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HRMG 2008-2009

With its firm commitment to social justice and health equity CHSJ has been systematically working to understand the health rights of marginalized communities. We have adopted a two pronged strategy:

  • To develop close linkages with networks and organizations working on the issues of exclusion - We have been providing support to WNTA campaign on Maternal Health and Social Exclusion and conducted orientation workshops in 5 states with partners of NCDHR on the issue of maternal health and social exclusion. State partners are currently engaged in collecting evidence of exclusion and marginalization in their areas.
  • To do independent research and evidence gathering to understand the gravity of the situation - This included looking at the national level surveys and other sources to bring focus on the issue of marginalization hidden within statistical data.  A qualitative study is being conducted to capture the experiences and perceptions of socially excluded communities in accessing health care services.

Literature review on Health and Social Exclusion - In order to understand the complexities of social exclusion phenomenon and its relationship with health, especially access to health services and health outcomes, an extensive and thorough literature review was undertaken on the following broad issues:-

  • Social Exclusion and Maternal Health
  • Social Exclusion and T.B
  • Family Planning and Social Exclusion
  • Maternal Health Care for Women living with HIV/AIDS


Polio Study  - The Pulse Polio Programme is currently the biggest public health programme in India. Keeping the health care needs of children affected with acute flaccid paralysis (AFP) CHSJ requested a MPH student from Liverpool School of Tropical Medicine to conduct a study on children affected by accute flaccid paralysis under the Pulse Polio Programme in Uttar Pradesh. The findings of the study show that children with AFP do not get any support from the government for follow up care, physiotherapy, reconstructive surgery or any for of rehabilitation. The study report has been shared with policy makers, however this year there are plans for wider advocacy action.

Facilitating Independent Review of Health Programmes - CHSJ has been facilitating a process of annual feedback on the National Rural Health Mission (NRHM) with special emphasis on RCH -2 components. CHSJ has also prepared two citizen's reports on the NRHM (2006 and 2007) which have been shared at National Stakeholders Consultation. The consultation was attended by bilateral organisations, UN agencies, Civil Society Organisations from across the country as well as the Government. The citizen's report was very well received by various stakeholders present in the consultation as they acknowledged the need for such independent feedback for understanding the process of implementation as well as mid course corrections.

  • Rapid Assessment of Health Programmes (RAHP) - CHSJ has been proactively creating platforms for civil society to share their concerns about health policy implementation to strengthen the process of accountability of health services. Over the years CHSJ has also facilitated a process of systematic enquiry into health programme implementation. This year CHSJ implemented a three phase training programme on “Rapid Assessment of Health Programmes” (RAHP) for grass root organizations to involve them in the process of monitoring public health programmes by using research methods. The training was organized in collaboration with University of Washington and UNFPA in which 11 organizations participated from various parts of the country. The capacity building process was intensive and included field level mentoring support in addition to training and review of research designs, instruments and draft reports. These reports will form part of the independent review of the NRHM for 2009. Some of the studies being conducted as part of this process include the following:

    •    Study of PPP for Emergency Obstetric Care under JSY in Maharashtra
    •    EmOC at CHC of Wardha District of Maharashtra
    •    Strengthening CHC for first referral care.- Meghalaya
    •    Influence On ANC Services By ASHA’s Interventions In Jharkhand
    •    Moving from Home Deliveries to Institutional Deliveries in Manipur
    •    Impact of VHSCs on service delivery under NRHM in Orissa
    •    Reviewing JSY from the perspective of marginalized communities in Bihar and HP

Exploring Universal Access to Medicines - About 80% of all private health care expenditures in South Asia are on medicines and ill-health is an important reason why South Asians fall into poverty. Yet not enough is known about the processes through which pharmaceutical products and their patterns of use help or hinder efforts to meet the MDGs.

CHSJ in collaboration with SAHAYOG and the University of Edinburgh (along with Martin Chautari in Nepal) is working on a research project “Tracing pharmaceuticals in South Asia: regulation, distribution and consumption”. This research has been led by a research group at the University of Edinburgh, including members of the Centre for International Public Health Policy and the research network on the Sociology and Anthropology of Health and Illness. The study integrates anthropological, public health and political economic approaches and aims to find the reasons behind the misuse of drugs like oxytocin(inducing labour), rifampicin(treating TB) and fluoxetine(depression) that are vitally important from a public health perspective by tracing their journey from production to consumption. It is expected that this might assist the development of effective interventions to improve MDG and other health outcomes and thereby contribute to poverty-reduction strategies.

Following is the list of working papers produced under the research project.

  1. WP1a - Pharmaceuticals Distribution Systems in India
  2. WP1b - Drug Procurement in Nepal
  3. WP2 - Qualitative Research on Fluoxetine and Oxytocin in India
  4. WP3 - Good Manufacturing Practice in the Pharmaceutical Industry

This research project is funded by The Department for International Development (DFID) and The Economic and Social Research Council (ESRC) , UK. The research project is near completion. Dissemination workshops are scheduled in the month from April-June 2009 in Delhi, Kathmandu and Edinburgh.