Cominunity Health Trainers Dialogue
Item
- Title
- Cominunity Health Trainers Dialogue
- extracted text
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Cor^ H
RF_COM_H_8_SUDHA
i
siram
AUXILIARI NURSE MIDWIFE
TRAINING PROGRAM
..
TRAINING DIVISION
DEPARTMENT OF FAMILY PLANNING
MINISTRY OF HEALTH AND FAMILY PUNNING, WORKS
BOUSING AND URBAN DEVELOPMENT. QOVWNENT OF INDIA
1
April, 1970
I
*
K-JS
.INTRODUCTION
A basic assumption of the family Planning programme is that the
ANM is the primary contact for the delivery of Maternal Child Health
and Family Planning services at the village levelo
This fact and the
realization that meh relevant information about the ANN programme and
its progress is lacking* prompted the Training Division to undertake
this survey of ANM Training*
Three hundred and thirty-seven (337) questionnaires were sent to
addresses listed iw’ith the
ANM training programmes
I
H
tion of--India as conducting
One hundred ninety-six (196)completed
questionnaires were returned to the Training Division
Nine (9) of
the returns showed that their programmes have been discontinued*
Four (4) of the questicnnaii’es were considered Invalid due to ill egib ility and incompleteness..
Omitting the discontinued schools and the
invalid returns, this report covers data provided by one hundred eight**
three (13?) schools or fifty six percent (56$)
The geographic spread
of the returned questionnaires is not significanto
Status pf Current
The one hundred and sixty-five (165) schools report a total enrollment
of five thousand one hundred and forty-five (5145) students,,
Of these
two thousand six hundred and twenty-five (2625) students are in the first
^•2'
year of training and the remaining two thousand five hundred and
twenty (2520) are in their second year.
The range of the class
enrollment is from one (1) to sixty five (65)«
neglected to report their
(Three of the schools
current census•)
Over half of the respondent schools have a student enrollment
of less than thirty (30) students per class*
Wastage figure wox*e
reported somewhere between one percent (1/0 and three percent (3$).
Using a wastage figure of about two percent (2%) of the student class
admission, the average school can be expected to graduate only eight (8)
to ten (10) students per year*
The size of student enrollment is closely related to the size of
the medical installation that provides the clinical experience for the
Aifo students *
The overwheJjning majority of the ANN schools reporting
are attached to hospitals with two hundred (200) beds or less*
A total
of fifty four percent (54%) of the student enrollment is concentrated in
hospitals with a bed census of less than one hundred (100).
Another
thirty percent (30%) of the students are enrolled in prograinmas connected
with hospitals with a bed eons vs of less than two hundred (200), while
the remaining seventeen percent (17%) of the students are receiving
their institutional clinical experiences in hospitals ranging from
two hundred and one (201) to eight hundred (800) beds*
Supervision
A high proportion of the AKM programmes are conducted within insti
tutions with a ’ainimum amount of experience facilities and without nursing
guidance and supervision for that experience*
Thirty-four (34) of
the institutions providing clinical experience do not have a matron in staff
position*
Sixteen percent (16%) of the reporting schools do not have a
sister tutor assigned to the teaching staff*
A high number, some eighty-
three percent (8J%) do not have a public health nurse on the staff*
A further critical weakness is that eighty me (81) (sixty two percent
62%) of the schools reporting on this area state that, no member of their
teaching and nursing staff have had any Family Planning training at all*
Stipend m Dint and NutritionEduoati^i
The amount of the stipends paid to ANM students varies widely
from five (5) to one hundred and sixty (160) rupees per month*
Obviously
some of the vei*y low stipends reflect only the pocket money given to the
students for personal use*
Tills practice is more common, in training
prograiemes run by the voluntary organisations,
Food costs to the students
are often assumed by these training institutions and are not considered
as stipend*
The very highest of the stipends include allowances being paid to
employees already on the state government payrolls and currently enrolled
as studentso
The most common stipend seems to be between rupees fifty (50)
and rupees sixty (60) per inonth*
Central Government reccnmiendations are
for rupees sixty (60) per month*
Seventy four percent (74%) of the
schools provide rupees fifty (50)»
Our overall survey and follow-up visits to many training instituticns suggest that this amount appears to be inadequate to maintain
a miniinal diet5* let alone provide for the personal necessities of the
students such as uniforms, toilet articles and so on
Inadequate
allowances impose naieh hardship on the students and is the most common
item of complaint of all schools*
&
The following mlnimlly adequate diet is suggested as a guide
for use in ANM schools* These calculations provide a daily
regimen for ten (10) students and the expenditure per day is
calculated at rupees twenty five (25) per day per ten (10) students*
This diet provides for one egg daily pel' student, vegetable once
a dayft rice or wheat twice a. day, a pulse or gram twice a day,
ehapatles twice a day, four oa* of milk cnee a day, tea (including
sugar and milk) four times a day and the ghee required for
cooking * It may be noted that the graduate ANM is expected to
include in her MCH services the very hnportant component of
nutrition education and it would be reasonable to expect that
the diet provided the ANM would meet minimm. nutritional standards o
The calculations provided by the minimal diet herein outlined
requires rupees ninety (90) per month per student outlay*
This provides rupees fifteen (15) for personal necessities and
rupees seventy five (75) food alone*
The ANM programme includes two (2) major areas for clinical experience.
institutional experience and community experience<>
experience is provided as previously reported
The institutional
The second area that of
community experience, many people believe should have a higher priority
than the first, since the largest portion of the population is rural and
training programmes should be designed to meet the general needs of the
majority of the population&
The Indian Nursing Council recommendations include three months
of experience in a PHC or similar institution toward meeting these
priority obj ectIves o
Analyses of the questionnaires discloses the fact
that there are only fifty five (55) ongoing AW programmes meeting this
significant and very crucial requirement<>
Twenty seven (27) of the
programmes partially meet this requirement by providing a one to two
months experience, while ninety six (96) programmes provide a few days
experience for observations or none at all0
The factors contributing to the failure of the schools meeting
this requirement emerge as the following:
1) The majority of the
Sister Tutors working in the AWM schools have not thews elves had experience
or training in public health nursing
.Sister Tutors are recruited
mainly from general nursing staffs and public health nursing is not &
part of this curriculunu
2) The absence of housing in the field and
the transportation necessary for this experi.ence to become a reality<>
3) The overwhelming majority of the controlling authorities who administer
the schools do not place a high priority on rural field community service
as an element in ANM training,
iT
Some thirty (30) schools (eighteen percent (18%)) tell us that
they consider their nursing care equipment inventory insufficient to
adequately carry out the teaching of nursing routines and procedures
in their classrooms
One can assure that nursing care equipment is
in even shorter supply in the practice field or the hospital«
Teaching of Family PJanntoR
Sixty-four percent (ninety eight (98)) of the respondents mention
the teaching of family planning either as a part of midwifery or as a
special block of instructiono
’Hie most common number of hours for the
block teaching was four hours o
Reporting of the integrated teaching
of Family Planning was rare.
Of the remaining thirty-six percent (36%)
of the schools it was difficult to determine where Family Planning came
into the curriculum if at allo
Each questionnaire requested information on how each training
institution saw their priority needs for immediate assistance.
were over two hundred and fifty (250) items requested.
There
Fifty four (54)
schools requested more educational written material on Family Planningo
These included books, graphs, journals, pamphlets and teaching guideso
The second most common request was for anatomical and contraceptive
models
Audio visual aids such as movie and slide projectors. films.
film strips were frequently listed.
Requests for more personnel, new
or improved physical facilities also received high priority.
A surprising
nurcbor asked for samples of contraceptives for classroom usa0
Other
requests included such thing as change in stipend^ uniform allowance.
special training px^ograiffiBija various clinical areas and transportation©
Oue interesting request that came up over and aver was the request to be
placed on routine mailing lists for Family Planning literature^
s
This report drawn from a questionnaire suiirey of one hmidr-ed*
eighty three (133) ANM training schools reveals a very wide 3?©uge of
enrollment per class
from one to sixty five..
The majority of the
schools have an oarollmsnt of less than thirty (30) students«
Glass enrollment figures? hospital training sites, available
nursing and teaching staff show a siae correlation *
Family' Planning training for nursing staff in ANM schools is at a
low level*
Stipends currently provided appear to be inadequate to provide
minimal nutritional diet need®The weakest area of clinical experisnca provided by these training
schools is in coaraniity nursing*
FaM2y Planning ite not integrated into
the ANM curriculwu
RECOyjj^DATKXjg
i*win>i ,iu; rimrimirw
Tiie following reconraendations are made based on the findings of
this report:
1
All Sister ’Tutors should have training Ln teaching and in ccwmnity
nursing*
ComDnity nursing includes experience in a PHC with a
Family Planning compononto
2o
Cosmmit.3y nursing experience for all ANJ4 students is an absolute
necessity,
3o
Physical facilities and oquipiaent inventories should be maintained
at an adequate levelo
This level should be standardised and
cheeked frequently,.
4o
All ANM schools should come under the technical direction of the
Deputy State Nursing Supervisor^ vho should be a qualified Public
Health Nursoo
&
5a
A nation wide study of the functions and the role of the OM should
be undertaken as soon as possible#
60
The Indian Council of Nursing condition for training schools should
be revised in relation to size of class enrollment, size of training
institution> staffing patterns and admission policieso
7»
The Indian Council of Nursing recommendations regarding isatTons
located at the site of training institutions should be enforcedo
8*
Stipends need to be revised*
9o
All ANM schools should be on the miling list of the State Family
Planning Officer•
1X>»
The status and pay seal© of sister tutors working in ANM schools
should be on a par with a is ter tutors narking in other nursing schools a
Chart No* 1
BAHGE ORDER OF 8WS
No.
Na, of
Quests
Ret5 d.
n>
No. of
Quesjt.
Sent,
Retm*n
uscxamcAMATd
1.
Goa
3
3
100
2.
Madhjra Pradesh
2>
28
89.. 3
3o
Punjab
7
8
87,5
4»
Mysore
27
31
87.1
5.
Gujarat
25
33
75.7
6. a.
Asas®
16
22
72.7
b.
Bihar
8
11
72.7
e6
Union Territories
8
n
72*7
7.
Orissa
8
12
66o7
8.
Tamil Nadu
9
15
60
9o
Uttar Pradesh
11
19
57o9
ID.
Maharashtra
19
35
54.3
U. a.
Haryana
5
10
50
b
Nagaland
1
2
50
12.
Kerala
8
17
47
13
Andhra Pradesh
LI
38
28.9
Uo
3amm -* Karhnrir
1
4
25
15.
Rajasthan
2
18
Hol
16.
West Bengal
2
20
10
196
337
58.2
<<
w,
Chart Ko. 2
/I
RANGE ENROLLMENT
1st Tea?
No. of School
2nd Tsar
No, of School
0
17
17
34
1
1-3
8
19
27
2
6-.W
32
30
62
3
11-15
33
28
61
4
16-20
26
20
46
5
21-25
U
18
32
6
26-^3
18
19
37
7
33-35
5
3
8
8
36-4.0
3
4
7
9
41-45
3
0
3
10
46.50
0
0
0
U
51-55
0
1
1
12
56-60
2
0
2
13
63.-65
1
3
4
14
No.
V'.. ■
/
Chart Noa 3
No.
Hospital
Sise Interval
No, of
Hospital
1
0
12
2
1-50
29
3
51-100
57
4
101-150
34
5
151-200
16
6
201-250
6
7
251-300
7
3
301-350
6
9
351-400
0
ID
400-:-
10
Totals
177
I
4r
R
?
4
(1)
53%
student mrolhRant
is here*
(2)
30% of student enrollment
is here*
(3)
17% of student enrollffi/apt
is here*
Charb Noo 4
K.W3
rten«Lx-.
STA1-E3
Ho. of
Students
of Students with Stipends
50 (Rs,)
Students
Schools
STATS3
Noc of
Students
■ it
1
Mysore
1020
23.5
945
1
Mysore
1020
2
KahEraehtra
589
6
2^9
2
Maharashtra
589
3
Oiljm-ai
499
12
259
3
Quj erat
499
4
K'ocxhya Pradosh
450
15
445
4
tl&dhyn Pradesh
450
5
Uttar Pradesh
1»5
33
5
Uttar Pradesh
446
Tamil Nadtt
428
5
376
6
’Tamil Nadu
428
7
Andhra Pradesh
259
6
109
7
Andhra Fredesh
259
8
Orissa
250
7
250
8
Orissa
250
9
Assam
213
15
213
9
Aasaffi
213
Punjab
193
6
184
10
Punjab
193
Bihar
Ifei-
3.5
131
11
Bihar
164
Kerala
151
5
151
12.5
Kerala
151
\2.5
Haryana
151
4
151
12.5
Baryanu
151
•tZj.
Raj as then
103
2
103
14
Rajasthan
103
15
West Bengal
96
1
20
15
West Bengal
96
16
17
Goa
Delhi
47
43
47
16
Gca
4?
43
Hlmch&l Pradesh
17
17
9
2
2
1
0
1
17
18.5
3Be5
2C
Delhi
43
Nagaland
17
17
Kashsdr
Hicachal Pradesh
9
. 6
u
18O5
13a5
20
5U5
nSa5*
17
0
9
373^6
5145
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4
RUHM^
RUHSA DEPARTMENT
CHRISTIAN MEDICAL COLLEGE HOSPITAL
I *
/
RUHSA CAMPUS
RUHSA CAMPUS P.O. 632 209
N.A.A.DISTRICT
TAMIL NADU
SOUTH INDIA
I
RUH SA DEPARTMENT OF CMC HOSPITA Lt.yELLO.RE
COURSE DETAILS OF DIPLOMA IN CO^NITY. HEALTH MAJIAGEME®.
INTRODUCTION
The Diploma in Community Health Management is a course
started at the RUHSA* Department, CMC&H, at it RUHSA Campus,
in 1983 with the assistance of Voluntary Health Association
of India, New Delhi. Planners of this course saw the need
and demand for competent and committed personnel in community
health management. The frustration faced due to lack of
personnel and managers with the attitude, knowledge, skills
and experience to provide dynamic leadership in this area
was also identified.
The 15 month DCHM course is planned to prepare:
* Managers and Team Leaders for Integrated
Community Health and Development projects
of Voluntary Agencies.
* Effective Trainers and Personnel for potential
community health and development training,
Research centres of non-government and
government organisations.
OVERALL GOAL
The overall goal of this course is to make available people
who have the skills and knowledge to be effective at the
management and supervisory level of Community Health and
Development programmes, projects and activities; people who
are concerned about social justice, health and economic
status of the people, willing to work for the oppressed and
marginalised and weaker sections of the community and
prepared to learn and grow personally with a desire to make
health and healthy community life a reality for all people.
* Rural Unit for Health and Social Affairs
: 2 :
'i
GENERAL OBJECTIVE?: Upon completion of this course the
candidate will be able to:
* Determine the effect on people’s health of socio-political
and economic systems at the macro and micro level.
* Create a desire to work collectively for a just and
equitable society.
* Take responsibility for own learning.
*
Apply problem solving methods.
* Plan, organise, implement and evaluate Community Health
and Development programmes.
* Accept role of change agent/facilitator in order to make
health a means and measures of development.
♦
Understand the team concept and show the ability to take
leadership role in the team.
* Promote and facilitate training, research and consultancy
programmes.
SELECTION CRITERIA
* Bachelor’s Degree in any discipline: Arts, Science,
Social Sciences, Law, Management, Engineering, Medicine,
Nursing etc.
* Non-graduates with work experience and proven ability
to handle the course are also eligible to apply.
* Ability to handle English as a medium of learning.
*
Experience in the field of Health and Development
programmes.
«
Strong motivation and committment towards working for
and with the poorest section of the society.
* Those sponsored by a voluntary agency with assurance of
a job, after the course, will be given priority in
selection.
* Passing entrance examination and interview conducted at
CMCH.
: 3 :
'i
COURSE CONTENT
* Studies of Society
* Health and Development
* Techniques of Studying Community Health
* Management and Administrative Principles
* Effective Change Agent
* Electives and Practicum
TEACHING METHODOLOGY
Methodology of instruction includes participatory techniques,
simulation and self directed learning techniques.
Student centered participatory training technique is adopted.
The following are the most commonly used methodologies:
a) Problem based learning
b) Workshops
c) Practical Field experience alternating with work
at the RUHSA centre on analysis end study of
problems and issues interlinking theory and practice.
d) Group Methods:- Discussion, seminars, panel, role
play, simulation exercises, etc.
e) Individual Work:- Book review and project reports
on problems in student's own field/interest and
study areas”in which the participant is deficient.
"
FACULTY
a) Full time core faculty in RUHSA with appropriate academic
qualification, good field experience and close understand
ing of third world countries, its resources and problems.
b) Guest Faculty: drawn from specialists in India for short
periods.
c) Visiting Faculty of experts from other countries who have
had experience in other developing countries having
appropriate knowledge or skills to share and can come for
periods of time.
t 4 :
>1
EVALUATION
This is done both concurrently and periodically. It is
participatory and each student is actively involved in
the process of his/her own evaluation. Comparison
between student is not adopted but individual growth
and performance of the students throughout the course is
stressed. Students who satisfactorily and successfully
complete the course are recommended to VHAI Educational
Council for awarding the DIPLOMA IN COMMUNITY HEALTH
MANAGEMENT.
COURSE DETAILS
* Venue
* No.of Candidates
: RUHSA Campus
RUHSA Post
North Arcot District 632 209
Tamil Nadu, S.India
Upto 20 per course
♦
Length of the Course
: 15 monthd1 (12 months residential
and 3 months practicum postings with the sponsoring
institutions)
«
Costs
Additional Expense?
Rs.
1,500
Tuition
100
Registration
200
Library
250
Assignment/Projects
75
Medical
900
Hostel (Rs.75x12)
Security Deposit
200
(Refundable)
Certification Fee
100
to VHAI
Project related
625
Travel
4,000
Food (Rs.500 -x 12)
Books (suggested)
(approximately)
Rs.
6,000
600
6,600
: 5 :
>1
f-’ate: Since the course is subsidised for students from
India and its immediate neighbouring countries, an intern Lional fee of US $2000 is charged f r students from
o! er ountries. Included in this is the co t of tuition t
accommodation and the average cost of rural South Indian
Food. International students need to make arrangements
for additional funds to have food according to their own
tastes and standards.
SCHOLARSHIP
Few scholarships are available for covering tuition and
accommodation costs. Sponsoring organisations or individuals
are responsible for boarding. The scholarships are provided
by VHAI. Intending participants should write to the
following* for scholarship and confirm availability of
scholarship if this is necessary. VHAI scholarships are
primarily meant for students from India and its immediate
Neighbouring countries.
* The Executive Director
Voluntary Health Association of India
40, Institutional Area
South of ITT, New Delhi 110 016
Tel: 668071 Fax: 011-676377
: 6 :
■
STI’D-NT PROFILE
The characteristics of the 74 students (attended from 1983
to 1990) with resp -ct to sex, age and educational background
are presented below:
Jptal_Sty<<ent^: 74
a) Sex:
Males
Ferna les
b) Age (Years):
15-19
20-24
25-29
30-34
35-39
40-44
45-49
48
26
2
15
23
18
8
5
%
3
c) Education! Predegree/Intermediate
11
Diploma/Non-Graduates
23
Graduates
19
Post Graduates
4
Nurses
12
Doctors
5
: 7 :
■ AGENCY PROFILE
The following are some of the important voluntary agencies
v.'hich sponsored candidates for the DOT' courses
J hd ia,
- Mazereth Hospital, Sisters of Charity, Bihar
- Child in Need Institute, West Bengal
. Hyden Hall Institute, Darje ling
- Bangalore Baptist Hospital, Karnataka
- St.Luke Hospital, Vengurla, Maharashtra
~ Holly Cross Institute, Bihar
•» Department of Health, Central Tibetian Secretariat,
Dharmasala
- Good Shephered Provincialate, Karnataka
- Bengal Rural Welfare Service, West Bengal
- Church of North India, West Bengal
- Taraknath Maternity & Child Welfare Centre, West Bengal
- Sihora Mission Marthoma Syrian Chui?ch, Madhya Pradesh
- Salvation Army, S.W.India Territory, Kerala
- Salvation Army, Cathrine Booth Hospital, Kanyakumari
- West Bengal Rural and Urban Development Centre, West Bengal
- Schefflin Leprosy Rehabilitation & Training Centre,
Tamil Nadu
- Bethel General Hospital, Vuyuru, Andhra Pradesh
- Rural Development Trust, Andhra Pradesh
- Memorial Hospital, Uttarpradesh
- Christian Hospital, Sampalpur, Orissa
- Indian Evangelical Lutheran Church, Tamil Nadu
- Nava Jeevan Seva Mandal, Gujarat
- Dharmapuri Clinical Diagnostic Centre, Tamil Nadu
- CSI Rainy Hospital, Tamil Nadu
- SUOTI, Andhra Pradesh
- Congregation of Carmelite, Sisters of Charity Gujarat
- Lutheran Christian Health & Medical Centre, Tamil Nadu
- Bosco Reach out Provincialate, Assam
- CSI, Vellore Diocese, Tamil Nadu
- Trivendrum Social Service Society, Kerala
I
: 8 :
- ' ' nipur State VHAI
- '' ngammal Health Centre, Tiruvannamalai, Tamil Nadu
- •.■■<DEP, St.Thomas Hospital and Leprosy Centre, Tai. il Nadu
- mural Integrated Development Organisation, Tamil Nadu
- ■Sisters of St.Joseph of Chambery, adhya Pradesh
A'
t
1'3d
- Seve the Children Fund, Nepal
- Gcdavari Alumni Association, Nepal
- Community Health and Development Project, Nepal
- Mityana Diocese, Uganda
- PFRDHAKI, Indonesia
- SONARS, Djibour, East Africa
- rHPSRN, Nepal
- Save the Children Fund, USA
- MFRU, Kenya
- Holy Family Provincialate, Srilankc^
- Lutheran World Service Community Development Project,
Nepal
« Red Cross, Sudan
F«x further details please write to:
Dr.Rajaratnam Abel
Head of RUHSA Department
RUHSA P.O. 632 209
(Via) K.V.Kuppam
North Arcot Ambedkar Dt.
Tamil Nadu
Phone: K.V.Kuppam - 52, 53, 54
Grams: KJHSA, Kilvayattanankuppam
/
Titles
COmUNITY HEALTH AND ST, JOHN’S
The Department of Community Medicine at St. ’John’s has always
played the pivotal role in fulfilling the most important objectives
of the college.
Serving the under privileged and more importantly
training others to serve the underprivileged has been the mainvfocus
h
of the Department.
The enabling process of identifying and attempt-
ing to meet the felt needs of the community 9 is done by the Department.
The training and service components are provided to all members
of the health team (from the grass-root level workers to tertiary
rare specialists) .
TRAINING FOR COMMUNITY HEALTH CARES
Being a Medical College, St. John’s is in a unique position tn
■’.
provide all the training components in the formation of a Health
tear.
Thift creates a better understanding of each member’s role
in Community Health Dare rather than a isolated form of traiining to
separate Health Team Members in separate institutions.
The/various
Training programmes in Community Health are as follouss1.
For Medical Studentss-
a) Rural Orientation Programme;- Conducted every year.., during the
months of January - February, the main objective of the camp is to
expose the medical studeots to the various facets of rural life
through a residential programme at Desmmasandra Primary Health Centre.
The students visit all the rural sub.centres and are guided in deter
*
lining the various factors which govern rural life such as
Agr iculture 9 Animal Husbandary, Small Scale Industries, F airs,
F estivals, Customs and traditions, Commerce and trade. Transport,
Traditional systems of Health, Housing and environment, Role *of
women in society, Maternal care practices, Child Care practices and
Food practices.
These are presented in the form of field projects
by groups of students.
In addition 9 the students also organise many
2
b) Clinico Social Case work for flBBS Students; -
This .is conducted
every month, by posting them ift batdhes to the health centres.
Their
training involves rase work in the field, working up the* social aspects
of a number of communicable diseases as well as antenatal cases.
The
objective is to train the students to consider a case as a holistic
health care problem rather than a mere clinical entity.
The socio
economic causes, contributing factors and consequences of major disea*
ses are highlighted in this training programme in addition to the
usual clinical features of the disease.
c) National Social Services in rural villages: -
Under this scheme,
the medical students carry out community health
and developmental
projects at
various villages in batches once a week.
t« the generally known NSS activities,.
In contrast
the NSS programme of this
iistitutittn aims at highlighting community h*ealth and community development, as the main features of this service •
Educati^n for school
childr en, adult education, school health education, improving environmental health etc.. are some of the main components of this programme.
d) Child to Child health education programmes~ Evolved as a novel
approach tn health education, this programme has proved to be an
immense success at D^mmasandra, Anekal and Bidadi health centres.
The basic objectives is to teach groups of children, various aspects
*
of health, using innovative teaching materials
and ’’health songs’1.
live demonstrations
Later the children are allowed to share their
knowledge with each other and each child is encouraged to tell the
other what he or she saw in her/his group teaching.
This way the
factor of curiosity and natural thirst for knowledge and sharing^the
ij
same, are invoked in each of the children.
This greatly contributes
to strengthening the health education in a natural cumulative manner
from child to child.
At each rural centre, the major middle and high
school are covered under this programme.
r.
The positive aspect t)f this
s
3
:
eno^Hers1 Motivation Programme; Groups
of rural mothers are invited
to the rural subcentres and they are made
aware of various facets of
nutrition, maternal care, child care,
immunization etc.. The Programme
is conducted in the form iof practical nutrition demonstration
immu9
nization procedures, infant feeding techniques
, preparation of weaning
n
diets etc.
Emphasis is laid-on the fact that all the components of
this programme must be d^ne through practical demonstrations
using
9
locally available resources only, with the mothers themselves
actually
executing the work.
mphasis is also stressed on the css-t facrtor during
these demonstrations.
n
f) Elisld work in urban slums J -
Senior clinical students visit families
and maintain family health records 9
enumerate eligibles for immunisation,
immunization coverage, refer to the St, John's Hospital those in
need of medical services and also carrv
field surveys
r r. Nutrition,
sunwavo in
carry nut
nut field
child health etc.
g) Seminars, discussions and Lectures?-
Over 400 hours are spent in
teaching community Health to medical students during their entire
M8BS training period.
All the subjects from concepts in Health care,
to Nutrition, Maternal and Child Heaith , Occupational diseases,
s ta
tistics, sociology, Behavioural sciences, h
ealth Management and
Planning, control of communicable and
nnn—communicable diseases etc*
are taught to the medical students.
h)Study tours to other Health related Institutions?- In an effort tl
expose our students to real life situations 9 they are taken to various
health institutes 9 field projects and institutions of public health
importance.
>1
^ere they get a chance to interact with other Health
agencies and their staff and actual field problems in health c atr e. n
4
2• F*r Nursing Students:
aQrisntation Programme for Nursing Students: - Conducted every
year during the month of May, the main objective of this camp remains
t^e same as that for medical students.
The camp is conducted at
Bidadi Primary Health Centre and the rural Mobilg Clinic stationed
therein is used extensively during the programme. . In addition to
A
theactivities refered to in the medical students camp 9 the’ Nursing
students are given extra assignments in the field of Maternal and
child care, ^omifciliary deliveries etc.
3. Far Community Health Uorkerss
Rural Training programme for Communit
j-s a
three mo nt
Health Workers,: - This course
programme , conducted twice a year, during which one
©•nth^as spent ,as/a rural residential camp
The emphasis du.ring this
r.Burce is on various field, cl in ical9 Lab and institutional training
i» the various aspects of community health.
Additional training in
M first aid, home nursing, natural family planning^ Herbal medicine,
counselling, community development and human biology are also conducted.
The rural posting comprises mainly of various field projects
on the. dynamics of rural life, rural Mobile clinic work, domiciliary
deliveries, maternal and child health, school health etc.
Rural
projects planning and management of health centres is also taught
to the community health workers.
As of the current 20th basic course
for Community Health Workers, a tatal of 355’ community health workers
from every state in India and also from Nepal have been successfully
trained.
4. Interns:
C'
Rural Internship training programme:-
All Interns in hatches, are
posted to the six rural subcentres for a period of three months dura
tion each.
Apart from managing the rural clinic , these interns are
also involved in epidemiological surveys, domiciliary visits, domici
liary deliveries?immunization and school health.
Bes ides, they parti
r
5
They have successfully participated in field evaluation surveys for
immunization coverage, in remote villages in a number of districts
in Karnataka.
5 • Training programmes for Deacons
Seminarians and others:-
Being basically a training institute 9 a large nu iber of small organi-Mations are constantly availing the facilities for training their
own health workers.
This programme is arranged on individual request
basis with the theme of the training being highly specific to the
meed of that organisation.
Many of these programmes are
of work experience in our ongoing rural programmes.
in the form
Some of the
programmes, however, are formal month long structured training progranime s *
The Deacons and Seminarians from St. Peter’s Seminaty, Suvidya
Colleg e 9 Deena Seva Ashram, Workers from Association of Physically
handicapped and several other Government and Non-governmental agencies 9
undergo these coursesin Community Health oonducted by the Department.
6• Food Hygiene Training Programme:-
Keeping in view the importance
of Food Hygien e in Public Eating Places, this training programme aims
at providing appropriate knowledg e and methodology of safe food keeping tft Hotel Managers 9 cooks and Servers.
This is a monthly programme
Conducted at the Hotel premises itself in the local language so that
the programme is highly effective.
The topics of food hygiene are
especially selected to reflect Indian foods and indigenous techniques
of food preparations.
7 • Plantation Health Services:-
Under the aegis of the United Planters
Association of South India and the Department of Community |V*edic infe,
a series of training programmes, collaboration research and service
Programmes are undertaken throughout the year for the plantation
workers 9 Doctors, Managers and Lab Technicians of the Tea, Rubber,
Coffee plantation of South India.
Elective clinical training for
6
training of plantation creche attendants are some of the major areas
of involvement of our institution.
Tha main objective is to provide
adequate community Health care to the workers of the plantation nommunity in South India.
3
8. Rnral School Health Programme:
Under this programme ail the rural
middle and high school teachers of Anekal Taluk are trained in the
The main objectives of this training
a
*
school teachers in basic health care, early detectian
various facets of school health.
is to train rural
ion of illness in children 9 immunrzation and health education.
Follow
i
up of this programme has revealed that the school teachers have success
folly organised regular teaching programmes in health (for their school
children•
In addition. some of the senior school children have been
trained to supervise healthy practices, environmental cleanliness etc.
Thus the responsibility for health is transferred to the school child.
Periodical school health surveys and health camps in the specialised
areas of ENT, Ophthalmology, Dentistry and Surgery are carried out by
the clinical faculty of the concerned departments of the Hospital.'
These clinical faculty participate in these rural programme regularly.
• P°r _tde students of Diploma in Hospital Admini-tration; - Apart from
severals hours of didactic teaching in Community Health, these students
are posted to our rural health training centres and other field heal th
programmes of the department.
They also carry out Health Management
projects with the guidance of the departmental faculty.
1• Colloquim for doctors and Community Health Workers uorking in
rural areas:-
In addition to basic training in health care to various
categories of health workers 9 it is important that a follow up is done
on the utilisation of the knowledge gained.
methods are followed.
For this purpose, several
At the professional level 9 doctors can seek
elective posting in selected specialities for skill development.
R eg.io-
nal colloquim are organised for sharing professional experiences among
o
7
Alumni doctors, permanently working in rural areas, attended this
two-day colloquim uherein they shared their experiences in management
of clinical emergencies with limited resources, motivation of villagers
on health awareness, communicable disease control, use of herbal medic in 9, management of social problem, cultural taboos, etc •
The follou-
ing recommendations were forthcoming as a result of this charing
experienresS— To arrange a one year training programme in family medicine covering
all major clinical subjects including behavioural sciences, counsell
ing, community development etc.
This could enhance the knowledge
and skill level of the rural-based doctors.
Several of the partici-
gating rural doctors have offered to participate in this course by
offering their own centres for specific training sessions under rural
conditions•
A short in-service, skill oriented training for all
they take up their rural postings.
interns, before
This training should essentially
cover maternal and child health.
- To coordinate a national network of our rural graduate doctors1 with
rtur college newsletter acting as the mode of communication between
the members of the rural doctors network.
- Conducting regional colloquia of a similar nature in various parts
of our country on a regular basis.
The present teachers of our coll-
ege should participate in these regional colloquia in order to discover the actual needs of our rural graduate doctors, so that their
teaching methodologies and syllabi ca/i be restructured to suit
rural realities.
11. Integrated child_J3eyelopme_nt^
Anganwadi Training Programmes —
Under this programme, the Anganwadi workers in the Anekal and ZAttibele
circles are trained in various health programmes with greater emphasis
:
8
o
12. Extension training in agriculture, water resources and Veterniary
care for
village yauth:- This progrfemrne has been organised in the
Dommasandr a 9 Anekal areas.
The programme consists of imparting field
training and guidance on improvisation of existing methods and provi
sion of expert assistance to extension workers.
The stress is laid
on youth motivation and training in these areas s'nee it has been found
this scheme provides useful outlet for youthful energies and enthusiasm
especially among those who are unemployed and sufficient!^ educated.
This scheme is seen as a method of providing entry into the field'of
agriculture and veterinary care for fresh workers rather than merely
intensify and promote already established rich farmers etc.
13. Integrated Health Care Training:to indigenous systems of medicine
resoi
Villagers in India often
The training at St. Sohn’s
for the
various categories of health workers including its own medical students
comp-rise training in Herbal Medicine 9 Herbo-mineral Medicine, Accupressure , Homeopathy and Yoga.
Many of its graduate doctors working in
remote rural areas have substantiated the fact that there is this need
to integrate allopathic Medicine with the other systemsof Medicine.
14 o Training of Govt, Medical Officers:-
At the request of the State
Government 9 our departmental- staff conduct training programmes in
Universal Immunization Programme methodologies for Govt, ^'edical Officers in various parts of the State.
5•Training of foreign Elective Posting
dical Students: Under this
scheme, on an average, 10 - 15 Medical students per year from U.K.,
U.S.A. 9FTance, Italy are given experiential learning in Community
Medicine for 4' - 6 weeks each at our rural health centres.
SERVICE PROGRAMMES IN COMMUNITY HEALTH CARE:
1. Maternal and Child Health Clinics:-
Conducted fortnightly at all
the six subcentres by the faculty of the Department these clinics
provide an apportunity for the women and children to avail themselves
10
2
5. Universal Immunization Programme: Organised in collaborat ion with
the UNICEF , this programme is a major service programme whose main
objq.Btive is to achieve pearly 100 percent of coverage with immunization against Diphtheria, Pertusifc, Tetanus, Policy Tb -1 Neasles for
children below 1 year of age in Anekal, Dommasandra and Bidadi Primary
Health Centres plus a five1lakh population in the urban areas as well. .
<*• Rural Nobile Clinics: — As part of the Re—Orientation of Medical
Education Programme, three rural Nobile Clinics operate in 18 remote
villages of the Anekal, Dommasandra and Bidadi Primary health Centres.
On an average, 80 to 100 patients attend-these clinics per day.
The
Nobile Clinics provide an ideal opportunity to conduct not opcby routine
clinical care at the remote villages, but they also provide an opportunity to carry out specialists care such as ENT, Ophthalmology,
Dentistry, surgery and Dermatology.
diseases can be taught
Basic clinical features of common
especially to para—medical workers at these
Nobil-e Llinica since the rural patients are not constrained by the awe
inspiring presincts of a large hospital.
This aids in batter inerac-
tion between the patients and health worker which is not possible in
the sophisticated hospitals.
7• Serving the Orban under-privileged:— -Urban slums in and around
Bangalore, are also served by St. 3 o h n ’ s ♦
Health programme such as
immunisation coverage against the major killer diseases for children 9
maternal and child health clinics for expectant mothers, school health
programmes are some of the urban-based health activities of St. John1s
In addition, the medico-social unit provides councelling in alcoholism
drug addiction, juvenile delinquency etc.
The trainees learn to
serve the under privileged in all aspects of health care.
8. Referal Services:- Village patients are refered to the Hospital for
tertiary care.
The referal is done by the resident intern at the rural
health centres and followed up by the social workers of the department.
3
s
This particular service is all the more important since large number
of famales ..patients often hesitate to be attended by our male reisidential interns.
During these clinics, the opportunity to educate the
mothers on ante-natal, natal, post-natal and child care services are
also availed of.
I
2. Rural Specialists camps:- As mentioned earlier, the rural Mobile
rlinics are amply provided with facilities which are made use of to
organise rural surgical camps in the field of Ophthalmology 9 ENT,
and Dental surgery.
This has been a novel programme.
Through these
rural specialists camps, it has been proved that it is possible to
conduct surgical procedures such as Tonsillectomies, Antral wash,
Cataract extraction, Dental extraction, Dental fillings, and other
surgical procedures, even under General Anaesthesia.
It has been
heartening to note that the^e has been no post operative complications
or infections reported so far although each camp has on an average
of 30 to 40 operative Cases.
^he local Youth Clubs are involved in
the management of the organisation and publicity etc., of these camps*
Follow up care is provided by the residential interns.
34 Natural Family Planning Services:-
The family Welfare °ervices .
section of the Department of Ob & Gynae of the Hospital accampany the
Maternal and child haaith service teams and conduct awareness programme in Natural Family Planning among the villagers of the Six rural
subcentres,
average of 4 to 6 couples accept the Natural Family
Planning each wee<.
4. Factory Workers Health Services:- Under the occupational Health
Services provided for small factory workers, the department is involved actively ir the provision of pre-placement9
factory safety education^Occupational
health.
periodic examination/
hazards survey and executive
:
:
11
The ENT, Skin, Dental and Ophthalmology departments participate in.^.
these specialist camps.
9. Food Hygiene Inspection*-
The
•«!«= Hospital Canteen and -other
------- Messes
-----------
#
ia the institution, are subject to regular food hygiene inspections t
■ ’f
carried oat by the Department faeulty.
This is done in collaboration
with the concerned administrative chiefs for"effective and prompt*
1
inpiementation of the recommended control measures.
10• Immunization Coverage Evaluation Surveys:-
In collaboration with
the State Government Directorate of Health Services, teams of staff
from the department conduct specialized immunization coverage evaluation surveys in various districts of the state such as Kolar District,
t
Mysore District, Coorg District etc.
r
e •
11. Preparation of Health Education Materials:-
With a regular artist
as part of the Department staff, several posters, charts, etc. 9 on
Wealth Education has been prepared and used in health exhibitions.
These materials are also borrowed for use by various other inst itdit io ns
The same is true of audio cassettes prepated in local languages to
depict songs and drama about important issues in health of the
Community.
*12) Participatory process:- The main objective of the various health
programmes of St* ZJohn’s aims at a participatory process, wherein the
the villagers themselves participate in financing health care, supply
qf materiajs and manpoyef, etc.
fcfee
Thif is paiticuiarly exemplified by
Mallur Health Cooperative Centre, which now has its own hospital
building and other facilities provided through a cooperative movement
which the college initiated in 1973.
Village Health Committees have
been formed at each of the Rural Health Centres, and all decisions are
participatory in nature.
A largepart of the organization of surgical
and other speciality Rural Camps is also under taken by village youth
groups asd Mahila Mandals
Even the training of the various categories
\
12
RESEARCH PRObRAMHE IN COmUNITY HEALTH
The fact that a large number interns are posted to our rural
health
centres each year, has enabled the formulation^dexecution
Some
pf several research studies, by the staff of the Department.
of the impoFtant^research projects covered over the years are detectioB of goitre in the fluHnar region,' health hazards of sreiculture
Prevalence'
workers, house dust mites and allergy in rural areas,
Polio lameness surveys
surveys of Leprosy, TB and other Major diseases,
K no ule dg e
Leprosy health education methodologies, helminthic surveys9
attitude practice surveys,
school health surveys, environmental
lealtto factors surveys, anaemia and productivity among tea pluckers
IB the plantation etc.
Papers have been published by the staff in
various aatiorypl and internatior/ health journals.
Publications in food hygiene and immunization methodologies
liave been written by the staff in English and the local language
i
of Itannada as well.
Using appropriate technology, practical methods of solar cooking
vegetable storage devices, smokeless chullas, kitchen nutrition
gardens etc., have also been evolved by the staff of the Department.
LOOKING BEYOND:
are dynamic in nature since
All the programmes outlined, so far 9 oxu
they are updated constantly depending on the feedback received oftheir effectiveness and efficiency.
The emphasis is thus on training
and health . ‘education rather than merely the provision of multiple
services. : This ensures that whatever may have been the- programme
self perpetuating and
inputs, the results will bo long lasting,
effective•
Com
,op
TRAINING A
HEALTH WORKER AT VACHAN
Introduction:
In the context of Primary Health Care approach, a VHW is seen as
v a rrr\n
I JL V M 1 kJ IX
EDUCATOR
v’nx r TI? nnnxrTnr ’n
rhuviuDh.
oiLh.vik/iS
for all the activities under its perview viz,
antenatal care (registration, provision of iron supplement)
Post-natal
(same as ANC plus advice
care
on
breast
feeding);
immunisation (motivate follow up)
growt h
monitoring
(weighing and
educating
mothers)
diarrheal diseases control (ORT) and so on.
At VACHAN a different view is taken; particularly in the light of
the lack of availability of curative services. A HW is
a provider of primary level CURATIVE HEALTH care service.
a provider of REFERRAL advice for serious ailments.
an
r? n 11 r’ a m n n
IL V kJ V; rt 1 UR
cl»
a part of his role as a healer.
a MOTIVATOR for health measures hitherto not taken by
community ; ORT/ disinfection of wells.
1
i—
L 11C
SELECTION OF HEALTH WORKER
Objective
To locate a person who is
ACCEPTABLE to all sections of the community.
- having
an
EDUCATIONAL BACKGROUND to
enable
him/her
TO
LEARN the necessary diagnostic skills(Normal in VACHAN
is
fifth to ninth standard educated boy/girl).
- placed
i—
uky
at a DISTANCE which can be
comfortably
traversed
a moderately ill person or a pregnant woman say
one
about
kilometer.
r"oces s:
Nomination
by
4-1---
rue
community
usually
in
a
community
meeting.
f inal
selection (if more than one person
nominated),
VACHAN after 2-3 contacts with the nominees in a
session.
2
by
training
TRAINING OF HEALTH WORKER
/
Level A;
Having
knowledge and skills to tackle health problems
that
are not life threatening
- do not require complex decisions to diagnose
are amenable to simple treatment
do not involve use of antibiotics or medicines that may
have serious side/toxic effects.
Problems include
viral infection like cold influenza, mumps, chicken pox,
uncomplicated measles, viral diarrheas with mild or
moderate dehydration.
other infections like uncomplicated amebic, bacterial
dysentry with mild dehydration amenable to 48 hours of
treatment, giardiasis fungal ingection of skins like ring
worm.
infestations like scabies, lice and worms.
wounds with no sign of spread of infection and of injury
arteries, nerves.
to important structures like bones, arteries,
allergic conditifns
as thama.
rashes,
like
colds,
uncomplicated
symptomatic treatment for short period for headaches and
joint pains, hyperacidity, dry coughs.
'i
3
Training includes:
- Anatomy and Physiology particularly their applied aspects.
- Concepts in Pathology e.g.
. immunity, antibodies and vaccines,
healing.
--
' ■
’■
: -
and
inflammation
- Concepts in Microbiology
. Different types of micro-organisms viz, viruses
bacteria, fungi and unicellular organism like ameba
- Types of bacteria
. Based on staining methods
- Concepts in Pharmacology
. Drugs Action
Side and Toxic effects
.
. Essential Drugs
Rational Drug use
.
.
Misuse of drugs incl. injections, tonics.
- Concepts in Nutrition:
their functions:
Components of our food
.
Carbohydrates, fats, proteins, vitamins, minerals
.
Their sources
. Nutritional def iciencies, symptoms and signs,
prevention
treatment,
- Concepts in Diagnostics
Problem solving Approach to medical/health problems
.
History, Examination and Investigation
.
Clinical Examination: What to look for: Anemia,
nutritional deficiency
. Use of Diagnostic chart & Table : Fever & Diarrhea in
ChcuX * —
adults. C Se.Q.
lei
Child Health:
. Weight Monitroing
. Nurtitional advice - weaning foods
Immunisation
.
. Common diseases/' problems
Ch
avcdJnl
AshVefexT
4
Level B:
knowledge and skills to tackle health problems
Having
- are not immediately life threatening
,
-—
—
• — ••
*
•
t-. • • ~
•
• I
.•
that
• •
- do not require complex decisions for diagnosis
- are amenable to simple treatment/ first aid measures.
may involve use of antibiotics or medicines that have no
toxic effects if used with caution.
Problems Include
Bacterial infections like tonsilitis, middle ear
infection, pneumonias, bacillary dysentery, urinary tract
infections, infections following delivery, vaginal
infections,
- wounds with signs of spread of infection
- bronchitis following filarial infection,
- bleeding after delivery
- referral advice for ailments like sudden severe pain in
abdomen, problems involving the central nervous system or
the circulatory system, problems of children that cannot
be tackled by them,
- Symptomatic relief for vomiting, motion sickness, pain in
abdomen
Training includes j_
- Pharmocology of anti-biotics
- Diagnostics involving clinical training in a hospital set
up.
5
Table —1
CLASSIFICATION OF AILMENTS FOR
Group of ailments
1.
PARAMEDICAL TRAINING PROGRAMME
Diagnostic
Treatment
Sa'ety
Prevalence
Feasibility
Feasibility
Factor
Factor
ntr
ttr r
Minor ailments
ttir
Ailments
Common cold, minor cuts,
headaches, constipation,
fungal infection, scabies
etc.
2.
Major aiffWnta
ttt
ttt
tn
nt
Diarrhoea, dysentery,URTI,
malaria, otitis media,
vaginitis, hyperacidity
hepatitis, etc.
3.
Serious ailments
tt
tt
t
t
Pneumonia, typhoid, fever
Acute abdomen, meningi
tis, Diptheria, tetanus etc.
4
Important chronic condi
tt
tt
tt
tt
tions that need early
leprosy,
Tuberculosis,
filariasis cancer, etc.
detection and health
education.
5.
Acute emergencies that
t
t
need first-aid and referral
t
t
Snake bites. Burns, Severe
dehydration; major acci
dents specially involving
brain,
chest
abdomen
and haemorrhages etc.
Note :
D
The examples under 'ailments' heading a.e not
a compete list but only a few cases for
illustration.
2)
The difference betwen category 3 and category 5 is that in category 3
( serious ailments )
there is little scope for first aid while in the later first aid can often save the patients.
3)
The diagnosis of, say snakebite, is easy but that of its effects is difficult and hence the
overall diagnostic feasibility is poor.
4)
Category 1 can be safety attended [by the paramdicals, while category 2 should be attended
with caution watching for indications for referral. Category 3 should be immediately referred
to medical experts. Category 4 needs , high suspicion index for early detection, supervision
over the treatment and health education and category 5 assisted with first aid before sending
for expert care.
5
FEVER DIAGNOSTIC CHART (for
XZ
o
□
o
O
co
CL
cu
CL
75
O
0)
x:
O
OJ
5
O)
.£
E
O —
° c: <n F
X
I
<D
XZ
s
OJ
D
O
02
S-5
< G- (U O
□ E
Z>
above
six years
TlNFORMATION ABOUT
OTHER COMPLAINTS
OJ
persons
TD
01
0)
FEVER
How Much
Character
~E
x:
$
.3
.9» 3
o
•o
O)
X
<D
of
A : ALWAYS, C: COMMONLY,
R : RARELY, L : LATE
t
OTHER SPECIAL FEATURES
L
C
c
R
C
R
R
Eyes congested, Stuffy nose, Contagious
C
cl
c
C
c
c
R
c
c
R
Malaise, Prostration
A
A
R
R
R
R
C
C
R
Redness on throat / tonsills, Dysphasia
C
R
R
C
Dry cough initially, Followed by productive coug
C
R
Acute onset* Dyspnoea, Prostration
R
C
Chronic condition. Anorexia, Productive cough
R
A
C
—
A |
A
_____ I
I
c
R
R
C
-
R
C
C
c
R
C
R
R
C
R
R
C
R
R
R
C
Check site of infection, Lymphadenitis
C
R
C
R
Prostrations, Relative Bradycardia
R
C
R
Hypochondiriac tenderness, Yellow sclera
R
C
Faer with chills, daily or alternate day
C
R
Neck rigidity, Change in behaviour
C
R
Joint swellnes, Valvular heartdiseas
C
Lymdhadenitis, Send night blood smear
C
Burning / ferqueney / turbidity of urine
R
A
A
R
I
I
R
A
A
C
C
R
C
R
R
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LYMPHADENITIS
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^FEVER WITH CHILLS'
NO
I
------------ 1
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Send To Hospllal
If Docs Noi Respond
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Refer To Hospital /
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ASK/ CHECK
NO
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J
i
V \
Community Health Trainers Dialogue
Society for Community Health
Awareness, ’ $ e sear ch & A c t i on.
3-5th October 1991
Tib . 326, V Main ;
. I Block,- Ko.ramangala,
Banqalore - 560 034.
THE B^AJAJ. REPORT
S.ome_Vi.eJ£ E°knJ-s
BACKGROUND PAPER VI
(Compilat ion)
RESPONSE VII
On the whole I feel the thrust of the report is in the right
direction. The re’port and thb discussions on it should be
publicised widely among government and. non-governmental agencies
and the general public. A few comments are, however, in order.
The situation analysis has been done well, The sections which need
The generation of relevant
stressingg are
2.7
2.9.
and
Ole sections
OKU b 1UHO 2.5,
ZL.yJ,
Z. • I
ailU
4. •
—---- •"
data as {part of health services research is in line with objective
4 of NEPHS. The mechanism envisaged is multi-disciplinary team
wotk through Universities of Health Sciences-(Section 8). The
details of such research and the link between this and on-going
generation of data for planning and evaluation is not clear and
needs to be worked out.
Regarding Objective 1, development of ’man power for all health
provider categories, a crucial element is the starting point of all
education - viz. recruitment,.,, The tone of the report relies on the
progressive model of education as propounded by Dewey — stressing,
the problem solving approach, self-oriented learning, reconstruction
of experience etc. What should be more relevant to our situation,
however, are the more- radical models which explore the relation
between knowledge, culture and power on one hand and issues of
schooling and socialisation on the other. According to these,
education reflects and reproduces the structure and culture of
dominant groups and the educational system distributes knowledge
and skills so as to perpetuate the unequal power relations in
society. The pedagog 1*'b1 process internalises and legitimises the
values which sustain the status quo. In this context when we talk
of a transformative pedagogy, a policy of health sciences should be
in step with legislative and other policy measures of the
government, for social change. Specifically, the NEPHS should
examine how support can be provided to subjects drawn from the
really oppressed sections of society - the dalits, tribals and other
economically poor classes, in terms of additional / supplementary
education before and during medical / other health courses. There
are of course many grey areas, but in my opinion a national policy
has to address the question of the sections of society from which
the ’to be educated’ are drawn. Obviously Prof. Bajaj has not cared
to reflect on the anti-reservation agitations launched by medical
college students in Gujarat and elsewhere.
In Gujarat I have seen that the nursing profession attracts a
disproportionately high number of women from the Vankar community,
a scheduled caste (l don’t have reliable data). Can an educational^
strategy help such experienced people move into positions of ’power
as medical doctors? Wouldn’t such people make better communityoriented -basic doctors? In other words, one aspect of continuing
. .2
'
2.
aspect of this link between, for instance, the nursing profession
and Uankar women, is also that it emphasises the deprivation of
this group in both the caste and gender structures. The tasks
associated with nursing have been traditionally considered impur
; and
therefore
c
and polluting irt'some senses and certairTy secondary:
point
is
x
this
(Si
'fit' for women and scheduled castes.
(Since
this point is not
not
elaborating
this point
not
directly connected with the NEPHS I’m
further).
Another general comment relates to the medium of instruct
.
English is a language of the dominant / privileged classes and it
effectively prevents large sections of people from gaming access
to powerful sectors of health care educational systems.
Ihe
difficulties faced by the few who do gain entry are well known.
Why doesn’t a national policy touch on this question. Translat
of major texts, bi-lingual instruction and examinations etc. are
areas for debate.
All the above comments are general in nature and related to entry
into the health education system, Related minor points include the
desirability of village experience for students prior to their
joining the course (rural students may not need this experience;
urban community experience may be needed for these students); age
and experience criteria of candidates etc.
ry disappointing feature and major weakness of the report is
A very
treatment of linkages between h®®lt^Tcar?
,
the 5superficial
’ ‘ *i sciences (Section 6). The formidable
and education in health
:
■
-j
"suffers
from sub-optimal performance'1. This
health infrastructureeducation
r
(or should It be re-orlehtatlon?) has
a. role to play. Continuing education as defined in the report
emphasises the skill component of a person's make-up. Perhaps a
focus on the goals of health, more democratic planning and
implementation, practical difficulties etc., could be included in
a 're-orientation'. Can alternative trainers, whose experience is
by and large with small-scale parallel systems, help here. what
structures, maybe at the district or state level, can be used or
introduced for this purpose? Can the processes of such training be
used to build up what is called team-work among the different
categories nf
of health-cars
health-care providers? What has to be done to make
the idea acceptable?
One important point (Section 4.1.9) is the upgradation of the skills
of para-medical personnel and of people working at the cutting
edge of health care - community health workers. The NEPHS should
consider the issue of how adequately equipped the CHUs are with
quality medical skills. This it cannot do without recognising a
decentralised model of health care and without tackling the
question of support and official recognition of ths work of the
CHU sector. The areas of support could include financial,
continued education, transport, participation in project design and
implementation at community-level and training of medical students.
ihus
Official recognition might imply some form of licensing.
oolicies for education of CHUs will imply recognition in their own
right and not as add-ons -of the existing health care systems.
. .3
3.
A specific comment with regard to Sections 4.1.1 to 4.1.8. The
speciality of Community / public health should be dispensed with
or altered. These inputs should be stressed heavily at the degree
level. The bio-medical as well as super specializations have to be
developed from a foundation of community medicine. The policy
should allow flexibility to different institutions to include other
subjects like teaching and management skills, social awareness,
management of emergencies in poorly controlled environments etc.
One last point which needs to be stressed, though I cannot comment
with confidence on it, is Section 3.4 - faculty development. The
technology ’of1 education needs to be worked out in greater detail.
Perhaps compulsory placement of teaching staff in government or*
non-governmental health institutions as ’health care deliverers
for specific periods of time along with inputs on teaching
methodologies may help. Our fresh medical graduates may then be
able to handle emergencies in poorly controlled environments more
adequately•
(P.G.Vijaya Sherry Chand, BSC,
Ahmedabad).
RESPONSE VIII
1. The formulation of such a National Policy is an important and
necessary step. Several issues and concepts have been touche
upon, however they need to be grounded to the situation and
system in the country if the Policy is to be used to bring about
change in a meaningful direction.
2. The report ignores important national documents which hatoe dealt’
with the issue of education of health personnel - right from the
Sokhey and Shore Committee till the Shrivastava Committee*
his
is a major omission for a national policy document and tends to
give the impression that there was total adhocism till the 1983
Medical Education Review Committee and National Health Policy.
3. More than 40 years post-Independance it may be worth reviewing
certain important policies of the GOi
G01 e.g.9 concerning medical
education
i) Who benefits from the State subsidy provided to education
of health personnel,
ii) Implementation and impact of reservation policy,
iii) Impact of the Department of Preventive and Social Medicine,
iv) Uhat is the present situation of the R.O.M.E. Scheme
(Reorientation of Medical Education) etc.
4. While the report speaks of the Indian systems of Medicine(ls^)
and Homeopathy as our national heritage in the first and last
paragraphs, there is no mention of the quantum of contribution
in terms of number of health personnel, training institutions,
traininq strategies and areas of strengths and weaknesses. it
we really believe in our "national heritage", then members from
these systems should also be represented in Committees drawing
up National Policies.
5. There are certain inaccuracies in the report e.g.,
i) The system of medicine which was developing in Europe was
. .4
4.
first introduced into India by the Portugese in thel6th
.'The Royal Hospital in Goa was built in 1510
century.
i .e., this system was not introduced in the last century.
ii) The statement that there was primarily a quantum growth in
medical education till 1965, after which there was greater
In fact the quantum
consolidation is not supported by data.
growth continues. That official statements have not been
including private and unrecognised colleges, cannot negate
the actual presence of these colleges training hundreds of
students and quite often using hospitals and health services
of the Government itself as their clinical training Cacijity
The figure of 106 medical colleges has been used for several
years and only more recently is it accepted that we do not
know exactly, but there are more than 140 medical colleges.
The rate of growth in terms of number of doctors graduating
per year has also been maintained, even post 1965.
6. The analysis is also rather weak about many factors 9 some of
which are’i) The root causes of ill health in the country and the need to
create an awareness of these factors during the ’formation’
. 'or training phase of health professionals.
ii) Recognising the role of folk health practitioners and local
health practices, the need to understand them and preserve
them if they are useful, and to educate health professionals
in this regard.
iii) The questionable role played by the ’recognised’medical /
'health professionals e.g. that inspite massive State subsidy
for the training of these groups and the build up of
’’formidable health infrastructure and manpower" we are still
very far from the goal of providing effective health /medical
services in the rural areas and to underprivileged groups.
iv) The regional / state level disparities between health
professional - population ratios.
7. There is need for a much deeper analysis of the content and
quality of education. This appears to be the weakest point in
the report and the system itself.
8. Other areas like impact of selection methods on future career
choices, types of text books available etc., could also be
touched upon.
9 . Important broader issues that need to be addressed are:
corruption at entry, exit and all levels of education , rapidly
declining values and medical ethics, the growing
commercialisation
of medicine as a whole and of the educational
.
►hi •
process, and the privatisation of medical education.
(Thelma Narayan, , CHC , Bangalore).
■
■
»i .
. TENTATIVE ;■ to be
modified with participant
COMMUNITY HEALTH TRAINERS, DIALOGUE
3rd to Sth October, 1991
Vidya Bhavan,
involvement on 3rd
Bangalore.
October^ Session I.
/l-S'O HTd
2ND OCTOBER
(Wednesday)
:-
Please Send Pre
Registration
Form in Advance
PARTICIPANTS ARRIVE AND CHECK
INTO
VIDYA BHAVAN
CONTACT CHC OFFICE IN VIDYA
BHAVAN FOR REGISTRATION/FILES
08.00 p.m.
3RD OCTOBER
(Thursday)
s-
Dinner
Breakfast
Welcome and Introduction
to Meeting
ioD
08.30 a.m. - 09.00 a.m.
09.00 a.m. - 09.30 a.m.
09.30 a.m.
Please handover i
materials for
display or dis
tribution to CHC
Office on arrival
Session I
bn 6
11.00 a.m.
- Getting to know each other '
- Programme Outline
- Participatory Planning
Mid Morning Tea
11.00 a.m. - 11.30 a.m.
Session I (contd.)
11.30 a.m. - 12.30 p.m..
Session II
12.30 p.m. - 01.30 p.m.
Educational Policy for Health
Sciences
i) An Outline
ii) Discussants : Key
Strengths and
Weaknesses
Two parti
cipants will
be requested
to set the
tone for the
discussion
01.30 p.m. - 02.00 p.m. - Lunch
02.00 p.m. - 04.15 p.m. - Session III
Group Discussion on Bajaj Report
(I to IV)
IOs
Tea
04.15 p.m. - 04.30 p.m.
Session IV - Plenary
04.30 p.m. - 06.00 p.m.
Education Policy for Health Sciences
- A SWOT Analysis
(Pulling jnfrom the Group Discussions)
06.30 p.m. - 08.00 p.m.
08.00 p.m.
-
Fellowship
Dinner
. .2
4TH ""OCTOBER
(Friday) ■.
s — -•-~08v3 0 .a < m. — 09.00 a.m.
09.00 a.m. — 11.00 a i’FR'y
.
•
■
04.15 £).m. - 04.30 p.m.
J
r
(Saturday)
.
2-
••
’
Session VI (Contd.) Plenary
Croup Reports & Discussion
C
Fellowship / Cultural
0t>e30 p.m. - 08.00 p.m.
Programme
pinner
08.00 p.m. -
04.30 p.m. - 06.00 p.m.
' <
STH OCTOBER
■
Group IV'- j (to be decided during introductory x
Group V tI
session on 3rd October)
Mid Morning Tea
11,00 -a.m. - 11.30 a.m.
Session VI - Plenary
11.30 a.m. - 01 ..30 p.m.
A s Group Reports & Hiscussion
02.00 p.m. - Lupch
01t 30 p.m.
Rest / Fellowship....
02.00 p.m. **- 03.00 p.m.
- passion VI (Contd.) Plenary
03.00 p.m. - 04.13 p.m.
ft ; Group Reports & Discussion
i
Fri
■
-Health ferainer Network.
••
*
t
'**’ ~ Se SS 2?Ott,*-V—
GROUP REFLECTIONS
Group I "Fr-Laying- the-Foundation - Exercise
Group II s Critique of the ^Anthology or Ideas1
Group Ills Building together
the Community
!
--v<
Breakfast
-
-
f .. ‘
-
■■ i
08.3Q a.m. - 09.00 a.m.
Breakfast
09.,00 a.m. - 11.00 a.m.
Session VII
Pulling in Learning Experiences and follow up
suggestions.
11.00 a.m. - 11.30 a.m. - l^ld Morning Tea
11.30 a.m. - 01.30 p.m. - Session VIII
Finalisation of Collective Response
(concluding) ta Educational Policy.
01.30 p.m. - Lunch
* * Earpigigagts=g§Y=le§Ye=af pep^ygc^i
ConyeporSj Rapporteurs, Dialogue Report Editors, Group Leaders
and Groups will be decided on 3rd October in Session I
j] Please note that the CH Forum meeting ||
!! mentioned in the last letter has been '|
»J|-postponed due to unavoidable reasons. I||
— SS3P<&SS=SSSS53=3S3:==S=5SS:S: ———
t..
.
■■ ■
—
———
—— — — — — —
•I
z
Corn k
Community Health Trainers Dialogue
Background Paper
II
Coulee tiye^Concerns,
W I
KEY COMPONENTS WHICH SHOULD FORM PART OF AN EDUCAT10NAL POLICY FOR
HEALTH SCIENCES IN INDIA
n
An opinion poll on the Key Components that the ’dialogue*
'dialogue 1
participants feel should form part of an Educational Policy for
Health Sciences in India was carried out as a sub section of the
participant form.
These are collated under six sub sections ;
1-B
Focus
2.
Broad components
3.
5.
Content / skills
Methodology
Process
6.
Issues
4o
The collation will give participants a feel for the collective
concerns of the group participating in the dialogue.
The list is exhaustive, covering a wide range of ideas and issues
arising out of the diverse experience and perspectives of the
group but the
the overall thrust towards a more community oriented.
socially relevant, responsive, pro-people oriented, educational
policy is evident
The listing is in a contextual order using original wordings as
far as possible. Since who said it is not as important as what
is said names have not been indicatedthough participants will
be able to identify their contributions.
Note ? These responses were received before the new Educational
Policy was circulated to all participants. They not only
emphasise many points covered in the Bajaj report but raise
many other crucial issues which need to be discussed further
at the workshop.
Cominunity Health Trainers Dialogue
Background Paper III
Collective
Concerns
KEY CONCERNS / ISSUES WHICH ARE IMPORTANT TO REVIEW IN ORDER TO
ENHANCE THE CONTRIBUTION OF COMMUNITY HEALTH TRAINERS IN INDIA.
An opinion poll, on the key concerns that the dialogue participants
feel would help to,enhance the contribution of Community Health
Trainers in India, was carried out as a subsection of the
participant form.
These are collated under eight subsections
- The Background
- Contextualising Community Health
- Exploring related issues
- Medical Education Policy
- Collating / Analysing Community Health Training experience
- Building Collectivity among trainers
- Issues arising out of community Health Training experience
- Additional issues.
This collation will give participants a feel for the collective
concerns of the group participating in the dialogue.
The list is exhaustive, covering a wide range of ideas and issues
arising out of the diverse experience and perspectives of the
group but the overall thrust towards a more community oriented,
socially relevant, responsive, pro-people oriented educational
policy is evident.
The list is in a contextual order using original wordings as far
Since who said it is not as important as what is
said, names have not been indicated though participants will be
able to identify their contributions.
as possible.
KEY CONCERNS / ISSUES WHICH ARE IMPORTANT
TO REVIEW IN ORDER TO
ENHANCE THE CONTRIBUTION OF COMMUNITY HEALTH YRAINERS
IN INDIA.
THE BACKGROUND
01. Increasing poverty of the masses
02. Declining health situation of women and children
03. Growing communalism and religious fundamentalism
04. Ever-growing commercialization
of health care system
05. The overall need for social justice
06. Disappearing ancient health patterns (practices) in
rural
areas (e.g. ragi to polished rice)
°n Allopathic medicines especially injections/
07* DtabletsCy on
08. Neglect of rural areas
Health Departments
areas by
Departments /
/
by Government
Government Health
Doctors / Hospitals
09. Drugs coming within the scope of 'Industries'
The overall thrust in health care
10. To critically analyse the present development and health
care system to see if it is helpful to the poorest or
not; if not look for the alternative
11. To explore ways of discovering culturally relevant health
information from the people
12 . To make them (people) look at health problems
in a more
wholistic way
13. To discover ways of using alternatives to empower people
especially the women and put health back into their hands
CONTEXTUALISING / CLARIFYING COMMUNITY HEALTH
14. Understanding of social realities in India and a deeper
analysis of the situation
15. Exploring Community health components - curative, preventive
and promotive in the local context
16. Community level-workers / volunteers / their potential as
primary health care provider
17. Community health in the context of people's organisations
and changing health practices
18. Locating community health in the context of wider societal
factors that operate in India.
. .2
2.
♦
EXPLORING RELATED ISSUES
19. Changing life styles for positive health
20. What is scientific and relevant health care?
21. Integration of community health, aspects of clinical medicine
22. Economics of Health
23. Integration of Indian Systems of Medicine with Modern medicine
24. Understanding of the economics of health / mechanics for
appropriation of public finance and communication / organisation
of the society
25 Lack of team work among different categories of health workers
and ways of overcoming it
26. Avoidance of identity crisis between SPM / PSM / public health /
community medicine / community health etc.
27. Using greater levels of behavioural sciences / psychology /
communication to bring about long lasting changes in health
practice among people
28. Identifying levels of demystification of medicine
29.. Issue of non medical versus medical administration
30. Role of pharmaceutical MNCs in drawing up syllabus for
medicine
MEDICAL EDUCATION POLICY
31.. Understanding the existing situation
- the class from where students come
- the location of educational facilities
- the appropriateness of curriculum and textbooks
- the elitist and commercial nature of the products
of medical schools
32. Reviewing the existing Medical / Health Education Policy
from a social /■economic / political context
33. Health Manpower Development - Policy
exploring existing policy and the lacunae
34. Understanding Medical brain drain
35. Evaluation System should be revi-ewed .....
36. Internship should be made more effective
37. Health Management should be stressed to a large extent
38. Training in Social Sciences to be strengthened
. .3
3,
COLLATING / ANALYSING COMMUNITY HEALTH TRAINING EXPERIENCE
39. Review of training and finding out the.impact of the training
40. Quality of training
41. Methodology of training in community health
42. Use of innovative methods
43. Identification of appropriate skills
44. follow up of health workers 10/15/20 years after their
training - what role are they playing / have they played
in health work / what areas need strengthening /what
methodologies are suitable for continuing education
45. New approaches to learning .
46. Problem solving methods and approaches
47. Work experience in projects
48. Collection of experiences to modify text books / teaching
materials in mainstream medical education
BUILDING COLLECTIVITY AMONG COI-WJNITY HEALTH TRAINERS
49. Networking to share experiences and enhancing collectivity
50. Peer group evaluation to increase accountability and improve
standards
51. Sharing experiences/ avoidingOduplication and wastage of
resources
52. Sharing resources
53. Dialogue and sharing of experience between community health
trainers
54. Develop a directory of what is available/ where and for whom
55. Need to consider training at different levels
56. Regular exchange of ideas among community health trainers
of different parts of the country
ISSUES ARISING OF COMMUNITY HEALTH TRAINERS EXPERIENCE
57. Community Health trainers to be clear on what being a
catalyst means
58. Reinforcement of identity - community health'trainees as
’social educators’ first of.7.all (attitudes/ motivation/
involvement)
59. To know and accept that health care is only one factor
responsible for Health?
60. To have real experience at field levels by living with a
low income family in the village and based on this experience
to adapt their learning to give effective health education
. .4
4.
V-
61. Population based education should be given higher priority
62. Need to consider training of trainers
63. Is there a need / role for registration / standardization?
64. Standardization of training needs with scope for flexibility
65. Communication / interactive abilities of trainers to be enhanced
66. Trainers should have field contact on an ongoing basis
67. Trainers should have awareness about politics in health
68. The x\rt of communication should be....stressed for both trainers /
trainees
ADDITIONAL ISSUES
69. The possibility of incorporating certain aspects of an
alternative into the mainstream paramedical training
70. Accreditation to enhance security / recognition of trainees
from a long term point of view
71. Provision of legal status to the trained
72 . Provision for continuing education and capability to work
upward from any level of trainee knowledge
73. Transferring NGO experience to Government
74. Sharing of experiences / methodology with government /
professional groups in a spirit of dialogue
75. Interaction of community health trainers and ’the system’
be it professional or government
76. Mechanics of intervention at policy level (political action)
77. Community health trainer’s deep commitment to participatory
approach should influence policy of health care and medical
education.
This collation is derived from the response of the following 24
participants (received as of 31st July 1991).
Dara Amarz Rajaratnam Abel, Desmond D'Abreo, Margaret D’Abreo,
Pramesh Bhatnagar, Vijay Sherry Chand, C.M. Francis, Ulhas Jajoo,
Hari John, Prem Chandran John, Abraham Joseph, Daleep Mukarji,
Jose Melettukochyil, Sujatha de Magry, Dhruv Mankad, Ravi Narayan,
Thelma Narayan, Shirdi Prasad Tekur, Sebastian Poomattom, Amla
Rama Rao, F. Stephen, Satish Samuel, Valli Seshan and John
Vattamattom.
■k
k
k
k
k
k
■k
k
k
-k
SOCIETY FOR COnNUNITY HEALTH AUARENE3S , RESEARCH A ND ,ACTI ON
THE BAJAJ REPORT
BACKGROUND PAPER
5.0ELe-.^i.eH E°i.ni.s
(Compilation)
V
The responses to the Bajaj Report have been
very varied and interesting among the six
participants who have responded by 31st August.
These comments are listed out for other
participants to consider and reflect on.
As
in the earlier compilations greater
’integration / dialogue’ will be an outcome of
the meeting.
RESPONSE I
By going through the National educational policy in Health Sciences
I feel that it is again the policy statement without giving details
of its implementation. From the beginning comprehensive approach
towards medical education research and Health have been recommended.
The National Education Policy further emphasize that - For
effective delivery of health care services, appropriate orienuction
towards community health of all categories of medical and health
personnel and their capacity to function as a team must be a part of
their education.
The main emphasis should be on the outcome of the
educational programmes and a person needs to be prepared for the
tasks he / She has to perform at the end of the educational process.
On page 3 in second para:- ’’Teaching, learning activities must
” has been talked
receive equal recognition and importance
about, but nowhere does it suggests what kind of learning activities
will improve the performance of a doctor. Para 2.9 where it says
that ’’primary health centre require teaching outside the four walls
of hospital----- .
It was a
big mandate and the Department of
Preventive & Social Medicine came in existence because of that, but
even after 30 years of their existence in various Medical Colleges
they havo not created any impressions on the minds of the students
nor have they strengt'Henedthemselves with the physical facilities
and appropriate learning material^. Why? needs to be looked into.
Unless different methods of learning are adapted, the improvement in
the system cannot be expected, There is no learning that is
complete at the end of a period. Therefore various methods and
. .2
2.
modalities for continuing education needs to be worked out. To be
able to keep abreast of the advance in medical technologies the
large number of continuing education programmes for different health
professionals need to be developed* Only regional training centres
can not do that as continuing education should be according to the
needs.
Suggestions
If in the policy statement we keep repeating objectives and goals
but unless our strategies are very well defined the goals can not
be achieved.
All 8 or 9 educational strategies recommended by the
policy can be achieved if the trainers themselves are given similar
type of orientation.
Little is done to develop the faculty, and
there is no training for teachers before they are selected alone.
As Health care programmes of this country are at three levels we need
3 different kinds of medical educational policy to be able to man
these services.
For primary health care approach - Public Health Nurses and a Doctor
with more humanities background and leadership qualities can be
utilised whereas for secondary and tertiary care more emphasis an
problem solving, learning, teaching methods may be required.
For super specialists we need people with more post-graduation
education.
The more practical training ic given to the doctors,
nurses and para medical the better it is going to be for their
performance. The number of students admitted in Medical Colleges
each year being so large it is not possible for them to have any
practical experience under supervision. Therefore when they go out
they are not confident enough to use their skills and depend mainly
on theoretical knowledge with the result the services suffer.
Changes in the curriculum content have not been recommended anywhere.
The poor methods of assessment and evaluation policy is well
r ecognised but the alternatives have not been suggested.
To my mind the policy requires little more thinking and the
strategies for its implementation must be planned in a phased manner
and each step must be clearly defined for the benefit of trainers.
(Amla Rama Rao, VHAI, New Delhi).
..3
RESPONSE.
II
* This is a very useful process of attempting to solve the problems at
present.
If well done this could prove extremely useful in developing
health sciences.
Specific comments are as in the following area.
2.7. I agree with the observation that there is a general lack of
education technology in health sciences.
A basic ability to
handle current educational technology is essential for
effective development of health sciences.
33.3. For over a decade there has been a desire to reorient medical
education. However, in actual implementation the process is
very slow. Without getting bogged down to any one method,
skills in as many methods as possible should be provided so
that there are competent faculty for providing medical education.
3.4. Technology of education and technology in education , has been
adequately mentioned above. Again I am more interested in the
technology of education and I believe that Doctors are
basically ignorant of this. Suitable remedial and corrective
measures had to be applied in this area especially in
developing suitable curriculum.
4.1.1 This issue of basic doctors has been discussed for a long time.
I am afraid that this process has not being adequately
carriedout and this need to be hastened.
4.1.5 Basic nurse itself is an area where we have constant conflict
&
with the nursing profession. The nursing professional feel
4.1.6
more skill and higher qualification are necessary in
carryingout the work. Those of us in the field believe that
this may be true, however, in practical term it does not take
place, as the higher qualified personnel leave the institution
away places for higher emoluments, whereas the
auxiliary level personnel stay on for a long period of time
providing and catering to greater services. This issue of ideal
quickly to far
nurse at each level needs to be solved at an early date.
4.2. In continuing education provision must be created and
• facilitated for medical personnel working in rural areas to
register for Ph.D under acceptable guides so that they could
receive Doctorate while working in rural areas. This will
greatly facilitate in decreasing the urge to move to big
centres.
..4
4. <
5.1. Education Commission in Health Sciences is a good idea.
&
5.3
I trust
that this body would be able to promote inter council
interaction which is very vital.
5.5. Having a National Apex Body would also be a very useful
suggestion.
7.
Practitioners of Indian systems of medicine and Homeopathy need
to be standardised especially with their qualification and
registration.
The registration at present is very loose and
therefore the allopathic doctors do not give necessary respect
for these practitioners.'
8.
Medical research is an area of crying need and I trust with this
suitable mechanisms would be developed for promoting research
in various aspects of applied primary, secondary and tertiary
levels of health care.
(Rajaratnam Abel 9
RESPONSE
R4JHSA, Tamilnadu).
III
Background
It would have been good to give the projected
manpower requirements for health functionaries
at various levels (including different systems
and alternatives). No educational policy can
avoid the type, responsibilities numbers, and
time frame.
Preamble
: Modern medicine was introduced much earlier
than ’’last century”.
It was first introduced
in Goa and then, Pondicherry.
Rapid expansion
: How many institutions (colleges and schools)
for the training of students in various systems
were there at:
1. beginning of the century
2. time of independence^
What was the output?
3. What was the stock, additions, attritions
(various causes including migration,
looking after family, etc.,)?
'’Delivered” &
11 Pro v i d e r s ”
: This words seem to be inappropriate when we
talk about health and especially community
health.
. .5
5<
Attitude
: Mention is often made of the development of
"skill and competence". Does that include
"attitude"?
Situational analysis • 17 medical institutions?
Postgraduate medical : Self-reliant or surplus?
education
Primary health care
and training
"A major lacuna has been the inadeguate
physical facilities", Do ue want another
medical college there? "Experimental learning"
or experential learning?
Faculty development
: Can promotions be linked to further training
■•and assessment?
-Health manpower
development
: "Over the successive years, particularly for
the past 1.5 decade there has been a
phenomenal increase in the number of the
health institutions that have been established
in the country".
Experiments
Any statistical support?
: Unless the institutions are allowed t.c
experiment with new ideas (same will succeed,
some, will fail), there is no possibility of
improvement.
Selected institutions may be
given autonomy and freedom to experiment.
Review may be done at the end of every 10
years.
More freguent review will not be able
to show results.
Specialities and
Superspecialities
: "With the dominant influence of western
med ic ine, there has been a fragmentation of
basic art of healing into specialities and
superspecialities". In an earlier section
(4.1.3) it is stated that "The order of the
day is production of a well groomed specialist.
The order of tomorrow will soon lead to an
era of super specialists". It is not clear
as to what is wanted.
..6
Eligibility for admission ? Nothing is mentioned about eligibility. t
Are the presently agreed criteria
sufficient to ensure ’’care,9 compassion
and concern”?
(C .I7!. Francis, SMH, Bangalore).
RESPONSE IV
I find Bajaj’s reporttalkingof high ideals without indicating how
to go about.
In any opinion, direction of right perspective and
strategy to implement the ideals have to be spelt out simultaneously.
The high set goals should not look like hanging in vaccum. beyond the
comprehension.
The Bajaj report is tight-lipped about the minimurn structural changes
which may be obligatory to achieve the goals.
It discusses inculca
ting attitudinal change and social commitment without suggesting how
can it be brought about.
The report does not talk about minimum resources required and their
distribution as per priority need. It is silent about privatisation
in health care and medical education and how to restrain this cult.
It has imagined vertical planning and does not mention need of
empowering people for a pro-people medical education and heaiti.
delivery system. It does not spell out how can alternative medical
education evolve during implementation of pro-people health care
delivery system.
I suggest the following for consideration in the Community health
trainer’s dialogue - - * In the present structure, medical science teaching institutes and
public health institutions (hospitals and health delivery structure)
are run parallel and independent of each other.
The two institutions need to merge together with authority and
responsibility be shouldered by medical science teaching
institutions i.e.9 medical colleges, nursing schools, para medical
schools etc.
Each teacher of medical science teaching institutes
be made responsible to provide primary health care services to the
defined population.
*
. Every graduate and post-graduate from medical science teaching
institutions should work for say 5 years in state health care
services before awarding degree or licence to practice.
. .7
F
• a
■
i
*
The over-all control of such institutions must be decentralised to
the extent possible.
I suggest it to be shouldered by a governing
public body comprising a nominated member from each village council
(Gram-Sabha) or Municipal Ward!
The financial resources of educational institutes and public
hospitals serving a defined area be channelised through governing
public body.
The planning be decentralised and be shouldered by intellectuals
nominated by governing public body.
The evaluation of work performance of village based staff should
rest with Gram-Sabha and that of central institutional staff
(college, schools, hospitals) with the governing public body by
co-opting experts.
(Ulhas Oaju 9 HGIflS, Sevagram)
RESPONSE V
The impression one gathers is that it is all due to lack of emphasis
on newer educational technology - pedogogical jargon most of it that has stood in the way of preparing our medical professionals
adequately in this country. There is hardly any pointed reference
to the lack of social awareness * orientation and commitment on the
part of the teaching faculty and policy planners which I think is the
most glaring lacuna in this document. There is of course no serious
effort to look at the rural realities and the gross inadequacies and
imbalances within the health system.
There ought to be atleast some
guidelines and directions as to how this could be corrected.
Not
certainly by making our health system and the structure more
complicated through the dumping in of more specialists and super
specialists in the scenario and putting all of these under the
protective, over-arching umbrella of a new commission.
(George Joseph, Council for Healing Ministry,
Madras).
RESPONSE VI
Major drawback of the policy is that it sees medical profession as
a static career eternally fixed at a particular level and type of
performance suitable to the community needs.
However in reality the
. .8
>
8.
professional aspires for career mobility, as long as he has freedom
of choice.
Hence any system of education planned which does not
consider career planning of the individual pupil will automatically
fail because of the inherent conflict of interests as has been in
medical education in India.
Some other areas policy statements are vague?
i) India may have a rich heritage of medical sciences but
unfortunate none of these systems were researched or developed
systematically till nou.
ii) The lack of concern for other categories of health workers and
over emphasis on medical manpower has been attributed to
1 medical bias1 in the planning process. Is it so?
because medical colleges made good business sense?
Or was it
iii) Inadequate efforts to facilitate acquisition of skills by
teachers that would facilitate self directed learning is also
because most of Indian education uses rote learning methods than
skill learning and it is difficult to change over.
iv) The definition of the basic doctor in 4.1.1 is quite idealistic
but unrealistic.
(fl. J.Thomas, Bangalore) •
* * * * *
* * * *
* * *
* *
*
1
C-OIY} H 8. 'B
Background- Paper - IV
Community Health T rain e r s Di a 1 o gu e
October 1991
OVERCOMING
NEBULOUS
MEDICAL
THINKING
EDUCATION
Debabar
AND
IN
ACTION
ON
INDIA
Banerji*
June 24z 1991
*
Professor, Centre of Social Medicine cr Community Health,
School of Social Sciences, Jawaharlal Nehru University,
New Delhi - 110 067.
Overcoming Nebulous Thinking And Action On Medical Education
In India
...
Foundation of Practice of Medicine
Admittedly, human beings anywhere in the world have almost the
same anatomical configurations, physiological activities and
pharmacological responses.
Disease causative agents cause similar
pathological changes in them and they have responses to therapeutic
interventions.
However, it is important to note that these
elements of medical sciences are used under different conditions
in different communities. In any case, they form only a small
component of the practice of Western medicine. They are merely
the bricks of edifices that are built under different conditions.
In terms of other components of practice of Western medicine, there
are many fundamental differences between Western industrialized
countries (i.e. the North) and the Third World (i.e. the South).
The North and the South are indeed poles apart in the practice of
Performance of a delicate heart operation by a
pediatric surgeon in a sophisticated hospital in an affluent
country and treatment of a severe case of diarrhoea in a child by
Western medicine.
oral rehydration by the mother in a remote hamlet in the Himalaya's
underline extreme variations in the practice of Western medicine.
The difference in these two models of practice of Western medicine
is in the terms ofs (a) relevance of different elements of medical
sciences; (b) formation of technologies that embody those elements
of medical sciences; and,
(c) organisation and management of the
health services for the "delivery” of the chosen technology,
interplay of the complex factors associated with the prevailing
ecological setting, epidemiological situations and cultural,
social, political and economic conditions have brought about these
major differences in the two models.
Health service development in a country like India should,
therefore, be studied in terms of the cultural response to the
complex process, referred to above. This response generates?
(a) cultural perception of health hazards and their cultural
..2
2.
meaning;
(b) health behaviour; and (c) various forms of health
technologies, practitioners and institutions, through cultural
innovation, cultural diffusion and/or through purposive
intervention from outside agencies®
Thus, this complex process
forms the foundation or the base on which the health service
system of a country is built®
The complex conditions forming the
base determine the shape of the health service system or the
superstructure and its subsequent growth and development. The
base thus places a constraint on the architecture of the edifice
that can b£ built on it®
The task before socially sensitive community health physicians in
India is to become architects who have the competence to understand
the basal (i.e., concerning the base or the ’infrastructure*)
conditions, both at a given time and in a time dimension, and use
such understanding to build a superstructure which can maximise
the alleviation of suffering due to health hazards, again both at
a given time and in a time dimension,.
It may be noted that
production of architects is itself a function of the dynamic
interactions within the base.
When there is a strong democratic
movement within a socio-political system, it is conducive to the
formation of more competent socially sensitive community health
physicians and in larger numbers,.
Sometimes, as a result of the -J-.rr.~gle of the masses, the basal
conditions may be favourable to building a stronger edifice for a
people-oriented health service system; the reverse may be the case
on other occasions-®
It may be emphasised that favourable basal
conditions do not automatically lead to the formation of a
stronger superstructure® A society would need a balanced team of
architects, engineers, masons and other workers to take full
advantage of the favourable basal conditions® The onus for
attaining this balance is on the political leaders®
Efforts Towards Social 0ri e nta tion
One of the significant aspects of• development of medical education
in India is that even before attainment of independence, both the
colonial rulers as well as the leaders of the National Movement
were conscious of the need for adopting a different approach in
the context of the entirely different conditions prevailing in
. .3
3.
The concern of the leaders of the National Movement were
expressed in the report of the National Health Sub-committee of
India.
the National Planning Committee; (1948) of the India National
Congress (Sokhey Committee). The Bhore Committee (GOI 1946),
which was constituted subsequently, was much more forthright on
this subject. It
It had
very carefully discussed the central questi>n
had very
of abolition of the licenciate
programme, One of the major
licenciate programme.
arguements of the majority of ^he members for abolition of that
programme was that they visualised fundamental changes in medical
education to create what they had termed as a .“Social Physician".
18) that the
The Bhore Committee had observed (GOI 1946 s
physician of to-morrow must bee
a scientist and social worker, ready to cooperate
in teamwork, in close touch with the people he
disinterestedly serves, a friend and leader he
directs all his efforts towards the prevention of
disease and becomes a therapist where prevention
has broken down, the social physician protecting
the people and the guiding them to a healthier
and happier life.....
A health organisation enriched by the spirit of
such a medical profession will naturally work
towards the promotion of the closest cooperation
of the people. It will recognise that ah inforined
public opinion is the only foundation on which the
superstructure of national health can safely be
built.
The inter-linkage of the National Movement and thinking on
a very significant
re- orientation of medical education is
phenomenon. Indeed, this has given quite a distinctive
perspective to the approach to' medical education in India.
to
As early as in the mid-fifties, India had taken the bold step
bring about fundamental changes in the approach to medical
education, with the upgraded departments of preventive and social
Subsequently, a
medicine, expected to play the pivotal role,
number of national
number of commissions have sat and a
conferences have been held tc stimulate this process.
. .4
4.
Taking note of past experience, the Group of Medical Education and
Support Manpower (Shrivastav Committee)
(GOT 1975), which examined
medical education in the context of the reorganised health
services, submitted in April 1975 a programme for immediate action.
Against a background of the need (a) to relate the problem of
health to poverty;
(b) to provide training in health services to
community representatives; (c) to strengthen primary health
centres; and (d) to develop a referral service complex, the Group
made many far-reaching recommendations concerning the basic content,
structure and process of medical education.
Essentially, the group
was for the creation, by an Act of Parliament, of a Medical and
Health Education Commission (patterned on the University Grants
Commission) charged with the responsibility of determining and
implementing a radical programme of reform in medical and health
education, and with functioning as an apex coordinating agency m
close and effective collaboration with the statutory national
councils of Tiea.ltri professions®
The Shrivastav Committee emphasised the need for .in-depth
discussions and taking of concrete steps for "immediate", vigorous
and sustained implementation" in tackling important issues. These
included; determining of objective of undergraduate medical
education? giving it a positive orientation? reorganising pre
medical education, revising the undergraduate curriculum, including
training of teachers; production of teaching and learning
materials," adopting suitable teaching and evaluation methods and
creating necessary physical facilities; .reccing the duration of
the course While ensuring improved standards; reorganising the
internship programme, postgraduate teaching and research and
continuing education? and, research and evaluation of health
manpower needs•
The report of the Group was favourably received by the Government
of India which called yet another nationwide conference of heads
of medical colleges to work out details for .implementing atleast
some of the recommendations. The ICSSR-ICMR report, Health for
Alls An Alternative Strategy, further reinforced the Group's
recommendations (-ICSSR-ICMR> 1981).
The working Group of the
Planning Commission set up to work out a detailed.strategy for
attaining Health For All by A.D. 2000, reiterated the need for
..5
5.
radical transformation (GOI 1981a).
These efforts are reflected in the Sixth Five Year Plan (GOI 1981b)
which states that the ’’emphasis would be on bringing about
qualitative improvement in medical education and training” which
should include, at the undergraduate level, six months of
compulsory internship and modifications in curriculum,training of
medical undergraduates in certain fields relevant to the problems
of rural health care, community orientation, etc., and encouragingprivate doctors to settle in rural areas through various
incentives".
Flowing from the ideas in the Sixth Plan, the
Government of India (1983) had asserted that post-graduate
education would be rationalised to effect a balance between the
national requirements of specialisations and opportunities for
medical graduates for advanced study.
Continuing education and
inservice training would be promoted.
Medical research would be
directed towards several problem areas like bio-medical and public
health problems, particularly communicable diseases, the economic
aspects of health administration and management, etc.
Among the
task-oriented research programmes for achieving the above
objectives, would be “close and continuous studies in the area of
information support, manpower development, appropriate technology,
management and community involvement to ensure the reach of
benefits of primary health care programmes to the rural
population" (GOI 1983 2 53).
The report of the consultative group of the National Education
Policy in Health Sciences (1989) is the latest document in the
series.
Even though it had the benefit of the hindsight of the
earlier reports, it contrasts very sharply even in the process of
analysis of issues, in drawing inferences and in making
recommendations. It marks a no'j low in the quality of study of
medical education in India.
Health Services, Health Manpower Development ancl Medical Education
One of the most significant requirements for strengthening medical
education in any country is to consider it as a part of the overall
approach to policies and programmes for Health Manpower Development
(WHO 1985). It is not possible to consider undergraduate
medical education in isolation. It has to be seen in the
(HMD)
background of post-graduate medical education, including education
..6
6a
i
. and trainina of physicians and other personnel for community health
work, in terms of nursing education, education for public health
engineers, social scientists, health educators, communication
specialists, and so forth. In turn, HMD can not be visualised
understanding of the overall health service
<
without having a clear
system. Again, a health service system has to be developed on the
basis of data derived from carefully conducted health systems
research.
Therefore, research for HMD can only be conducted in
the context of Health Service Research for Manpower Development
(HSMD)
(Fulop and Roemer 1982).
If one
It is not always possible to work under ideal conditions®
has to consider medical education without having enoagh information
concerning health manpower development and/or the health service
system, it is essential to have atleast a broad understanding of
the structure of the health service system and the approaches to
develop other components of the required health manpower.
Even with a very broad understanding of the conditions, it becomes
quite clear that defining the content of medical education is a
crucial issue in medical education in Indiaa If the contents are
not defined adequately, all the other activities in the field of
medical education lose a great deal of their relevance. This is
because in a country like India it is totally unacceptable to
interpolate the contents that have been developed in the context
of the affluent Western countries, The onus for bringing about
social orientation of the practice of clinical medicine and public
health in India rests squarely on scholars of this country.
It is
in this area that medical education in India had suffered most.
Even when very well researched ideas have been developed to give a
different content to medical education -in India, that has not been
followed by the authorities concerned.
This active resistance of
the authorities to bring about a social orientation of the content
of medical education in India is rooted in the power relations
emanating from the social structure and is by far the most
critical problem facing this field. The Shrivastava Committee
had raised the question of content or curriculum. However, ru has
not realised adequately how critical this issues is in itself and
in giving shape to the other elements of medical education, which
are discussed below.
The consequence of the active reluctance to change the content is
. .7
7.
i
that the teachers by an large have alienated themselves from the
actual requirements for the making of Social Physicians visualised
by the Shore Committee.
Over and above, there are very serious
problems of having infrastructural facilities for providing
medical education.
An extre.ne example of almost a mockery of
medical education is to be found in the establishment of the so
called capitation fee medical colleges in the country.
That
despite their very poor infrastructure, politicians have not taken
steps to curb the mushrooming of this type of medical colleges is
a reflection of the socio-cultural and political conditions
prevailing in the country.
Weaknesses in the infrastructure is
reflected in providing the so called rural exposure to the
students.
Unfortunately, by rural exposure it is usually meant to
take students to rural areas where teachers of the medical colleges
teach them about rural health. What has been the basis of the
teacher's teaching about rural- health? What has been the
competence of the teachers to do that?
What efforts have been
made to develop the content of rural health teaching?
crucial questions are seldom asked.
Such
Because of these limitations
it is not surprising that the"much acclaimed Rural Orientation of
Medical Education (ROME) has failed so consipicuously.
The same
applies to the experience of involvement of social scientists in
medical education.
The problems in medical education that are being seen today ought
not to have been so serious had the institutions which had been
specifically developed for strengthening medical education had
satisfactorily performed the functions assigned to them.
One
example is that of the All India Institute of Medical Sciences
(AIIMS) in New Delhi.
One of the key mandates of the AIIMS has
been to provide leadership in medical education to the country as
a whole, Development of the discipline of preventive and social
medicine was an integral part of that mandate, AIIMS has fallen
far short of that mandate. Similarly, there has been the Indian
Association for Advancement of Medical Education, They have made
some brave efforts. However, these efforts were seldom followed
up in the form of specific action programmes. The idea of
having separate medical universities is being tried out in states
like Andhra Pradesh and Tamilnadu.
These Universities have not yet
come out with any new directions for S-Ction^ As pointed out
earlier, the Consultative Group of Natiorial Education Policy in
- .8
I
Health Sciences is the latest in this series,
■
An analysis of the
process of thinking which formed the bases of the recommendations
and actions of these institutions will reveal the reasons why they
could make so little contributionso
Crisis in the Medical Profession
_
II lira II
H
I"
*
■
’■■■I ■■■ I I ■! .c*_-dam- m
.>
One very unfortunate outcome, of the present stats of medical
education in India has-.been the nature of socialisation of the
students who go through the process of education.
It .is indeed
difficult to imagine that the ..graduates who come out of medical
colleges, and who join various services or undertake private
practice, indeed belonged to the cream of the society at the time
when they had entered medical colleges. It is a severe indictment
of the system of medical education in India that it "converts"
some of the brightest students of the country into such dull and
unimaginative groups of the physicians, after they complete their
As if that is not enough/ they receive a very raw deal
if they happen to join the health sbrvxces in the union and state
education.
governments, when compared to, say, those belonging to the IAS.
The product that are seen, say, 10 years after their graduation
most often bears almost no resemblance to the bright young boys
and girls who had been chosen for entrance into medical colleges.
This sums up the real crisis in medical education and the medical
profession (Banerji 1989)o This needs to be attended to urgently.
The Shrivastva Committee has described, the situation in the
following words (GOT 1975s 38-39)3
It is widely recognised that the present
system of undergraduate medical education
is far from satisfactory.
Despite the
recommendations made by numerous >
Committees and Conferences, improvements
in the quality and relevance' of medical
education have been tardy.
Although
the setting up of Department of
Preventive and Social Medicine in the
med’ical colleges over 15 years ago was
a step in the right direction, this by
itself has not met.with significant
success as it lacked scholarly foundations
and the field practice areas have not
. .9
X
been adequately prepared.
9.
The stranglehold of the
inherited system of medical education, the exclusive
orientation towards the teaching hospital (five
years and three months out
the five years and six
months of the total period of medical education
being spent within the setting of the teaching
hospital), the irrelevance of the training to the
health needs of the community, the increasing trend
towards specialisation and acquisition of post
graduate degrees, the lack of incentives and
adequate recognition for work within rural
communities and the attractions of the export market
for medical manpower are some of the factors which
can be identified as being responsible for the
present day aloofness of medicine from the basic
health needs of our people”.
Reporting four years later, the I'CSSR-ICMR Study Group (ICSSR-ICMR,
1981s 156-59) did not find the situation any betters
”In spite of all expansion, doctors are still largely
urban-based; and their distribution between different
States is uneven. Standards have improved in some
institutions and some sectors, but the average has
declined considerably because of the proliferation
of sub-standard institutions. The medical education
system and the health care delivery system have each
gone their separate ways. There is little
congruence between the role of the physician and the
needs of society, little equilibrium
between
medical education and health care. Medicine is
still regarded essentially as an enterprise of
science and technology; the physician is the
repository of all knowledge and dispensations;
specialisation is the hallmark of progress; and the
training ground is the teaching hospital. Recent
efforts to change this unhappy situation, to
produce the ’right' kind of doctor and to give
a community orientation to medical education, have
yet to make any meaningful impact”.
Conclusion
The field of medical education reflects the paradox that exists in
,.10
j
10.
many other fields of socio-economic development in the country.
Gunnar Myrdal had long- back labelled this paradox as a ’’soft state II
It may, however, be
noted that the very fact that the leadership had to take to
-high on rhetoric and low in implementation.
rhetoric shows that there are pressures from the people which
impel them at least to talk about social issues; there are so many
countries which do not even have the rhetoric.
The critical need to bring about social orientation was being
talked hbout by the political leadership well before India
attained independence.
Active steps were taken to bring about the
needed changes about four decades back. However, these efforts did
not bear fruits. On the contrary, the political leadership and the
leaders of the medical profession have not been successful in
preventing the steep decline in almost every aspect of medical
education.
The profession has failed even to diagnose the malady.
The result is a plethora of prescriptions mainly focussing on
isolated symptoms.
There is little scientific efforts at a
holistic conceptualisation of medical education as a complex
interdisciplinary system, which, in turn, is a subsystem of the
wider health manpower development.
Again, health manpower
development must be based on a scientific approach to health
service development to meet the health needs of the people of the
country.
Seen against this background, the approach adopted by
some key studies of medical education is nothing short of quackery.
For instance, the Shrivastava Committee and the ICSSR-ICMR Working
Group had advocated the setting up of a Medical Education
Commission on the lines of the University Grants Commission (UGC)
as a keystone of their recommendations. If they have studied the
role of the UGC in relation to strengthening higher education in
India, they would have been at -least a little less ■ euphoric about
their recommendations.
The analysis and the recommendations of
the U.S. Bajaj Consultative Group provide an even more disturbing
example of poor quality of thinking among top level medical
educators of the country. This shows how deep is the’ malady that
is afflicting medical education in India to-day and how urgent it
is to have a critical mass of scholars who are capable of.
developing a more -holistic and a more scientific approach to this
very important problem.
1
4
>•
11.
References
1.
Banerji, D (1989)s Crisis in the Medical Profession in India,
Economic and Political Weekly, Vol. 24, No. 20, pp. 1091-1092.
2
Fulop, T and Roemer, M.I, (1982)3 International Development
of Health Manpower Policy, Genova, Morld Health Organization
(WHO Offset Publication Mo . 61), pp. 157-161.
Ik
—y ir— i~»it- -T~ ——■' i—ii—
—A--.
,
_ —fc.n
- ._**.*■
• ■«»*-. « --* » - ..
- ■— ^1 ,1.
. ii.
I
. . ..o-* w-'. -f,
■ —» , ■ li
Illi
...
3.
Government of India, Health Survey and .development Committee
(1946) s Report (Shore Committee), Delhi, Manager of
Publications, Vol.IV.
4.
Government of India, Group on Medical Education- and Support
Manpower (Shrivastav Committee) (1975) □ Health. Services and
Medical Education g_ A Programme for Iniinediate Action/r Report,
New Delhi, Ministry of Health and Family Planning.
5.
Government of India, Working Group on Health for All bh 2000
A.D. (1981a)3 Report, New Delhi, Ministry of Health and
Family Welfare.
Government of India, (1981b)s Sixth Five Year Plan, 1980-85,
New Delhi, Planning Commission.
Government of India, (1983) s Annual Report „1932~8j3/ New Delhi
Ministry of Health and Family Welfare.
Government of India (1989)s National Education Policy in
Health Sciences, (Chairman s J.S.BajajT, New Dellii,
Ministry of Health and Family Welfare.
Indian Council of Social Science Research and Indian Council
of Medical Research (1981) 3 Health for Ally An Alternative
Report of_____
Group Set up Jointly by ICSSR
a Study
Strategy
____________________
and ICMR, Pune, Indian Institute of Education.
National Planning Committee, Sub-Committee on National
Health (1948) s Report (Sokhey Committee Report), Ed by
K.T. Shah. Bombay, ^Vora.
6.
7.
8.
9.
10.
11.
World Health Organization (1985)3 Report of a Expert
Committee on Health Manpower Recpaireinents for th_e Achievement
of Health fpr All by^Jtjie^p;ear 2000"through Primary Health
Care, Geneva, World*"Hea’l*th Organisation#
(WHO Technical Report Series No. 717).
x-x-x-x-x ■x-x-
Co/V) j-i B,/0
Summary report of the workshop on 'Trainers Dialogue'
held at NIMHANS, Bangalore on 13th & 14th October, 1988
The •Trainers Dialogue' at Bangalore started with a welcome
address from the Dean & Professor of Psychiatry of National
Institute of Mental Health & Neuro Sciences, Neuro Surgery,
Dr. S.M. Channabasavanna. He shared the training programme of
the Institute and told the participants how the staff is involved
in the training of Community Health workers in relation to Mental
Health, that was till today a neglected and weak-link in the
training of all health functionaries, They also organised training
of multipurpose workers and medical officers of Primary Health
centres.
After the introduction of twenty two participants gathered there
from different organisations (list is attached in Appendix),
Dr. Amla Rama Rao explained the objectives and purpose of this
dialogue. She said that this is the first time Community Health
trainers are meeting and entering into a dialogue at one place
where not only voluntary organisations, but also the govt, health
functionaries are involved. The main purpose of the workshop was
to find out about the training programmes and to share the facili
ties and type of courses that are being run by each organisation.
If time permits, the group might look into the type of training
material available but would also like to discuss important
issues pertaining to health training in general.
Dr. Ravi Narain, as a result of 'Brain Storming' brought out the
following important issues concerning health training programmes.
a.
Type of courses
b.
Course contents
c.
Curriculum planning '
d.
Selection of students
..2
i
<
: 2 :
Motivation of students
f.
g*
/
Relevance of course and needs /
Govt. & NGO participation in training programme
h.
Planning process in training - tasks analysis, writing
of learning objectives
i.
Evaluation of training programme. Z
j.
Trainers* training programme
k.
Net-working mechanism with clear objectives#
Each participants started sharing their experiences keeping these
issues in mind and most of the time one issue was related to the
other and as such, a lot more was discussed during the day.
As a
result of day*s deliberations, the whole group had decided
that there is a need for networking. On 14th morning the group
divided itself into two and started working on objectives and
mechanism of the Network.
As an outcome of their recommendations
the following was suggested:
objectives:
1.
2.
3.
to collect information on various types of training programmes
in health in the country. both govt, and non-govt.
to store the information
members.
and disseminate to ether network
to conduct seminars and workshops relevant to the needs of
trainers.
4e
to help identify, strengths and weaknesses of existing training
programmes of the members for the purpose of self-appraisal.
• •3
: 3 :
5.
to develop a long term strategy for networking-
6.
health
to influence the govt, on policies of training in
field.
Mechanism of Networking:
The group considered VHAI to take responsibility for dissemination
of information through .fiYfL req ion a Incentres, North, South, East,
West and Centre.
RUSHA from South, & CHETNA from West, volunteered to do that.
CINI was suggested to work as a regional resource centre for
East but Regional centre for North & Centre was yet to be
identified.
VHAI was made responsible to develop minimum requirement for various
that are conducted, with their strengths
types of training programmes
and weaknesses and how each programmei must be assessed on these
basis. May be this can be used as a <guideline for self assessments
or for peer evaluation, for further improvement of the programme.
Regional resource centre will take the responsibility of collection
of information from individual network members, and listing their
resources including human and material and the type of training
programmes run by them.
VHAI should also take a lead in identifying training institution
and help others to become a part of the network.
After some discussion on recognition of courses by the govt, or
universities, it was considered not important, but the group
felt that their should a national level umbrella to offer
recognition to all courses. With the result, the standardisation
of training course at different level must be considered
seriously.
: 4 :
It was suggested that:
a.
be spared in each issue
A column in 'HFM* magazine of VHAI can
it would be a
for Community Health trainers' Network news,
good start.
advertise their training courses
b.
Members of the network could
c.
Certain issues that need to be
d.
training material
VHAI should also be able to review various
various regional centres.
available and assign what is needed to
e«
through 'HFM1.
discussed pertaining the
training should become a regular feature of HFM.
VHAI should organise a meeting every year
for Network members-
and programme plan was prepared with
The action^ responsibility
the help of the groupCcopy attached)•
- t of the recommenThe meeting ended with reading out the summary
joined the participants for
dations of the two groups, The Dean
also present in the
an informal get-together at lunch and was
valedictory function.
ended with thanks giving to all the participants,
The meeting
director and staff of NIMHANS by Dr. Dara, Hony.
organisers^
Voluntary Health Association of Karnataka.
Secretary/
DR. AMLA RAMA RAO.
sd
24.10.1988
: 5 :
THE PROGRAMME PLANNING
RESPONSIBILITY
DATE
collection of information.
VHAI
End of October^ 88.
Getting feed back from
members organisations.
Members
network
by November 15/ 88.
Draft of Directory of the
Regional resource persons
VHAI
by January 1, 8'9,
Evaluation of training
programme — an article for
HFM for April issue.
Nandita ~ Fachod.
first week of
March/ 1989.
Regional resource
centre.
by February 15# 8^,
VHAI
by March/ 1989.
ACTION
Preparation of report for
Collection of Bibliography
and other training material
from Network members.
ompilation and circulation
of the material.
LIST OF PARTICIPANTS ATTENDED "HEALTH TRAINERS DIALOGUE*1
from 13th to 14th OCTOBER 1988 at NIMHANS, BANGALORE.
1.
Sylvia S. Babu
Council Lodge CMAI
Smruti Theatre Compound/
Mount Road Extn./
Nagpur - 440 001.
2.
T. Thasian
Senior Training Officer
RUSHA Department
RUSHA Campus
RUSHA P.O. 632 309
Tamil Nadu.
3.
Jacob Cherian
Christian Fellowship Community
Health Centre
Shanth ipuram
Ambilikai - 624 612
4.
Christina De Sa
Association of India
1--Voluntary Health
^rea
Institutional
40/
South of IIT
New Delhi — 110 016
5.
S.B. Arora
Association of India
Voluntary Health
1
40/ Institutional Area
South of HT
New Delhi — 110 016
6.
Fr. Remy T.O.R.
St. Dominies Church
A-1, Poorvi Marg/
Vasant Vihar
New Delhi — 110 057
7.
Ravi Narayan
Community Health Cell
47/1 St. Marks Road/
Bangalore.
8.
D.J. Bhaskar
• - r 1—
Health Association of Karnataka
Voluntary
?/o St John’s Medical College
r
jangalore - 560 034
9.
Aobey John
C/o Dr. H. Sudershan
V.G.K.K.
B.R. Hills
Mysore - 571 313
• •2
: 2
10.
Dr. Dara S. Amar
Community Medicine Department
St. John’s Medical College
Bangalore - 560 034
11.
T. Neerajakshi
Promotional Secretary
Voluntary Health Association of Karnataka
C/o. St. John’s Medical College Hospital
Bangalore - 560 034
12<
jayashree Ramakrishna
Department of Health Education
NIMHANS, Bangalore - 560 029
13.
S.M. Subramanya Setty
Department of Health Education
NIMHANS, Bangalore - 560 029
14.
Dr. Amla Rama Rao
Voluntary Health Association of India
40, Institutional Area,
South of IIT
New Delhi - 110016
15.
Nandita Kapadia
IHMP
P.O. Pachod District
Aurangabad - 431 121
Maharashtra
16.
Sujatha D’Magry
insa
-india
2/ Benson Road
Benson Town
Bangalore - 560 046
17.
Dr. Mohan K. Issac
Department of Psychiatry
NIMHANS, Bangalore - 29.
18.
Indu Capoor
•CHETNA1
2nd floor t Drive-in-Cinema Building
Ahmedabad - 380 054
19.
Edwina Pereria
WSA-INDIA
2, Benson Road
Benson Town
Bangalore - 560 046
..3
: 3 :
20<
K. Gopinathan
Community Health Cell
47/1, St. Mark's Road
Bangalore - 560 001.
21.
Dr. C.R. Chandrashekar
Asstt. Prof, of Psychiatry
NIMHANS,
BANGALORE - 560 029
1
THE_DEVEL0Pf1tM UORKER AND THE PEOPLE
-I. THE riEftNING OF HELP?
One can safely assume
that a voluntary organisation is primarily The word beneficiary itself speaks of
in the field t« heir the beneficiary*
5 relationship between the voluntary'
Therefore, the
In this
• fi helper and helped.
• rganis.atien and the beneficiary will be one
a person who is helped.
relationship two different parties which
often have very little in common
are brought together by a magic uRrds ’’help •
When this word is understood
unconscious level, by
in exactly the same way at both the conscious and the
misunderstanding bdtween
both the giver and the receiver th^ likelihood of
unfortuna—
minimal. But,
the beneficiaries .are
the voluntary organisations and
;
tely, this is not always the case.
For the beneficiary help was a very narrow
• f :j»oor people,
meaning-
In the lives
urgent
solution, to
there is always one thing whic^i needs
This is his need,
a well in the fields.
pay back a debt, to find employment,
something else is just
,
Any talk’-»n
Help means to take care 'of that need.
words, words,
For
words 1
the voluntary-rganisation on the other hand, help is very
likely tn be understood in a very different maWar, and in different ways
depending -n the main aim of the organisation.
Thus, if the main aim rf^the
VO is education, then the help which the beneficiary needs will be un•
-
t. be-oducation; but' his main need will .^e to curative ^di-ne, nous
Agriculture, lift irrigation, control of rnjl^y.r Wyd
S'>, ep '
is the voluntary organisati.n's mail area'.Af activity.
oft what
In short,
thiig-t. the voluntary
help m9y
different cne to the be.eficia.ry, hiving rise
‘ •Brganisation and a very
Indeed, the very first question, that a voluntary
misunderstanding.
to be given in answer
Should ask itself is this? "If hel, has
•rganisat ion
the hei» which I give?" Sometimes our
to
need doc® it answer
doctor needs the
needs meet? the patie.t needs’the' doctor ,36 ■uch as the
eed the patient itore than the
But sometimes thd ti.cto* ma/ im
tested to protract
the doctor may feel
patient needs hirti?* ii which rase,
and clears* word?, the need of the
' the lllaess ,uf the,patient. • ii .ther
made ta be the ne^d, *f the
voluitary •rga.isatini or its personnel is i
the latter.
■' people. Or J ii other words, ^the for.ei jj»oje»t their nse
Let us
This pr«jer4ioi can be of eit*SF
^«-nal needs.
’patieat I
■fe'
explain
separately.
:6>
- V
V
g,
-
.
•>
>
)
■■ ■
' ■
'-■• fi
•*
-
»?•
2. PROJECTION OF PERSONAL NEEDS s
■
‘
- .. . .£!• -' -.1 •
-
.' •.
The distinction between personal and institutional needs: takes
cognizance of the fact that the personnel manning the voluntary organisation
may have needs different frorr^ those' _of the institution he serves.
Now
these personal needs may wor^ against the beneficiary. To clarify this
\
;
*
point, let us take a hypothetical example where the voluntary organisation
aims to help the beneficiary prstis-ely whoBQ-jhc wants . td be helped.
• j
The
example: A voluntary organisation well aware that' there'i. lot of unemployment
and gager to solve tho problem •sets out to help the beneficiary^ by'setting up?;.
1
'
~ ‘
■•
w
'
’J
'
•
■■■
.
...
____i.
a milk—producers’ Cooperative on the^understdhding that the ^chetie..will provide
additional'employment and income.''
The organiSatidn
provides the initial ■
loan, the managerial and animal husbandry know-how and evch*hcIps- in buying
the buffaloes^
The result is a megnificient cooperative.*' ^The cooperative
■
t
.fc-.
1
is so successful that people from all over the country come to see it;, even
international
organisations take interest in* it.
feel riice.
he cooperative helps so many
begin to court its managers.
of the beneficiary.
The voluntary workers
people that the local politicians,
The voluntary worker feels powerful.
cooperative now becomes an end in itself.
*
The
It did satisfy the first need
But the cooperative is subsequently made tn serve the
The cooperative which
personal needs of thq so-called people’s helpers.
then
could have helped t,he beneficiary f|rst to achieve economic independence,
(competence in animal husbandry and finally managerial skills to. run the
«
»
All this, of course,
cooperative himself,, stops short : of these lofty goals,
Because, it is agreed,
in the name of the people and their true welfare.
if the management is given •vor’to : eneficiary, the cooperative.will soon end
up in corruption and mismanagement.
. Those who so speak might not have
’If I give power to
been able to answer an entirely different question;
■i
the people where.jam I?”
,
.
Herd the personal needs of the "voluntary worker stand in the
way th the true development of the?^beneficiary.
The need
need ”to feel needed”, the •peoef ,fo fathcr-o.r mother
• f such personal- needs.
IT;
for power, the
people are all examples4
•j.
rV
From the above some*m'ay*^.r'hw tfaceconclusion that development work
demands .so much detachment / 5^ 'to bo beyond the ^possibility of ordinary
human beings.
or saints;
This is not true.
Development work does not ask for ma hat mas K-
All that it asks* Fo* is ^^LLLght-ened self-interest.
hows To begin with, it is impoA^nfc to stress that, no
Let us see
personal need is bad
in itself; therefore, nobody sAodid*b'c ashgrged cf having- such needS are
motives.
Secondly, it is vbry imptJrtdht that ibhcso
the person in question and by his .Jbrganisntion.
needs be accepted by
Nccds^ .which are denied by
'
‘
'*■
3
out
and his organisation must find/creative ways of dealing with those needs.
A creative way is that which satisfies the personal needs without harming
the client.
Thus, in the above mentioned example withdrawing in time will
not decrease but increase the prestige of the voluntary organisation and
its personnel.
far
And, by replicating the model somewhoro else, personal power,
from being lessened, is greatly enhanced.
The only difficulty in the whole exercise is that the person in
question requires personal courage to accept one^ own needs to oneself and
to others.
One
requires self-confidence to believe that what has been
done here can be replicated somewhere else,
are not these great
Personal courage, self-confidences
individual?
Here is the
"The more we give, the more we receive”.
"Acceptance
’’developmental" needs of evdry
great paradox of life?
of the developmental needs of our clianted leads to our own personal growth”.
A person need nbt be a groat man to do development work; but he may very
well end up by being one if he does it in a professional manner.
For, if
development work demands from us self discipline and detachment so does
personal growth and emotional maturity.
This may not be perceived by
voluntary workers because they, like the beneficiaries at another level, are
so blinded by their immediate needs that they forget their long-term interests.
Development work may bring about this awareness.
3.
INSTITUTIONAL NEEDS PROJECTED QN THE. BENEFICIARY
The above example has taken for
2
granted that sometimes, the
professed need of the organisation and the felt need of the beneficiary
can
meet.
But
unfortunately that is not always that case.
cas e •
Sometimes they
differ, in which case the likelihood is that the voluntary organisation may
project its needs on the beneficiary.
Here again is
a hypothetical example of an organisation which
specialises in slum clearance,
Food, clothing and housing are understood to
toe three of the basic needs nf man.
In a city lack of decent house is seen
by the affluent society as a crying need which
demands urgent solution^
And so gn organisation has been set up to take care of this need,
of rich and well-meaning citizens offer their money,
Government and inter—
national agencies see it as their duty to help in the venture.
new organisation goes to a slum.
Fob
A number
And so the
What is the help the slum dwellers need?
one set of persons atleast there is no doubt - what these people needs is
a good housing solheme.
Now the chances are that
the slum dwellers1
housing is a need which is very low in
list of priorities.
In which case help (the satisfaction of
their needs) will be understood differently by the beneficiary and the
4
Let us now examine the
possible situations which this misunderstanding
A voluntary worker goes to a slum to meet the people.
may give rise to.
After the first initial
There they are® he and they, rich and poor.
misunderstandings they
help thmn*
begin to receive a clear message® ”He
wants to
employment and he offers them housing.
But
— they
- - / need money or
r
want anything to do with him”.
Others cleverer
say: ”He is rich, he has influence. We do not want a house,
shall secure what we want",
well be that JX we accept it we
But it may very
Some of them say? "We don’t
The others see
reason in this and now all agree to go along with him.
This situation has all the elements of a bargain. Briefly? there is
a
■>arby(a voluntary organisation) which has a need to set up a housing scheme.
There is another
party(the beneficiary) which needs, let us say
money#
In
the former and its project?
this situatiorKhow chics the latter see
as something he
1. The beneficiary may look at the organisation
needs.
In which case the project will be seen as something to be done in
order to pres-erve the organisation’s services.
Tho project then becomes the tribute
the voluntary organisation.
if the project
A
the beneficiary has to pay to
tribute is always paid reluctantly.
is sabotaged in more or less subtle ways,
No wonder
for example, the
houses may be sublet or sold and the peorle may revert to the slums.
2. The beneficiaries may not see the voluntary organisation as
indispensable; but they may see the project as
means to achieve their aims
In this case, the project becomes the handle which can be used to manipulate
"them".
project.
"They have plenty of resources.
We give it to them.
We need money.
Let them now give us money".
project must be giving plenty of money to "them".
in it.
The need a housing
OR
"This
Now we also cooperate
Therefore,
Therefore, we should! also share in the spoils •
In this situation, the beneficiary feels that a tough bargaining
is shead; and 9 therefore, ho is likely to adopt the usual bargaining
"One does not show one’s cards”.
Secrecy mill be one of them
t a ct i cs •
And, of
Indeed he may even try to mislead the voluntary organisation,
course, in every bargain the stakes must always be kept high.
In the process the slum dwellers keep on looking at the voluntary
organisation as the other bargaining party.
interpreted in this lights
All its moves will be
”How do the voluntary workers play their cards?”
1. They may be very soft towards the beneficiary, in which case
the letter is likely to interpret this attitude in three possible ways:
(i) That the former are stupid, and there-fore, have no credibility,
5
2, '
If the voluntary organisation is seen as a very hard
bargainer he is likely to see it as an improved replica of
the local money-lender Zamindar. This means that the
relations between him and the voluntary ciganiisation will be
patterned very much along the well known relationship of
money-lender and the poor.
3.
There is* of course, a third possibility i.e. when ’
the voluntary workers turn the v/hole situation into g learning
. one. More will be said about this later.
This attitude of the people may trigger off similar
reactions among the voluntary workers. Thus, ’they may brand
the beneficiary as a cheater, as a lazy person or ignorant,
or any other adjective to describe a situation which they see
as unreasonable. If that-be the case, the relationship between
them and the beneficiary becomes vitiated.
4.
-THE NEED OF MALOGbE:
■ •
The important thing in all the’ possible situstion
describ'eS so far is that the feTatlonship established between
the people and the voluntary organisation is not a sound
one, simply because it is based on either a misunderstanding *
(in the case of help being understood differently) or in
attitudes which are not authentic when the voluntary worker s
avowed aim is one and his real motivation is another.
When such a relationship exists, it is' evident that
no dialogue is possible because no real communication has been
established. Therefore, growth does not take place. And
who can deny that growth may be required sometimes Joy ~ e
beneficiaries, sometimes by the voluntary organisa iono a
sometimes by both? In development work it is fi s
of the voluntary workers to. grow by making sure
are not acting out their personal or institutional needs
on the people. One way to do it may be self examination and
another way is to start a dialogue with the people in order
to understand them better and also to make themselves
better understood by the Ipeople. Whatever may be our
shortcomings the people have a way of teaching us and
correcting us which is wonderful, if we only listen to them
6
The beneficiary in this case must be made aware that his need .
is only part of .a bigger reality, and that no affective means
can be taken to solve their felt needs unless thu totality of
the situation is taken into consideration. An example will
help to illustrate this point.
A Voluntary organisation working in a village, studies
the situation and comes to this conclusion: the expenditure
of the beneficiaries is higher than their income and conse
quently the people arc indebted. A study of their expenditure
reveals that not enough is spent on the necessaries of life,
food, clothing, housing and agriculture, while too much is
spent on social customs, medical bills and uneconomic
borrowing. Since they are so hard for money they are forced
to accept loans on adverse terms. Again, since they don t
have money to buj they must take on credit paying double,
The amount of money paid on interest is higher than the
original amont of money b orrowed.
A study of their income reveals that their income
from agriculture.
is too low because their methods of culti
vation are too primitive and because not enough is invested
in their fields.
The beneficiaries are haunted by the money lenders
and have an unavoidable need of cash, If the organisation
gives them money, it knows too well that it is, helping to
perpetuate a system, if the voluntary worker, ignoring the
beneficiary’s needs, tries to push, say an agricultural
improvement programme, than he is facing a sure
failure, since the beneficiaries are not likely to give their
full-hearted cooperation to something which they consider
irrelevant to their present needs.
There is only one way out and that is a true dialogue
where the voluntary organisation keeps on relating the beneficiaries’ need to the totality of the situation. Education
is anotherword for this dialogue.
On the other hand, this dialogue is not as easy as it
It requires from the organisation's personnel
may appear,
skills; (i) The ability to listen to the people
professional
but the real meaning
and understand not only their words b..-
7
(iii) Knowledge of the wider reality viz., that of the whole
country (and of the world at large) of which situation is only
a part.
It requires also certain inner attitude without which
those skills will not be put to good use"
1, beIf-confidencet to face the seduction, opposition
and indifference of the beneficiaries without either being •
trapped or feeling personally threatened.
2. Authenticity and courage to ownup one’s needs and
motivation.
5. Faith in the people; If voluntary workers lack
this faith no meaningful dialogue is possible with the benefi
ciaries and no real education will take place. Indeed the
chances are that the v oluntary organisation will eventually
work against the long term interest of the beneficiary. If
the social workers believe that the beneficiary cannot take
care of himself, evidently they will never work towards an
eventual stage where he becomes self-reliant. If they do
not believe that he can learn they will not even try educating
him, or, if they do they will unconsciously'undo what they
are professedly doing Let, on the other hand, the voluntary
organisation have or. the people and that faith will be
communicated to them. If the voluntary workers fail they will
attribute the failure not to the beneficiary but to their
approach or methodology their imperfect understanding of the
situation and the people. In oiiher words, when there is
faith, failure makes the voluntary organisation search. When
there is no faith failure makes the voluntary organisation
blame the beneficiary.
Faith in the people can be said, without fear or
exaggerting, to be most important virtue of all those required
by development workers.
Much is being said in development literature about
dependence and ofter. it is assumed that social or developmental
work leads unavoidably to a state of dependence. That this
happen often is evidently true. Taht this is in the nature
of things is not so clear. F-aith in the people and courage to
8
foster in-.the people, the' attitudes and skills required to
b ec ome self-reliant at an early stage.
5.
THE NEED OF PROFESSIONAIS:
This paper assumes that development work may be of
many types and it claims that all of them estaolish a specific
relationship with the beneficiaries which requires very definite
skills and attitudes. In other words, development work requires
professionals: people who have mastered their own discipline
be it agriculture, medicine, economics or engineering and at
the same time have acquired the skills required to effectively
dialogue with the people. And development workers like all
professionals must have their own code of conduct based on the
inner attitudes which
mentioned earlier.
which h?"^
have been mentioned
earlier. Development
work, like education, like medicine or education demands a
certain dedication and a code of conduct, When a person possesses them, he is a good professional, Unfortunately, little is
done to create a cadre of professionals in the field of development work — even though its need is so> keenly felt by everydeveloped by government
body.. This cadre has, of course, been c.
There are other examples
and all government related^ agencies,
like the National Dairy Development Board which in its effort
to create Milk Producers' Cpopcrative of the Anand type, has
professional cooperative men. But
set up its own group of
this is not the rule with voluntary agencies.
To create a body of professionals in this field
two things are required. 1) Professional salaries should be
offered to prospective candidates, and 2) Institutional
support must be provided which will guarantee permanence in
service. There are many e
organisations (National and
international) which make material resources available for
development. They are ready to pour their money in buildings,
equipment, digging sells* offering food for work, procuring
loans, etc. etc. But how many agencies are ready to create
the only thing which will make all these projects successfulhonest and competent development workers? If my experience is
an indication, then there are practically none. Bor some time
I found it almost impossible to secure money to pay salaries.
9
It is difficult to have competent people working
for a task which is hard in itself. But, if on top. of this,
they are-not sure of a professional salary, or if that salary
can be offered only for the duration of short project5 is
there any likelihood of creating the desired cadre? Without
it, the development work carried out by voluntary organisations
is left either to amateurs or to that select band of exceptional
people who are ready to work at a great personal sacrifice.
The task ahead of us is so great that it is shortsighted to
depend only on exceptional people. A wider not must be cast
t* draw into this work all the honest and competent people
available.
India has at present a great number of unemployed gra
duates who could be utilised for development work. There are
better trained people whose training and creativity are wasted
away in routine jobs which can provide no challenge to them
and consequently give them no satisfaction. But the security
offered by Banks or Government (in a country where employment
is such a big problem) will not allow them to accept a better
paid.and more challenging joh at the risk of that security.
Even apart from the employment problem there is
special difficulty.in India to find people who are ready to do
development work. This work usually entails working with the
lower castes and.the poor people. Given the caste system
prevailing in the country, many people have still ingrained
prejudices against the lower castes. It is not easy to
overcome this prejudice. Even religions, like Islam and
Christianity which in principle uphold the equality of all
men, have, in practice fallen prey to caste prejudice. An
individual may overcome them and still he may succumb to the
pressure of his Relatives and friends demanding him to
either uphold the values of the caste system or at least,
to conform externally to them. Hence the difficulty of
finding people who are really committed to social change.
Now when financial insecurity is added to the difficulty,
specially when it is question of giving up a secure job,
the chances of creating a cadre of professional men are very
small indeed.
4.
10
One of the objectives of this National Work-shop
on Rural Development is "to evolve a more effective strategy
for the mobilization of people and the resources in the
struggle against poverty and injustice". The above consider
ation have been submitted having this objective in mind.
6.
THE NEED OF PROFESSIONAL TRAINING;
One often hears complaints about the shortcomings of
the people working for development. To point out defects is
the first step to remedy a situation; but it is not enough.
One must study the causes leading to such a situation. This
paper has already suggested fhe first step towards better
development work — the professionalisation of its services
by creating those conditions which will makd it possible
recruit people'who are botK competent and comitted.
There remains one question to be answered: are there
such people avslluble in the country. The nnsver, unfortunate
ly
is negative.
Dr. Kuriun of the national Berry Dovelopmen
Board She been forced td plan his oen training servioee
o
provide his cooperative^ with competent personae .
While much of''the theory needed In development work
is given »t the various schools of social work:, theory “
not enough.
And indeed the same
X^X^valuia held are a=t. -.any
> different,
/j
- vn‘hrins* about committment.
case, theory alone does not bring
of the values one upholds. And,
universities are x
latter is the product
values prevalent in our universitie
^titudes towards development
fortunately, the va
the right attitudes towards
nn+, 1 ikelv to promote rne rigmmore specific:
work. To
To be more
can be made
made of those vaues
specific", mention
mention can
which lead people to believe that teaching is more impor an
ir ru
than learning; that city people are better than
the standards of success
counterparts; that money and power are
one who has made if into
of life; that a successful student is
When our universities accept
11
understand others and to communicate with them which is the
basis of a meaningful dialogue and true education? Therefore,
development work cannot rely entirely on the training given
by our universities.
May be that this work shop could explore the possi
bility of using the existing voluntary organisation to develop
—•
’------- ----our own training facilities.’
If the voluntary organisations could set a model of
unity and cooperation; if the aid-giving agencies could also
do the same; and if, as a result, permanance of service and
professional salaries could be offered to prospective candi
dates, then the system could be rounded off by a number of
volunatary organisations joining together to offer training
services as well.
Let this paper end by stating in clear words the
assumption on which the whole paper has been basedo True
development means, in the last analysis, personal growth
the ability to cope every time more effectively with difficult
situations; the ability to make history meaning!ully. May be
if voluntary organisations spent a little more time in
’’developing” their staff they would be in a better position
to help in the development of others.
V-
MsVU/3
H
CHW BC
WOBKING WITH THE COftiTOETI
3.1
DEFINITION
A community is a social group determined by geographical
boundaries and/or common values and interests.
Die members of a community, particularly in a rural area, know
and interact with each other and create ceitain norms, values, and
social institutions.
COMMUNITY HEALTH FEFERS TO THE HEALTH STATUS OF THE MEM
BERS CF THE COMI UNITY, TO THE PROBLEMS AFFECTING THEIR
HEALTH, AID TO THE TOTALITY 01' HEALTH CARE PROVIDED FORTHE COMMUNITY.
The assessment of the health status of the community requires
an understanding of the general populations to be served. Refer to
sections 4.3.1 and 4*3.2 for the methodology for collecting general
information and conducting a base-line survey.
4 HEALTH CARE PROVIDES A WIDE SPECTFUM OF SERVICES INCLUDE NG
PRIMARY I-3EALTH CARE. TLE WEGTaTION OF PREVENTIVE AND
CURATIVE SERVICES? HEALTH EDUCATION, THE PROTECTION OF
MOTHERS AID CIULDRENJ FAMILY PLANIHNG AID THE CONTROL OF
ENVERONI ENIAL TOPS AND CO! lUNICABLE DISEASES.
The system of health care delivery, if it is to be effective
and servo the needs of the community, must have the following
characteristics:
i. It must bo accessible to all tie population.
ii. It must be available when needed.
iii. It must be Dree of economic barriers, i.e. it should be
available to all economic groups.
iv. It must not be limited by social or cultural distinctions.
v. It must reflect certain inherent characteristics of the
community.
vi. It must be flexible in its approaches.
via.. It must recognize that the primary avenues to health may
be through education, economic progress, legislation or
other aspects of s ociety rather than through organised
health structures.
3.2. YOUR ROLE IN COMMUNITY HEALTH ACTIVITIES
As a health worker in a rural community you arc also a community
worker and you must, therefore, work very closely with the community
and other workers, e.g., agricultural, educational, public works,
housing and communications, working within the same community.
WORKING WITH THE COMMUNITY LEADERS
3*3
your services ‘to "the community are to achieve their objectives
you must create a demand for those services within the community This
demand can be created in the following ways:
"
1. Involving the comr-unity in all aspects of
health services
of health
services
delivery, i.e. in the planning, delivery, utilization and
evaluation of health
-.1 caro.
ii. Inter-relating the «services with other operating social systems
within the community,
J 1-
w4
: 2 :
Your success will depend on how faro you will be able to
got the ,support of the community to help you with your work. A. very
crucial part in this respect is placed by the community leaders.
3.4
TYPES CF LEADERS
In every rural conwnity there arc formal and informal
leaders who can either promote or obstruct any health programme.
i. Formal loaders (Official/Functional): These individuals
are often employed by the Government and include the
sarpanch, school teachers, tax collectors, etc. Some
nay bo elected or appointed to bd the leaders of non
governmental organizations.
ii. Informal Leaders (Nalural/Status): These indivicLals
may be any influential mon or women in the comrunity
such as midwives, shopkeepers, fp.r ers, housewives or
other persons who h^vc the r spect. and confidence of
the people. They may hold a position of leadership on
account of their ago, caste, religion, wealth or education.
SUPPORT FROM BOTH TYPES OF LEADERS IS NECESSARY SO THA^?
THEY CAN POSITIVELY INFLUENCE PEFSOFS WHO BELONG TO THEIR
RESPECTIVE GLOUPS.
3-5
IDElJTIFimiON OF LEADERS
Mich care needs to be given to the identification of comuunity
leaders sc that they are well-accepted by the people. Trusted local
leaders can be expected tc exert considerable influence on their
community.
There arc various methods you can use for identifying
leaders in any community. These methods are:
1. Interview licthod: You nay interview formal leaders to
obtain the names of men and women whom they consider
to be influential in the community and who represent
Various com unity groups.
ii. Observation Method: You nay observe which persons in
the community arc consulted frequently by the people who
arc in need of advice anci assistance.
iii. Scciometric Method: You nay a'sk several recognised leaders
to nano throe or four persons whom they consider as
leaders. Those whose names are mentioned frequently
are identified as community leaders.
iv. Sampling Method: In this Method you. nay interview the
head of every third, fifth, tenth, etc., family to get
his opinion a ■ to whon his family would like as a leader.
The. persons whose names are rientioned me st frequently
arc approached to act as leaders.
ORIENTATION OF LEADERS
Orientation sessions for community loaders and their expected
roles with regard to health programmes should be planned byyou along with
with your supervisor. The participation cf the Medical Officer and the
Block Health Assistant from the Primary Health Centre often adds
importance and prestige to such mootings and arrangements should be
made fortes, if the situation requires it.
3.6.
: 3 :
2. Tlio vartcus health problems existing in the
community and the role of the loaders in helping
to solvo those problems.
3* Specific infer ation related to various health
problems and pro gramme s^ o.g.,
1. Cause and control of communicable diseases
ii • atornaJ- and child health
iii. Family planning
iv. Nutrition
v. Environmental smitetion.
4-
56.
3.7
Identifying and utilizing tee resources in the
community to improve the healt1 status of the
community.
licthods of educating and motivating the community
to improve thear health status and change their health
behaviour.
The need for coordinate'ng the vo.rious developmental
activities of the community sc achieve improvement
in the total well being of the community.
UTILIZING THE COMi.UNITY LEADERS
When you work with the community leaders, y^ou should
remember tint you are working, through them, with coteunity you arc
serving. They can promote or destroy your programme, so you should
ensure flat your relationship with them remains cordial, iriendly,
cooperative and promotes team work. Utilize the community leaders
o in
as follows:
i. Enquire what the current needs of tee community are.
ii. Relate these needs tc the objectives of tee health
sorvj'-Ccs and ensure that your activities will sa.tisfy
their needs. If you arc unable to satisfy these needs
explain to the letters why you cannot do so, and what
meet thoir requirements.. ' ’
they could ch to noct
iii. Han xd.th-.tho leaders the delivery of health services,
their tiring and what motivational steps arc necessary
tc promote health programmes.
iv. Request the Lein of the leader'■ in tec delivery of
the health programmes.
v. Enquire from the leaders whether the community is
satisfied with tlio services being delivered. If not,
ask why and try to find ways, in consultation with
the loaders, fr improving the programme.
■1 pjEii-jEi/BSR TW BECAUSE OF FIWmWaL 03 NSTF/Z14TS ONLY THE
ESSENTIAL NEEDS OB’ THE COMiUNITY CAN BE SATISFIED . HOWEVER,
YOU C/JT HELP THE COIAiUHITY TO SELECT HEALTH BICRITIES Al©
MOBILIZE THE COHiUNITY RESOURCES IN ORDER TO OVERCOME THESE
. CONSTRAINTS . ______________________________________ __«
vi. StimLnte the loaders to .relate health programmess
with other develop-lental programmes in the community
Remember that major improvements in the health of the
comumity can result from minor changes in the cultural
behaviour and economic standards of the people or in
the existing community organizat’j ons •
•vii. Use the loaders to motivate members of the community
who arc resistant to health programmes. This can be
: 4 :
viii. Inflncnco tho leaders to assist yen in your
work thnogh ccrraunity parti cipation in health
activities.
IS lALEW) AIY) OHTATFD WH
: RElA-ffiMBLR THAT IF A
GOMOTLTY P/JvTICI PATION, E.EIR INTEREST VEIL BE 'iVINTAINED
..AID THE HtOGFAlI E FILL BE MORE EFFECTIVE.
ix. You should plan for noctings vzith the loaders
from tino to t i ie either individually or in
groups. At these sessions, the following
topics could be discussed:
a. Information a1-out to achievement of the
health., programne in the area.
b. Specific problems or doubts raised by the
community- members.
c. Now developments in the health; programme.
d. Hanning for involve wont of the community
in the education and service prograr '00.
o. Orientation of now loaders in the community.
3.3.
WORKING WITH OTHER COMMUNITY WORKERS
resides werkors from the health department, there are workers
fron other departments such, as teachers, agricultural workers, community
development workers, brlsovikas, etc., all of whom have specific rosponsibilitics but v.lth the so.no overall goal of inprovi-ng tire welfare of the
community. It is necessary for you to work closely with all these
workers in order to benefit the community to th isaximun extent possible
The following arc sone of the ways in which you can get assistance fron
your colloacu.es, or help in their vr rk :
K
3.9.
i. Jhrticipatc in th-c act lad.ties of tire team.
ii. Exchange information with the other community
workers to identify areas of -werk where you can
cooperate with each other.
iii. Lc< k for opportunities where you con contribute
to improving the welfare of tie cowimnity, e»g.,
by giving health talks to schorl children,
cooperating with t1 .o panebayat Icodsjrs etc.
iv. request the assistance of other workers in your
prograwnc-, e.g., the coLi.Tunity development
officer can help w' th v/ator supply schoncs, the
or'riciltvral officer with advising the community
on kitchen gardens, etc.
v. Request the panehaynt leaders for assistance
with r.nr-power to support health nrogr annos, e.g.,
in spraying oporalien.
TIIE CWIUSITY LEVEL WOFKEE.
The idea of utilizing coruaunity level xjerkors to deliver
health services of an olonontary nature has now boon accepted as
part of the health delivery systu'Li in India. These workers will
net be government or.rrloyo< s but will be selected by the cennunity
and, after training, will work within the con- unity. These corirxinity
level werkors will be dra.wn fron among teachers and educated and
willing housewives.
: 5 :
Your help my bo requested by the village leaders or
comunity in selecting a proper person who can bo trained in elementary
health, work. In giving this advice you will need to use your judgement
and to keep in riind that you will be working closely with ibis worker.
REI-UPMBEF TH/LT THE C0l«JNITY LEVEL WQRKEL IS NOT IN COMPETITION
WITH YOU, BUT THAT I4E IS YOUI’ HELPER /ID IS TH LE TO EXTEND
HEALTH CARE IN YOUB. ABSENCE .
6 ,
- ST* JOHfflS WICAL COLLEGE & HOSPITAL,BAW.L0BE
TBAI1LENG PROGRAMME FCR COl-ONITY HEAITH WRKERS
C0M1CHITY
DEVELOJMEHT
J »M. Meredcrd''
Definition of Coraunity:
A sense developed ly people of their local conuon goo.!.
a) Sense
: To the extent to which a group of people
develop a sense of their common good, to
that extent, we say, there is a community.
b) Conuon good
: It embraces various aspects:
Political: (Political is taken here in the
sense of sliaring power).
a) to avoid a position of depondonce which nay lead to exploitaw (through united
tion* The connunity
organisation) acquires sufficient
power to do fond the rights of its
nenbers* In other words, the
conuunity assorts its rights.
Aims:
2* Social
:
b) The individual whether in a tradi
tional or in a nodern society has
very little control ever his life.
Most of the decisions which affect
his life are taken by others. In
the western consumer society this
has led to non-conformist movement
like the hippies. In India, the
caste controls the majority of
individuals through the manipulations
of a few traditional loaders . In
either traditional or modern society
the net result is the loss of indivi
dual autonomy.
The community where each member is
aware of those facts and willing
to do sonotliing about them is the
only means to restore the autonomy
of the individual *
Man is a social animal- There are
certain things which can only be
satisfied in a society, Tims, for
example, the need cf mutual support,
of friendship, the need of celebrations,
arc needs which arc best taken care
of by the community. More in parti
cular, man is communicative. The
community provides a forum where its
members can exchange their ideas.
Again, man needs recreation. The
Cooriunity helps each Liember, accord
ing to his age etc., to fulfill this
need.
t.
/
f
2
3. Religion: a? Religion lias <lrtu”s -un a social
phononenonr efe coririmity helps its
.
noubors to worship in ccmon.
b) Society inposcs on ran values which
run counter :'o Ids religious convic
tions. One ran. can individually re
ject these values, hut it is in and th-"
through the conr.iunity that ran am have
his religious values accepted^in a
riannor wliich is relevant to hin and
his neighbours at a particular tine
in a particular place* To extent to
which the true fundamental values of
religion are accepted in the coDiiuniify
• to that extent religion has meaningful
relevance in society. This is a living.,—
process whore men discern in their own
. re*l5 g~i on, the difference between funda
mentals and accidentals, between irmer
attitudes and external rituals and, in
thoir daily lives, non are able tc see
the difference between real needs and
addictions or compulsions.
c) Com.’unity work should bo an antidovo
against institutionalised religion
where the institution bo cones more
important than the message and, espocialli
the people.
d) The community is important to religion
and vice versa) because it is in the
former that the ideas of the latter arc
implemented* ’pccifLcally, it is
through the community that the fight
against social ovils and injusti co can
best bo waged.
The community helps its members to
teach and to learn.
a) Tlie community helps its nonbers to
learn:
i) to bo norc ethically sensitive
in solving problcns by taking
cognisance not only of one’s own
interests but also of his neighbours;
4. Education:
ii) ro-assess one’s own attitudes and
habits- vis-a-vis their impact on
one’s own neighbours;
sone very specific skills which
an individual loams in the community
are connuni nationsand leadership s
skills;
iv) in short, the ’ individuhlsvlcarn
how tost to help.the boniTwity'-.
to achieve.!the ’ ooLyion Joed. ' i
' 7' s:
3
of the sccio-occnonic sty/.cturos
which ihiluonco or mnipulato it;
ii).thc connunity nay organise other
minor schemes whore individual. members
will impart specific skills to others.
5 .. Econorjic: Anong the weaker sections of society, the
coniTUT’ity nay bo the only neans to solvo his
ocononic difficulties^ Cooperatives of all
types nay be the onlysnswer to solve problems
lilce indebtedness, marketing difficulties and
even unemployment.
—
-Voea of. 0 or.T;.-rui.ni'! m /~ : Their cmro.cteristics and adv-- ntaff'cs
-I • ■
The Casxc as Cornwity
Caste are autonomous groups within the country, with their own
legislative, executive and judiciary systems operating. indepeiidentjly.q/ithin
their own sphere. Consequently, each g?oup has a well-defined code of
legislation which regulates their social life, and which confers -on every
caste nonb er his own sot of rights and duties.
This social structure provides for a clear sense of identity.and
belongingness, which is found r.issing in the so called "atomised society'
of the West.
Another characteristic of the caste is tliat it is not merely an
effective group, or a group organised for action but also an affective
group pr a group hound together by links of common fellowship.
Rel igion as a Command tv t
In India, religion creates a cormiunity clearly among the Par sees.
Although religion has united the Muslims as a minority in some wel*L known
nolitical fights, still, in the day-to-day working of community the bhslims
are too divided by castes and sects as to crea.te a community. Something
si th ~1 ar may be said about the Christians. Hinduism as a religion seldom
*
*'
,
gives rise to a community^
Territorial Group as a Gonr iunity:
Government have consistently talccn the view that caste and religion
lead to casteisi-.i and conmumalisn and consequently,' they cannot form the.
basis of a community. Therefore, government and many liberal organ! nations
claim that the territorial groups should form the basis of the community.
In rural areas, it is the village, and in an urban set up it should be
. .
the neighbourhood e
While there is no doubt tliat certain caste evils must b5 rocted
out it is an open question whether the whole system must be eradicated.
In which case the caste would serve as an obvious basis for community
development . This will become clearer if we study the characteristics of
’
f
traditional and modern societies.
/•V..
Characteristics of a Traditional Society:
n T —
.
T Ji TL -
-.-•-•.Tn--. - . - -.1 .
x -r -- r ■-
-.i-
II
I'-. - I- --J I.- . -I..
>
I".
M,
9
RLthout attouipting to define it, certain characteristics are given
iii)
iv)
.'-v)
not questioned. This sense of belonging binds the
nenbers of the conLiunity togetherThis co. non uenl er ship defined their identity,» Tradit-i ona‘1 ly groups are characterised by a strong sense
of identity.
A traditional group tends to possess distinctive
qua"lH tn cs of social life whic.i arc peculiar toitself*
Like ail group it has its ova culture but unlike
other groups this culture is more rigid. There are
three conpc iWits of this culture. First, the normative
Systea that tplls people how they should behave.
Secondly, the action systen which includes the actual
ways in which things arc done — the custom, folk
•ways, etc. Thirdly, the things which are produced,
the s^nbols and mater al products, must also be includedAs for the-acceptance of fundaricntally perceptual and
normative values, it is above all the connunity which
largely det unincs the individuals1 perception of
possible questions and their answers*
Characteristics of. I c xrn Sociotic/7
n0ver the last ccntruics, it is clear that the Western societies
have moved from an emphasis upon social organisation based upon kinship,
fealty and status to one based upon contract and rational co-ordination.
This movement is characterized by increasing specialization...of function
and increasing rationality in the lives of the members of the soci'oty->---- ..
Specialization lias led to the ,g?owing division of labour. There
has been a powerful process of see Lal differentiation which has operated
in the separation of function of the major institutions in society and in
the growth of associations aimed at furthering specific interests.
Nationality has helped the Western Society to move away from un•ritieal acceptance of the established order. There has been a.trend towards
secularism and pragmatism. Ways of doing things arc measured in terns of
effectiveness in achieving sone i atorial end. This has been summarised by
Talfott Parsons in the notion that the dominant value theme in advanced
ro>lcty is mastery of the world around• This emphasis upon secularism
and rationality is elicved to go hand in hand with inpersoiulity in human
relations * an emphasis on heads net hearts. This society, according to
Tonnes, produces the 1 nss society1 of rootloss individuals bound together,
not by unquestioned perceptions of reality and an undisputed normative order,
but by personal choice. Thus, the bond is still there, hut it is a much less,
secure one. It is dependent upon fads and fashions of individual choice and is
more prone therefore to violent change and to ’sickness! or ’normlessness 1.
Mxrantages of Traditional over Jk dern /xcicticsj.
1. Greater sense of belongingness
Greater sense of identity
3* More emphasis placed on affective links
Thcrefcre, a tradit: cnrl society lends itself tetter to coixnmity development.
pisadvantar^es s
1 • It may give undue prominence tc its leaders.
(This may be counteracted by greater awareness
: 5 :
IH. COfrWIICT DEVEWIMEhT *
11 Definition:
i huiiic.r beixijs can
Coni-Tunity Devolcpncnt is o. social rrc.coss ” "
becone none conjretont to live vi.tli> and gain sone
itrcl
local
aspects of a frustrating a nd changing world.
2• Explanationj
i). It is a gr-’u.p method for expediting pcrsn'.lity gro/rth, which
can occur wlicn geographic neighbours werk ecgather to serve
their grn.ing concept of the good of all *
ii) .It involves co .perative study, group discussions, collective
action, and joint evaluation that loads to continuing action.
iii) It calls. for.the utilization of all helping professions andagencies (from Iccal to international), that can assist in problem
solving.
iv) But personality growth through group responsibility for the
local common good is the focus
,
Frcri the above it is clear that in recent tines there iiaf been a
change of onpha-si-s -fren inprovenont of facilities, and even of public
opinion to inproyonont in people. But this personal betternent is brought
about in the nidst of social action that servos a graving awareness of
connunity need.
CennunitY Devclornunt is a Brocess:
- - — -As- we- shall use the- word, pro-cess refers to a, or-.-gression ef events
that is planned by the participants to serve goals the// pr< crossively
choose. The events point to changes in a group and in individuaZLs that
can be terned growth in social sensitivity and cor.Tpote^'ico-. The essence
of. process. dees , not consist in any fixed succession of events (these r.iay
var^^ widely fTotigroup to group and fren one time to another) but in the
growth that occurs within individuals, within groups, nd witloin the
connunitios they sorv^o.
J.Y
Extracts fron: Biddle & Biddle: The Comunity Develop-;lent Process.
** The Coixmnity development process is, in e ssencc, a planned and organized
effort to assist individuals to acquire the attitudes, skills and concepts
required for their democratic participation in the effective solution of
as w ide a range of comunity ir.iprcyor.ient problems as pssiblo in an . order
- of priority determined by their increasing levels of .competence” •
J .D . bfczirow, ”Comunity Development as an Educational Process1’,
Community Development, Nati nal Training Laboratorios Selected Reading
Series. No*4, (1961)., * p.16 .
: 6 :
IV.
TIE COIEDNITY DEVELOPER
• 1 • His Aim:
Conr-iEtnity clcvclopi.iont*is; essentially, huriap- devcljpnent• In
the field of coanui'iity dovelopncnt. the goal is to create an ebuosphere
in which non and wor.en can express thuir inherent right to 12Life, liberty
and the pursuit of happiness’’, unf ttcrod by the chains of hunger, poverty
and ignorance. The avtainnent of that goal oust start with the basicneed
of the hurian soul tc express, to grow, to build a life that will fulfill
its dreams. Ho needs ■. nly the stimulus of understanding; the loiowlcdgc thau
others recognize his individuality and. respect it; and the guidance that
evokes his latent ability to achieve his goals?
2. ILL s Role :
a) A nucleus level worker is the central figure in the drama of
community development . Ho is the instigator of process. His responsibility
is significant, but difficult, for ho has a role of. paradoxes • Ho is called
upon to take actions that seem to - :;o contradictory in themselves or to run
counter t o much conventional wisdom.. He is a central figure who seeks
prominence for others.
b) Is a nucleus-level cncourager an innovatcr? Most people use
the word ’’innovator' to describe the inventor, the introducer, or the promote.,
of a now idea. A com'.unity developer is none of these; hens rather an
instigator of processes that call upon others tc become innovators. He tal^es
the initiative so that others will‘take the initiative.
c) Neither is the community developer a change agent in the
sense of an advocate of (to him) favourable chonges. He is rather the
expediter of the favourable change 3 that people have chosen.
Though the process may begin and continue without loin, he is
contralto any planned and organized utilization of it. Rrofessionaly
nucleus—level workers of sone sort become indispens-ablc, and some institu-7
tional responsibility for employing and training them is called for, if
community development is to have any impact upon the history that is lived.
But if the professional workers do their job adequately, they can expect
people to learn how tc develop with loss and less encouragements from them
selves . An cncourager instigates a growth of initiative that should run
«way from him.
3. Dilcu.ias of the CcLii.wity Devoloper:
a) The Institutional Dilerra,:
..........JU helping pr/jfossicns face a dilemma posed by their institutionali- zation,: Hliich shall come-fir-pt -7 service tQ^hteart beings or loyalty to
employing organization?
j •
. P
;
The n oxi bill ty that is required to serve the people’s needs is
restricted by the pressure upon the community developer to support the
sponsoring institution and to follow its prograramo prescriptions.
The institution makes its own domancls, many of which are incompatible
with the processes of community development. For example, an institu
tion may demand to bo aggrandised, ’’played up”, given credit; and, usually
there is pressure to follow traditional rituals. But the community may
go off in pursuit of r.otivitios of its own choosing — Indeed, the
: 7 :
In working with people through the communtiy dove lor’ •
process,
it is easier for a community developer to be self-effacin'" t; am it is for
him to red' ce the prominence of his institution- Uut then, ip ..titutions,
too, can change - in aspiration end in the nature of their programmes.
Sometimes they do this as a r. suit of pressure (..ontly applied.) from
employees. There are sone 'that arc. beginning to set up programmes which
call for the flexibility to meet people where they arc and which will free
employe's to follow the stumblin g yet hopeful development of ordinary people
h)
The prolhleu of fhiancial support;
The employed community development worker wants to keep his institu
tion solvent, if only t’o preserve his salary. But if the work with commuhity
nuclei is so little heralded that the donors to the i?istitution do not hear
of it, this particular won.: may fall on evil days, or the institublum
be in jeopardy.
c)
Identifi cation w?..th bourr<eoise values :
Most institutions, once they have received public recognition for
their work, tend to identify with the 11 establishmentn. In practice this may
moon lining up with middle-class morality and values, with the ethic of
"success”, and so on. Indeed, most community developers must wrench themself
away from their accepted beliefs to accept the patterns of value that may gre
in the nuclei. Uncomfortable as the community developer may be, an institu
tion is cyen more uncomfortable when it discovers that its employees have
identified with people other than those who accept middle-class values. The
community developer who does come close to people’s needs and. thinking may be
condemned for lowering Ms standards of excellence or for being disloyal to
middle-class ethics.
d)
Personal Dilcnms:
r**-
.
.
.
. .j...
1 • Personal Itelationships:
There arc uniquenesses of personal relationship that seem to effect
outcomes ■ favourably or unfavourably. The success of process seems to depend
upon a mutual trust between the community developer and the community develop
ed. Unless the community developer trusts and is trusted, unless he is
acceptant' of people, the process cannot be expected to work.
The relationship (rapport) is one of warmth toward people, one
in which they cone to trust him because ho obviously believes in then.
Ho is acccptant of then, as they are, but with tho expectation that they
will bo cone better in a process that develops from friendship. He likes
then as individuals and believes in their favourable potentials. His belief,
expressed in manner, tone of voice, and activity, more than in words, tenets
to create an atmosphere of confidence —- confidence in themselves and in the
growing competence of other members of the group and in tho group as a whole.
Tlie community developer contributes to this social atmosphere by
being the kind of person he is. He is imperturb-blo, non-shockable, quietly
confider.it, patient, nonpartisan but devoted to people.
Tho people thus encouraged tend to discover that they are creative
in ways that they had not earlier expected.. This leads then to act increasingly
bettor. In other word ., to the extent to w ich the co;inunity..dovolopor is
successful to that ext-end his services will gradually become loss and loss
necessary. This is the shokc of diminishing dopcndcncc - when ho realises
:S •
2• 3 olf-concopt s:
i) Expectation of Fr-or.iinoncc:
hfost trained workers-w .th~pooplo feel obligated to exhibit
the skiH s in which ihey arc expert • The teacher rush instruct; the social
worker must take care of people; the rclipiouo worker must conduct worship
services; the sociologist must make community surveys; : nd so on down a long
list. The iroinod person’s concept cf his own dignity rests upon his doing
the job that is associated with his. pwn sense of importance* Merely to under
stand people, to sliane their worries, to bclijve in then, and. to create cir
cumstances that will chip them to solvo their problems, Liay not give a
community developer enough of a conviction of his contribution, a sense of
his importance.
The desire for personal prominence tends to interfere with sensi
tivity to'tho people who are to develop. Hopes for recognition (conscious
or unconscious) redi^ce the probability of learning along with the partieija nts
It is bettor to seek the triuophs of success in the lives of those who
develop. There is satisfaction in discovering such triumphs, But this is
not likely to be apparent until the expectation pi .prominence has been cheer
fully cibandoned.
ii) D o-G-ooder I mpulsos :
All community developers suffer from another dilemma, which is as
\ helf people., This might be termed ”the frustration of
old as the impulse to
have humanitokrian motives, -th oy
Since
the do-gooder”. C„_ _ community
______ _.v developers
______
have, or rapidly acquire, ideas about the ’’correct” improvemeiis people ’’must ”
accept. They set’ cut to bring the benefits they have chosen, and then they
find the potential beneficiaries unwilling to acquiesce. In an extreme form,
the do-gooder becomes desperate because ho concludes that the people are so
apathetic, stupid, or badly motivetueb that t?ioy will not or 'cannot do his
bidding •
Tlie emphasis upon predetermined imporvements and the reliance
upon process represent extreme poles of a scale of operational influence.
Few community developers fully escape dc-gocder impulses. The seeking of
acquiescence to ’’my1’ good ideas is over a, temptation. Rut some developers,
have been attempting to make clearer a method that seeks the strengthening
of problem-solving initiative among the beneficiaries of development.
iii) How nnich influcnco?
A final paradox needs to be mentioned. It has to do with a.
community developer’s concept of his influence* Ho may be instrumental in
bringing about the fundamental changes in people’s lives that make them
more ethically competent citizens. At-the same time he mus^! recognize that
his voice is a feeble one among the cacophony cf influences that exist in
modem life.
A community developer wields one vei7r small infj.uonce in the
midst of a confusing complex of forces'* The process ho hopes for may never
sta.nt, mo.y bo stopped after storting, or may be diverted to undesirable pur
poses by extraneous events and circumstances* While almost miraculous
changes may oe.eur in people (we have seen them occur time and time again),
he must also be prepared for the disappointment of poor response.
*
S U MMA R Y
1 • The community developer attaches more importance to ma.n?
than to institutions/ideelegies.
2. His main aim is to make the individual^in^tiie—community
3* His meihod is to develop in the people critical awareness *
Hls most effective weapon is faith, in the people.
5. HLs greatest joy is to sec that ho is no longer needed
because the community has talon over.
C-Orp h %.|h.
COMMUNITY HEALTH TRAINING IN INDIA—PROFILES
COMMUNITY HEALTH AND DEVELOPMENT
1. 4 Weeks training programme on Community Organization
and Development in English, Telugu and Tamil
for Rural Health and Community Development
Workers: conducted by Rural Unit for Health
and Social Affairs (RUHSA)./
They also conduct Workshops on HOW TO START
A COMMUNITY HEALTH PROJECT.
For details write tp:
Head of RUHSA Department
RUHSA Campus Post
North Arcot Dist 632209
2. 6 weeks Leadership Course in Community Health and
Development: conducted by Deenabandu Training
Centre. It is designed to upgrade the skills
of middle level community health workers without
specific academic qualfications. The participants
should however be able to read and write English.
The training programme covers topics such as
concepts and ap roaches to community health;
human relations; communications; programme
management; maternal and child health; communi
cable diseases; development actvities including
income generation; survey methods etc.
For details write to:
The Course Coordinator
Deenabandu Training Centre ♦
R.K? Pet 631303, Tamilnadu
| J
3. 10 weeks training programme on Community Health and
Development: conducted by Internatio al Nursing
Services Association (India)• The course is for
health professionals and others involved in
com: unity health programnes. It is divided into
6 we- ks class room teaching and 4 weeks field
exposure. The topics covered include health and
development, drug issues, nutrition, teaching
methodologies, communicable diseases, cost
analysis etc. The course is followed by a
Workshop after one year. The medium of instructior
is English.
For details contact: The Programme Director
INSA/India
2 Benson Road, Benson Town
OOCUM^TATION )
Bangalore 560046
UN'T
c
2
4.
12 weeks
training programme for Community Health Workers:
conducted by St John’s Medical College and Hospital.
The training is both institutional and field based.
The course is directed at attaining self-sufficiency
in knowledge and skill for Independent management
of a health centre. The trainees are also given
basic skills in herbal medicine, homoeopathy,
accupressure and herbo-mineral medicine.
The course is open to candidates with a basic
educational qualification of SSLC or equivalent
engaged in health and development work. For details
write to:
The Principal
St John’s Medical College ;
Bangalore 560034
5.
2 years Diploma Course in Community Health (CH Guide)t
conducted by Christian Fellowship Community Health
Centre and Christian Education^ Health and Development
Society* They also conduct various training courses
such as:
—PG Diploma in Applied Nutrition and Dletics and
Catering
—PG Diploma course in Health and Development
—Multipurpose Health Workers (ANM) Course
—Village Health Workers (VLW) Course
These courses are either under Madurai Kamaraj
University or are recognised by the government.
They also conduct special cours s on Rural Health
Orientation and short term courses for voluntary
institutions. For further informations, write to:
Christian Fellowship Community Health Centre
and Christian Education, Health and Development
Society
Santhipuram, Ambilikkai 624612
4
Anna Dist., Tamilnadu
6*
Two years M*Phil programme in Social Sciences in Health
for postgraduates in Sociology, Psychology, Public
Administration, Political Science, Economics,
Anthropology.
b« Three years PhD programme in Social Science in Health
tor Mephil in Social Sciences in Health or a
for a distinguished research worker.
c* 2 years MCH (Masters in Community Health) programme for
MBBS graduates and MSc Nurses*
3
d. PhD programme in Community Health for physicians
and MSc Nurses.
For details, write to:
The Centre of Social Medicine and Community Health
Jawaharlal Nehru University
New Delhi 110067
I
COMMUNITY HEALTH MANAGEMENT
1.
6 weeks residential training programme on Management
of Primary Health Care: conducted by Institute
of Health Management# Pachod, The course is designed
to provide a working knowledge of the process
of management in the field of health including
management concepts; community organization and
development; principles of public health and health
and management information system* The course is open tc
people who are involved in primary health care
services. The medium of instruction is English.
For further information contacti
Institute of Health Management
Pachod
Dist Aurangabad
Maharashtra 431121 «
I
2. 11 months Post-graduate Diploma course in Health Care
Administration: conducted by St John’s Medical
College Hospital. The course is not a traditional
class room lecture oriented one. Emphais is on
job trainingt case studies# exercises# seminar etc.
It is open to medical doctors# qualified pharmacists#
graduates in corwnerce# science and arts with hospital
experience. Some of the topics covered in the course
are Principles of Management; Organizational Behaviour;
Materials Management; Personnel Management; Finance
Management and legal aspects of health care. Successful
candidates will be awarded a ’’Post—graduate Diploma
in Health Care Administration”. The medium of
instruction is English and organizational sponsorship
is essential. For further details contact:
The Coordinator
Health Care Administration Office
St John’s Medical College Hospital
Bangalore 560034
3. 15 months Diploma course in Community Health Management:
Conducted by RUHSA in conjunction with Voluntary
Health Association of India. The course is residential
and is conducted in RUHSA campus. The course is open to
people engaged in health and development field
preferably with a Bachelor’s degree/Nursing Certificate.
On completion of the course a Diploma will be awarded
by the Voluntary Health Association of India (VHAI).
For details write to:
The Director
LI3RARY
> O'
Course
DCHM
AND
post# North Arcot Dist t
RUHSA
DOCUMENTATION
Tamllnadu
632209
UNIT
■
’•
r
¥
i
4.
2 years Certificate Course in Community Health
Planning, Organization and Management, This is a
correspondence course designed for managers, supervisors,
and others involved in health and. development work. The
course covers principles of management; personnel management;
materials management; elementary accounting; basic labour
legislation etc. For details write to:
The Coordinator
Community Health Education Training & Personal
Voluntary Health Association of India
40 Institutional Area, South of IIT
New Delhi 110016
Development
5. Diploma in Hospiral Administration (DHA)
On year Diploma: conducted by Armed Forces Medical College,
Pune (eligibility MBBS with 3 years Army
service) under Pune University
Post Graduate Institute, Chandigaigh
(eligibility Postgraduate or graduate
in any discipline plus 2 years experience
in hospital/health service)under Punjab Univ*
Masters in
Hospital
Administration
(MHA)
conducted by All India Institute of
Medical Sciences, New Delhi
Post-graduate/graduate in any discipline
with experience in health/hospital services
are eligible.
PREVENTIVE AND SOCIAL MEDICINE/COMMUNITY MEDICINE PROGRAMME IN INDIA
M,D.
Name of institution
University
Basic qualifi
cation
Duration
Andhra Medical
College
Vishakapatnam
Andhra
MBBS
3 years
Darbhanga Medical
College,
Laherl Sarai
Bihar
Mithila
MBBS +
1 year rotating
internship + 1 yr
house job or
6 months in
allied subjects
2 years
Patna Medical
College, Patna
Bihar
Patna
MBBS + 1 year
compulsory
rotating
internship
2 years
BJ Medical
College
Ahmedabad
Guj arat
MBBS
3 years
Smt NHL Municipal
Medical College
Ahmedabad
Gujarat
MBBS
3 years
Govt Medical College
Baroda, Gujarat
Sayajirao
MBBS
3 years
Govt Medical College
Surat, Gujarat
South Gujarat
MBBS
3 years
Bangalore Medical
College. Bangalore
Bangalore
MBBS
3 years
Medical College
Trivandrum
Kerala
MBBS
3 years
Medical College
Callcut
Calicut
MBBS
3 years
Govt Medical College
Jabalpur
Jabalpur
MBBS + 1 year
housejob
3 years
MGM Medical College
Indore
Indore
MBBS
3 years
Govt Medical College
Nagpur
Nagpur
MBBS
3 years
2
Name of institution
University
Basic qualifi
cation
Duration
Grant Medical College
Bombay
Bombay
MBBS
3 years
Armed Forces Medical
College, Pune
Pune
MBBS with 3
years service
in Army Medical
Corps
2 years
Seth GS Medical College
Bombay
Bombay
MBBS
3 years
Topiwala National Medical
College, Bombay
Bombay
MBBS
3 years
Govt Medical College
Auranbabad
Marathwada
MDBS
3 years
Dr VM Medical College
Solapur
Shivaji
MBBS
3 years
WS Medical College,
Baria
Sambalpur
MBBS
3 years
for direct
students
MKCG Medical College
Berhampur
Berhampur
MBBS
2-3 years
Medical College, Amritsar
Gurunanak Dev
MBBS + hous‘ job
1 year
2 years
Govt Medical College
Patiala
Punjabi
-do-
-do-
SMS Medical College
Jaipur
Rajasthan
-do-
-do-
SP Medical College,
Bikaner
Rajasthan
-do-
-do-
RNT Medical College
Udaipur
Rajasthan
MBBS
2 years
Christian Medical College
Vellore
Madras
MBBS + 1 year
housejob
2 years
SN Medical College, Agra
Agra
MBBS + 1 year
housejob
2 years
Motilal Nehru Medical
College, Allahabad
Allahabad
MBBS
MBBS
2 years
JLN Medical College,
Aligarh
Aligarh
MBBS t ,1 year
house jo.•b
2 years
3
GSVM Medical College
Kanpur
Kanpur
MBBS + 1 yr
houseJob
2 years
LLRM Medical College
Meerut
Meerut
MBBS + 1 year
housejob
2 years
Karnatak Medical College
Hubli
Karnatak
MDBS
3 years
MBBS + 1 year
housepost
2 years
MBBS with 55%
Marks
2-3 years
All India Institute of
Hygiene and Public Health
Calcutta
All India Institute of
Medical Sciences, New Delhi
Calcutta
AIIMS
Maulana Azad Medical
College, New Delhi
Delhi
MBBS + 1 year
housejob
2 years
Lady Harding Medical
College, New Delhi
-do-
-do-
-do-
Goa Medical College, Goa
Panaji
Bombay
MBBS
3 years
JIPMER, Pondicherry
Madras
MBBS
3 years
f
D«P.H.
Name of Institute
University
Basic qualifi
cation
Duration
Institute of Medical
Sciences, Hyderabad
Osrnania
MDBS
2 years
Armed Forces Medical
College, Pune
Pune
MBBS with
3 years army
service
1 year
Govt Medical College
Aurangabad
Marathwada
MBBS
2 years
Seth GS Medical
College, Parel Bombay
Bombay
MBBS
1 year
Topiwala National Med
College, Bombay
Bombay
do
-do-
SMS Medical College,
Jaipur
Rajasthan
MBBS + 1 year
|housejob
1 year
All India Institute
of Public Health &
Hygiene, Calcutta
Calcutta
MBBS
1 year
Bangalore Medical
College. Bangalore
Bangalore
MBBS
2 years
DMCW (Diploma In Maternal and Child Welfare)
All India Institute
of Hygiene & Public
Health
Calcutta
MBBS
1 year
MBBS + 1 year
housejob
1 year
DTM&H (Diploma in Tropical Medicine)
Darbhanga Medical
College, Leheri Sarai
Mithila
DMLT ( Medical Laboratory Technology)
Govt Medical College,
Aurangabad
Marathwada
BSc
1 year
St Johnfs Medical
College, Bangalore
SJMC
PUC
1 year
r
ft *
I
CO
VARIOUS
-
HEALTH
TRAINING
PROGRAMMES
CONDUC
K
BY
NGO’S
OF
INDIA
1
I
Pr
Com
Vol
40,
Sou
< .
■- ?
Nov
I
^FQJW\TION ON COMl-lU^ITY
Duration of Course
' rqar
_
... isation
Type of course
Child in Need
Institute
Post Box 16742
Calcutta
Job training course
/for supervisors
3 months .
6 day refresher
course for super
visors
6 days
T2T~
'
'---- —
Training of Instruc
tors of Angcnwadi
18 days
training centre
y-..
T RA 1N ERrlETWO
Method of Selection
Through- Govt.
DO
Interview
Orientation course
for Statistical
Assistants
6 days
Through Govt.
Anganwudi Training
3 months
Through Ranchayat
Anganwadt Helpers
6 days
Training programme
on Community Health
for B.Sc. nursing
students
15 days
College of Nursing,
Govt, of W. Bengal
Orientation course
on M.C.h.
4 week
BY NGOs
0 rientotion course
for Doctors forC.H.
6 months
Through interview
DO
<3rt ad whpn
?ic
r)
Satisfactory
DO
'(9)
Around 30
DO
(16)
It dep ds
on Gov’.
DO
£o.
<li>
)
Residentia
Non-reside
tial
(1
Residentia
ICDS community
Health & Nutri
tion, Early
childhood stimu-r
lation. Approa
ches of work with
the communities.
DO
Focusing on learn
ing needs
ICDS training meth
Availability
odology, subjedwise
of trainers.
input.
At least two
courses in
every year.
Bio-statist ics,
This course
management in
has started
very recently formation system.
ICDS, NUTRITION,
Depends on
Health,
Child
selection
Development and
Community contact
DO
Child care, supple
mentary nutrition,
certain skills to
support child care
activities.
Community Health
nursing
DO
DO
Arounc 2 0 to
25
DO
Around 30
DO
Around 50
DO
Around 50
DO
DO
Around 30
From 1988
DO
DO
Summer &
Winter
DO
DO
Usually end
of this year
DO
DO
DO
DO
Compreh en s ive
Mother and Child
Care.
Health care manaDO
g em en t, commun ity
health & Nutrition,
Exposure to differe
nt community health
work, writing project
eroposel on community
11 xth.
3
(1)
(2)
(3)
(4)
Particioatory Train
ing methodology
It takes in 3 Straight offered to
phases# duratin Instructors of
different trg. centr
of each is 7
I
working days
Short orientation
on C.H. for village
practitioners
6 working
days
Through village
selection committee
Orientation on child
survival and develop
ment course
6 days
Through Mahila
Mandsl
National project on
Demonstration on
Improved chullah
10 days
Through village
working committee
Training for primary
health care in collabo r at ion w ith th e
Jadavpur University
6 weeks
Through interview
2
""T*
Issues
P
Strategies in 5 days
RUHS^ Dept.
Christian Medi- Adult Education
cal College &
Hospital/ RUHSA
Campus/P.O.632209
North Arcot List.
T.N.
Curriculum Levelogment 5 days
Personnel involved i
policy level promoti
of adult education/
heads of adult educa
programmes
First come first ser
-sponsored candidate
1(1.;
C
)
’ LI5.
(-2)
2? to 25
End of Winter
Pari -cipatory
trailing approach
and its Philosophy
DO
DO
30
Beginning of
Winter
Community Health,
Use of drugs/
management of
referral services
DO
DO
25
End of Winter
Child survival Sc
development
DO
DO
20
DO
30
8 years
20-30
1983
4 years
20-30
1985
DO
April to March Environmentalsanitation, demon
stration on improved
chullah.
The beginning Community health Sc Non resi
of winter and Nutrition, dgild) -tial
end of summer Survival
Design Sc develop a
curriculum, identify atleast 5 strategies,
plan Sc implement, evalua
te the learners, identi
fy areas of evaluative
research in the field
of Adult Education.
Analyse available methods t
select community volunteer
identify criteria for sele
tion of VLWs, demonstrate
teaching methodologies,
develop model for .supervi
sion monitoring system,
develop instruments to
evaluate training, analyse
administrative issues
(3)
4
Centre for Health Training for
Education, Training ranging from
& Nutrition Aware Balwadi
Teachers(pre
ness, 2nd floor,
Drive-in-Cinema
School)
Building, Thaltej
Rd., Ahmedab ad•
(4)
3-7 days depending
on orientation/refresher course
Ms. Pallavi
Health, work
ers Training
5-7 day orientation/
refresher course
Health work
ers Training
Ongoing with local
voluntary agency
once a month 3 days
tra in ing
Dai Training
3 days Refresher/
Orientation course
)
Participatory
training £
communication
techniques
6 days
Nutrition Pfelth 3-5 days
training for
middle level
functionaries
C-to-C workshop
(ch ild-to- -child)
tr ining implsmen 3-5 days
t.;Os/t
ci.'. - ..VS
- lo-
(1)
(2)
(3)
C-tc-C workshops 3-5 days
with children/
youth.
(4)
6-14-18 years old
children.
Nutrition and Health 3 days Balwadi teachers
Training for gross
root level workshops.
Training Creche
Workers.
3 days Creche teachers
pay care Centres.
Training for organi- 7 days Organisers from village
level awareness camps,
sers awareness generation programme.
Awareness generation 2-3 days Women of the village
camps. (Womens aware
ness nutrition
health care etc)
(5)
Christian Medical- Project Managers
15 days Advertisement Project Ma
Training(CBPHC)
Association of
Indiazp.B.No.24,
F.S.Training(CBPHC) 15 days calling appli- Middle lev
Nagpur-M-S .
Dr.Bima1 Charles.
Health wor
cations.
Project Managers
5 days screening
Project ma
Training.
invitations
I/-
(1)
$
(2)
(3)
F.S. Training
(CBFP)
5 days
CSCD Staff training
5 days
(4)
Women Health & Deptproject staff training 3 days
CBPHE
CBFP
CSCD
(6)
Christian Fellowship Post grsduate
Community Health
dipJome course
Centre/ Santhipurani/ in applied nutrition, di-.ties &
Ambilikkai-624 612
Dr. Jacob Cherian
caterinc.
CO214UNITY BASED PRIMARY HEALTH C.
COMMUNITY BASED FAMILY PLANNING
CHILD SURVIVAL 6c CHILD DEVELOPMEN
1 year
Written exam & oral
P.O. ai>loma course
in health 6 develop
ment
2 years
it
A.G. diploma in
Business m<nagement
(Part <-ime)
1 year
DO
Certificate course
in Rural D( velopmant science
1 year
DO
B.Sc. Nursing und er
M.G.R. .asdical
Un iv./r s ity
4 years
DO
>2-
(3)
(2)
(1)
Multipurpose Health
Workers Course (ANM)
2 years
Dip. in CommunityHealth.
1 year
Dip.in Civil, Mechanical, 3 years
Electric
Electronic.
(4)
Written Exam
& Oral
(5)
Womens
Mens
II
H
n
Ct
N.B: Mess fees extra..
(7)
National Insti- Training in Mental Health 2 weeks
tute of Mental
Ce re.
Health & Neuro
Sciences z Bengalore
Deputation by PHC Doc
Dept.of Health
Family & Welfareo
DO—
1 we^ek
—D0—
Health w
— DO—
4 weeks
—DO—
Mental H
Teachers
DO—
3 days
or
through ICMR or
individual
application.
Deputation by Anganwad
Trailing in -Mental 3-7 days
on request
Any grou
who are
Training in
Counselling.
on request
Any inte
Once a
week for
one year.
(11)
(10)
1-.)
Management of common
mental disorders.
(1
Resid
16
1982
2C - 25
1982
16
19 83
Principles & practi
ce of Community
Mental Health
DO
2C - 30
1985
Identification &
management of child
hood psychiatric
problems
DO
Identification and
care of mentally
ill.
Non-r
tial
10
10
r:
20
30
20
30
1982
DO
Princ iples and
methods of couns filing.
DO
DO
(1)
(2)
(8)
St.John’s Medical College Comrrunity HealthBangalore/560 034.Basic Course.
Dr.Dara S.Anar.
(9KZ
(3)
(4)
3 months Direct application
Experience in rura
health work.
Food Hygiene Course
10 days
Direct application
Health Care Course
for Seminarians/Deacons
2 weeks
Application throug
their superiors.
Training pregramme for
Medical workers in
universal Inmunization
Programme.
4 days
Deputation from
their Organi
sation.
Training pre gramme for
para-medical workers in
universal ir munization
programme•
2 days
—DO—
Rural Health Development
10 weeks Screening of appli
International
rs Trai ning Programme 6 weeks cation forms.
Traine
Nursing Services
theory
(only 15 at a time
Association.(INSA)
4 weeks
2 Benson Road,
practicals
Benson Town, Bangalore.
1 year super.
Ms.Sujata de Magry
vised correspondence
Ms.Edwina Pereira.
which includes one
faculty visit and ends
with one follow up
workshop.
t
(10)
(11)
'.
(s)
(9)1tw2eks supervi
sed, 1 yr followup
Max • 2 0
May 1982
Health in develop- Re
10
ment subjects•
Administration of No
C.H. Dept, program f
y
Project planning
in impl am en t a t ion
Evaluation of
projects.
(o *■
(1)
(3)
(4)
(10)
Vivekananda GiriJana
Village Health- 3 days every Existing VHW’s
Ka 1 yana Kendra, B.R.Hills Woxkers
6 month.
P. C. & Via. Chama raj a naga r
tra ining
Mysore.Dt.571313.
programme.
Dr.Abbey John.
Dais training
—DO—
Any practising D
Programme.
(11)
Community Health Cell
47/1 St. Ma rk1 s Road
(1st Floor)
Bangalore-560 Oil
Dr.Ravi Naryan.
The Community Health Cell (CHC) is a resource
supporting on-going initiative in Community He
awareness building efforts. It is not primaril
Trainer and does not run specific courses of i
cn-gcing basis. It participates as resource in
to exp!ore more participatory approaches and h
Crouj s to plan and evaluate their training exp
together manuals based on this experience. exp
(105
)
(10)
(11)
3 years
15
20
1986
1.Treatmant of
common a ilments
ii,Giving compete
nce to be health
educators
3 year
10 - 15
1986
i.Review of exist
ing obstetric
practises
ii.Antisepsis
(11)
(1)
(12;
)C)
Health Management
VoluntaryHealth Association (CHPOM)
of India.
(5)
(3)
(4)
1’Year-
By applications People w
in the V
who are
area man
middle l
of Com.H
i.e./ al
in the s
with dec
powers.
School Health
3-5 days By applications Health C
working
Teachers Training
in School Health,
7 days
Health Awareness
3-5 days By request
Developm
By request
Who are
& involv
& Docume
Training on Infor- 5 days
met ion & Documentation
Training for Dais
By applications School T
3-5 days on the request
of State VHAs.
Local pe
Health workers
Local He
Traditional Medicine 5 days
(12) Working jn Health
Projects.
20
every year in Sept, study of Society
Health & Development
Techniques of Studying
in Community Health.
Management & Administrativ
Principles.
Effective Change Agent
Elective/ practicum.
Working in Health
Proj ects.
2 0-25 Any time
What is School Health Prog
How to start School Health
Basic Principles of Planni
Involving teachers & Stude
in School Health
Communication strategies.
Working School s
20
Health related subjects
Common Problems with child
How to deal with them
How to involve children in
activities.
30 or 40 As and when
required.
Health Issues.
20
Concepts on Documentation
Theory part of Information
Source/selection/collectio
classification.Cataloging/
Indexing/Bibliography etc.
Practicals on the tech.asp
of classification/ catalogu
indexing/ cross reference
bibliography.
Visit to other documentati
centres for further study.
Village survey/data collec
audio-visual documenation,
coaraon techniques & networ
C"1 'es Cc group discussions
As and when
required.
10
*
20
(12)
As and when required
Pre-natal, Anti-Natal
& Post-natal care.
Delivery Care
Better Child Care
Anybody
t
20
As and when required
Health awareness on
Home Remedies.
H - 2.
ST. JOHN’S MEDICAL COLLEGE, BANGALORE S60 034
Orientation of the College to Community Health
AIMS AND OBJECTIVES
Goal: The education process in Community Health is so designed as to pay
attention to problem based education. Which is learner centered and
Community onented. This is done by acquiring the knowledge, skills and
attitude necessary to grasp the social and political dimension of health action,
such that it will enthuse the people in the community to be enablers of their
own health in all its dimensions.
Objectives:
1.
To bring about, in the student, an awareness of the social, political and
economic status of the Community, the environmental problems, the
existing health practices and beliefs.
2.
To study the role of the Government and Voluntary Organisations in
tlie integrated welfare of the rural community.
3.
To acquire the skills of carrymg out a field survey and other studies,
using appropnate sampling techniques and learrung the analysis and
interpretation of data.
4.
To get acquainted with the principles of health education to individuals
and groups in the rural setting and to understand the role of various
members of health team.
5.
To acquire knowledge and skills in epidemiology, health planning and
administration, national health priorities and programs, population and
family welfare programs, maternal and promotive services to
vulnerable groups in the population.
6.
To catalyse the process by which the families in the village/urban
slums will own up the responsibility for their health and take
appropnate promotrve, preventive, curative and rehabilitative
measures, harnessing the available resources in the community.
12. Movement for Alternative and Youth Awareness. Which silk route this? A
situational analysis of child labor in the sericulture industry. Bangalore
MAYA 2000
15
- Media
RF_COM_H_8_SUDHA.pdf
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