GRAAM’s advocacy efforts reached new heights in 2014-15 with a series of initiatives that truly resulted in taking the ‘community voice’ to the policy makers. With advocacy events at the State level and several tools generated, we were able to ensure that the research and evaluation outcomes reach the intended audience. More importantly, the positive acknowledgement and assurance of action from key people in the system, in response to GRAAM’s evidence-driven policy inputs, are a testimony to the organization’s non-confrontational approach to advocacy.
In the year gone by, GRAAM embarked upon a series of events titled Ground Realities with the aim of publicly disseminating evidence and the outcomes of GRAAM’s research work. The events, as the title suggests, comprised dissemination of facts from the ground along with an analysis and inference of the data. Needless to add, specific policy recommendations were also a critical component of the programs. Two events were held in Bengaluru over the year – one on public health and another on issues of employment for persons with disabilities.
Ground Realities – Public Health
On 13 June, 2014, ‘Ground Realities (Public Health)’, a dissemination event was conducted by Grassroots Research And Advocacy Movement, Mysuru, based on findings and experiences from its studies and projects in public health, in Bengaluru. Mr. N Sivasailam, Principal Secretary to the Government, Health and Family Welfare Services Department, GoK attended the event which saw about 50 participants from government departments, research institutions and civil society organizations working on public health. The focus of the event was on the issues of community participation in monitoring of health services and regional disparities in health in Karnataka.
During the event, the presence of regional disparities in health situation as well as health facilities and services were highlighted, based on GRAAM’s performance evaluation study of NRHM in Karnataka. Mr. Sivasailam agreed with most of the fundamental issues raised in the presentations and encouraged the use of report cards based on community inputs to guide the delivery of services. Towards reducing regional disparities, he agreed with a key recommendation of moving away from facilities-based approach to needs-based approach.
GRAAM’s successful experience in technology enabled community monitoring of Primary Health Centres in Mysore district was also presented during the event. A strong case was made for continuation of government support in community participation based on the evidences of Arogyashreni – a 3 year initiative undertaken by GRAAM between 2011 and 2014.
Continuing the dialogue – Addressing regional disparities
Following the event, GRAAM pursued its dialogue with the government on measures to address regional disparities in the health services in Karnataka. The regional disparities are most visible in the skewed distribution of health facilities in different districts of the state. While, Belgaum (Belagavi) and Gulbarga (Kalaburagi) administrative divisions of the state have fewer PHCs and higher population coverage per PHC, Mysuru and Bengaluru divisions have a higher number of PHCs. In comparison to the IPHS (Indian Public Health Standards) guidelines, Mysuru and Hassan districts have 81 excess PHCs each. Hence rationalization of the distribution of PHCs is a key step in addressing regional disparities.
Towards this, GRAAM developed a scheme and submitted a policy note in this regard to the Principal Secretary. As per the note, GRAAM has recommended opening new PHCs in those Taluks where the average population coverage per PHC is high and to close or merge PHCs where the average population coverage is low. However, certain factors like utilization levels of the PHCs, distance to other health centres and their location, must be considered before closure or merger. GRAAM continues to advocate for rationalization of distribution of health facilities and for change in funding patterns to the district, towards addressing regional disparities.
Ground Realities – Inclusion of Persons with Disabilities
On 19th June, 2014, GRAAM conducted a workshop to disseminate the findings of a study conducted in Kolar district of Karnataka in collaboration with Employment and Disability Institution of Cornell University. The event was attended by Mr. H K Patil, Minister for Rural Development and Panchayat Raj, Govt. of Karnataka, who assured that steps will be taken towards inclusion of persons with disability in Mahatma Gandhi National Rural Employment Guarantee Act.
The objective of the study conducted by GRAAM was to understand the efficacy of MNREGA in including PwD and to identify any barriers for their inclusion. The study involved field research and analysis and brought out the challenges faced by persons with disabilities in accessing employment opportunities in India’s flagship employment guarantee program. Evidence further points out that MNREGA is a crucial source of income as well as dignity for persons with disabilities since 61% of PwD are from socially vulnerable and backward groups.
GRAAM released a set of 4 factsheets and a policy brief during the event. Mr. Basavaraju R, the Principal Investigator of the study made a detailed presentation of findings highlighting inclusion level, barriers for inclusion and action required at the policy and implementation level. Dr. Susanne Bruyère – Director of Employment and Disability Institute and Associate Dean of Outreach, ILR School, Cornell University, USA, was also present at the event, which was attended by govt. officials, members of civil society organizations, academic institutions, students and media.
During the year, GRAAM provided policy inputs in different sectors including public health, education (mid-day meals), public distribution system, livelihood for persons with disabilities, strengthening grassroots governance and sanitation, among others.
Inputs to the National Health Policy
The Union Ministry of Health and Family Welfare has embarked on a process of drafting a new National Health Policy. Towards this, the Ministry, along with the State level health departments, has conducted consultations with various stakeholders. Dr. R Balasubramaniam and Rohit Shetti attended the Karnataka consultation in October 2014 during which various public health issues in the state were brought to the notice of the Deputy Commissioner, Dr. N K Dhamija in the presence of the Mission Director, NRHM, Karnataka.
Further to the consultation event, GRAAM team members have been engaged in deliberations and discussions on the theme and have drafted a policy note comprising points for consideration by the Union Ministry of Health and Family Welfare as inputs to the National Health Policy. A copy of the note was also shared with Shri Atul Kumar Tewari, Mission Director, National Health Mission, Karnataka.
A critique on the Draft National Health Policy 2015
The Ministry of Health and Family Welfare, G ovt. of India, had put its Draft National Health Policy in the public domain for comments and feedback. In response to this initiative, the GRAAM team has prepared a critique on the policy draft and submitted it online on the Ministry’s website. This is further to the earlier exercise in December 2014, wherein the GRAAM team had drafted a policy note comprising points for consideration by the Union Ministry of Health and Family Welfare as inputs to the National Health Policy.
In its critique, GRAAM has observed that the Draft National Health Policy, 2015 document makes an attempt to comprehensively list different issues that India faces in terms of health and is more detailed than the Health Policy draft of 2002. However, the document uses these concerns to set strong policy directions in a very limited way. The document also oscillates between being a commentary on the health situation and a narrative on ideal situations, but falls short of being specific on policy intent, objectives and the commitments of the State and more importantly on how the states will be equipped and empowered to deliver on the policy’s ambitions.
Dialogue on Karnataka State Health Policy
The Karnataka State Health Policy was last drafted and adopted in 2004. Over the last decade and more, newer issues and challenges have emerged in the health sector which need to be tackled. At the same time, stakeholders, including communities, civil society as well as private sector players, have been engaged in furthering their relevance in the policy formulation and implementation space.
GRAAM along with other civil society organizations has engaged in creating a space for a multi-stakeholder dialogue on the State health policy driven by the state itself. This calls for stakeholders working on different subjects within the ambit of public health, health services, etc. to come together and use their experiences and evidences to review the policy that is currently in place. The idea has received positive acknowledgement from the Department of Health and Family Welfare, Govt. of Karnataka and further activities are being planned in that direction.
Ombudsman for Public Health – Concept note
GRAAM prepared a concept note on the position and scope of Ombudsman (Public Health) and submitted it to the Principal Secretary, Department of Health and Family Welfare, Govt. of Karnataka. The intent of this document was to present the need for a Ombudsman (Public Health) in the Public Health system of India. In the document, the Ombudsman (Public Health) is viewed as a part of a larger system of Ombudsmen for Public Services with a larger aim of providing channels of communication to citizens that will help in reducing the asymmetry of information.
The Ombudsman (Public Health) has been envisaged as a position that not only facilitates conflict resolution and addressing of grievances, but also as a proactive position, whose office can influence positive systemic changes. As per the concept note, the Ombudsman would be positioned at each Sub-divisional Hospital (Taluk Hospital) and above, including Government District Hospitals and other Government Hospitals with 100 beds or more. The structures, norms and terms for the functioning of the Ombudsman have to be developed further and this document aims at providing a starting point for the same. The document is available on GRAAM’s website and we seek inputs and suggestions to improve the concept further. GRAAM would also be happy to join hands with like-minded organizations to push for the position of Ombudsman in Public Health with the larger aim of bringing transparency and accountability in the sector.
A land purchase policy to meet the State’s housing targets
GRAAM has undertaken the task of preparing a draft policy on Land Purchase for Housing Schemes in Karnataka for the Rajiv Gandhi Rural Housing Corporation Limited (RGRHCL). The objective of this exercise is to have in place a policy with practical guidelines that supports the State in implementing its housing schemes, especially for the poor, with an accompanying framework for land acquisition for housing. For the purpose, the GRAAM team has been involved in multiple consultations in both urban and rural settings to be able to grasp the ground realities in different parts of the state. Basavaraju R., Executive Director, GRAAM is also on the Advisory Committee on draft Land Purchase Policy for Housing Schemes in Karnataka, which is chaired by the Principal Secretary to the Government, Department of Housing, Govt. of Karnataka.
Strengthening grassroots governance
In an effort to improve the Panchayat Raj institutions and their functioning, the Department of RDPR, Govt. of Karnataka has initiated a process to review the Karnataka Panchayat Raj Act, 1993 and has set up a Committee headed by Mr. Ramesh Kumar for the same. Based on the experience and knowledge of team members, GRAAM has prepared a note consisting of inputs for the consideration of this committee.
The note comprises points that can lead to the strengthening of grassroots governance and mainly touches upon administrative reforms, measures that can make Grama Sabhas more effective and steps that can be taken towards improving transparency and accountability along with more democratization. The note also mentions the use of technology to strengthen community monitoring processes and how the Govt. can partner with reliable civil society organizations towards achieving this objective. The complete note provided by GRAAM may be accessed on GRAAM’s website.
Improving Mid-Day Meals in Karnataka
In response to an advertisement issued by the Rajya Sabha Secretariat in leading newspapers on 19 Oct, 2014 seeking inputs and suggestions towards ‘examination of the Mid-day meal Scheme’ by the Department Related Parliamentary Standing Committee, Human Resources Development, Govt. of India, headed by Shri Jagat Prakash Nadda, M.P., Rajya Sabha, GRAAM prepared and submitted a list of suggestions to the committee.
These suggestions were made based on the observations and experiences of GRAAM’s team members who have worked in the sectors of education, health and nutrition, rural governance and community participation in development in rural areas.
Reforms in PDS in Karnataka
GRAAM has engaged in dialogue with the Commission for Food, Civil Supplies and Consumer Affairs, Govt. of Karnataka with regard to the Rapid Appraisal of Annabhagya Scheme in Karnataka right from the inception of the study to the presentation of findings. In addition, GRAAM has also been dialoguing with the Commission on other issues related to PDS such as leakages and procurement of coarse grains. GRAAM appreciates some of the initiatives undertaken by the Commission in reducing leakages and looks forward to continuing the engagement.
Supporting the ‘Making Democracy Work’ campaign
GRAAM continued to support the ‘Making Democracy Work’ campaign undertaken by Vivekananda Institute for Leadership Development. The campaign preceded the Lok Sabha Elections of India that were held in May 2014 and covered the Mysore Parliamentary Constituency that included 6 Talukas of Mysore and Kodagu districts. The campaign comprised several public meetings, walkathons, talks at colleges, door-to-door campaigns, voters’ clinics across the city and generation of resources.
Dr. R Balasubramaniam was the key speaker at many of these events in addition to chairing a committee of respected citizens that was formed to oversee the progress of the campaign. Rohit Shetti represented GRAAM at civil society meetings where people’s manifestos were presented to political representatives for consideration and dialogue. The building and maintenance of the campaign website was also supported by GRAAM team members.
GRAAM’s vision of holistic village and community development
On 15th August, 2014, the Prime Minister of India announced the Sansad Adarsh Gaon Yojana (SAGY), a program towards converting villages across India into models of progress, development and sustainability. SAGY entails that all Members of Parliament adopt one village in their respective Parliamentary Constituency to start with and initiate measures locally to address all development issues of the village and put it on the path of progress. By the end of their term, the MPs are expected to take at least two other villages and replicate the process. If carried out sincerely and successfully, it would be possible to have more than 2000 model villages across India in a span of 5 years.
Around the same time, the GRAAM team also worked on its own vision of an ideal and progressive Gram Panchayat and prepared a comprehensive document on the same. The key philosophical underpinnings of this document included looking at development as an expansion of human capabilities, interconnectedness of urban and rural development, decentralization, self-sufficiency and ecological sustainability. In terms of approach, the document laid out that no additional funds need to be allocated for such development, based on the recognition that not only the Constitution of India and the various Acts, but also several programs and schemes launched by successive Central and State Governments are aimed at achieving the goals of poverty alleviation, quality education for all, healthcare, food security, protection of environment, right to livelihood, women’s empowerment and social uplift of the marginalized communities, welfare and justice, among others.
The document further laid out targets and outcomes in different sectors that the Gram Panchayat may take into consideration based on contextual factors. Lastly, monitoring and evaluation frameworks to ensure that the programme is on track, were also recommended. The document today serves as a useful reference for carrying out capacity building, planning and monitoring activities at the village level.
GRAAM developed several advocacy tools including factsheets and policy briefs over the year that were key to furthering its advocacy efforts.
Arogyashreni – Making Community Monitoring Work
Factsheet on the methodology and contributing factors for success of community monitoring of Primary Health Centres.
Arogyashreni – Community Driven Changes
A summary of the results of community initiated advocacy efforts in health, as part of Arogyashreni initiative.
Regional Disparities in Health – Evidences and Recommendations
Factsheet highlighting evidences of regional disparities in health in Karnataka and some recommendations to address the issues.
Making the Disability Certification Process Accessible
Challenges that persons with disabilities face in the certification process that makes them eligible to avail benefits from Govt. schemes.
Discrepancies in data on Persons with Disabilities
Discrepancies in the data of persons with disabilities at the National, State & District Levels that become a factor for deprivation of support and opportunities.
Inclusion Barriers for Persons with Disabilities
Numerous barriers prevent inclusion of persons with disabilities from benefitting from MNREGA despite provisions in the Act.
Why MNREGA is important for persons with disabilities?
Mahatma Gandhi National Rural Employment Guarantee Act is an important and, sometimes, the sole source of economic and employment support for persons with disabilities in rural areas.
Draft National Health Policy – A critique
A critique of the draft National Health Policy prepared by the Ministry of Health and Family Welfare, Govt. of India, and placed in public domain for comments and suggestions.
Towards strengthening public health in India
This document, drafted by GRAAM, contains points for consideration by the Ministry of Health and Family Welfare, Govt. of India, as inputs to the National Health Policy of India 2014.
A scheme for rationalizing the distribution of PHCs in Karnataka
A proposed scheme to address regional disparities of health services in Karnataka through review of distribution of PHCs based on average populations covered by them.
Improving grassroots governance
Inputs on strengthening governance at the grassroots level by the committee set up by the Government of Karnataka to review the Karnataka Panchayat Raj Act, 1993.
Inputs to Mid-day Meal Schemes
Suggestions for improving the implementation of Mid-day Meal Scheme submitted to the Department Related Parliamentary Standing Committee – Human Resources Development, Govt. of India.
MNREGA and Persons with Disabilities
Policy recommendations, at the State and National level, that can help make MNREGA more inclusive of persons with disabilities and make a real difference to their socio-economic conditions.
Ombudsman for Public Health
Concept note describing the need and approach for introducing the position of Ombudsman in the public health system of India.
Commemorating 30 years of Bhopal Gas Tragedy
2014 marked the 30th anniversary of the world’s worst industrial disaster, that took place in the heart of India. About 25,000 people have died and lakhs more injured as a result of a gas (Methyl Isocyanate) leaked from Union Carbide’s pesticide manufacturing factory on the night of December 2, 1984 and due to the contamination of the ground water as a result of the toxic material buried in the ground by the company during its operations. Though 3 decades have passed since that fatal night, justice still eludes the victims and activists of this disaster and the entire issue is one that raises serious questions on corporate accountability, environmental justice and preference of profit over human life.
To engage with these questions, a series of college talks were held in Bengaluru and Mysuru where Mr. Satinath Sarangi, one of the key members of the campaign for justice in Bhopal, engaged with students on the issues surrounding the tragedy. The talks, held at Azim Premji University, Bangalore, JSS Law College, Mysuru and SDM Institute of Management and Development Mysuru, were coordinated by Rohit Shetti and organized in October 2014.
Advocacy with the Prime Minister’s Office
With a new Government at the Centre formed on the basis of a clear majority of seats in the lower house of Parliament, there was an unprecedented opportunity to engage with the Central Government on the approach that may be adopted for development interventions. This led to the preparation of several documents that were circulated among key members of the Prime Minister’s Office. These included:
- A development vision for India: A document and a presentation on guiding principles of policies to be adopted by the newly formed Central Government.
- A national body for integral development: Preparation of a presentation and document for a national body replacing the Planning Commission of India.