Podcasts – the future of story telling

We recently were part of the Radio Festival 2018 as podcasters. We were thrilled to be able to discuss future of podcasts in India and how podcasts could help revive radio.

Podcasts are online shows that can be downloaded to any personal mobile device, or streamed online. Simple enough. They have been referred as the future of radio and might even alter the way radio have been streaming information.

In India, radio is still considered one of the biggest source of information for people living in tier 2 and tier 3 cities and towns. Radio is able to reach and connect to different parts of the country, where other source of information might not have reached in the past.

In the recent years, mobile has been able to penetrate some of these unreachable parts of the country. With the number of mobile towers that are getting erected in the rural parts of the country, people in the rural areas have more access to mobiles. So there is access to the infrastructure for the information, but content of the information is very much still limited.

Present of Podcasts 

Radio also for the longest time in public memory has been doing something similar. It has been producing content in mass for general public and has been reaching to people in different parts of the country. So what is different about podcasts?

Podcasts decentralize the power of content creation, and let common person enter the domain of knowledge production. Audio Podcasts does not require technical expertise with regard to infrastructure. It requires some equipments and some passion for audio content.

It is one of the by-product of the internet which has allowed people from all walks of life to enter into knowledge production business.

Podcasts, let user run into details and lets you play with details. It is a medium, which works on details without having the trouble of visualisation. Matters of representation is totally dependent on user’s imagination. Imagination is the key in audio podcasts. Audio podcasts play with user’s imagination and at the same time provide them with power to recreate stories and content in a manner they are most comfortable. Focusing on audio only forces user’s imagination to fill in the blanks.

 

Future of Podcasts 

India has so many traditions of storytelling. It thrives on oral archives and for the longest time oral conversations were one of the methods of transmission of knowledge. Radio has been an extension of this, where communities were connected by a common thread of information, which was mostly controlled by state. With privatisation more private players got into this domain and with internet, it opened spaces for citizens to become the creators and archivers of stories. It just slightly shifted its storage space – from direct human interaction, to radio transmitters to finally an equipment one holds on to their hands – mobile device. Our stories are still living and thriving amongst our spaces.

More and more people getting active on podcasts production. In India the knowledge production is still limited to elite class and the cities, but the dissemination of these podcasts are definitely seeping in different classes and demographics. One of the disruption brought in by podcasts are the fact that a lot of marginalised communities have access to a range of content and can make choices. Members of these communities with personalised access or small group access can listen to various content in their space and time. Radio has always been seen as a source of education where mass knowledge was shared for benefit for the society. This content always had a certain kind of approach which pushed for public policies which mostly re-iterated patriarchal notions of the society. Since the source of knowledge production was state, there was not enough space for dissent.

This is where podcasts present the future, it lets the individuals take on space in knowledge production, and provide an alternative, or different types of narratives within different platforms. At a time, when radio has been completely taken over by Bollywood songs, the long  oral form has been pushed out of .

Check our podcasts here : 

At Hidden Pockets Collective, we believe that audio podcasts has a huge potential in the field of sexual and reproductive health and can reach places which are generally kept away from knowledge production. It is cost-effective and involves fewer resources and time. It is a great concept especially for young people who would like to create their own content.

APCRSHR9: Asia Pacific coming together to discuss Sexual and Reproductive health?

Hidden Pockets Collective participated at 9th Asia Pacific Conference on  Reproductive and  Sexual Health Rights in Vietnam in 2017.

The Asia Pacific Conference on Reproductive and Sexual Health and Rights  is a biennial gathering of civil society, young people, academia, government, media, private sector, and development partners from the region concerned about sexual and reproductive health and rights (SRHR). The first APCRSHR was organized in 2001 in Manila and the succeeding seven conferences were hosted by countries across Asia as Thailand (2003), Malaysia (2005), India (2007), China (2009), Indonesia (2011), Philippines (2014), and Myanmar (2016). It was the first time Viet Nam hosted this conference in the context of Viet Nam had big change in laws and policies related to SRHR.We were there to present our work with young people around abortion and comprehensive sexuality education.

It was super exciting to be there with some amazing other organisations from India like the YP Foundation and CREA.

 

 

 

 

 

As part of ASAP Youth Champions ,  Aisha George from Hidden Pockets collective was there to meet young people from Asia Pacific working on issue of abortion.

Jasmine George, as part of Women Deliver fellowship was there to share stories around usage of audio podcasts to deliver comprehensive sexuality education in schools in India.

 

 

 

 

FC2 also had a booth in the conference where they were showcasing their products and even helped us in understanding their female condoms. Remember, we have reviewed their products in the past and were only happy to meet them in person and also get a chance to see a demonstration of the Female Condoms.

 

Overall, it was a great experience to meet young advocates working on sexual and reproductive health and demanding changes from their various governments. It was also fun learning about so many great initiatives being conducted in countries like Philippines, Vietnam, Pakistan , Mangolia and many other countries.

 

 

 

 

 

 

 

 

Sexual Health Data : Do Indian cities think about its reproductive health?

Hidden Pockets Collective for last one year has been working with young people accessing sexual and reproductive health services in 7 cities of India. These cities are New Delhi, Chennai, Bangalore, Jaipur, Ahmedabad, Kolkata and Kohima.

Abortion stigma can often lead to negative consequences for young, single women in need of accessing safe abortion services. There are several challenges that women face starting with lack of information on abortion itself, not knowing where to access services, encountering judgmental provider attitudes and bias, prohibitive cost, and fear due to social norms. These and other factors can push women into vulnerable situations where they opt for unsafe services that put their lives and health at risk.

We were trying to understand the response of young people to sexual and reproductive health in these cities. Did the cities vary in their attitudes to these issues? Were young people able to access these services? Was there a general awareness about these issues related to sexual and reproductive health issue among young people in these cities. These were some of the initial questions that we were working on.

This report is a trailer to our final report about the data collected over 1 year in these 7 cities.

Laws : 

Abortion in India, is mostly covered under Medical Termination of Pregnancy Act,1971. The Act covers a range of situations, in which Indian laws allows a women to access abortion services.

The MTP Act is worded in a way in which the medical termination of pregnancy is based on medical opinion. So there is no on demand abortion in this country. And the MTP Act also lays down the conditions under which the pregnancy can be terminated. A registered medical practitioner can go ahead and terminate the pregnancy only based on medical opinion in the existence of any of these conditions. So in a sense even though since 1971 there is official legal access to termination of pregnancies, it’s not a right. It’s only one judgment of the Bombay High Court that has viewed the existing law from the lens of the woman and has termed it as a right. But the legislature is still not looking at it as a right.

What type of services? 

In our study, we only were focussed about accessing public health services, and at Hidden Pockets Collective, we wanted to promote accessing public health services. In most of the public health sector, there are various type of sexual and reproductive health services provided. Some of the services are :

a) Adolescent friendly Health Services

b) Counselling

c) Medical Termination of pregnancy

d) STI and RTI testing

e) Long term and Short term contraception choices

f) Family Planning methods

Abortion as a right?  

Is Abortion a right? No, not till now.

So what prevents us from making it right?

Abortion can only be accessed by a woman, if the doctor feels like the pregnancy would result in some kind of danger to her life. It still depends on the opinion of the service provider.

Which are some of the centres where abortion services can be accessed access?

  • Public Health Centres
  • Urban Health Centres
  • Community Health Centres
  • District Hospitals
  • Government Hospitals

There does not seem to be much conversations around sexual and reproductive health data in our cities. Even when National Health Policy 2017 was introduced various cities did not account for the young people in their cities. There is no conversations around keeping one’s sensitive data be it abortion data,HIV data within privacy debate.

Hidden Pockets Collective is working on this and effectively will produce a report regarding the affect of sexual and reproductive health data in urban planning. We need young people be seen as change makers and not just end users of exploitative interventions which does not reflect their realities.

We need to understand the habits of young people and consider it within the urban planning of the future smart cities of the global south.

Where can I get an abortion in Lucknow?

If you are unable to find the service, please do write to us.

Write to us at hiddenpocketsinfo@gmail.com
WhatsApp us at +918861713567

Finding places in Lucknow can be a pain, especially if you are navigating the old part of city. Narrow lanes, slow traffic and lack of signs, all makes it a tough task. As a volunteer for Hidden-Pockets, my colleague and I, recently decided to look for places that offer sexual and reproductive health services in Lucknow. So we paid a visit to a family planning clinic of Family Planning Association of India (FPAI) Lucknow. As per FPAI Lucknow branch office, FPAI has 3 clinics in Lucknow. Finding the clinics’ number was not easy, as they don’t have any official landline number for their clinics. Google maps was also of limited help because the information available on the Internet about FPAI Lucknow is outdated with wrong numbers. So we used the rough directions received from Lucknow branch office, to visit the FPAI clinic located nearest to us, which was Sadar area inside Cantt. General hospital.

Directions: Riding on a scooty, we missed the turn for the clinic and had to take a U-turn back to Burlington crossing. (People visiting it from Hazratganj, please take a left from Burlington crossing and go straight). Once you are on the road to Sadar from Burlington crossing, you have to drive straight till you cross a flyover. As you descend from the flyover, look for Cantt. General hospital on the right.

After reaching the Cantt. General hospital, finding the clinic itself was easy. There was a big sign in the parking at the entrance, showing the way to the clinic. Clinic occupies first three rooms of a long corridor and is a hub of activity with a staff of 10.

As we made our entrance into one of the rooms, three women, who though relatively surprised at seeing us, greeted us warmly. We informed them about our purpose and settled to have a conversation. They were working as counsellors at the clinic.

Services offered: Talking to the counsellors was informative as they told us about the range of services provided at the clinic (See the pic). Anyone can avail of Sexual and Reproductive Health (SRH) services at the clinic by just walking in without any prior appointment or ID proof. They also have tie-ups with government functionaries like ASHA workers in rural areas. According to the staff, regular village camps are conducted by clinic. ASHA workers also refer patients to the clinic and get a small incentive for the referral.

That particular clinic has been in operation for more than 30 years. It shares both the premises and facilities of Cantt. General hospital like pathology labs. It has an 8-bed unit with one doctor. Currently, the clinic doesn’t provide 2rd trimester MTP services and refers patients to Queen Mary hospital in Lucknow, whenever any such case comes up. The clinic currently did not have any male patients. This, we believe, was due to lack of outreach effort by the clinic and also because of low awareness about its services in Lucknow city area. Talking to the counsellors at the clinic we felt comfortable and welcomed. They showed us around the clinic and were proud of the work they were doing. One of the counsellors is close to retirement after serving a long term with the clinic.

Right counselling continues to be a big challenge in the Indian healthcare system. Discussing your health issues in a safe and trusted environment with trained professionals is difficult. It often makes people anxious, especially sexual and reproductive health related issues. FPAI clinic at Cantt. General Hospital can be a good resource for someone looking for counselling on sexual and reproductive health in Lucknow. It has a friendly environment and experienced staff who are more than willing to listen to your concerns and answer your queries with a smile. Do check them out!

PS: “FPA India clinics may charge, what we prefer to call as a ‘partial user fee’ to the clients for seeking abortion or any other SRH service. This fee is very subsidized and helps the Association meet some running costs. However, all FPA India clinics also have a “NO REFUSAL POLICY”, which states that no client walking into any FPA India facility is denied any service, especially if he/she is unable to afford even the subsidized fee. Thus, poor and marginalized clients can also access quality services in FPAI clinics. Only when the facility is not equipped to provide a particular service (for example some client may need a specialized service, or admission or higher level emergency care) are clients to other facilities.”

About the writer:

Nitin Malik is a volunteer with Hidden Pockets.

5 things you should know before using a pregnancy test kit

If you are unable to find the service, please do write to us.

Write to us at hiddenpocketsinfo@gmail.com
WhatsApp us at +918861713567

It is a known fact that no method of birth control is absolutely foolproof, and all it takes for someone to get pregnant is a single sperm! With that given, if you are someone who is sexually active, even a delay of a day or two in the arrival of your period can make you panic. The first thought one would have is probably that of a pregnancy. Whether or not you are hoping for it, you would definitely want to know what is going on with your body. And that is exactly what an at-home pregnancy test kit was invented for!

If you take a long look at the history of detecting pregnancies, you would find that the methods employed by people have been murky. In the past, physicians used a number of bizarre mechanisms ranging from testing pregnancy using wheat and barley to testing on animals. But owing to science and technology, gone are the times when people used unreliable methods to diagnose a pregnancy. In fact, detecting a pregnancy has become very easy with the invention of at-home pregnancy test kits, which were first launched in the markets in the 1970’s. Since then, women have been granted the freedom to find out on their own whether they are pregnant or not. These pregnancy test kits have freed women from the need to rush to a physician at the slightest hint of a potential pregnancy and enabled them to find out if they are pregnant in the privacy of their own homes. Since this method of pregnancy detection has gained favour from women all over the world and is widely in use, it is important for everyone to know about it in detail. Here are a few things you should know about pregnancy test kits before you use one-

1) How they work

All at-home pregnancy test kits work by detecting a hormone called human Chorionic Gonadotropin (hCG) in the urine. This hormone is produced by the developing placenta after fertilization takes place. The fiber strip of the test is coated with a chemical that reacts with hCG to change colour and produce result. Here are a few tips that you should keep in mind while using hCG kits:

  • An hCG kit should be stored between 4° C to 25° C for maintaining shelf life. Preferably, it should be refrigerated before use.
  • It should be brought to room temperature before use.
  • Some brands claim higher accuracy than the others, which might not be necessarily true. What does affect the quality of the pregnancy test kit is the way it is stored. The result will not be accurate if the kit is faulty, damaged or expired. Thus, it is advised that you buy the kits from a store that actively sells and restocks pregnancy test kits.

2) There is a slight chance of inaccuracy

Most pregnancy test kits claim to be about 99% accurate. However, under certain conditions, the results might be imprecise. There can be two case scenarios when it comes to inaccurate results; it could either be a false positive or a false negative. The latter out of these two is more likely to happen. For example, if you are testing too early in your pregnancy, the kit might say ‘negative’ even if you actually are pregnant. This might happen due to the fact that that your hCG levels are not high enough to be detected. Also, consumption of excessive amounts of fluid before testing may dilute the urine, producing inexact result. To avoid these kinds of situations, it is advised that you take the test a day or two after the missed period, since the hCG levels would have risen to a detectable point.

False positives occur very rarely. These might occur in the case of ‘biochemical pregnancy’ wherein the chemical imbalance in the body causes the hCG levels to rise and give the false impression of a pregnancy. Similarly, ‘ovarian tumour’ can cause the secretion of hCG which can be the reason behind a false positive test result. In some cases, false positives can occur in the case of early miscarriage of pregnancy wherein traces of hCG would be left behind but there would be no living embryo. Consumption of fertility drugs which induce higher levels of hCG also might cause false positive results.

To get accurate results, one has to take multiple tests(preferably 2-5) at different time intervals. If your test turns out to be negative but you still haven’t received your period, you might have to take another test a week later. Although the test can be taken during any time of the day, it is said that the best time to test is early morning as the urine is more concentrated and hormones levels will be higher, and thus sensitive to detection.

3) There are different types of pregnancy test kits

There are a few variations of pregnancy test kits available in the market. These include-

  • Standard kits: These are the ones that show results by changing color of the strip.
  • Digital kits: These pregnancy test kits have a screen on which printed letters that either read out ‘pregnant’ or ‘not pregnant’ appear. Some of them use other symbols which are usually mentioned on the instructions leaflet. Digital tests are more expensive than standard kits but are more accurate and facilitate the clear reading of results which the standard kits sometimes fail to provide one with.

Variations also exist in the way urine is collected by the kit. While the most common type of pregnancy test kit comes with a test strip or dipstick, a few brands also offer a second type which comes with a urine collection cup.

4) There is a difference between ovulation predictor kits and pregnancy test kits

Ovulation predictor kits and pregnancy test kits work in different ways. While the former observes an increase in the luteinizing hormone, which occurs before a woman ovulates, the latter looks for increase in HCG levels. Although ovulation predictor kits are used by women to test whether they are ovulating or not, they can also be used as pregnancy test kits because both of these hormones work similarly in the body. However, if you decide to use an ovulation predictor kit to detect pregnancy, it would be better to confirm the result by using a pregnancy test kit itself.

5) If you are confused, visit a doctor

If you find the pregnancy test result to be ambiguous, then it is time to visit a doctor. Some situations might create a contradiction between what the test has to say and the way your body behaves. For instance, if your period arrives suddenly but the test you took turns out to be positive, then it’s important to take a blood-based pregnancy test which is more accurate. Similarly, if you are very late on your period but your pregnancy test kit says negative, then you should make an appointment with the OB-GYN. Be sure to get medical attention if it is called for.

Some pregnancy test kits available in the Indian market

Since the past few decades, women have increasingly started to depend on at-home pregnancy test kits rather than clinical tests as the former provide them with comfort and privacy. A number of companies dealing with products related to sexual health and wellness have started manufacturing pregnancy test kits. Here is a list of a few popular brands from which you can choose what suits you best-

1)I Can- I Will Pregnancy Test: Manufactured by Piramal Healthcare Ltd, ‘I Can- I Will Pregnancy Test’ is a one step pregnancy detection kit. It is easily available on online platforms as well as pharmacy outlets. A pack of 3 kits is priced at 144.80/- .

2)Getnews One Step Pregnancy Test: ‘Getnews One Step Pregnancy Test’ is manufactured by Nectar Lifesciences Ltd. A pack of 5 kits is priced at Rs. 350/-. It is commonly available on both online platforms as well as pharmacy outlets.

3)PregaNews Pregnancy Test Strips: This pregnancy test kit is manufactured by Manforce Pharmaceuticals. Each pack kit is priced at Rs. 49/-. You can find it on online stores as well as in pharmacy outlets.

4)Pregakem Pregnancy Detection Kit: This brand is manufactured by Alkem Healthcare Ltd. A pack of 5 kits is priced at Rs. 228/-. It is selectively available in pharmacy outlets and commonly available on online platforms.

5)First Response Pro Digital Pregnancy Test Kit: This digital pregnancy test kit is Bluetooth enabled and connects with its smartphone app, which provides pregnancy and cycle details. It claims that it can show the results 6 days sooner than the woman’s missed period. Each kit is priced at Rs. 1452/-. It is only available on online platforms and not pharmacy outlets.

About the writer:

Purnima P.V is pursuing History(Hons) from Miranda House, University of Delhi. Although a huge history buff, sociology is her one true love. She is also a photographer by passion. She describes herself as an ambivert, an amateur traveler, an avid reader with a special interest in the genre of fictional non-fantasy, a politically opinionated feminist, and an ally as well as a member of the LGTBQIA community.

Launching Radio Show on Sexual and Reproductive Health

We are going live on Radio Active (Community Radio) : 90.4 hz this Wednesday in Bangalore!

The show would be discussing issues on sexual and reproductive health. Our own podcaster, Aisha George would be conducting interviews, talking about issues and asking you for your views on these issues.

Tune into our show and let us have as many conversations as possible on this issue!

To check out some of our episodes:

Radio

National Health Policy 2017: What’s in it for sexual and reproductive health?

After a gap of 14 years since the National Health Policy of 2002, the cabinet approved the National Health Policy 2017 in March 2017. As an organisation working in sexual and reproductive health, Hidden Pockets has attempted to look at the policy from the lens of sexual and reproductive health of the population in the country. The policy has set targets for several parameters relating to sexual and reproductive health including family planning, HIV/AIDS, antenatal care coverage, newborn immunization, neo-natal mortality, infant mortality, among others. In a way to achieve these targets, several programmes and steps have been outlined in the policy. Some of the key highlights in the policy affecting sexual and reproductive health are:

National Health Programmes

In terms of National Health Programmes with respect to sexual and reproductive health, the policy includes:

  • RMNCH+A (Reproductive, Maternal, Newborn, Child, and Adolescent Health) services would address factors affecting maternal health and child survival by addressing – “the social determinants through developmental action in all sectors.”
  • With respect to children and adolescent health, it acknowledges the need to expand the scope of reproductive and sexual health in order to address issues like

“inadequate calorie intake, nutrition status and psychological problems interalia linked to misuse of technology, etc.

  • Increase the proportion of male sterilization from less than 5% currently, to at least 30% and if possible much higher.
  • Focused interventions on the high risk communities like MSM (Men who have Sex with Men), Transgender, FSW (Female Sex workers), etc. and prioritized geographies for control of HIV/AIDS

Our take:

  • It is progressive that the government acknowledges the need for expansion of reproductive and sexual health for adolescents and the need to address social determinants for maternal health. However, how it intends to implement these measures has to be seen.
  • Linking of psychological problems due to misuse of technology to sexual and reproductive health, could also lead to curbing of access to technology, especially for girls. It is already happening in some parts of India. How does the government intend to balance between gender equality with respect to access to technology/opportunity and healthcare?
  • It is also interesting that the policy includes MSM as a high-risk community. Sec 377 criminalizes carnal intercourse against the order of nature (which includes homosexuality). It would be interesting to see the government’s initiatives to target this group.

Primary, secondary and tertiary healthcare

  • The government will be introducing Health and Wellness Centres to provide “larger package of comprehensive primary health care.” To access these services, every family would be given a health card linking them to these facilities and making them eligible for a “defined package of services anywhere in the country”. The government intends to do this by using digital health to link primary, secondary and tertiary levels of healthcare.
  • At the secondary care services, even “caesarian section and neonatal care would be made available at least at the sub-divisional level in a cluster of few blocks.”
  • At the tertiary level, referral mechanisms will be operationalized to private institutions with deserving patients being admitted at a designated fee/subsidized beds.
  • Also, select tertiary services will be purchased from non-government sector hospitals to assist the poor

Gender based violence:

The section on Gender based violence notes that public hospitals need to be made women-friendly and the staff need orientation to gender sensitivity issues. It also states that healthcare to survivors and victims of gender based violence needs to be provided free and with dignity in the public and private sector.

Our take:

  • Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.
  • Even with respect to women, the policy does not qualify or define gender violence or gender sensitivity issues.

Women’s health and gender mainstreaming:

The policy notes,

There will be enhanced provisions for reproductive morbidities and health needs of women beyond the reproductive age group (40+) This would be in addition to package of services covered in the previous paragraphs.

Healthcare for transgender:

Apart from control of HIV, there is mention of transgenders only with respect to research –

Research on social determinants of health along with neglected health issues such as disability and transgender health will be promoted.”

There is no mention of transgender community in the list of vulnerable groups that the government intends to target with the new policy.

Our take: Apart from being vulnerable to sexually transmitted diseases, the transgender community continues to face discrimination in terms of access to basic healthcare. This is often due to lack of clarity regarding the hospital-ward of admission for members of the third gender. This continues to be the case even with provisions in the Transgender Persons (Protection of Rights) Bill and the NALSA judgement  that criminalizes denying of services to them.

The government recently issued a guideline to the SwachhBharath Mission (Gramin) stating that the third-gender community may be allowed to use public toilets of their choice.  Can we expect more such guidelines to make healthcare inclusive for the transgender community?

Some of the other highlights in the policy that could also have an effect on sexual and reproductive health are:

Partnerships with non-governmental/private organisations:

  • There is heavy emphasis on government-private partnerships in the policy including capacity building, skill development, disaster management, mental health programmes, disease surveillance, health information system, Corporate Social Responsibility (CSR), among others.
  • The policy also suggests government collaboration with the private sector for ‘Health and Wellness centres’ to set up fully functional primary healthcare facilities.
  • Private organisations have not been defined properly. In some cases, the term ‘non-government’ has been used for both ‘profit’ and ‘not-for-profit’ organizations. Two senior bureaucrats have clarified that non-governmental organisations meant both NGOs as commonly understood as charitable organisations – as well as private for-profit organisations as indicated by a Wire report.
  • The policy recommends a Health Information Exchange involving the private sector also pooling in data. With such high involvement of the private sector in healthcare, will they also be subjected to the regulations of the Right to Information Act? What guarantees accountability?

Financing and cost of healthcare:

  • The government intends to finance its health policy by increasing health expenditure from the existing 1.5% of GDP to 2.5% by 2025 and increase state sector health spending to >8% of state budgets by 2020.
  • The policy also notes that finance will be allocated by targeting specific population sub groups, geographical areas, health care services and gender related issues.
  • It also suggests timely revision of National List of Essential Medicines (NLEM) along with appropriate price control mechanisms for generic drugs in a way to decrease cost for patients seeking healthcare in the private sector.
  • The policy recommends the setting up of a medical tribunal to address disputes/complaints regarding different issues including prices of services.
  • The policy states that only few states have adopted the Clinical Establishment Act of 2010: Advocacy for adoption of this Act by other states will be undertaken.
  • Primary healthcare in urban areas would involve a cost for the middle class as against vulnerable groups.They will also be privatized.
  • It states that at the tertiary level, in the geriatric and chronic care segments, both for in & out-patients, most drugs and diagnostics would be free or subsidized with “some co-payments for well-to-do”.
  • It also notes that to encourage private sector participation, private sector would be incentivized through reimbursement/fees

Our take:

  • Would 2.5% of GDP for health expenditure by 2025 be sufficient to cover all plans mentioned in the policy? Sujatha Rao, former Union Health Secretary explains why this allocation could be too little too late
  • Which are the population sub groups, geographical areas and gender related issues? How will they be prioritized? On what basis? There seems to be a lack of clarity.
  • The policy has mentioned cost control measures only for medicines in the private sector. Though the policy talks about a medical tribunal with respect to pricing of services, it is not clear if services provided by the private sector would fall within the ambit of this tribunal. According to the data released by the Health Ministry for the year 2013-14, Indians spend 8 times more on private hospitals compared to government hospitals.

Health Information Exchange:

The government intends to establish integrated health information architecture to strengthen health surveillance, establish registries for diseases of public health importance by 2020. It intends to set up a Health Information Exchanges and National Health Information Network by 2025. This includes exchange of information even from private hospitals and non-government hospitals.

The policy suggests exploring the use of “Aadhaar” (Unique ID) for identification. Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics, creation of health information exchange platform and national health information network, use of National Optical Fibre Network, use of smartphones/tablets for capturing real time data, are key strategies of the National Health Information Architecture.”

The government also intends for private sector participation in developing and linking systems into a common network/grid, which can be accessed by both public and private healthcare providers.

Our take: The policy mentions that the medical tribunal will also be responsible for resolution of disputes related healthcare and also the need for protection of patients including right to information, access to medical records, confidentiality, privacy, among others. Information related to health is of sensitive nature especially sexual and reproductive health. This could include details about HIV and AIDS patients, abortion data, among others. What happens if there is a data leak? The government recently admitted to Aadhaar data leak.  Note that the government is already running a pilot to link PLHIV to Aadhaar number in Delhi. There is no privacy law in India yet.

In case of vulnerable groups (as mentioned in the policy) like sex workers, the government intends to provide them with better healthcare. With linking of phone numbers to Aadhaar number being mandatory, the phone numbers and biometrics of sex workers could be susceptible to misuse. What is the protection assured to them against harassment, once their Aadhaar biometrics and phone numbers are entered into the system to access healthcare?

Right to Health as a fundamental right:

Right to Health is not a fundamental right promised by the constitution of India. National Health Policy 2017 has reiterated the same. It advocates an “incremental assurance based approach”. The policy tries to understand Right to Health from two perspectives.

Questions that need to be addressed are manifold, namely, (a) whether when health care is a State subject, is it desirable or useful to make a Central law, (b) whether such a law should mainly focus on the enforcement of public health standards on water, sanitation, food safety, air pollution etc, or whether it should focus on health rights- access to health care and quality of health care – i.e whether focus should be on what the State enforces on citizens or on what the citizen demands of the State?

Our take: Focus on public health standards (sanitation, water, food safety etc) alone may not be sufficient in terms of ensuring sexual and reproductive health standards in the country. Considering the cost involved in privatized healthcare especially in sexual and reproductive healthcare, it already is quite difficult for all to access good and affordable healthcare. Even without Right to Health as a fundamental right, access to healthcare could become a problem with (mandatory) Aadhaar integration if authentication failures continue to persist, as has been the case with several states in the country. There is also the concern regarding deactivation of Aadhaar number without any recourse for the Aadhaar holder. How will this affect a person’s access to primary healthcare or health and wellness centres, as the policy calls it? How does the government intend to tackle this? It is appreciable that the policy highlights the need to improve the healthcare standards in the country before Right to Health is made a fundamental right. However, it does not mention a timeline for the implementation of this “incremental assurance based approach”. What is the vision for Right to Health as a fundamental right?

Implementation Framework:

The policy also envisages an implementation framework to be put in place to deliver on the policy commitments.

“A policy is only as good as its implementation.”

Mapping Jaipur and its reluctance to sexual health

Hidden Pockets Collective visited Jaipur as part of our mapping studies and went in looking for government hospitals in Jaipur. A lovely city  which is full of colourful people, we were really looking forward to this study. We visited Prayas, an excellent NGO working on the issue of Public Health and Medicines in Rajasthan and decided to seek their assistance before we started our mapping. This time, we wanted to cover different forms of public health facilities and understand how were people using facilities at different parts of the city.

Every time we ask someone for government hospital, people tend to tell us the name of biggest government hospital in their cities. It was the same case in Jaipur, as asked people around and did some search on internet we ended up looking at SMS Hospital and Medical College in Jaipur. It was conveniently located right in the middle of the city. It was crowded. We entered from Gate number 3 and went looking for sexual and reproductive services in the government , we were guided towards the Dhanvanthri department, Parivar at first floor in Room number 17.  It was right next to free medicine counter.

Then we headed towards a district hospital :Rukmani Devi Beni Prasad Jaipuria Hospital, located in Milap Nagar. We had heard that it had a One Stop Crisis Centre – Aparajita for rape survivors. It was a clean hospital which had a very good ambience for people. It was not at all crowded like SMS hospital and seemed like a good alternative for Sexual and Reproductive Health services. The images on the wall was a refreshing change from the normally sad looking walls of a hospital.

Post this, we headed towards Zenana Hospital, a hospital that was specifically for women and children. It was located right opposite to the Chandpole metro station. It was easy to locate though really crowded. Even though we were able to find services listed on various boards, we just could not find the rooms. We asked people around, even used the fancy not-so working info- booths, we just could not find the rooms for adolescent friendly health clinics, and other services.

We were really surprised by the number of posters for wifi in the different government hospitals. It seemed interesting that government was heavily promoting the usage of internet and technology in its various forms in the hospitals. Sadly none of them were in functional phase. 

Our last visit to Sanganer, which was bit far away from the city. We went there looking for a Community Health Centre, Sanganer.  A CHC is secondary level of health care and provide specialist care to patients referred from Primary Health Centres. A CHC is a 30-bed hospital providing specialist care in obstetrics and gynaecology according to the Indian Public Health Standards prescribed by the Ministry of Health & Family Welfare in 2012. So we decided to find this CHC. It was a bit far and we realised nobody really understands the term CHC, but if we referred it as “Sarkari hospital”, we were able to evoke response.

We didn’t see any crowd there as well and we were surprised to see a clean gynaecologist room and a room for counselling for Adolescent Friendly Health Clinic. We also encountered a poster that read in Hindi “Surakshit Garbhapath” which meant Safe Abortion. We were so happy to see a poster providing such positive message in the middle of a small town in Jaipur.

We were really happy with the services available in the Community Health Centre and returned back to our bus ride to Jaipur. On our way back, we wondered about the reason for people to head to big referral hospitals in cities, wasting time and their resources when they have good services in their towns.

We do understand there is a lear gap between implementation of these policies, and also lack of interest on the sides of service providers in assisting people in these smaller health centres, but if we could de-congest the big hospitals and still make this a good opportunity for the service providers. It would provide a great deal of relief for the patients of the related area. Until then, these were some of the hospitals that we visited in Jaipur and generally had a good experience.

Audio Podcasts

For some of us, audio senses has its own pleasure, and we decided to curate and create some of these stories in an audio format.

Through this audio podcast, get to know about Aravani Community (Transgender Community) and also about the Aravani Art Project.
A talk with Poornima Sukumar, Founder of the Aravani Art Project.

 

Young people from South Asia and South East Asia talking about Safe abortion, Single woman accessing Hospitals and about Government hospitals in general.

Listen to the conditions prevailing in South Asian as well south east Asian countries with respect to sexual and reproductive health. Know about how young women use the facilities in the hospitals, why do they prefer private or public hospitals.

#IWillGoOut was a national level event hosted by a collected of young women across in India, resisting the impositions and reclaiming their rights, and spaces on roads.

Background score: Credit: Destinazione@altrove-paintthesky missJudged

What is sexual pleasure for you? Do women experience this differently? We asked LoveTreats and found some interesting answers.

Pourakarmikas are Bangalore (Karnataka – India) based men and women who clear different kinds of garbage, from food waste to discarded cell phones, from the city’s streets.

Pourakarmikas are fighting for a life with dignity. On 8th March 2017, on International women’s Day they decided to protest at the BBMP head Office. Hidden Pockets joined them.

I want to thank the Facebook page ” Pourakarmikas Demand their Rights ” for providing us with useful content.

Music credit: @nop and destinazone_altrove

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Our City – Namma Pourakarmikas by Hidden-Pockets is licensed under a Creative Commons License.