The right to health is recognized in several core international and regional human rights treaties and national constitution. The International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Convention on the Rights of the Child (CRC) are some of the central human rights instruments for the protection of the right to health.
The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002. The draft health policy is in the process of updation.
In major urban areas, healthcare is of adequate quality, approaching and occasionally meeting Western standards. However, access to quality medical care is limited or unavailable in most rural areas, although rural medical practitioners are highly sought after by residents of rural areas as they are more financially affordable and geographically accessible than practitioners working in the formal public health care sector.[i]
The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The Union Cabinet vide its decision dated 1st May 2013, has approved the launch of National Urban Health Mission (NUHM) as a Sub-mission of an over-arching National Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Sub-mission of National Health Mission.
The article shared the finding of the health facilities availed to the most marginalized communities in six blocks of Uttar Pradesh (Badagaon, Pindra blocks -Varanasi, Chaka block- Allahabad, Robertsganj block – Sonbhadra district and Tanda block – Ambedkarnagar district) and one block of Jharkhand (Domchach block – Koderma).
Here the term of marginalization discusses as introduced by Robert Park (1928). Marginalization is a symbol that refers to processes by which individuals or groups are kept at or pushed beyond the edges of society. The Encyclopaedia of Public Health defines marginalization as, “to be marginalized is to be placed in the margins and thus excluded from the privilege and power found at the centre"
76% of the informant gets treatment from local coax or Ojha and Sokha and only 24% of the informants go for treatment in Government hospital especially for institutional delivery. Due to discriminatory treatment and feeling of marginalized in hospital, these communities preferred to get treatment from because they were easily accessible and they feel more connected to them. Jab bhi ham sarkari aspatal mein dawa lene jate hai toh doctor sahab ham logo ko yah kahakar bhaga dete hai ki tum logo jao yaha se tum logo badbu aati hai (whenever we go for the treatment in Government hospital we are ill – treated and without being diagnosed we were asked to leave their chambers). The vulnerable groups that face discrimination include women, Scheduled Castes (SC’s), Scheduled Tribes (ST,s), children, aged, disabled, poor migrants, people living with HIV/AIDS and sexual minorities. The negative attitude of the health professionals towards these groups also acts as a barrier to receiving quality healthcare from the health system.
The role of Ojha and Sokha(coax) are more important doing the treatment, the witch hunting and especially in moulting the malnutrition with burning the part of body with hot rod. The ojha’s and sokhas are in various follows categories:
1. Junior Ojha: belong to same community and residing in the same village
2. Middle level
3. Senior Ojhas
Anita (name changed) resident of village Mangari under block Pindra of Varanasi district said “My 5 children died than I started to visit Ojha in my village for the exorcism (jhad fook). I visited to many ojhas in different places then also my child does not survived. During that time I came to know about famous Ojha in Gazipur. I visited the Ojha after looking me he said you “You are surround by 10 witches from your to maternal home to your husband house. I will cure you those witches if you will pay me 10000 Rupees. After paying the money he squad the witches but after few days my 13 pig felt sick and died.
I ranged to the Ojha he said it does not happened by the witch squad by him. If anybody can claim same witch is creating problem than in same money I will do treatment will return back the money. My relative gave witch to my niece in food. A Sokha living next to my house came to my house and said he hmouth. She got cured. I gave sokha one dress (Kurta and Paijama), one goat, one bottle of alcohol and 1500 Rupees.
My husband got infected with Tuberculosis. Whenever he takes medicine he felt ill. I took him with to various ojha’s and he feel better.
The PVCHR activist Prabhkar tried to convenience her to get proper diagnosis and treatment of her husband from Government hospital. He called grass – root health worker ASHA[ii] for taking him to hospital for the diagnosis. The discourse went for more than a month when his condition started deteriorating then she ranged to Prabhakar and pleaded “Please immediately take my husband to hospital otherwise he will die.” Now he is under medical treatment in Pandit Deen Dayal Hospital (district hospital) after being referred by Primary Health Center.
PVCHR with the aim to eliminate the superstition through regular health camps, focus discussion and activation and monitoring of health system. After having discussion with community the activists prepared the expense of the treatment with Ojhas or sokhas as follows:
1. Fees of Ojha or Sokha: 500 Rs.
2. Travel expense: 500 Rs.
3. Treatment cost: 5000 – 15000 Rs. depends on the category of witch
4. Followup for six months: 3000
Not only mental illness but several times physical illness is often misinterpreted according to local beliefs ‘they are mad’, or by religious healers ‘they are obsessed by gods and ghosts’. Although the community may accept these people, it may also lead to torture and rape such as the continued prevalence of ‘witch hunting’ where the villagers beat the ghost out of these women.
Jagesari Devi, aged 32, a tribal woman of Sonebhadra district, became a victim of witch hunting and her tongue was chopped off. Smt Manbasia, aged 45, was subjected to inhuman ordeal and on 17 July 2010 after the demise of a boy in the village, she was not only attacked with sharp weapons but also paraded naked in public. In another case, a woman Somari Devi, aged 40, wife of Dinesh Gond was branded as a witch and pushed into a fire, however, her husband saved her. In her testimony, she alleged that the police did not register her complaint and instead of punishing the culprit, the police let him off scot-free. PVCHR got information of these cases through daily newspaper. Team psycho therapists went to Mayorpur block a remote area in Sonbhadra district and provided psycho – social support through testimonial therapy.
The cases were brought in notice to National Human Rights Commission 11772/24/69/2011-WC. The commission recommends to the Chief Secretary, Government of Uttar Pradesh to make payment of Rupees 3,00,000/- as monetary compensation to three survivors.
30 years old Chinta Musahar resident of village Raunawari, post Mangari, Tehsil Pindra, block Pindra district Varanasi said “I felt slight pain in my stomach and went to the Gangapur hospital at 10 am on a hand cart with my mother-in-law and village ASHA. At the hospital the ANM did the check up and said the baby will not be delivered now hence you may go back and come again before 7 in the evening as the child is expected by then. I was not given any injectable medicine. In the evening again I felt pain and this time it was severe. I called up ASHA at 7 and she came at 7.30 and took me to Rajpura health centre on a hand cart only. The pain aggravated further and I was in labour pain then.
The ANM was an upper caste (sawarn) and apart from that ANM and a dai (help/maid) there was no one in the health centre. I was made to relax on the bed and having done so I saw ANM going out and followed by the dai, who’s face was covered by cloth. My mother-in-law was beside me and I was in pain. For some time I changed position in pain and cried but the ANM did nothing. When my mother-in-law went pleading for medicine the ANM chased her away.
At around 8.30 in the night the hands of the foetus were out and it was immense pain. But the ANM did nothing. I pleaded before her and at 9 pm she only told me that it was a serious case and I should go to Varanasi city for treatment. I got frightened and said, “I have no money sister where should I go and what should I do now.
This is not a single story of Chinta Musahar but many pregnant mothers like chinta are facing structural discrimination against these groups takes place in the form of physical, psychological, emotional and cultural abuse which receives legitimacy from the social structure and the social system.
The institutional delivery is lowest among women from the lower economic class as against those from the higher class. So, in 2005 Government of India launched Janani Suraksha Yojana to decrease the neo-natal and maternal deaths happening in the country by promoting institutional delivery of babies. Janani Suraksha Yojana was launched in April 2005 by modifying the National Maternity Benefit Scheme (NMBS). The NMBS came into effect in August 1995 as one of the components of the National Social Assistance Programme (NSAP).
As far as social security and development is concerned dalit, tribal and minority women have little access and are subjected to dual atrocity thereby. Those bodies that are responsible for womens’ health services are engaged in money making from these women only and ignore their needs. At times women have lost their lives due to such an attitude.
“At that time in the Hospital there were present 2 female attendants of pregnancy, one senior female attendant and one compounder. Two female attendants came to me and asked me to deposit Rs 150 for exercise injection to my daughter. I told them that I had no money. Then they replied why I had come to the hospital and they refused to attend my pregnant daughter.
Then my niece gave me Rs 100 and I gave it to the lady attendant and the lady attendant gave injection to my daughter. After some time my daughter gave birth to a male child. Again the lady attendant demanded Rs 100-200/- but I told her that I had no money. Then they refused to hand over the baby to me” Says Munni Mushar of Mangari.
"Upper-caste health workers refuse to visit Dalit communities," "Because of that pregnant Dalit women do not nutritional supplements and the majority of them are anemic says Lenin Raghuvanshi" [iii]
The marginalized communities in northern India are socially and economically deprived. They did not have permanent livelihood option and or received less remuneration of work is given in form of kind, mostly as food or food-grain. Thus they have no savings for their times of need, and are forced into starvation at times when they have no regular work. Malnutrition deaths of children are very alarming. Integrated Child Development Scheme (ICDS)[iv] is one promising scheme against malnutrition.
While monitoring the functioning of ICDS center at the grass – root level the two issues came in limelight that:
1. Structural violence faced by children by ICDS worker
2. Inactiveness of the ICDS center
PVCHR monitored the health of the children following the format used by the ICDS workers to monitor the weights of children. The finding shows more than 70 % children faced Grade III and IV malnutrition.
The organization brought the issues in consideration of National Human Rights Commission, District Magistrate now these children are receiving the service as mentioned in the ICDS (supplementary nutrition, immunization, health check-up, referral services, pre-school non-formal education and nutrition & health education).
In the cases of acute malnutrition and hunger the Uttar Pradesh government issued a directive on 24 December 2004 signed by the chief secretary after a very massive campaign of PVCHR. This directive requires every Village Council in the state to form a committee for hunger and malnutrition. The committee is issued an emergency fund. When a credible case of starvation is documented, the family or the person suffering from starvation is to be provided immediate financial help of Rs 1,000 rupees.
The work of the model village focused on Institutional reform (health centres and ICDS centre), increase community awareness and community ownership on various schemes through empowerment of marginalized communities and breaking culture of silence of caste system, which is promoting follows:
Availability: functioning public health and health care facilities, goods, services and programmes in sufficient quantity
Accessibility: non-discrimination, physical accessibility, economic accessibility (affordability), information accessibility
Acceptability: respectful of medical ethics and culturally appropriate, sensitive to age and gender
Quality: scientifically and medically appropriate
Above resilience of communities for activation of quality health services is helping the process of medical support and medico-legal process in cases of torture and organized violence too.
[i] http://en.wikipedia.org/wiki/Health_in_India [ii] http://en.wikipedia.org/wiki/Accredited_Social_Health_Activist [iii] http://www.impatientoptimists.org/Posts/2013/05/Women-Birth-a-New-Vision-for-Maternity-Care [iv] http://en.wikipedia.org/wiki/Integrated_Child_Development_Services
Shruti Nagvanshi & Shirin Shabana Khan