CEHAT supported KHOJ, the petitioner of the PIL for increasing health funding by providing specific budget information and budget analysis to the Mumbai High Court

Center for Enquiry into Health and Allied Themes (CEHAT) along with KHOJ (Quest for Knowledge, Hope, Opportunity, and Justice) did a budget analysis at the local and district level to prevent child malnutrition in Maharashtra.

Background

In 2007, three voluntary organizations1 together with the local government started a counselor program to improve health services for pregnant women and children in all government hospitals and health centers of Melghat, a tribal block in Maharashtra. The program trained local girls and boys from the Korku and other forest-dwelling communities to be counselors who were then placed at all health facilities to promote health education, increase access to health services of Indigenous people and facilitate referrals to reduce child and maternal deaths. For this programme, the voluntary organizations put in resources and undertook efforts to train the counselors and coordinate the implementation of the program. In early February, 2010 the district authorities terminated the counselor program, without taking stakeholders into confidence and not offering any explanation for such action. From Feb 1, to 16th April 2010, the voluntary organizations repeatedly requested authorities in the district/division/ then Guardian Secretary- Dr. Goel to review the decision.

Suo Moto Writ Petition in the Mumbai High Court

Failing to achieve any favorable decision locally, KHOJ wrote a letter to the Mumbai High Court registrar requesting an investigation in mid-April 2010 and also on 7 May 2010, following which the Mumbai High Court (Suo moto writ petition 3270 of 2010) issued an order to the State for continuation of the counselors program.

On 25 November 2010, the State filed an affidavit that raised several issues which invited the attention of the Hon. Court. In fact, several inter-sectoral issues like transport, communication has been raised by the representatives present on behalf of the Dept. of health. To counter the state affidavit, KHOJ and CEHAT made a presentation bringing in the ground reality and also problems in administrative interventions, the way it overruled and sidelined the involvement of the voluntary organizations who are stakeholders. The petitioners also stressed on the fact that funds allocated for the CTC and VCDC program were quite inadequate.

Affidavit of the Petitioner in Response to the Affidavit Filed by the Respondent Date 25th November 2010

Following this, the court instructed the government to review the funding issue raised by the petitioner (in the high court of judicature at Bombay civil appellate jurisdiction writ petition no.3278 of 2010 : date saturday, december 04, 2010)

The order stated
Regarding budget provision, it is submitted that during the current financial year 2010-11, a budget of Rs. 41.19 lakhs [1] has been kept at the disposal of the District Health Society, Amravati under RCH-II PIP 2010-11 for organization of VCDCs (Counseling centres) and CTS (Child Treatment Centres).
The petitioners' submit that the amount of Rs.41.19 lakhs will not be sufficient for the current financial year 2010-11 because about 50,000 children in Amravati district are suffering from malnutrition and the aforesaid amount of Rs. 41.19 lakhs would come to Rs.82/- per child for the rest of the year. It is submitted that the requirement is Rs.30/ per child per day i.e., Rs.900 monthly per child and therefore for four months (of the remaining fiscal year) the said amount is not sufficient.
Hence, the Additional Chief Secretary states that government will consider the above suggestion.

Organizing a Consultation

The district administration and the secretaries of the Tribal, Rural and Health Development responded by approaching NGOs to join them in developing the District Vision Document which could be the potential guiding document for all the plans in future. On 24 January 2011 a formal government-led consultation was convened titled "Tribal Health Plan Implementation Processes and Budgets" with various stakeholders. Workshop/consultation was jointly organized by Divisional Commissioner, Amravati and Civil Society Organisations... Concept note and summary of the meeting)

The participants of the consultation agreed that the allocation should be a proper cost basis allocation, equivalent to Rs. 900 per child per month (or 15 times the present allocation of Rs. 1350 lakhs, assuming a three month child nutritional treatment). In the meeting, the civil society also raised another demand that the normal supplementary nutritional program run by the Integrated Child Development Scheme would receive additional funds to prevent the children already participating in the program from lapsing into malnourishment.

The consultation participants' demands were reiterated in the Mumbai High Court hearing on 5 February 2011. The recommendations containing several points of action, was prepared, by Bandu and Purnima from KHOJ, Dr. Satav from MAHAN, Prashant Raymus and Rahul Sapkal from CEHAT and Ravi Duggal from the International Budget Partnership, and submitted to the court.

Outcomes and Current Status

The Court has said that this is not an Adversarial Litigation and hence we must take an opportunity to bring about certain policy changes for difficult areas like Melghat. It also ordered that cost based allocation was a justified way for allocating resources and the budget allocations should be made using such calculations. The court also ordered the authorities to look into the suggestion, that the National Rural Employment Guarantee Act (NREGA) should ensure employment in the Melghat region to improve the tribals' livelihoods and opportunities to fulfill their nutritional needs. The NREGA, which is an employment guarantee programme should invest optimal resources to provide the guaranteed 100 days of employment and this in itself would provide enough resources to poor families to deal with nutrition issues apart from the supplementary diet budget for malnourished children. Thus budget allocations should include 100 employment days to nearly 90,000 workers registered under the NREGA instead of the 10,000 currently employed. The court issued instructions to the government to take immediate action and make all necessary resources available as suggested by the petitioner.

The next hearing to review the status of these demands is scheduled for 30 April 2011

1 MAHAN, KHOJ, ICICI Centre to child and nutrition