Filed under: Health Education and Health Communication, Healthcare General
I recently came across a petition asking people if they recognized a victim of trafficking? To that I would say, NO, we cannot recognize a victim of trafficking so easily unless and until there are circumstances which seem geographically, psychologically and emotionally disagreeable to a common individual.
But all too often, most human trafficking victims pass through the health care system unnoticed and unaided. Many medical professionals haven’t been trained to recognize the signs and symptoms of human trafficking and abuse. Ideally, doctors and nurses should know to be wary of controlling companions (traffickers, abductors/suitors) — and suspicious when patients do not speak for themselves or do not have control over their own identification documents. Other signs include marks of physical abuse, fearfulness, depression, and extreme submission.
In India, human trafficking victims – for example troubled young girls working as domestic workers, labourers, nannies would be seen going to local gynecologists on their own or forcibly taken by the controllers to get an abortion done. At this point of time, the doctor or the health practitioner is somewhat doubtful but not in full confidence of handling the situation well. Many a times there have been girls who were trafficked for work to a metropolitan city and they had to return back to their village/hometown to give birth. In this process, they get socially excluded, harassed and doubly vulnerable again to more such instances.
I want to draw your attention to the some “Visible Indicators of Trafficking in Person” given by the website – www.humantrafficking.org
Visible Indicators May Include:
* Heavy security at the commercial establishment including barred windows, locked doors, isolated location, electronic surveillance. Women are never seen leaving the premises unless escorted.
* Victims live at the same premises as the brothel or work site or are driven between quarters and “work” by a guard. For labor trafficking, victims are often prohibited from leaving the work site, which may look like a guarded compound from the outside.
* Victims are kept under surveillance when taken to a doctor, hospital or clinic for treatment; trafficker may act as a translator.
* High foot traffic especially for brothels where there may be trafficked women indicated often by a stream of men arriving and leaving the premises.
Trafficking victims are generally kept in bondage through a combination of fear, intimidation, abuse, and psychological controls. While each victim will have a different experience, they share common threads that may signify a life of indentured servitude. Trafficking victims live a life marked by abuse, betrayal of their basic human rights, and control under their trafficker. The following indicators in and of themselves may not be enough to meet the legal standard for trafficking, but they indicate that a victim is controlled by someone else and, accordingly, the situation should be further investigated.
Understand the profile of a trafficked person
What Is the Profile of a Trafficking Victim? Most trafficking victims will not readily volunteer information about their status because of fear and abuse they have suffered at the hands of their trafficker. They may also be reluctant to come forward with information from despair, discouragement, and a sense that there are no viable options to escape their situation. Even if pressed, they may not identify themselves as someone held in bondage for fear of retribution to themselves or family members. However, there are indicators that often point to a person held in a slavery condition. They include:
1. Health Characteristics of a Trafficked Person:
Trafficked individuals may be treated as disposable possessions without much attention given to their mental or physical health. Accordingly, some of the health problems that may be evident in a victim include:
* Malnutrition, dehydration or poor personal hygiene
* Sexually transmitted diseases
* Signs of rape or sexual abuse
* Bruising, broken bones, or other signs of untreated medical problems
* Critical illnesses including diabetes, cancer or heart disease
* Post-traumatic stress or psychological disorders
2. Other Important Signs:
In addition to some of the obvious physical and mental indicators of trafficking, there are other signs that an individual is being controlled by someone else. Red flags should go up for police or aid workers who notice any of the following during an intake. The individual:
* Does not hold his/her own identity or travel documents
* Suffers from verbal or psychological abuse designed to intimidate, degrade and frighten the individual
* Has a trafficker or pimp who controls all the money, victim will have very little or no pocket money
Questions to ask if you suspect you are in the presence of a trafficking victim
1. Is the person free to leave the work site?
2. Is the person physically, sexually or psychologically abused?
3. Does the person have a passport or valid I.D. card and is he/she in possession of such documents?
4. What is the pay and conditions of employment?
5. Does the person live at home or at/near the work site?
6. How did the individual arrive to this destination if the suspected victim is a foreign national?
7. Has the person or a family member of this person been threatened?
8. Does the person fear that something bad will happen to him or her, or to a family member, if he/she leaves the job?
Anyone can report suspected trafficking cases to the responsible local authorities/NGO’s etc. If the victim is under 18, professionals who work in law enforcement, health care, social care, mental health, and education are mandated to report such cases. Through a grass-roots community-wide effort and public awareness campaign, more professionals on the front line can readily identify the trafficking victim and have him/her treated accordingly.
Contributed by Karuna Dayal
(The author is with Multiple Action Research Group in New Delhi and has extensive experience of dealing with trafficked victims during her association at Human Rights Law Network)
Filed under: Health Education and Health Communication, Healthcare General
Giving further information in Rajya Sabha today the Minister of State (I/C) of Women and Child Development Smt. Krishna Tirath stated that in urban and rural areas, anaemia in women (age 15-49 years) is 50.9% and 57.4% respectively while prevalence of chronic energy deficiency is 25.0% and 40.6% respectively.
The Minister said that the problem of malnutrition is complex, multi-dimensional and inter-generational in nature. The approach to dealing with the nutrition challenges has been two pronged: Multi-sectoral approach for accelerated action on the determinants of malnutrition in targeting nutrition in schemes/programmes of all the sectors. As the multi-sectoral approach takes some time to show results and when implemented together, have a trickle down and horizontal effect to benefit the population over a period of time, other part of the approach is direct and specific interventions targeted towards the vulnerable groups such as children below 6 years, adolescent girls, pregnant and lactating mothers.
The Minister assured the House that the Government has accorded priority to the issue of malnutrition and is implementing several schemes /programmes of different Ministries/Departments through State Governments/UT Administrations. These programmes include the Integrated Child Development Services (ICDS) Scheme, National Rural Health Mission (NRHM), Rajiv Gandhi Schemes for Empowerment of Adolescent Girls (RGSEAG) namely SABLA, Indira Gandhi Matritva Sahyog Yojna (IGMSY) as Direct targeted interventions. Besides, indirect Multi-sectoral interventions include Targeted Public Distribution System(TPDS), National Horticulture Mission, National Food Security Mission , Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), Total Sanitation Campaign, National Rural Drinking Water Programme etc. All these schemes have potential to address one or other aspect of Nutrition.
Smt. Tirath said that several of the schemes namely, ICDS, NRHM, Swarnajayanti Gram Swarojgar Yojna have been expanded/universalized to provide increased coverage and improved services to the people which would further improve the nutrition situation.
Elaborating further on the issue the Minister stated that for effective implementation of the programme like ICDS, a five tier monitoring and review mechanism has been set up at the National, State, District, Block and the Anganwadi level. Regular review meetings with States and field visit/inspection are also carried out.
(Release ID :75032)
By: Karuna Dayal
Filed under: Community Health, Health News, Health Planning, Health Systems, Healthcare General, Public Health
The National Rural Health Mission (NRHM) has been described as one of the largest and most ambitious programmes to revive health care in the world and has many achievements to its credit. It seeks to provide universal access to health care, which is affordable, equitable, and of good quality. It has increased health finance, improved infrastructure for health delivery, established institutional standards, trained health care staff and has provided technical support. It has facilitated financial management, assisted in computerisation of health data, suggested centralised procurement of drugs, equipment and supplies, mandated the formation of village health and hospital committees and community monitoring of services. It has revived and revitalised a neglected public health care delivery system.
Challenges and solutions :
The NRHM has injected new hope into the health care delivery system in India. However, it continues to face diverse challenges, which need to be addressed if its goals are to be achieved in the near future.
Health as a State subject : The location of health in the State list rather than the concurrent list poses major problems for service delivery. This is also compounded by the fact that the NRHM funding is from the Centre while the implementation is by the State governments. Health care delivery cannot be improved to provide a seamless service without the removal of these barriers.
Project mode and problems : The NRHM is currently functioning as a project of the Government of India and is due to end in 2012. Its significant contribution to improving health care infrastructure and service delivery across the country will be frittered away if its funding ceases with the 11th Five Year Plan (FYP). The NRHM should be not only included in the 12th FYP but also be changed from its limited term project mode to a permanent solution to India’s health problems.
Its status as a project makes the integration of the NRHM with the State health care systems problematic. The divisions run deep resulting in irrational distribution of human resource and infrastructure. The inertia of the old system and the low morale and discipline of its staff continue to be major challenges. The NRHM has been able to add new infrastructure and personnel; however, its impact on re-inventing and re-invigorating systems seems to be limited, with much more effort being required. There is a need for a more coordinated approach which optimally utilises resources.
Improving governance : A comparison of data between States and within regions and social groups suggests marked variations in the NRHM process indicators, utilisation of funds, improvements in health care delivery, health indices and in community participation. Regions with prior good health indices have shown marked improvements, while those with prior poor indices have recorded much less change. This is true, despite a greater NRHM focus on and inputs to poor-performance States. Improving governance and stewardship within the NRHM programmes mandates general improvement in the overall governance of States and regions.
Increased funding : Health care costs for the average Indian usually results in catastrophic out-of-pocket expenditure and is a well recognised cause of indebtedness in the country. The total health budget for India is about 1 per cent of the country’s GDP. Most developed nations prioritise health care and provide 5-10 per cent of their GDP. The 12th FYP should increase funding for health to the tune of 2-3 per cent as promised by the United Progressive Alliance.
The diversion of funds, through private health insurance schemes for the care of rare disorders to be treated in corporate hospitals, takes away funding from the public health care system. The injection of such money into the public system would allow for the provision of universal health care, improve government health systems and provide for common health conditions benefiting larger numbers.
Urban health : The NRHM has focussed on rural health. Many parts of urban India have similar health care needs and currently have glaring deficiencies. The National Urban Health Mission should be accorded the same status as the NRHM. Both efforts should be coordinated and combined into a National Health Mission.
Expand focus : The major focus of NRHM is on maternal and child health. While this is vital, there is a need to expand the vision to other common general health problems. There is evidence to suggest that other crucial government programmes (e.g. blindness) have taken a back seat.
Cash transfers and outcome : The NRHM currently employs process indicators to measure its implementation. The measures used are mainly related to finance, infrastructure and personnel. There is need to shift over to indicators of efficient functioning and examine their impact on health outcomes. The initial high rates of mortality tend to reduce rapidly with early inputs but require fully functional, efficient and effective systems for sustained results. The Janani Suraksha Yojana, a conditional cash transfer scheme to incentivise the use of health services to reduce maternal and neo-natal mortality among poor women, has become a success by encouraging institutional deliveries. However, the evaluation of its success should be based on its impact on the health outcome of the mother and baby, rather than on financial process indicators.
Similarly, the diverse and difficult circumstances of medical practice across the country mandate a differential reinforcement for health professionals. There is need for differential payments to health care staff who work in remote situations and difficult contexts.
Health information and monitoring : The NRHM has provided for infrastructure, personnel and training for Health Management Information Systems. However, these are not optimally utilised. There is need to improve the information system as part of the process of monitoring health indices of populations and functioning of the public health care system. The NRHM already has a programme of community monitoring and social audit. This should be strengthened in order to monitor the use of funds and empower local communities.
Social determinants and public health approaches : The goals of the NRHM clearly state the need to impact on the social determinants of health by coordinating efforts to provide clean water, sanitation, nutrition, housing, education and employment. It should, in conjunction with other government programmes, work towards the reduction of poverty, social exclusion and gender discrimination, all of which have a significant impact on health. There is need to increase the synergy and coordination between government programmes (e.g. the Integrated Child Development Scheme, the Mahatma Gandhi National Rural Employment Guarantee Act, etc.) and the NRHM.
Improvements in health of populations contribute to economic development and vice versa. This bidirectional relationship justifies increased investment in health. The NRHM should become an integral part of the Five Year Plans and the health budget should be increased to 2-3 per cent of GDP. The National Urban Health Mission should receive equal funding priority and be coordinated with the NRHM. Greater financial inputs to improve governance and specific funding to coordinate NRHM programmes with those of the State health services are crucial, as is cooperation with other government programmes to target social determinants of health. Strengthening of health information, community monitoring and social audits to assess its impact on health outcome indicators is necessary. Improved funding for the public health sector to treat common health conditions, rather than providing private health insurance for uncommon disorders, is mandatory. State governments also need to prioritise health and increase their share of the health budget.
The NRHM has made a significant impact on health care delivery. However, greater political, administrative and financial commitment is required for it to make a substantial impact on health outcomes. The 12th Plan should allocate ring-fenced budgets for specific operations. There is need to develop systems to monitor and audit performance and health indices; this will allow for course corrections.
The health care system has flaws, both at the conceptual and operational levels. However, there is no simple, band-aid solution to the problem. There is a need for continuous monitoring and appraisal, allowing for regular course corrections. Unfortunately, health is a prime example where good politics and good policy diverge. One cannot ignore the economic interests of the health education-hospital-pharmaceutical-insurance industries who directly profit from tertiary specialist care, indirectly when public health delivery systems are run down and when the social determinants of health are neglected. In our capitalistic world, these interest groups cannot be expected to look beyond their strategy to generate profit. Politicians and governments are also unable to see the ethical issues related to equity and lack the conviction to provide services for the poor. Health, a human right, and universal health care should not remain an aspiration but should become operational in the near future.
The bidirectional relationship between economic development and health justifies greater investment in the health sector.
By Professor K.S. Jacob
(The writer is on the faculty of the Christian Medical College, Vellore.)
This article was published in The Hindu on August 8, 2011. It can be accessed here