01 Apr 2014 - 31 Mar 2015
01 Apr 2014 - 31 Mar 2015
There has been a significant rise of urbanization in the country over the last decade. The inaccessibility of the health care facilities in the urban areas is due to the following reasons- overcrowding of patients, ineffective in outreach and referral system and lack of standard and norms for urban health care delivery system, social exclusion, lack of information and assistance to access the modern health care facilities and lack of economic resources and corruption. Women belonging to Dalit and Muslim communities face further vulnerabilities due to social exclusion and traditionally entrenched gender disparities.
The population of Bangalore city is currently over 6.7 million. It is estimated by civil society organizations that there are 778 slums in Bangalore city and about 26% of the total population of the city lives in these slums. BBMP (Bangalore Bruhat Mahanagara Palike) runs fairly large network of health system which is supposed to be catering to the needs of health of urban poor. These health system networks are poorly managed due to lack of political will, fund crunch, inadequate supply of medicines and human resource. Marginal communities like the Muslims and Dalits are further rendered vulnerable without sufficient access to service. The practice of irrational diagnosis and treatment, negligence, denial of services and added to that corruption at all levels adds to the problems faced by these communities to realize overall health and well being.
SPAD has over the last been able to mobilize communities through awareness and education and directing them to assert their right on health in the public health system. The formation of Solidarity groups in different locations, conducting community score cards for each of the hospital catchment communities, consultations with health personnel in the health centres, raising issues across the table by the community groups has led to mark changes in the quality and the practice of services at the government health centres. The combined voice of community is heard well. The communities also felt that they are capable of making accountable the government health sector to the needs of the community. The project’s concerted effort in the last one year has led to quantifiable changes at the local level.
With the launch of National Urban Health Mission (NUHM) in Bangalore city, a number of awareness activities have been facilitated by SPAD with the solidarity groups and monitoring committees. Along with this, awareness about recent developments around ward committees have also been shared with these groups as well as other CBOs and the larger community in the area. In these meetings, SPAD has developed a set of recommendations on NUHM, ward committees and how the two will coordinate for better health outcomes – a pamphlet has also been printed on this issue. These recommendations have been shared with government officials, including the Technical Resource Group set up by the Union Health Ministry for NUHM. Activists and solidarity group members have taken the lead in presenting these recommendations in various meetings with government officials and the community.
A long road to delivery
Chaitra, a young woman of 28 years living in Bhavani Nagar, is a member of the Maternity Home Monitoring Committee (MHMC) at Gavipuram Guttahalli (GG Halli) Maternity Home. Her personal experience with accessing government health services in Bangalore city has strengthened her commitment to community action for improving health services.
Chaitra's sister-in-law, Sambhavi,aged 24 years began experiencing contractions on the evening of February 19th, 2013. Chaitra accompanied her to GG Halli MH(BBMP) and got her admitted. The next morning, labour had not progressed as expected and Sambhavi was told to go to JJR Nagar Referral Hospital, about 4 km away – Chaitra and other MHMC members ensured that she was sent by ambulance. Sambhavi's contractions had subsided by the time she reached JJR Nagar Referral Hospital. She was told that her case was complicated and was referred to Vani Vilas Tertiary hospital. At Vani Vilas hospital, she was refused admission. The staff scolded her, saying 'You go to those BBMP hospitals for antenatal checkups and then come here at the last moment for delivery. Go back there.' She and Chaitra went back to JJR Nagar Referral Hospital. The doctor said that it would take more time for her to deliver and referred her to Banashankari Referral Hospital of BBMP 7 km away. At this point, the two women, exhausted, went back home and decided to go to a private hospital. A SPAD activist came to know of the situation and offered to accompany them to Banashankari Referral Hospital. At the hospital, Sambhavi was examined and told to come back 2 days later. However, labour pains resumed the next day and she went back to Banashankari Referral Hospital, where she eventually delivered through C-section. Due to their awareness, Sambhavi's family paid only the standard user fees and no bribes were demanded of them.