The document summarizes direct monitoring efforts by community members at the Primary Health Center (PHC) in Pati, Madhya Pradesh. Villagers and local organizations directly observed PHC services for 4 days to identify deficiencies like doctors arriving late, reuse of needles, and denial of free medicines. As a result of continuous monitoring, services improved with doctors staying full days, ambulance use, separate needles, and no charges for treatment. The struggle then expanded to demand better care at the district hospital in Barwani.

1. Direct Monitoring at PATI, Community Health Center in
Madhya Pradesh
Presentation by
Sant Kumar, SATHI
at International People's Health University course on Health and Equity
September 2009, Bangalore

2. Barwani

3. Deficiencies Observed in CHC,
Pati
- Doctors not coming on time to the
CHC in working hours, leaving
within an hour or so.
- Health staff in the CHC
demanding money for service.
- Ambulance not given to the
people in case of emergencies
- One needle used to inject upto
10-15 patients
- People asked to purchase
medicines from outside
instead of providing them
with free medicines from the
CHC.
- Doctors of the CHC asking
patients to come to their
private clinic for consultation

4. ‘Direct Monitoring’ of Services in Pati Block CHC
 Repeated protests to improve health services in the Pati had
yielded minimum results. People decided to organize ‘direct
monitoring’. Main actors involved were
Villagers
Tch
en
icaS
lu po
prt
by
Jagrut Adivasi Dalit Sanghtan
Village Health Committees
SATHI-Nodal NGO
 Collaborative efforts of these actor help strengthen the programme

5. How was Direct Monitoring Done?
Direct Monitoring involved 50-
200 persons camping in the
CHC premises continuously for
four days (19th to 22nd May,2008).
People’s direct
monitoring
Groups of villagers Villagers had direct
Doctors were present People were
directly observed dialogue with
outside who rechecked provided
Services along doctors of CHC
patients who went to the information about
with VHC members regarding
CHC health rights
and ASHAs present poor services offered

6. How was Direct Monitoring Done?
Villagers divided themselves into
groups and observed services
If deficiencies were found,
announced on mike, people went
and questioned the doctors
present
.

7. How was Direct Monitoring Done?
Doctors were present outside the
CHC who examined the patients
and if any mistakes were
discovered they were send back to
the CHC to demand rectification

8. Results of ‘Direct Monitoring’
- Doctors started coming on time and
staying for the entire day.
- Ambulance services were made
available to Patients for the first
time.
- Separate needles began to be used fo
each patient.
- Health Staff demanded no
charges for services offered.
- No medicines were prescribed
from the stores.
- Doctors stopped calling patients
for private consultation to their homes.

9. When People
Assert For
Their Health
Rights.

10. Struggle continued at District
Hospital, BARWANI…………….
- On 27th May 08, around
thousand people demonstrated
outside the District Hospital, to
demand the improvement in
Health Services.
Struggle for
Right to Health Care has
not stopped here….
It continues ……………