Citizens in rural Maharashtra exert their power through public hearings to address health issues

Ranibai Vasave travelled for 45 kilometers from Shahada taluka to Nandurbar in March this year to confront officials in the district about the lack of basic heath facilities in her village. The 30-year-old adivasi woman was joined by many others who had gathered for the jan sunwai in this district in the northwest corner of Maharashtra. Their complaints ranged from the failure of funds meant for pregnant tribal women reaching their beneficiaries to the primary heath centre in the village not stocking medicines.

Jan sunwais orpublic hearings are a platform for people to raise their voices against government apathy towards social issues. This one concerned the health of the people.

Organised through the Community Based Monitoring (CBM) programme, under the National Rural Health Mission (NRHM), one of the key outcomes of the programme has been empowerment at the grass root level. In Maharashtra, CBM is co-ordinated by Support for Advocacy and Training to Health Initiatives, (SATHI).

Nandurbar has a high tribal population, and is also one of the ‘high focus districts’ under the NRHM. The problems here are acute. “There are no ANMs (Auxiliary nurse midwife) in our village, and last year, after a woman gave birth no one came to see her for weeks. She did not get any medicines, and the baby was not vaccinated,” Ranibai stated. At a series of public hearings held across the State in March this year, many such cases came to light.

After the NRHM was introduced in Maharashtra in 2005, CBM was made an important component of the Mission in 2007 to ensure people’s participation and accountability in the delivery of health services. Initially launched in the five districts of Thane, Pune, Amravati, Nandurbar and Osmanabad, the programme has now been extended to eight more districts of Nashik, Chandrapur, Gadchiroli, Aurangabad, Raigad, Kolhapur, Beed and Solapur, covering 680 villages in total.

Maharashtra is the only State among the 18 NRHM states that has recognised public hearings as a crucial aspect of the CBM.

Since 2007, the CBM has enabled people to engage in a dialogue with the decision makers at the village, taluka and district level. Annually the authorities are held accountable by the people themselves.

In the Jan Sunwai held in Nandurbar, authorities were asked why women were denied the Rs 800 (Rs 400 in cash and Rs 400 for medicines) that they are supposed to receive from the government under the Matrutva Anudan Yojana for tribal women upon delivering a child. Even as the authorities tried to skirt the issue citing that the previous years’ payments were still pending, people stood strong on their demands. Finally, the District Health Officer gave in, and promised that the payments would be made within two weeks.

The Taluka Health Officer of Dhadgaon, where there are a large number of pending payments under the Janani Suraksha Yojana (JSY) for maternal health, was sent a show cause notice for not being present at the public hearing. Other issues such as the lack of telephones in Public Health Centres (PHCs), corruption in rural hospitals, hygiene and cleanliness were brought up. Going by Sathi’s xxxxx experience in the last five years, one area that has seen significant improvement in all five districts is the hospital staff’s behaviour towards patients, especially the tribal patients in Nandurbar and Amravati districts.

According to Dr Nitin Jadhav, State coordinator for CBM from Sathi, while such issues are relatively easier to solve at public hearings, the State government is still being evasive about major policy level changes. It is here that ‘community participation’ fails to make a difference.

The issue of vacant Class 1 posts of medical officers was one of the most prominent in the public hearing, and has been a major cause of concern in Maharashtra. In the district hospital in Nandurbar alone, there are 14 posts, whereas only four have been filled. This includes the post of a radiologist, which has been empty for more than year, Dr Hemantkumar Borse of the Nandurbar district hospital said.

“The private radiologists in town flourish because of the lack of specialists in government hospitals,” he said. Entwined with this is the issue of government doctors practicing in their own private clinics. “This is illegal and merits criminal action. On one hand the doctors say they are overworked in government hospitals, and on the other, they run their business openly,” Dr Jadhav laments. At the public hearing, villagers are not scared to point at the government doctors, stating that they run private practices. “We want the doctors to stop their business and do their duty towards the people,” a villager said.

According to a state government figures, more than 50 per cent of seats of Class 1 medical officers are vacant in the State. Officials in the Directorate of Health Services said that out of the 1517 sanctioned posts in the State, only 676 have been filled, whereas 841 are vacant. Close to 30 per cent of the seats are reserved for rural areas.

The Maharashtra government is struggling to fill the seats, especially those in the rural and tribal areas, as officers refuse to live in areas with bad infrastructure and worse living conditions.

An issue peculiar to the tribal areas, Sathi observed that apart from doctors and medical staff, the region also needed counsellors to act as translators between the tribal population and the doctors. State health officials stated that Rs 3.6 lakh had been spent in the appointment of counsellors or dubhash (translators), but according to Sathi, there were none in Nandurbar.

Another area that needs immediate intervention is that of restructuring of PHCs. People from Dhadgaon taluka in Nandurbar complained that there are several villages where the PHCs are more than 25 kms away. According to Dr Jadhav, this is the case in many other districts. “A government study has planned the restructuring of PHCs, and the local MLAs are supposed to conduct meetings with villagers to restructure the PHCs, which is not yet being done. Political will supersedes administration in such cases,” Dr Jadhav states.

These issues will be brought up again by the civil society organisations in the State level meeting to be held in Mumbai in the first week of July. While community participation will continue to push the boundaries of the State machinery, it is necessary that the government which receives Rs 1470 crores as NHRM funds annually gives women such as Ranibai their due.