It was unanimously agreed that health
was reflective of a state’s socio-economic status, which would improve
with increased state spending on health. It was felt that
the issues concerning public health were a common responsibility
of all stakeholders – the government, NGOs, civil society,
institutions, individuals and the community. In order to
translate ideas into concrete action, it was agreed that
a “Task Force” for the state of Orissa would
be constituted. The Population Foundation of India, with
the cooperation of the state government, would be the facilitator
for this mission.
The traditional approach, in which the government was visualized
as the sole provider of services, had to be amended. The
government, along with NGOs, could play the role of facilitator
to empower the community. As poverty alleviation, social
development, health and population stabilization were closely
inter-related, only an integrated and comprehensive programme
could effectively address these issues. It was strongly felt
that the programme should include gender and equity concerns.
The conference also addressed key concerns in the context
of the socio-economic profile of Orissa. Enhancing female
literacy and improving the nutritional status of women and
children were of prime importance in the context of the state.
The participants stressed upon the need to impart information
on health to the people, so as to empower them to tackle
their health problems. It was felt that diseases could not
be eradicated by technical interventions alone. People need
to be sensitised in order to assume the role of facilitators
in the healthcare system.
The participants felt that a public-private partnership
was vital to mainstream public health initiatives across
the state. Advocacy through elected representatives would
ensure public acceptance of these issues amongst the masses.
At the same time, strategies had to be developed to ensure
political commitment.
The shortcomings within the government
system were also touched upon at the conference. Lack of
manpower, delayed response and low motivation were some
of the problems cited by the participants. Yet, despite
such shortcomings, the government remains the biggest provider
of services. Therefore, efforts would have to be made to
ensure that the government implemented its mandate. In
this regard, NGOs could lead the way by sensitising the
government to replicate these strategies. The impact of
the government-NGO partnership at the grassroots level
was questioned – it was felt
that it was the responsibility of both the government and
NGOs to develop mutual trust at all levels.
Another issue raised was the danger of the government co-opting
NGOs. Some felt that it was possible to work with the government
and still criticize it. Additionally, NGOs were cautioned
and advised to only commit to tasks they are capable of,
rather than taking up projects because the government funded
them. It was felt that by working with the government, critical
data could be collected and presented at all forums.
It was also felt that the Panchayati
Raj had to be strengthened, with greater financial power
and institutionalisation based on the healthcare delivery
system. Cultural and caste barriers could be overcome through
an approach in which the community serves as the starting
point for all discussions. The involvement of citizens
at the grassroots level in any initiative is paramount.
Several models initiated by community-based organisations,
such as Dr. Abhay Bang’s Gadchiroli model and Dr. Antia’s
Parinchey model are examples in themselves. Their plans of
action could outline the mechanisms to provide integrated
services to the community.
During the two-day deliberations at the conference, the
role of social marketing in population stabilisation and
socio-economic development was discussed extensively. In
the social marketing framework, Oral Rehydrating Solution
(ORS) and other important health products like anti-tubercular
drugs need to be an integral part of the framework. Despite
the government supply of various commodities such as condoms,
rural people opted to buy social marketing products. Factors
like better packaging and a general perception of better
quality contribute to this trend. As such, social marketing
efforts should focus on rural areas without compromising
on quality of care. It was ascertained that people were prepared
to pay for what they perceived as quality products.
It was further suggested that cost-effective, sustainable
and community-based health insurance and healthcare methods
were required. The universal registration of marriages, pregnancies,
births and deaths involving community volunteers at minimum
cost was also recommended. A greater emphasis must be laid
on evidence-based, rather than impression-based, advocacy.
