On vulnerable groups of Indian Sundarbans

1. The variance in understanding of the health rights of vulnerable groups in the Sundarbans, India
UpasonaGhosh,ShibajiBose, SabyasachiMondol
HSR Cape Town
3rdOctober 2014

2. Right to Health to which India is a signatory
Article 12 “The right to the highest attainable standard of health” of the International Covenant on Economic, Social and Cultural Rights
General Comment 14 of the Committee stated right to health requires availability, accessibility, acceptability, and quality of health care.
Community interprets Right to Health extending not only to timely and appropriatehealth care but also to the underlyingdeterminantsof health
Alma Ata Declaration
right of access to health facilities, goods and services on a non-discriminatorybasis
ensure accessto the minimum essential food which is nutritionally adequate and safe
provide essential drugs
Citizen Charter on Hospital Care
Providing generalinformation
CasualtyandEmergency Services
Out-patientcare
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3. Guiding logic behind the research
Whoare the vulnerable of the vulnerable?
What extent they are more vulnerable?
How health rights of these people are getting violated?
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4. The Sundarbans
Geographical barriers
Frequent climatic shocks

5. Sundarbans‟ Health SystemChallenges of Accessibility, Affordability Acceptability and Parallel Health Market
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Accessibility
Affordability
Acceptability
Parallel health Market

6. 6Objectives
To Explore:
The most vulnerable groups within the already geo-climatically vulnerable context
Extent of their health vulnerability
Violationof their health rights

7. Methodology
Census of Public health infrastructures in PatharpratimaBlock
Ethnographic observation for two months
Six FGDs with communities
21 Case studiesThree villages in PatharpratimaBlock with varying geographical locations:
Completely Deltaic
Partly Deltaic
Non-deltaic

8. Findings
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9. 9
Who are more Vulnerable among the VulnerableWomen with out- migrant husbandsCrab collectors
People living on the embankment
„Meendhara‟

10. Extent of Health Vulnerability (self perceived)
Mothers
Direct health impacts
Skin infections
Gastro-enteric diseases
Vaginal infections
Body ache
Animal attacks
Psychological stressors
Impacts on social determinants
Livelihood
Shelter
Food security
Child
Direct health impacts
Gastro-enteric diseases
Acute Respiratory infections
Malnutrition and related morbidity
Drowning
Insects and snake bite
Impacts on social determinants
Food insecurity
Lack of psycho-social care
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11. 11
Availability of health workforce and facilities in Patharpratimablock (actual compared to IPH Standards)

12. Do I have right?
“Doctor comes and goes as he wishes. We simply do not know how many days he is require to stay”.-Respondent, Non-deltaic village
“ we are unsure of what kind of treatment is available in different Govt. health facilities. Can you give me a list”? – Respondent, -partly deltaic village
“Every year people in my village dies out of snake bite. May be this is our fate”-Respondent, Deltaic village

13. Violation of Health Rights of the Mothers
Basic Rights
Right to receive equitably distributed functioning health care facilities, medicine and services
Right to receive emergency medical care
Right to receive treatment from skill and trained medical personnel
Right to receive information regarding out- patient care
To what extent it is violated
18 out of 21 respondents reported non- availability of Doctors and medicine during time of need
All respondents reported no emergency care facilities in times of like animal attack, snake bites or injuries and during climatic disasters
All respondents reported RMPs are the first point of care for general and emergency health issues
17 out of 21 respondents do not have concrete knowledge due to frequent changes in out-patient care timings
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14. Basic Rights
Right to born in a safe hand
Right to receive care during the 1st month followed by full preventive care
Right to fed according to the universally accepted good feeding practices
Right to receive treatment from qualified provider when fall sick
Right to receive regular supplementary nutrition
To what extent it is violated
All the respondents delivered at home
16 out of 21 didn't receive any supervision from any health worker
Initiation of breast feeding just after birth was done by all the respondents. Exclusive breast feeding has been done by 11 out of 21 respondent
Children of all respondents receive care from RMP at a first point
12 respondents out of 21 reported ICDS centers are far off
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Violation of Health Rights of the Child

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More in-depthunderstanding on needof the vulnerable groups-felt or unfelt
Perception of Supply side regarding special need of these vulnerable groups
Perception of decision makers regarding the health rights of the vulnerable groups
Scope of further research

16. Conclusions
The vulnerable groups are unawareabout their health rights as an entitlement
Conceptof health rights are more supplier determined
Noplans or provisions for specific, targeted and tailor maid health care supplyfor the vulnerable groups

17. Thank You
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