Womens Health in Kerala in the Context of PPC Ms'Aleyamma Vijayan SAKHI, Womens Resource Centre, Tri

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Womens Health in Kerala in the Context of
PPCMs.Aleyamma VijayanSAKHI, Womens Resource
Centre, TrivandrumMarch 7, 2003, New Delhi
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2001 Males Females
Total   Population 15,468,664
16,369,955 31,838,619 Sex ratio
1058 Literacy 94.20
87.86 90.92   Source Census of India
(provisional)
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(No Transcript)
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Social constraints Poverty- Among these 35 are
female headed Unemployment-4 times compared to
national average Violence against women
increasing Lack of autonomy Participation in
politics low Work participation rate also is
lower than national average Suicide rates high-3
times that of national average
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Other constraints -1 High percentage of male
migration and consequent problems Disturbing
trends like unfavourable sex ratio among 0-6 age
group Child marriages still prevalent in the 4
northern districts (36) High morbidity-both
acute and chronic diseases MMR is not low in
spite of 93 institutional delivery Over
medicalisation of womens body cesarean rate is
30 (rural) to 35 urbanCs in private
institutions is 43.2 Overall cost of care going
up due to privatization
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• Other Constraints - 2
• The proportion of elderly aged (60) in Kerala is
  9.5 and higher proportion are women
• Numerically it is about 3 million people
• Very high morbidity recorded
• Morbidity of the marginalised communities like
• It is high among fishing and tribal communities
  but both groups have been neglected in health
  plans

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• Given this context what does decentralised
  planning mean from a gender perspective?
• 33 per cent reservation
• PPCs emphasis on womens participation
• Womens component plan-10 of funds to be spent-
  mandatory
• Formation of neighbourhood groups(NHGs) and
  self-help groups(SHGs)

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Womens Roles Role Of Elected Women
representatives (EWRs)- level of participation
do they represent womens interests or of their
respective parties? How do they get selected to
compete in elections? What is their gender
awareness? Role of Women in the community and
their Participation in gramasabhas(GS)-
attendance Vs participation what is portrayed as
their needs/interests? Is the agenda of GS
evolved in meetings? Or is there a prepared
agenda in respect of benefits
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Enabling environment
PHC
Women
PRI
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Objective

• To examine the role of decentralisation through
  the peoples plan campaign in improving local
  priority setting for womens reproductive health
  needs
• How effective are the linkages between PRIs and
  PHCs?

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Methods

• Stake holder interviews with Panchayat members
  and health providers using in-depth interview
  guidelines
• Action research to bring both groups, PRIs and
  Health Systems personnel to participate in
  district level seminars

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Expected Process of Linkage

• The Doctor should initiate prepare draft
  discussion paper on the PHCs budgetary
  requirements
• No written draft till 2002 and allocations made
  on verbal discussions
• Process made mandatory from 2002

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Perceptions of PRI-PHC Linkages -1

• Decentralisation improved or has the potential to
  improve the health status of the people
• PRIs increased the awareness of health issues
  among the communities
• Decentralisation enabled better functioning of
  PHCs through
• Improvement construction of
• outpatient inpatient buildings
• Operation theatre
• Laboratory facilities
• Toilets
• Prompt repair of water, sanitation other
  facilities

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Perceptions of PRI-PHC Linkages - 2

• Doctors play an advisory role while panchayats
  play managerial role
• Allocation to health determined by
• Level of institution (block PHC gets more funds
  and support for improvement and maintenance of
  facilities)
• Relationship between the PHC and PRI members.
• The study found that the level of interaction
  between the PRIs and the PHCs were directly
  proportional to the levels of allocation

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Role of Health Care Providers in PRI Activities

• Doctors participated in panchayat planning and
  review meetings
• HDCs health camps provided opportunities for
  panchayats PHCs to interact
• The MPWs attended all Gramasabha meetings but
  were not able to effectively highlight health
  issues

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Constraints in PRI-PHC Linkages

• Lack of training of Panchayat members in managing
  health projects.
• Limited resources available with the PRIs
• Low priority for health, and PRIs did not have a
  perspective on womens health needs
• Disinclination to make any culturally
  unacceptable changes
• Lack of effective communication
• Hierarchical nature of both systems prevent
  health workers from taking up health related
  issues

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Conclusions - 1

• The processes for planning for health and the
  roles and responsibilities of PHCs and PRIs in
  this are not clearly understood by either groups
• Enhanced interaction between the PHC-PRI has the
  scope to really improve health in general and
  reproductive health in particular in the
  communities
• Initiatives by the district level officers seems
  to have the potential to strengthen the linkages

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Conclusions - 2

• Increased awareness of health as a priority among
  PRI members as one doctor of a Block PHC in
  Thiruvananthapuram said major change in the
  health of the people could be brought about by
  raising awareness of health issues among PRI
  members. Such knowledge will make the politicians
  talk about health and only then changes can
  occur

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Thank you