What are the major challenges in the way of improving public health services and health awareness in India and the developing world?
Public health service and level of health awareness of a country are intrinsically linked with its condition regarding literacy, poverty, gender equality, knowledge and information base of people. With regard to health services and awareness the biggest challenge at present is to bring the concept of ‘public health’ within the domain of ‘general health’. Health services by and large are curative in nature with minimal emphasis on generating public awareness and particularly neglecting reproductive health. Poor people who actually need public health service have not been able to avail much what they needed. Gender differentials that we see has also been a big constraint in providing holistic health service. Most of our health initiatives are centered around family planning with less emphasis on public health. On the other hand, there are discrete verticals of malaria programme and leprosy programme but at the end the concept of ‘Total Health’ had been grossly overlooked. So, we need to go back to the continuum of basic health, where nutrition, reproductive health, general health and preventive health receive equal weightage. Lack of awareness about reproductive sexual health is also a deterrent. Increasing awareness of unmarried men and women health in reproductive sexual health possesses a tremendous potential of transforming the overall health conditions in India as well as in other developing countries.
MAMTA has a strong background in advocating for health policies. What are the prominent policy interventions that MAMTA has been able to make for improving health system/services?
In terms of policy interventions the major achievement that MAMTA can claim as an organisation is in successfully advocating for health issues of adolescents and young adults (10-24 year olds). What we see today in policies like National Population Policy, Youth Policy, Health Policy or for that matter the Tenth Five Year Plan, giving due consideration to youth and adolescent issues are all results of a strong advocacy by MAMTA and similar such organisations. However, we have not been able to succeed as much towards incorporating concerns of young and adolescents in the National Health Policy as compared to others. Issues of youth and adolescent health have been overshadowed in National Health Policy against larger health agendas. Currently, MAMTA is working on it through its expertise in policy research, advocacy and training. However, we have been able to bring sexuality and reproductive health of young people into focus. We are striving hard to intertwine these issues into existing health framework.
Kindly elucidate the various progarmmes of your organisation and issues that are being addressed through them.
MAMTA’s action programmes are quite broad based and covers a number of strategic areas. First and foremost is ‘field intervention’ in which MAMTA directly intervenes with the community on specific health themes and issues. These programmes are primarily based on participatory models with people driven agendas. Such developmental models are already working in states of Delhi, U.P, Haryana and Karnataka.
The other way of our action work is through partnering with external development agencies and augmenting their skills through training and collaborative research. This comes under the programme known as SRIJAN (Sexual and Reproductive Health Network for Joint Action). We are also using this network to address issues of illiteracy, early marriages and school dropouts, which somehow influence reproductive health and sexuality. Currently the network is covering 102 districts across 7 Indian states with more than 150 member NGOs.
Another area of our work is primary and first-hand research.
We have conducted research projects with various national and international institutions. Some of our research partners are the various government departments; national institutes like NIHFW, NIPCCD, NCERT, IIHMR, WHO, UNIFEM and UNICEF.
Apart from these, we are also engaged in creation and dissemination of health information and knowledge through preparation of working papers, documents and websites, as well as through workshops and conferences. We have conducted training programme in institutes like Lal Bahadur Shastri Academy and also in health resource centres in Punjab, Haryana and Chandigarh under RCHO project of Government of India. We have done similar work in Bangladesh as well, under the Reproductive Health Initiative of Young Adults (RHIYA) project of UNFPA. In China, we developed a close collaboration with Centre for Reproductive Health & Training Institute to initiate a south-south Asia partnership for training in gender rights, reproductive health, sexuality and HIV-AIDS.
How is MAMTA addressing the UN MDGs and what are the strategies for integrating them in its overall programme management?
By and large our programmes are addressing almost six or seven MDGs. They are covering issues ranging from poverty, infant mortality, maternal health, HIV/AIDS, education and overall social well-being. As an institution our focus is to address MDGs through young people mechanism. In India, most of the reproductive activities happen in the age group of 15-29 years. That’s why we find that 50% of HIV-AIDS patients in India fall under this particular age group. In case of pregnancies, 19% of cases fall under the age group of 15-19 years, 35% fall under 20-25 years and adding the age group between 26-29 years will cover almost 3/4th of all pregnancy cases. So, obviously mortality rate is also high in this particular age group. Again, infant mortality is directly proportional to maternal mortality. Moreover, research finding says that younger the pregnancy more is the inter-generational poverty. Younger pregnancies results in higher school dropout of girls, compels women to go for menial jobs and restricts their skill development. Thus, knowledge about the outfalls of all these issues is crucial for the community. This is where MAMTA’s interventions come into play. Thus, I would say that our work is not simply driven by MDG agendas, rather, we aim to contribute to these agendas by investing in such issues.
What is the level of preparedness of our country towards meeting the MDGs? Will it be possible for us to achieve these goals within the stipulated time frame?
As regarding MDG targets, I am very hopeful that we will able to achieve them – if not within the stipulated time frame but definitely with some more time. However, my concern is whether we have put in enough processes to achieve those targets. Whether we care for educational levels to go up both in terms of numbers and quality and for that matter move beyond just primary enrolment to quality education and higher student retention. Commitments in terms of financial resources, if achieved in reality, would itself be an indicator for preparedness. The centre-state relationship will also play a pivotal role in this matter. Strong political will across all parties is very crucial for achieving MDGs.
What are your views on the role of ICTs in leveraging health education and services? How is MAMTA implementing ICTs in its initiatives?
No wonder ICTs are growing fantastically and doing a great job. However, my concern is that ICTs are still too much urban centric. If we want to look into ICTs as tools for development it has to be more rural specific. ICT should also move beyond the literate population. It has to somehow work for even illiterates. For that matter, we have to focus on text-less (i.e. pictorial and graphical) interfaces, which can even be used and understood by illiterates and semi-literate masses. I think ICT has a huge potential to reach out that no other mechanism has. Moreover, it can be totally apolitical in nature while being age-appropriate, sex-appropriate and even culture-appropriate.
MAMTA has started taking up ICT in a serious way. We have initiated this effort through our ‘Informatics Centre’. We have built a dedicated website and portal for information dissemination about our organisation, our programmes and all information related to reproductive sexual health, maternal and child health, adolescent health and likewise. We have also converted our entire website in Hindi language and put it into a CD for the purpose of off-line viewing. We are in a process of sending these CDs to all government schools with computer facility. We are also planning to send them to village panchayat (village level governing body) offices where computers are available. On-line and off-line ‘Youth Forums’ have also been set up at district level for mobilising youth community resources. We are even focusing on generating more content in local area languages and make ourselves as much locally relevant as possible. We are even trying to get hold of local dialects and use them in our communication channels.