22 Jun

Kabir Antyeshti Yojana III

हमारे सिटीजन केयर कॉल सेंटर में 13 मार्च, 2019 एक को कॉल आया था | कॉल पर वैशाली जिला के राजापाकर प्रखंड के बखरी बरई पंचायत की निवासी सविता कुमारी जी का कहना था की उनकी माँ श्रीमती उर्मिला देवी की मृत्यु 20 फरवरी, 2019 को हुई और उनके दाह संस्कार के लिए भी पैसे न होने के कारण उन्हें गांव में किसी से उधार लेना पड़ा | ऐसे ही परिस्थिति में तत्काल सहायता देने के लिए बनी कबीर अन्त्येष्टि अनुदान योजना की सहयोग राशि उन्हें उस समय तो नहीं ही मिली, पिछले 3 महीने से अलग अलग कर्मचारियों के चक्कर काटने के बाद भी उनका परिवार इससे वंचित है | इनकी इस स्थिति से सम्बन्धित फेसबुक पेज पर पहला पोस्ट 10 मई को और दुसरा पोस्ट 24 मई को डाला गया था।

इस कॉल के बाद हमने पंचायत स्तर पर इस वंचित परिवार को सहायता दिलाने की कोशिश की किन्तु नाकाम रहे| अंततः 2 मई को हमने बिहार लोक शिकायत अधिनियम के तहत इस सम्बन्ध में एक लोक शिकायत दर्ज की (अनन्य संख्या 999990102051965148 है)।जिसकी पहली सुनवाई 23 मई को हुई जिसमे परिवादी सबिता कुमारी ने महुआ अनुमंडल लोक शिकायत कार्यालय पहुंचकर अपना पक्ष रखा लेकिन इस योजना से सम्बंधित कोई कर्मचारी उपस्थित नहीं हुए। लोक शिकायत पदाधिकारी ने इस शिकायत निवारण की अगली तारीख 6 जून, 2019 को तय की थी लेकिन उसकी सुनवाई 13 जून को हुई परिवादी सबिता कुमारी ने इस दिन भी महुआ अनुमंडल लोक शिकायत कार्यालय पहुंचकर अपना पक्ष रखा लेकिन 13 जून को भी इस योजना से सम्बंधित कोई कर्मचारी उपस्थित नहीं हुए और इस योजना से सम्बंधित कर्मचारी के तरफ से पत्र का कोई जवाब नहीं मिलने की बात कही गई और अगली सुनवाई 27 जून 2019 को तय की गई।

सविता जी दोनों पैरों से दिव्यांग हैं फिर भी इस योजना का लाभ लेने के लिए लगातार संघर्ष कर रही हैं, उम्मीद है अगली सुनवाई के बाद इन्हे और दौड़ना नहीं पड़े।

24 May

Kabir Antyeshti Yojana II

हमारे सिटीजन केयर कॉल सेंटर में 13 मार्च, 2019 एक को कॉल आया था | कॉल पर वैशाली जिला के राजापाकर प्रखंड के बखरी बरई पंचायत की निवासी सविता कुमारी जी का कहना था की उनकी माँ श्रीमती उर्मिला देवी की मृत्यु 20 फरवरी, 2019 को हुई और उनके दाह संस्कार के लिए भी पैसे न होने के कारण उन्हें गांव में किसी से उधार लेना पड़ा | ऐसे ही परिस्थिति में तत्काल सहायता देने के लिए बनी कबीर अन्त्येष्टि अनुदान योजना की सहयोग राशि उन्हें उस समय तो नहीं ही मिली, पिछले 3 महीने से अलग अलग कर्मचारियों के चक्कर काटने के बाद भी उनका परिवार इससे वंचित है | इनकी इस स्थिति से सम्बन्धित एक पोस्ट हमारी फेसबुक पेज पर भी 10 मई को डाला गया था।

इस कॉल के बाद हमने पंचायत के स्तर पर इस वंचित परिवार को सहायता दिलाने की कोशिश की किन्तु नाकाम रहे| अंततः 2 मई को हमने बिहार लोक शिकायत अधिनियम के तहत इस सम्बन्ध में एक लोक शिकायत दर्ज की (अनन्य संख्या 999990102051965148 है)।जिसकी पहली सुनवाई कल 23 मई को हुई जिसमे परिवादी सबिता कुमारी ने महुआ अनुमंडल लोक शिकायत कार्यालय पहुंचकर अपना पक्ष रखा लेकिन इस योजना से सम्बंधित कोई कर्मचारी उपलब्ध नहीं हुए। लोक शिकायत पदाधिकारी ने इस शिकायत निवारण की अगली तारीख 6 जून, 2019 को तय करते हुए इस योजना से सम्बंधित कर्मचारी को लेटर भेजने की बात कही है।

सविता जी दोनों पैरों से दिव्यांग हैं, उम्मीद है उन्हें ये सहयोग राशि लेने के लिए और दौड़ना, भटकना नहीं होगा |

10 May

Kabir Antyeshti Yojana I

कबीर अंत्येष्टि योजना 2007-08 से लागु है। इस योजना के तहत बी ० पी ० एल० परिवार के किसी भी उम्र के सदस्य की मृत्यु की स्थिति में अंत्येष्टि क्रिया कर्म के लिये वर्तमान में तीन हजार रूपये ( 3000 ) प्रदान करती है। हर पंचायत में किसी भी समय 7 मृतकों के लिए राशि उपलब्ध होती है। लेकिन हमारे समाज का दुर्भाग्य यह है की मृत शरीर के अंतिम संस्कार के लिए भी लोगो को इस योजना का सहयोग लेने के लिए ब्लॉक और मुखिया जी के चक्कर लगाने पड़ते हैं । फिर भी सही समय पर सहयोग नहीं मिल पता है। 
हमारे संसथान के माध्यम से चल रहे सिटीजन केयर कॉल सेंटर में 13-03-2019 को कॉल आया | यह कॉल वैशाली जिले के राजापाकर ब्लॉक के बखरी बरई पंचायत के निवासी अमोद सहनी की थी | उनका कहना था की उनकी माँ (उर्मिला देवी ) की मृत्यु 20-02-2019को हुई थी लेकिन अभी तक इनको कबीर अंत्येष्टि अनुदान योजना के तहत मिलने वाली राशि 3000 तीन हजार नहीं मिली थी । 
हमारे कार्यकर्त्ता ने उनके घर जा कर उनके परिवार वालों से मिले और देखा की मृतक के परिवार का घर कच्ची मिट्टी के दिवार से बना हुआ था | घर में अमोद सहनी की पत्नी जो एक आंख से दिव्यांग है और उनकी एक बहन सबिता कुमारी रहती हैं | सबिता कुमारी दोनों पैरो से दिव्यांग है | इनके अलावा घर में चार (४) छोटे -छोटे बच्चे रहते हैं | अमोद सहनी ईंट भठ्ठा पर मजदूरी करके अपने परिवार का पालन पोषण करते है। 
हमारे कार्यकर्त्ता ने मृतक के परिवार वालों से बातचित की | अमोद सहनी और उनकी बहन सबिता कुमारी ने बताया की पैसो के अभाव के कारण उनकी माँ का मृत शरीर पूरे दिन घर पर रखा रहा | पंचायत के मुखिया को सुचना भी दी गयी लेकिन नजदीकी मुखिया या ब्लॉक के कोई कर्मचारी नहीं आये। अंत में उन्होंने कुछ समान बंधक रखकर पैसों का उपाए करके अपनी माँ का अंतिम संस्कार किया ।
ऐसे ही बहुत असहाय परिवार है जो इस योजना से वंचित है।इस योजना से संबंधित कर्मचारी एवं पंचायतों के प्रतिनिधि से नम्र निवेदन है की ऐसे असहाय परिवार को इस योजना का लाभ दिलाने में मदद करे।

31 May

Our attempt at setting up a PMKVY center

In our blog posts, we generally shed light on challenges we face, write about how we’ve overcome these challenges and speak about modest accomplishments in our field work. These posts, however, do not always paint the full picture. They often do not discuss a string of setbacks that we face when we roll out an action plan for an idea we come up with. They don’t always capture the trials and frustrations our team undergoes when a plan we put into action fails. Keeping this in mind, we address in this post one such recent plan which we did not successfully execute.

Since its inception, Seva Setu has addressed two core issues – facilitating citizens and empowering them. In an attempt at empowering the societies we work with, we have for long now established satellite training centers and production management units. We teach stitching and fundamentals of IT and have worked with communities to manage the production of both, blouses and sattu. In an attempt at scaling this effort, we decided to set up a training center this quarter as part of Pradhan Mantri’s Kaushal Vikas Yojana (PMKVY). Doing so would have helped us establish a financially viable option to increase our reach to villages at the outskirts of Patna city.

PMKVY’s framework mandates a training center to follow certain specifications to be eligible to run a training center. In return, the center is paid a sum of roughly 7000 INR by the central government for every student it trains. Anyone older than 18 years is eligible to get trained. This is a non-residential program, where a student spends roughly 8 hours a day at the center and is involved in both, theory and practical training.

Keen on starting such training centers ourselves, we set out on a month-long effort to ensure we set one up. We decided to train students as domestic data entry operators, a skill/job identified by the National Skill Development Council (NSDC), the government-backed organization running PMKVY. Setting up a center to teach this trade was not resource-heavy – at least so we thought. We needed to have one classroom and laboratory (roughly 10 square feet of floor area per student we train) with power-backup, equipped with one laptop for every student we planned to train, a projector and some stationary.

A practical setup
SevaSetu 1 SevaSetu

We were practical in our approach in setting up a training center and rented out a flat in a residential apartment complex as our place of operations. Having complied with the various requirements specified by PMKVY, we were eagerly looking forward to our on-site inspection. The inspection did not turn out in our favor. The inspector very quickly ruled out the possibility of using a flat as a training center. This is in spite of having the necessary floor space to accommodate 20 students, the batch-size that we were aiming for. The technical reason provided was that the training center led to other areas like small rooms, while it was required to be an enclosed space. We read through the guidelines [link] quite carefully and did not find this anywhere being mentioned. We were also told that the minimum floor space required for the classroom was 300 sq ft. This asserted fact was also nowhere to be found. Following the inspection, we received the inspector’s report which informed us that we had not been granted permission to run this training center as part of PMKVY. The primary reason was that our classroom did not seem to be a typical classroom. Read the full report here.

guidelines

Guidelines – A tad too impractical?
At the risk of sounding like the proverbial fox which found the grapes sour, we question the framework laid out by PMKVY to skill our citizens. One wonders why the means are so heavily regulated when it ought to be the ends that matter. If the outcomes of the training are heavily monitored and regulated, would it matter if we taught students under a tree as against an air conditioned classroom? The need of the hour is quality teaching, which even the best PMKVY centers fail to provide. After having spoken to various training centers in and around Patna, Bihar, we gathered that centers which have been around for a while are on the look out for faculty to teach these modules. With Seva Setu’s technical expertise and collective experience in academia, technology, and assessments, we strongly believe we would have given the best in this business a run for their money. We believed that bootstrapping these centers in a small apartment and then moving upwards based on its success would’ve been the right, sustainable way to establish such a center of excellence. But NSDC wouldn’t have any of our practical ways forward in approaching this problem.

A few other requirements which were mandated didn’t make sense either. The guidelines state that miscellaneous stationary items like glue sticks, staplers etc. be provisioned for every student. We don’t understand why this is a necessity. A projector screen, a flip-chart and a microphone-system are also mandatory to have in the classroom. Why? For a group of 20 students, are these really must-have requirements? When was the last time we sat in a classroom with a flip-chart?

Nevertheless, this setback hasn’t doused our spirit to go ahead with this idea. We’re thinking through other alternates which can be a compelling and sustainable model to train our youth on skills that are demanded in the industry today – like being fluent in productivity tools like MS Excel, and other various aspects of working in a professional workplace. We march on!

26 May

Overall disability percentage calculation – its mathematics and inconsistencies

In our previous posts [link] [link], we focused on various challenges we face while working on issues in disability. In this post, we shall discuss how the overall percentage disability of a person is calculated by a medical board. Understanding this process sheds light on how people get scored a value which determines whether they receive pensions or not.

Another important reason for understanding this process is to question the inequity we notice in the assessments made on a daily basis by a medical board. We come across cases wherein two beneficiaries, with striking similarities in the nature of their disabilities, get assigned very different percentages. This is crucial because a person receiving a percentage of less than 40% is simply ineligible to avail the state’s pensions. And we do notice cases where people with similar symptoms are scored on either side of the 40% threshold. In such cases, we have no means to reason the differing assessment.

We refer to documents released by the Ministry of Social Justice and Empowerment which lay out the guidelines for assessing disability [1] [2]. In this post, we highlight the broader mechanism used to evaluate this percentage and also raise some concerns about its use on the ground. We focus on just the assessment of physical disability in this post.

Physical disability is identified and assessed in the upper and lower limbs of the body. The guidelines categorize each of the two limbs into components. For instance, the lower body is categorized into two main components – Mobility and Standing. Each such component is further divided into sub-components.

Quantifying sub-components
Each component generally is divided further into sub-components. For instance, the Arm component of the upper limb consists of sub-components like measuring the loss of motion, muscle strength, and coordinated activities. Likewise, the Hand component of the upper-limb involves measuring prehension, sensation, and strength. Each of these three sub-components, in turn, have sub-sub-components which need to be assessed. Various such sub-components and sub-sub-components are defined in the guidelines [1].

Consolidating various sub-components
One score can be given to a sub-component by consolidating values of each of its sub-sub-components. Some of these sub-sub-components are quantitatively assessed and some qualitatively. For instance, the Arm component of the upper limb contains loss of motion and muscle strength as sub-components. Loss of motion is defined quantitatively by averaging the loss in the three joints of the arm – shoulder, elbow and wrist. Each joint’s loss is measured by the percentage loss in angle of movement in the joint due to the problem. On the other hand, muscle strength is relatively qualitative, wherein a value between 0-100%, at an interval of 20%, is assigned to a joint based on physical inspection.

Consolidating components
In an attempt at quantifying and consolidating these various components, the following formula is provided to combine these different sub-components: CodeCogsEqn (6), wherein a and b are the scores of the various components. If a limb has more than two components, then the formula is repeatedly applied, in which the answer produced by the formula in one iteration becomes the value of ‘a’ in the next iteration.

An example
Here is an example of how one would compute the overall percentage disability for a person affected by Foot Drop, a case of polio affecting one’s foot, and a relatively common occurrence among those differently abled we facilitate —
The components defined for the lower extremity of the body are – Mobility and Stability. Mobility has Range of Motion and Muscle Strength defined as sub-components. This is how the values are quantified and consolidated –

Component 1: Mobility
Sub-component 1: Loss of range of motion (ROM)
Three joints – hips, knee, and ankle are evaluated. Each is weighted equally (30%, adding to a total 90%). We can assume the hips and knee are unaffected in this case. The disability of the ankle is quantified as –

Sub-sub-component Active ROM % Loss
Dorsiflexion 0 100%
Planterflexion full 0%
Inversion 0 100%
Eversion full 0%

Value for the total loss in ROM: CodeCogsEqn (1)

Sub-component 2: Muscle strength

Muscle strength is again calculated at three parts of the lower limbs – hips, knee and ankle. Assuming the hip and knee to be unaffected, the strength in the ankle is calculated as –

Sub-sub-component Strength (scale of 1-5) % Loss
Pl. flexors 5 0%
Dorsiflexors 0 100%
Invertors 0 100%
Envertors 5 0%

The values of 0 and 5 are provided based on visual inspection and the doctor’s expertise in assessing a score between 1-5. The total loss in muscle strength is then calculated as  –

CodeCogsEqn (2)

The combined value of mobility is calculated as  –

CodeCogsEqn (4)

Component 2: Stability

Let us assume that the stability component is unaffected in this case.

The overall disability percentage for the person would hence be 27.5%

Issues

As much as we appreciate the mechanism to make this process objective, we raise here some concerns in the manner in which its implemented on the ground.

Lack of transparency

Our biggest challenge on the ground is a lack of transparency in the calculation of the overall disability percentage. This calculation is not provided anywhere in the certificates that are finally handed out to the citizens. One in thirty citizens we facilitate ends up receiving a very different overall percentage as compared to another in spite of having similar symptoms to the other. The matter complicates in such cases. Our field team is left with no concrete information to appeal against such cases. To add to this woe, there exists no well-defined process to appeal for a re-evaluation. One has to speak to the doctors from the board and plead a case. They rarely agree to re-evaluate and even when they do, they agree to do so at a much later date. This adds to the inconvenience to the common man, given that s/he generally has to travel a good 20-50 km to visit the district hospital each time.

The right way to go about this is to publish this entire calculation and make it open to public scrutiny. In doing so, one is at least equipped with the right information to appeal a case. Neither is implementing such a process infeasible.

Validity and Random errors

There exist various sub-components in this evaluation system which still rely on non-quantitative methods of evaluation. Such a qualitative assessment could vary the overall score by a good number of points. For instance, in the example above, had the values of the muscle strength been rated 2 in each of the cases where it was 0, signifying a mild but prevalent issue, the overall percentage would have jumped to 30%. Such errors could then add up when consolidating scores from different components, greatly affecting the overall score. From an assessments viewpoint, the instruments used to assess metrics like muscle strength ought to be externally validated. There ought to be several well-established instruments which reliably assess such metrics.

In all, we do realize that there may not be a thoroughly objective way to replace these seemingly qualitative metrics, but we strongly believe this to be a research problem in itself. We believe that innovative assessment methods using low-cost technology like camera phones, sensors etc. can quantify the severity of specific conditions like muscle strength etc.

Systematic errors?

Using such a score to quantify disability warrants a careful study on any systematic errors that may be occurring. Doctors and medical boards may be systematically misinterpreting the formula in specific cases and assigning very different scores as compared to their peers in other boards. Assuming the overall distribution of the differently-abled population to be similar,  it is necessary to routinely look at numbers from different boards, districts, and states. This would identify systematic errors in the way the formula is interpreted and evaluated. Putting together this data is, however, an uphill task.

Why is the cut-off at 40%?

The reason behind selecting a cut-off score of 40% as the point of eligibility for pensions is not very clear. Nothing in the formula, to the best of our understanding, dictates setting such a value. Studying the distribution of percentages of every person evaluated for disability till date is of relevance when understanding the role of 40% as a threshold. This will reveal whether the 40% mark is leaving too many behind.

A silver lining

A silver lining in these cases is our field team has become well equipped. They’ve grown to possess a keen sense of what the overall percentage of a person would end up being. Consequently, they are fairly accurate in spotting when such a miscalculation has happened. We then work closely with such families in ensuring they visit the medical board on another day, giving them hope that they would be evaluated correctly!

Interested to know more about our work? Write to us at contact _at_ sevasetu.org

References

[1] http://www.ccdisabilities.nic.in/page.php?p=guide_others
[2] Explanations of the Guidelines and Gazette Notification of the Ministry of Social Justice and Empowerment, by Dr. Ratnesh Kumar et al. Link: http://niepmd.tn.nic.in/documents/Disability%20Evaluation.pdf