Passing On The Baton

After spearheading Centre for Enquiry into Health and Allied Themes (CEHAT) for six-long years as the co-ordinator, which took the NGO from strength to strength, Ravi Duggal had recently opted out of his demanding job to work as an independent researcher. His ties with CEHAT would be as a consultant now. He spoke to Rita Dutta about his years in CEHAT, the reasons for leaving his current position and his plans ahead.

At a time, when you had become synonymous with CEHAT, why did you decide to leave CEHAT?

I had joined CEHAT in November 1999, when it was poised for rapid growth. It was a great challenge as well as an exciting opportunity to contribute to CEHAT’s growth. In the six years that I worked with CEHAT, it emerged as a national institution, taking projects at the national level as well as collaborating with other national institutions, both public and private.

The reason for my move is two-fold. The position of co-ordinator requires quality time to be spent in managing the organisation, guiding others, building their capacity, steering projects and programmes, raising funds thorough project grants, liaisoning with the external world of donors, public agencies, NGOs and other civil society groups. These are very intensive activities and demand 14 - 16 hours of work every day, including weekends. This affects family and personal life and hence such existence is not sustainable.

Further, CEHAT believes in periodic change in leadership. The first co-ordinator, Dr Amar Jesani, led CEHAT for five and a half years, before I stepped in. We wanted to make this position rotate every three years, but I had to extend my contract up to six years as it was not easy to find a good replacement.

Which are the main projects and programmes that you had worked on during your tenure as a co-ordinator?

When I joined CEHAT, the two major projects that were going on were both community- based. One was in a Mumbai slum, which dealt with community health issues with a special focus on domestic violence. The other was based in rural Maharashtra and Madhya Pradesh again focusing on community health issues, but in the context of rural areas and in collaboration with grassroots peoples organisations. This project now continues on a larger scale and has become pivotal in the Peoples Health Movement in India as it also houses the National Secretariat of the Indian chapter called the Jan Swasthya Abhiyan.

Within the first year of my joining CEHAT, three new and major initiatives were taken up by CEHAT, which helped catapult it into a national institution. The first was a major national research and advocacy initiative on abortion called Abortion Assessment Project India. This involved undertaking various studies related to abortion - quality of abortion care, provider perspectives, women’s perspectives, facility surveys, household studies, cost of abortion care and qualitative studies. These studies were conducted across 18 states and 14 different institutions collaborated in the studies. This national project was co-managed by me and a colleague Vimala Ramachandran from Health Watch, an advocacy group on reproductive rights.

The second major project emerged from the Mumbai slum project on domestic violence. Our study and interface with the community led us to believe that a public hospital- based crises centre was one useful solution to provide solace to women who faced violence within very intimate relationships within the family. This gave birth to the ‘Dilaasa’ initiative in collaboration with the MCGM, which started from the Bandra Bhabha Hospital. ‘Dilaasa’ now has become a model for the country as a whole. Within Mumbai, it is now being replicated in three other public hospitals and there is also a demand from other parts of the country to help and facilitate setting up such centres.

The third major initiative was an institutional development programme which had two components, one establishing the physical infrastructure of CEHAT, which helped CEHAT acquire its own office space and another component to develop the health services research and the health and human rights program within CEHAT. This project provided the foundation for development of the present Health as a Human Right programme within CEHAT, which helped focus research on various dimensions of health as a human right, including health systems and financing, and health care access of various vulnerable groups like women, dalits, adivasis, the aged, migrant communities, HIV/AIDS affected etc. This research will contribute to developing a shadow report on right to healthcare under Article 12 of the International Covenant on Economic, Social and Cultural Rights. It has also helped CEHAT to set up a national training programme on health and human rights, which CEHAT runs in collaboration with Tata Institute of Social Sciences (TISS) awarding a joint certification for participants.

As part of the health and human rights programme, CEHAT developed expertise in public interest litigation (PIL) and the work on the PNDT Act is a unique contribution of CEHAT in collaboration with MASUM, a Pune-based women’s group and Sabu George, an individual activist. Following the successful PIL and amendments to the PNDT Act, CEHAT has helped facilitate a national network to monitor the implementation of the PNDT Act.

Another major contribution under the health and human rights programme has been the work on budgets and its use as an advocacy tool. CEHAT has successfully initiated a network of groups across Maharashtra, whose capacities have been developed to read and understand budgets and subsequently use them for advocacy of various rights.

Besides, an initiative that emerged during my tenure was taking forward the process of accreditation of private hospitals and regulation of the private health sector via strengthening the BNHR Act. This has been a difficult process due to the slow response of the government in helping push the initiative vigorously. We have had some success with motivating a few medical associations to become a part of this process by setting up together a Healthcare Accreditation Council. During my tenure, CEHAT’s work on investigation of sexual assault was revived. The kit and manual developed by CEHAT was updated and active advocacy for its use in investigation of rape has now been taken up. Also acknowledging CEHAT’s contribution to gender equity issues, the Maharashtra government approached CEHAT to undertake a capacity building and advocacy initiative on issues like sex selection, gender based violence and age at marriage to support their RCH work across the state. Apart from this, a number of small studies on various aspects of health systems have been done.

And finally, CEHAT has also developed into an important resource unit on various health issues with a well-established information centre, which includes a library and documentation unit, databases on various health issues, and development of a wide range of audio visual material on various health concerns related to the different projects done by CEHAT.

What are the challenges that you faced, while working with CEHAT?

One challenging and unique aspect of CEHAT as an organisation is the decision making process which is done within a democratic framework. CEHAT has an elected executive body called the Working Group, which is the key decision-making body. This makes CEHAT quite unique and is also a model in organisational management. This makes the management function a different kind of challenge, as well as helps to develop leadership skills amongst all categories of staff.

What projects do you plan to take up as a consultant? In which areas do you plan to work?

As a consultant, I give about one-third of my time to CEHAT on some ongoing research activities and in the remaining time do consultancy as an independent researcher. My area of expertise is health systems and financing and I would like to do research on a consulting basis in these areas. Specifically I have defined the following areas for my future work: health policy, systems and financing; budgets and national health accounts; health equity; political economy of health; health and human rights; public and private health sector reforms; health information and databases; reproductive health and rights and monitoring and evaluation.

Apart from research, I am also involved in training and teaching courses on health systems, health policy, health economics and political economy of health. I am a visiting faculty for the Masters in Public Health course at the Achutha Menon Centre for Health Sciences and Studies in Trivandrum as well as I take occasional lectures at TISS.

To whom did you pass on the baton as a co-ordinator?

The new co-ordinator is Padma Deosthali. She was earlier managing the ‘Dilaasa’ project. She is being supported by Amita Pitre, who is the Joint Coordinator. Both Padma and Amita are highly committed to CEHAT and enjoy the confidence of the staff.

Calls in CEHAT are still directed to you. Would you like to go back to work for CEHAT?

Well these things happen and would soon fade out. I still spend two days each week in CEHAT and would continue to associate with it in some form, even if I move away from the city of Mumbai.

rita@expresshealthcaremgmt.com