OUR INITIATIVES (1994 - 2002)

CEHAT's projects are based on its ideological commitment and priorities, and are focused on four broad themes,

  1. Health Services and Financing
  2. Health Legislation, Ethics & Patients' Rights
  3. Women's Health
  4. Investigation and Treatment of Psycho-Social Trauma.

An increasing part of this work is being done collaboratively and in partnership with other organisations and institutions.

(1) Health Services And Financing

Establishing Health as a Human Right (2003 onwards)
This project begun in late 2003 is in a sense bringing together the entire work CEHAT has done over the past decade. CEHAT's mission has been to work towards right to healthcare for the people of India and this project is an opportunity to consolidate this through research and advocacy on issues impinging on right to healthcare. The project will research and document key factors that contribute to create universal access to healthcare with equity and these will provide support and evidence for the Jan Swasthya Abhiyan's campaign on right to healthcare. Among expected outcomes of this project is a strategy for universal access to health care and a country shadow report on Articles 12 of ICESCR. Also the project would support initiatives towards bringing legislative changes to establish right to healthcare.

Standard Treatment Protocol-Project (2004-2005)
Aims at preparing Standard Treatment Protocols for Medical Officers in Primary Health Centres and Rural Hospitals and also for the sub-center staff. It also aims at preparing training modules for these protocols. Supported by Department of Health and Family Welfare, Government of Maharashtra.

Mapping Healthcare Facilities in a District (2004)
This study was undertaken for the National Commission on Macroeconomics and Health and is part of an 8 state multicentric study. CEHAT has done the Maharashtra study in Jalna district. This study is a virtual census of all formal healthcare facilities in the district and collates basic information on the characteristics and functioning of these facilities. The study results are being used as an input by the Commission to formulate a strategy for reorganizing the healthcare system in the county.

Healthcare Development in backward Districts of Maharashtra (2003)
The government commissioned CEHAT to undertaken an assessment of health and nutrition in the three most backward districts of Maharashtra, namely Yavatmal, Jalna and Nandurbar as a follow up to issues which had emerged in the Human Development Report 2002. The assessment identified key issues of concern in health and nutrition based on field assessment across the districts and suggested a strategy for action. This study was part of a larger study which looked into a wide rage of social and development issues and was coordinated by Indira Gandhi Institute of Development and Research.

Pada Aarogya Saathi Project (July 2003 onwards)
A collaborative project with the health department to mainstream some of the gains of the Hamlet Health Worker (HHWs) programme in the Aarogya Saathi Project. Fifty women HHWs from the PHC areas in Dahanu Taluk of Thane district in the government's ongoing Nava Sanjeevani Yojana have received enhanced training from the SATHI team of CEHAT. The SNDT Women's University approved the course prepared by the SATHI team for such training and awarded them certificates after conducting their examination. The health department specially sanctioned Rs.50,000 for the drug-supply to these HHWs, which have treated more than 7700 cases of minor illnesses in a year.

Study on demand for a public hospital in Mumbai (2002)
The study brings out the importance of the municipal health care system in metropolitan cities. It shows that non-availability of public hospitals and inadequate dispensaries in the vicinity push people to seek care from the private health sector.

SATHI Cell: (2002 onwards)
SATHI
(companion) stands for Support for Advocacy and Training to Health Initiatives. SATHI cell aims at fostering a broad-based health movement by offering training and advocacy related inputs to various organisations taking up health initiatives. Activities include continued collaboration with four People's Organizations in Dahanu, Aajra, Badwani and Sendhwa areas for strengthening the ongoing Community Health Worker (Arogya Sathi) programmes and local advocacy on Primary Health Care issues. Other activities include giving inputs for state / regional level advocacy related to Primary Health Care and Health Rights; developing relevant training, advocacy, awareness material and doing action research on specific areas. The SATHI team has been one of the leading elements in Maharashtra and at the national level, of the Jan Swasthya Abhiyan's 'Right to Health Care' campaign

Public Health Facilities in Mumbai (2002)
CEHAT's interaction with the public health care system and dissemination of health information, demonstrated a need for a comprehensive and portable directory on the public health care facilities in Mumbai city. (The English edition is published and the Marathi edition will be brought out soon.)

Maharashtra Human Development Report (2001-2002)
CEHAT was requested by the Maharashtra Government to write the chapter on Health and Nutrition for the first Human Development Report of the state. This was published in 2002.

Maharashtra Health System Report (2001)
Health and development in Maharashtra, from the period 1961-2001. A review of Maharashtra's health and healthcare development, it contains comprehensive information and data on the health sector in Maharashtra and is a useful reference document. This is also being translated into Marathi.

Review of Private Health Sector Studies in India (1999-2000)
An initiative to critically review and document studies on private health services and financing to identify crucial areas for policy intervention. This was done collaboratively with Foundation for Sustainable Development, IIT Chennai, Centre for Social Medicine and Community Health, JNU New Delhi.

Arogya Sathi: (1998-2001)
Community health activist-based, locally sustainable primary health care and conscientisation programme in three remote areas of Maharashtra and Madhya Pradesh having a strong people's movement and organisation. The aim was to reduce medical deprivation and exploitation, help people's organisation in their advocacy efforts to make public and private health care systems accountable. [From 2002, this work contined as part of the SATHI Cell]

Database on health
User friendly computerised time-series (1951 onwards) database on health for India and all its states, on health indicators, infrastructure, human power and government expenditure. First version with data upto 1994 was released in July 1998 with customised software to access and compute statistical information. The second version, which is windows-based, has been released with updated information upto year 2000. A number of other issue-specific databases are also in process. CEHAT's database unit also provides services in compiling data sets for other organisations.

Patients' satisfaction in a public hospital (1996)
Study of indoor patients' satisfaction with services in the context of their socio-economic background and the availability of basic facilities in a public hospital in Mumbai.

Private health care sector in India (1995)
Critiques the nature of private health sector; studies emerging trends within it and recommends that it should be brought under the ambit of planning and regulation.

Health expenditure across states (1995)
Database and analysis of state expenditure on health care for the Special Statistics section in the Economic and Political Weekly.

Financing of disease control programmes (1994-95)
Disaggregated financial data analysis of major disease control programmes such as Malaria, Tuberculosis, Leprosy, Blindness and AIDS, for the period 1989-90 to 1994-95 across states.

(2) Health Legislation, Ethics & Patients' Rights

Prenatal Diagnostic Techniques (PNDT) Act (Legal advocacy against sex selective abortion)(2000 onwards)
CEHAT along with MASUM and Sabu George (independent activist) filed a PIL in the Supreme Court in February 2000 to review the “Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act – 1994”. The case had reasonable success with improved implementation by states and a complete revision of the PNDT ACT implemented from January 2003 onwards as a consequence of the case.Currently active advocacy is being pursued for awareness generation and action against defaulting medical practitioners. Answers to Frequently Asked Questions have been framed to clarify legal and ethical issues regarding the practice for lay persons, doctors and appropriate authorities.

Organisational options for quality assurance (2000)
This study was done for the National Panel on Quality Assurance set up by the Ministry of Health and Family Welfare to help work out a framework, structure, systems etc. for developing national and state councils on quality in health care.

Ethical guidelines for research in social sciences and health (1998 -2000)
Through a national level initiative, which was co-ordinated by CEHAT, ethical guidelines, contextualised in the ethos of Indian society, for conducting social science research in health were evolved. Among others, their adoption by research institutions, universities, NGOs, government, donor agencies, is being advocated for.

Private hospitals and nursing homes: Need for an accreditation system (1997-99)
Reviews hospital self-regulation for improving quality of care and assesses the need and feasibility of an accreditation system for private hospitals and nursing homes in Mumbai.

Market, medicine and malpractice (1997)
Discusses issues and case studies based on the work of Medico Friends Circle (Mumbai Group) on Medical Malpractices, in a book jointly published by CEHAT and Society for Public Health Awareness, edited by Amar Jesani, P.C. Singhi and Padma Prakash.

Medical ethics for self-regulation of medical profession and practice (1995)
Examines the meaning of self-regulation, the code of ethics, the evolution of laws establishing Councils for health professionals in developed countries and India, their actual functioning, and lastly, the recommendations for bringing about change.

Laws for health care providers (1994-95)
Reviews health laws and legislation in India. Advocates comprehensive legislation for ensuring right to health care and universal access to services.

Physical standards in private sector hospitals and nursing homes (1994-95)
Studies the physical standards of health care in the private hospitals and nursing homes in Satara district of Maharashtra. It also recommends minimum physical standards for hospitals and nursing homes with less than 30 beds.

(3) Women's Health

Advocacy on Key Issues for Better Reproductive Health in Maharashtra (2004 onwards)
CEHAT in collaboration with Maharashtra Government is involved in advocacy on issues impinging on reproductive health in the State including age at marriage, gender equity, gender based violence and sex selection. The project will involve development and dissemination of awareness material, training of public health functionaries, orientation and awareness of other stake holders and development of audio-visual documentation This is being done in six districts of the state.

National Abortion Assessment Project (2000-2004)
This is a multi dimension and multicentric research initiative co-coordinated by CEHAT and Healthwatch. A wide range of quantitative and qualitative studies looking at various dimensions of the abortion issue from profiling abortion services, quality of care, methods of abortion, cost of abortion services, decision making in abortion, sex selection, pregnancy outcomes, informal providers etc. were undertaken in 16 different states by 24 research institutions. These studies are now published and widely disseminated. Also a series of 10 working papers based on existing abortion research, and a special issue on abortion of the journal 'Seminar' has been published. The findings from these studies have also been widely disseminated in 24 states through consultations involving a wide range of stakeholders including policy makers, health program managers, medical professionals, women's groups and NGOs.

Abortion Rate, Care and Cost: A Community Based Study (2000 onwards)
CEHAT has undertaken a state level sample household survey to arrive at abortion incidence rates and to examine the nature and extent of abortion related morbidity in Maharashtra and its management. The study also endeavours to examine women's choice of abortion provider, to understand the expenditure patterns on abortion care and reasons for seeking abortion in the light of their socio-cultural milieu.

Women's Health Project:(2003-2004) An outcome of the research done on Abortion Access, an effort was made to place it in the larger context of Gender, Women's Access to Health Care and Women's Rights and four workshops were organized in rural Maharashtra culminating in a dialogue with decision makers.

Reproductive health services research in 1990s – an annotated bibliography (1999 - 2000)
A compilation primarily aimed to take stock of research in this area to help identify research gaps so as to give direction to and sharpen the perspective for future research in reproductive health.

Aarogyacha Margavar: Violence and Women's health (1998 – 2002)
This women centred health project led to the establishment of community based health work, through trained women community health workers. It included an outreach programme for preventive and promotive care, health education, a referral clinic in the community and networking with public health systems.

The research component through qualitative group discussions and a household survey helped understand the extent and patterns of domestic violence, women's perceptions about its nature, causes, coping mechanisms, help seeking behaviour and community response to domestic violence.

Women, work environment and health (1998 -2000)
Studies work and environmental factors and their impact on women's health in the context of liberalisation and structural adjustment programmes. Examines women's work and health in garment and leather industry (Tamil Nadu), grape farming (Maharashtra) and slum conditions (Mumbai).

Research and advocacy for improving quality of abortion care (1997 - 2000)
Critiques the MTP Act, from women's point of view, lays down norms for quality of care including medical and non medical aspects. The quality of abortion care in registered and non-registered centres in two districts was assessed using this model. Advocacy for improving access to quality of abortion care in Maharashtra was undertaken and efforts towards this continue.

Women and health care (1996-99)
Studies women's health problems, use of health services and expenditure in 1600 households in Mumbai City and Nashik district of Maharashtra. It also provides gender sensitive quantitative methodology and tools for analysis for understanding women's health issues.

AIDS awareness (1994-97)
In collaboration with Prayas, a gender sensitive slide show in Marathi for AIDS awareness programme was prepared. Useful for conducting training, education as well as for carrying out advocacy campaigns. A booklet gives additional information for each slide.

Women's abortion needs and practices in rural Maharashtra (1994-96)
Socio-cultural study of women seeking abortion, their choice of providers and expectations from them. One of the outcomes has been a slide show that is useful for education and advocacy purposes.

(4) Investigation and Treatment of Psycho-Social Trauma

Dilaasa: Crisis Centre in a public hospital for Counseling of Women Survivors of Domestic Violence: (2000 onwards)

This Centre has been set up in a peripheral public hospital in collaboration with Brihanmumbai Municipal Corporation (BMC). CEHAT will continue to provide support in terms of conseling and allied services to survivors of domestic violence for the next 3 years. The crisis centre model is being replicated in two other hospitals in Mumbai and one district hospital. In addition the activities will focus on prevention of violence against women, community based support system for women survivors of violence, research on violence faced by health care professionals and the violence which exists within the system. It will also upscale the training function through regular 'Training of Trainers' programme and a course for nurses on 'Gender Based Violence and their Role In Responding to the Survivors of Violence'.

Involuntary Resettlement of a Slum Community in Mumbai - A Human Rights Perspective (2002)
This action research study is an attempt to capture the nuances of the social experience of resettlement and reflects on its consequences within a human rights framework. It aims at documenting people's experiences of the process of resettlement- the experience of shifting, experiences both individual and collective of life in the resettlement colony. This study attempts to develop guidelines for assessment of impact specifically pre-empting adverse consequences on health and education and suggesting measures to prevent adverse consequences.

Safe Kit: Sexual Assault Care and Forensic Evidence Kit (1997-98 and 2004 onwards)
A kit and manual for care, collection of medical and forensic evidences in cases of sexual assault on women. This kit helps improve the collection of scientific evidence in cases of sexual assault, and is envisaged as an advocacy tool to address care and evidence linked issues. Use of this kit by doctors, police, women's groups etc. would aid survivors in getting justice. Following a medical consultation to update the kit, advocacy is on for use of the kit by the public health system.

Violence in Hindi films and Television serials (1998 -99)
Review of depiction of violence and torture in Hindi films and television serials and its impact on children. A video film depicting violence from Hindi films along with a commentary has been produced.

International Conference on “Preventing Violence, Caring for Survivors: Role of Health Services and Profession” (1998)
This conference deliberated on four areas of human rights concern (a) state violence (b) violence against women (c) caste and communal violence and (d) development, health and violence. The conference organised in Mumbai from November 28-30, 1998, was attended by 223 delegates from India and abroad.

Survey of torture in Maharashtra (1997-98)
Survey of human rights situation and torture in Maharashtra in order to understand need for treatment and rehabilitation of torture survivors.

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