Documenti di Didattica
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(concept paper)
For
Workshop on Disaggregate (social inclusion and
marginalized group) Data System
Organised by:
Department of Health Services
Teku, Kathmandu, Nepal
Prepared by
Introduction 1
References 16
Introduction
The root of social inclusion in Nepal can be traced in Sixth Plan (1980 –
85), in this plan women's development was incorporated. Subsequently,
identification of 16 deprived groups in 1994; incorporation of sections on
indigenous groups and downtrodden community; formulation of
National Committee for Development of Nationalities (NCDN) in 1997;
formulation of Committee for Upliftment of Downtrodden, Oppressed
and Dalit Classes (CUDODC) in 1997; upgrading of NCDN to National
Foundation for Development of Indigenous Nationalities (NFDIN),
establishment of National Women commission (NWC) and National
Dalit Commission (NDC) in 2002; Road map policies on economic and
social transformation in 2003; Committee on Reservation
Recommendation, and policy announcement on job reservation in 2004.
Those institutional arrangements made shows that though government
has identified the need to empower and facilitate the different excluded
groups but the approach seem to be piece meal in nature instead of
adopting holistic approach. In the words of Dr. Gurung, in a paper on
Social Inclusion and Nation Building in Nepal, all these measures except
NFDIN had no legislative foundation and are inherently ad hoc and
unstable.
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Concept Paper on Social Inclusion Information System Page [3]
Before developing conceptual framework for social inclusion
information system in health sector, we need to know about what social
inclusion means, who and how socially excluded, what may be
consequences or impact of social exclusion, what is the relation between
social exclusion and health, what is the importance of social inclusion
data in health sector. So this paper will first put highlight on the areas
mentioned above. This paper further explores the difficulties in
measuring social inclusion, suggests some indicators that might be
useful from the social inclusion perspective in health sector and
accordingly a comprehensive information system to provide
information on the proposed indicators. This proposed system will not
only intends to propose a system which will provide information on the
indicators mentioned rather it concentrate to propose a comprehensive
platform of information system which will be able to identify, capture,
process, analyse, and disseminate necessary information related with
social inclusion issues in health sector effectively and efficiently.
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Concept Paper on Social Inclusion Information System Page [4]
migrant status or where they live" (DFID 2005). Similarly according to
Cappo (2002) "Social exclusion is the process of being shut out from the
social, economic, political and cultural systems which contribute to the
integration of a person into the community."
So from the above definition we can conclude that some people, group,
communities and areas are systematically disadvantaged to enjoy the
socio-economic, political and any other services offered by the state.
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Concept Paper on Social Inclusion Information System Page [5]
Social inclusion requires improvements in incentives and capacity
within different level of organizations so that these organizations can
and will respond equitably to the demands of all individuals –
regardless of their social identity. In socially inclusive system, the
individual’s identity as a citizen trumps all other identities (e.g. gender,
ethnicity, caste, religion, income level and geographical identity) as a
basis for claims for state services and commitments (e.g. justice, social
service provision, investment in public infrastructure, police protection)
through the constitution and legal system.
From the above discussion we can conclude that social inclusion is the
process how people, group, communities are included in the
mainstream of society or able to enjoy their rights without any
discrimination. Social inclusion process empowers and facilitates
excluded people to access, utilize, participate and control health related
decisions by eliminating the socio-economic, political and legal barriers
that excludes them changing policies, rules, regulations, process,
procedure, project, programmes and practices.
• Unemployment,
• Poor educational attainment,
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Concept Paper on Social Inclusion Information System Page [6]
• Ill Health (mental health problem, disability, HIV/AIDS etc.)
• Low income,
• Crime,
• Remoteness,
• Gender,
• Language,
• Caste,
• Religion and culture etc.
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Concept Paper on Social Inclusion Data in HMIS Page 7 of 19
DFID emphasised to focus on the understanding of the processes by
which people are excluded, which will help to tackle social exclusion.
Institutions and behaviour that reflect, enforce and reproduce prevailing
social attitudes and values, particularly those of powerful groups in
society was regarded as a basic cause of exclusion. This paper broadly
identifies two ways of exclusion - one is deliberate and another is rigid
social systems and prejudices of their society.
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Concept Paper on Social Inclusion Data in HMIS Page 8 of 19
objectives. Reducing equity gaps and increasing social inclusion in
health together create the basic conditions necessary for improving the
health status of the poorest people.
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Concept Paper on Social Inclusion Data in HMIS Page 9 of 19
One example that is relevant in term of health is delay in decision making,
one of three delays causing maternal death. Delay in decision making to
carry obstetric complication cases to health facility is a major cause of
maternal death in Nepal. The family has to wait for the decision by the
head of the family or husband to carry her to health institution. This sort
of traditional social behaviour is excluding pregnant mothers to
entertain the right to utilize health services provided by the state.
From the above discussion, we can conclude that social exclusion not
only reduces social integrity and hampers overall national development
but also increases mortality by deteriorating personal health.
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Concept Paper on Social Inclusion Data in HMIS Page 10 of 19
regional, ethnic and gender disparities in the achievement of these goals.
This shows the need of disaggregated data to measure the MDGs. He
has indicated that the socio-economic indicators of some of the
disadvantaged indigenous nationalities are very low compared to the
national averages. According to him this is due to the low access of
these communities in productive resources, state delivered goods and
services and also due to structural barriers to the access of these groups
to national policy and decision making levels. In his paper he has
mentioned that the health services are not adequately targeted for
Madhesi women.
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Concept Paper on Social Inclusion Data in HMIS Page 11 of 19
so to measure. At the same time subjective and objective domain of
social inclusion makes it more complex to measure. Need of qualitative
analysis more than the quantified analysis in social inclusion also makes
social inclusion measurement more difficult.
• Suicide rate
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Concept Paper on Social Inclusion Data in HMIS Page 12 of 19
• Number of social practices discriminating people on the ground of
health problems
Managers
routine information system
research, survey,
Census,
EDPs, I/NGOs
Researchers
General people
Web-portal
Process Output
Input
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Concept Paper on Social Inclusion Data in HMIS Page 13 of 19
output, outcome and impact of social inclusion programme, projects or
interventions at different levels.
Process
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Concept Paper on Social Inclusion Data in HMIS Page 14 of 19
Social Inclusion deals with the ways by which social exclusion can be
overcome. These can include changes in law, changes in the policies and
practices of organizations and institutions, support for communities,
provisions and appropriate or improved services, increasing
employment and educational or training opportunities and
improvements in access to services (Lothian Anti Poverty Alliance,
2001). This system should also provide the information on the change in
laws, policies and practices of health institutions for improvement in
access to health services.
This information system will take input from census, research, survey
and from routine health management information systems and process
it to make understandable in the particular context for decision making
as well as for research purpose. The following figure shows the
proposed information system for social inclusion in context of Nepalese
public health informatics.
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Concept Paper on Social Inclusion Data in HMIS Page 15 of 19
References
Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste,
Ethnic and Regional Identity in Nepal: Further Analysis of the
2006 Nepal Demographic and Health Survey. Calverton,
Maryland, USA: Macro International Inc.
DFID Nepal Country Assistance Plan (CAP), Feb 2004.
European Commission Green Paper on European Social Policy Options
for the Union 1993:20-1
Ministry of Health and Population (MOHP) [Nepal], New ERA, and
Macro International Inc. 2007. Nepal Demographic and Health Survey
2006.
O'Brien & O'Brien, 1996 (cited in Learning About Mental Health
Practice, Theo Stickley and Thurstine Bassett, Published by John
Wiley and Sons, 2008)
Orr, Shepley W., 2005, Social Exclusion and the Theory of Equality:The
Priority of Welfare and Fairness in Policy, Centre for Transport
Studies, Department of Civil and Environmental Engineering,
University College London
Reducing poverty by tackling social exclusion, A DFID policy paper,
Published by the Department for International Development,
September 2005
Resilience Amidst Conflict: An Assessment of Poverty in Nepal 1995-96
and 2003-04, CBS/World Bank/DFID/ADB, September 2006.
Sen A. Development as Freedom. Oxford University Press, 2001
Silver, Hilary. Social Exclusion: Comparative Analysis of Europe and Middle
East Youth. Middle East Youth Initiative Working Paper
(September 2007).
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Concept Paper on Social Inclusion Data in HMIS Page 16 of 19
Social Analysis Sourcebook: Incorporating Social Dimensions into Bank-
supported projects, (working draft) August 2002, p.2, Social
Development Department, World Bank, Washington.D.C.
Social Inclusion and Nation Building in Nepal, paper presented by Dr.
Harka Gurung at Civil Society Forum Workshop for Research
Programme on Social Inclusion and National Building in Nepal,
organised by Social Inclusion Research Fund.
Stegeman, Ingrid & Costongs, Caroline. Health, Poverty and Social
Inclusion in Europe. EuroHealthNet. 2003
Subba, Chaitanya. 2008. Social capital formation in Nepal: MDGs and
social inclusion.
Walker, Alan & Wigfield, Andrea. The Social Inclusion Component of
Social Quality, 2004
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www.health-inequalities.eu
www.health-inequalities.eu
www.library.nhs.uk
www.mobilityagenda.org
www.sochealth.co.uk
www.socialinclusion.org.uk
www.undp.sk
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Concept Paper on Social Inclusion Data in HMIS Page 17 of 19