| Community of Practitioners on Accountability and Social Action in Health |
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SAHAYOG
Context
Since 2006, SAHAYOG has been working closely with 9 partner Community Based Organisations (CBOs) and with with three other CBOs, towards facilitating the grassroots organization, Mahila Swasthya Adhikar Manch (MSAM or the Women’s Health Rights Forum). The MSAM which includes over 11000 rural, largely poor and non-literate women across 12 districts of Uttar Pradesh, works to monitor and advocate for entitlements around maternal health services and related social determinants. MSAM women leaders work in teams of five, to improve access to healthcare, nutrition, livelihoods, social security, and freedom from violence. SAHAYOG has built capacities of the MSAM women and the local partner CBOs to understand the various aspects of maternal health and rights. After getting information about their entitlements, the MSAM with support from the local CBOs attempt to promote women’s access to the health services they are entitled to. Their work has been enabled by the National Rural Health Mission (NRHM) in India, which provides service guarantees and also promotes citizen participation and community-based monitoring. The MSAM women have also learnt about using the Right to Information Act for monitoring.
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Voices from the Ground
A short video clip on community empowerment on maternal health rights. This was a field project of "International Initiative on Maternal Health and Human Rights" and this video was produced by SAHAYOG, India
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Area of Work
Uttar Pradesh (India) |
Approaches to implementing Community monitoring/ accountability
SAHAYOG’s approach to CBM consists of the following steps:
- Participatory discussions with CBO partners and MSAM women leaders helps to identify the key issues for monitoring each year (there are two MSAM Steering Committee meetings each year and four meetings with CBO partners).
- Studying the entitlements provided by the state in this regard, and develop simple, mostly pictorial material, in the local language Hindi, to make the MSAM women aware of the issue, and to inform the MSAM women about their entitlements.
- Organize capacity-building workshops for the MSAM leaders on that particular issue (the leadership teams of 5 women handle 5 issues) which are residential and usually of three days duration. In these workshops the materials and pictorial tools are used to explain the issues, encourage discussions and plan for monitoring.
- Following the workshops, detailed plans are made with CBO partners who facilitate the MSAM women leaders to carry out their monitoring exercises.
- The CBO partners work with the local MSAM leaders to carry out the monitoring in the planned number of health centres or villages, and collect the data. They may make use of the Right to Information Act as well.
- SAHAYOG supports them in analyzing the data, and preparing composite reports.
- The CBO partners and SAHAYOG organize District Dialogues with the relevant officials and inform them about the monitoring findings, and the MSAM leaders engage in discussions with officials on how to effectively improve the situation.
Results
- We have provided an example that was used by the Centre for Health and Social Justice to scale up in the government’s own CBM policy within the NRHM. However, our work remains distinctly different in that we are not part of any government-led exercise within Uttar Pradesh.
- Women have presented their monitoring findings to the State Health Minister in 2008 and again in 2010, presented a set of concrete recommendations based on their monitoring. The ministers have called for enquiries on these cases. The human rights institution has also set up a committee to study the human rights aspects of maternal mortality.
- The MSAM women leaders have repeatedly expressed their sense of empowerment following the CBM exercises, and the opportunities to dialogue with health officials and policy makers. They have found it most empowering to actually know what the state has promised them in terms of entitlements, since they are often deprived from that information.
- Their level of articulation has increased dramatically, given that these are the rural poor, and all the more invisible being women, and not very literate. It has enhanced their sense of active citizenship, beyond merely holding public officials to account every five years through their vote.
Lessons
- Positive: CM is carried out by the community women in partnership with the local CBO; the CBOs and SAHAYOG have constructed a space where the findings can be shared; the method is flexible and varies according to the issues identified by the women and the CBOs.
- Weaknesses: CM work is very poorly funded; the CM work is not part of a regular government programme component but is elective and depends on the voluntary effort of the citizens. This means that there is no formal accountability to take action in the light of the findings.
| Monitoring Free Maternal Health Services in 11 districts of Uttar Pradesh, India 2012 |
Other materials in hindi are available at www.sahayogindia.org