There is a well-known saying ‘Jiski Ladai Uski Aguwai’ (loosely translated it means - people involved in the struggle should be the ones to lead it). This adage has been proved right by the 12 community led organisations (CLOs) in Uttar Pradesh who are fighting for inclusive education and healthcare services in the state. These grassroots level organisations along with the Samaveshi Swasthya Suraksha (SSS) Forum conducted a survey to review the status of Village Health Sanitation and Nutrition Committees (VHSNCs) in 12 districts.

VHSNCs, formed under the National Rural Health Mission, led by the Gram Pradhan is a key institution for facilitating and monitoring the delivery of health, sanitation and nutrition services at the village level. The VHSNCs are allocated Rs 10000 per annum for carrying out its operations.

Grassroots evidence show that the state government have failed to deliver health services to the most marginalised — Dalit and Muslim — communities. Despite the presence of National Rural Health Mission (NRHM) communities lack access to quality and affordable healthcare.

The CLO-SSS survey showed that only 16% of VHSNCs received funds from the health department. The survey revealed that only 12% of the funds were utilized between April 2018 and March 2019; out of 5 Gram Panchayats surveyed by SSS Forum, only one utilized funds and the remaining VHSNCs showed zero utilization of funds. These VHSNCs utilized the funds only for sanitation work, while work related to other health issues such as safe drinking water and village health plans were ignored. 69% of front line workers i.e, Anganwadi, Auxiliary Nurse Midwifery (ANM) and Accredited Social Health Activist (ASHA) informed that while VHSNCs were formed in their villages, the committee members themselves were not aware of it.

The survey, released at the regional consultation in Unnao on February 23, 2019, shows that the government has failed to take proactive steps to ensure community participation in governance through the key village level institutions.

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In addition to the inefficient functioning of public health institutions, negative perceptions and social norms are also responsible for the poor health of the marginalised communities. For instance, among the Muslim communities in some areas there was a perception that the government provided medicines that would make their children and future generations impotent. For instance, in a Muslim block in Ballia, the Kasaiwada community opposed polio immunization due to this perception. The CLO members approached the religious leaders and convinced them to encourage the community to shed the negative perception. The community agreed and children were immunized.

In another instance, Muslim communities in Kadha and Behar village refused to get their children immunized against measles rubella; again due to the negative perception that it would make their children impotent. The Basic Health Worker (BHW) in Unnao district, Shaitanshu Verma, then consulted with the Medical Officer In-Charge (MOIC) and educated the community members about immunization.



Caste-based discrimination is another major reason for lack of health services for the marginalised communities. At many places, members from the general caste refer to the Dalit (SC) communities as ‘Neech Jaat’ (inferior caste). Due to this discrimination, the community wasn’t able to access immunization services. It was also seen that during elections for VHSNC members, power dynamics play a crucial role; the village headman, especially from the general caste, oppose the election of dynamic Dalit or Muslim members in the committee. They instead nominate people from these communities who are not very active and are just a headcount to meet the quorum.

The results of the survey concluded that engagement of local authority, i.e the Pradhan is crucial for effective functioning of VHSNC. A strong political will and public demand for quality and free public health services can ensure that the most marginalised person has access to healthcare.

Oxfam India and a network of civil society organisations (CSOs) is campaigning for “Yes Democracy” to demand the political parties to include free and quality public healthcare in their election manifestoes and the subsequent follow up in policy making. Uttar Pradesh Swasthya Abhiyaan (collective of CSOs advocating for right to free healthcare) and SSS Forum engaged with political party candidates and encouraged them to sign a pledge to include the demands for healthcare services, if they come to power.

READ VOTE FOR A NEW INDIA! #YESDEMOCRACY

The demands under the Yes Democracy campaign include increasing public health spending to 2.5% of GDP, strengthening public health system, providing free diagnostic and medicines in public hospitals, transforming Pradhan Mantri Jan Arogya Yojana (PMJAY) to an insurance based-model of health services to National Health Protection Scheme for universal health coverage, regulation of private hospitals and regularization of ASHA, Anganwadi Workers & Helpers by covering them under employment protection schemes.

Oxfam India and the network of CSOs are also engaging with community members and citizens to sensitize them about their right to health so they may make informed decisions while voting and demand their right to free and quality health services. #YesDemocracy



This blog is written by Binod Sinha, Programme Coordinator, Oxfam India, Uttar Pradesh. He can be reached at Binod@oxfamindia.org.