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An Ushahidi-Powered Platform Shows "Free" Healthcare In India Comes With Hidden Costs

BY Jessica McKenzie | Wednesday, June 18 2014

Mother and child, India. (Thessaly La Force/Flickr)

Two and a half years after a pilot program called Mera Swasthya Meri Aawaz (My Health, My Voice) was launched to record and document the informal fees that plague India's “free” maternal health services in Uttar Pradesh, hundreds of reports have been collected and mapped. The Indian human rights organization Sahayog, which helped launched the initiative, tells techPresident that around 40 public health facilities in two Uttar Pradesh districts have been connected to informal fees, a kind of low-level corruption.

Since the World Health Organization (WHO) launched the global Safe Motherhood Initiative in 1987, maternal mortality rates in India have fallen dramatically, but poor rural states like Uttar Pradesh have seen slower progress than wealthier urban areas.

The maternal mortality ratio in India fell from 560 deaths per 100,000 live births in 1990 to 190 deaths per 100,000 live births in 2013. However, the state of Uttar Pradesh has the highest maternal mortality ratio in India: 517 deaths per 100,000 live births according to this 2012 report.

“Who asks what happened afterwards? ... If a person dies, she dies. If someone hangs himself then it becomes a police case. But if someone dies in a hospital then no one cares,” a neighbor of a deceased pregnant woman in Uttar Pradesh told Human Rights Watch (HRW) in 2009.

Although this can in part be attributed to insufficient healthcare services, Human Rights Watch has also identified informal fees as a factor in maternal mortality rates.

“Nothing is free for anyone,” a community health worker in Uttar Pradesh told HWR in 2009. “What happens when we take a woman for delivery to the hospital is that she will have to pay for her cord to be cut... for medicines, some more money for the cleaning. The staff nurse will also ask for money.”

The pilot program Mera Swasthya Meri Aawaz was conceived as a way to document the corrupt practice of asking for informal payments in return for supposedly free services. The program is a collaborative effort by Sahayog and Mahila Swasthya Adhikar Manch (Women's Health and Rights Forum), among others, with funding from the MacArthur Foundation.

Y.K. Sandhya, a program manager at Sahayog, explained in an email to techPresident that although community based organizations are aware of informal fees, they have lacked the technology to document the practice and “hold their government accountable.”

Sandhya wrote to techPresident:

We at SAHAYOG believe that the health system is a core social institute, and it should be a place where inequalities are redressed rather than exacerbated. This project by strengthening the capacities of poor women in these districts is an attempt to enable them to document such cases thereby strengthening citizen led monitoring to promote accountability. [sic]

Women and their families can report informal fees by email, an online form, a smartphone app, or by calling an interactive voice response system, and the reports are subsequently uploaded to the website and mapped on the Ushahidi platform.

This is a short introductory film produced by Sahayog that explains how Mera Swasthya Meri Aawaz works, how they are educating women about the reporting mechanism, and how they hope to lobby the government for healthcare reform:

Between January 24, 2012 and May 24, 2013, Sandhya informed techPresident, 873 reports of informal payments were made through Mera Swasthya Meri Aawaz, implicating roughly 40 public health facilities. All 873 reports come from the two districts (out of the 75 in Uttar Pradesh) in which the program was launched. Since January 2, 2014, there have been more than 350 reports, which can be sorted by category (e.g. bribe for examination, money asked for blood or operation, maternal death).

Reporting was higher in areas with active grassroots community groups, Sandhya tells techPresident.

She adds:

Almost half (44%) of all reports were payments made for food and transport followed by payments made for medicines, examination and supplies (20%) and ambulance services during referral (20%). A little over 40% of all payments reported to the Mera Swasthya Meri Aawaz helpline were over 500 INR [USD$8.29].

In January the program expanded to two additional districts in Uttar Pradesh, so it is now active in four districts in total.

Personal Democracy Media is grateful to the Omidyar Network and the UN Foundation for their generous support of techPresident's WeGov section.

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