Millions left behind in India’s public health system

Two news reports in the span of 10 days bring home just how grave the crisis in India’s public health care system is.

First was the report from Odisha of a tribal man who had to carry his dead wife’s body on his shoulders for over 10 kilometres because he was denied an ambulance to go back to the village for her final rites.

Then less than a week later came the tragic story from Kanpur of a 12-year-old boy who died after he was denied admission at a government hospital. His father, who was holding the sick child in his arms, was told to go to a children’s hospital despite his obvious poor health. The man’s pleas for transport to carry the boy to the children’s facility were denied.

These are just two instances that we know of because they got media attention. Imagine the thousands, even millions of people across the country, who are unable to access medical treatment on time.

The World Health Organization says the ideal norm is 1 doctor for a population of 1,000. Going by that measure, India falls short by 500,000 doctors as pointed out in a recent IndiaSpend report. Going by these figures, there is one doctor for 1,674 persons, which is worse than Vietnam, Pakistan and Algeria. Even this, many experts believe does not reflect the reality and that the ratio is closer to 1:2,000.

The shortfall is evident not only when it comes to doctors but also support staff like midwives and ASHA workers who form a critical backbone when it comes to rural health care. Under the National Rural Health Mission, more health centres have come up in our villages but there are simply not enough doctors and nurses to man them.

The shortfall gets reflected in the statistics relating to infant and maternal mortality. Despite interventions at various levels, the figures are not improving fast enough. All the plans and policies remain words on paper because there are not enough people on the ground to see them through.


Fighting gender violence together

A recent IndiaSpend report on crimes against women in the Capital brings home the many promises made in the aftermath of the Nirbhaya rape in 2012 that remain unmet; and how four years after that horrific assault on a paramedical student, the number of rapes in Delhi has tripled.

After the incident, the Verma Commission that was entrusted with looking into reforms proposed many changes to the law. Chief among them was hiring more women in the police force as it was seen as a vital step towards ensuring greater sensitivity towards rape survivors. As the IndiaSpend report highlights, this, like along with many others like hiking expenditure on police training remains on paper.

Police, the world over, handle rape badly. Even in developed countries like the US and the UK where resources are so much more advanced, there is a huge variation in the way rape is recorded and how survivors are treated.

In India, where this is compounded by a crippling shortfall of staff, experts say there is a need to take a more pragmatic approach towards tackling crimes against women.

One that does not put the entire onus on the police, but a multi-sectoral approach that involves different agencies across key sectors – health, psychosocial and justice – working together.

Increasing the number of female cops is not the sole answer, says Dr Nayreen Daruwalla, Program Director for Prevention of Violence against Women and Children, SNEHA. “Women share the same concepts of patriarchy and are not able to shed their deep entrenched attitudes while dealing with cases and survivors of violence”, she says. “We are working towards making violence against women and children a public concern, so should not the responsibility of assisting the survivor lie with all duty bearers, irrespective of being a woman or a man?”

Daruwalla argues that a multi-sectoral approach offers a more effective, long-term solution to bringing down crimes against women, pointing towards SNEHA’s convergence approach in the Mahim and Nehru Nagar police stations of Mumbai.

In September 2013, when SNEHA started an observation and in-house training program in gender sensitivity in these two stations there was some initial discomfort. However, gradually there was an understanding from both sides of each other’s pressures and needs.

While the counselors got to witness firsthand the extreme stress and staff crunch the force faces, the police too realized that SNEHA’s presence and inputs were helping them handle cases related to gender based violence in a better manner. It also helped tone down levels of aggression and the use of abusive language. Gradually the police began to reflect upon their patriarchal mindsets.

A study done before and after the program on the policemen who participated showed significant results. Some of them were –

*Greater understanding of the law against domestic violence

*Greater awareness of stalking, violence and disrobing as forms of violence

*53% decrease in the number of policemen who thought it was important to ask if a woman had provoked an act of violence

*Nearly 70% decrease in the number of police who said a woman’s sexual past was not important while recording a rape complaint

The greatest testament to the changes came from the women in the community who said that they were satisfied with how they were being treated by the police in these two stations.

“Changing mindsets is a longer term process that requires regular follow-up and reinforcement”, says Dr Daruwalla. “We work with the premise that the police are ready to fulfill their role appropriately and adequately if given an opportunity to work in a supportive environment. “

The convergence approach pioneered by SNEHA holds many lessons. Enabling the law system to respond to violence against women and children needs a supportive environment, one where various agencies come together and work in partnership with the police.

Instead of seeing the police as the ‘other’, it brings the community closer to the men in uniform, making the fight against gender based violence, everyone’s battle.





Water crisis has links to women’s rights & economic progress

Just how grave the water shortage in India is brought out in IndiaSpend’s latest report, which says that India is facing the worst crisis in a decade, with the shortage likely to create drought-like conditions in many parts of the country.

We are already seeing the worst of it in many regions. Farmers in Bengaluru led a protest over water scarcity that lasted days. The water crisis in Karnataka is affecting Tamil Nadu and Andhra Pradesh, which are among the states that will be worst hit this year.

The impact of this scarcity will be felt most by women and children, especially girls, on every count, be it health, education or nutrition.

In Bundelkhand, Uttar Pradesh, the acute drought has led to an alarming drop in nutrition levels. 86% homes have cut down on dal intake, while 84% have cut down on milk for their children.

The threat of food scarcity is not limited to Uttar Pradesh alone given that there is not enough water to irrigate farmlands. So we are looking at a potential food shortage across the country.

Clean water affects education. It helps keeps children in schools. This is especially true of girls because in rural India, the task of fetching water still remains the primary responsibility of women. Families in Marathwada, in rural Maharashtra, which is facing severe water scarcity, are pulling their children out of school so they can help fetch water.

Perhaps the biggest concern is the impact on health. The acute shortage of safe, drinking water will lead to a spiralling of diseases like diarrhoea. There are over 300,000 diarrhoea-related deaths in the world every year. 45% of them are from India.

Access to clean water is not just a supply and demand issue. It has links to women’s rights, maternal and infant health and overall economic progress. Its time we looked at water from a larger perspective rather than battling it from season to season.