internship report (1)

INTERNSHIP REPORT
“Economic burden analysis on the household of female
sex workers due to expenses incurred on medical
expenses on healthcare needs of the children.”
SCHOOL OF HEALTH SYSTEM STUDIES
Submitted by: - Organization: - Awabai Vadia Health Centre
Nikita Pandey Project: - SNEH, Shivaji nagar
M2015PHHP009

INDEX:-
1. ABOUT THE ORGANISATION
1.1 ORGANISATION
1.2 WORKFORCE STRUCTURE
1.3 SERVICES
2. ANALYSIS OF THE ORGANISATION
2.1 ANALYSIS OF MISSION, VISION AND GOAL
2.2 ANALYSIS OF WORKFORCE STRUCTURE
2.3ANALYSIS OF SERVICES
3. MANAGEMENT PRINCIPLES
3.1 MANAMENGT STRUCTURE
3.2 SWOT ANALYSIS
3.3 PESTLE’S ANALYSIS
4. ISSUES AND RATIONALE
5. RESEARCH METHODOLOGY
6. RESULTS
7. CONCLUSIONS
8. POLICIES AND PROGRAMMES
8.1 NATIONAL, CIVIL BODY AND INTERNATIONAL POLICIES AND PROGRAMMES
8.2 ANALYSIS
9. COMPARATIVE ANALYSIS
10. POLICY BRIEF
10.1 EXECUTIVE SUMMARY
10.2 BACKGROUND
10.3 POLICY CONTEXT
10.4 RECOMMENDATIO

ORGANISATION
Introduction:-
Family Planning Association of India, Mumbai Branch is a non-profit, non-political, non-
sectarian organization which provides voluntary, non- governmental commitment to promote
sexual and reproductive health and rights, including family planning and child health. FPA
envisions health with emphasis on young and marginalized people. It focuses on the broad
context of sustainable development, eradication of poverty, stabilization of population, gender
equity and human rights. It supports the rights of individual to reproductive choice, including
legal and safe abortion; work towards reducing the spread and impact of STIs/HIV/AIDS and
increasing access to gender sensitive SRH information, education and services to all especially
the young and marginalized and eliminating violence, discrimination and abuse.
FPA Mumbai Branch has four running clinics – Kutumb Sudhar Kendra (Mumbai Central),
Prajanan Swastha Kendra (Bhiwandi), Kutumb Niyojan Adarsh Kendra (Thane) and Avabai
Wadia Health Centre (Tilaknagar), all of which are running Global Comprehensive Abortion
Care Initiative (GCACI) activities. There are total of 8 projects operational at Bhiwandi in
addition to 4 other projects running at the AWHC clinic, out of which Service, Education and
Training Unit (SETU) will be closing down in April 2016 and activities integrating into the
system. Avabai Wadia Health Centre, situated in Tilaknagar caters to the larger unmet needs of
family planning, reproductive health and pediatric health care in areas across Mumbai and Thane
district. The three major projects named SETU, MESU- clinics on wheels and SNEH project are
functional in and around the areas from Mankhurd, Govandi to Vashinaka.
MESU is a Land T funded mobile medical unit project which works as an outreach unit wherein
various camps, exhibitions and medical checkups are organized and performed by the unit
comprising of a field programme officer, two community outreach workers, a nurse, a medical
officer and the driver. Voluntary community distributors were voluntary participants in the
project who worked as distributors for the various contraceptive pills and condoms amongst the
community of a particular area. The coverage areas of MESU project are Mankhurd, Ghatkopar,
Chembur and Vashinaka.
. The Satellite Clinic under the SETU Project is presently working as the referral unit, counseling
centre and no clinical procedures are performed there. The clinical staff consisted of a counselor,
the head nurse, the programme officer and the link worker who deal with major health issues like
white vaginal discharge, unwanted pregnancies, reproductive tract infections and other menstrual
health problem.
SNEH a project working with Female Sex Workers have their satellite clinic in Baiganwadi area.
The major services provided by SNEH are regular medical checkups, ART registration and
referral, HIV testing, VDRL testing for Syphilis, free condom depots for distribution, organized
social security camps for Aadhar card and Election card.

WORKFORCE STRUCTURE:-
PRESIDENT
VICE – PRESIDENT
HON. SECRETARY JOINT HON. SECRETARY
JOINT HON. TREASURERS
HON.DIRECTOR AVABAI WADIA HEALTH CENTRE
BRANCH MANAGER
PROGRAMME MANAGER
OUT REACH WORKER
PEER EDUCATOR
The project manager specific to every project leads the activities under the mission of every
project. There are 4 outreach workers working with approximately 12-13 peer educators/
community workers from the target population. The community workers/peer educators majorly
work towards counseling and distribution of contraceptive pills and condoms.
ORGANIZATIONAL STRUCTURE OF SNEH PROJECT:-
HON.SECRETARY
BRANCH
MANAGER
PROJECT
MANAGER
OUTREACH
WORKER
PEER EDUCATOR

SERVICES:-
Basic Services:-
The services being provided by the AWHC for sexual and reproductive health are contraceptive
services- Spacing and Permanent, Safe abortions, RTI/STI Testing, HIV/AIDS Testing and
Counseling, Sub- fertility services and Maternal and Pediatric Care Clinic.
Special Services:-
Special weekly OPDs for men, adolescents and children are conducted by all the four
Reproductive Health Family Planning Clinics to help increase the accessibility to male clients
specifically. Mumbai Branch started Colonoscopy training to increase the clinical services
provided. The Mumbai Branch expanded the number of contraceptive services by adding Female
Condom and Progesterone –only Pill (POP), in the basket of contraceptives. Social marketing of
Condom was initiated by CBDs. AWHC was also recognized as Laparoscopic Training Centre
for training doctors in Laparoscopic surgeries.
Other Events and services:-
Experience sharing by the females who underwent sterilization surgeries as a part of celebration
of World Population Day to raise awareness in making family planning services was organized.
Mumbai Branch also worked in association with MTNL and sent out SMS messages on family
planning to all MTNL Mobile users in Mumbai. Municipal Corporation also permitted AWHC to
conduct Comprehensive Sexuality Education in BMC schools. AWHC also helped the
adolescent girls complete Bedside Assistant Course to get suitable jobs.
Under the AIDS strategy, four migrants, four female sex workers and Shadows and Lights
projects were functional targeting the migrant population, female sex workers and transgender,
male to male sex and people living with HIV for HIV care, testing, counseling and required SRH
services. Special efforts put up to reach out to the newly married couples for creating awareness
about responsible parenthood, safe motherhood and adoption of contraceptives for spacing
children. Youth forum members developed Mobile Android apps and used it for sharing
information among the youth about the services available in Mumbai Branch Clinics.
PERFORMANCE:-
As compared to the previous year 2013, in the year 2014 AWHC showed increase of 15% in
project performance in all indicators except contraceptive and safe abortion services. In the year
2015, an increase in the numbers of clients accessing the services has increased by 4500 but a
reduction in the numbers of services provided has seen negligible increase. Also the increase is
seen in clients seeking services related to contraceptive measures. The number of SRH Services
provided through different Service Delivery Points of Mumbai Branch in 2012 increased by 65%
in 2013 and further increased by 34% in 2014.

ANALYSIS OF THE ORGANIZATION:-
Analysis of the Goals, Mission and Vision:-
With a broader objective of promotion of sexual and reproductive health amongst the population,
Avabai Wadia Health Center (AWHC) caters the unmet needs of the family planning. The
AWHC due to its strong IEC activities in the community is a preferred referral centre for various
services related to reproductive and sexual health. The voluntary services being provided are not
entirely non- profitable and are progressive in nature in terms of the fees charged for services in
accordance with the socioeconomic status of the service seekers. As an organization it was very
reflective of the constraints faced in providing free services due to the non-sustainable nature of
the projects planned and high dependence on the funding agencies. Withdrawal of funding from
any of the funding agencies led to the complete closure of the project or its integration with the
other running projects leading to the fund fragmentation and loss of focus on the target
population.
In lieu with the missions, AWHC was found to be focusing more on the counseling related to
STIs/ HIV and family planning, of contraceptives and barriers, abortions services and surgeries
related to sterilization. The legal aspects, prevention of discrimination, abuse and violence were
found to be secondary activities with very less focus on the same hence deflection from the
mission as mentioned was seen.
On interaction with the various stakeholders in the main branch and the satellite clinics various
aspects of understandings of the functioning of the organization were developed. The stakeholder
at the administration levels were concerned with the “No Refusal Policy” along with the profit
motives in running the various project. The outreach workers although working in close
proximity with the beneficiary population had very strong orientation towards the welfare of the
community which the projects have been targeting ever since the functional years which more or
less has a span of half a decade. The new recruitments at the managerial levels led to certain
changes in the way of service delivery the repercussions of which were faced by the frontline
workers from the community. The administration too is bound to do structural adjustments as
suggested by the funding agencies who play the role of the most important stakeholder in the
entire project functioning.
Though the vision and mission of the AWHC doesn’t envisions working in close proximity with
the state, but the support and referral by the Anganwadi workers was found to be playing an
important role in the population’s preferences towards AWHC for seeking services. The vision
clearly lacks the inclusion of community in achieving various objectives thus making various
projects unsustainable, which can be seen during the near to closure tie of one of the major
projects SETU running since 2010.The project though has selected Community Based
Distributors , identified Depots for easy access to the contraceptives like Hair Salons and MoUs
with the private medical practitioner of the areas to be covered, but the major role of these

community interactions are very limited to merely providing the contraceptives and condoms.
This has led the community to be dependent on the free supplies being provided by AWHC ever
since the start of project and sudden abortion of free services has led to non-cooperation amongst
the population and outreach workers with the AWHC main centre.
PROFESSIONAL UNDERSTANDING DEVELOPED:-
“Add little to little and there will be a big pile”
- Ovid
With regard to the functioning of the organization the foundation of vision, mission and goals
play a very important role. Establishment of activities undertaken to run a project shall run in
lieu with the goals, mission and vision established. While the formulation of the same shall be
realistic the various risks and assumptions made play an important role in planning the project to
be sustainable and successful too. Too broad and vague an objective might lead to overambitious
setting of goals which becomes difficult to achieve. The target population covered with the
capacity of the project shall be rationalized in terms of keeping up with the various measures of
achievement set. The planning of the project right from the beginning shall envision a period for
which it will be functional and the target community shall be empowered enough to be working
towards self sustainability post the project period.
Community plays a major role as a stakeholder in any of the projects. A close knit association
with the community and the state in working of a project are the crucial measures to be kept in
consideration. The mere consideration of the population as service seeker and services delivered
in accordance to the facilities provided by the funding agencies creates a demand and supply gap.
Project planning along with periodic strategic planning was understood to be the most important
element of the formulation of a project. A self sustainable financial source along with the
funding agencies shall be kept as a important plan for financing the project throughout and post
the funding period.
Analysis of the workforce structure:-
The hierarchy existing in the workforce structure leads to a clear disconnect in the frontline
workers and the administration. The targeted approach to finish certain number of key population
in seeking services in a given period of time leads to propaganda of the basic profitable services
being provided at the AWHC clinic by the grassroot level workers while the demand of the
community for services might have opinionated differences.
The community workers often ended up in conflict with the administration when rationing of
services was done in response to fund crunch. While the outreach workers were answerable to
both the population and the branch administration, the managers were held accountable by the
board of directors and the funding agencies.

The understanding developed in context with the workforce structure was mostly related to the
lack of work distribution with planning and the disadvantage pertaining to the targeted output
approach for the outreach workers in covering the population for services. A participatory
approach towards developing the kind of services to be provided to the population keeping in
account of the demands of the target population acts as a major contributory factor in the
successful running of the project.
Analysis of the services provided:-
“Services being provided are more important than the source”
- Project Coordinator, MESU.
This section would be elaborated in parts discussing the service delivery under the various
projects running in the umbrella of AWHC i.e. SNEH, MESU and SETU.
MESU:-
The project is a clinic on wheels concept of reaching to the community for IEC activities, Drug
distribution, medical checkups and referral. The MESU Clinic has a well prepared pamphlet of
services delivered and the schedule for the weekly visit to various areas which facilitates and
keeps the community informed about the visits of the MESU Clinic Van. The exhibitions held by
the MESU team for raising the awareness tend to be more of a referral system or advertisement
of the AWHC for seeking services specifically related to sterilization. On interaction with the
outreach workers the clear misconduct of adolescent health education programme was seen. Due
to the inability of the same set of adolescents to attend the workshops organized extending over a
period of 4-5 days, the outreach worker tries summing the session up within a day so that she can
brief the girls about each of the topics related to sexual and reproductive health. This leads to
incomplete module being followed for Comprehensive Sexual Education Module on Adolescent
Reproductive Health. A major focus of the entire project in adolescent reproductive health was
on the adolescent girls with no programmes designed to meet the unmet needs of counseling and
services related to sexual and reproductive health to the adolescent boys.
SETU:-
The project SETU catered to the reproductive and sexual health of the major population residing
in areas of Baiganwadi. Presently, merely working as a referral unit for the clinical services in
AWHC, it was a functional clinic when the project started. The center for SETU will be down by
the first week of April. This project is being integrated with the other projects due to withdrawal
of funding agencies from the financial aid provided. The head nurse now in the SETU Clinic
refers patients to AWHC for follow ups or any diagnosis related to STI/RTI. The contraceptive
pills and condoms earlier were distributed for free from the depots or community based
distributor’s house, but presently a certain price is charged for the same. This sudden withdrawal

of the services has led to the non-cooperation of the population and also there has been instances
wherein the outreach workers were blamed to be selling the amenities by the target population.
The attrition rate too has increased following the notice of closure of the project which made the
monitoring and evaluation phase of the project suffer.
SNEH:-
Working for the sexual and reproductive health of the female sex workers in the areas of
Rafiqnagar, Nirankarinagar, Shivajinagar and Chembur, it was found to be one of the most
successful of the projects running for the target population. The concept of identifying a “Peer
Educator” amongst the female sex workers has led to a well built rapport of the SNEH project‘s
members with the whole key population. There has been reduction in the coverage of the target
population from Female Sex Workers (FSWs), Male to Male Sex (MSM) and Transgender
(TGs), to specific targeted intervention on Female Sex Workers. The reason for the same as
reported was that there were many more NGOs working towards the benefits of MSM and TGs,
hence the target population was reduced and this led to more focus on targeted intervention.
Also a condom gap analysis being done by the peer educators accounting for the usage of
condoms and contraceptives amongst the FSWs are done, in response to which the monthly
supply of the stock is regulated. This participatory method of supply in response to the demand
of the population is a very successful method of service distribution.
On a SWOT Analysis of the SNEH Project presented with the following findings:-
STRENGTH
1. Well motivated staff
2. Staff from the key population
3. Good rapport with the beneficiaries
4. Participatory planning approach
WEAKNESS
1. High attrition rate
2. High violence in the area of work
3. Social exclusion or stigma faced due to
nature of work
4. Delay in salaries
5. Career opportunities limited in terms of
growth
6. Low salaries
OPPORTUNITY
1. Funding agencies
2. International fundings
THREATS
1. Disconnect with the administration of
AWHC
2. Lack of political will for newer
initiatives
3. Social stigma attached

Professional understandings developed:-
The propaganda developed to raise awareness shall have clear motive of the same rather than
working as a source of advertisement for the services provided in any of the centers. Hence, the
motives in designing, training and functioning of the project per se shall be always kept in mind
as the deviation from the same may lead to mistrust in the beneficiary population. An inclusive
participatory planning for designing the service delivery shall result in the success of the project.
Also as outreach workers are the first point of contact working with the target community,
periodic strategic planning and alterations as required in consultation with the same shall be
practiced.
The self sustainability of the projects after the funding period ends shall be well planned before
the running of the project. As sudden withdrawal of services and closure of project leads to
unemployment of the project members and mistrust amongst the beneficiary population too,
hence planning to deal with the same shall be done prior.
The rationing of the services provided and beneficiaries or target population rationally and
periodically saves a lot of resource pooled in for providing the services, thus not leading to a
negative deficit or monetary loss in the project. The project shall be designed such so as to
provide sustainable livelihood opportunities and path to progress to the members working in the
project.
Scaling up of the services in accordance with the increase in infrastructure shall be well planned.
AWHC recently extended its clinical services in the pediatric care; the integration of the same
with any of the projects is missing for of now. The target population can be beneficiaries to
service provided by the pediatric wing too, as AWHC is a famous referral unit amongst the
private as well as government health centres for reproductive health services. There shall be a
balanced maintained in the governing of the services provided by the funding agencies and the
centers catering to the same. Shift in the fund allocation from the funding agency due to
alternative motives shall not deflect the service delivery in accordance with the vision, mission
and goals set during the foundation of the project.
Formulation of special services related to digitalization and electronic media shall be done by
keeping in mind the access to the same by the target population and compliance to use the same.
The work distribution to deliver the services shall be such so as to not over burden the outreach
workers (ORWs) while making sure that the ORWs are trained enough to be not bound by
specialization in working in specific field.

Management principle: - A short introduction of the Structure, Mandate and Governance policy
of the AWHC
The hierarchy of the human resource involved in the SNEH Project is as follows:-
MANDATE: - A “No Refusal Policy “The mandate or the vision of the management holds a “No
Refusal Policy” for the beneficiaries.
GOVERNANCE: - Self empowered in governance with a board of directors and trustees, larger
influence of the funding agencies in decision making regarding the services being provided.
ORGANIZATION OF WORK PROCESS: - Responsive to target populations and outreach
worker’s demand with periodic strategic planning in certain projects like SNEH.
HUMAN RESOURCE POLICY: - Honorarium to peer educator, Limited career opportunities
for growth of the frontline workers.
RESOURCE AVAILABILITY: - Financial crisis, SETU deficit of - Rs. 38,386 in the year 2014.
HON.SECRETARY
BRANCH
MANAGER
PROJECT
MANAGER
OUTREACH
WORKER
PEER EDUCATOR

Analysis of the Management Principle of the Organization:-
The analysis of the management of the organization will be done in two parts wherein the first
part will be dealing with the SWOT Analysis , the second part will analyses the same based on
Pestle’s Analysis principle of management:-
SWOT ANALYSIS
STRENGTH
 Strong admistrative will to work
towards welfare
 Qualified and well trained workers
 Functional health center for referral
 Equipped health center
 Foreign funding
 Qualified Administrators
 Good will amongst the target
population
 No Refusal Policy
 Community BasedApproach
WEAKNESS
 Programme integration
 Increased attrition rate of the staff
 Less career opportunities
 Withdrawal of projects leading to
noncooperation amongst the
community
 Unplanned extension of the services
rendered
 Profit motives
 Strong hierarchy leading to
disconnect between the voice of the
frontline workers and the
administration
OPPORTUNITIES
 Raising awareness in the community
about the sexual and reproductive
health
 Increased focus of national policies
on the maternal health and family
planning
 Increasing gender sensitivity in the
society per se.
THREATS
 Religious constraints
 Funding agencies as governing body
 Mistrust due to sudden abortion of
the projects
 Multiple non-governmental
organisations working in similar
areas and fields as well
 Competition for funding from
agencies.

PESTLE’S ANALYSIS:-
FAYOL’S practical list of principles guided 20th century managers to efficiently organize and
interact with the employees. The AWHC will be in the further section analyzed based on these
14 Principles of Management specific to the SNEH Project.
1) Division of Work: - The division of work in the SNEH Project was clearly divided with
clear specifications of the targets to be completed in the given period of time. Though the
number of staff was scarce which led to the over burdening of the Outreach worker and
also increased attrition rate amongst the peer educator delayed the proceedings of
services in certain areas.
2) Authority: - Though the hierarchy is strong at the administration level, at the project level
the manager preferred to hear the voices of all the staffs and an inclusive decision making
was done and followed.
3) Discipline: - The staff members of the project are strongly motivated to work towards the
cause and hence were disciplined to render the services. This also was due to a close
rapport built with the community who held the staff accountable in absence of the
services or any delay.
4) Unity of Command:- Only one direct supervisor helped maintain the unity of command
5) Unity of Direction:- one plan formulated to coordinate the actions, though periodic
strategic planning was missing,
6) Subordination of individual Interests to the General Interest: - Working towards the
welfare of the female sex worker, a strong combined interest of the community is kept in
mind.
7) Remuneration: - Honorarium is provided to the peer educator which is unsatisfactory for
them. There has been no increase in the salary since the commencement of the project
.No travel reimbursements are given to the outreach workers. No promotions for the
frontline workers.
8) Centralization: - Decision making is inclusive with a participatory planning approach.

9) Scalar Chain: - timely reporting to the upper cluster of the hierarchy is followed.
10) Order: - The workplace is not very safe as the office lies in close proximity to the field
work which generally records for high crime rate in the area.
11) Equity: - The manager do maintains fairness to the staff with no favourisms seen.
12) Stability of tenure of Personnel:- very high attrition rate pertaining to the low salary, no
benefits and no growth in the career as such
13) Initiative:- Outreach workers do have the freedom to propose to the newer initiatives as
per the demands of the target population
14) Esprit de Corps: - Team spirit and unity maintained with close association in terms of
work distribution and social circle sharing too.

ISSUES AND RATIONALE:-
Issues faced by the population seeking services in reproductive and sexual health:-
On interactions with the staff members of the various projects under AWHC, the secondary data
from the health post in Lotus Colony, Shivajinagar, interaction with the community and the
outreach workers various issues were identified related to the burden of disease and the unmet
needs for the treatment of the same.
The data as collected from the health post indicated high prevalence of tuberculosis amongst the
population residing in the area of Shivajinagar. There were a total of 413 patients registered for
DOTS in one of the health post which included 80 cases of multi drug resistant tuberculosis and
9 cases of XDR tuberculosis. There were also 9 cases of leprosy seeking treatment from the
particular health post.
A rapid community assessment was done to identify the major issues related to health and also
on interaction with the community on various field visits and exhibitions health at Mankhurd
station, led to the identification of certain issues which the adolescent girls and women in
reproductive age come across. It majorly consisted of issues related to menstrual hygiene, the
problem of white discharge and itching in the private parts. A large proportion of the women in
the community were found to be preferring permanent sterilization and there was very less
awareness seen amongst the men related to family planning or reproductive health.
The project allotted and chosen by me to work on as a part of the internship curriculum was the
SNEH Project working for the reproductive and sexual health of the Female Sex Workers. The
major issues that the whole key population of FSW faced was a very high incidence of violence
faced both from the customer and the intimate partners. Major stigmatization by the society led
to inaccessibility of basic healthcare services and the condition worsened for those living with
HIV. The FGD also presented with some facts wherein the key population mentioned that for
any kind of illness they come across they don’t consume any medicine instead they prefer using
drugs like “MD”,”Button”, “Cigarette” and “Alcohol” for pain relief.
On organizing an FGD with 6 female sex workers and a peer educator, the major health issue
with maximum economic impact was surprisingly the expenses on medicines for their children.
One of the female sex worker quoted “I can spend money; I am ready for the same. But we don’t
have time to take care of our kids and hence we go to the private clinics. I have spent as much as
2000 rupees on my son’s medicines this month.”
In a FGD conducted amongst the peer educators, the concerns on the economic burden of the
medical service expenses for their children were raised. Hence, following a stakeholder analysis
and rapid community assessment, I have decided to do an in-depth economic impact analysis on
the household of female sex workers due to medical expenses on healthcare services of their
children ( aged 0 months to 15 years) of age in last one year.

Title: - Health Issues amongst the children of Female Sex Workers and its Economic Impact on
Household
Objectives:-
To analyze the economic impact on the households of female sex workers due to expenses
incurred by the healthcare needs of their children in the areas of Rafiqnagar,
Nirankarinangar,Vashinaka and Sanjaynagar, Mumbai.
Research questions:-
1. What are the common illnesses prevalent in the area amongst the children?
2. What is the average no. of visits to the healthcare facilities due to episode of illness
amongst all the members and the children specifically in last one year in a household of
FSW?
3. What is the average direct and indirect costs incurred following the episode of illnesses of
the children of FSWs in last one year?
Methodology:-
The study is a Quantitative Descriptive Cross-Sectional Study measuring the economic impact
in the household of the female sex workers due to the medical expenses incurred due to illness of
the children in the last one year. The age specified as a part of the operational definition of the
children ranged from 0-15 years of age suffering from all the major and minor illnesses.
The major illnesses included Tuberculosis, Typhoid, Malaria and Jaundice whereas the minor
illnesses included skin diseases, fever, cough cold and gastrointestinal disorders.
Tools: - Questionnaire, Interview schedules.
Sampling: - Purposive, Snowball Sampling
Due to the limitations to the access and identification of the households of Female Sex Workers,
snowball sampling was done wherein one of the respondents facilitated the meetings for
interviews with the other respondents belonging to the key population.
Sample size: - 40 households (as prescribed as a part of the assignment)
Catchment area: - Rafiqnagar, Nirankarinagar, Vashinaka and Sanjaynagar
Primary Data Source: - Questionnaire as answered by the respondents
Secondary Data Source: - Health posts (Lotus Colony), Avabai Wadia Health Centre
Respondents: - Female Sex Workers

Result: -
On data analysis the major illnesses which were found among the children of the FSWs in
specified area as presented below:-
Figure 1.1
(Fig 1.1)34% of the children of the respondents suffered from Fever and Tuberculosis each. The
illnesses which were included in others were episodes of epilepsy, cleft lip and palate, accidental
injury due to electric shock and mental retardation. There also was seen 11% prevalence of
Typhoid amongst the children of the respondents. The results supported the secondary data
assessment of the high burden of tuberculosis amongst the population residing in that area. The
number of children in a household ranged from (fig 1.3)0-3 in 47% of the families while 50%
had 4-6 children in the household. Only 3% of the household had children more than 7 in
numbers.
The high prevalence of Tuberculosis is majorly due to the poor living conditions with closed
spaces and poor nutritional status of the children. The number of members in the household in
were (Fig 1.2) 6-10 members in 57% of the household of the respondents. 3% and 40% of the
respondents have a family size of 11 and above and 0-5 members respectively. With a huge
family size around (fig 1.4) 42% of the household had a monthly income between 4000-7000
rupees, rest 33% fell in the range of monthly income between Rs. 7001-10,000.
34%
34%
6%
11%
5%
5%
5%
Fever Tuberculosis Jaundice Typhoid Malaria Skin Diseases G.I. Infections Others

Figure 1.2
The average number of household members and the average number of children per household
calculated are as follows:-
Figure 1.3
40%
57%
3%
Average membersin the family
0 to 5 members 6 to 10 members 11 and above members
47%
50%
3%
No. of children in the household
0 to 3 children 4 to 6 children 7 and above children

Figure 1.4
Figure 1.5
The cost of medication incurred by 45% of the household ranged from Rs. 40-500 which
included cost for medication, hospitalization and investigations. No indirect costs were included.
42%
33%
25%
Average income of the household per month(in
Rs.)
4000 to 7000
7001 to 10000
10000 and above
5%
45%
7%8%
10%
25%
Cost of medication in last one year (in
Rs.)
No expenditure 40-500 501-1000
1001-2000 2001-4500 4500 and above

While almost 25% of the household have expenditure over Rs.4500 in last one year and 10% of
the household had expenditure ranging from Rs.2001-Rs4500 in last one year on the medical
costs incurred due to the illness of the children.
When looking into the fragmentation of the expenditure on the doctor’s fees, cost of medicine
and lab investigation and cost of hospitalization, following results were calculated:-
Figure 1.6
Majority of the households of around 52% paid no fees for the consultation (fig 1.6), while 37%
of the households paid Rs.10 to Rs. 100 as a part of consultation fees. Only 3% of the households
paid consultation fee above Rs.500.
Total of (fig 1.7) 40% of the households incurred cost for hospitalization in last one year. Out of
the 40% of the households, 38% of the households spent approximately between Rs.3100 to
Rs.10000 on the expenses incurred due to hospitalization .While 12% of the households had to
spend nothing as the cost for hospitalization, as free of cost hospitalization services are available
in the government hospitals. Approximately 19% of the households had to spend more than
Rs.10000 as a part of expenses incurred due to hospitalization.
The total number of visits to the health center in last one year for the children’s illnesses in the
households of the female sex workers ranged majorly from 0 to 3 visits per year in almost 46%
of the household (fig 1.8).27% of the household had to visit the health center for about 4 to 7
times in a year for the medical care needs of their children. 20% of the households visited the
health centers more than 11 times in a year to seek care for their children’s illnesses.
37%
2%
3%
58%
Doctor's fees(in RS.)
10to 100 101 to 500 501 to 1200 NO FEES

Figure 1.7
Figure 1.8
12%
12%
19%
38%
19%
COST OF HOSPITALIZATION
Did't Spend 100 to 1000 1001 to 3000 3001 to 10000 10000 and above
46%
27%
7%
20%
No. of visits to the health center for the children's
illness
0 to 3 4 to 7 8 to 11 11 and above

When assessing the indirect costs incurred due to the medical needs, the cost for travelling and
the wage loss incurred due to child’s illnesses were calculated.
Figure 1.9
37% of the household preferred to visit the nearest health center and hence had no expenditure
on the cost for travelling (in fig 1.9).While 33% of the household spent Rs.251 to Rs.500 per side
per episode of illness to visit to the health center and hospitals.
The wage loss incurred by the household per day which did include the wage loss of all the
earning members due to the illness of the children are as follows:
Figure 1.10
37%
20%
10%
33%
Cost of travelling per side per episode (in Rs.)
Didn't Spend
10 to 100
101 to 250
251 to 500
2%0%
43%
55%
wage loss (in Rs.Per day)
100 to 250
251 to 500
500 and above
No wage loss

Almost (in Fig.1.10)55% of the household did not undergo any kind of wage loss, but 43% of
the household underwent a wage loss of more than Rs.500 per day due to the illnesses of their
children in last one year.
Conclusion:-
 Median total direct cost incurred by the female sex worker’s household on their children
healthcare needs was Rs. 3131.85 per household in previous year.(Direct Cost)
 43% of the total household faced a wage loss of Rs.500 and above per year due to loss of
wages
 30% of the household spent an average of Rs. 250 per side per episode of illness in
travelling to the healthcare facilities
 Average wage loss incurred by the 43% of the household due to the illness of the children
amounts to Rs.260.58 per household per day in last one year during the episode of
illnesses
 Deviant cases of medical expenses incurred in three household were identified, wherein
Rs.60,000- 70,000 was spent on the surgery following cleft lip and palate in last one year,
a total cost of approx. Rs. 2 lacs was spent on the treatment of the child suffering from
mental retardation* and the last household incurred a cost of Rs. 2-3 lacs in surgery
following tuberculosis and pneumothorax.
 The Median total Cost incurred by the family of Female Sex Workers’ household on their
children healthcare needs was Rs.3642.43 per household in previous year .
Health care systems policies and programmes:-
The various policies being formulated in state, national and international levels are mainly
concentrated on the rescue of the children trafficked or towards rehabilitation of the female sex
workers through education. There exists no policy or programme from the state concerning the
children of the female sex workers.
Government’s Initiative:-
An initiative called as CHILDLINE together with the Ministry of Women and Child
Development, Government of India, Department of Telecommunications was taken. It provided
a platform for the state and community youth to work for the protection of rights of all children
in general with special focus on the vulnerable including the children of the sex worker. The

initiative basically worked with the Allied Systems (Police, Health care etc.) to create a child
friendly system and rehabilitation of the children in need of care and protection .No other
specific programme dealing with the health of the female sex workers existed from the
government’s side .Although there were several policies and legislations to prevent and reduce
child and human trafficking.
Integrated Plan of Action to Prevent and Combat Human Trafficking with special focus on
Children and Women – The Ministry of Women and Child Development had formulated a
National Plan of Action (NPA) to combat trafficking and commercial sexual exploitation of
women and children in 1998, with the objective of mainstreaming and re-integrating women and
child victims of commercial sexual exploitation in to the community. To formulate a more
holistic policy and programme for trafficking in persons which will incorporate all forms of
trafficking (such as sexual exploitation, child labour, bonded labour, organ trade etc.) and enable
an integrated approach to tackle the problem, the MWCD, in collaboration with the Ministry of
Home Affairs (MHA), Ministry of Labour and Employment, National Human Rights
Commission and National The National Commission for Protection of Child Rights, examines
and reviews the safeguards provided by or under any law for the protection of child rights and
recommends measures for their effective implementation.
The National Plan of Action for Children, 2005 – Prepared by the MWCD, it commits itself to
ensure that all rights of all children up to the age of 18 years are protected. Further it plans to
undertake all measures and create an enabling environment for survival, growth, development
and protection of all children, so that each child can realize his or her inherent potential and grow
up to be a healthy and productive citizen.
Protocol for Pre-rescue, Rescue and Post-rescue Operations of Child Victims of Trafficking
for the Purpose of Commercial Sexual Exploitation – A special protocol developed by
MWCD provides guidelines for enforcement agencies and NGOs involved in the rescue of
victims from their place of exploitation, medical and legal procedures to be followed and
rehabilitative measures to be provided to the victims.
Civil Body Organization’s initiatives:-
PLAN International – India Plan India17 is a child-centered development organization that
aims to promote child rights and improve the quality of life of vulnerable children. The
organization’s child centered community development interventions focus on child protection
and child participation, children in difficult circumstances, education, HIV/AIDS awareness,
health, early childhood care and development, water and environment, sanitation, disaster
preparedness, household, economic and social security and community governance. The focus of
Plan and its partners is to ensure that “children in India, especially vulnerable children, live in a
safe and enabling environment where their rights are recognized, realized and respected”.

Prerana- The anti-trafficking intervention of Prerana, a non-profit making voluntary
organization started in 1986 right in the midst of Kamathipura, one of the largest red light
districts of the Asian continent and a dreaded one. Adopting a rights-based approach, Prerana
initiated every kind of intervention that was needed to protect the children and women victims of
commercial sexual exploitation and trafficking (CSE&T) and those directly, inescapably, and
closely exposed to the danger of CSE&T. Prerana globally pioneered the intervention
‘Elimination of Second Generation Trafficking’ (ESGT), piloted it successfully, replicated,
standardized, and mainstreamed it. The component programmes of ESGT namely the Night Care
Centre, Institutional Placement Programme, Educational Support Programme were adopted by
the Government of India in 1998 in its first Plan of Action with due recognition. PRERANA
believes that the model has undisputed global replicability.
Save the Children India (STCI)- STCI is a non-profit organization established in the year
1988. It has been working towards the empowerment of the underprivileged women and children
through its many health, vocational training and education programme. The Save Our Sisters
(SOS) unit is an initiative for combating trafficking and was set up in 2001.
Sanlaap- Sanlaap has evolved as a pioneering organization to holistically address the issue of
trafficking in persons, particularly for the purpose of commercial sexual exploitation. SANLAAP
is considered as a pioneer and resource organization in South Asia in the area of institutional care
provision for victims/survivors of trafficking and commercial sexual exploitation. The
organization has not only attained quality care standards in its care facility, but has also trained
several Governmental and non-governmental institutional care set-ups and is working towards
achieving minimum standards of care and protection in all shelter homes in the region.
International initiatives:-
Global Health Promise, a US-based not-for-profit, is dedicated to understanding the needs of
these women and their children, to create awareness about their issues, and to assisting mothers
who are trafficked or in sex work, and their children. Global Health Promise is conducting
regional meetings with sex workers in 7 countries, to represent theses voices at Women Deliver
2016, a global level conference focused on adolescent girls and adult women.
Analysis:-
The policies formulated across national and international agencies have focused majorly on the
rescue of the children with no special focus on the children of female sex workers. As mentioned
by Jennifer Beard et al in the article ,” Children of female sex workers and drug users: a review
of vulnerability, resilience and family-centered models of care”, the authors mentioned that
because parents' drug use or sex work is often illegal and hidden, identifying their children can
be difficult and may increase children's vulnerability and marginalization. Hence very limited
research has been done on the health related issues of the children of the female sex workers.

The initiatives taken by Prerana, as an organisations to help the rehabilitation of the children of
the female sex workers with a right based approach has been very successful. The
criminalization of the commercial sex work devoids the children of the FSW of the basic
existential rights superadded to which the stigma attached to the same worsens it. Initiatives like
above with a comprehensive approach to abort “Second Generation Sex Work” shall be
considered as a potential policy option at the national level.
Available Policy Options:-
Integration of Janani Suraksha Yojana with various civil body organisations working towards the
child and maternal health of the female sex workers with special emphasis on HIV Testing,
vertical transmission of HIV and Immunization and pre and post-natal care of the female sex
workers who are pregnant will help focus majorly on the child health right from the beginning.
Along with the ICTC and HIV Testing camps the monthly health checkups of the children
residing in the red light area shall be done.
The high vulnerability of drug abuse right from the beginning amongst the children of the FSW
shall be taken care of with programmes leading to early intervention and prevention of drug
abuse amongst the children. As a part of the social exclusion being faced in the admissions of
children of FSWs in schools and frequent ostracization faced, it will be difficult to do a drug
prevention intervention and hence shall be planned as such to facilitate the easy access to the
children.
Integration with the ICDS and Anganwadi Centers with compulsory centers and crèches to cater
to the nutritional and educational needs of the children of Female Sex Workers in areas identified
as red light shall be established to cater to the needs of the key population.
To facilitate a right based approach, a crisis management committee in association with the
Mahila Mandals and other regional women groups to facilitate legal rights and prevent the
children from being exploited shall be formed to strengthen the social foundations of the key
population of FSW and their children as a whole. The major reasons identified to the non-
attendance of the children of FSW in illness is due to the fear of wage loss by the mothers while
visiting the health facilities. This can be identified and managed by weekly or monthly medical
checkups in the resident areas of the Female Sex Workers and distribution of free medication
during the non-working hours of the mothers.
Comparative perspectives between the paper policy and community’s perception:-

As a report by National Commission for Women (NCW) recognizes, "No woman suffers more
discrimination in access to services, whether for health care, fertility regulations or safe
abortions as much as women in sex work." As mentioned in one of the papers published by the
Indian Journal of Medical Ethics, “Unmet needs: Sex workers and health care”, Geetanjali
Gangoli, there is a marked absence of adequate health care facilities in red light areas. As Gita,
a sex worker attached to the BMC-HIV/AIDS cell points out, "Private doctors are no good, they
charge a lot of money, and the treatment is not always good. Municipal hospitals are cheaper,
but sometimes the doctors treat us badly if they realize that we are prostitutes. And I have seen
them to be rude and uncaring with AIDS patients." Despite this, however, Gita prefers
government hospitals. This view is shared by women in other parts of the country. Padma, a
brothel keeper in Sonagachi, Calcutta, says that she takes the women in her brothel to the
government-run health care centers. "Those in the area who have money go to private doctors
because they feel that they might give them better care. But I don't think so. Even though I don't
lack money, I prefer government clinics, because the doctors are more thorough."
One of the female sex workers working in the Rafiqnagar area of Baiganwaadi, Mumbai when
enquired about their children’s health responded, “I can spend money; I am ready for the same.
But we don’t have time to take care of our kids and hence we go to the private clinics. I have
spent as much as 2000 rupees on my son’s medicines this month.”
This certain dialogues gives us a bizarre picture of the perspectives as mentioned at the policy
levels and the ground reality of the same. On interviewing about the various health problems
faced by the female sex workers in the area of Nirankarinagar, Mumbai, She said,” These NGOs
just come to distribute condoms, nobody deals with the real problems we face. Customers don’t
want to wear condoms and turn violent if forced to”.
These statements reflect the shallowness in terms of identification and formulation of policies in
response to the needs of the female sex workers. On inquiring about the various policies
available for rehabilitation by vocational training, one of the peer educators responded,” We earn
as much as Rs.20, 000- 60,000 a month. These trainings won’t help us earn to suffice the needs
of our households. Also even if we try finding a job the stigma attached won’t go and we won’t
find a suitable job.”
Due to the lack of the evidence based policy making there exists a wide gap between the supply
and the demand side measures to deal with the major issues in the household of a female sex
workers. While majority of the health related policies and programme focuses on the HIV/STI
prevention and testing, there exists a wide gap between the free kits provided by the

governmental agencies to conduct the tests and the population of the female sex workers in the
area.
The AWHC under the project SNEH, conducts 6 monthly testing of the HIV amongst the key
population of the catchment area. The outreach workers are supposed to do testing amongst the
female sex workers of their areas and a target is provided to be completed. Due to shortage of the
kits supplied from the MDACS and other partner agencies and improper storage facilities, many
a times the testing done are inefficient. Also lack of proper universal protocol for sterilization
was seen due to inadequate training in handling the kits. So existing gap between the trained
professionals, availability of kits and equipment and storage methods was seen in the programme
running for the HIV Testing of the FSWs.
As a part of the rapid community assessment done and FGDs conducted the unmet needs of HIV
Testing of the intimate partners and the children of the Female Sex Workers were also felt.
During the camps organized for the ICTC and HIV Testing of the FSWs, a large number of
service seekers from the resident community who were the family members were willing to get
themselves tested, which was refused due to the non- availability of any policy to cater to the
need of the same.
The medicines being distributed during the camps held consisted mostly the medicines supplied
by the funding agencies as a part of compulsory distribution and any drugs required other than
the one being distributed was to be purchased by the person from pharmacies. This was also seen
as a part of the expenditure incurred during the illnesses, wherein the population preferred
government hospitals for availing services but there always existed the non-availability of drugs
in the government hospitals and hence they had to buy the prescribed drug from private
pharmaceutical stores. The refusal of services under the various programmes for BPL population
like Rajiv Gandhi Jeevandayee Arogya Yojana, was also reported in certain government and
private hospitals.

POLICY BRIEF
LOVE AND BEYOND
“A PolicyBrieffor the medical expenseincurredon the
healthcareneeds of the children of Female Sex Workers in
the areas of Shivaji nagar”

Executive Summary:-
The area of Rafiqnagar, Nirankarinagar, Sanjaynagar and Vashinaka has a population of
approximately 5000 female sex workers. The nature of work is distributed amongst the Highway
based, home based, brothel based, bar based, street based and trip based sex work. The
geographical location of the residence of the same lies in the most excluded of the areas of the
city of Mumbai near the largest dumping ground of Asia, Baiganwaadi. The social exclusion
along with poor living conditions make the families of Female Sex Workers the most vulnerable
in the society.
The severe violence faced by the intimate partners , the clients and the police acts as a double
burden on the health of female sex workers along with the exploitative nature of work practiced
in unhealthy and unsafe working conditions. The worst of the sufferers bearing the consequences
of the same are the children of the female sex workers. The denial of admission of the children in
the school, refusal of admissions in hospitals for healthcare needs to the non- attendance of
mother to the needs of the children healthcare makes them very vulnerable and worst of the
sufferers of the plight of the sex work. The area of Baiganwaadi, is supposed to be the breeding
ground of MDR, XDR Tuberculosis with frequent cases of relapse of the disease due to drop
outs from the treatment.
The negligence and difficult accessibility leads to late detection of the cases of Tuberculosis
amongst the children leading to a huge economic burden involved in repetitive investigations and
empirical treatment done for the symptomatic relief of the children. The exclusion faced by the
children as a consequence of the nature of work of the Female Sex Workers violates the right to
life of the children of the same devoiding them of the basic existential amenities.
With an India 2020 vision near to approaching the end and the formulation of the new
Sustainable Development Goals, the need to cater to the unmet healthcare needs of the children
of FSWs shall play an important role in establishing the Universal Coverage and a “Health for
All” order in India. A close knit well planned evidence based policy formulated to recognize the
needs of the health of the children of FSW will help comprehensive rehabilitation of the same
and also prevent the households of Female sex Workers from catastrophic expenditures being
faced in meeting the healthcare needs of their children. A strict “No Second Generation Sex
Work” policy will remain toothless if the health of the children are not taken care of right from
the beginning of the foundation years.

Background:-
In accordance to the interviews conducted the healthcare needs of the children and the economic
burden on the household of the female sex workers were found to be the major concerns of the
key population. The root cause of the problem addressed are multi-faceted. As majority of the
population not only belongs to the low socio economic strata the discrimination faced on the
grounds of social stigma attached adds up to the burden of the sufferings.
The major issues identified pertaining to the poor health of the children of the female sex
workers are as discussed in the following section:-
Poor Maternal Health:-
Poor nutrition, high violence at workplace, very high drug abuse, multiple unwanted pregnancies
and unsafe abortions, leads to a very poor maternal health of the pregnant FSWs leading to
severe ill effects of the same on the health of the new born. They are highly vulnerable at the risk
of vertical HIV transmission. Frequent STI/RTI, make the neonates vulnerable to congenital
abnormalities leading to the compromise of the overall being
Inaccessibility to services:-
Refusal of admissions by various healthcare practitioners and hospitals, leads to delay in the
detection of avoidable infectious diseases, thus increasing the severity of the influence of the
disease.
Lack of Attendance by the Mothers:-
Due to the working conditions, odd hours of work and inability to afford a crèche for the same,
the children suffer a lot due to the lack of medical attention from the mothers. A fear of wage
loss for the day further prevents the early treatment seeking behavior during the illnesses thus
prolonging the effect of the same on the children.
Social stigmatization and exclusion:-
The social stigma attached to the nature of the work of the mothers of the children of FSWs
make them vulnerable to the various stigma and ostracization faced by them. The basic services
available catering to the needs of the children under ICDS at Anganwadi centers fails to focus on
the needs and reaching out to the children of the FSWs. Education too suffers because of the
denial of admissions in schools and special schools for the children of the FSWs further
increases the marginalization and closes doors for the integration of the children of FSWs with
the other school going children.

Policy context:-
With an India 2020 vision near to approaching the end and the formulation of the new
Sustainable Development Goals, the need to cater to the unmet healthcare needs of the children
of FSWs shall play an important role in establishing the Universal Coverage and a “Health for
All” order in India. A close knit well planned evidence based policy formulated to recognize the
needs of the health of the children of FSW will help comprehensive rehabilitation of the same
and also prevent the households of Female sex Workers from catastrophic expenditures being
faced in meeting the healthcare needs of their children.
A strict “No Second Generation Sex Work” policy will remain toothless if the health of the
children are not taken care of right from the beginning of the foundation years. “Protocol for Pre-
rescue, Rescue and Post-rescue Operations of Child Victims of Trafficking for the Purpose of
Commercial Sexual Exploitation” as formulated by the Government of India, cannot exclude the
healthcare needs of the same as the health system per se lacks potential responses to the needs of
violence survivors. The drug rehabilitation center, health centers and the police administration
has to work in close association to be able to rehabilitate the rescued child holistically and ready
for responses during the crisis situation with the survivors.
AWHC with SNEH project working for the upliftment of the sexual and reproductive health of
the FSWs, with all the foundations of work and facilities available can act as a potential ground
for catering the needs of the children of the key population too. Scaling up of the project by
including the targets to meet the healthcare needs of the children of FSWs can be proposed as a
part of the extended services offered at AWHC with the pediatric wing. The longer time span of
working with the same community due to the ongoing projects and the referral centers too will
help in integrate the services for the children too.

Recommendation:-
1. AWHC Pediatric Wing:- The services being delivered by the pediatric wing can be scaled
up to meet the healthcare needs of the children of the FSWs, as AWHC is already a
popular referral center amongst the FSWs for the unmet needs of sexual and reproductive
health
2. HIV Testing for the Children: - Extension of the HIV Testing services to the children of
the FSWs to identify the vertical transmission amongst the children and early start of the
ART regime.
3. Crèche and Anganwadi centers: - Facilitation of the FSWs and the children to access the
services provided by Balwaadi and Anganwaadi to meet the nutritional and educational
needs of the children of FSW.
4. Monthly Health Checkup Camps: - Monthly health checkup camps to be held for the
children so as to early detection of the various illnesses and providing medicine to the
same in timings comfortable to the working hours of the FSWs.
5. Awareness programmes for Tuberculosis: - Due to the high prevalence of tuberculosis in
the area of Shivaji nagar, frequent AFB testing of the symptomatic children and raising
awareness related to the symptoms and prevention of tuberculosis can also be integrated
with the ongoing IEC/BCC services for the sexual and reproductive health.

ANNEXURE:-
INTERVIEW SCHEDULE:-
QUESTIONNAIRE for economic impact analysis on female sex workers due to the medical
expenses ontheir children’s healthcare services in the areas of Rafiqnagar Part 1, 2, 3,4
and Babanagar, Mumbai.
Date: - Time:-
Informed Consent:-
Participant Information Sheet
Dear Respondent, I am a student of M.P.H Health policy, Economics and Finance with School of
Health Systems Studies, Tata Institute of Social Sciences. I am conducting a study to learn about
the economic impact on households of female sex workers due to the healthcare services availed
for their children in Rafiqnagar and Babanagar area of Mumbai Metro City. We will be
interviewing approximately 40 female sex workers in their households in Mumbai. You have
been chosen to participate in the study as you have identified yourself as a member of the key
population as registered with the Sneh project. In this study, we will collect information on
details of the members of your household, illnesses experienced, the health care sought and
household expenditures. The interview will take approximately 20 minutes. By participating in
this study, you will not incur any loss or risk. This study will not provide you any monetary
benefit or any direct services. However, the information you provide will be used to understand
health care needs for the children of female sex workers. The information you provide will be
treated as confidential and will not be disclosed to anyone including health workers. This
information will only be used for research purposes. Any personal details are not included in the
questionnaire about your name and address. Your participation is completely voluntary. You
have the right to refuse to participate in the study. You have the right to with draw anytime
during the interview or not answer certain questions. We thank you for giving us the valuable
information and your time for the study.
In case of any further information, you may contact the following:
Nikita Pandey
(9997502301)

Section 1:- Demographic and socioeconomic information
Question
No.
Questions Options Skip to
101 What is your age?
102 What is your religion? 1.Hindu
2.Muslim
3.Christian
4.Sikh
88.Others (Specify)
103 What is your present location?
104 Are you currently employed? 1. Yes
2. No
If no go on Q.107
105 If yes, what is the kind of your
workplace?
1.Home based
2. Brothel based
3. Bar based
4.Street based
5.Dhabha based
6. Highway Based
7.Trip Based
88.Others
(Specify)
106 Is there any other source of
income as well?
If yes, please specify.
107 What is your marital status?
108 How long you have been
married?
109 How many members are there in
your family?
110 How many children you have in
the family?
111 What is your monthly income?
112 What is the monthly income of

the household?
Section :- Prevalence of disease
Question
No.
201 Did any of the members of your family
fell ill in last 1 year?
203 How many episode of illness did they
suffer from?
204 Did they seek medical attention?
205 If yes, how many times did they visit for
one episode of illness to the Health
Centre?
206 Did any of your children fall ill in last one
year?
207 If yes, then what was the illness? Please specify
208 How many episode of illness did they
suffer in the last one year?
209 How many times did you visit the doctor
for the same illness?
210 What kind of healthcare service did you
go to?
1. Private
hospital
2. Public
hospital
3. Private
practitioner
4. Both
88.Others
Please Specify.

Economic burden analysis
Question
No.
301 What was the cost incurred in
medicines for various episodes of
illnesses in children in last one year?
302 What are the registration/
consultation fees for public/private
healthcare services?
1. Private
hospital
2. Public
hospital
3. Private
practitioner
4. Trust hospital
5. Others
(Please
Specify)
303 Was there any episode of
hospitalization due to ill health of
the children in last one year?
If no, go
to 305
304
If yes, what was the expense on
hospitalization and for how many
days they were hospitalized?
305 What is the cost of travelling from
your house to the healthcare facility?
306 Did you incur any wage loss due to
the child’s illness?
If no 308
307 If yes, for how many days and what
amount?

308 Did your husband/ intimate partner/
any earning member in household
other than you incur any wage loss
due to child’s illness?
309 If yes, please specify. 1.Husband
2.Intimate partner
88.Other
PHOTOGRAPHS:-
PHOTO CREDITS:- ROHITH KRISHNAN

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