Health Services and Financing

Through research carried out through the project, CEHAT intends to generate critical insights into neglected issues/areas in health and healthcare reforms and policy besides sustaining some of the activities related to human rights education and budget advocacy, research and documentation. Research on neglected issues/areas would involve primary studies on migration and health and urban health. Health policy and programme research under this project would include primary and secondary research on public private partnership, user fees, and an impact study of the Prevention of Mother to Child Transmission (PMTCT) programme on women which would be conducted in 16 peripheral hospitals in Mumbai. The findings from the research would feed into the policy.

Seasonal Migration and its Impact on Health-A Case Study of Prawn Harvesters inGujarat
User fee in Municipal Hospitals in Mumbai
Mapping of Urban Health Facilities in Maharashtra
Public private Partnerships
Impact of the Prevention of Mother to Child Transmission (PMTCT) program on Women

Seasonal Migration and its Impact on Health-A Case Study of Prawn Harvesters in Gujarat

Prawn harvesters from the Little Rann of Kutch (LRK), Gujarat, largely members of the Miyana community, are seasonal migrants from along the coastal areas of Gujarat. These seasonal migrants face many problem with regard to lack of basic services like food, health an education particularly children among the migrants miss education and immunization. CEHAT is doing such a study on the fish prawn workers in Gujarat this study has been conceptualized by CEHAT and Anandi. It has been found that the area where these fish prawn workers migrate does not have schools or anganwadis, lack drinking water pipelines to electricity. Fishing is a traditional livelihood activity of these communities largely concentrated in two blocks Maliya and Halvad. Prawn catching is a good remunerative business in good season. There are about 3000 families involved in this activity

Objective

• To study the living conditions of fish prawn workers in Gujarat, their state of health and the extent of health care facilities available to them.

Findings

• The study highlights the lack of access to basic amenities such as potable water, sanitation, health care, transportation, education and public distribution system for the prawn harvesters from the LRK.
• The poorest are the worst affected from general deprivation - they rely more on poor quality water from the ditch, spend larger portions of their earnings on meeting needs of daily lives such as purchase of drinking water and engage in additional hardships of gathering firewood.
• Morbidity rates are higher than other tribal populations from the state probably as a result of combined effect of harsh environmental and work conditions, unhygienic living conditions and poor access to health care facilities.
• At temporary settlements, the women bear the double burden of household chores, and back-breaking work related to prawn harvesting which also keeps them in direct contact with prawns for long durations. These work conditions and prolonged contact with sea-food are known risk factors for health conditions including asthma, skin conditions and poor obstetric outcomes.
• The study findings point towards the urgent need for provision of basic amenities including drinking water, PDS shops, health care, sanitation and education at temporary settlements. Mobile schools and mobile health care vans can be arranged for the prawn harvester residents at the temporary settlements. Social mobilisation and strengthening of cooperative societies could help the prawn harvesters gain the essential power to negotiate market rates. Appropriate investigations should be carried out to assess the impact of various environmental and occupational risk factors on prawn harvesters’ health.

Team Members: Anagha Pradhna, Tayyaba Shaik, Nidhi Gupta and Chandrima Chatterjee Funded by: Oxfam-Novib, The Netherlands

User fee in Municipal Hospitals in Mumbai

There have been many studies on user fee, indicating that the average hospital receipts forms a negligible percentage of the total hospital expenditure and if the administrative costs are deducted then the recovery is all the more meager. There has been evidence from the NSSO, which show that the utilisation of public health facilities has declined in the last two decades. User fee was introduced in India in the 1990’s as a part of Health Sector Reforms and many studies show that levying user fee in public health facilities is an important factor that has contributed to decrease in utilisation of the public health facilities

Objectives

• To map the flow of user fees and to examine its role in cost recovery

The study design is finalized and Preliminary information has been collected by visiting the municipal hospitals and informal discussion with the staff has been carried out to develop tools for data collection.

Mapping of Urban Health Facilities in Maharashtra

In recent decades most third world countries have experienced unprecedented growth in their urban populations. Yet little or nothing has been done to provide services and amenities essential for healthy lives where these growing populations live. India has a rapidly growing urban population. The proportion of urban population to the total population has been also increasing. There is a growing need to provide health services to this rapidly growing urban population. Though The National Urban Health Missions (NUHM) programme has a focus to meet the health needs of the urban poor in many of these cities but the at the state and national level little focus have been made on the explosive growth of urban population in Class I cities following gaps in health provisions for these populations.

Objectives

• To study the gap between a growing urban population in Class 1 cities and provision of health facilities in four cities (Nagpur, Nashik, Aurangabad and Solapur) in Maharashtra

Findings

• The present study examined the spatial growth of public and registered private health facilities in selected cities of Maharashtra. The mapping method used in the study has been really useful in highlighting the availability of private/public facilities in these cities.
• There are clusters of private hospitals in the city centres, with the urban poor completely excluded. The private health sector has been growing without any kind of regulation. Unlike education where schools cannot be set up in an area where a school already exists, the health sector does not have any such norms. The growth of private hospitals is determined not by need but by the market, thus leading to high concentration zones within the city.
• The study highlights an urgent need for a norm for location / distribution of private hospitals within the city to facilitate a more equitable distribution of health services.

Team: Anandi Dantas
Funded by: Oxfam-Novib, The Netherlands
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Seminar on Spatial Dimensions on Health Care-Use of GIS in Health Studies

The use of Geographical Information system (GIS) in the field of health research is increasingly becoming important. GIS can be effectively used as location technique for analysis for decision making in relation to optimum gainful utilization of available medical resources. The seminar was organized in collaboration with the Department of Geography; University of Mumbai. The aim was to discuss the prospects and future development of GIS in spatial health and health care management.

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Public private Partnerships

The discourse around Public Private Partnership is complex and attracts research studies that are largely based on case studies. The proposed research intends to serve technical inputs to the ongoing monitoring of the National Rural Health Mission Program and other policy level reforms. This will illuminate critical aspects and facilitate the process of policy development of reforms in the health sector. It intends to bring out scientific evidence for developing partnerships with the private sector in order to work towards ensuring the right to health care to vulnerable groups of society.

• To map Public Private Partnership models in the health sector in India

The research study would be executed in two phases, first one that of mapping the existing models and in the later stage, impact assessment of the selected few models would be carried out.

Team: Anuja Kastia

Impact of the Prevention of Mother to Child Transmission (PMTCT) program on Women

The changing face of HIV/AIDS shows that more women are getting affected by the disease as compared to men. Women are biologically, sociologically and culturally more vulnerable and this is also the main reason for paediatric transmission of HIV/AIDS i.e. from mother to child. There is evidence that reducing mother to child transmission is the most successful intervention and a cost effective approach to manage paediatric cases of AIDS. The National Aids Control Organization has set up Integrated Counselling and Testing Centres (ICTC) within the public health system. While there are studies done elsewhere, there is none in India. Research elsewhere shows that fear of violence, social discrimination, coping with the diagnosis are some of the reasons for non acceptance on ICTC.

• The ICTC counsellors were interviewed in terms of what training is provided to them, how do they provide counselling to their client, the issue of ‘Consent’ for testing was also discussed.
• The ICTC counsellors training curriculum was reviewed and gaps were identified.
• A Gender Sensitisation training was conducted.Thirty counsellors attended the training.This training was an important step in improving quality of counselling services provided through the ICTCs and a valuable contribution to the field of counselling training.

Team: Nidhi Sharma and Padma Deosthali