had come from grassroots as they could not relate to theories of equity that relate to policy analysis work.
• Last session on group work on People’s Health Charter was greatly appreciated as it gave an opportunity to all the participants to think through.

Health Services (Globally)

David Legge made a presentation on “Health System and health funding policies: from PHC to stratified health systems”. He briefly mentioned the policies for health development since World War II. He also stated the data on public health spending and out of pocket expenditures in various countries. With in South Asia, India and Bangladesh fares poorly in terms of MMR per 100,000(%) while Sri Lanka was an exception with a figure of 17 only. He further elaborated on pros and cons of using multi-tiered approach to health and managed care.

The presentation was followed by a group discussion to ponder mainly on whether Alma-Ata fit in today’s global context and does PHM position financially sustainable or politically achievable? There was a consensus on the fact that primary health care principles need to be modified as per current global context. It is financially achievable given the resources available with each country however we need to stress on better management.

We then moved out for tea/coffee.

Health Services (India)

Second session of the day was taken by Ravi Duggal. He presented his ideas on the Health and health care in India. Although it’s a long debate but he summarized it to the house. He raised a point on protection of health system from privatization. This will end up as making health care as a commodity and then it will be accessible to only those who have better purchasing power. Approach for the health care in the sub continent is much focused and not comprehensive. As he emphasized, there is need to universalize and institutionalize the public health system. It should be highly decentralized as then only community will have better say in the comprehensive health care and will own the systems. Poor social security net is also one of the major concerns.

He further said that private health care is more interested in curative care and caters to a very limited population, whereas public health system is a larger net with emphasis more on preventive care and caters maximum number population.

This session was followed by Lunch.

Reports from Practice (Rights Approach)

This session was moderated by Vandana Prasad. She initiated a discussion by asking the participants to explore what are the alternative approaches to Rights based approach to Health. Out of the various approaches suggested by the participants, the primary approach that came out was Health as Commodity.

This discussion was followed by case study presentation by Shailly Gupta on Trade and Access to Medicines. She shared that Right to Health is an integral part of Right to Life as per article 21 of the constitution. Access to affordable and equitable medicines is an element of Right to Health. She further presented the situation of Access to Medicines in India followed by factors affecting the access and stakeholders who are involved in this issue. She further explained the advocacy strategy being followed by her organisation in tackling this issue.

The second case study presentation was made by Upendra Bhojani on Tobacco Control (Upendra) focusing on pictorial warnings on tobacco products. He outlined the current usage of tobacco in India followed by policy related aspects on tobacco control and involvement of various stakeholders on this issue. He shared the strategies being used at the national and state level in particular Karnataka to deal with this burning issue. He also shared the lessons learnt from this campaign which can be useful in further taking this issue forward.

Vandana Prasad then mentioned that both the presentations were rights oriented and were talking about policy level concerns She then requested the participants working at field level to share their stories which would give an insight about grassroot level concerns.

Gonardhan Yadav and Ashish Parvat shared their experiences about grassroot concerns about rights in their respective states.

This session was followed by tea break.

Working with Communities

Before assignment of discussion topics to the groups, a tone setting session was delivered by Tejram jat. He threw some light on the different approaches to the community participation. Based on the Alma Ata declarations there are three basic approaches to the community participation:

Based on these approaches for community mobilization, there could be three ways of ensuring community participation:
1. Working in community
2. Working with community and
3. working for community

Working with or in the community implies transfer of knowledge both ways, which is the real essence of activism. Whereas working for community involves power relations within it. Some principles of working with the community are empowerment, participation, inclusion, self determination and alliance building.

Theory of social change is an innovative tool to design and evaluate social change initiatives, as stated by David Legge. He also discussed some theories related to change.

The participants were divided in four groups. Group 1 and 3 discussed on what are some of the common difficulties which activists face in working with communities and group 2 and 4 discussed about kinds of principles to be developed to guide inexperienced activists. The presentation of Group 1 and 3 identified the problems faced by them while working as an activist mode are identification and involvement of local stake holders, mobilizing the community to go for its rights, lack of faith among the public health system as well as NGOs. Group 2 and 4 proposed IEC, training, surveillance and advocacy as strategies. The desired attributes among individuals for the activism are effective communication skills, ability to identify the problem, mobilize the community, efficient use of media resources and networking with various stakeholders.

Previous
Next
Return to Jaipur Index Page
Review Program Overview