PARTICIPATORY EVALUATION-STUDY OF CHILD SURVIVAL AND CHILD DEVELOPMENT PROJECT OF CHRISTIAN MEDICAL ASSOCIATION OF INDIA.
Item
- Title
-
PARTICIPATORY EVALUATION-STUDY
OF
CHILD SURVIVAL AND CHILD DEVELOPMENT PROJECT
OF
CHRISTIAN MEDICAL ASSOCIATION OF INDIA. - extracted text
-
RF-CH-6.5 SUDHA
PARTICIPATORY EVALUATION-STUDY
OF
CHILD SURVIVAL AM) CHILD DEVELOPMENT PROJECT
OF
CHRISTIAN MEDICAL ASSOCIATION OF INDIA.
DR. SHIRDI PRASAD TEKUR,
D.C.H., Ex. Capt. A.M.C.
Community Health Cell#
Bangalore.
PARTICIPATORY EVALUATION - STUDY OF THE CHILD SURVIVAL AND
CHILD DEVELOPMENT PROJECT GF CHRISTIAN MEDICAL ASSOCIATION
OF INDIA.
INTRODUCTION t
This study follows the decision of the C.M.A.i. to
- look at how appropriate the CSCD project is,
- assess the prcgresss and effectiveness so far,
- obtain guidance on future involvement of C.M.A.I. in
Child Survival and Child Development issues in India.
The details of the memorandum of understanding is in
Appendix -> ‘A*.
i
The format of presentation of the report is as follows »
I. C.M.A.l.
— Policy on Community health
• Philosophy behind CSC© project
- Objectives of CSCD programme
II. Process of the Evaluation Study
• Expectations of the C.M.A.l.
- Preparatory Phase
- Field Visits
III. Observations and recommendations for future of programme
- to C.M.A.I.
- to Project
- t© Community
I. The C.M.A.I. - POLICY
The C.H.A.I. is the official health agency of the National
Council of Churches in India, whose membership is primarily
open to all Protestant and Orthodox Churches in India.
2
2
The C.K.A.l, policy priorities,
- appreciates that health is not a reality for many In India,
- la concerned with social justice in the provision and
distribution of health services,
- believes that people have an Important role to play in their
own health, and
- recognises the right to health care.
The policy on eorsnunity health is to create -awareness,
understanding end support for the principles and practice of
eomtranity health with special ersphaels on comunity based
care. In this context to work closely within the health
policy of. the Government of India and to give priority where
the needs and problews are greater.
On the Basic principles of Cosmmlty Health, C.M.A.I, identifies
- Ccmminity participation as an essential component,
— that conwunlty health services should be appropriate,
acceptable, easily available and affordable by th® community,
- the Importance, relevance and need for utilising traditional,
indigenous health practices and understanding them in the context of
cultural and socio-economic situation of the people.
Philosophy behind CSCO ..2^1^ «The CECD project is an innovative approach to conaaunlty health
aimed at
— promoting health among people
- going beyond the traditional role, clientele and membership
of the C.K.A.I, to do so,
• working through the church and related agencies for a more
meaningful involvement in the healing ministry, and
*,3
3
• introducing the church to a holistic approach in making health
•nd healing a reality tor the people.
The CSCh 1$ baaed on C.M.A.l.’s belief that
- health work cannot be viewed in isolation, hut should be
integrated with development and other related activities •
- community health work could be done by people themnelves
towards a movement for health.
- non-hospitel based Christian and social agencies who are
already working with people in various areas could take up
health work also even if they do not have any prior experience
in health related activities.
- to build a healthy nation, we need to focus attention on
children of today.
- survival of all children in a cormunity upto two years of
age could be achieved with low-cost appropriate intervention®
among pregnant mothers and children upto 2 years age.
Objectives of GSCP t
The essential objectives of the CSCD Scheme is to Introduce
simple, low-coat and effective health interventions that can
help women and children in the community*
It is meant to focus on communities of low socio-economic groups
predominantly in rural areas.
4? - if "vS b v bC
To see that all children torn in the corwunity reach their second
birthday.
II. PROCESS OF THE WAIAJATIOH - STVOY :
The process included an intensive two day preparatory phase
st C.H.A.I. headquarters, followed by field visits to projects
to study and sample ground realities.
- Refer Appendix ’A*
4
4
pREPAPATCaV PHASE J
During this phase, discussions with key persons in C.M.A.I.,
dealing with the CSCD project took place, and one of the CSCE
project Managers who visited CMAI was also interviewed.
In addition, all files and documents relating to the CSCD project
were perused for information helpful to the study.
- Appendix *B* for list of documents / papers
perused.
An understanding of the CSCD project obtained from the above
interactions as follows s-
The essential objectives of the CSCD project focusing on wcxnen
and children was translated into a project-wodel. The plan
offers 3 years of active support frost cite C.F..A.I. after which
the process is expected to be self-sustaining.
»
/
This project model at micro level is expected to
v.
zfvlG
- cater to a population of 3030 to 5000 where nritcu_lSt> pregnancies
would arent in a year and %t\ebc- to be seen through, safe deliveries
and the survival of the-iu,
of 2 years.
fctiitdren /or a period
- One CW per 1000 population is identified for the health work
involved, with a project manager taking overall responsibility
for the CHV*s work in the total population.
The components of the project are,
1. Identification of expectant mothers and provision of AtJC services.
2. Assurance of safe deliveries to all expectant mothers, and
3. Assurance of normal growth and development of all children under
2 years of age through appropriate services so that each new-born
can live upto 2 years.
..5
5»
CMAX*s Child Survival Development Progratfitne
following activities s
involvesthe
1. Identify interested Church related development programmes
keen on introducing a health component and taking up this
CHAT Scheme.
2. Through CKAI’s programs development and advisory services
to assist potential implementing agencies with application
and preparation for implementation. This will include site
i
programme .ImplemCErfilf^. staff.
3. Each implementing agency who gets awarded a grant from CHAT
under this scheme would be expected to
a. Identify the local community to be served (about 3000 —
5000 population).
b. Give special attention to women and children. This
would include Ante-natal care, child health and family
welfare services.
/
v'
c. Follow up betifnee-lt?O"ESS children born in the
community frommother‘s pregnancy to second birthday
ensuring there is proper nutrition, education and
health education to mothers and immunization coverage
for mothers and children.
d, develop simple, community based primary health care
services that emphasises FIONA (F s Family Welfare,
I i Immunization, a : Orel rehydration, H : Nutrition
of women and children and A t Vitamin A).
4, CMAI will provide advisory and follow up services to
implementing agencies which includes training, monitoring,
evaluation and financial support. Each project will be
followed up for at least 2 years.
6
6
Implementation of the CSCD programme t
The CMAI started the CSCH programme in 1967 by inviting Christian/
Social agencies working with people and interested in including
community health in their range of activities.
The implementation of the project started in 1988 with Fifty-two (52)
micro-projects approved and. selected for CSCD intervention. Twenty
11 (20) projects did not fulfil the requisite criteria and were not
</ accepted of the total of Seventy-two (72) applications.
Of the fifty-two (52) projects started, thirty-one (31) are at
present operational, while twenty (20) were closed for various
reasons. One project completed three years.
The reasons for closure of these twenty (20) projects were mainly
administrative, where the micro-projects had
- internal problems linked to their own organisation, offices,
staff and area of work.
- not complied with the minimal reports and returns required.
- not shown adequate interest and initiative towards the CSC®
programme, presumed to be due to preoccupation with other
programes they were involved in*
graining ‘
The CMAI organised an initial training programme of one-veek
duration in 1988 at three regional centres for Chief executive
Officers (CEO’s) and Project Managers (FM’s).
/
This was followed by six (2-3 days) short-duration regional
workshops held during 1989 and 1990, where CEO’s and PM* a and
Community Health volunteers (CHV’s) selected for the CSCE
programme attended.
The training covered all aspects of the CECD prograrafle with
pre and post evaluations.
5'foev ^CiZ-Lttc5
Jr&'tvL- (-AiZhT
j
CS C£> JncffUX'M
CMAT
nJ,
,
_
Lt/lcc.
' t
b- to
.«
Ptt>S f b^CY~rfyc&
--A
L- t
JixAM
W
AfmoX- t'V'vXt-V
teC^vM-vC^vt
N'j t)<2c^ty'/
My
XS^VcC-e
PlCNA
^vcpplzzet
^'-c
A? Z&.-V 6
Itx-L'U. Zo
■v^^iy^cp'^c^cP.
Reports and Retoms i
The initial format used for reports and returns was complicated
and not understood by the participating micro-projects, and led
to confusing initial reports* while mystifying the simple steps
involved in CSCD implementation.
CrCD Manual t
Considering this, a very concise ’MANUAL FCR child SURVIVAL AKD
CHILD DEVELOPMENT PROGRAMME* was put out by the CHAI, simplifying
the CSCO mes-.age and also the format of reporting. Thia came into
use from January 1990, after which, there is more coherence and
understanding seen in the project activity.
Feed back »
The system of acknowledging reports/returns and feed-back to
projects about their work has been streamlined, and seems
effective in the micro-projects performance.
FILES ASP INFORMATION AT CMAI s
The CHAI maintains updated files on each of the projects for
financial transactions, correspondence and health reports / returns.
In addition, registers prepared by the project officer gives data
at a glance. This was very useful for rapid assessment of project
status.
From these sources, information was extracted on the 31 micro
projects operating all over the country, with the help of a
format.
- Appendix *c*
The details looked for helped tc look at variables in the projects
which could affect the objectives of the CSCD programme.
The compiled master-chart is in -
— Appendix *D*
8
8
In this context, it was interesting to not© an office - assesssacnt
of the Ci-'AI about the projects as Good (G), Above average (aA) and
Average (A),
This classification Is based on
— the rdcro—projects’ understanding of CSC1' programme,
- reliability end progress shewn in micro-project reports and
returns,
- micro-project milestones in health,
— handling of finances by micro-projects, and
- reports from field-visits to the micro-projects by CHAI staff.
This classification correlated well with the reported progress in
micro-project activities and ix$ also a reflection of the c-xperential
assessment of CMAi Staff, Hence it is used for data—analysis which
is presented below s
ANALYSIS OF IOTA COLLECTED PROF. CMAI FILES
Total
G
ba
A
—
—
25
6
17
2
2
1
6
3
Maharashtra
Tamilnadu
Andhra Pradesh —
Kerala
-—
Karnataka
Nagaland
—
Manipur
Madhya Pradesh —
Himachal Pradesh—
Crissa
8
6
4
3
2
2
2
2
1
1
5
5
2
2
1
2
Mm
—*
3
*X£
«m>
1
1
«w
*■*
•
«•
Location :
Rural
Urban
States
1
1
1
.cat
1
1
«•
w
2
1
«•
1
9
9
Consent i
e) The urban projects are not doing as well as the rural.
b) The States of Bihar / Uttar 1-radesh / Rajasthan / Assam /
West Bengal in the northern belt do not have representation
in micro-projects, while national statistics show a poor
state of health in these areas.
c) Projects in the relatively well-off states (health—wise) of
‘laharashtra, Tar.ilnaelu, Kerala, Karnataka and Andhra Pradesh
seem to be doing well, and also, number of micro-projects are
more in these areas.
2. Tyo-& ox other d-svelpvar.ent work ga.3 J
Social development
Economic developmnt
—
agricultural development Kater development
Vocational Training
Educational development Health development
Ron-specific development multipurpose development -
26
20
15
2
4
5
3
1
1
Cement :
- Ko significant correlation.
- 'She micro-projects with health and Educational development
programmes are doing better than others.
3. Duration of work in area s
less than 10 years
10 to 25 years
more than 25 years
—
—
Total
G
we-
aA
A
15
9
7
9
4
6
2
1
«•
4
4
1
Consent *
- Ko significant correlation
- the older or newer project see® to be doing better compared to
those between 10 to 25 years of age.
..10
10
4. Year of
project
second year
Third year
Total
•G
MM*
8
23
5
14
aA
A
3
3
6
Comment :
- Ko significant correlation.
- Projects in third year, with more experience
off.
are
better
5. Health care resources in area s
Total
aA
A
a) Nil in area with resources
more than 10 k.m. away
10
7
1
2
b) nil in area or within
5 K.Ms. (Resources 5 10 K.Xs. away)
6
5
0
1
c) Others - with clinics.
Private / Mission Hospitals
Govt, health resources in
area
15
7
2
6
Cqmn-ents s
a) Micro-projects with less health resource in the area seem
to toe utilizing the CSCD progranrse better.
6. Access / roads / distance to nearest Health resource
The access has been classified as Good or Poor depending on the
reads / distance and availability of transport facilities :
A
aA
Total
G
•w
With Good access
With Poor access
15
16
8
11
2
1
5
4
Coouent t
- There is no significant correlation.
- The areas with poorer access utilise the CSCT better.
11
11
7. Attendance of Training Sessions a
All CEO’s, PK’s have attended ttw? long-duration initial training
and either they or their field staff have attended the short —
duration training sessions. There is no correlation to attendance
at training sessions as.d performance of the CSCD programme.
Remarks :
From this analysis it appears that the needy (rural / Inaccessible /
far from health resources) are taking up the GJ CD programme more
vigorously and having exponents of Health or Education in their
development strategy helps in their getting the CSCH message to
the people.
Another factor which relates to poor performance is where the
turnover of field staff has affected the programme and when
Inadequate understanding of the need to record / report / assess
the programme regularly is present.
FIELD VISITS s
Field visits were made to seven (7) micro-projects and one (1)
Training and co-ordination centre. Two simplified formats of
questioning was employed, one for the C£C~. programme implementing
staff (CUG / J?K / CW) and one tor the group from the people
(Mothers / others) who ore •beneficiaries’ of the programme.
- Appendix ’E* &
12
12
The break-up of the interactions during these visits is as
follows :
C.jCP Micro-Project
Staff
j".others/others
Total
1. YWCA Kagpur
2. E.L.C. Kagpur
3. YMCA, Hyderabad
4. YMCA, Madras
5. CTVT, Madras
CEO + 2 CHV’s
PM t 3 CHV’s
CEO
CEO -i- 3 CHV’s
1 Co-ordinator
of cscn projects (8)
1 CHV + 1 C.O.
CEO + 1 HK + 2 C.O.
t 1 animator
CEO -t- 2 CHV’s
PM at CHAI His.
3
15
1
6
6
19
2
10
•=#
15
1
17
21
16
—
26
19
1
6. CSI, Coimbatore
7. CSI, Soodithittu
s. YP.CA, shimoga
9. MVK, Nagpur
Total
101
sawaas
The field visits involved a major effort in learning of the what,
how, why, where of the CSCiJ programme implementation areas, with
minimal time spent in the office and files and maximally in the
field.
Constraints of a short-notice, distance of projects from headquarters/
offices and non-availability of staff/mofchers, did affect the process
in some areas, but a reasonable understanding of the projects was
obtained.
The selection of micro-projects was made covering samples of
- micro-projects in their 2nd and 3rd year of CSCD activity.
- those labelled ’Good’ and tAverage’.
- States where more micro-projects were located.
- urban and rural areas.
- those not recently visited by CMAI Staff and taking into consideration
time and travel connections and constraints.
13
13
A focus of attention was the people who were implementing the
CSCD programme, their problems, feelings and understanding/
the people of the area, their needs, relevance of CSCEJ intervention
and the impact of the programme on children.
The responses collated from the prepared format (Appendix ’E')
is detailed below to appreciate the range of ideas about the
C&CD project.
1. Understanding of role s
CEO
- As coordinator implementor CSCR activities.
— Reaching the unreached.
- Overall development of people of area (Slum).
- Infusing confidence among people about their capabilities
in tackling health.
- Educator of people / Trainer of CHV’s.
— Co-ordinator and Liaison between Govt, and Private
agency activities.
- To establish good relationship with Community.
- To promote total health of children / adults / pregnant
women.
- To reduce IMR.
Understanding of Responsibility :
— Awakening potential in women and children and building up
peoples confidence in themselves.
— Record keeping.
- Training of CHV’s.
- Co-ordinating all health related activities.
- Implementing CSCO project.
- Relating health to development.
- Prevision of health facilities / camps etc., where not
available.
- Impart health education to coeaaunity.
Understanding
Future of Project i
- Requires weaning over next
- Can be well integrated *
' 2 years.
into other activity.
••14
14
• Requires educational support / Technical support.
— Support to children above 2 years — creches etc.
- Requires good contacts with Govt. / Private health services
for good follow-up.
- Salaries for health staff.
- Nearby hospitals will make this less effective,
— In spreading message of health among mothers.
- Ongoing even if CMA1 withdraws.
- Adopt wore villages into programme.
CHV»S
Understanding,of role s
— Motivation of people for better health.
- Educating mothers and children.
- As implementor of all health programmes.
- AKC Ate / Immunization care takers of the community.
- Co-ordinator of health resource in area.
Understanding of Responsibility :
- Education of mothers.
- Recording Pregnancy / births.
- Monitoring health,
- All problems of people.
- For health of all children.
- Co-ordination of health activities.
2. Problems faced with project t
- Organising people.
- Motivation of girls (adolescent).
- Ko nearby health facilities / Services.
- Social / Economical / Cultural problem.
- superstition.
- Resistance to change.
— Training CHV's, , Staff and Commitment vs
mediocrity in CHV’s.
..15
15
- Migration of CSCD mothers at delivery titre.
- Other yolags not co-operating.
- Private health enterprises.
0 - Illiteracy.
t*
. - Vaacxne supply by Govt.
n i
- Accessibility and area of work distant.
- Timings of field work due to different working hours of
different people.
- More CHV’s needed for better coverage.
Problems faced with CHAI?
- Pressurised for prompt reports / returns.
- Earlier not clear in communication.
- Delay in release of funds.
- Social activities columns - not adequate need to- fill-up.
- Suggest “input" a.s- "Service" - difficult in cash.
- Kot willing to sect salary / expenses of Health Workers.
3. Training. so far - CMAI Workshops *
- Training done apart from CMAI from local doctors / VHAI / RUHSA /
CSI / PHC / Other Voluntary agencies.
CEO’s - not availed any other training apart from CMAI.
CSV’s - many local and other resources were used for training.
- Heeds in future
- Health education for Manila Mandels and People.
- nutrition.
— Regional language needed for information transfer.
- Training in financial manageoent of project.
- Balwadi / Day Care Centres.
- Adoption procedures / facilities.
- T.B.A.
- S.S.I. / Social and Economic development programme.
- Tackling disease in pregnancy and lactation.
- Minor ailment treatment.
- Supplementary nutrition-" programme.
16
16
- Herbal medicines St drug / Non raedical therapies.
- CHV training.
- .■.■School-health,
- Handicapped children,
- Adult Education,
- Conduct of Health Camps.
- Immunization training.
- To support child till 5 years age.
- Preventive health / Sanitation.
— Further training in all aspects.
- Suggestions fox" .innovfet-ion& s
- Circulating library.
— Adult Education.
- Fund-raising activities.
— io tag on to women’s programmes.
- Policy disability rehabilitation for children / mothers.
- use tpt;/staff / other office staff for Health Education,
/ Income generation programmes to generate income
^cUv^s- f^-cscii.
- neighing Scale / bag.
- Schools for drop-outs by youth.
- Loans for economic development.
- Small savings / chits,
- Co-operatives,
- Mass health camps + Social awareness and Social Service
Camps especially for immunization.
- School teachers for health.
- Concentrating delivery spacing in 1st year project with
FPAI inputs.
- «Rotating chick • for income.
- Training CHV’s by local doctors.
- Interactions of CfSV’s with other organisations.
- Extending project beyond 2 years upto school (5 years).
- Folk media for Health Education.
— Setting up curative facilities when other health facilities
not available.
- Social awareness / Social Service Camps / Baby Shows /
Cultural Programmes / Debates on health issues.
17
17.
Below are brief notes on each of the projects visited, not covering
the aspects already covered in the analysis so far. It ia a
Qualitative, observational, experiential account of the visits and
includes the responses from the people, recorded as "perceptions
of the people". "General Remarks" at the end covers areas uncovered
by the analysis.
1. YWCA - Kagpur (Rural) »
Progran.-res :
women’s organisation, sccio-econoreic programmes, vocational
training, schooling, adult education.
CSCV :
Part-titre doctor and clinic based approach / CHV’s tag on to
Government Ahf’.s and now familiar vrith field conditions. Partly
utilised by ANHs for record keeping - hence record-keeping style
different, but all information obtainable. Good liaison with
Government and Voluntary agencies. Have innovated own weighing
scale and bag. Have innovative ideas for CSCD services to
extend into other areas of activity.
Health needs / nroblems :
Water / Sanitation / Herbal Medicine / Health Education / Social
organisation / TBA training.
Peoples perception t
A very useful prograrane for mothers and children.
rore services and education facilities.
Should provide
innovations :
+ bag
Weighing scales / Circulating library for adult education /
adoption facilities / planned polio rehabilitation centre.
2. E.L,Cy - Waqpur (Urban) :
Programmes i
Social organisation. Women’s organisation. Youth groups. Health
18
10
work*
CSCS 8
Part-time doctor for curative care at clinic* PM trained Health
Inspector - under utilised* One CHV very dynamic and assumes
leadership role in all problems of slum dwellers - overshadows
others. If trained* can t-e FS and PM if needed. Utilize
Government services well and obvious better conditions of
children registered under C2Cn seen.
Health needs /problems s
later / Sanitation / TBA training / Minor ailment treatment /
Herbal or home remedies / Health education.
Peoples perceptions s
Very useful at present for the slurp-dwellers, Needs more facilities/
services. Requires some socio-economic programmes to help people.
3.
- Hyderabad (Aural) ;
Programmes s
Social organisation* Income generation* Women*s programmes, Schools,
esen s
Field area distant, but well connected by road. PM dependant on
CHV’s for- contact with people. One CHV on maternity leave. Other
managing alone, ether Voluntary agencies working in same area
being well utilized, like UEICEF / FPAI, etc. PM more familiar
with schools and introduced innovative health programmes for
children.
Health needs / problems a
Mnor ailment treatment / Herbal indigenous medicines / Health
Education.
..19
19
Peoples perceptions a
Programme useful for women and children.
development into health care for all.
See scope for
4. YMCA - Moiras (Urban) s
Programmes :
In areas of schooling, vocational training, working with
disabled and adult education..
CSCE :
- have part-time doctor for curative health care.
- CHV’s clinic / curative / medical oriented. ChCT' is only
activity with preventive / promotive health inputs.
- buy own vaccines / medicines. Hot utilizing nearby VHS /
Corporation and other Voluntary / Government health services
wel 1 •
Health Care needs / problems :
In areas of water supply, sanitation, health education, minor
ailment treatment.
- temporary / illegal nature of slum settlement.
— migration of people in search of work.
people*s perceptions i
— ss a centre for minor ailment treatment and advice for
mother end child.
- as a service providing centre which needs upgradatlon to
hospital facilities.
Innovations >
Planning Balwadis to bridge gap between CSCE and School in
child care.
20
20
- a co-ordinating agency for 8 CSCO projects in South India.
- monitor CSCf programme along with other activities in these
projects - mainly in reports / returns and training areas.
- Indirect contact with field and hence do net appreciate
fleld-problems well•
- have good contact and liaison with large Voluntary agencies
end Ccvernment organisations utilised for health work.
- believe health to be a good entry point for development and
utilise CSCE for this.
- feel CSCh should support cbil-drc.* till 5 years age to be
really helpful to people, in technical and financial aspects.
Also coverage of child population could be increased with
appropriate funding for Health worker.
- problems faced are in areas of staff turn-over and private
medical enterprises with profit motive.
- feel need for trained worker exclusively for water and
sanitation hygiene.
6. C.s.I. ~ Coimbatore (Rural
1 Urban Centre - Hettupalya:?) t
Programmes s
In areas of women* s organisation, Socio-Econteic development
programmes, education and vocational training.
eser
j
riainly educative on fICNAj utilizing local Government and
Voluntary agency facilities. Areas of work far-flung, but
accessible by road/bus. Urban slum area at Hettupalyam very
far and methods effective in rural areas net working. Single
Health worker in charge of those areas and unable to adapt
to urban slum problems. CEO was out-of-atatlon but sent filled
up questionnaire.
21
21
Health care needs / problems »
Water, Sanitation, Nutrition, Personal hygiene and minor ailments.
Need for TRAs and indigenous herbal medicine resources.
People*n perceptions :
- as an education to mothers in teking care of children.
- as an issue which engages ail renters of the community.
- in the urban slum area, the pressures of earning a livelihood
take priority over health care needs, though the effort is
appreciated for its value.
Cȣ.X. - Boodithittu / Periyapetna - Mysore (Moral) s
Programmes r
Schooling, Vocational training. Social organisation, Socio-economic
development programmes and organising tribal population.
CSC? s
- nearby IMA is the main source of medical support for camps,
immunization programmes, etc.
- other Voluntary’ agencies in surrounding areas also co-operate
in development efforts / CSCD efforts.
- distance from headquarters in Mysore is a limiting factor for
adequate supervision.
- a well-trained active Field Supervisor having recently left
after marriage has put a lot of pressure on the new incumbent.
- credibility of programme and CEO is high among people, and is
helpful for community organisation.
Health care needs / problems i
- Competent curative facilities to back the CSCi. nearer the area
than the present Government Hospital which is 10 kiss. away.
• •22
2.2,
- Minor ailment treatments / Indigenous herbal medicines /
Trained Firth attendants.
- Setter connecting roads / Bus and other transport facilities.
- Pre-School children’s care - Creche centres.
- Supply of Vaccines / drugs from Voluntary agencies.
Government supplies unreliable.
Since
People* s perceptions
— as a good effort in health out needs curative - service inputs.
8. Y.’-CA - ShiKioqa (Urban) :
Progrsomes :
women’s organisation, Socio-economic development activities,
Vocattonal training.
CSCO :
Well trained, efficient Field Supervisor left. CHV promoted to
FS is not dynamic and has not understood the CSCD programme well.
Ho direct contact between PM and people, hence dependant on CHV‘s,
Areas of work selected are very needy. Other Voluntary agencies
and Government field staff to be co-ordinated with CSCD activity
for improvement.
Health care needs / problems s
water / Sanitation / Nutrition / Minor ailment treatment / Low
cost curative care and all socio-economic problems of urban
slum populations.
People’s perceptions :
a useful educative process. Government hospital nearby puts
pressure for curative orientation which they believe in.
as
Sugcestjons :
difficult to match CMI contribution in funding.
be taken as local contribution to CSCD.
Hence ‘work* to
..23
23
General Remarks :
The remarks are based on observations in general, and not applicable
to particular micro-projects, staff or Cl-AT. They have a bearing
on the CSC'.' project ano its future.
1. The taking up of a health component by development projects
usually has a ‘medical* connotation and consequent ’awe* in
tackling it. I he time period for breaking this understanding
and subsequently reaching the people it very variable depending
on local conditions.
2. The tendency to employ a ’medical* person, for the programs makes
the process more difficult.
A need to confirm each step or innovation with ‘medical* persons
inhibits the capacity and freedom in innovating for health.
3. Feelings of inadequacy in tackling health issues diverts their
attention to ’activities* and not processes, quantitative
reporting methods add to the confusion and become ends by
themselves.
4. The need for relevant documentation useful for periodical
assessments, marking milestones, planning arc evaluation means
paper-work, development agencies in the urge to *get-on* with
‘work’ usually neglect even basic documentation.
5. ieople view all new projects and activities as temporary
phenomena affecting their lives. Planning for handing over
people-oriented, people-directed programmes to the people
requires strong social organisation as a pre-requisite.
6. The knowledge and attitudes transferred at training sessions
usually suffer at the level of practice due to the above factors.
7. Transfer of the health message orally by health workers usually
needs support with some health education material - locally
evolved. This brings up their credibility in the eyes of
the people who can understand logically why such interventions
are needed.
24
24,
8. health activity is usually taken up separately, and not tagged
or. directly to development, activity (its effects not being clear)
in order net to jeoparadise ongoing work. It is because, involvement
in health work raises many questions or survival needs wiiich may
not be comfortable to face up to.
It is only after some experimentation that health is added on to
otiier activities.
9. Health activity finances are thought to be related only to •medical*
work 2nd so, are apprehensive about using tunes for health activity.
PlCch..
c?'v
:
/
These recommendations are based on my appraisal of the CSC!? project j
of C.‘:Ai detailed so far, and summarised below as strengths, weaknesses,
needs and opportunities.
The CSC3 project is successful innovation in ccssnunity health oriented
interventions, and presents the CHAI philosophy, policy and objectives
in a nutshell.
/t
"tc CMAI7
ivLt’J/f) Lv-titi zw-Ovi(toCTvOj, £V<Adt
kfV
Ji iv^lc
wd-
The C--1C3 project has
v
p
- been well conceived,
- evolved with flexibility in response to field conditions and needs,
- helped •non-health* development agencies understand their capabilities
and role in promoting health.
- put into action the philosophy of the Healing ministry towards
who!istlc life.
- focussed on national priorities in health and supports national efforts
in a co-operative spirit, and
- reached out to those who need it most.
- C.:..C". expectations in health returns v;ithin a time frame is
4deal 1tie-.
,
- ihe pace at which ••.ecrolc and development organisations work
is dictated by local conditions and variables - and consequently
the progress in CSCD project>«44
- Centralised responsibility for training and monitoring health
activity progress.
deeds :
The C5CD project needs
- to evolve Qualitative and social process indicators to make
appreciate the quantitative data realistically.
- tc focus attention on poor performers in terms of personnel /
technical / administrative / financial / evaluation help to
learn from the experiences.
~ to evolve methods of taking local organisations, priorities,
language and socio-cultural problems into consideration to
make the CSCD locally sustainable and grow.
- to look into economic sustainability of the CbCfc by tagging
it directly to economic activities of co-operatives, income
generation activities, etc.
-
look into the turn-over of health workers and their job
security.
- to help evolving local health education media and methods.
- to identify, encourage and publicise local innovations.
- to help development organisations in selecting areas of CSCD /
health intervention.
- to help appraisal and utilization of all local health resources.
- to obtain self-appraisal reports from micro-projects for balanced
..26
26
assessment of programme progress.
- to evolve networking arrangements at level of CHV’s for direct
information transfer at field level.
Opportunities »
The wider opportunities the CSCD project offers are,
— getting into crucial areas of health care, like safe water,
sanitation and personal hygiene to tackle the commonest problems
of communicable disease.
- extending the CSCD project to care for children upto school age,
vis., Balwadis and Anganwadi where Government facilities are not
available.
- promotion of school health interventions.
- enlarging scope of activity into Rehabilitation interventions
for handicapped children.
- intervention in maternal care by training Traditional Birth
Attendants.
- incorporating Minor ailment treatment ox at least mother and
child, and
- promotion of indigenous, herbal / home remedies for health care.
In areas where these interventions are felt-needs and likely to
help the people.
The best opportunity CSCb affords is its scope for developing into
a Community development programme through Child Survival interventions,
ft, •'Vvwtkx. cv
S'ViQl'It'AC^vvA CC/UAVUNiT-y DEV0L2MCTVT p'Wp't
Suggestions to CMAI t
1. The CSCD project encapsulates the philosophy, policy and priorities
of the CHAI. It is a successful innovative approach to community
health that requires encouragement.
2. To facilitate growth of CSCD into areas of community health and
development that respond to people’s needs.
.*7
27
3. To consider extension of CSC? into other development / social
agencies that are working with people and interested in
community health.
Suggestions to the Project :
1. To consider incorporation of elements of other projects like
the CKPHC and women’s development progranmes into CSCD to be
able to respond to local needs.
2* To focus on areas of Education for Health in the project,
involving all age groups in the community,
3. To consider extending the time period of the CSCD project to
five years, with staggered inputs to include
a) an initial one year period of incubation with preparing
of the micro-projects by selecting areas of work,
assessing capabilities, computing logistics of the
programme and understanding of aims / objectives /
responsibi11ties.
b) followed by a three year period with an intensive first
year, consolidating second year and withdrawing third
year of work. The resources could be alloteu according
to needs of the phase, with weaning off over the third
year. An additional period of one wore year could be
utilized to tackle unforeseen problems.
4. To strengthen the training component of the programme with
- additional inputs.
- decentralization to regional levels.
- utilization of local resources, and
- adding on of experiential perspectives from the present projects
To enlarge the scope of training to include First aid, Minor
ailment treatment. Indigenous herbal medicine inputs and training
of Traditional Birth attendants.
..28
28
5. To consider the inputs of post-graduate students in Health
Care management in helping out in various problems of micro-projects
as part of their training.
6. To help ensure job-security and commitment for the duration of
support from field staff who are crucial for proper utilization
of the CSCD idea.
7. To help evolve a soclo-epidemiological perspective in micro-projects
to make them self-sustaining health initiatives in the future.
Suggestions to the Cormnunity :
1. CMAI’s initiative in promoting community health through the
Child Survival and Child development project is a departure
from its traditional role and clientele in an effort to make
health a reality to the common man. It needs to be well
utilized.
2. CSCD is people’s health being handed back to people and requires
the innovative approaches, ideas and initiatives generated by
practical living conditions to make health a people’s movement.
It needs encouragement.
3. The CSC!) focus on Women and Children is a recognised, tried and
tested approach to ensure better health conditions for future
generations. It deserves a comraited approach to succeed.
*********
Place
Date
t
s
Bangalore
DR. SHIRDI PRASAD TEK’JR.
APPENDIX 'A'
christian_medical_association_of_india.
CHILD SURVIVAL AND CHILD DEVELOPMENT PROJECT EVALUATION
Meandum
of
Understanding .
Christian Medical Association of Inida, the Official Health
Agency of Protestant and Orthodox Churches in India has
decided to study the progress and achievements of its Child
Survival and Child Development Programme in the field since
inception in 1987. The over all goal in undertaking this
evaluation is to :
1.
Assess the progress of the CSCD Projects in the field and
their achievements so far.
2.
Get guidance on the future involvement of CMAI in Child
Survival and Child Development issues in India.
3.
To look at the appropriateness of the model undertaken
at present, its effectiveness and suggestions to improve.
Dr. Tekur from Community Health Cell, bangalore on invitation
has kindly responded and had a dialogue with the General
Secretary.
The agreement on the 2
3*11 terms of reference " has been as
follows"
1)
The evaluation will done during March 1991 with the
final report available on 31.3.1991.
2)
This process will oe "Participatory " involving CMAI,
CEO's ot the projects and staff working in these projects
and the local community served.
3)
CMAI Expectations :
a)
b)
cj
Review of Child survival and Child Development Projects
of CMAI to examine the role, contribution and technical
assistance of cMAI for these projects.
Review of a sample ot tne projects to examine the local
processess, progress and performance.
Give suggestions to CMAI on the future of the programme.
-
Within CMAI
-
Within the project
Within the community
Within Churches
2
1.
i
(
Preparatory Phase :
Review and study of all papers and related documents
available with CMAI.
-
II.
Discussion and informal interview with Key CMAI Staff
involved in implementing this project.
Field visits
-
:
A sample of few selected projects can b
visited with the following objectives:
Meeting with CEO’s of implementing projects to assess
their understanding of role, responsioilities and
,
future of the project.
Interviews with Project Manager and other staff invol'
in implementing the project.
-
Meeting with the Mothers who participated in the prog:
and get their feed back ( Beneficiaries ) .
-
Focus group discussions with :
Teachers
-
TBA’s
-
Adolecent Girls &
-
others.
The travel arrangements are to be made by CMAI whenevee Dr. Tek
undertakes. CMAI will re-embure^, all the cost of his travel wh
he travels on his own in relation to this evaluation.
The Field visits and the travel plan of Dr. Tekur accompanied
by Mr. K.A. Antony has been worked out.Seven Institutions are
selected for the field visit and the schedule of visits are as
follows s
3/
3
ees
Mode of Travel &
Transport
From
TO
!91
FLT.IC 469 &
Taxi
Delhi
Nagpur
FLT.IC 269 &
Taxi
Nagpur
Hyderabad
-
-
—
-
Stop for the
night at
Hyderanad
4) YMCA, Madras
soy's Town
233,Tiruporur
High Road
Madras -600 041.
Institutions
visited.
1) xWCA of Nagpur
Civil Line
Nagpur - 440001.
2) Evangelical
Lutheran Church
in M.P.
Civil Lines
Nagpur-440001.
Stop for the
night-Hyderabad
3)
Taxi
YMCA Development
& Social Concerr
Narayangunda
Hyderabad, A-P.
..91
. 91
FLT.IC 439 &
Taxi
Hyderabad
Madras
Train 6673 &
Taxi
Taxi
Madras
Coimbatore
FLT. 534
Coimbatore
-
-
Bangalore
. 91
Traval oy night
5) CSI Package of
Devt. for Rural
&Urban Women in
Coimoatore
Halt at Bangaloi
at night
Halt at Bangalo;
.91
Bus & Taxi
Bangalore
Mysore
Bus&Taxi
Mysore
Shimoga
6) CSI Bodithittu
Project
2995, Five Ligh
Circle
Church Road
Mysore-570 001
Travel oy night
L9.3.91
TUS
•'
Taxi
Bus & Taxi
7) YMCA Child
Survival &
Devt. ProjAshok Naga
3rd Cross
Shimoga - ■
Bangalore
-
Shimoga
The Terms and Conditions of the contract are .as follows
1.
CMAI will cover all official travel for this Consultation involvin
second class AC sleeper or the most suitable mode.
2.
Board and Lodging for the
Consultation period will be provided by
or its member institutes when visiting them.
3.
Local incidental travel will be covered.
4.
CMAI will pay a consultancy fee of Rs. 300/- per diem for the days
involved
in the Consultation.
5.
No further expenses or fees will be covered.
CMAI expects a draft report to be discussed with us before the final r
is submitted. When the final report is submitted CMAI expects 6 copies
We would also expect to be given the 'Floppy* if a word processor
has been used.
in acceptance of the above Memorandum of Understanding it is signed by
Dr. Dalbep S Mukarji
GENERAL SECRETARY.
CMAI, NEW DELHI.
Prasad Tekur
Shir
CHILD HEALTH CONSULTANT
ANGALORE
CH
Appendix *B*
Bibliography of Documents / material used to corapile this report
1.
Files of the 31 CECD micro-projects currently in operation.
2.
CMAX - Set of policy statenants.
3.
A manual for Child Survival and Child ’development Frograiwne
- Dr. Sukont Singh. CHAI.
4,
Report on the CS and CD programme October 1990 — CHAI.
5.
Child .survival and Child Development Programme — CHAI — 25/1/91.
6.
Course outline - Orientation course for staff from CS & CD
project - CMAI.
7.
Pre-test and post-test formats — training courses of CSCD
projects — CMA.I.
S.
CSCD projects — Service coverage report up to 30th June 1990.
9.
I'lOKA - A manual for the Managers of Community Rased Primary
Health Care projects - CHAI - 1937,
10. Job descriptions - Project Manager & CHV - CHAI
SL.NO •
01
PROJECT
STATE
-------------- 2—___________ ______
3
Adivasi Kristiyo Samaj
Orissa
LOCATION
rural/urban
TYPE or
• WORK
DURATION
OF WORK
IK YEARS
HEALTH
RESOURCES
IN AREA
A
5
Rural
6
s/e/A/u/vt
7
14
8
C ♦ MH
CLASSIFICATION
&
ACCESS/
TRAINING HEALTH STATUS
COMMUNICATION ATTENOE'J/ IMMUNIZATION
TO HEALTH
U'HO?
COVERAGE
r'*CIL1TY
MQTHER/CHILO
.
...
9
Good
10
CED
G
A
11
COMMENTS
12
02.
Vadala Leprosy Control
Maharashtra
u
Rural
s/h
33
C
Good
CEO/PM/FS
C
G
03.
C5I
OEAP Trichy
Tamllnadu
G
Rural
s/e/a
04
Nil-C.H,
13 KF. away
Poor
Pfl/FS
G
G
mm
mm
Reporting
not under
stood well.
Health
Project.
Ecumenical Centra,
Trivandrum.
Kerala
A
Urban
S/E
04
GH/MH
Good
CEO/FS
05.
YMCA Madras
Tamllnadu
aA
Urban
s
20
C/GM nearby
Good
CEO
rt
G
*
06.
YMCA Hyderabad
Andhra Pradesh
A
Rural
s
75
C
Poor
CEO/FS
bA
A
Trained F/S
loft
07.
CSI Sodithittu,Mysore
Karnataka
aA
Rural
S/E/A
04
Hil-GK-^M
10 KM away
Poor
CED
bft
A
Trained
F/3 loft.
08.
Aden! Area Rural
Development Initiatives Andhra Pradesh
G
Rural
s
03
Mll-GH 20 K.R.
Poor
ceo/pm/fs
G
G
BCG Coverage
low.
09.
Flora Samuel
Andhra Pradesh
aA
Rural
S/A
08
C/MH
Good
CEO
G
G
Adm.,
project
problems.
10.
YMCA Hullankinevillai
Tamllnadu
G
Rural
s/e/a/u
12
Hil-PHC
10 K.M. away
Good
cEO/rs
G
G
Using MH
Neyyur.
11.
YMCA - Nagpur
Nil - gh
10 K.M. away
Poor
CEO/FS
G
G
w
YMCA - Shimo^a
GH
Good
CEO/FS
G
G
12.
04.
Maharashtra
Karnataka
G
G
Rural
Urban
E
S/E/VT
86
06
FS left
doubtful
reporting.
12
10
13.
Naxeroth Family
Helper Project.
14.
Kerala
East Kerala Diocese
15.
CSX
16.
Kerala
PDPRW, Salem
Rural
G
Rural
Himachal Pradesh
Madhya Pradesh
IB.
YHCA Muolachal
Tamilnadu
19.
Haredueilly Tribal
Andhra Pradesh
Mayon Haga Saptisb
G
Rural
A
G
G
A
Manipur
Christian English
School
Nagaland
ft
22.
Zelicngromg
Evangelistic
Manipur
G
23.
Lic-Longidans
Nagaland
G
24.
CSRO Ahmednagar
Maharashtra
A
25.
csho Kept!
Maharashtra
G "l:
26.
CSRD Agadgaon
Maharashtra
G
/
27.
CSRO Shend!
Maharashtra
G
/.
28.
Maharashtra Village
Ministries, Nagpur.
Maharashtra
A
29.
Deep Day Caro Centra
Madhya Pradesh
G
30.
CSI PJPR and U.U.
Tanilnadu
6
31.
E.L.C. Nagpur
Maharashtra
K
II
1- I
-
. ...................
5/E/A
04
S/E
06
Nil - GH/C
5 K.M.
Good
CEO/FS
G
G
Nil - MH
6 to 7 K.M.
Poor
CEO/PR/FS
G
G
Good fteeerde
C
G
Good Govt.,
Servicco*
Doctor
G
G
Health
Project.
Good
CE0/F5
G
bA
Nil - GSC
10 K.M* away
--- ---1-.
X
X
■
5/E/A
12
C/«H
Rural
S/E
25
C/MW
Poor
CE0/FS/CH9
G
A
Rural
S/A/WT
03
Nil - CH
10 K.ft* Qaiey
Poor
PR
G
G
Nll-G S/C nearby
poorly equipped.
Poor
PR
4B»
a*
\
Bed roeordin
Bed reportin
PR/FS
G
G
Rural
Multipurpose
14
Hll-GH 8 K.R.
Poor
CEO
4
G
Rural
S/£/A/Ed
05
Nil
Poor
PR/FS
4»
«»
Urban
S/E/ft/Ed
29
PHC
Good
pr/ceo
t»A
A
Rural
5/E/A/Ed
29
PHC
Good
pr/ceo
G
A
Rural
S/E/A/Ed
29
PHC
Goad
pr/ceo
G
A
Rural
S/£/A/Ed
29
Good
6
S/E
07
Poor
pr/ceo
Or/CEO/FS
G
Rural
PMC
H11-GH18 K.R.
bA
A
Rural
S
07
Sil-GH 10 K.M.
Poor
CEO
G
bA
d»
Rural
S/E/A/VT
06
mu-
Good
CEO/FS
G
G
4»
Urban
H
15
GH Nearby
Good
PR/CEO/FS
*
ee
S • Social
E - Economic
ft -Agriculture
w • Water
VT- Voc.Trg.
£d-Education.
....... .i—ii..—......... .. .................... .. .......................................................
1-23s3rd yr.C - Clinic
24~31*2nd yr.RH—ftission Hoop.
GH—Govt*,Heap•
PMC-Prloary health
Centra.
GSC-Govt* Sub Centre.
■■■•.................................
. ......... «w..........................
■
Population
BOGO covered
not regular
Govt., ofFort
not recorded.
Eddcation and
Retivation
Streeeed on.
Not underato
reporting.
Rot reported
wu.... .........
Good-TOjt A
above
Average •
70-50S
bale* averagebelow 80S
I
-n,.Miil.r.m.'
■
<p-
Poor
/
J
Nan-specified
Dev.Program
05
PHC
Sil-Gw 33 tc.e.
/
H,
Poor
GH
25
. /
J
04
S/E/A
/
/
H
Rural
S - ««»<*
I
!
a* — above a/verade ■' \
A — avsraca
/
■ I
I
\
I0TEB:
I
25
Bpral
Rural
21.
„
S/E
X.
Kriat Seua Kendra
20.
Urban
G
Tanilnadu
St.Mary’s Church,
Kotgaph.
17.
G
APPENDIX 'E'
CEO / Project Staff
Name of the Project
1)
2)
Understanding of
aJ
Role
b)
Responsibilities
c)
Future of the Project
Problems faced with Project
Problems with CHAI
3)
Training so far
Needs in future
3 a)
Training done apart from
CMAI
4)
M.I.S.
5)
Contacts with other Voluntary / Government Agencies
6}
How do you relate the nealtn component to Developnent
Comments
coitponents
7)
I
Suggestions for innovations / other models /
APPENDIX 1F‘
t ions _to_Mo the rs/_Te ache rs_/_TBAs_/_0t he rs
1|)
What is your understanding of the CSCD Project ?
2)
What are the benefits of this project to the Community ?
Qi
I '
t'
3)
Do you have any suggestions for improving the Project?
- Media
RF-CH-6.4 SUDHA.pdf
Position: 3740 (2 views)