May 22, 2013 Sub: Immediate release of Ms Madhuri Krishnaswamy and mandatory establishment of Grievance Redressal and Community

Monitoring Mechanisms Dear Mr Desiraju, We would first like to thank the Honorable Minister of Health and Family Welfare, Mr Ghulam Nabi Azad, yourself and all others at the Department of Health and Family for the very laudable decision to withdraw the parity and age related restrictions related to Janani Suraksha Yojana from the high performing states. This step will benefit millions of women from the marginalised communities and marks a significant step in fulfilling the Governments commitment towards inclusive development. We would also like to bring to your notice a very unfortunate incident that took place on the 16th of May 2013 when a senior social worker Ms Madhuri Krishnaswamy, associated with the Jagrit Adivasi Dalit Sangathan, was arrested in court in the Badwani District Court in Madhya Pradesh, and is currently under Judicial remand in Khargone district jail. This case is related to the protest over the childbirth of an Adivasi woman Baniya Bai which took place in full public view outside the Menimata PHC in Barwani district in 2008, when she was thrown out of the PHC during labour following inability to pay Rs 100 demanded by a Compounder. This event had happened after NRHM had started providing incentives for promoting Institutional Delivery. After the protest and continued demands for action, the Compounder was suspended, but he was re-instated later, and he filed an FIR against Madhuri, Basant ( husband of Baniya Bai) and others. On 16th May 2013 when she went to court to attend a hearing related to the case, Madhuri was arrested under Sec 147, 148 332, 353 of the IPC and Sections 3 and 4 of the Madhya Pradesh Chikitsak Tatha Chikitsa sewa se sambandhit vyaktiyon ki suraksha adhiniyam 2008. There have been many studies which show that JSY has increased the expectations of the community from institutional delivery, however the quality of care has been shown to be deficient. There are cases of disrespectful and abusive behaviour, and denial of services which have even been highlighted by the NHSRC report on JSY, the Common Review Missions and the departments own review. However there are no functional grievance redress mechanisms; and even Community Monitoring which provides a platform for dialogue and expression of community grievances, is limited to a few districts in some states, and faces significant resistance from state health departments. In such a situation, local protest in the face of poor quality, disrespect and abuse often remains the only democratic means for the poor and marginalised to express themselves. You will agree that such repressive and arbitrary behaviour by local authorities will provide a negative impetus to the government programmes like the JSY. These actions also provide a very negative image of Indias efforts at providing essential maternal health services, which have till now been lauded internationally.

We would urge you to first enquire into the arrest of Ms Madhuri and her colleagues and ensure that the case is speedily discharged so that the faith of the poor on the public system is not that of an oppressor but a provider. Second we would request you to urgently ensure mechanisms and platforms for the people to express their opinions and feedback in a constructive manner so that the performance of the public health system improves and we can avoid such confrontations in the future. Grievance redressal mechanisms and community monitoring must be made mandatory with adequate budgetary support from MOHFW / NRHM, otherwise such events of public protest against poor services will continue to increase. We may end up exposing the poor and those who work with the poor to the double jeopardy of poor services and jail for coming to the hospital for accessing officially mandated services. Sincerely, Dr Abhay Shukla, SATHI, Pune, Maharashtra Dr Abhijit Das, Centre for Health and Social Justice, New Delhi Dr H Sudarshan, Karuna Trust, Bangalore, Karnataka cc: Ms Anuradha Gupta Mission Director, NRHM, GoI Principal Secretary,Health, GoMP Ms M Geetha, Mission Director, MRHM, MP

Dr Mira Shiva Initiative for Health & Equity in Society and Diverse Women for Diversity, New Delhi Dr Sharad Iyengar, Action Research & Training for Health (ARTH), Udaipur, Rajasthan Dr Sunil Kaul, the ANT, Chirang, Assam Dr Yogesh Jain, Jan Swasthya Sahyog, Bilaspur, Chhattisgarh Mr Harsh Mander, Aman Biradari, New Delhi Mr Subhas Mendhapurkar, SUTRA, Himachal Pradesh Ms Jashodhara Dasgupta National Alliance on Maternal Health and Human Rights, India Ms Mirai Chatterjee, SEWA, Gujarat Ms Padma Deosthali, CEHAT, Mumbai, Maharashtra Ms Poonam Muttreja , Population Foundation of India, New Delhi Ms Renu Khanna, SAHAJ and CommonHealth, Vadodara, Gujarat Ms Suneeta Dhar, Jagori, New Delhi Prof Gita Sen, IIM, Bangalore, Karnataka