JSS has tried to intervene in influencing policy and practices where possible in issues of primary health care of the rural poor. The main areas of advocacy have been:
- Drug pricing, procurement, weeding out irrationality, and the listing of essential drugs.
- Diagnosis, treatment and control of malaria in the public health system and the community.
- Treatment strategies, choices and diagnostic strategies in tuberculosis treatment.
- Antiretroviral therapy care availability for HIV positive people at the state level in Chhattisgarh.
- Better PDS and food availability and supplemental oil in PDS.
- Access and quality issues in primary health care- advocating universal health care and a package of health care that looks at all the needs of the rural poor people.
- Need to reinstate a proper leprosy treatment and control programme.
- Radiotherapy facilities in central and northern Chhattisgarh.
- A special programme for the under 3 child- especially to address the complementary feeding needs.
Excerpts from Reports
Availability of edible oil in the Public Distribution System
It has been shown previously that the nutrition levels of adults and children are abysmally low due to poor food availability. The PDS provides for 35 kilograms of rice at Rs 3 per kilogram in Chhattisgarh state to all poor families. However, this is not adequate. It has been shown previously that the diets of people contain less that 20 ml of oil per day, while the necessary amount should at least be 40 ml per person per day. We had been arguing for long that like rice or wheat, the PDS should provide for edible oil too, a measure that will increase calorie intake without increasing the bulk of food. In May 2008, this demand has been met, and now each family gets one litre of edible oil @INR 60 per family (much lower than the market price) per month.
ART centre in Raipur
Due to advocacy efforts, the first centre offering access to anti-retrovirals opened in the capital city of Raipur in January 2007. We have been referring patients to this centre and have already described the positive impact that access to anti-retrovirals has had on the lives of PLWHAs, in our previous reports. While this is a positive practice change, it is still inadequate for a single centre in a state of 133,000 sq.km and a population of 20 million, with large distances and inadequate public transport.
Issues in tuberculosis treatment and control
We have been arguing for changes in the management of tuberculosis for several years. The following changes have resulted in the public health system's practice in tuberculosis:
- The World Health organization accepts and recommends daily frequency of drug treatment in tuberculosis for all types of tuberculosis as the preferred frequency rather than intermittent frequency in the last 3 years. We had reviewed the literature and our own experience and had found intermittent treatment regimens inferior to daily treatment regimens.
- The need for supplemental food in treatment of tuberculosis has also been recognised. The World Food Programme is now going to make provision of food for patients with tuberculosis and HIV in selected states.
- The need for treatment provision for Multi drug resistant tuberculosis in the public health system has been accepted. While the numbers are small, the state has agreed to it.
Heart diseases in children
Heart diseases in children are a significant cause of morbidity and death. A great majority of them are manageable if diagnosed early and surgical treatment planned. Due to our highlighting the issues, the following has happened at the policy and the practice levels:
- The child cardiology society of India has developed standard guidelines- a policy document for management of these problems for the entire country. In August 2007.
- The government of Chhattisgarh has initiated a child heart diseases management scheme that will provide funds for diagnosis and management of these children and will organise the care.
Creches for the under 3 child
The policy document for the under 6 child, recently prepared has specifically recommended opening of village level crèches for the child below 3 years of age in rural areas, in addition to the anganwadis that are existing. We had been advocating for crèches based on our service work, in order to address the problem of complementary feeding in the young child effectively.
Agriculture: System of Rice Intensification
We have successfully advocated for the adoption of the system of rice intensification in dryland areas by the government of Chhattisgarh in order to increase food production.
Leprosy
Our aggressive advocacy for reinstatement of the recently disbanded National Leprosy Eradication Programme has only resulted in it being recognised as an issue that needs redressal. However, there have been no changes at the policy and the practice level.
