SJMCH PAPERS ON RURAL HEALTH SERVICES AND DEVELOPMENT
Item
- Title
- SJMCH PAPERS ON RURAL HEALTH SERVICES AND DEVELOPMENT
- extracted text
-
1
ST. JOHN'S MEDICAL_COLLEGE,BANGALORE
RURAL HEALTH^ SC HE ME_ - NEWS LETTER
January - June 1983
Volc. 3 No:l
EDITORIAL:
My^dear friends.
For some of you the time is un to say good-bye to the beonle
w om you served these two years in the rural areas. Looking back
on these years must certainly mean achievement, in a certain sense.
1. e thing is sure, a growth as a doctor and a nerson. All your
rich experience has not only been recorded in the rages of memory
but also
.
--- is ■engraven
in the hearts of simole neonle to whom you
were someone
There are others who are just venturing upon their new taste?
yet others are questioning the stand they have taken in choosing to
serve in rural India, Will it mean frustration? Is there any
future to the career as doctors ? ’’There are always right answers
to all our questions if one is oreoared to ask the right guestion".
says little Anna, in " Mister God this is Anna".
This newsletter, a
a simole
simple one
one in
in fact,
fact, includes an article on
breast feeding and a few hints <
The directives of the C.B«C.I.
advance. “ t'”t Y“
ready for the
Whatever may be the role one’is 'called unon to nlay, I hone the
following prayer of St. Francis of Assissi comes
to your aid some
times;
Lord make me an instrument of your oeace
Where there is hatred. let me sow love;
Where
there is injury. pardon
Where
there is doubt, 1faith;
Where
there is desoair,, hope;,
Where
there is darkness, light
Where
there is sadness. joy.
*****************
DR. SR. ADELCIA.
The Secretary of C.B.C.I. sneaks
RURAL SERVICE
educational objectives for which St. John’s
Medical College was established is to ensure "dedication in the
service
• e^Decially the disadvantaged and the
,of
_ the rpoor in the spirit of^Christ"
j °2
T:>art of our graduates, as
noted in the prospectus of the College j The C.
See-iety
for Medical Education has been
l
insisting almost ad nauseam that
what should distinguish St.. John's graduates from others is their
readiness to serve the Door in rural areas. Tn the thousands of
villages of rural India, there live a mass of humanity that hardly
has even the barest necessities of life.
Cont' d.\ o . /2.
1
:
2
s
Health is a basic need for every human being. Health is not merely
the absence of disease, but a feeling of euohoria or well-being that
gives satisfaction and contentment to man anH enables him to work
har^nd live haonily and contribute2 to the imnrovement of the
quality of life in and arouhd him.
It is common knowledge that the
slums in our cities and the rural areas of our country are infested
with different kinds of diseases, and health has Become a casualty in
such places. Malnutrition, lack of sanitation, lack of drinking
water facilities etc. are the main cause for the noor condition of
health of our disadvantaged brethren, They need to be educated in
preventive tiealth care anart frs
rom __
reouirinq curative treatment, and
who is better suited than the doctor
—to orovide medical care and
instruction in hygiene?
A doctor?) by virtue of his nrofession, is well accented by our
rural folk and well oualified to be a leader of the village comminity,
not only in regard to health care but also where their economic and
social amelioration is concerned. He can be an agent of change,
a catalyst who can bring about a transformation. No other oerson can
be in such close contact with peoole as the doctor in a village.
e should, therefore, canitalise on this oriveleged oe,sition of his
and try to bring about a revolution - a real change in the outlook
of people towards health care and social and economic uolift.
excelle?t training imnarted to the graduates ofSt. John's
will become meaningful only when they actually act as catalytic
agents in the remote parts of our vast country.
It is then that
they begin to face the real challenges of life and will havek© decide
how best they can apply the knowledge and principles they bad
acquired during their formative period at St. John's. Jhe village
setting is such that it affords ample opportunities for making
independent judgements. The doctor can be the master and cantian
of the destiny of the villagers. He can be the monarch of all he
TS"r^yS* • TJjic?ue therefore is the role of the doctor in a village,
it this is borne in mind, our alumni can understand why the C.H.C.I.
ociety for Medical Education is insisting on a two year rural service
bond on the cart of the students before their admission to the
Coilege.
It is necessary for our alumni to involve themselves
wholeheartedly ih the life-pattern of our rural folk. fhey must
get into the. main stream of rural life and only then can they feel
the pulse of the people both literally and figuratively, when a
doctoris involved m this manner, the oualities of compassion,
understanding and other humanitarian values will come into play and
provide the doctor with
the
--—a correct perspective; otherwise his mind
would be con the
'’
good things of life-*the amenities and social
enjoyment that our cities provide.
T’_ cannot be al hapny doctor in
- •a village if he does not integrate himself into the life nattern of the
the villagers.
The oreventive, curative and rehabilitative role of the
doctor and his involvement in the life of the rural folk is a
gigantic task and calls for herculean efforts d>n his oart.
But once he identifies himself with the neode, his task will
become less difficult. Even so the goal will remain a
distant reality. The sower of the seed may not see the fruit.
But the trouble taken by him will not go unrewarded. Little
by little, the economic, social and health standard of our
rural folk will rise, thanks to the effective role of the doctor.
ContMo .3-
k
3
?
Our alumni are aware of the sanctions attached to nonfulfilment of the rural bond. The sanctions are orovided not
with the view to oenalizing, but securing actual rural service.
There, are also incentives to those who complete the two-year
rural service bond. A recent incentive (which can be viewed
as a sanction as well) is that cost graduate seats in St.John’s
Medital. College, will not be given to those who have not done
rural service for at least two years and a greater weightage
will be given to those who have put in more than two years of
rural service.
As noted, above, service to the poor and disadvantaged must
be rendered in the spirit of Christ. Christ went about doing
good, his healing touch and soothing words were available to
every one. The same spirit should animate and actuate our alumni.
FR? IGNATIUS PINTO.
* -k-k'k * -A-* ********* *
ADDSD TO THE NUMBER...,
Dr. Paul Joseph,
Karuna Bhavan Hospital,
Koruthode P.O,
Via Mundakayam ,
Kottayam Disto,
KERALA
Dr. Boban Joseph,
Samaritan Hospital,
Murikkasserry P.O.,
Idukki Dist,
Kerala - 685 562.
Dr. Jacob'Vadakekalam
Maria Nam Hospital,
Sooranad - 690 522
QuiIon Dist.,
Kerala.
Dr. Edwin Dias,
Holy Cross Hospital,
Trasi P.O. -576 .235,
Coondapur Tg,
South Kanara.
Ruben Abraham,
Pittathankal,
Pongumood,
Trivandrum 695 01'1.
Dr. Martin M.R.
St. Joseph’s Hospital,
Poovathussery P.O.,
Parakadavu, Via Kurumasserry-683 579
Kerala.
Dr. Jbse Jacob,
Mary/Queen/Mission Hospital,
Palaonpra P/O.,,
Kan j/LrapaJly,
KotSayam Dt. ,
Kerala- 386 518.
Cont’d../4.
>
: 4 :
BREAST FEEDING AND AFTER - A GUIDE TO INF ANT F EED TNG
Since ancient times, breast milk has been the only fooH for the
human infant, and it was known and realised that if for any reason,
/had breast milk was unavailable the infant/no hone o^ surviving for very
long. The same bolds' good in all develooinc country’s til] today,
Unecrupuldls advertising by industrial films and the inexcusable
indifference and lethargy of medical and paramedical nersonnel have
contributed significantly in nronagating the belief that breast feeding
is in no way superior to artificial feeding. Recent work has not only
re-emphasized the emotional and economic advantages of breast feeding
but scientific data has proved the specific nutritional, antiallergic and
contraceptive nronerties in human milk. Stuart Cloele States.
For the truth is that for babe or man there is no security to be
found, in a bottle. There is only one thing to be done with it and
that is to empty it.
It cannot be t^yed caressed or stroked. It is
not warm or soft.
bottle is stone, is sand fused and orocessed
into a vaguely breast like shape for the holding of the goods, but
to the infant it is a mockery.
On the other hand the breast-fed newborn has the close contact
of the mother* s skin paralleling the ■warm enconroassing amniotic
fluid, he has just left. The auditory stimulus of the mother’s
heart-beat continues to be heard. The intra uterine swaying is
continued as rocking on the mother’s lap. The continuous sunnly of
nutrients transported to the fetus through the umbilical cord is
almost as continuously supplied by ilnstreched breast feeding.
It is heartening to note that studies are being developed all
over the world to try and determine more clearly the unicue
biological quality of mother’s milk, its protective role and the
effects of storage on its various properties.
As a result of the selective process o^ evolution, each snecies
produces milk whose composition is optimal for its young so in reality
we cannot‘humanise bovine milk (or bovinise human milkl) as is so
claimed* There is also a visual difference in the milk
7sPecies i. e. Kangaroo’s milk is oink while buffalo’s
milk is white. Human milk is not usually seen, but mothers making
an inspection worry over its thin bluish aonearance as it does not
conform to their expectation based on cow’s milk.
The production of milk during lactation consists of 2 chases:1. A stage of secretion under the control of prolactin which stimulates
alveolar tissue to secrete milk. Prolactin secretion can be
enhanced by stimulation of the nipple by sucking - prolactin reflex.
2. Stage of propulsion of milk or let - down reflex is under
psychomotor control and is initiated by stimulation of the nipple
by sucking -rWalses- posterior pituitary - releases oxytocin acts.on smooth muscle surrounding ducts - ejection of milk into
terminal ducts of both breasts - nipple - infant.
ref]Avh^diHfe^^e between
prolactin reflex and the let -down
and
difference between.milk production in the alveoli
va CJ
n "I Tx*1 ’{'"Th
'h
«*
|
—
^1 milk
is ava??A^?77^
’
-a
successful
let-down
reflex OO« of milk
availabel to the baby m seven minutes.
The unique quality of Mother’s milk:
underoone
aSla?anre
appearance.
early secretion of the mammary gland which has
resorpt1On.
It has a bright lemony yellow viscous
It is high in antibody rich orotein esoecially IgA
Oont’d.../2.
• 3 :
As
but more sodium chloride^Bz
inc^’^iBhat
less fat
lactose b
function but its biochemical cowosJmB
mafly an anti-infective
'•
Proteolytic effect which helps Bear Jut tSX mX * laXative' even
supplies
...
-J a concentrated dose of ceBBn% H ^oonium . it also
certain important nutrients like 7,inc.
Breat milk is the best and < '
only food for infants as there is NO
substitute which
lust nnf exacBy duPlicatelt iBltever"
say, it is just
^verti^ments
not possible to humanise eow^mH^
cow's milk.
Studies of breat milk and breast feeding show that?
1. Breast milk best
satisfies the infants needs for the first 4-6months of life.
2o
Breast milk provides immunological
protection for the infant.
3 ’ sZSt fe!d1"9 COStS r“Oh 1833 th“ feed1"'’ ”ltt' substitutes.
costs much less than
4.
U3e PraparlnrSsSutos’55
and malnutrition."
5
are less i^ely to develop infections
i?S:Jlcers9XK°r“Yi;fLOtrL19n OrOtei" ln -»'• "U* «„ oroduee
6.
bcotocts against pregnancy, however the contra
ceptive effect is
- maximum when the infant suckles frecuently
and is solely nourished
---- by breastmilk i.e. for the first 4-6 months.
7. Closer maternalviolence in the
in many factors-social.
social. Psychological, technical and
?
Some of these r
- related basically ti attl^X e” c^O”^lnq
«o
especially the decline in breast feeding and altered Patterns"f9
somato-sensory contact.
Immunologically protective agents in human milk are:i) Immunoglobulins
which produce enltbodles ,g,lnst SDeclflc b,cterl.
and viruses.
11’ thTbX8 w7ch aestroy b,ctert’ ™a At”er
«»«,„c9S.
turn, prevents the
lnterstlMlOdlseasI"na£Jlralf?"sD15Snl';3? lively to develop gastrobabies are ajs* ie3s JikelftoBof
ctionsBreast fed
to psERz position during feedino)
if aaff
lnfections (related
cSS1?? ®
.nothersr ^,2a^0;
ii! S£Sr^°|
and aiie^i‘ ”h”Striraa“Lrs9‘as
to lactating
---
'
’
iii) its degree of ianinisation.
Conf H..
/
A
I
’
6
iv. Its solubility is fats an-i water.
Drugs contraindicated during Lactation areoral contraceni-1 \7^cbarbiturate
•'
,
Y ■ -Lries
teroids, reseroine, diazeoam, diuretics
"aU~'lxlc
Dif£ersnce between Human and Cow's milk- ,'
a) The nroteins in milk
-Jr. -5
11±Kta<Uv
lactglobulln.
i-,^4-Z-.-Ul .r infants ano is known to form
™nk, iS Hifflcult to
Soa
The
U
fm” iS'tsLL ?: r” ‘r crs
i-e«fl,ary
£i^rlObUlln' -
b) efsen?iaiefatw source
SQU^ce.of
of cenergy, fat soluble vitamins an*
essential fatty aci*s in human
human milk.
milk, Levels ot essential
polyunsaturated fatty acids, r
• -essential
,
especially
linoleic
aci^ an^ alnhalinoieic adid are higher in breast milk
..11":. than in cow's milk, ^he
-atty acid content varies with the mother's ^ieto
*sian women
tend to have a relatively higher
than their European counterparts. oronortion o^ shorter-chain aci^s
o.-. fat rises by unto 40 G/L and the During a feer’ the concentration
content of lactose an^
nrotein falls slightly,c> The concentration of the major carbohydrate
co^StXn^^^ rO1'.ln -^alninc ' lactose, IS high
low electrolyte
a> «■^
am?iJ3H™rtfi
1us!y1?r^
oeX'to:?L,£ ■“& p th™
VTXr
oomoareZ^
’c^3 ^l^or^oJ^X^aXil
fee}
' th^Cn^s1!
breat fe^ than ln tbe ^^ulaorotein ScaJse of Its TZ'
tO C°mbine witb human "lilk
iron i?«>iyWy.- ? •
SaSln conter,t- ^e coneentrat ion of
Enough
fulFit^T^
’ 700/0 an'
nrwiaas
iLoi?’ '
-cent^tlon^
*
1
deal wit^a h^rioa/o? solJtef CaQaClfey
e
^4./
tbe ne’-born ki*nev to
St°re °f fat S°±Uble
relate*
er s diet during pregnancy - the milk oG a woll f^a
sS:
mother^ diX an(5.Ca^ serious health consequences." mbs'
motner s diet needs to be sunnlemente*.
Prolonged Lactation:- Prolonged breast feeding is initiailv
tr°ir
cmvdor th’ •qm
’a
Protein 11
ifVbe.onlv
available source of
strata
It can be^n t' °r 12fants in tbe lower eocio-economic
protein fcodiTe
/°r 1 - 2 ye*rA if
alternative
foods after the S?an? iS
with ™,nl„g
: 7 :
22£ter chllr1blrth/ lactation begins in
24-4P hours ; for the first few
clays the breasts secrete colostrum,
Milk comes in on the 2nd-.sth day.
and. mature milk is available after 2 weeks.
For successful breast feedings
1. Psycholoaical
,■
■ of
the mother
Psychological preparation
<
reparation ot the
breasts. This is an important aspect of antenatal
care an^ must be
pursued with missionary zeal.
2. The infant must be out to the breast as soon after WrM,
knowing its immense value to the newborn baby. Me Ws
jaggery or honey should be permitted anri fpO^-:nr7 bo+-+-i»<=
4prohibited in eternity -ward,
’ "13t
f
3. From the
day gostnatally the Quantity of milk
Slven
?S
the
given as the infant demands and not by the eXoi?
clock
the end of the second ]-■•••to thir^ week to 3 hrly feeds,
hv
4. Night feeds: TUsually
’
babies allow their >mothers
■'
to sleep FrOTp
10 nm - 6 am after the 1st month - but if they need
,
n - ,
.
- " —- ■ a milk fee^
after that then thev should
be oiven milk; NOT water.
5. Feeding time
feed.
15
6. Positions- as the
20 mins.
The breasts must be e^ntle^ at each
mother feels comfortable*
7. Burning or "bringing un wind"
is essential a.tter each -fee^.
infint- Awoman
W0an Wh
2 13
"aSt fee
^i^ her Infant
an^ sucklinq
who
is br
breast
Feeding
:* *“
n ant demands
needs
no
contraceptive
for
6
months
postpartum as the
“
-- "3 no contraceptive for 6 i
have to be
then Progestin
rills onl-f(which
onlv(which mav inor-a^ t^e oills
'll given
\
—z?--pills
breast milk) or ’
as the conventional pills interfe.r with mlk secretion.
Sucking bv the infant is the
strongest ^timulns
milt nroHuction.
If the milk does not "come in" b
b<r the
the second
second dav
a^v an iniertion o^
5 units of ritocin 1 * M. helps, and chlorpromazine
25 moms mo.s -for $
days being a dooamine antagonist increases the secretion
------ - . of
. : prolactin.
Bowe Pattern:- breast fed infants
rasa sticky, semi-soli^ yellowish
stools sometimes 6—7 times a hay after
feeds; there are some infants
who pass a stool every 2nd ~ 3rd day-both these bowel natterns are
normal.
I
0s?
p,g) ar° to be usea
Weaning is a process by which foods other than i
milk > are
intro^uce^
into the.infant's diet, first to comnlement breast
'
milk an^ then to
n^tritTrV! 7 r?Dlace,it and adant the infant to the adult dIP^' “For
nutritional. reasons the introduction of other foods to a who'll v’
reastfled infant becomes necessary between 4-6 months
The exact
time that weaning should begin is determined by the lactation
oFZhe^nf6 t tbeToth^
rate of g^wth and mStu^t?on
infants it
t <
2^ tberefor® H®?e"d on age but for'most
in .ants, it is between the ages of 4 -Smonths
poor knowe^e on tbe part
the.totber SXhtpp’”:
requirements of the baby, the neriod between 6 months, an^ 2 years is
one
one of ''Perpetual hunger".
J
ont1 r*. o/8
o
8
:
knowledge of weaning foods and practices:
While low income is important as a cause of malnutrition,
ignorance about the nutritive value of food is ecrually important.
Two important facts are to be communicated to the mother - at what
age which foods are to^be given and what cruantity to be given* TAThen
giving advice about infant nutrition remember the economic state of
the family, any prejudices about certain foods and also the availability in the local market* ‘Vb far as nossible discourage mothers
from
buying n expensive
prepared baby
foodsJ sold in the market*
, .’
.
-x -•f
■
’
■
time
to
explain
to tine mother and allay her fears; and nreJudices*
Remember that the na^tnal grand3 mother has a considerable say in
infant feeding and must be " converted” if' wea.ni.na is to be smooth
and successful*
In India, due to the warm climate, food does
‘
mot keen loner an^.
therefore, imust be freshly nrenared for every meal* The basics of
hygiene should be patiently explained1 t
to the mother e^necially that
food should not be brought from outside and should be nrotected from
flies and dust.
Outline of Diet:
5_.to.. 6 months:- Mashed banana in milk or norridge with suii, atta
ground rice, ragi, millet - a little oil or ghee to be mixed to '
improve the taste and increase the food value - start with
teasnoonfull and gradually increase so that after 3-4 weeks the infant is
taking 50 — 60 gm
a cup)/or one whole banana*
Fruits in season e*g* papaya, chikoo, manao can be given* Apples
and pears, to be given, after stewing - start with small Quantities
and increase slowly.
6
_7 months
Vegetables to be. added - o-ptato, marrow, carrot later
peas, beans, boiled and steamed, mashed and sieved*
Add oil, start
with small quantities and gradually, increase* No food value in
wiun
giving the water in which the vegetables; are cooked.
cooked, meat soun,
contrary to popular belief also has no food value unless thickened
with mashed vegetables or flour and added oil.
7 - 8 months ?- Combinations of rice, legumes and vegetables, curds,
egg-yolk, bread, biscuits, thick roti softened in milk, dhal or
gravy.
Raw egg is less nutritious than a boiled or noached eoq.
The infant is teething at this-stage and can be given toast, crisp
• roti* , carrots or biscuits to bite
9
10 monthsquantity of foods are increased and minced and
ground meat and fish can be added*
1—z lh. months
should eat all household food without soices, bulk of
calories to be supplied by food not milk* T‘Thite
‘
‘
of~ egg ~ given
before the age of one year may cause allergy*
New foods should be started in small quantities
guantities and one at a
time so that if it disagrees with the baby it can be immedi^p^iy
discontinued. 0
-- ' ’
..
.
Sometimes
food nut on the
tin
of the tnnnue is
immediately spat out*
This is usually a reflex and does not
necessarily mean that the infant does not like the food, Of course.
infants do have their likes and dislikes in regard to new foods
and these should be respected„
ifi a new food is rejected something
else should be started and try made again after 2-3 weeks* If
solids are not introduced in time i.e. before the infant is one
year old it may be almost impossible to wean the child from a
purely milk diet after this age and the stage is set for a ^ceding
time struggle between adults and child-^ in addition to noor feeding
habits for many years*
Cont'd„o/g
rX- •
s 9
™ch the i^f^dTtak^^ ?r bTrl S° that tbe
hoJ
tiSs%h° ftt' P^enhnt^-e,a^S^
aroundhooo^'alorie^i1: ITtl hungrY:
At
At one vear the infant need's
Ca-Lories 1-e’
the re
r-ouirement
The
cni ire went of the mother
morehr= Sentd7
tO be fed small* ouantities
infants have to
frequently.
X.... quern-ry.
Children like chickens,, should be Mways necking".
Feeding problem in children can be avoifiea lf a rational
approach to feeding infants is practised
Singing, dancing and
Ead habits formed
fami?v Id i
®S should be nleasant for all members of the
If a child C
1 nOt be-d battle ground between narents and child,
to stavt toe hr
VT V O1 ^liberately retoses a meal then no food
t stav- the hunger like sweets or biscuits should be qiv-n bedor- the
next mea! - it must be remembered that "hunger is toe best sauc^l
not SS? •
raC
instead of a meal serves toe child's o1]rnoso of
habito?
9
9rV bUt defeatS tbS
iTnartino good fee4ng
***********
Extract of the iminutes
*
of the meeting of the Executive Committee of
the Governing 3o^
iol ToP®
Society for Medical Education
held on 17th. 18th & 24th Enril pQ?.’
Norms for se1ection of
ost-graduate bourse"
1. Applications for admission
nost-gra^uate
courses of study will
addiission to r~
1
^ertisement in newsnaners about three months bo^oro fho
expected date o- the commencement of the
. j courses.
2. A candidate can apply for not ’■ ore than two sub-jects.
3. Eligibility
i) Candidate!s should
’
- - -have satisfactorily comnleter’ the one year
compulsory rotating internship
— after
~_er passing M.B.B.S.
ii) Candidates iwho
n
have taken more than 2 years beyond the minimum
period required to pass the MoB.B.S.
-course will not be eligible
. . , v to aPn^y f03^ t;he post-graduate course <»
in) Only candidates who
have done
done two
two years'
who have
years' rural service after
rull^registration will be eligible to anoly. ^reference will
be given to those t^ho have: ddone more than the minimum two
years of completed rural service.
In case there are not
enough suitable condidates with two years of completed rural
service, other can^ates may be considered for admission
to the vacant seats.
4e Entrance Tests
i) There will, be two written tests:
a ) Paper One will be <
comwonfor all candidates and the
questions will be general in
- * all
—- subjects of Medical
Sciences.
Cont'./IO
: 10 :
b) Paper two will be in the subject anolied for.
ii) The written tests will be
held at St. John’s Medical College,
iii) Bqsed on the performance
in the written .tests candidates
5.
will be called for interview
—.,,r by the selection committee.
Weight age will be given to those who have had five
years
oomp^leted
satisfactory
service
. i .
-■* —
- ’'—’-'J m the defence ForoAA , sorrw
weightage may be given for - orces.
conduct and behaviour of
candidst© duirincf th© ©ntiire under-graduate course.” the
▼* —
«u
LIBRARY AND INFORMATION SERVICES FOR THE GENERAL
PRACTITIONER
K N KITTUR
Librarian
St. John’s Medical College
Bangalore 560 034
The objective of this r
.
.
.
is
JO
nged for a
...
the General Practitioner (DP) . Emphasises
the importance of continuing education of the Gp' r
continuing education of the GP. Enumerating
their information needs,
needs, points
points out
out the
the need
need for
for the
the GPs maint ni m’ r><
own
personal
libraries.
Discusses
the
’
sn~h+-°Wn pers°nal libraries. Discusses the role
role ol
ot lelrned
?.JeS' Professional^associations and instructions in meeting
the information needs ox the GP m providing library facilities,
the package library
services, mobile library services and clinical
and drug information
^^ices. The role of public nad hospital
libraries in moo-Hnmeeting the information needs of the GP are also
discussed.
^^TROD^CTION: The General Practitioner (GP’) is a doctor of first
contact. He may be defined
"a
‘ jeror or rirst
undertakes to e^Sce'S^eSts^rSlX?
branches without restricting to any particular speciality".
150,000 doctors'^trafned'1^
Ts^M10^173' maj°rlty
^ndia ou$
a total of approximately
wbomraree^^^a
the rAstP!fC!nta?®ls saving in Government Medical Institutions and
me rest as specific speciality.
IgQRTANCE CF GP: The work carried out by the GP embraces the
prevention, diagnosis and management of illness and diseases, not
£ mebical specialities. No more than 15% of nati-nts
85% of patientshTltalS a?d.the detailed analysis of the remaining
oo/j or patients whose c^Tplaints
--- quite
••
are
unknown ,to specialists
is handled by the GPe Moreover,, all the 15°Z passed on to hospitals
are seen by the GP, often at a very early undifferentiated stage
of diseases.
Irthe1?!^ are fOf.De classes while the GP is not for the masses,
follows that tb^nrp^tes
majority in our country, it logically
Ha am!
2 the GP has an important role to play. The GP should
A^Tbl 4-t traJ?Sfer new knowledge and technology into community
£ • £ ^tlOri and m<2et effectively the health needs of the country in
wnicn he serves.
igrtTV " THVP' Ph^i‘=1“’ “Hl contlnu. to reject small to™,
rural areas because as a group they place a high value on the
rents^^th1 aPPri^utes °£ the setting for medical practice. Although
in the city have always been higher than in the surrounding
countryside, people have always been willing to pay that price.
In the
t if one lived away from the place where, for him, the maximum lines
“^communication converged, he was effectively cut off from essential
information, that is, information without
Cont1 d e e /1 le
: 11 :
which he could not live or work effortvoiv
the'ep pSf^ "T collea^s
facility‘for
In the absence of
continuing eciucation.
the GP prefers urban areas for his Practice.
CONTINUING EDncamT-N py
rp ,
begins after graduation and oo i• he medlcal man's true education
Sir William OslJr SJohn Shaw Tit throughout bis life time,
in establishing the imnortaS roTe of^H
. influential
medical eduation. Osler pointed out the6;^11^^177 ln contiwing
bedside for betlent cere.
W Io0°UOs£: ZteT USe bO°kS ”= the
For the gcieiax
general practitioner,
practitioner, a well-used
of the few correctives
of
+orary is one
correctives
of the1 ^J^^ture
13 so ant to oSrtaJe h?m
senility which
aot a to
overtakelife
him.\ Self-centred, self-taught,
he so
leads
solitSv
--j
a
solitary
life,
is control'll
V
and unless his everyday exn^riAnce is e
careful
rearUng or by
MdlcS socS^y °r
efU1 rear,ln<s
b- attending a
z;
•«**««
a
reading a doctor <-’’ractlce medicine, but it is net
astonishing how badly he may do it".
THE? GP's NEEDS
The specialists who iwork in academic institutions and bigoer
hospitals anb a GP in a large city
resources available - a librarv of may have many medical library
a teaching institution, a
hospital library, a loca.l c'~
°r
medical society library.
But a
1 rural area is busy and far a^av from the libraries’
it is
difficult for him to have library facility.
as much
aoing’SXSr?’ medicine.service
por, he must:
those, m
or
1. Keep himself abreast of the
current development in the
subject,
2. K^icS^S^Se!1^ UQntlrn,atlon
doubtful points
and confirmation
43
5o
mako\h|mSelf tO the chan9ing needs of the society,
subiect* and Sytrebutions to the advancement of the
.ubject, and through these means;
society.hiS Drbfessional competence and service to the
PERSONAL LIBRARY:
The GP, fto meet his needs for continuing education and better
patient, care may develop a r~
personal library consisting of important
medical books. He is entitled
._J to get an official organ after
ecoming a member of learned societies
and
‘ ’
societies
and nrofiessional
nroijessional
'd
two periodicals
™wSedassociations,
, - ■ 7exclusively
Journal of AnSied mm|f1Can Practitioner, General Practitioner,
Prac??tioneJPPPrI^
ne' Journal
Ro'/al College of General
cJmpanSs to'send ^h^T etC- °P may reqUest the pharmaceutical
remXtlt b?
1 Y houf9.JOUrnals
literature Published
Ph^iologicL Xoertits0^ tttiUSefd1 informatiPn
Physical and
2
y
properties of various drugs manufactured by them.
RESPONSIBILITY
LEARNED suciETISS
SOCIETIES AND
AND PRCFESSI^t^L
associations
are^several
international,
learned6Qer.T
r!-'SeVer?1 ln
ternational, inational,r and local level
= c.=r,-- j.- Cleties
an
^
professional
associations, _ ^he dutv of "these
------ and professional associations.
and confe?encil
b
f
or
Fanisinq meetings,
oyer by merely organising
meetings. lectures''
an; conrerences.
It is a fundamental duty of these bodies to
assist in the ccontinuing
\1_.
education of its members. The American
Medical Association,, one of the oldest associations(1A47),
Cont’d../I 2
: 12 :
has been doing tremednous service to its members for their
continuing education. The societies and associations can make
arrangements for continuing education of their
members
---- ----by providing;
1. Library facility'
2. The oackage library service, and
3O The information services
LIBRARY FACILITY
A good library is an essential wing of any professional
association. It has a distinct role to nlay in information transfer and
exchange activities among the members of association. The guide line
set by American Medical Association serves as a standing example
for associations in India, in establsihing a good library facility
for their members.
It is interesting to note that ouite a few
medical associations such as Indian Medical Association, Calcutta;
Associations of surgeons; Madras; Tuberculosis Associatioh of India
New Delhi, not only have a good library, but also have qualified
librarians. Other medical associations in the country should
follow the examples set by IMA and others.
Every year the cost of medical books and Periodicals hav been
increasing by 30 to 35%O
It is difficult for t^e OP to ourchase
many books and periodicals.o Therefore the association should come
forward in maintaining a good collection of medical textbooks,
monographs, pamphlets and other reading materials.► Members
.1
may be
requested to donate their personal collection to the association
library.
As most of the important medical research is reported first in
periodicals, the library should concentrate on the building u^ of a
good periodical collection.
-^t may become a member of the US
Medical Library Association, US Book Exchange Programme and WHO
International Exchange of Duplicate Medical Literature for building
up the back volumes of periodicals. Local academic institutes and
hospital libraries may also be requested to snare the duplicate
copies of periodicals.
Apart from the traditional activities, the library should
provide other services such as reference services, compilation of
bibliography and arranging the Inter-library loans. Abstracts of the
important useful articles mPS.y bo sent to the OP since be does not
have enough time to go through the entire article.
i
Books may be sent by post to the outstation members. The
Library ■should.have.nbotoconyihg facilities so that the articles can
be duplicated immediately and sent to 01° on nominal charges
instead of loaning the entire volume of Periodicals*
THE PACKAGE LIBRARY SERVICE
Dr. Johnston, Librarian of American Medical Association,
established a package library service as long ago as 1^24 which
today is one of the most nodular and important services of AMA
library.
Ten to fifteen reprints or photocopies of the important articles,
reports etc., on all Phases of clinical medicine may be sent to the
GP for two weeks or so. Packages mav be returned immediatelv after
use or may be renewed thereafter unon reouest. The library should
try to collect the reprints on all the medical disciplines for
the last ten years bv writing to the various authors.
rout'd. -/13
i
i ;■
:
13
:
IW ORMAT.TON SERVICES
product Inforrnation Services
D^s: Many newly-discovered drugs have their dangers too anart
, .
Usefuiness. The new antithyroid drugs of ikkFS-’-c
thPwhTr11 H?UD °ccasionally have a serious toxic effect oh
E® hlte CN1S"
Ifc 13 unfortunate that Strentomydin doees
enough in tuberculosis meningtis
nenincjtis to nroduce
produce a cure are often J
toxic enough to harm the oatient: r-'*
------- deafness and
'
r .n
and cause
occasional blindnegSo This is the case with antineonlastic
drugs also.'
,
t
The GP is subjected to high pressure advertising
comnaiqns
by pharmaceuticals comna,
the
drugs
by giving inadequate,
.
about
them,
MAny
of the gullible GPs iare mislead an^ treat their
patients by wrong
symptoms and subject them
- - to
- ) unwanted drug hazards.
Again, the iresponsibility
to rsave the GF and the Patient too from
such practices lies with the societies
associations.
-- _ H and
associations.
T’he
members of the societies and associations should be ‘
the new
i
drugs with full dstslls 'suS
such as usefulness, dosage
and adverse effects as and when they are introduced in the market.
The drugs which are withdrawn
from the
or the
'
'
”n from
the market
market or
the ;adverse
ef-Feets
recently
ecently renorted
reported also may be informed
in-Formna to the members.
—
GPs need to keen themselves informed about the results of clinical
con-urte'1
ho^tul, ana
research laboratories. The Indian Association of ^neral
elSllTT3 'T CO11:Ct 311 SUCh cli^al trial reports and
rSrtu Jo
f°r
“’tlnq
«««
Surgical apparatus and c
'J
other
equipments; The members of societies
and association should be kent
l.T
abreast of the recent surgical
and other hospital equipment
— released in the market. /**•
The GP who
has an in-natient section w'Til.; bq, highly b-nef ited -From
i this.
Information of Mannower
There should be ian information Bureau attache-1 to the societies
and associations.
about
the fnc-inX-Whirb collecta
isseminates information
how manv CPa
TS H general practice in a Particular area and
how many GPs are already practicing in that reaion
This will
t,ly co-etltlon !„ cental -ractlce ha tjL “
OTHER LIBRARIES IN THE SERVICES QE THE CP
Academic Institutions
librSioPipThdSpr65' univ®^ity libraries and other research
libraries m Health Sciences should extend library facilities
to the GP.
-ea^mq materials may be lent against some denosit
Some of th
C?1P?T libraries like Madras Medical Colleae
and St. G
John s Medical College, Bangalore do allow the use of the
library by the GP for
-reference Purposes.
Hospital Libraries
The importance of hospital nonaries
libraries is
is recognised b , 4-hA
us^.
the' LibraryRssociation in UK and US
?:. Tbe Medical Section of
and Medical Library Association, USA
preparinah?lsi’talf
buiW^ un better CollectionsHy
preparing lists of recommended books to cater to physicians.
Cont’
x
' 14
hospital administrators
in the hospital.
professional anrl technical personnel
inst?tltbn= rt f
t®achlnc' l-'O'soitals attached to academic
h
V3rY fSW hosr>ltals maintain medical libraries. Though
there is a provision for accuirinq books and periodicals in ^ivii
“«wr,
ve?., Si ,f
found making use of this facility.
Public Ljbraries
The St. Marylebone Branch of Westminister Public Libraries, London
contains a medical collection as large as many hospital libraries.
with the difference that it can be used by all,,-reqar^less of^stabs.
Some of the larger public libraries in In^ia like state Central
Libraries_and City Central Libraries
bigoer cities have collections
of medical books and eriodicals, but in
a wider range o^' documents
have to be procured by tHem to serve the Cn better.
‘iy.YXwU
The mobile library unit of public libraries mav have
a styjarat^e section
for medical books and periodicals. opi
s nee
fis piay be fulfilled at
pP's
needs
this place bv the regular visits o-^" the
“
mobile library.
The public libraries mav seek be helo of societies
an^ associations >
m selecting the books and periodicals. rBooks ard periodicals -5w-rr
and associati^ libraries’may be collected by'the
mobile library operated by Public Library an^ delivered to the
Contact Libraries:
The contact libraries maintained by foreign governments especially
American libraries and British 1libraries which h^vo collections
of medical books and periodicals
i , - - ! nla^ an itnortant role in heloino
GP. These
libraries lenri the books not only to the local
members but also to the outstation members.
DOCTJMEPTATIOM SE^VICBS
I
The Indian National Scientific and Documentation Centre, New Pplhi
and its regional offices may be annroabhdd-Por compilation of
bibliogr-Whies, photocopying and translation ^vicns?
The
National Medical Library, New Delhi? WHO Library,
Ceneva;
Laslie
Calcutta, can also offer photocopying services
at nominal charges.
t
CONCLUSION
General Practice is the corner stone of health service of the
country and nlays a Pivotal- role in the general health pf the
society. The GP should foe given more importance while nlannino
tor the National Information System for Medical Sciences.
,7)z? /2clV/
£ • T
1
rc'
5
o
H Z.
X-
J
i
'*5600 34
vsJ;
^LULal health services and training programs
24.11oo3
AN IWITAT10 N
Dear
The work of the GONOSHASTHYA KENDRA (People ’s Health
Centre) of Bangladesh under the leadership of Dr Zafarullah
Chovvdhury is well known« starting with the establishment of
the health centre soon after independence, the Kendra went
ahead step by step to establish the Women fs vocational Centre
(Nari Kendra), the People’s workshop (Gono Shilpalaya), the
People’s Shoe Factory (Gono Paduka), the People’s School
(Gono Patsnala), the People’s Farm (Gono Krishu Khamar) and
the Gonoshastnya Pharmaceuticals. During these years, the
Kendra also organized training programmes for the paramedics
of^Savar and later cooperative health workers (IRDP 6c UNICEF)
and field programmes for medical students and post-graduate
doctors- Last year it has initiated steps towards the evolution
of an alternative people’s health oriented, medical education
experiment19b2, has also witnessed in Bangladesh the governments bold
decision to ban 1707 hazardous and irrational drugs, fix the
fees for doctors, stop construction of eight new medical
colleges and encorce a five year compulsory rural work before
permanent registration of doctors—all these being steps
towards a more people-oriented health service-
We are very glad, to inform you that at the request of many
groups including the Indian Academy of Paediatrics , voluntary
Health Association of India , Medico Friend Circle, Lok vidnyan
Sanghatana (Maharashtra), Kerala .Sastra sahitya Parishad ,
NISTADS, FMRAI and others , Dr Zafarullah Chowdhury has agreed
to visit India from 24 Nov to 4 Dec 19b3- He will be passing
through Bangalore on 1st December 1963 and. we cordially invite
you to come and hear him share his experiences at the following
two venues during that days
i
1- THE PEOPLE’S HEALTH CENTRE
(a lecture on the evolution
of the GK Project and its
training programs)
2- TOWARDS A PEOPLE'S HLZ-xLTH
POLICY- (a public lecture on
the GK Pharmaceuticals and
Bangladesh Drug Policy)
: Room No * 117 Ground Floor,
St John *s Medical .College
Bangalore 56 0 0 3 4
Time • 9 am to 9 <>45 am
Materials Research
Laboratories (MRL)
Indian Institute of science
Bang alore
Time i 3-30 pm to 4-30 pm
A special file on background information (priced Rs-5/-)
will be available on the GK Project, GK Pharmaceuticals and
Bangladesh Drug Policy at the Indian social Institute, 24
Benson Road, Bangalore 56 0046 (telephone :5L 169) from 2b Nov 63
and at the venue of the meetingswe request you and your friends to participate and make
these programmes meaningful..
With best wishes9
Yoijrs sincerely,
Ravi Narayan
Associate Professor: Community Medicine
ON BEHALF OF
medico friend circle 5 science Circle
(Indian Institute of science), Indian
Institute of world Culture, Indian
Social Institute and voluntary Health
\ ■ soci atio n (Kar n at aka) ■— B angalore
notice
23 Nov 1963
DR ZAFARULLAH CHOWDHURY of the PEOPLE'S HEALTH
CENTRE (Gonoshasthaya Kendra), Bangladesh, will
be visiting St John’s Medical College on the
1st December 1963<> Dr Zafarullah is an internationally
renowned figure and we are privileged indeed that
he has agreed to share his experience with us
during his tour of India. He will be delivering
a lecture on ’THE PEOPLE’S HEALTH CENTRE’
on 1.12<» 19o3 in^ Rdom^^IJ.^of St John’s Medical
’Co’l’lege^Trom"*9"".o*u aomV *to 9.50 a.m.
Dr Zafarullah has been one of the founders of
the Gonoshasthaya Kendra in Bangladesh and has
been actively involved vith its community health
programme, medical and para-medical training
programmes and the GK Pharmaceuticalso
All staff and students are cordially invited to
attend the lecture.,
G M MASCARENHAS FRCS FZiCS
Dean
To
All the Heads of Departments in College and Hospital
The Medical superintendent
The Administrative Officer/Deputy Administrative Officer
The Administrator
The Assistant Administrator
john ^s medical college^ bangalore"'*56oU3*4
-rurs^rYices and, ;training^ programs
*
MEDIGZJu EDUQ.TION
o
Dear
Further to my letter dated 24 Nov 1963, informing you about
Dr Zafarullah Chowc’hury *s visit to Bangalore and his progtam
of public lectures on 1st December, this is to invite you to an
informal group discussion W'ith him on the theme “Alternatives
in Medical Education". This discussion will be held in the
Board Room (next to Dean’s office) of st John’s Medical college
from 10 am to 11.30 am on 1st Dec 63. It will follow/ a lecture
which Dr Chowdhury will deliver to staff and students of the
college from 9 am to 9.4>am on the same day (Room 117, Ground
Floor of the college). The topic of the lecture will be "The
People *s Health Centre11.
*
Since 19b2, the conoshasthya Kendra in Bangladesh has been
exploring the possibilities of evolving an alternative medical
curriculum more suited to the health and socio-political and
cultural realities of countries such as ours. In March 1963,
there was a special conference held in Dacca entitled ’PEOPLE
AND HEALTH* organised by the Kendra and the Jehangir Nagar
University at which some reco name-nd at io ns for such a curriculum
was made.
Though the meeting we have planned in St John’s will be a
short one (in view of Dr Chowdhury fs packed programme in
Bangalore) ? we hope,
hope it will be an opportunity for him to share
his ideas with those of us in Bangalore who are keenly interested
in this topic and ■will also initiate a contact for many of us
with this innovative
.
. experiment in the future.
— 3. It is also hoped
that this meeting will stimulate some of us to think of possibi
lities of similar ventures in our own country and institutions<.
Kindly let me know
knov; by return of post or telephonically
telephonic ally
(565435 Ext. 26 5 inform Mr K Gopinathan) before 29>th November »63
whether you will be able to attend this lecture and group
discussion. This discussion will be for a small group of special
invitees and since the number has to be necessarily limited we
want to know in advance who all will participate. On hearing
from you we shall post some cyclostyled material to you as
background to the discussion.
Looking forward to your participation?
With best wishes?
Yours sincerely,
'7°^
24.11.S3
Ravi Narayan
Associate Professor• Community Medicine
and
Co-ordinator, Rural Health Services and
Training Programmes
^.cT^rounS^aperT’^^T^rrTartlves irF’me?icaT'e3ucation •
Report of the Dhaka Conference on
S18-22 March 1983S DHRUv MANKAD.
’PEOPLE AND HEALTH1
(An extract from the Report of the Conference which
featured in medico friend circle bulletin Noob9, May3 19b3)o
r^TrociucE io n
People and Health - was the topic of the conference
jointly organised by Gonoshasthya Kendra, and J.ehangir
Nagar University (Bangladesh) at GK campus from loth to
22nd March 1983♦ Around 70 delegates from Bangladesh and
30 delegates from abroad (13 from India out of which 6 mfc
members) took part in the 5 day long deliberations with a
view to lay down some guidelines on how a new medical
curriculum - an alternative to the present extent is to be
formulated - the present medical education is hospital
centered, urban biased and aimed at an individual patient»
The participants also included around twenty five students
and interns from various medical colleges in Bangladesh.
keynote address
Dr D Banerji in his keynote address pointed out that
the introduction of western Medicine in the Indian
subcontinent was intended to serve the British Army and
deprived the nati- es of their own indigenous system by
destroying the economic base of their whole way of life.
He contended that it was only the pr sence of concious
doctors like Dr BC Roy within the mainstream of the anticolonial movement that a national health policy was formulated
after independence» He argued that though change in health
status of the people is a function of the socio-economic
change, a ’critical mass’ of conscious doctors who could
initiate such a change in the health status are necessary
as a part of the broad movement for socio-economic change.
He urged that it was with the aim of producing such a
’critical mass ’ that the new alternative curriculum be
formulated. He stressed the need to orient the new doctors
towards community diagnosis and action.
Bountry^papers
Delegates from Sri Lanka, Phillipines, Malaysia, Nepal,
Mozambique, Bangladesh, North Korea and Thailano
presented their papers. The papers generally covered the
health situation, the health set up of each country and.
the alternatives tried out in their respective countries .
concTusions
recon^n^a^iorisj
In the opinion of this conference the health care and
medical education in the most third world countries is not
satisfactory and there is a growing restlessness on this issue
among the people as well as vithin the conscious section of
medical profession. Attempts arc being made to bring meoical
education more closely aligned to the health needs Oj_
individual country and this is reflected in the recent
curriculum revision here in Bangladesh.
Though the socio—economic factors like poverty, illiteracy
and politics are the major determinants of the health status
of the people, the health services have an important role
to play. Constraints do exist in the present situation but
I
2
existing constraints instead of sitting silently and waiting
for the ' ideal’conditions,
TO remedy the present day system of health care, it is
necessary to go to the people and subordinate medical
tectaotogy io th’ httds of tho peoylo, rather than to servo the
interests of the upper class.
hXSBEXX fXgX^g|r|Xra
immediate attention are - Children, Women,
^Xth the
nlAAAes in urban as well as rural areas. To deal with the
I^XihSt eith prohlrms of tho target groups through prrmary
health care, - community health team approach rs essential. In
most cases doctors as the leaders of the team will have to
carry out this task currently . Doctors are. not trained to
perform tais role- adequately.
The new role will require a different kind of preparation
perform the following
so that doctors can <effectively
---functions s
priorities of the area,
1. Diagnosis of health problems and tools.
using scientific epidemiological
2o
3.
4
of' a community health
planning ? execution and evaluation
the community diagnosis.
programme in accordance with 1---- -----Competently diagnose and treat the common as well as
important clinical problems.
hea1th wdr ker s
Training of the t^am including the village
5. supervision and. leadership of the health team.
in the health system.
6. Act as a change-agent
of the masses and actively
7o Understanding the problems
associating with them.
above functions,
restructuring
an
ere as follows, (sentences in
. .
-i n ter tor eted as
after the workshop was over).
1
Selection of students - giving special attention to the
SStFSOS^^
^L^LSarltory.^Snlng3
2o
«ss
tn^So l^lcT science s >
The
in the community basud ^W'^ ^diXlet level hospital
project in rural area).
•i
3
3. Clinical Training - with a commitment co excellence and
emphasis on the practical methods of diagnosis and manage
ment of the priority problems (Training would not take
place in big? sophisticated hospitals. Maximum emphasis
would be placed on practical problems» Preclinical training
(especially 5 anatomy 9 biochemistry etc) would be limited
to fundamental anc applied aspects and details would be
avoided. These subjects be taught by clinical teachers
eg. Anatomy by surgeons. Preclinical and clinical aspects
to be taught simultaneously and in an integrated manner).
Community Health Skills " To be developed in applied
training^ so that the doctor can fulfil the new role
practical responsibilities during
(Students be given specific
:
training)•
5.
Teaching of social sciences — especially understanding,
economics, sociology 9 anthropology 3 psychology and ethics
as they relate te the genesis and management of health
problems.
6 o The medical education institution should have a department
devoted to clinical research and practice of traditional
medicine. The research should
and non-allopathie systemsj of
<
combined
diagnostic
and therapeutic
be carried out usin
techniques of the traditional as well as the modern medicine.
The remedies found to be effective and safe should, be
actively included in the teaching and be practised.
7o
personality development - ie.3 attitudes and values in
personal life as in relation to the people3 especially
with underprivileged classes and. women J also . an ability
to work with a team. (Students imbibe the attitude of their
teachers. Hence the teachers must practice these values m
their daily work).
It is not possible to undurt-ke this during and innovative
task in the existing system of medical education- A new
experimental medical education institution needs to be set up
which will need flexibility and autonomy m the fields of
administration, management, curriculum development and training
methods. It will also need necessary academic recognition and
support. (J.ehangir Nag ar university may open a new medical
college of 20 students with the help of Gonoshasthaya Kendra,
All aspects of medical education like curriculum, selection of
students, teaching methods etc., would be formulated and
implemented in an autonomous manner, without regard to
recognition by the Bangladesh Medical Council. The product of
this3medical college can very well work in voluntary projec .
If hc/she is superior to the existing doctor, society would
recognise them in,hue course).
HEALTH AND DEVELOPMENT DSSUEa IN BANGLADESH
Dear
Further to the letter dated 24 Nov’ 633 informing you
about the visit of Dr Zafarullah Chov.dhury to Bangalore
on 1st December 19s3 and' inviting you to two of his public
lectures at St John rs Medical College and Indian Insticuto
of Science respectively9 this is to personally invite you
to an informal meeting with him at the Indian Institute of
Science on the same day between 12 noon and 1 pm and later
2 pm to 3 pm in KSCST Conference Hall.
During this meeting 3 we- will get an opportunity to
discuss many health and development issues in the context,
of Bangladesh and. the impact of the GK Project as well as
the newly promulgated government drug policy. As preparation
for this discussion we reguest you to collect a resource file
on Bangladesh which will be available at the Indian Social
Institute 9 2< Benson Ro ad 9 Bangalore 560046 (Telephone 5 55189 )
from 2bth November 19d3. Since the number of participants
at this informal meeting will have to be necessarily limited
kindly inform one of the undersigned (leave message at
numbers given) latest by 29th November 1963 whether you
will/will not be able to attend the meeting.
Looking forward to your participation 5
Yours sincerely5
Ravi Narayan
ST JoWT Mecl ical
College
56 5435 Ext. 26 5
24-11 J9d3
Du arte Barreto
’Indian SociaT"
Institute
55189
San j ay Biswas[
'inc’ian InsTitute
of Science
(science Circle)
34411 Ext. 331
IBB .
J'
zzz
ST JCHN‘S O1CAL CCLL^GE
B ANGAL ORE
5PJ-?HTAT 1 aj PH
h
KEY
o
A - Completely False
B - Mostly False
C - Partly False
D - Partly True
E - Completely True
Using the above key
1
indicate your choice ;
Villagers are incapable of making independent decisions» (
)
2« 1 enjoy the company of simple village folk ( )
3®
Villagers line is a sta-te of ignorance ( )
4» it is impossible to educate the villagers about primary
health matters ( )
c
. If our country has to prosper it is necessary to improve
)
our villages.
(
Go
I believe that a dedicated Doctor can do a
a village.
(
)
lot to improve
7. i would be unhappy if I would have to live in a village most
of the time• (
)
o. To understand the villagers and the village life one must
live in a village. ( )
9. To be a successful doctor one should work in large Hospitals ( )
10 • A talented doctor is wanted . in a village (
)
11. I am sure that after ten years I would be working in a
village ( )
12. I feel that villagers are a dirty lot ( )
13- I believe that the health needs of a village can never
be met fully in the village alone (
)
14t I am of the opinion that villagers are foolish people (
15. Village life is Healthy (
)
0 o o 2
)
p
2
•
16. It is the duty of every educated citizen to contribute his
services for the upliftment of our villages ( )
17
For pleasure and happiness every person must have basic
amenities of life ( )
)
lb. I feel that villagers indulge in malacious gossip (
19 • In general villagers can be described as tolerant people (
solve the socio-economic
20. I would like to do my best to
problems of
country ( )
' ) understand the villagers if we are to
21. It is necessary to
)
be of any service
£---- ----- to them (
22. All villagers are unhygienic people (
)
71^ am convinced
23 . I would like to work in a village because
unless
the
health
that our country will not prosper u~looked
after
(
)
problems of every village are -------— —
it is acceptble
24 . I would like to work in a village because
to me (
)
25.
I feel that villagers are highly superstitious (
)
)
26. Villagers are highly suspecious people (
must have knowledge of both rural
27. To be a good, doctor one
)
ard urban life (
prk/191281
«
Com h ^>-3
ST JOHN’S MEDICAL COLLEGE
BANGALCRE
FURAL COMMUNITY ORIENTATION PROGRAMME
Most of the- following questions can he answered
a.—
by checking ( )
one block in the series opposite each item
'
or writing in a single
word of figure.
2 .Age
1. Na me
3. Sex
4. Home Address
5. Educational attainment of:
Profe -
General
Not
Can just
literate read & write
Primary
Secondary
College Deorgr e
Dip
loma
5.1 Father
5.2 Mother
6. Father's/Guardian's Employment':
Medical (
Business (
) ;
Engineering ' ( '
Others, specify
7 . Father fs/Guardian rs
approx. Monthly Income
8.1 Religion:
) ; Agriculture (
Upto Rs.200 (
); Rs.201-500 (
1;
Rs. 501-1000 (
); Rs. 1001-3000 (
Above Rs.3'300 (
Hindu (
); Muslim (
other specify
Christian (
8.2 Caste
9. Previous Residence
Village
Town
Less than 10,000
Approximate No. of
years
10. Any other relatives who
are in health work ?
Yes (
)
no
(
Specif'' Fa+
r-.1 « -■
9. . .
City
ST JOHN’S MEF1CAL COLLEGE
BAbJJALOPE
. *
Datc
opposite each speciality indicating the extent of your own
interest in the speciality.
e— .
Speciality
•
•
•
•
Not
. Slightly
interested interested
Moderately
interested
Greatly
interested
1. General Practice
2. General Medicine
3. Obstetrics and
Gynaecology
4. Opthalmology
5. Paediatrics
6. Preclinical
7. Paraclinical
8. Community
Medicine
(in medical
college)
9. Public Health
(services) •
10. Surgery
11. Other
specialities,
specify
For office use only
Name :
. . .2
4. Plc-asG chock (
) in appropriate column
4.1 Ten years from now, what do you expect to be General Practitioner
Research Worker (
(
);
Specialist (
); Other, specify . . . .
4.2 Ten years from now, where do you expect to be India ( )) ; United Kingdom (
U.S.A. ( ) ;
Other, specify
4.3 Ten years from now, how much money do you expect to earn
monthly ? Please check ( ) in appropriate column below :
Less than Rs.1OOO
Rs.1001-2000
Rs.2001-3000
More than Rs.3000
5. We would like to have your views of the conditions under
which you would be willin'
center. Please check (
Conditions
to serve in a rural health
one block opposite the statements
Pisagree
Partially Partially
disagree agree
1. I do not wish to practice
in rural areas
2. I would accept a rural
health center job as my
family is. in urgent need
of financial help
3. I would go only as I am
legally required to serve
in rural areas.
.. .5
Agree
4. contd....
Disagree
Conditions
Partially
disagree
Partially
agree
Agree
4. I would work in a rural
healthcenter only if I cannot
find w )rk c-lsc-whc-rc-
5.
I would work in a rural
health center if this will
give advancement in
government service .
6.
I would work in a rural
area if I would not be
stuck in village for life
7. I would go only if permit
ted to live in a nearby
town
8.
I would go to a rural area
if there was improvement
in both professional
standards and living
condit ions
9. I would go if a liberal’
rural allowance and
‘ provision, for personal
comforts were provided .
but without significant
improvement in present
professional opportunities
10. I would go if facilities
for maintaining good
quality professional
standards were provided
and without particular
regard for improved
living conditions
11. I am willing to go and
serve in a rural area
•indefinitely
For Office use- only
. . .6
aTuo
asn 90 WO JO J
Burqoeoi ’OT
-5
(aqeAxjd^ A^T^eiaads
JcaquaQ
Ajewij^
*q
saajoj
pauijy (j-p aoTAjag
•£
’9
suoTq.riq.Tq.suT
UOTSSTLU
6uTpnT3UT stsitcIsoh
aq.GATJ^f ut aoTAjzag
loan'd
eoiq-oejd
aqeATjd -[ej-au^
ueqjfl
aoTqaejd
aq.e-AT.id qejauag «g
“■qTd sopq quatuujaAog *
aaiAJos ’[eiydsoq .
pue qq-^eaq
- uoTqejcqsiUTiupv • f
paq.sa jaqciT
A-[q.e3jD '
poq.s ojzoqu^
A-faq-ejapoyy
pL'?rC ?j:32 jt
paqs-aj ?qu ■£
W
•Aq.TAf^3v
3J AneucsJ3a ‘ noyO uo?u£To?—
q.u-aq.xa
aqq. Buiq-eoipui qo^a aqAsoddo qooTq -3uo (
) >{oaqa aseaqj
•saTq.TATq.ae 79uoTssajocid jo sadAq suotusa acce MOfaq paqsTq
adAq. ^eq + Aq p
*3
3. How important to you are the following factors in choosing
your career? Please check ( ) in appropriate columns below :
Factors
1. National Nc-cc3s
2. Family opinion
including parents,
anh close
relations
3. Nearness to home
4. Prestige
5. Intellectual
sat isfaction
6. Influence of
teachers
7. Financial
remuneration
8. Jeb security
9. Specified hours
of work
10. Leisure
opportunities
11.‘Humanitarian
and religious
motivation
12. Career opportu
nities
For Office use only
Nat
Slightly
Important important
Moderately
important
Very
important
■! i J1- i j a i i
•»'i!
-
i-a i a v.
tnomisor t O' ? r.
ff ''
7. Listed below arc- a number of f actors pwteidh-vmaiy finfIw-n^e dglf ,11
unfavourably the way you feel ai-out working in -ei ruraVta^Q-^e
• -.. Pl‘c’a"se“ fndica±c~hotAr fm-port-a-nt- •thcse-~jm-at-ters—-sc-em—to ••you—f-y---- ■
chcckino ’ C ‘1 one.' of the blocks- opposite ■ each ■ itCjrarO fvofbf? .01
__ 1 17 •
• •
7
. - .r-. -.
. -
“. *r • “• • p •
“
NUf .
’ ’” Slightly ’1' '- Moderaf-e±y~-’Very
• important, important ' important : import-
Factors •
................... - --
O.^_.e..r]^(------- .
...... .
■-4' ■
T. x'Lack of opportunity for ’
postgraduate education
---- ------- ------ ------ -- —
'1
2. Problems “with personal
7^ " jfbKmTng^and--' appcarahee’ ' '
3.,. Unsuitable Housing ,
- - -------
:
I o dv,/ e ar-, yfioummO0
■ slodv.-/
’ :
,
■
•
............
J™-------- ---- -
•-
——f—- -—-rrr----------- —
■
«- 4-.- Lack .of.-opport-unitLes.
for professional
af vfnc c mcht'
.
x
.
■''I
:f
:
•
■
■
•
.
.
;
•
it
’no'tnfifem
‘—r—H---
5. Inad_e_guatc_c-gui_pmcnt
; . I - M ao •••-•;
aL
-
--I
-I'-•■■qv-'fr
6. Objections of wife/
husban ci(cvcn if not
married -
■
7. Objections of other
family members-
8. Lack of stimulating
professiona1 c o nt a ct s
9. Lack of transportation
facilities and communi
cation with urban areas
IO; Inadequate drugs and
supplies
11. Pi-fficulty-of ac-e-e-ss
to libraries, reference
materials and research
facilities—
_
-
-
- -
-
— *-»- —
-M1-—■■■' «■ I ■
■
—— -— —-
12. Lack of social activities
and- recreational facili-ties
• i- M
13. Not enough- remuneration
i
•
-
- I,
....................................... .....................
■
- - -»■ «■■ I ■ ■— - »• -
■
'
-
-
I73. Poor quality professional
assistants
contd . . .
6. Listed below arc a number of factors which may influence favourably the way you feel about serving ini a rural area.
Please indicate how important these factors seem to you by
checking ( ) one of the blocks opposite each item.
Factors
1.
Not
slightly moderately
important important important
very
important
Combining preventive
and curative services
for individuals and
families
Service to particularly
needy pc-oplc-
3.
Opportunity for meeting
unpredictable medical
problems
4.
Helping to meet the
national need
5.
Participation in
de vclopmental
activities
6.
Chance to organize health
service for a large
group of people
7. • Opportunity to study-a
community as a whole
8,
Spiritual and humanitarian
motivation
9.
Being able to make your
own schedule
i'O. Having independent
responsibility for
diagnosis and treatment
IK High position in village
soc icty
12. Medical Care
For Office use- only
. . .7
41...,
T*
V
7. contc1
Factors
Not
Slightly Moderately
important important important
Very
import
ant
»
15. Lack of variety
in clinical work
16. Lack of educational
facilities for
children
17; Lack of consultants
18. Health hazards for
family
19. Being supervised by
non-medical person
20. Too: many oaticnts
21. Fear of losing
clinical skill
22. Too few patients
23. Fear for personal
safety
24. Political inter
ference25. Involvement in
medico-legal work
26. Living in a village-
For Office use only
.. .9
T8ST8T/Vd
Afuo esn ooij-JC J oh
buidissob q.cN
duydTssob AxsnoTOTxew *9T
□Tq.sTUJTq.do
snoTq.Txsj3dng
□Tq-STtUTss-aj
'
“
‘GT
Xeuoiq-ej •izT
snoiOTfaJ-uoN •ex
snoTbxxoH
q.s3UcqsTd
AddequQ
q-SdUCH
•ST
injjaoqo ’TT
paj-AxJooj ’GT
P-3J-IT3M
buiq-soji
snoT-oidsns *6
qsTxooj
■3STM
-8
aXqepuadopun •£
0X'4BPu'3d°Q
paujJOjiUT Axjood
paiujojUT TI-3M
’9
snoTaq.snpux
Az eq- *g
3ATq.ej:3doooufi
-3ATq.ejDdoo0 ‘v
'AxpuaiJjun
AxpuoiJd *8
Aqq-xeaqcif]
Aqq-XB3H —"
AxJTO ~
□93X0 *X
a
a
0
V
•UTex-iao xou oje noA jt U3A3 suoTssojdujT jnoA 3Aeq ox 3>iTT""P^ncm
) 'paqo uaqx puTqun acre’Aaqx >{UTqx noA XT PUB1 ‘0
3M
’Q (
z -.y-^T'.'TT'
A-aqx HUTGX
°X XT
^ooqo pxnoM" noX
puTqun oxx^-TX9e Boje Xeqx
'4UW n
noA
di ‘8
9 V3qD
pciT>i xB
^
mouios
3je Aoqx
Aaqx q
quyqx
ncX
PXnoM noA pUT^
4^3
mo? aue
uT4d ri
oA jt
XT ‘v ooeds >[D3qo
pXnoM noA’\3UT>[ Atoa aje AxxB^U36 sJ36extlA >iuTMd n°X xi
puTy[un
a
a
o
V
PUT>I
: 3xdiuex3 joj
•JTed qoe-o U33MX-3q ooeds oxeT^doJdde uo 6uT>p3qo
oxdood 36exXTA X0 suoTssa^duiT x^^uob jnoA sn oat6 3se3Xd.
•sjawsue 6uoj:m io xG^tj
ou aje 3J3qi ’aaou>{ Aeui noA ja6exTTA 3lJ0 Xue jo ueqx jaqxea:
dnojd e se sj-obexxTA jo >{UTqi •dnoocb Aue -aqTJOsap ox 'posn -oq
xq^Ttu xeMd sujt3x axTscddo poJied atuos acre Moqoq poxsTq •oxdoao
■o6exTTA Tnoqe suoTssajduJT jqoA xo oujos Mouqox 3>lTT PTn0M °M ‘8
:
ST JOHN’S MEDICAL COLLEGE
BANGALORE
RURAL COMMUNITY ORIENTATION IP.OGR/-\MME
A4ost of the following questions can be e.answered' by checking ( )
one block in the series opposite each item or writing in) a single
word of figure.
2 .Age
1. Na me
3. Sex
4. Home Address
5. Educational attainment of:
Profe -
General
Not
Can just
literate read & write
Primary
Secondary
College DegE-e
or
riploma
5.1 Father
5<2 Mother
6. Father ’s/Guardian’s Employment:
Medical (
Business (
) ;
Engineering (
Others, specify
7. Father ’s/Guardian Ts
approx. Monthly Income
8.1 Religion:
) ; Agriculture (
Upto Rs.200 (
); Rs.201-500 (
h
Rs.501-1000 (
); Rs. 1001-3000 (
);
Above Rs.3000 (
Hindu (
); Muslim (
other specify
); Christian (
8.2 Caste
9. Previous Residence
Village-
Town
Less than 10,000
Approximate No. of
years
10. Any other relatives who are in health work ?
Yes (
)
pj0 (
j
Specify,
.,rc- , .
City
ST JOHN’S METICAL COLLEGE
BANGALORE
Date-
1. Wc would like to know your own personal preference among the
medical specialities listed below. Please check ( ) one block
opposite each speciality indicating the extent of your own
interest in the speciality.
Speciality
Not
Slightly
interested interested
Moderately
interested
Greatly
interested
1. General Practice
2. General Mec1icine
3. Obstetrics and
Gynaecology
4. Opthalmology
5. Paediatrics
6. Preclinical
7. Paraclinical
8. Community
Medic ine
(in medical
college)
9. Public Health '
(services))
10. Surgery
11. Other
specialities,
specify
For office use only
Name:
. . .2
4. Please check (
) in appropriate column
4.1 Ten years from now, what do you expect to be -
General Practitioner (
Specialist (
Research Worker ( ); Other, specify ....
4.2 Ten years from now, where do you expect to be India ( ) ; United Kingdom (
; U.S.A* ( ) ;
Other, specify
4.3 Ten years from now, how much money7 do you expect to’ earn
monthly ? Please check (
) in appropriate column below :
Less than Rs.1000
Rs.1001-2000
Rs.2001-3000
More than Rs.3000
5. We would like to have your views of the conditions under
which you would be willing to serve in a rural health
center. Please check ( ) one block opposite the statements
Conditions
Risagree
Partially Partially
disagree agree-
1. I do not wish to practice
in rural areas
2. I would accept a rural
health center job as my
family is in urgent need
of financial help
3. I would go only as I am
legally required to serve
in rural areas.
.. .5
Zig re c
4. c ontc1. . . .
Pisagrc-c
Conditions
Partially
disagree
Partially
agree
Agree
4. I would work in a rural
healthcenter only if I cannot
find w)rk elsewhcre
5.
I would work in a rural
health center if this will
give advancement in
government service
6.
I would work in a rural
area if I would not be
stuck in village for life
7. I would go only if permit
ted to live in a nearby
town
8.
I would go to a rural area
if there was improvement
in both professional
standards and living
conditions
9.
I would go if a liberal
rural allowance and
provision for personal
comforts were provided
but without significant
improvement in present
professional opportunities
10. I would go if facilities
for maintaining good
quality professional
standards were provided,
and without particular
regard for improved
living conditions
11. I am willing to go and
serve in a rural area
indefinitely
For Office use only
. . .6
2.
Listed below are various types of professional activities.
Please check (
) one- block opposite each indicating the
extent, to which, you personally feel attracted by that type
of professional activity as o career .choice.
’
Activity
1. Administration he alth and
hospital scrvice
2. Government Hospit-
tai
3. General privatepract ice
Urba n
4. General private
pr a c t i c e
Fural
5. Service- in PrivateHospitals including
mission
institutions
6. Pcsearch
7.
Service in Armsd
Forces
8. Primary Health
Center
9.
Not
inte rested
Speciality (Private)
iO. Teaching
For Office use only
Slightly
intcre stcd
Moderately
interested
Greatly
interested
3. How
H
’
•
important
to you are the following factors in choosing
your career? Please check ({
) in appropriate columns below :
Factors
1. . National Nace’s
2. Family opinion
including parents,
and close
relations
3. Nearness to home
4. Prestige
5. Intellectual
sat is faction
6. Influence of
teachers
7. Financial
remuneration
8. Jeb security
!
9. Specif ice’ hours
of work
10. Leisure
opportunities
11. Humanitarian
and religious
motivation
12. Career opportu
nities
For Office use only
Nat
Slightly
Important important
Moderately
important
Very
important
7. Listed below arc a number of factors which may influencc
unfavourably the way you feel about working in a rural area.
Please indicate how important these matters seem to you by
checking ( ) one of the blocks opposite each item.
• Factors
Not •
Slightly
important important
Moderately Very
important import
ant
-- 1. Lack .of opportunity for
postgraduate education
2. Problems with personal
grooming'and‘appearance ■
3. Unsuitable Housing
4. Lack of opportunities
• for professional
advaneerne nt
5. Inadequate equipment
6. Objections of wife/
hush an ^(even if not
married
7. Objections of other
family members
8. Lack of stimulating
professional contacts
9. Lack of transportation
facilities and communi
cation with urban areas
10. Inadequate drugs and
supplies
T
11. Difficulty of access
to libraries, reference
materials and research
facilities
12. Lack of social activities
and recreational facili
ties
13. Not enough remuneration
I75. Poor quality professional
ass istants
contd . . .
6. Listed below arc a number of factors which may influence favour
ably the way you feel about serving in a rural area*
Please indicate how important these factors seem to you by
checking ( ) one of the blocks opposite each item.
Factors
1.
Not
slightly moderately
important important important
very
important
Combining preventive
and curative services
for individuals and
families
Service to particularly
needy people
3.
Opportunity for meeting
unpredictable medical
problems
4.
Helping to meet the
national need
5.
Participation in
developmental
activities
6.
Chance to organize health
service for a large
group of people-
7.
Opportunity to study a
community as a whole
8.
Spiritual and humanitarian
motivation
9.
Being able to make your
own schedule
10. Having independent
responsibility for
diagnosis and treatment
11. High position in village
soc icty
12. Medical Care
For Office use- only
. . .7
7. conic1
Factors
Not
Slightly Moderately
important important important
15. Lack of variety
in clinical work
16. Lack of educational
facilities for
children
17. Lack of consultants
18. Health hazards for
f amily
19. Being supervised by
non-medieal person
i
20. Too: many oaticnts
z 1.
Fear of losing
clinical skill
22. Too few patients
23. Fear for personal
safety
24. Political inter
fere nee25. Involvement in
mec’ico-legal work
26. Living in a village
For Office use- only
. . .9
Very
import
ant
DTq.sTUJiq.do ~~
.
T82T8T/>1^
Ayuo asn 30TJJC
6uTdTSSo6
joj
6uTdTsso6 AjsnoTOTjej^ •91
Tq.STtUTSS-3j ’GT
jcn
-[euo-tje j •tzT
snoTbipoj-uoN ’CT
js-duch
jnjxooqo •TT
paj-Ajjooj •OT
sncToidsns *5
-a stm
01 qe pu od 9 pun
pOLUJOjUT IJ9M
Az eq
*8
•£
*9
eg
•9at q.e j od 009 'p
A-[PU3TJJ
Aqq-qeoqun -g
ueojo •-[
a
0
V
8
•UTeqjoo q.ou oje noA jt udao suoTssoJdtUT jnoA 3Aeq oq. PHU pi now
■ 9M ’’□
) H99M9 uoqq puiqun oje Aoqq. qUTqq noA jt pue? ‘0
a ((
qooqo pync/'A
pioom' noA
noX pUTqun 9iq.q.Ti
9Tq.q.Ti e oje Aoqq. quTqq.
quyqq. noA jt ‘g
q qo
qDoqD
PinoM
q.UTqq. noA jt ‘v eoeds qDoqo
pinoM noA pUTq
pUT>[ q.eqM3tuos
q.eqM3iuos • 3J-e
3ie A3qq.
ADqq. ..q.UTqq.
piriow noA'^puTH Ajda 3je Ane^suod sjoBoiita quTqq. noA jj.
puT^un
a
0
tl
V
purx
: Didwexe
joj
•jjed qoeo U33Mq.3q ooeds speT^doadde ..up BuTqosqs •
oidood sBeiiTA jo suoTss3.idiuT
suotssDjdiuT lejouoB
-[ej-DU-oB jnoA sn dat
-3at6B ssesid
oseoxd
•SJewsue Buojm jo q.q6>TJ
ou 3je 9J9qi -mou^ Aeui noA jeBenTA euo Aue jo ueqq. joqq.ej
dnojB e se sjoBeniA jo .quiqi ’dnojB Aue oqTaosop oq. posn oq
q.q5Ttu q.eqq. sujjoq. ojTsoddc pojjed otuos 9Je ‘Moioq poqsTq ’oidoou
oBenjA q.noqe suoissojdiUT JnoA jo otuos Mouqoq. 9HTT PI^om om *8
■
.
>
-
-
1......................................................................... -
-O
$
>
-
<:
-■
.-/■
-
• •
•
.
■
.
ST JCHN‘S •PELUCAL CCLL^GE
B ANGAL ORE
RURAL CCiiplUl'sITY CR1ENTATIO>J PROGRAMME
KEY S
A - Completely False
B - Mostly False
i ■'
' 1
C - Partly False
D - Partly True
E - Completely True
Us ing the above key, indicate your choice ;
!• Villagers are incapable of making independent decisions. (
2. I enjoy the company of simple village folk (
)
)
3» Villagers line is a sta-te of ignorance ( )
4. It is impossible to educate the villagers about primary
health matters ( )
■/
ca
:m.
■
■
5. If our country has to prosper it is necessary to improve
our villages.
(
)
a,, c
6. I believe that aodedicated Doctor can .do- a
a village•
lot to improve
)
(
7. I would be. unh.appy if4 I would have to live in a village most
of the time. (
)
E
’■’’r'Xs<;.
* -OSit ’
b* To understard the villagers and the village life one must
live in a village. (■ 1...
9. To be a successful doctor one should work in large Hospitals ( )
)
1O. A talented doctor is wanted-. in a village (
11I am sure that after ten-years 1 wpujd be working in a
village (:
)
'
12• 'I .feel that villagers are a dirty lot ( )
13. I believe ..that the health needs of a village can never
be met fully in the village alone (
)
24, I am of the' opinion that villagers are foolish people (
.
5
■
..
■
v
’
■■
15• Village life is/Healthy (
t
t.-.?
/
■
'
.
•
It J -i
• >■
. r.J, ' t■
■■
'
ca. 1.. .f:
roc--, i-- -iry to r px .
: r C>S;
■
-
)
-
-
■
-
.
,
..
'
; ■’/ C
9
..2
r
)
.
.
-
.
-•
f.j;
• t'-
_
;-r-•.<
o-k. J. :u v-i
oa
.Ok
■-''•••
\
J-'JC".-.C.
’r
> .■
4
•.•.•to
V § '.Ji' t
\
/.>-.£ daxloob
VJiOOr. ig
'
h
(
j
i
. 1 : '■ -■
Ji / J. .j
. -tij( ' fi V'■ '• ;
<:■ oij/'-O
:
b
t'-O/p :hfc^;r- -.O
'
V. U.
itr-f
' . - Ol ' .L - I > ? £ g
; enoih, opallxv ohi.ni vilul
o-o •-•:.,o ,...p
o •
■•
r
J.
ic bo f »\ [
r.^Oij£dJ?i-2 ..A_.hJ noxoo ro
0d
OLUS'. OX;;.: I
-‘O'
-'J
C ■
It is the duty, of .every educated' git ten' to conthfeutc* his
■
;
3VQ sepvi^for the. Upiiftnient of our'villages^ 'Ajo if , J
16 •
17. For pleasure ard happiness1" every person muX''Wave Basic
ovo-f/r/dmenitiL^S^
figAox-.X b■■/<;„■•.:
toy
y . 'V-i.i o. "I ,
■'Io; I feel that villagers indulge in malacious ’g'dsXp i ’ )
(
19. In general
aav-T'-wouldcelite^o^o gity b^s.t; tcjs^ivb Vhe, sGcio-oc'.,i:omac
problems of my country . ( ,) s
; . /
u I a . r. L
. :i 21. -CEt i&anicessasy.AQ
be of any service to them (
) ?
• -1
)
22* All villagers are unhygienic people (
23. I vjould like to work in a village because I am gohvinced
that our country will not prosper unless the health
problems of every, village are looked after ( )
24. I would like to work in a village because it is acceptble
to me ( ) '
25.
)
i feel that villagers .axe'highly super st icious (
26. Villagers are highly sus'pecious people (
)
27. To be a /good doctor one'must have knowledge of both rural
ard urban life (
prk/1912Jl
-i
i
)
Cj2>
H 'J- ) - '4-
$
DIRECTORATE OF RURAL HEALTH SERVICES
AND TRAINING PROGRAMMES
ST JOHN ‘S MEDICAL COLLEGE
BANGALORE 34
TRAINING PROGRAMME FOR COMMUNITY
HEALIH WORKERS
JSS?
DATE S
answer as many as you cam from- the following
i» 1. Write- a few sentences about Community Development ?
2o
Name the extension services involving any three areas
of Development ?
3
Mention the names of a fev; Voluntary Organisations
you know ?
4o
If you are required to identify the local leaders
what method.s you adopt ?
5
Tick the correct functions of a Primary Health Centre
from the following »'
1) Control of communicable diseases
2) Transport and communication
3) Environmental Sanitation
4) Lanking and Industry
5<) MCH A Family Planning & Nutrition
6) Health
d uc ation
6- When you visit a family in a village and spend one
hour 9 what are all the items you observe which have
bearing on the health of the family.
7» During your family visit, (one of" the
‘’
members asks you
about diseases spread through water,► What are they
and how will you explain ?
b. What is communicable and non-communicable diseases ?
Give examples»
9e How will you manage a case of diarrhoea in a child ?
10. How can you make water safe for drinking ?
. ..2
/
. f
I
• 2 i
II. Write vjhat you know about the following s
1. Minimum needs programme
2. Integrated Child Development Scheme
3 • B al anced. Diet
4. Village Birth J-Xtehdant or Dai
5* Fever Treatment Depot
6. Flannelgraph
7• Incubation Interval
o. Contamination
Isolation
10. End emic
11. Crude death rate
12« Fly control measures-
3
/
5
3
Answer YE»S OR NO depending on whether you agree or
disagree with the following statements $
III
1. It is better to keep the local loaders away for
effective implementation of any health programmes
(YesAio)
2. Vitamin
A 1 deficiency leads to beriberi
(Yes/bio)
3o Chloroquin is an antileprosy drug (Yos/no)
4o Soakage pit is ideal in porous terrain
of rural areas
(Yes/no )
5. Waterseal prevents fly breeding in Hand Flush
Latrine
(Yes/no)
6
Postnatal care includes care of mother and care
of infante
(Yes/pio)
IVo Fill up the blanks with the correct word given in the
brackets ,
. - -
1
Deficiency of iodine in food leads- to
(Goitre/yiarasmus/scurvy)
2» Deficiency of iron in food causes
(Anaemia/Scabies/Anguler stomatitis )
3.
is richest single source of Vitamin C
(Sapo t a/Amia/Papay a)
4. Groundnut is rich source of
(Protein/vit.A/Calcium)
5. Night blindness is caused by
(Deficiency of VitA/vit.c/vit*D)
6.
Flash cards could be effectively used as an educational
aid for
(Mass/Small group/big group)
7.
Kwashiorkor is caused due to
(Successive pregnancies/rice eating/
protein deficiency)
So
Secondary Immunization against tetanus is ito be given
for antenatal mothers
(Once/Twice/Thrice)
9. Bleaching powder is used to disinfect
(Water/Milk/Meat)
10. The formula to calculate the Quantity of water in a
round well is
o
I
rural
ORIENTATION- pro ora we
Assessment guestionnaire
Li st out 4 n
“■- •
consequences
of the
following situations, IN THEIR
ORDER OF PRIORITY, that YOUthink
---------------- : are most important for a RURAL
family.
: t aim urn monthly expenditure requirement
and monthly income do not
meet.
.Chronic indebtedness to the local money lender,
■The monsoon rains have failed
railed this
this year
' STuo U'atSr U,B11S
th8
bl0ck of the village have
'--ijan has been elected to the Panchayat of the village
t-’he nearest rural Health Centre is 25 Kms.
away
■ j.j mother of a sick child believes that
she and her child are
i..cing ounished for their sins.
'■Th ?e is only one bus which
passes through the village on its way
-he City and its timing and
regularity are unpredictable.
^Tho village is at the r~~- cross-roads where several buses from
it.erent parts, pass through
i, on their way to the city.
’■
nearest primary school is 15
Kms. away.
r’-.o ''illage has a primary school, a middle school and
a high school.
■->P|V|ojority of the villagers
are farmers.
' -Majority of the villagers
are petty tradesmen
: -«• -Jority of the villagers
work in the factories of the nearby -ci’ty.
■^T'-'oro are four daughters
aged 12 to 18 years, in the family.
6.6 me ibers of the family
live in a single—roomed bouse.
1 the 3 sons
—
of the family have completed their B.Sc. and 0.^.
degrees in the
-■•J nearby City and are currently unemployed.
' C
’ ’ -e pp
-s a woman representative in the local
panchayat body.
village has a Primary Health Centre with
10 beds, 2 doctors
' -ng a lady doctor and several health workers. '
-The nearest post office and bank are 25 Kms. away.
'
t
snS^ank?38
office as well as
birth of a male child in
a rural family is more welcome
• that of a female child.
ho tjumption of rice is
considered as
>ng Lhe villagers.
a social status symbol
■ Six t imes a '■
year, the village is used as a Training Centre by
a nearby urban medical
— college.
-ther situation which you feel relevarrt to the
village
co mm unity.
1
C-J3> ,A/\ V<
Ct
ruul oRiEMT^Tirrnr PROcmmE
Assessment Questionnaire
n ^nse^ences of
following situations, IN THEIR
p.
r PRI°RITY, that YD U t hink are most important for a RURAL
ami ly •
■'ini mum monthly expenditure requirement
■’eet.
and monthly income do not
■Chronic indebtedness to the local money lender.
■ne monsoon rains have failed this year
i?--inking water wells in the Harijan block of the village have
•jtu.00
up.
■-i. Ha-ijan has been elected to the Panchayat of the village
--■-ne nearest rural Health Centre is 25 Kms. away
.■ - n^her of a sick child believes that she and her child are
buing punished for their sins.
^here is only one bus which
i passes through the village on its way
-o the City and its timing ,
and regularity are unpredictable.
Too village is at the
cross-roads where several buses from
•iiierent parts, pass through on their way to the city.
Tho lea rest Primary school is 15 Kms.
away.
: ■: village has a primary school,
a middle school and a high school.
• A.’!ojority of the villagers
•.Majority of the villagers
are farmers.
are petty tradesmen
'' 3.j°rlty of the villagers
work in the factories of the nearby cfty.
’J^Trere are four daughters ,
aged 12 to 18 years, in the family.
•' 6 5 members of the family live
in a single-roomed house.
'«All the 3 sons of ths family have completed their B.gc. and 0.^.
•-■egreeo in the
- .J nearby City and are currently unemployed.
ojre is a woman representative in the local panchayat body.
■'llSng9a
a Primary HeaUh
Health Centre
Centre with
with 10 beds» 2 ^^ors
lady doctor and several health workers.
nearest post office and bank are 25 Kms. away.
■’’e village has its □wn post and telegraph office as well as
a hmall bank.
Tin birth of a male child in
a rural family is more welcome
then that of a female child.
!?P-‘'!sumption of rice is considered as
a social status symbol
among the villagers.
times a year, the village is used
as a Training Centre by
nearby urban medical college.
CCv SitUation
feel relevant to the village
&
CLd
>' S
DEPT OF COMMUNITY MEDICINE
ST JOHN’S MEDICAL COLLEGE, BANGALORE 34
RURAL HEALTH EVALUATION REPORT
The following pages contain a number of incomplete stories.
We want you to read and complete them giving your imaginative
best as to what happened from the point where it was left off.
There are no right or wrong conclusions to those stories.
Please do not try to read all of them first anc1 then go
back over them towrite the conclusions.
yyur +KY°U-haYS °nR 5 minutes for each. In order to finish all
tbRaH?tteCp tlme you wil1 have to write your spontaneoreaction immediately after reading each story.
_
---------yvno 11QO
1.
Dr Singh
is5 aa young -doctor
who
has 1X11X0
finished a year's suroical
tn , h0USG
house °£
officership
fl<=ership in his medical
mehical college
colleqe hospital. He has
2Oyearsfe betWGGn two assignments
assignments each
each for
for aa period of approximate
m-iincR6
15 ,a government primary health centre only
__ 5
that itr?s th6 myical college with
with good
good road
road connections
connections so
Hf+Ht L
T.f°r botb Patients
■'
, . and the
— doctor to
go back and
The second is a I
which is’supported by his
an area of q:
outside world
IVhat choice did he make and why ?
2.
Mi uPcaicutL3 Tj v SSfU1
. P
i ractlti
— oner
—” who
....j had never been
to a village
village where
Tchad
ooXud
fr°m hiS first visit
where
he
had
Pr Chatterji, a yfunq cflleaX Ln 3 WJdln9 P^y.
In talking
young colleague
a village, he exp?essef
in ft™n who? W3S bornJnfJ bought up in
disgust at the lack of laterinf^i^thfDillan! rcTulsion and
. - hXXt
He
th “th1 TVGrr9° baCk 10 a villa9e again because
’beX
again
because
9OiU °Ut t0 tbe bielbs
morning
59 he i
J and night.
Dr Chatterji responds
3.
Tr. Viswanathan had been surprised to find that his 5 years in
VS ean1'1"9
“ipcdn°sc:^.
..y.was^allpr' ^xt Poor and found the 4 year ol£ friend of'his
SSSS ? 13 E
Dr Viswanathan immediately
4.
On graduation from the medical college Dr Gupta had three
alternative
choices.
Primary
Health Cent^^re^J^ld^^S
fa
His.maternal uncle who i
practitioner in a big city
invitee' him to join his was.private
clinic
notin'"
’
aS
+
a
jun,10r' at 200 rupees a month,
He was selected to do jpost gracuate work
in a subject for which hchad no pn-.-titular preference.
■'id-r to
.
After careful consideration
1
s7^/c
DEPT OF COMMUNITY MEDICINE
^T JOHN'S MEDICAL COLLEGE, BANGALORE 34
RURAL HEALTH EVALUATION REPORT
The following pages contain a number of incomplete stories.
We want you to read and complete them giving your imaginative
best as to what happened from the point where it was left off.
There are no right or wrong conclusions to those stories.
Please do not try to read all of them first anc1 then go
back over them towrite the conclusions.
+uY0U.haYS °nV 5 minutes for each. In order to finish all
°U+in T thLa+1?ttGr tlme you wil1 have to write your spontaneoreaction immediately after reading each story.
'j?
_____
u
1>
R, eing«-S5 a3 .Y
Ung .doctor who has
finished a year's surqiceJ
°ffic
ership
in his
his ^dical
medical (college
"'
to ch ho.se,t°N
Cer
+Shlp 10
hospital. He has
2 yea?s! between two assignments each for a period of approximate'
.,
first is a government primary health centra onlv 5
?i3tSl+ L"
college with g?o« road con^lonl so
fSh to the rit!Or ™
patients and the doctor to go back and
eo^ole^-
It is in S
by
weather anc1 bad roads.
IVhat choice c1id he make- anc1 why ?
2.
out oDcalLtta3
Practitioner who had never been
village^hlre h^ had SneTifr°m hiS first visi?
to a
Dr village,
Chatter’
ji,
a
he
'*? "aS ^"^"^ugh^ “in"9 "
Cisgust at the- lack of latcrl^s’l^ZTl^lagc8/9^1’™"
that
the^thouohtTf90 ^3Ck T 3 Vllla§e again because he can’t’ bear
It Chatterjl res^Ss
he
"’orr’ir’9 and night.
3.
Tr Viswanathan had been surprised to find
‘
that his 5 years in
a rapid and pleasant
aged 4-2 and
enjoyed the
severe vomitting and diarrhXVn the
d°CtOr
,‘5'.VjS-.iC?*1’^Gr\ne,x’t.(Joor ancl found
Dr Viswanathan immediately
4.
On graduation from the medical college Dr Gupta had three
alternative
choices.
Primary
Health Centre^whPTchcCrU1i 1acfa j°b in a government
he coulcnr!r+^+
1
His maternal uncle- who where
was private
* earni?9 Rs. 550/- per mon'
DIRECTORATE OF RURAL HEALTH SERVICES
AND TRAINING PROGRAMMES
ST JOHN ^.S MEDICAL COLLEGE
BANGALORE 34
TRAINING PROGRAMME FOR COMMUNITY
HEALTH WORKERS
PK2/P0ST COURSE TEST
LY-xTE 2
ANSWER AS MANY AS YOU CAN FROM THE FOLLOWING
In
1
’Write a fev; sentences about Community Development ?
2o Name the extension services involving any three areas
of Development ?
3» Mention the names of a fev; Voluntary Organisations
you know ?
4o
If you are required to identify the local leaders
what methods you adopt ?
5
Tick the correct functions of a Primary Health Centre
from the following i
1) Control of communicable diseases
2) Transport and communication
3) Environmental Sanitation
4) Banking and Industry
5) MCH c: Family Planning & Nutrition
6 ) He al th Ed. uc at io n
6« When you visit a family in a village and spend one
hour 9 what are all the items you observe which have
bearing on the health of the family.
7* During your family visit, one of the members asks you
about diseases spread through water, What are they
and how will you explain ?
b. What is communicable and non“communicable diseases ?
Give examples•
9e How will you manage a case of diarrhoea in a child ?
10. How can you make water safe for drinking ?
. o.2
T
■
s 2 :
II. Write yjhat you.knovv about the following
o
1. Minimum needs programme
2. Integrated. Child Development Scheme
3 • B al anc ed Diet
4. Village Birth Attendant or Dai
5« Fever Treatment Depot
6. Flannelgraph
7. Incubation Interval
o. Contamination
9. Isolation
10» Endemic
11. Crude death rate
12
Fly control measures^
<>3
• 3 s
IIIo Answer YES OR wo <depending on whether r —
you agree or
disagree with the fo Ho wing
J statements^
!•
is better to keep the local leaders
away for
effective implementatr
■-an of any health programmes
(Yes/woj
2. Vitamin 1 A 1 deficie
ncy leads to beriberi
(Yes/wo)
3 Chloroqum is an antileprosy drug (Yes/wo)
an a-
4
Soakage pit is ideal in
porous terrain
of rural areas
(Yes/wo)
5
Waterseal prevents fly breed?ing in
Hand Flush
Latrine
(Yes/wo)
60 Postnatal
care includes care of mother and
care
of infant
(Yes/Mo)
Sacked bl^kS
1
the correct word given in
the
Deficiency of iodine in food leads to
(Goitre/warasmus/Scurvy)
2. Deficiency of iron in food causes
(Anaemia/scabiesAnguler stomatitis )
3.
is richest single source of Vitamin C
. 3apo t a/Amia/Papay a)
4. Groundnut is rich source of
(Protein/Vit. VCalcium)
5. Might blindness is caused by
(Deficiency of VitA/vit.c/vit.
6.
7.
Flash cards could be
effectively used
aid for
as an educational
(Mass/Small group/big group)
Kwashiorkex is caused due to
(Successive pregnancies/rice
protein deficiency)
■>
8. Secondary Immunizatio
f
o r an
ten at al mothers n against tetanus is Jto be given
for
antenatal
9. Bleaching powder is used
/
eating/
——------- (Once/Twice/Thrice)
to disinfect
(Water/Milk/Meat)
10. The formula to calculate
the Quantity of water in a
round well is
D)
A-
DIRECTORATE OF RURAL HEALTH SERVICES
AND TRAINIMG PROGRAMME S
ST JOHN is MEDICAL COLLEGE
BANGALORE 34
TRAINING PROGRAMME 'FOR COMMUNITY
HEALTH WORKERS
pre/post^, course test
DATE s
ANSWER AS MANY AS YOU CAN FROM THE FOLLOWING
lo
2
Write a few sentences about Community Development ?
Name the extension services involving any three areas
of Development ?
¥•
3» Mention the names of a fevj Voluntary Organisations
you know ?
4. If you are required to identify the local leaders
what methods you adopt ?
5o Tick the correct functions of a Primary Health Centre
from the following •
1) Control of communicable diseases
2) Transport and communication
3) Environmental Sanitation
4) Banking and Industry
5) MCH & Family Planning & Nutrition
4
6) He al th Ed uc at io n
x'* •
6. When you visit a family in a village and spend one
hour5 what are all the items you observe which have
bearing on the health of the family.*
7. During your family visit, one of the members asks you
about diseases spread through water, What are they
and how will you explain ?
b. What is communicable and non“communicable diseases ?
Give examples.
9e
How will you manage a case of diarrhoea in a child ?
10. How can you make water safe for drinking ?
• o.2
c
2 :
II. Write v/hat you know about the following s
1. Minimum needs programme
2. integrated. Child Development Scheme
3. Balanced Diet
4* Village ■ Birth ’-attendant or Dai
5. Fever Treatment Depot
6. Flannelgraph
7• Incubation Interval
o. Contamination
9. Isolation
i
10» Endemic
11. Crude death rate
12. Fly control measures™
...3
s 3
III
:
Answer YES OR NO depending on whether you agree or
disagree with the following statements s
1. It is better to keep the local leaders away for
effective implementation of any health programmes
(Yes/Mo)
2. Vitamin
3
1 A
1 deficiency leads to beriberi
(Yes/No)
Chloroquin is an antileprosy drug (Yes/no)
4* Soakage pit is ideal in porous terrain
of rural areas
(Yes/No)
5» Waterseal prevents fly breeding in Hand Flush
(Yes/no)
Latrine
6. Postnatal care includes care of mother and care
of infante
(YesAio)
IVo Fill up the blanks with the correct word given in the
brackets? ... • ’
1. Deficiency of iodine in food leads to
(Goitre/Marasmus/;scurvy)
2» Deficiency of iron in food causes
(/-anaemia/Scabies/Anguler stomatitis )
3.
is richest single source of Vitamin C
(Sapota/Amla/Papaya)
4. Groundnut is rich source of
(Protein/vit-A/Calcium)
5* Might blindness is caused by
(Deficiency of VitA/vit.c/vit <>D)
6.
Flash cards could be effectively used as an educational
aid for
(Mass/Small group/Big group)
7.
Kvvashiorkei is caused due to
(Successive pregnancies/rice eating/
protein deficiency)
8* Secondary Immunization against tetanus is ito be given
for antenatal mothers
(Once/Tv; ic e/Thric e)
9. Bleaching powder is used to disinfect
(Water/Milk/Meat)
IO. The formula to calculate the Quantity of water in a
round well is
©
Operations Research in Health Systems Development
Ct/se no. 5
Alternative
Methods of
Health Care
Delivery at the
Village Level
Ranga Reddy district,
Andhra Pradesh
Dr. Prakasamma*
Background
A-r*case study describes an innovative field experiment in which
1 two types of health workers were appointed to assess their
effectiveness on providing access and quality of services in rural
areas. This experiment was set up in two villages where government
health centres were not located.
The Academy for Nursing Studies (ANS), Hyderabad with financial
assistance for the research component from the International
Committee on Management of Population (ICOMP), Kuala Lumpur
carried out this experiment. Expenditures on services were met either
by the community or by the clients.
The Partners: ANS and
ICOMP
The case study compares quality and quantity of services provided
in two village health centres, both started in March 1997 in Ponnal
and Kolthur villages under Shamirpet PHC of Ranga Reddy district
in Andhra Pradesh. The two villages were similar in many respects.
Both the villages were located at some distance from the PHC and
subcentre. Kolthur was located 9 km from the subcentre and 15 km
from the PHC. Ponnal was located 7 km from its subcentre and 10
km from the PHC. Both the villages were away from the main road.
Ponnal
Kolthur, Panga
Reddy district
Though bus facility was available, buses were irregular and infrequent.
The situation was worse during the rainy season. A bad stretch of
road made them inaccessible during the rains. As a result, ANMs
from government centres visited those villages usually once a
fortnight. Both villages had strong and functional Women’s Health
Groups. These groups had their own bank accounts and were
registered societies. Both villages were located away from subcentres.
Government ANMs visited these villages once a fortnight or less.
Other common features of the two villages were:
Communities had decided to start the centres
Community managed health
centers
•
WHGs were responsible for monitoring both the centres
■
Health workers stayed in the village and provided round-the-
•
clock services
Village health workers collaborated with the government health
■
workers
Academy of Nursing Studies ensured referral linkages and
supervised at both the centres
*• Honorary Secretary, Academy
for Nursing Studies (ANS)
46
June 2000
A Report of Selected Innovative Approaches
Operations Research in Health Systems Development '
HOW THE INNOVATION WAS IDENTIFIED
In 1995, ICOMP had initiated a series of projects in three Asian
countries (India, Vietnam and Sri Lanka) to improve the quality of
care in health and family welfare programmes. In India, the
Administrative Staff College of India (ASCI) implemented the
project in Shamirpet PHC, during 1995-97.
This project had shown that the benefits of ANMs’ services were
available to those villages where sub-centres were located. Villages
located far away from these centres did not receive even the basic
health services. Some of these villages were large enough to require
health centres of their own. In most villages, demand for services
had increased due to die intensive community mobilisation activities
carried out during the quality of care project. WHGs in these villages
were willing to participate in health care activities and wanted to
establish regular health services in their villages.
In the meantime, the Government of Andhra Pradesh was also
considering the possibility of expanding health services to remote
villages to increase their access to services. The government had
started a massive programme for building awareness regarding
government health facilities. Moreover, the Vision 2020 of the state
government had envisaged a universal health services programme.
In accordance with that vision the government planned to introduce
ArogyaSevikas who would be trained for a short duration (3 months)
and posted in their villages. They would operate village health centres
with support from ANMs. The government had already started
Health scenario in project
area
Government of Andhra
Pradehs’s Universal Health
Service Programme.
trainingin some districts.
ANS decided to try out an alternative, which was to be a self-employed
ANM willing to operate village health centres. Andhra Pradesh has
surplus trained ANMs who have not been absorbed in government
service. The field experiments planned in Kolthur and Ponnal
involved starting two village health centres, one looked after by an
Arogya Sevika and one by a self-employed ANM. This experiment
was to provide inputs for the state government’s policy of appointing
Arogya Sevikas and assess the effectiveness of the proposed
Arogya sevikas and a self
employed ANM
alternative.
Description of the Intervention
In this experiment, two service-delivery options were tried in two
large but remote villages where access to government health centres
was low. One option was a married woman from the village and
A Report of Selected Innovative Approaches
June 2000
47
Operations Research in Health Systems Development
another was a self-employed ANM (Box 1).
Box 1: Service delivery options
■
Option I: ArogyaSevika (Village health worker)
This option involved selecting, training and guiding an educated
married woman of the village, to provide basic health care round
the clock from a village health centre.
Option II: Self-employedANM
This option involved appointing, training and supporting a
qualified ANM not employed in the government system, to set
up and manage a village health centre.
Two villages—Ponnal and Kolthur, in Shamirpet PHC were selected
for this experiment. The similarity between the two villages was
deliberate, so as to facilitate comparison of results at the end of the
experiment.
Active WHGs
Both villages had poor access to health facilities. But the village
environment in both the villages was supportive to the experiment.
The panchayat members showed interest and willingness to contribute
in cash and kind to the health centres. Both sarpanchs were women
from backward communities. The WHGs of both villages were active
and wiWing to support health centres in their villages. Tn one village,
Ponnal, the Women’s Health Group (WHG) nominated a young
married woman from the village.to run the viDage health centre. In
another village, Kolthur, the health centre was run by a qualified
ANM as a self-employed health practitioner.The WHGs held regular
meetings and demonstrated team spirit and cohesiveness among
themselves.
However the two villages were slightly different on three counts—
their size, spread and people’s willingness to support an ANM (Box
2)
48
June 2000
A Report of Selected Innovative Approaches
Operations Research in Health Systems Development
Box 2: Details about the two villages
Population
Households
Outreach
Willingness
Ponnal
Kolthur
2,101
400
No hamletsattached to the village
3,210
Villagers doubted their ability to
SL1PPort a qualified ANM
600
Village was spread out with two
hamlets.
Villagers wanted a fully
qualified ANM and were
willing to take responsibility for
her payment and
accommodation.
Both the centres functioned under the administrative control of the
village WHG. The Academy for Nursing Studies undertook technical
monitoring, PHC and other nearby hospitals provided referral
Ro/es of
health facilities
yiNS and
support. The WHG decided the amount and mode of payment to
the health worker.
IMPLEMEN 1AT1ON EXPERIENCE
The implementation process consisted of five steps.
For selecting .Arogya Sevtka^ the ground rules; were that she should
be educated at least up to tenth standard, must be young and married.
She should have a small family and minimum financial constraints so
that she could devote time for health activities. The choice of Arogya
Sevika was left to the Women’s Health Group. ANS took the
responsibility for selecting an ANM. For that the ANS first conducted
a seminar on self-employment for ANMs. More than 60 trained
AN Ms who were not employed in the government service, attended
Identification of health
workers
this seminar. There it became clear that many ANMs were in need of
employment and that several of them were willing to set up village
health centres on their own if they were given the oppprtunity and
initial support. This is a peculiar situation in Andhra Pradesh, which
has the largest number of ANM training schools in the country. Their
output is too large for the government to absorb. Thousands of
ANMs are working in private nursing homes and hospitals for very
low salaries.
A Report of Selected Innovative Approaches
June 2000
49
Operations Research in Health Systems Development
The health workers selected in the two villages were (Box 3):
Box 3: Characterisitics of the health workers
Arcg'ja Sevika at Ponnal
0 A young married woman from the village with two grown
up children
0 Educated up to tenth standard, no prior training in health
0 Nominated by the WHG.
0 Willing to run the health centre for the remuneration decided
by WHG
Self-employedANMatKolthurhealth centre
0 A qualified ANM from another district
0 Selected and trained by the ANS.
0 Previously worked in a private nursing home.
0 Willing to operate a health centre on a self-employment basis
Discussions with community
members
NegotiatzoM-f and Bargaining
50
After ensuring that it was possible to recruit an ANM to operate a
village health centre, members from ANS held meetings of the gram
sabha (village panchayat) in both the villages. These meetings were
conducted in open places where anyone in the village could
participate irrespective of caste or economic status. Three such Gram
Sabhas were conducted in Ponnal and four in Kolthur. Issues
discussed were whether the panchayat would provide space for the
health centre, who will maintain the facility, what services will be
provided, role of WHG, and how the fee structure would be decided.
Villagers in both the villages agreed to provide space and suggested
possible sites for the health centre. They made the final decision in
consultation with the ANS members.
Negotiating terms for setting up the health centres was an interesting
process that took place at three levels. The first level was between
the ANS and the villagers. The villagers tried to get the most from
the ANS funds for drugs, repairs, maintenance, salaries, etc., while
the ANS tried to insist on local resources and participation. The
second level was between the WHG and the village panchayat. The
women’s health groups wanted panchayat contributions and official
support for its activities. Panchayats wanted the WHG to generate
as much funds through fees and donations as possible. The third
level was between the health workers and the WHG. This included
June 2000
/4 Report of Selected Innovative Approaches
Operations Research in Health Systems Development
negotiating the terms of work and payment between the Arogya Sevika
/ ANM and the WHG.
Finally the ANS bore the costs of equipment, furniture, records, and
training. The panchayat gave a house to the WHG and made necessary
repairs.
The voluntary Arogya Sevika in Ponnal required repeated and long
duration training in basic health care. The training was provided by
ANS, and an ANM from the PHC. The training included certain
clinical skills such as antenatal examination and care, child care, simple
health concepts, high risk assessment, checking blood pressure, giving
injections, first aid and simple medication. In spite of repeated
training the Arogya Sevika did not feel confident about conducting
deliveries. The community did not think she was properly trained
Recruitment and training
because she had not attended any formal training program. She
therefore had to enrol for the 6-month Anganwadi Workers training
programme provided by the Women’s Development and Child
Welfare Department.
Tn Kolthur, the ANM did not need technical training since she had
been previously working in a private nursing home. ANS gave her
one-month’s training mainly in clinic management, accounts and
record keeping. This was followed by a short refresher course every
three months. She was also asked to make a commitment to work
for at least two years.
The project spent about Rs.50,000/- on setting-up the two health
centres. This amount excluded payments for the workers and costs
of monitoring and mid-term evaluation (Box 4). The project
provided a medicine grant of up to Rs. 10,000 per centre to cover
their first two years of operation. Thereafter medicines were to be
Setting up of the centres
purchased either by the panchayat or by the patients. However,
payment to the workers was always the responsibility of the
community. In Ponnal, the WHG paid the Arogya Sevika Rs. 450
per month as honorarium. In Kolthur, the ANM earned about. Rs.
2000 - 3000 per month from the service charges she collected, using
the fee structure decided by the WHG.
A Report of Selected Innovative Approaches
June. 2000
51
Operations Research in Health Systems Development
Box 4: Direct expenditures from 1996-98
Ponnal
(Rupees)
Kolthur
(Rupees)
Community mobilisation
Equipment and furniture
Records and stationery
Drugs and supplies for three months
Training of health workers
Support of ANS
15,000
13,500
2,200
10,000
3,500
5,000
15,000
15,000
2,200
8,000
Total
49,200
46,700
6,500
Outcome of the Intervention
Evaluation of the
experiment
Three years after the experiment was initiated, three independent
investigators evaluated its outcome in February 1999. Data for this
evaluation was gathered from 145 households of Ponnal and Kolthur
villages, from village leaders, health providers, members of WHG,
and government health staff. Their evaluation termed Ponnal a failure
and Kolthur a success based on the f oilowing findings.
At Ponnal, the evaluating team noted that:
The village health centre was not functioning regularly
Villagers did not trust the abilities of the Arogya Sevika and did
not utilise her services to the desired extent.
Arogya Sevika did not seem confident about providing health
services due to her lack of experience and formal training.
She did not stock medicines because villagers were not willing to
buy medicines from her.
She did not make village rounds; there was a gap between her
and the villagers.
The village health centre had functioned only for about a year;
villagers were mostly going to a private practitioner who had
spread the word that the Arogya Sevika was not trained to
provide health services.
The WHG in the village had stopped functioning because of
internal fights. As a result, the Arogya Sevika had lost interest in
the village health centre and was looking for better avenues of
employment.
AtKolthur, the evaluation team noted:
•
52
The village health centre was well maintained and the ANM was
June 2000
/I Report of Selected Innovative Approaches
Operations Research in Health Systems Development ■
•
residing in the centre with her family.
Since the ANM was well trained, villagers trusted her skills and
•
were willing to use her services.
The ANM seemed knowledgeable and confident about providing
treatment for minor ailments and handling deliveries.
The villagers paid for medicines. The ANM was able to maintain
good stock of medicines, which she purchased from
•
pharmaceutical salesmen.
The ANM made frequent visits to villagers which helped her build
a rapport with them. Women in turn visited her frequently.
The centre was functioning without a break and round the clock
because the ANM stayed at the centre.
However, the ANM was running the health centre almost as a
private practice with little supervision from the WHG.
The household surveys in the two villages also found substantial
differences in the awareness, utilisation and satisfaction levels in the
two villages (Box 5)
Box 5: Survey results
Ponnal (n—74)
Kolthur (n-71)
(%)
(%)
1. Awareness about health centre
85.1
100.0
2. Knew timings of health centre
35.1
98.6
32.4
84.5
Nil
1
22.8
97.2
23.0
84.5
36.5
98.5
86.5
98.6
3. Households reported having used the
centre in previous 6 months
4. Number of deliveries conducted in the
centre in one month
5. Respondents expressed satisfaction
with centre’s functioning
6. Thought the care provider had the
necessary skills
7. Respondents appreciated the attitude
of care provider
8. Respondents felt the centre should
continue to operate
A Report of Selected Innovative Approaches
June 2000
53
Operations Research in Health Systems Development
Lessons learnt
Several lessons emerging from this experiment can guide efforts to
extend primary health care to remote villages. Most large size villages
that are located away from the health centre need a village health
centre. But to make that centre a success requires several ingredients.
Consensus on establishing
the centre
The decision to establish a village health centre was on consensus
among village residents, especially among those who were involved
in the centre’s functioning. Starting a centre involves many decisions,
some of which have potential for conflict. For example, the decision
about where to locate the centre, what support to provide, how much
to pay to the worker, are issues that are potentially contentious. In
this experiment most of these issues were amicably settled probably
because of the involvement of ANS, a helpful and competent
outsider. VCTen a NGO is not involved, a PHC can play that role.
The presence of an active and motivated women’s health group was
very important for starting a village health centre. This group
negotiated with the village panchayat and with the service providers
Presence of a support group
in the village
to get the best possible terms for village residents. The group
provided support to the workers, which the village panchayat could
not have provided . In Ponnal village the centre functioned as long
as the WHG was active. When the WHG stopped functioning due
to internal conflicts, the clinic also became ineffective.
The interest of the health worker in operating the centre was the key
to sustaining the health centre. In both the villages, the community
decided what they would pay to the worker. In Ponnal village the
Sustaining workers interest
community decided to pay a salary to the worker. The amount was
based on the community’s ability to pay and not necessarily on what
she deserved. Arogya Sevika was dissatisfied with what she received
as honorarium and began to look for better alternatives. In Kolthur,
the ANM was allowed to charge fees for her service as per the fee
structure decided by the WHG. This arrangement allowed her to
earn more by providing services, and retained her interest in running
the centre.
I
Quality and accepatability
of services
Community’s perception of service quality was the key to
acceptability of services. The community will be interested in
sustaining a health centre if the service provider is perceived as
competent, if the services are available at the time of need and the
service provider is seen as being helpful and doing her best.
54
June 2000
\ Report of Selected Innovative Approaches
Operations Research in Health Systems Development' ‘
In Ponnal village, the community did not think that OatArogyaSevika
was providing quality services. There lay the crux of the centre’s
failure. In Kolthur village, the ANM’s services were highly acceptable.
Therefore the centre continued to function well even though people
had to pay for the services they could get free of cost from the
government ANM.
The community not just participated, but also owned the initiative.
Though initiative for this project came from a NGO, the village
panchayat and the WHGs were aware that the NGO’s involvement
would be limited and its support would be for the first three months
only. Though WHGs in both the villages participated fully, the
ownership sense in Kolthur was stronger than that in Ponnal. WHG
members in Kolthur village actively sought donations in cash and
kind. They devised schemes to generate corpus funds. They organised
Shramadans for cleaning and maintaining the health centre. They took
pride in announcing the fact that their village was the first to start a
health centre of its own. They invited leaders from the surrounding
villages, PHC Medical Officers and staff, and also the press to give
publicity to their centre.
This experiment showed that a qualified ANM working as a selfemployed professional is a more effective option for service delivery
in remote villages than a poorly trained woman from the village.
This concept needs to be promoted especially in states where
unemployed ANMs are many. One should also realise that this
concept will work in villages that are remote but not too poor. People
must have the need and capacity to pay for services. In the country,
there may be a sizeable number of such villages where this option
needs to be encouraged, to improve quality and access to primary
health care.
‘
»
I
Community ownership
f
Self employed ANM an
effective option in remote
villages
I
*
J
I
A Report of Selected Innovative Approaches
June 2000
55
1
-1
H
<
nnwing about rural community development in india.
Subject; knowing about iiu al community development in india.
Date: Sun, 1 Jui 2001 19:43:58 +0200
From: "Gopal Dahade" <dabadejpa1^)yabon.com>
To; "aarti” <aaili_iii@giriA.iKt>, "abdul khan” <lickhan48@yalioo.co.in>,
"Ajit Benadi" <aiitbenadite)nikocm?.de>, "Amtha” <snownitha@yahoo.com>.
”Ashok Nisha Mudkani” <mudkani@hotaail.com>, "Augustine Kogoro” <okpeman@yahoo.com>
”Bcuianiin” <b3u872@yahuo.cuiii>, Bibi Hidalgo" <bhidaigo@dvabosion.com>,
"chinu" <chiniis@email com>. "Christel Albert" <c.albert@netcologne deX
"Christian Barto If * <nikgandhi@berlin. snafu. de>,
’Chrisiiane rischer und Kai-Uwe Dosch” <dosch.fischer@t-online.de>,
’'Community Health Cell" <sochara@vsnl.com>, "David Werner" <HealthWrights@igc.org>,
"Decpa” <kunju@staiiford.cd^, "Dcvosh Poddar” <deveshd@bom3.vsnl.nct.in >,
"Dr Ekbal" <ekbal@vsnl.com>, <elisabeth.zemp@bs.ch>, <FSironi(k7)aol.com>,
"gayatri" <shubak2-ishna@telstraeasymail.com.au >, "Hebbar M N" <Hebbar@t-online.de>,
"Heiko Stoll" <hsioil@biulefeld.ihk.de>, <heinz.klein@due.org>,
"Helena Walkowiak" <HWalkowiak@msh.org>
"Janapada Seva Trust" <jan^ada@rediffinail.com>,
"javanthi manohar" <jaymanu@bgl.vsnl.net.in>,
"jogendra bhagat” <jogendrabhagat@hotmail.com>, "Joseph Jeyakumar" <jeyala@hotmail.com>,
"kiran usha" <ushavuk@yahoo.com>, "Lakshmi Raman" <lrisabs@bgl.vsnl.net.in>,
"Mavis Hiremath" <mavishiremath@yahoo.com>,
"Mies Bouwmeester"<mies@miesbouwmeester.tmfweb.nl>, <mjuarez@stance.fsnet.co.uk>,
"Mohan Konvi i” <moiiankoiivii@wvb.de>, "Peteiji" <linger@swissaid.ch+,
"Pieder Casura" <casura@hekseper.ch>. "Rahul Ramagundam" <rahulelm@ndb.vsnl.net.in>;
"rajeev jain" <rajeevsjain@yalioo.com>, "Revan Banakar” <Revan.Banakar@unpib.org>,
'Rolf Belling <roiibeiiing@hoimaii.com>, "Saihvik!! <Samvik@ieisira.com >
"Sheshadrivasu Chandrasekharan" <baraha@hotmai1.com>,
"ShubhaclaP^avindraMooditliaya"
<srccnivasa@bcrlin.dc>,
"8R1NA1H THAKUR" <thakursrinath@hotmail.com>,
"Sunder Supriya David" <S.Damel@ifw Dresden. de>,
"Sushma Jaiswal" <sushmajaiswai@holmail.com>,
"Vanaja Ramprasad" <nanditha@b!r. vsnl.net. in>.
"Verena SCHMIDT" <Verena_SCTDIIDT@berlin.msf org>, "VILXK" <vhak@bgl.vsnl.aet.in >,
vidhva revan banakar" c kusum y2b@yahoo.d^>, "Vishwatha" <vishwama@yahoo.de'>,
"Vivekanand Dabade" <vivekdabade@yahoo.com>,
"Yamiiii Joshi" <yaiiiiniJoshi@holmail.com>, <bukophaniia@conipuscrvc.vsnl.com >,
"N. K. Anand" <anands@tca.net>. "Nasendra" <nrao@.gmx.net>.
"Tim Jani e " <tint, schenke I @t- on! ine. de>
Dear friends,
,
Greetings
in 1988, Gopai quit his job in the hospital from the twin city of Hubli-Dharwad, and we decided to go a
working in Kittur (in Beiguam district, in Karnataka, in India) with the villagers in remote rural areas on issue
health, but with an open mind to being flexible, depending on the people's need. It was a great experienc
several things (had to unlearn what ever we had studied in colleges!). People's priorities turned to be set
children, transport, water and ultimately the struggle for the land and not the dozens of diseases that were
medical colleges.
A friend of us, Srikar M S visited us at that time. And here is the report he presented.
Bui why this report now?For that we will have to take you for a little flash back.Our friends who, worked
us(Gangadhar, Ashok and Mahaveer) in the villages at that time continue to work in a neighbouring clustei
We will visit them this time (as we are visiting India on July 6th for a period of six weeks) and get more ne
those who are interested in knowing about community development,
So do let us know what you feel about getting to know more and also getting involved in this venture.
With ait best wishes.
Sharaaa and Gopal
Kuiavaiii Gudda
zn D
(
7/2/01 11:21 AM
:
j
about rural community develnpTnent in tndia.
A
Struggle
Still
Unrecognised
by
SrikarMS
((National Law School of india;Bangalore)
INTRODUCTION
“The power, when it comes, will belong to the whole people of India".
M K Gandhi.
It has been 48 years since India gained independence from the clutches of British dominance, but wl
’belongs” to the peopie of India is questionable. Before independence, it was quite evident that the Bril
bourgeoisie were the one s to benefit the most. Has the India Bourgeoisie taken over even after “mdepei
Conditions at the macro level have no doubt changed but the direction of these developments pose seri
ctiii ijnAnswered There seem to exist "Two-India's-In-One", the prosperous elite; the computerised Indie
the poor and the neglected: the masses called 'Bharat'. Unimaginable socio economic inequalities exist
two parallel societies in India. The masses seem to be powerless, the power having shifted to corrupt po
influential bureaucrats, both oi whom show an utter lack of concern to the myriad of problem s faced by tl
My exposure to Kulavalli Gudda (in belguam) proved to be an excellent opportunity to comprehend tl
various peoples in Indian villages The word Gudda literally means hills The outcome of this visit was my
the harsh realities of life, the socio-economic condition and the complex legal intricacies that the people ;
in.
A BRIEF HISTORY OF KULAVALLI GUDDA
The Kulavalli Gudda comprises of 9 villages namely Kulavalli. Sagara, Kathri Daddi, Paper Mill Galag
Gangyanatti, Machi, Ningapur and Dindalkoppa, having 30 to 40 houses each on an average, the populati
Lingayats, Muslims, Dalits, and Scheduled Tribes living in different proportions in these villages. It's histc
traced back to the times of Rani Chennamma of Kittur who along with her trusted lieutenant Sangolli Raye
about 12,000 acres of land to the persons who had assisted them in capturing Sangolli Rayanna. This 12
Kulavalli Gudda, which once comprised of rich and thick forests. The Inam or gift was given to persons \
called Inamders and they came to own these lands. The once thick forests gradually vanished with the
Inamdars/Landlords allowing various people from other nearby places to clear the forests and cultivate th
done illegally and without records. Thus small farmers have cleared small tracts on for the past three or f<
The majority consists of the marginal farmers who barely seek out an existence by cultivating unviabk
iand. Since irrigationai facilities are unheard of by the farmers, there is absolute dependence on the unpn
monsoon showers.The only other source of income is daily-wage work in places as far as Goa on constn
The people of these villages face certain problems peculiar to them with certain typical problems fac
whole of rural India. The most vital issue for the villagers is that of "Land".Along with the complex land iml
is lack of clean water, transport, education and electricity. In some villages the situation is acute that one)
whether our luxurious city life is justified. India's independence, 'equality', liberty', freedom and of late
makes no sense to the peopie who are denied basic necessities.
In spite of myriad social welfare legislations enacted by the state the situation has not changed for th
villagers are still uncertain about the status of'their'Ia.nd.The absence of their names in the records of rig
cultivators.fTenants column maker it all the more difficult for their legitimate right The response of the Go
officials was not very encouraging. They seemed to have turned a blind eye to this problem contributing
to the lack of faith of the peopie in the Governmental machinery. Though at the moment, the threat from tl
nas been overcome, a new threat in tne form of corrupt officials seems to be rearing it s ugiy head.
The problem on the other front is equally depressing. One of the villages had no access to drinking v
all Further there was no public transport facility connecting the villages to the nearest town. There were n<
roads linking the villages, the villagers having to walk through forest land to reach other villages and the m
Provision of basic medicaJ facility by the State, not surprisingly was unthinkable. The state of affairs since
to have improved to a little extent but the major problems keep recurring and the overall picture is dismal.
Free and compulsory primary education is one of the directive pnncipies of irtate Policy, though it is
non-iusticiable principle, as it is supposed to serve as a guideline for the functioning of the Government,
there is nothing like education in a couple of villages in Kulavalli Gudda. The school as a concrete structu
exist However, the Government teacher probably does not view teaching as his or her duty Regular abs
feature here.
Drinking water scarcity is yet another problem of these villages. The bore wells have stopped functic
nearest well is drying up. in some places peopie have to content themselves with dirty water, unfit for drir
small, shallow tanks. This water problem poses as a perennial handicap, which fails to draw the Governm
attention.
? nF T
r
f
7/2/01 1!:21 AM
shout rural community development in India
)
*
The situation as tar as electricity is concerned hasn t changed since 1992. Villages still lurk in darknt
even a single lamp post visible in it's vicinity Houses continue to be lit up by tiny lamps while India's elite
innovative lighting styles and improved quality lighting systems!
Compared to the oadicr transport services the present seems to bo far better. Yet there is a lot be <
pubiic transport system has established itself as being infrequent and unreliable. With no other means of
mere is total reliance on the dus service operated between the villages. People nave to walk miles to buy
commodities. The irregularity is such a common feature that the villagers depend less on this transport s'
HISTORY OF THE STR! IGG! E ORGANISATION AND MOVEMENT
Until 1988 the Inamdars wore playing havoc in these villages by collecting rents not legally entitled t
by taking over a good proportion of the produce cultivated by the farmers, inspite of the institution of inar
being abolished and the paternalistic - state enacting iand reform legislation, the villagers fell easy prey t
of the landlords because of illiteracy and lack of awareness. The exhortation by ruthless Inamders contim
No aovernment came to their assistance, no official seemed to understand their problems It was in this s
that a socially motivated doctor, Gopal Dabade, decided to plunge into this intricate web of problems. Ale
wife Sharada Dabade and a couple of dedicated, socially active youth, he set out to make people aware >
injustice they were subject to. initially they faced innumerable hurdles from the Inamdars (who saw an imr
to their authority) but also from suspicious villagers. Gradually they gained the confidence of the people,
importance of orqanisation and awareness Dr Gopal instilled a kind of confidence and fearlessness that I
villagers a great deal in combating the myriad problems then faced at that time. Dedication and hard work
of this group won the hearts of the people and they eventually became one with them. Facing immense p
the influential but having the indomitable strength of 'people's power' they'were successful in drawing gc
attention to their plight. The struggle paid rich dividends, and the exploitation that once seemed permanet
out. However, in aii this activity, demanas for rights over iand feii on deaf ears. No amount of pressure wa
tilt the scales in favour of the toiling masses.
The organisational apparatus in the form of Sangha Mahila sabha weekly meetings, which gained p
the people, continue to this day but in a subdued manner. The reason for development is that the threat f
exploitative Inamdars is no longer visible and thus seems to have become loss relevant.
LEGAL TANGLE
In 1994 a federation of eminent and concerned persons along with some of the cultwators filed a I
Litigation in the High Court of Karnataka. The battle for occupancy rights over the lands which had taken p
the Sitigativc
had
i i i*> frjit. Tho whole legai tangle emanates from a riOtiriGation issued by th
Dcpcii U i id il of li ie Fui cbi Depai li i id ii uf u ic li id i doi i ibety Slate i iwliiyii ig 11 ioi to u id i t UUU act
Oi id id ii
uuaaa as rorest iana unaer Section 35 or tne Forest act, 1927. I hus when the vakkuta (federation) appii
occuoancy riahts before the land tribunal. It was rejected , the justification being that the land in question i
controlled by forest department under the 1955 notification. This decision was probably taken on the ass
the earlier notification affected the ownership of lands in question. However decisions of the Karnataka H
regarding the interpretation of Section 35, state that such a notification in no way alters the ownership of L
logically the land mu^l belong io the Govdi tiTidit of Karnataka aftd the ianu rxefonii Act came into focce
the social legislation the cuitivators (tiiiers of tne soil) are entitled to tne ownersnip. However, another corr
arose - no entry of the cultivators names in the record of rights and tenant column. Hence although the vill
been cultivating small pieces of land since decades., in the eyes of law they are Rightless Thus, the pre
is sought to be*remedied by appealing to the judiciary to render justice.
----- EW-----
’ - f.'?
7/2/n! 11 22 .AM
- Media
RF_COM_H_27_SUDHA.pdf
Position: 522 (12 views)