The 4th session of Health Assembly for social participation in Health Policy

Date: July 25^th, 2024

Time: 10:00-13:00 IST, 11:30-14:30 ICT, 13:30-16:30 JST

Number of participants: 9 (Ameer Khan, Suresh D, Chhaya, Khannita, Yonten, Stalin, Jalaluddeen, Ambrose, Karuppusamy) and 3 AHI staff (Yayoi, Kyoko, Yuko)

Agenda:

– Learn how the concept and model of the Health Assembly in Tamil Nadu were developed and by whom

– Learn the structure and organizing mechanism of the Health Assemblies in Tamil Nadu

– Learn the opportunities and challenges associated with the Health Assembly in Tamil Nadu

 

Brief Minutes

Ameerkhan and Suresh from SOCHARA have long been involved in health system observatories and are co-conveners of the Jan Swasthya Abhiyan (JSA), also known as the People’s Health Movement (PHM). JSA’s early contributions significantly supported the development of the Health Assembly (HA) through monitoring and advocacy for health improvements.

 

Presentation by Ameerkhan and Suresh

The National Health Mission (NHM), launched in 2004, emphasized community participation by introducing Village Health and Sanitation Committees (VHWSCs) in Tamil Nadu to oversee local health services. Established in over 200 Panchayats in Tamil Nadu in 2009, VHWSCs played a crucial role in community health monitoring and planning until 2013. Although they have since been restructured into Rogi Kalyan Samiti (RKS) committees with a reduced emphasis, some of their practices persist through civil society. The ASHA program, another NHM initiative, remains active nationwide.

Despite the NHM’s focus on community participation, government support has waned, with minimal priority and funding, leading to inactivity or neglect of community participation efforts like VHWSCs unless prompted by external pressures.

 

The World Bank (WB) became involved in 2008, launching the Tamil Nadu Health System Reform Program (TNHSRP). This program aimed at improving health infrastructure and introduced performance indicators to enhance transparency and accountability through citizen engagement. The WB funded the HA concept in Tamil Nadu, marking its inception.

In 2019, JSA Tamil Nadu members, including Ameerkhan, Suresh, and Mr. Raman, developed guidelines for the HA, informed by the Thailand Health Assembly model, Tamil Nadu’s community monitoring and planning practices, and public hearings organized by JSA.

The HA, initially planned to start in 2020, was postponed to 2022 due to COVID-19.

 

The HA in Tamil Nadu represents a collaborative effort among civil society, the government, and academic experts, aiming to place people and communities at the heart of the health system and empower them to take an active role in their health.

 

The HA process in Tamil Nadu includes a multi-tiered assembly approach: Panchayat, Block, District, and State levels. Preparation and execution involves several committees:

1. State Governing Body
2. State Working Committee
3. District Working Committee
4. Block Working Committee These committees plan and execute the HA, involving civil society members and technicians.

 

The district HA was conducted in 14 districts during Phase 1 (2021-2022), expanded to 16 additional districts in Phase 2 (2022-2023), and included 10 more districts in Phase 3 (2023-2024).

 

Key aspects of the HA process include:

1. Government-led organization of HAs, a novel approach in India, with commitments from officials.
2. Political neutrality, allowing open discussion of health issues, even by ruling party members.

 

Notable achievements include a state HA inaugurated by the Chief Minister, ongoing discussions, and funding approvals for resolutions. Despite these efforts, challenges remain in securing funding for some resolutions and monitoring their implementation. Resolutions without immediate funding are addressed through alternative solutions or follow-up actions.

 

While the program has made significant progress, its success depends largely on civil society’s active participation. Civil society plays a crucial role in ensuring the HAs are conducted democratically and effectively, providing feedback, and raising awareness about the program. Districts like Krishnagiri and Thanjavur have demonstrated high levels of engagement due to strong civil society mobilization, whereas districts with weaker civil society involvement have not utilized the HAs as effectively.

 

To enhance the process, it is recommended to improve transparency by making resolutions public and ensuring HA events are more visible to encourage broader participation. Institutionalizing the HA process within the health system and ensuring it becomes a regular, serious program is also essential. Engaging a wider range of stakeholders, including trade unions and professional associations, is crucial for broadening participation. Advocacy for the Right to Healthcare Act could further formalize and strengthen the HA process.

 

Overall, while the HAs in Tamil Nadu have shown progress, there are gaps that need to be addressed to make the process more democratic and impactful. Continuous improvement and sustained civil society involvement are key to achieving the program’s goals.

Planning Future Interactions: Next Steps
Ambrose found the previous sessions with Thai counterparts helpful, while Khanitta recommended interacting with Thai NGOs that work closely with local HAs. Chhaya proposed engaging grassroots organizations involved in community-level HAs and supported planning future meetings for direct interactions between Tamil Nadu and Thai NGOs. Ameer showed interest in online interactions to enhance the HA process. All participants agreed that Khanitta’s team will present the Thai model to a broader audience in Tamil Nadu during the next session, scheduled for the beginning of September.