Ethical Issues in Community Based Monitoring of Health Programmes: Reflections from India - Renu Khanna
This paper explores the different sets of power relationships and resultant ethical dilemmas that arise when developing community monitoring systems. Community Based Monitoring and Planning, as part of the Government of India’s strategy to achieve quality health care within the National Rural Health Mission, is used as an exploratory case study. The exploration hopes to benefit and protect the interests of those who are most vulnerable and powerless. The discussions – emerging from a series of conversations between a few community monitoring practitioners in India -- are targeted at a wider community of practitioners who are involved in designing and implementing such programmes. It is hoped that these discussions can be taken further by practitioners and can assist them in ensuring practice which is underlined by a clear set of ethical principles.
The paper consists of three main subsections. The initial section describes what is meant by the process of community monitoring and planning and how it is implemented. This section ends with how community based monitoring and planning fits within the existing power discourse. The second section of the paper begins with a brief history of modern bioethics and then goes on to focus upon ethical principals in community action and different research areas, but specifically shows how community based monitoring and planning, whilst maintaining uniqueness, intersects with several other realms including: community development and social action, community based research, public health interventions and social science research. The ethical principles of do no harm, maximise beneficence, autonomy and self- determination and social justice, are explored within each discipline. The final section looks at the various sets of relationships within the process of community based monitoring and planning, the associated differing power dynamics and the ethical issues emerging in each set of relationships.