“Nothing About Us, Without Us”
New Delhi, April 10, 2015

Each year as many as 44,000 Indian women die needlessly during pregnancy and childbirth. Official estimates place India’s Maternal Maternity Ratio (MMR) at 167 maternal deaths per 100,000 live births. 

In order to bring country-wide attention to the issue of safe motherhood and the importance of citizen’s participation to achieve that, White Ribbon Alliance India (WRAI) along with Centre for Catalyzing Change, FPAI, IPPF, Plan India, Save the children, and World Vision India, at a national meeting, appealed to citizens and government to actively engage and work out an action plan to address women’s and children’s health in India.

The national meeting in India took place in New Delhi.  Attended by more than 150 representatives from civil society, government and citizens, this meeting stressed that citizens must be empowered to demand their entitlements, and be engaged in matters that are important to their health and well being. Accountability mechanisms must be set up to enable citizens to track commitments. 

“Engaging citizens is what will take us from setting goals to actually meeting them,” said Aparajita Gogoi, National Coordinator, White Ribbon Alliance India.

For citizen engagement to truly work, accountability mechanisms need to be created where citizen’s voices are heard and acknowledged in designing, implementing and monitoring the programs for women’s and children’s health.
 

CITIZEN & CIVIL SOCIETY RECOMMENDATIONS

  • Decentralization of powers to local levels is essential, especially in the areas of planning and monitoring, to ensure that all plans are drawn up and implemented keeping the needs of the community in view.
  • Community awareness generation and empowerment programs can be used to enable the community to claim their  entitlements and expect a better standard of the quality health services they receive.
  • Communities should learn about existing health systems structures and obtain opportunities to monitoring of health services. User friendly and simple tools should be developed for the community to track service delivery in their areas.
  • It is important that marginalized and minority sections of the society are empowered and encouraged to contribute fully and fearlessly in development plans and schemes.  
  • Acute shortage of Comprehensive Emergency Obstetric Care and referrals remain inadequate  at most of the public health care facilities in India needs to be seriously addressed by the government.
  • Readiness on the part of the public health system is essential to ensure an effective citizen engagement process. 
  • Develop client feedback and client and staff redressal mechanisms to address grievances related to entitlements and public health services. It is also important to ensure that citizens are not subjected to any reprisals following their complaints.    
  • Greater efforts are needed to make gender an integral component of the national political agenda, including adopting gender based budgeting
  • The high prevalence of anemia amongst Indian adolescent girls and women is indicative of poor status of the girl child. It is important that issues of good nutrition for girls and women are brought to focus. 
  • Gender equality cannot be achieved without the involvement of men and boys.  A male cadre of frontline health workers should be developed to augment and fill in for the non-availability of female health workers in some care in order to strengthen the public health care system at the grassroots level.
  • Develop a comprehensive BPCR mechanism for both supply and demand side.
  • Quality Ante Natal Care (ANC) mechanisms are crucial for timely identification and treatment of complications that might arise at any point of pregnancy. 
  • Post Natal Care (PNC) is equally important to detect and treat any life-threatening post delivery condition. 
  • Role of midwife, ANM and nurses are critical in preventing maternal deaths and therefore it is vital to improve their competence and skill sets. 
  • Elected representatives need sensitization to the government’s initiatives for women and children’s health and on the facilities and funds available to makes services available. 
  • In addition to strengthening the service delivery component on public health care system, concentrated efforts are also needed to promote preventive health care services such as ante-natal care and immunizations.
  • Bring-to-scale CSO led successful pilot projects.
  • Media is a powerful tool in influencing the development agenda of any country. Engaging with media is important not only to influence the public health policies but also to act as a platform for civil society to make their voices heard.  
  • Include the youth and their voices in deciding the health agenda for the country. 
  • India’s civil society should strive towards being closer to the Prime Minister’s Office (PMO).  For example it might be possible to be part of the inner circle of the highest office of the Indian government when traveling abroad, just as currently manufacturing and big business is.

 

People need to be more responsive and demanding so that no mothers die in India. We need to empower citizens to demand fulfillment of entitlements and quality health services
— Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family Welfare, Government of India
Through this campaign, we want to send out the message that every woman has a right to live and survive pregnancy and childbirth, and that citizen’s engagement can go a long way to help achieve the goals
— Dr. Aparajita Gogoi, National Coordinator, WRA India
We want to ‘Move from a parliamentary democracy to a participatory democracy. Creating accountability structures, citizens’ engagement for policy making, the AAP government is working to include citizens through the Mohalla Sabhas and the newly developed Delhi Dialogue Council
— Raghav Chadha, Spokesperson, AAP
We need to ensure that citizen partnership is not gender neutral and women get adequate representation.
It is important to ask whether women’s voices have been heard. The gender agenda has to have a political voice
— Yamini Mishra, UN women
There needs to be greater investment in strengthening and empowering citizens…We also need tools which are simple and ready to use and should be in place to ensure better maternal and child care
— Smita Bajpai, WRA Rajasthan Coordinator