Sharing power with communities

Sharing power with communities

As a matter of health and social justice, health research should improve the health and well-being of those considered disadvantaged and marginalised and foster their engagement in all phases of its conduct. Such communities’ engagement in priority-setting is a key means for setting research topics and questions of relevance and benefit to them. However, without attention to dynamics of power and diversity, their engagement can lead to presence without voice and voice without influence. What is needed to give marginalised communities a voice in agenda-setting for health research projects? In this talk, Bridget will present the findings of conceptual and empirical research that address this question. Key ethical considerations for sharing power with community members that should be taken into account before, during and after priority-setting will be identified and discussed.

Speaker

Bridget Pratt

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Affiliation

Ethics researcher, University of Melbourne

Date

04-December-2018

Time

11:00 am – 12.00 pm

“At Source Waste Segregation and Management program” in KG Halli

“At Source Waste Segregation and Management program” in KG Halli

 

Institute of Public Health (IPH), in association with the Bruhat Bengaluru Mahanagara Palike (BBMP) and Sarvagna Health Care Institute (www.shci.in), another non for profit trust, kick started a project to change KG Halli to address issue of waste management. Bengaluru Development Minister Shri K J George inaugurated this program.

During the launch, residents in a colony of economic weaker section at Kadugondanahalli (KG Halli) were provided with two separate bins and awareness material about wet and dry waste for each house and Urban health team members created awareness about the importance of segregation at source for these residents.
The process of  waste collection from house till the  disposal will be followed up closely and documented to understand the effectiveness of this initiative and to scale it up to other areas in a phased manner.
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To know more about this program click on the links below:

NGOs and BBMP Launch Unique Solid Waste Management

KG Halli set to say goodbye to garbage woes

CP or CP? Community participation or Corridors of power

A recent visit to the offices of the local government health offices and the tertiary level hospitals confirmed what I had suspected for ages, after working in the field of public health for over two decades. There are two key reasons why our public health system is in shambles on the ground, despite India being one of the first countries to sign the Alma Ata Declaration. Briefly, the first is the completely top down approach of the government hierarchy and mindset of medical education. The  second is the colossal divide between the preventive and curative wings of our health system. This article explores the first fact, the second I leave for another day.

Permit me to outline how the first operates in translating great planning on paper to a non-functioning apparatus in the field. The experience of these visits will be used to illustrate why, even if we straighten out the “systems”; integrated, holistic, affordable care will never be available to our one billion people, while our “experts” in the field hold conferences on achieving Universal coverage in New Delhi and Geneva.

In every document that outlines how the public health systems in the rural and urban areas should function, the interface with the population of responsibility is seen as being important. Obviously, people should know who they should rely on for health care, but experience has shown that it is equally important that the health care services should be responsible to the population they serve. The balance of this translates as a spectrum of community participation- from the lowest level where people are passive recipients of care to the highest level where communities plan, monitor and evaluate the services.

We strive to the latter goal. Let me clarify who ‘we’ are. As a team of researchers, trying to bring both private and public providers onto a platform with local community leaders, we have been working for two years with the local doctors and community members in a single geographic ward of the city. Time and again we have been struck by the warm hearted welcome in the homes, particularly the poorest. The home of a patient in the community may consist of a single room, 6 feet by 10 feet, in which a family of 2 to 8 members might live. Even so, in this room, where walking is restricted by the tiny space, there is no awkwardness in rolling out a mat or putting out the single foldable chair to make one feel at home. And with this single human act of trying to make the visitor feel at home, a relationship is established which dictates the future partnership.

Contrast this with the reception our team met with in the various offices we visited last month. In an effort to meet the officers in charge of the health services in the city, we hired a taxi and went from office to office, hopeful that someone in the system might be interested in what we were attempting. And everywhere the response was the same. More often than not, a waiting of 15 -45 minutes outside the room, a cursory invitation to enter, not necessarily to sit…a brief look up from the files to hear what we had to say. And before we had launched two minutes into our story , an interruption with “ So tell me Madam, what is it you want me to do?” as we shuffled on our tired feet.

The interesting fact is, in both cases (the patient with us and then us with the officer) the only need was to be listened to. But in the first, the community member has taken the proactive step of setting the stage for listening to happen. (I remember a senior physician who taught us in Medical College saying that sometimes the most important input for an inpatient on rounds is the doctor sitting by the bedside in order to listen to him or her.) And in the latter, a power equation that invisibly translates from officialdom – top-down. The assumption on the part of these authorities is that they already know what needs to be done, so your presence in their office could only be for audience, permission or financial aid. And undoubtedly, the stroke of a pen on a file changes the response down the line. A three minute brief at the Commissioner’s office got us the desired result.

So we were honoured by the visit of the officer-in-charge to the ward, at the behest of the senior authority a day later. The visit and her interface with the community workers can be best described in their own words. “Madam, when they learn to be big doctors and officers like this, are they not taught manners?”

So I conclude that while community participation and corridors of power are identical, mutually exclusive acronyms, like all health system reforms, work must happen at both ends.

Response: caught between two world views

As a trained allopathic practitioner myself, two decades ago I found myself in similar circumstances (1) and appreciate the dilemma of the young doctors. Since this analysis is after the event, it must be read as a tentative explanation of the confusion we often create for ourselves.

Historical influences on a doctor’s professional behaviour

The beginnings of this story must go back to the time when we clinical practitioners, along with the rest of the scientific community, adopted positivism as the way that knowledge was constructed. A positivist approach emphasises “facts” as perceived by the five senses as the basis of empirical evidence. When these facts are shared by a community of “objective observers”, the common ground becomes the basis of “truth” or “real” knowledge. In fact, the positivists would say this is the only truth, proven and set in stone. Interpretation does not play a role here, as the shared observation is considered to be true (1).

However, this knowledge is still from a particular point of view, however closely shared. Western science, in its claim to be objective, separated the observer from the observed and was willy-nilly given pride of place in the hierarchy of knowledge. Medicine, claiming to be a science, needed to be free of “subjective values” (1). This is one limb of a doctor’s training; the attitude imbibed from it has repercussions which we shall see as we proceed.

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Community Health Day – Nittur PHC, Tumkur

Community Health Day – Nittur PHC, Tumkur

Community Health Day (Institute of public health,IPH)Karnataka State Health and Family Welfare department has declared year 2011-2012 as National Vaccination Programme. The goal is to increase focus on seven vaccine preventable diseases. To promote the programme much further, the department observed September 20 as Community health day in all the districts of the state. The prime agenda on the community health day at all Primary Health Centres(PHC) and Community health centers (CHC) over Karnataka was to undertake a promise to ensure that all children in their respective villages are immunized against the seven deadly diseases- Tuberculoses, Poliomyelitis, Diphtheria, Pertusis, Whooping cough, Tetanus, Measles.

Place : Primary Health Care (PHC), Nittur village, Gubbi taluka
Date : 20/9/2011
Time : 2:30 to 4:30 PM

Programme objective:

  1. To inform all village health stakeholders about National Vaccination year.

  2. All stake holders to take oath, to ensure that all children in their respective areas are immunized.

  3. To create awareness about facilities and services/schemes provided at PHC

  4. To take innovative ideas and suggestion from the community representatives on ways to improve health care services at PHC.

Community health day reportPhotos
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