1 MATERNAL & CHILD HEALTH CARE FOR THE URBAN POOR IN BANGALORE Findings from a Citizen Report Card on the Quality of Care

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, 2010 Methodology -1  This citizen report card was an initiative to improve the health services provided by the government by stimulating the government’s interest in dealing with the basic issues involved.  There were allegations about corruption and ill-treatment within the system which were anecdotal in nature and it would have been unfair to draw conclusions without a systematic investigation of the issued involved.  Thus, Public Affairs Center (PAC) undertook a comparative survey of maternity homes and the new outreach centres all over the city jointly with several interested Non Government Organizations (NGOs) which was presented to the municipal authorities in-charge of the health services.  These NGOs included Awas, Sumangali Sevashram and Maya who sent volunteers, who were mostly from the concerned community, to do the survey after being trained by PAC. 2

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, Methodology -2  Maternity Homes, Urban Family Welfare Centers (UFWC), and India Population Project (IPP) Health Centers were covered in two phases.  In Phase patients from these facilities were interviewed from 21 slums, 12 maternity homes, 12 UFWCs and 20 IPP health centers.  In Phase staff of these facilities were interviewed where one doctor, two nurses and one other staff from each maternity home, one doctor, one nurse and one other staff from each UFWC and IPP Health Centre.

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, Major Findings -1

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, 2010 Major Findings -2  Findings indicate distinct differences in service quality between Maternity Homes (MHs) and IPP HCs.  The clear distinction between MHs and IPP HCs in matters of hygiene & issue of basic medicine are reflective of poor discipline and low levels of responsiveness among the staff at MHs.  The practice of corruption is far more entrenched and a serious problem in MHs than in IPP HCs. The average amount paid by a poor women at this centre was Rs.1300 ($29) for all services. It was found that women had to pay Rs. 300 ($7) to see their babies if male and Rs.150 ($3.5) if female.  The study also shows that the staff are not ready to even concede that there is a problem of corruption let alone confronting it. 5

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, Major Recommendations  An effective oversight mechanism should be created for monitoring through a board of visitors.  A patients’ charter should be created.  There should be a move to a system of user charges which can be used for the maintenance and improvement of the particular facility.  Provision should be made for the diversification of the management and control of the outreach centers.  Support groups of women should be created.

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, 2010 Reforms  Boards of visitors to groups of maternity homes and the outreach centers have been set up.  A patients’ charter has been prepared.  There has been an introduction of user charges for selected services.  The management of a maternity home has been handed over to an interested NGO.  A helpline desk is being experimented with by one NGO in one maternity home.  The NGOs involved have continued their participation and monitoring has continued to take place.  PAC is currently engaged in a project supported by the International Budget Partnership carrying out public expenditure tracking in selected maternity homes in Bangalore. 7

Citizens Report Card, Public Affairs Foundation, Public Health Watch (PHW) Community Monitoring Workshop, March 23-25, 2010 Comparison between the Citizen Report Cards of 1999 and 2003  In regards to speed money paid for one service or another, the incidence had declined from 90% in 1999 to 81% in  Respondents’ satisfaction with behavior of doctors had increased from 73% in 1999 to 83% in Satisfaction with behavior of nurses had increased from 73% in 1999 to 80% in  In 1999, the maximum bribe was paid for delivery and for seeing the child. The total average amount paid by the users for all services to get their work done was Rs.1089 ($24).  In 2003, the two services for which the highest number of respondents had reported paying a bribe were still delivery and seeing the child. The total average amount paid by the users for all services had decreased to Rs 273 ($6). 8