PHM India: Notes from the Talk by Madhuri Krishnaswami, on Re-politicization and De-professionalization- The way forward for the health rights discourse

13 Nov 2013

Speaking in Karnataka, Madhuri Krishnaswami fore-grounded the broader understanding of health to include social determinants of health and drew attention to how lack of health and health care is rendering the lives of not just the poor and marginalized, but also the middle class fragile and vulnerable. However it was the working class who bore the brunt of repeated illness due to poor nutrition and over -work, non-functional, unresponsive public health system and increasing health care costs, which was pauperizing them and pushing their children to drop out of school to look after the ill and augment family income.

Explaining that the chances of a soldier surviving a war posting were far higher than a pregnant woman surviving the risk of pregnancy and delivery, she said that health is a fundamental, livelihood and a survival issue for the people and not a technical issue to be pursued by experts. The fact that the State has begun the deliberate onslaught of privatization and starving the public health system of resources is an issue for the people’s movement whose lives and livelihoods are affected directly. People should be on the streets fighting against the exploitative system of having to pay for health care which is stealing their livelihoods and their children’s future.

Exploring why one does not find a vibrant people’s movement on health, Madhuri said that on the one hand health what one  sees is a soft issue devoid of politics and power. On the other hand, the NGOs have moved-in either to provide service or to mediate between people and the State through their ‘rights-based approach’. In the process they have taken away the people’s prerogative and replaced it with expertise and skills. As it is, people are wary of doctors and their ways and now they have to contend with a host of experts and professionals who tell them they do not understand. It is the experts in universities along with the government and now the private sector players who are telling the people what their health status is, why it is so, that they will do whatever needs to be done and people have nothing to do with it. This is the present crisis of health rights movement which is reduced to experts talking in conference halls to each other. Much like the four blind-folded wise men asked to describe an elephant, experts talk about issues in their sectoral area of professional training and expertise, which is myopic and fragmented. But that is not how people live their lives. They are confronted by the elephant everyday and understand it in its entirety.

If the health rights movement has to be rescued from its present crisis, then it has to move forward as a democratic movement for citizens’ rights and build an understanding of the system from people’s own experience and not merely through the experts. And experts if well-meaning should lay their expertise at people’s disposal, they should be talking to people on the streets and not in conference halls and learn from the people. In the face of a silent emergency of malnutrition, maternal deaths and infant deaths she urged that the health movement should move forward as a mass movement anchored in people’s vision of a democratic just society demanding that the State take complete and full responsibility for directly providing free universal good quality health care for all. 

Madhuri Krishnaswamy works with Jagrit Advivasi Dalit Sanghatan (JADS) in Central Indian state of Madhya Pradesh.JADS has been in the forefront of various struggles to reclaim community commons, realize livelihood and cultural rights in their larger fight against oppressive forces of class, caste and gender that have systematically denied the most marginalized people a life of dignity. In this process JADS has been forcing the public health system to be more responsive and accountable to the people and has been at the receiving end of State repression. For instance, Madhuri was recently arrested for raising the issue of an adivasi woman who was denied delivery care in a government health centre and was forced to deliver on the street. 

As someone who stands on the margins with the adivasi communities Madhuri is able to see the fractures and fault lines in the health rights "movement" and activism which in India continues to be led by NGOs and experts who are far removed from people's lived realities, do not share their world view and more seriously in many instances have themselves become conduits for furthering the privatization agenda. It is this departure that Madhuri foregrounds in her talk in Bangalore organized by the Janaarogya Andolana Karnataka (JAAK), the Karnataka state circle of PHM.

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