Human rights activist Binayak Sen, whose inclusion in the steering committee on health by the Planning Commission has upset the Chhattisgarh government, had contributed significantly to the conceptualisation and implementation of ‘mitanin' or rural social health worker programme initiated by the State — now adopted under the successful National Rural Health Mission (NRHM). The ‘mitanins' of Chhattisgarh are known as Accredited Social Health Activists (ASHAs) elsewhere in the country while mitanins continue to be known by the same name in the State as a special concession.
Dr. Sen was member of the State Advisory Committee that developed and conceptualised the Mitanin Programme in 2003 when Ajit Jogi was Chief Minister.
The guidelines had been brought out by the State Health Resource Centre with support from ActionAid India. Dr. Sen's inclusion in the Planning Commission's panel prompted the Chhattisgarh Chief Minister to register his protest with the Prime Minister and decide not to attend the panel meetings.
Dr. Sen was charged with sedition in 2007 and imprisoned for life by a trial court. His case is admitted and pending before the Chhattisgarh High Court while he was granted bail by the Supreme Court last month.
The Planning Commission included him as it believes that his experience in the tribal areas of Chhattisgarh could help in formulating policies for the Twelfth Five Year Plan as it feels that an individual's intellectual capabilities do not diminish just because of charges or even conviction, for, several under-trials from Tihar and other jails have proved themselves on several occasions.
Contributing on “Health and Human Rights” as a representative of Rupantar — a non-governmental organisation — Dr. Sen wrote in the concept paper on the Mitanin programme that the major factors causing disease in modern societies were social, economic and political in nature. Famine, pestilence, and war, the traditional sources of human ill-being, are the result of public policy, almost always mediated by state power.
The Mitanin programme was conceptualised as an ambitious innovative programme launched by the Chhattisgarh government with the partnership of civil society and with the financial support of the European Union.
“It is in the nexus between two bitterly contending forces that the current situation of working people of India needs to be located. In most cases the equations work out to their disadvantage. With the exception of family planning and immunisation programmes, primary health care in Chhattisgarh is for all practical purposes non-existent,” Dr. Sen wrote.
“Auxiliary Nurse Midwives do not have stocks of sterile disposable lancets to collect slides and are reusing these without boiling. Primary health care services have been heavily compromised by levying user fee and the prevalence of private medical practice by doctors and paramedics.”
Dr. Sen wrote: “The programme for training and deployment of community health workers in Chhattisgarh, laudable as it is, cannot be seen as the extension of government health care services into the community. Instead, it must be seen as the beginning of a campaign to establish human rights in the health care sector.
The programme for structural change in the healthcare system will need to create the capacity to correspond to this campaign.
“The Standard Treatment Protocols will be critical documents on the basis of which this response will be articulated and evaluated. The extension of the Panchayati Raj to Scheduled Areas [PESA] Act along with an effective financial devolution will provide the legal and administrative bases for communities to access and control the restructured primary health care system.