A primary objective of democratic governance must be the assurance for every citizen of a guarantee of public health. Yet in India, despite the endeavour of successive governments, a network of primary health centres down to the level of every panchayat and a multiplicity of schemes for the welfare of the poorest, ready and easy access to quality health facilities still evades too many. This is despite the existence of some of the world’s best doctors in our midst and hospitals to which patients gravitate from across the world to seek affordable and quality treatment. We also have the choice of medical systems apart from the allopathic, which have ensured widespread healthcare for centuries, when Europe was still struggling with primitive instrumentation.
The success of government initiatives, in a country as vast and diverse as ours, particularly in ensuring delivery of public health, depends on the collective contribution of the public in seemingly small, everyday changes at the ground level. In targeting millions of people we can only be effective if, village by village, we can build the foundations of a healthier community. The gram panchayat, therefore, holds the key to building and sustaining healthier, better-nourished communities, particularly mother sand their offspring. At the time the 73 rd amendment to the Constitution was planned, this was in fact among the principal aims.
Uttar Pradesh, India’s most populated state, cries out for the very best interventions in health and nutrition. Today, the statistics are witness to the scale of the challenge: Only three in 100 couples in UP use contraceptives after childbirth, leading to closely-spaced births that pose a grave risk to the mother’s health; five out of six mothers in the state do not exclusively breastfeed their children in the first six months, and nearly half of all adolescent girls in Uttar Pradesh are anaemic, setting into motion a cycle of low immunity and poor health that can be passed on to their children as well.
The tragedy is that although these statistics are shocking they are true not only of UP but of several other states with but small variations.
Panchayati Raj Institutions (PRIs), more than any other instrument of the State, were specially designed to include individual citizens in the rural areas in governance. Gram sabhas, designed to be the font of the country’s legislative framework, make every citizen a legislator. Empowering them and ensuring that they act to ensure the basic necessity of better health and nutrition in the villages are vital to the idea of public participation in governance. Government initiatives such as monthly village health and nutrition days (VHNDs) have, where effective, done much to improve access to and delivery of essential health and nutrition services. It only remains to ensure that these initiatives are integrated with the panchayat plans of village development.
The VHNDs, even where active, today focus more on immunisation. Creative, active gram sabhas can ensure that the village health and nutrition days become an avenue for interventions such as ante-natal check-ups, Iron Folic Acid (IFA) tablet distribution, counselling on family planning, supplementary nutrition to pregnant and lactating women and children among others. The village health and nutrition days, where successful, give even the most marginalised sections of the population a platform to seek health services.
Given that the VHNDs are organised by women health workers such as accredited social health activists (ASHAs), auxiliary nurse midwife (ANM) and Anganwadi workers, there is also acasefor women in the community and the PR I leadership to take the lead in building healthy communities together. There is much promise in this respect. Of the 1,192 gram pradhans elected in UP in 2015, 568 are women. This is an example of an institutional framework in existence, waiting to be used. This can be readily done by placing the Primary Health Centre (PHC) under the control of the panchayat and made an institutional resource for the VHND.
Incentivising good performance also ensures a greater assumption of responsibilities, and can motivate the PRI leadership to deliver. The UP government, for example, announced that from the 2017 Women’s Day (8 March), 100 women pr ad hans would be awarded a prize of Rs 1 lakh each for exemplary service. This can also then be an access point to the village of NGOs, both national and international, willing and able to contribute with finances or expertise to the resolution of ills facing our rural citizens.
It is also encouraging to see the Centre committing firmly to stronger and more effective PRIs. Its recent Gram Uday initiative seeks to build awareness and motivation towards more socially harmonious, empowered, prosperous and healthier villages.
Mahatma Gandhi said “India’ s way is not Europe’ s; India is not Calcutta and Bombay. India lives in her seven hundred thousand villages.” It has taken us almost half a century of freedom to finally bring to consummation the Mahatma’s dream of village governance through the Constitution. “True democracy”, the father of our nation had said, “cannot be brought about by twenty men sitting at the Centre. It has to be worked from below, by the people of every village”. The institution of panchayat, in Uttar Pradesh as elsewhere in the country, working with its legislature, ‘the people’ referred to by the father of our nation, duly empowered, has the answer.
Wajahat Habibullah is former secretary, ministry of panchayati raj . The views expressed are personal.