SUSTAINABILITY ON HEALTH CARE
Item
- Title
- SUSTAINABILITY ON HEALTH CARE
- extracted text
-
NATIONAL SEMINAR ON ALTERNATIVE AND SUSTAINABLE DEVELOPMENT
E.C.C., WHITEFIELD, BANGALORE
Afternoon session, Thursday 13th Oct.,1994
Some Notes on the theme
TECHNOLOGY AND ECOLOGY
on
’sus t ain ab1e
The
need for seminars or workshops or research
choice
we
face
alternatives'
arises
because
of the Hobson's
be
between technology and ecology: promoting one always seems to
at the expense of the other. Technology being seen as the primary
the
mode of promoting human well-being, and e cology the basis of
a
well-being
of our planet, the choice between the two leads to
Our
of
this
dilemma9
serious
dilemma.
Is
there any way out
present condition on planet earth is such that we had better find
only
a
way out, and that too pretty quickly, In my opinion, the
lies
in
recognizing
the
link
between
really
viable
way
out
ou r
from
ecology,
morality
and spirituality - all three arise
the
wholeness'
is
also
quest
for
'wholeness'- and this same
us
fountainhead of all creativity, a flowering of which can show
needs ( inc1uding
technologies)
without
the
way
to meeting our
destroying the ecological balance.
an
at
To
understand
this link better, let us begin by looking
ancient Chinese story:
who
When Tzu-kung was passing through Han — yin, he saw an old man
old
vegetable
plots.
The
way
this
engaged in irrigating his
was
into
the
well-pit
by
footholes
it
was
to
let
himself
down
man did
wh i ch
a
pitcher
which
he
eme rg e
into
the
side
and emerge
clasping
cut
expending
a
great
deal
of
ch
ann
e
1
,
arefully
emptied
into
a
channel,
thus
c
energy with very small results,
"Th ere exists",Tzu-kung said to him,"a con t riv anc e with which on e
c an irrigate a hundred vegetable plots a day. Unlike what you are
but
energy,
it
demands
a
very small
expenditure
of
doing,
^ou
tell
to
very great results. Would you not like me
p reduces
T zu-kung.
at
abou t
it?" The gardener raised his head and gazed
instrument
carved
out
of
asked. "It is an
"What is it like9", he asked,
light
in
front.
It
scoops
behind
and
wood", said Tzu-kung,"heavy
up the water like a bale,as quic k1y as one drains a bath-tub. Its
name is the well-sweep",
laughed
look of indignation c ame into the gardener's face. He
A
to
be
told
by
my
teacher
that
where
used
saying,"!
scorn fu11y,
contrivances
there
will
be
cunning
cunning
there
are
p e rformanc es, and where there are cunning performances there wi 1 1
h as
lies
be
cunning hearts, He in whose breast a cunning heart
nature;
he
who
has
blurred
the
blurred the pristine purity of his
troubled
the
quiet
of
his
soul,
pristine purity of his n ature has
will
and with one who h as troubled the quiet of his soul the Tao
know
about
this
invention,
but
that
I
do
not
not dwell. It is not
it."
to
use
ash
amed
that I shouId be
the context of our discussion
with
morality
discussion linking ecology
In
and spirituality, what this old Chinese gardener had to say about
well-sweep
the introduction of even a simple technology like the
to
a
disturbance
of
our
‘
pristine
purity'
without
which
ou r
leading
will
not
dwell'
in
cur
hearts
makes
very
interesting
‘the
T ao
Even
more important,
has
made
i mpo r t an t, the link this gardener
reading.
‘
cunning
con
tr
ivances
'
,
cunning
performances
'
and
con
t
ri
v
anc
es
b e twe en
hearts' is
is worth
worth deep reflection. This is particularly
‘cunn i ng
ord e r
relevant
in
smart
machines are the
i n today's world, where
more
the
of
the
day,
d ay, and the smarter we and our. machines are ,
quest
1
on ed
h ad
civilized
we are supposed to be. Mahatma Gandhi
Swaraj',
' Hind
this
approach
in a very fundamental way in his
app roach
and
cunn ing
maintaining
that
a
process
that makes .us
more
to
be
therefore
more
self-centered
and selfish cannot
claim
England,
having a ‘civilizing’ effect on us. When, on a visit to
Western
of
he
was
asked by a reporter,"Sir, what do you think
a good
i
t
wouId
be
civilization?", he
replied
puckishly,"
I
think
he
idea"'
Gandhiji's viewpoint in this regard have been shared by many wise
Albert
such
as
hold
in high
esteem,
personalities
that
we
To
Schroed
inger
.
Arnold
Toynbee
and
Erwin
Einstein, Will Durant,
quote Arnold Toynbee:
is
civilization
ingredient in the
Western
ob vious
"The
most
the
alone
.
In
cannot live by technology
yet
man
t echno1ogy,
fulness of time when the ecumenical house of many mansions stands
and
the
temporary
Western
foundations
its
own
firmly
on
it
scaffolding falls away, as I have no doubt it will, I believe
are
firm
at
jlast
foundations
manifest
that
the
will
become
religion."
because they have been carried down to the bedrock of
Like Gandh i , Toynb e e too recommended a new era where the
of
the
field
all human pursuits, including in
of
foundat ions
Like
bedrock
of
religion
’
.
b ased
upon 'the
are
technology,
particular religion o r
Gandh i , again, he was not referring to any
to
those
wonderful processes of
but
any rites, rituals or dogmas,
termed
h ad
level of consciousness that Einstein
ou r
enh anci ng
called
h
ad
cosmic religious experience’, and which Gandhi
the
re
1i gion that underlies all religions’.
' the
technology,
that
possibly could be the connection between
What
services
for
our
‘
here
now
’
existence,
and
and
produces goods and
is
generally
associated
with
afterlife?
This
re 1ig ion,
which
quest ion often arises because of our ignorance of religion’s deep
with this life. Once
religion
One e the connection between
conn ec t ion
form
and
this
life
is
understood
in
its
proper
in
its
true
we
can
find
an
answer
to
one
of
the
most
difficult
answe
r
perspective,
we can
apparent
contradirtion
di 1 fl mm athat modern man in facing: the
ecology.
The
enormity
of
this
problem
was
between technology and
then
Soviet
Minister,
Eduardo
Foreign
Sovie
t
referred
to
by
the
the process
war
in
p roc ess of 'thawing ’ the cold
Shevardnadze,
during
important
role.
Pointing
out
that
the
ro
1
e
.
which
he
played
an
their rapid
unforeseen but absolutely disastorous consequences of
the failure
for
reasons
main
one
of
the
strides in technology was
he
said:
of the Soviet experiment,
a
"We
are positive that the impending environmental disaster is
of
weapons.
The
process
than
nuclear
g re ater
threat
even
for
are
underway.
As
started
and
talks
h as
d1s a rm amen t
the
realized
mankind has not yet fully
hazards,
env ironmen tai
any
know
full
extent of the danger they carry and does not yet
answer. "
When
we study some of the burning ecological issues of
the
day,
such as the ozone layer depletion or the vanishing
non-renewab1e
resources, we get some picture of the horrors we may be subjected
to in the years to come. Yet, as Shevardnadze was wise enough
to
point
out,
we
have no clue as to how these
disasters can
be
avoided.
It
seems a Hobson's choice between
techno log i es
that
improve our
standard of living and
en v i ronmen tai
preservation
without which life on earth itself is likely to be wiped out.
This
is a global problem of the most immense magnitude, How
can
we
f i nd
a
clue to the answers required? To do so,
as we
are
sitting
here on the Navad arshanam land, let us shift
our
focus
from the global to the local.
When Navadarshan am's friends and well-wishers obtained this
1 and
from the local villagers, it could have been easily classified as
' wasteland ‘ ,
a term used for it by an IAS officer who had
come
for one of Atheetha Ashram's health camps. The top soil had
been
washed
away, the land had become highly unproductive
and
there
were only three trees in the entire 105 acres.lt is now less than
two years since we have been able to take full possession of this
land,
and erect a fairly good (though not foolproof)
fence.
We
have
tried
to ensure that nature regenerates itself
here,
and
that this process is not disturbed by grazing, logging or
forest
f i res.
We have not succeeded completely in our efforts it
is
not
easy
to control the actions of
hundreds
of
surround i ng
villagers who own many thousands of cattle, especially as we have
bent
over backwards to ensure good relations with them. Yet,
as
you
can see, the results are remarkable. Several thousand
trees
have
made their appearnace, without our having planted
them
in
any
way. Prominent among them are honge, accacia, flame
of
the
forest,
bilwar and the wild variety of jamun. These
trees,
the
everpresent grass, the many varieties of birds (our friend
Omk ar
Krishnan
has
identified 111 vanities that can
now be
spotted
here)
and
the
unhindered
activity of
the
insects
and
microorganisms
have all contributed to a fantastic
regeneration
of
the
soil here. Perhaps 10 years from now, the land will
be
like
it is at the one place we know where a similar
experiment
has been carried out - the Valley School on Kanakapura Poad south
of
Bangalore, which is now a lush, green forest
where
anything
planted grows so well.
How did
this
land start
regenerating
itself
despite
h av ing
reached
such a degraded condition? We can talk about the
effect
of the birds, insects, micro-organisms etc., but the fact of
the
matter is that we do not know and we cannot know, that is, at the
level
of
the intellect, how this regeneration
started
and
is
carrying
on.
The mysterious processes of nature,
and of
life
itself,
are beyond the ken of our analytical,
dissecting
mind.
This
is the fundamental point we need t_p internalize if we
wan t
to understand
what
ecology is all about, and
to
resolve
the
technology-ecology dilemma. Donald Worster drove home this
point
with reference to soil regeneration:
c an no more manufacture a soil with a tank of chemicals
than
c an
invent a rain forest or produce a single
bird.
We
may
enhance the soil by helping its processes a 1ong , but we can never
recreate what we cestroy. The soil is a r e sou rc e for which
there
"We
we
is no substitute.
Like the earth itself, i t i s
a n etwork
<^£tivity that we cannot yet understand let alone replicate.”
of
The soil, and the earth itself, has life, and the Science of Life
is not the physics and chemistry of the molecules that
constitue
our bodies, which only act as containers of this life force
for
limited
periods of time. Once this fundamental fact is grasped,
the
link between ecology, morality and spirituality
falls
into
place, and we can then recognize the immense necessity for
those
wonderful
processes
of education that Einstein referred
to
as
‘the cosmic religious experience' - processes that can lead to
a
flowering
of
our creative talents in such a way
that
we
will
create
technologies
that help rather than
destroy
ecology
by
swimming
along
with rather than battling the tides of nature.
Towards the end of his life, the great psycho 1ogiest Carl
Rogers
termed
this possibility 'the most exciting challenge' before
us
in a speech appropriate
appropriately
1y titled "Do we dare?":
in
"Perhaps
the
coming generation
of
younger
psychologists ,
hop e fu11y
unencumbered
by
university
prohibitions
and
resistances, there may be a few who will dare to investigate
the
possibi1ity
that there is a lawful reality which is not open
to
our five senses; a reality in which present, past and future
are
intermingled,
in
which
space is not a
barrier
and
time
has
d i sapp e ard; a reality which can be perceived and known only
when
we are p assive 1 y receptive, rather than actively bent on knowing,
It is one of the most exciting challenges posed to psychology."
t rile
such
It
is
an education that will open our eyes
to
the
secrets
of
the universe of which we are an
integral
part.
In
other words, learning to close the eyes of our consciousness
to
the extern al, physical world of duality will open our eyes to the
wonderful, subtle forces that are at the root of our life and all
creation,
including this physical world. This is of
course ' the
path
that
the
Father of
our Nation
had
been
constan 11y
recommending
to us.
He was
not
’anti-technology'
or
’ant ias is often made out; but spoke of a different kind
science '
of
that would lead to even greater
scientific
'mirac1es'
scienc e ,
than we are witnessing :
"Modern
science is replete with illustrations of
the
seemingly
impossib1e
having become posible within living memory.
But
the
v ictories
of
physical
science would
be
nothing
against
th e
victory of the Science of Life, which is summed up in Love
wh ich
is the Law of our Being."
hand
It
is
such
a new Science of Life that would on
the
one
are
recognize
the
reality of the
spiritual
dimensions
that
than
in
transcendent
yet immanent (i.e., all around us, rather
c re ation
some distant heaven), and on the other hand lead to the
of technologies that enhance rather than destroy ecology.
T.S.An antnu
Corv\ |-t 36.X
Giving
People
Choices
n
©W© .
K w
ACTIONAID
saMnwy wws
THE NEWSLETTER OF DISABILITY DIVISION ACTIONAID-INDIA
EDITOR’S COMMENT
Sustainability of voluntary effort in any field is
a concept with many dimensions, with various
factors contributing or detracting from it.
There is a growing acceptance of the need for
prog
nes to be sustainable and not wind up
or bec^.ae non- productive. With increasing
human care needs,limited resources and
increasing cost of services, it is recognised that
judicious and optimal use of available
resources is important. The earlier assumption
that doing “good work” is sufficient to ensure
a perpetual How of funds is slowly being
replaced with the recognition that results are
important and that programmes need to be
effective and accountable. In the Guest
Editorial, Dr. Ravi Narayan brings together a
balloonist overview of factors from real life
experience to support individuals,
organisations and projects who may be facing
a sustainability problem, to help them evaluate
themselves and identify the contributing
factors. The article would have achieved its
primary purpose if it helps in providing an
evolving framework for problem identifica
tion.
This issue carries a review of recent research
on childhood disability in the Caribbean,
along with the details of the development of
a Disability, Attitude, Belief Behav iour
•(DABB) research project being earned out
jointly by the Department of Psychology,
University of Allahabad and the International
Centre for Advancement of Community
Based Rehabilitation(ICACBR) of Queens
University, Kingston, Canada. The use of
Focus Group Discussion in an urban slum
disability programme, and the importance of
early identification and assessment in
developmental disabilities are described in
other articles.
Issues of employment opportunities and work
training for people with disabilities have also
been dealt w'ith in this issue. The analysis of
the feedback on the newsletter is presented as
well. The feedback analysis suggests that the
target population and the contents of the
newsletter are appropriate and that it contains
information which is useful and not available
elsewhere.
The summary proceedings of the Symposium
on Research and Evaluation held on 3 May
1993 in Bangalore, along with the papers
presented and circulated on the
occasion.constitute the Supplement of this
issue.
DR. MAYA THOMAS
DIRECTOR
DISABILITY DIVISION
ACTIONAID - INDIA
GUEST EDITORIAL
SUSTAINABILITY OF PROGRAMMES IN THE VOLUNTARY SECTOR - Reflections
on Some Questions
INTT
AUCTION
This paper attempts to identify parameters and
determinants of sustainability of programmes
primarily focused on disability care. It looks
at why some programmes grow, develop in a
meaningful way and remain creative for longer
phases of their evolution; and why some
programmes wind up, become inactive or
remain stagnant and sometimes even unpro
ductive.
The identification of facilitating as well as risk
• factors from a collective experience could
serve many purposes. The most important
purpose of this exercise could be to outline a
list of self evaluation questions or issues that
would help every organisation to review itself
and to strengthen its own development by
identifying lacunae in efforts that need to be
attended. From the funding partners' point of
view, it may help to decide which projects
should be selected and which should be
supported with caution. This may however
degenerate into a ‘betting on the winning
horse’ situation, which is undesirable. More
important than both these likely purposes is
however, an opportunity to learn from each
others’ experience.
This paper attempts to bring experiences and
perspectives from the larger/wider sector of
voluntary effort and to build a framework for
exploration by providing some principles and
perhaps provocative questions. While much of
this comes from beyond the ‘disability sector’
of voluntary effort, these issues of
‘sustainability’ are relevant to all types of
voluntary projects irrespective of focus or
objective.
RECOGNISING OUR DIVERSITY
•
A short historical overview of voluntary effort
in India highlighting key thrusts, focus and
impulses is a necessary’ adjunct to help one to
appreciate the djvcf.^'■ and wealth of expcri-
CONTENTS
Vol.40 No.2E3 1993
Editor's Conunent.............................................
27
Sustainability of Programmes in the Voluntary Sector
Reflections on Some Questions... .................................................................. 27
A Review of Recent Research on Childhood Disability in Jamaica ..31
The DABB Research Project.......
33
Focus Group Discussion with Parents of Disabled Children
35
An Approach Towards Early Identification and Assessment.
of Developmental Needs in Children................ ............
37
Employment of People With Disabilities - International
Perspectives and Strategies for India..-;................... .’.........
41
Work Training for People with Disabilities A Perspective in Reverse.......... ....................................................... 44
Information on Publications
.................................................. 47
Letters to Editor ................................................ ;................................. 49
ACTIONAID DISABILITY NEWS - SUPPLEMENT
ACTIONAID DISABILITY NEWS
ence. Do we realise what a ‘mosaic’ we
represent?
In the last five decades since Independence,
voluntary effort in the country has passed
through many phases of growth in terms of
focus, key thrusts and in its relation and
context to government effort. While each
decade has had its main theme, as it were,
affecting the specific voluntary agency that
may have developed in that decade, these are
not watertight phases that can help to classify
projects into one type or another. The concept
of diversity in focus or thrusts only helps to
understand the reality - that any collective
effort of a group of voluntary agencies at any
point of time, will discover this diversity and
mosaic of expectations and experience, and
that this can often be tracked back to the
original vision or impulse of the voluntary
agency at the time of its inception.
Pie-1950s: Most of the voluntary sector was
deeply involved and linked with the National
Movement for Independence.
1950s: The focus was on collaboration with
the Government of India in the common task
and commitment to Community Development,
and collaboration was significant.
1960s: With the experience of Government
programmes, the operationalisation of
development strategies, and a growing
understanding of field realities, the inadeqi[uacies of the strategies themselves began to
emerge. This led to intense dissatisfaction.
Alternative socio-political solutions began to
emerge in the development sector leading from
collaboration to confrontation.
1970s: The realisation that alternative socio
political systems needed alternative technol
ogy systems, alternative care delivery systems
and alternative human power trainers led to the
decade of ‘Alternative’ generation, focusing
on health, education, environment, women’s
issues and trade unionism.
1980s: As the number of voluntary agencies in
development increased, two additional features
emerged. First there was a growing recogni
tion of the need for collective support and
efforts leading to networking. Secondly the
alternative generation began to recognise the
need of projects that moved from alternative
service provision to supporting activities like
training, lobbying, issue raising, communicat
ing, research and policy generation. The era of
specialisation had arrived.
1990s. The overall themes of this emerging
decade have been collaboration with the
government and ‘professionalisation’. The
voluntary sector seems to have come of age
and is now actively contacted for collaborative
efforts by the Government. While this should
take the form of a critical collaboration, there
is a growing danger that it will be more of a
co-oplion.
The need for professionalisation is also
sweeping voluntary effort and while this is
definitely important in the context of improv
ing efficiency of efforts and increasing impact,
the danger lies in professionalisation bringing
in market economy values. Both these factors
have also led indirectly to a phenomenal
proliferation and mushrooming of voluntary
effort - high in quantity and low in quality,
which seems to be a matter of serious concern.
Where would we place ourselves in this
evolving and interpretative history? What are
the key thrusts and focus of each of our
projects? What are our similarities and what
are our differences?
Do we recognise that our diversities are in the
area of our focus, our size, our ideologies, our
sti'uctures, our leadership, our governance, our
approaches, our levels of functioning, our
methodologies, our linkages, our management
and indeed our evolution?
Could we pause and reflect on this diversity,
and affirm and recognise the mosaic of
experiences and impulses that we represent?
SUSTAINABLE
Reflecting on the dictionary definition of a
word helps us to discover the ‘true depth’ of
its meaning. Colloquial usage often focuses
on a narrow meaning, and in the context of
sustainability, it primarily has acquired an
economic dimension. There are ten definitions
which help us to explore the larger concept of
the word “Sustainable”. These are:
To uphold
To perpetuate
To bear with
To maintain
To suffer
To support
To give strength to
To keep alive
To preserve
To keep going
There may be many more.
We should therefore include all this and not
just how to ‘find the funds for’ continuing our
programme. Also, our focus should not be just
on a time bound project but essentially a
creative process, which we seek to initiate
through our work.
LEARNING FROM EACH OTHERS’
EXPERIENCE
While reflecting on our diversities, we might
begin to doubt whether our experiences can
really be relevant to each other. I believe they *
can be relevant, if inspile of our diversities we
adopt some principles in our sharing and
learning.
First, we must recognise that the evolution,
growth, effectiveness, methodology and impact
of our projects are affected by these diversities.
Hence we should not extrapolate from our
situation into that of others. We cannot just
generalise for all situations from our own micro
situation, and generalisations if made, should
really be suggestions with caution.
We should learn from each others’ experi
28 Vol.40 No.20 1993
ences, focusing on overall approaches rather
than making it a quest for models or the
identification of ‘package deals’ or services.
Ultimately each of us must evolve our own
creative response recognising our own local
realities and our own particular constraints.
An intracellular or single experience or single
project exploration must be replaced by
appreciating multiple experience and multiple
projects, which could be termed as a ‘balloon
ist’ overview. This paper is an attempt at
building such an overview.
Finally while we learn from reviewing
our successes, we need to seriously
reflect on our failures as well. Learning
from our failures can often be more
significant than the appreciation of our
success, though this is seldom done.
RECOGNISING THE PHASES OF OU’
GROWTH
Sustainability must also always be seen in the
context of the phase in which our action is
located. All voluntary effort starts with the
catalyst phase - about 1 -2 years of initial high
intensity involvement of a few initiators,
followed by a growth phase - involving a
creative expansion of work and outreach often sustained for at least 2-3 years.
In most cases the 5th year can be termed the
crisis phase - with intensive individual styles
of the inception phase clashing with the
growing collective demands of the growth
phase. A sort of evolving mismatch, often
focused on styles of functioning and processes
of decision making, takes place. This is further
complicated by factors of routinization,
bureaucratization and inadequate
decentralisation.
The crisis phase then leads to a status quo
phase if not tackled adequately. Alternatively,
a re-evolution phase may emerge depending
very much on how creatively the organisation
understands the crisis and tackles it. Project or
process sustainability must appreciate these
phases of the growth process and be sensitive
to it. While the overall focus of the project
could be similar in all the phases, the time
allotted for dimensions of work, like planning,
training, action, team building and evaluation
would be different in each of these phases.
FRAMEWORK FOR FACTOR
IDENTIFICATION
As a prelude to this reflection, all the factors
that in different experiences had led to serious
review or enquiry, of the sustainability ..of a
project or process were listed. These were then
classified into groups, with a logic built up for
their classification. The result shows that
factors affecting sustainability can be
classified into seven groups:
Internal factors
External factors (agency-target
interactions)
Funding agency factors
ACTIONAID DISABILITY NEWS
Agency-Government interaction
factors
Monitoring/evaluation related factors
Support mechanisms
National/regional climate factors
EXPLORING SOME FACTORS FOR
SUSTAINABILITY
Each of the ideas identified in this section is
based on a real life problem, but what has been
highlighted is the issue and not the actual
problem situation, to maintain confidentiality.
This set of questions could help each project
reflect on its own state of growth and identify
whether that aspect of its work could become
an important contributor to the non
sustainability of the work in the near future or
in the long term.
This is not an exhaustive list. An exploration
of the -''aders’ experience may identify even
more
ors and issues. The list will however
very likely reaffirm some of the existing and
ongoing problems.
INTERNAL FACTORS
These are factors that operate within the
management structure of the project/agency
and focus on aspects of governance.
Do we have a clarity in our goals, objectives,
roles and types of services we would like to
organise through our project/institution?
Lack of clarity generates ad-hoc responses and
confuses the project team and its partners,
reducing motivation and job satisfaction as
well.
Do we have hidden agenda in our work?
Political? Religious? Economic? Or even the
pursuit of power, status and individual glory?
All these make our work less sustainable in the
long run, diverting effort from stated objec
tives to other pre-occupations.
Does
management style - planning,
decision making, supervision and evaluationinvolve the whole team in an increasingly
participatory way or do we continue to believe
in orthodox top-down, hierarchical and
authoritarian models of management? When
team members at all levels experience a sense
of participation in the project evolution, long
term sustainability is greatly enhanced.
Do we have a rational process of staff
selection and provide team members with
. adequate financial and,other forms of work
security? Or are we ad-hoc in this aspect of
management as well - eg., selecting staff in an
ad-hoc manner, paying some more or some
less and generally deciding issues on extrane
ous influences? Work under voluntary
auspices - whether part time or full time; truly
voluntary or getting some remuneration needs a higher degree of commitment and
motivation because of the nature of the work
and the insecurity of the situation. Rational
and meaningful staff security including social
security can go a long way to increase
29 Vol.4^ No.2® 1993
sustainability.
While we cannot always get the type of
volunteer and team member we need, do we
have an ongoing process of staff development
and enrichment that not only orients the staff
to the goals of the organisation, but consis
tently upgrades their knowledge and skills?
Creative staff development provides space for
every team member to discover his own
stiengths and potentials, and prevents the ‘cog
in the wheel’ feeling that can be detrimental to
sustainability.
EXTERNAL FACTORS
These are factors that operate at the interface
between the project/agency and its targets,
beneficiaries or partners.
Are staff adequately oriented about whom they
are trying to. reach through the project
initiatives? In institutional care this was
relatively easy because we had a ‘captive’
target. In community oriented programmes
this clai'ity is crucial. Are we focusing on all
the community or those who are more
marginalised or underserved? Are we
reaching those who can be reached easily or
•arc we focusing on reaching the unreached?
Does our team work from a superior cross
cultural position looking down upon the
community and its culture as different and
inferior from their own? Or do they make
attempts to reduce the gaps between ‘us’ and
‘them’, between literate and illiterate by
identifying with the local culture and building
bridges of understanding and shared values?
A cultural gap between the ‘provider’ and the
‘community served’ can be a far greater
barrier than even a physical structure like a
wall between the project and the community.
Does our team understand our efforts as a
skills transfer, demystification process so that
the community and all our field partners grow
in knowledge and skills or do the skills and
information remain confined to us at the end of
the process? My surmise is that sustainability
of a project is directly proportional to the
levels of demystification and ‘skills transfer’
in a project since this is one of the key
investments in community level sustainability.
Does our concept of participation mean the
‘myopic’ version that is rather common, of the
community participating in the services we
provide or does it involve the ‘wide angle’
view that ‘we need to invc^lve the community
and its representatives’ in all aspects of the
planning, decision making, organisation and
evaluation aspects of the programme’? In the
ultimate analysis this is probably the most
crucial component of long term sustainability.
Have we. been able to generate a need, a
consumer awareness, and more importantly a
consumer commitment to the continuation of
the programmes?
Do our team members give primary impor
tance to loaming from their own field
experience or do we base our actions on
concepts and solutions imported from
elsewhere? A corollary of this is the impor
tance we give to feedback from the community
and our field practice - especially from the
grassroot level field worker and the commu
nity based volunteers. The more we focus on
grassroot realities, the more we will respond
with creative solutions to local problems, and
the more sustainable will be the process we
seek to promote.
FUNDING AGENCY FACTORS
Most funding partners arc concerned about the
issue of sustainability of projects they support
and rightly so. However most of them do not
realise that they themselves can be a major
factor in the sustain ability process, sometimes
supporting it positively, and sometimes causing
a problem.
Do our funding partners have a project or
process orientation?
Understanding the work initiated by a partner
as a process in the community, and not just as
a time bound project with fixed time schedules
and targets is very helpful, since it allows the
project to evolve gradually, responding to
local needs and constraints. However close
may be the partner’s interaction or experience
with a community, a project proposal can
never predict all the possibilities and is. at best
a guestimate or probability. So when targets
are not achieved within a time schedule, both
partner and funder must evaluate the problem
together, asking why? and not, why not? This
helps long term sustainability.
Do our funding partners have a quantity or
quality orientation in evaluation?
Linked to the above factor is also the problem
of evaluation by funding agencies which most
often focuses on quantity indicators and not on
quality indicators. Quantity indicators such as
how much immunisation was given and how
many pills were distributed are given far more
importance than quality indicators such as how
many decisions were made by the locals and
how many mothers have skills or knowledge
now, which they did not have before etc.
When ‘providing’ becomes more important
than ‘enabling’, community participation,
which is crucial for long-term sustainability, is
not activated adequately.
Is the relationship between our fund
ing partners and us - an imposing or
supporting relationship?
‘
The funding agency - partner linkage*is a
major issue. When it is a true partnership with
both funder and partner seeing the available
funds as being held in trusteeship on behalf of
the people, then sustainability is enhanced
because the partnership is based on a relation
ship between two adults.
When the funder-partner linkage is a donor
beneficiary relationship, then the linkage
becomes one between unequals, and a parent
child or master-servant situation develops
which is unhealthy. Funding agencies make
subtle demands or lay down conditions
ACTIONAID DISABILITY NEWS
couched in legal language and partners play
games with the funder - presenting strengths
and glossing over weaknesses. Transactional
Analysis would then be a better solution than
management theory!
and building up supportive funds, gradually
making the process more viable in the long run.
MONITORING / EVALUATION RE
LATED FACTORS
AGENCY-GOVERNMENT INTERAC
TION FACTORS
Have we built good feedback mechanisms
from grassroots level upwards in our work?
Do our funding partners impose ideas from
outside?
Do we collaborate with, compete with, or
confront Government services?
Closely linked to the above is the style of the
funding agency. Does it impose ideas from
outside? Does it force strategies that may have
worked in other cultures and other countries
but are not necessarily relevant to local
realities? Docs it derive all its professional
support from resource persons in its own
country or does it Uy to understand each
country’s realities and initiate dialogue with
resource persons closer to the project situa
tion? Does it stifle local initiative or support
the generation of creative solutions by the
locals themselves? Does it support collective
exploration of local experience among its
project partners?
The voluntary agency’s own ideology vis-a-vis
government programmes can be a major factor
in sustainability. Does it collaborate, compete
or confront government through its
programmes? While all these may be
perfectly legitimate in the context of the
ideological framework in which the voluntary
agency evolves, it does affect its sustainability
- especially in terms of relationship or support
from government.
Good feedback mechanisms at all levels of a
project and especially supportive of feedback
at the project team - community interface is an
investment in sustainability, since it ensures
that the process is alive to local problems and
emerging constraints if any. Regular feedback
also helps to make concurrent or mid course
corrections in plans.
Is our funding partner flexible or bureau
cratic in its management style?
Is the planning, organisation and evaluation of
projects including funding decisions done in a
flexible, participatory way or is the funding
agency bureaucratic, imposing all sorts of
requirements, reports, forms to be filled,
indicators to be provided in a top down,
bureaucratic way? The funding agency’s field/
project officers can be a major support or block
to the process of sustainability. However
ilexible or participatory the funding agency's
management may be, it is at the interface
between project officer and project partner that
the process succeeds or fails. Orientation of
field officers is therefore a major step towards
the larger goal of building sustainable linkages.
Are we ‘scaling up’ due to pressures from
our funders?
To expect successful efforts to scale up so that
the impact of their efficiency or creativity can
reach large numbers is a sensible proposition.
But when scaling up, pressures from funders
are imposed for extraneous reasons, such as a
spirit of competition with other funding
agencies, a reallotment or a self imposed
diversion of funds to a predetermined
objective, or based on naive management
. theory that what works in 10 villages will now
^v-’ork in a hundred, or even worse, to keep
-• administrative costs of the funding agency
low. then these affect the sustainability process
greatly. For example, scaling up of operations >
from 10 villages to a 100 villages in a year, Or
-Irom 2 lakhs to 20 lakhs will put pressures on
a process that will, inspitc of earlier successes,
make way for new unprecedented problems.
Small is beautiful and creative, and docs not
necessarily continue when it becomes large!
Also a gradual scaling up helps the project to
evolve its own realistic dynamics, creating
linkages with the community resource groups
30 Vol.4^ No.2^ 1993
Are we an accountable voluntary agency?
An accountable voluntary agency - account
able to the community, to the support groups
(including funding), and to the government in
the context of legal status etc - is far more
sustainable than one that is isolationist in’its
ethos and world view and ad-hoc in its style of
management.
If we collaborate with Government - is it
‘critical’ or ‘co-opted’ collaboration?
Collaboration with government is an increas
ingly possible role because of the increasing
recognition of the success and effectiveness of
‘voluntary’ effort. However there is a danger of
co-option into the government system or loss of
identity. The agency should therefore critically
collaborate which means in practice, collaborat
ing actively but complementing it with
continuous feedback about grassroots realities
including the community experiences of
government programmes and initiatives.
Critical collaboration also means choosing
programmes that fit with the agency’s objec
tives and building up the space to experiment
with alternative methods of functioning.
Is the Government attitude to us at state or
local level, one of suspicion or of policing?
Governmental regulations are increasing and
there are times when the regulations are based
on suspicions of voluntary sector motivations
or linkages. At the local level this can often
result in government functionaries being
threatening or ‘policing’ in their attitudes.
This greatly affects sustainability of the
process because vested interests or status quo
forces at the community level can often use
this as a means tp neutralise efforts. A good
dialogue relationship with government at all
levels is'a ‘preventive’ that is worth investing
in. While each agency cannot do this,
networks, associations, consultative commit
tee. etc, are good means of ensuring and
evolving this relationship. Being active
members of such networks and assoc: aliens
therefore helps sustainability.
Do we focus only on ‘successes’ or explore
‘failures’ as well?
Evaluation and monitoring often focus on
Strengths and Successes and not Weaknesses
or failures. It seldom focuses on available
Opportunities and assessment of Threats.
Sustainability is greatly enhanced when a
process is reflected upon in all these dime
sions (SWOT sessions). Reflective evaluation
on weaknesses and threats can help evolution
of creative alternative plans. Reflection on
strengths and opportunities can help build staff
morale. Both positive staff morale and creative
alternative plans help the sustainability
process.
Have we initiated a participatory process in
our evaluation strategy?
Evaluation is often thrust on a project/process
from outside, with experts coming to study the
project. While this may inject a certain
objectivity, it also causes insecurity. A
participatory form of evaluation helps both
project team and members of the beneficiary
community to understand the objectives, the
processes, the problems and helps evaluation
to become a learning experience for the future,
thereby greatly enhancing its sustainability.
SUPPORT MECHANISM FACTORS
It has been mentioned earlier that
sustainability is often seen only in financial/
economic terms, but needs to be seen in a
wider canvas, which have been outlined above.
This is however not in any way to reduce the
importance of finances or adequate monetary
resources to meet our objectives. The attempt
is to highlight that funds are an important
factor but not a sufficient factor for
sustainability.
Is our fund raising system a single source or
a multisource one?
Multiple funding partners for activities
conducted by an organisation help
sustainability. A single source causes much
insecurity on a long term, because of the
vulnerability that could be caused by a change
in relationship or policy. Each funding partner
can support one sub-unit so that there is a stake
in a specific activity, but funders should also be
ready to pool resources for core costs, provid
ing a small percentage of the budget.
ACTIONAID DISABILITY NEWS
Do wc have a network of supporters or only
large institutional grants?
Do our friends and associates include
competent technical resource persons as
well?
Apart from large grants, voluntary agencies
that build up a network of regular volunteers
and support through small but regular financial
contributions even from individuals, greatly
enhance their own long term sustainability.
The increased number of people who would be
committed to seeing them through a financial
crisis or a problem, enhances sustainability.
Any organisation that builds up linkages with
friends who can be technical resources also
help their own sustainability process. Some
times technical resource or competence is as
important a problem solver as adequate funds
or managerial competence.
Do we have Patrons/Friends committed to
our growth and development?
Is the national climate suitable for volun
tary effort ?
Many voluntary agencies initiate the concept of
pations and friends, and because of the legal
provisions they also need an executive committee
and/or a governing board. Organisations which
create these linkages with individuals for notional
reasons and accept or even promote passive
indifference are compromising their own
sustainability. Committed and involved patrons
and friends can be a great support in tapping
avail^’e resources and can support fund raising
pail
iy.
Finally, but not the least important, is the
whole national climate - socio-economic,
political and cultural - a contributory factor to
sustainability! When there is stability, a sense
of well being, a sense of direction and
committed visionary leadership, such a climate
itself acts as a great support to all types of
voluntary effort. On the other hand as in the
past two years in the country, when political
instability, communal violence, strife and
terrorism abound, pessimism sets in, affecting
voluntary effort greatly, by paralysing
initiative and stifling creativity.
Sustainability therefore is a multi-dimensional
concept and it is necessary for voluntary agen
cies and funding partners to explore a wide
variety of factors that contribute to it. By
operationalising meaningful strategies to make
these factors positive supports and not negative
obstacles to the evolving process of voluntary
effort, sustainability can be ensured.
Dr. Ravi Narayan
Society for Community Health Awareness.
Research and Action
Community Health Cell
367. Srinivasa Nilaya, Jakkasandra
I Main. I Block. Koramangala
Bangalore - 560 034
India
A REVIEW OF RECENT RESEARCH ON CHILDHOOD DISABILITY IN JAMAICA
INTRODUCTION
This paper summarises some of the major find
ings from a study carried out by the Department
ofSocialand Preventive Medicine, University of
West Indies and of other papers which have
recently been published on the topic of child
hood disability.
“Low Cost Methods for the Rapid Identification
and Assessment of Childhood Disability in Ja
maica” was a collaborative study conducted be
tween 1987 and 1989. as part of the International
Epidemiological Study on Childhood Disability
(IESCD). The other collaborators were the Jinnah
Post Graduate Medical Centre, Karachi, the
Uni
ity of Dhaka, Bangladesh and the
Geru. .e Sergievsky Centre of Columbia Uni
versity, New York.
AIMS
The aims of the study were:
to develop an improved, low cost method
for the assessment of the prevalence and
risk of disability in children
to devise and test instruments and ap
proaches relevant for the primary aim,
and to assess the competence of commu
nity workers (CWs) to identify and
categorise disability, measure its impact
and identify risk factors
to develop a standardised professional
assessment protocol, and
survey of all children between 2 years and 9
years in the selected areas, and professional
assessment of all “positive cases” along with a
sample of “negatives”.
The Jamaican project aimed to study 10,000
children between the age of 2 and 9 years in 3
chosen sites in Clarendon. However, only two
communities and 5500children could be screened
because of the high rate of positive cases (15%)
based on the Ten Question (TQ) screen. Field
work began in January 1987 with a key infor
mant study (1), along with the pilot study and
testing of instruments. Eight Field workers were
trained in July 1987 for thepurpose of thehouseto-house survey in central and south Clarendon.
This was completed a year later. Professional
assessments were done in four clinics each week
by a doctor and a psychologist, with CWs doing
the screening for vision, hearing and nutrition. A
follow-up of 3000 children who had been as
sessed was done between September and Octo
ber 1988, 9 months after the first assessment.
The records used to collect the data are given in
Table 1.
Table 1
Numbers
The study used a two stage design : a community
31 Vol.4QI No.2^ 199'3
5500
1219
Activities of Daily Living Questionnaire
(ADLQ), which consisted of 20 ques
tions concerning self help, social, lan
guage, motor and learning handicaps.
This questionnaire was used only for
thosechildren designated forprofessional
assessment (TQ positive or part of the
random sample).
170
Individual Programme Plans (IPP), made
by the CW in discussion with the parent
and based on the handicaps identified in
the ADLQ. If there was no handicap,
there was no IPP.
Professional Assessment Forms
994
Description of the records
2900
Household forms with social and demo
graphic data on the families of the 2-9
year olds.
3350
Mother-child forms with social, biologi
cal and obstetric data of the mothers of
all the 2-9 year old children.
5500
Ten Question Screen (TQ). a question
naire designed to detect six types of
disabilities (cognitive, hearing, speech,
visual, motor disabilities and epilepsy).
Community worker (CW) assessment
forms, where they answered questions
as to the presence, type and severity of
the disability and whether the child
needed professional assessment.
A random 8% were pre-marked to get a
control sub-sample.
Community Survey Forms
to develop appropriate intervention and
prevention strategies
MATERIALS AND METHOD
The questionnaire included other basic
data about the child.
Medical assessment forms consisting of
a detailed paediatric and developmental
history with a semistructured checklist
for enquiring about all disabilities, a
simple functional assessment, and a neu
rological, nutritional, visual (Landholdt
C) and hearing screening using a Maico
audiometer.
A diagnostic sheet, including the impair
ments and disabilities identified, the
medical diagnosis, and referral needs.
994
Psychological assessment forms which
incorporated the Child Disability Ques
tionnaire (CDQ) on all children, the Dcn-
H 36'3
ij
°J n
No.35
BSjMWX RESEARCHlKAsiy
NEWSLETTER
April-June-1991
EDITORIAL
WHITHER SUSTAINABLE DEVELOPMENT ?
l
Changes in the Indian economy during the last one month are being viewed with apprehension, hope and even
despair. It can be safely said that most of us will be around to see their impact on the country. It is clear that the government
is seeking loans from the International Monetary Fund to the tune of $5000-$7000 million (Rs. 1,25,00 croresRs. 1,75,00 crores ), so as to facilitate adjustments in the domestic economy. We have witnessed two rounds of
devaluation in rapid succession which has caused the value of the Rupee to fall by around 20 %. A major change in the
import-export policy has been initiated and, last but not the least, a revamped industrial policy has emerged. This package
has been presented to the nation on the same day as the proposed budget for 1991 -'92.
The economy is going through a crisis. One does not have to be an expert/economist to feel the impact of
inflation, expanding unemployment, stagnant or decreasing productivity. This has occurred because the country has been
living beyond its means in the last decade, and the government has lost effective control over macro-economic balances.
Consequently, we have been facing over-increasing budgetary deficits and sustained inflationary pressures; savings
have plateaued; and the trade balance has deteriorated, despite an unprecedented growth in world exports. An indication
of this problem is provided by the perpetua! internal and external debt burden on the government.
Besides the revenue crisis, we are also faced with a much bigger problem of structural crisis. One of the
symptoms of this is, the lack of will and the inability of the government to control non-plan expenditure, which has led
to burgeoning revenue deficits. Intensifying infrastructural constraints is another structural crisis which is imposed on
account of the resource crunch faced by the various utility sectors and, in part, because of the rampant inefficiency in the
public sector.
A near total breakdown of performance based rewards and entitlement systems in large segments of our
economy is also a bottleneck. Inability to generate additional employment in the organised secondary sector; continuing
reduction in the country’s share of global exports; slowdown in investment in capital and intermediate goods; increased
inflationary pressure (despite a better than expected agricultural performance over the last three years), are few other
symptoms of the structural crisis. The "green revolution” techniques don’t seem to be able to expand agricultural
productivity anymore.
Since the time the Indian planning process was initiated, the major emphasis has been on maximizing our
economic growth. This has been the broad focus of all our planning exercises. A mere “lip service” has been provided
to the issues of equity and social justice. We are simply following the “trickle-down’’theory of development. Here,
one assumes that the benefits of rapid economic growth will percolate down to those segments of the economy which
are not directly involved in such growth.
The present reforms, as envisaged by the government, seem to continue the trickle-down approach. The entire
emphasis of these reforms is on the gearing-up of our industrial growth. Employment and social justice have not
even got their due share of lip-service, this time around. Given all these indicators, the eighth five year plan win also
be reformulated by this government and the stillborn draft (with its emphasis on employment), will die its natural death.
An argument in defence of the “trickle down" approach is that India has not been ab'e to achieve a threshold
rate of economic growth so as to allow the benefits to trickle down. With the structural reforms that will be (or are being)
carried out, the thrust is to attain this threshold level. The benefits would, through the interlinkages between the va ous
sectors, trickle down. But, what is that threshold level ? Can the restructuring of the industrial sector allow the benefits,
if any, to percolate down to the unorganised sector of our economy ? Can the emphasis on export growth lead the country
to its overall growth ? Are not reforms required in that major area where most of India dwells and feeds off ?
The new environment that these reforms seek is to create a moreopen economy, with more intense interlinkages
with the world economy. It can also make the economy more susceptible to external shocks and pressures. We have
not been exposed to these earlier to such an extent due to our insular policies. It would also perpetuate a greater divide
between India and “Bharat", unless specific remedial measures are undertaken to rectify this dualism. But, there does
not seem to be a motivating force, such as an IMF loan, to inspire the government to do something constructive in this
direction.
How can there be any economic growth (sustained increase in per capita income over a period of time) without
integrating all the segments ofthe economy? Sooneror later, the economy is bound to run into bottlenecks. An integrated,
wholistic approach is required if the government is genuinely interested in solving the mess that the economy is in^
nowadays. It is the issue of economic development on a sustainable basis, that the planners should tackle rather than
toeing the one-track emphasis on economic growth.
REPORTAGE
NBWS OF INTKMST
Occupational Health and Safety
Slide Show
PRIA organised a regional training programme on
occupational health and safety at Amar Bhawan
Rourkela from April 9-11, 1991. About 29 partici
pants from various organisations attended the
workshop. The objective of the workshop was to
develop an understanding about occupational health
and safety.
PRIA organised a lecture cum slide show presented by
Dr.D.N.Kaliya of P.G.D.A.V. College, Shri Nivas Puri, New
Delhi, on June 18, 1991 at PRIA The slide show was on
“Pollution in Yamuna River and Traditional Water Supply
Systems of Delhi". About 30 participants attended the
programme.
Training of Trainers Programme
100 Crore live in Poverty
Phase I! ofRound VII of the Training of Trainers pro
gramme was held at Sneh Jyotl, Bangalore during
April 16-23,1991. Twenty nine participants attended
tills training programme. The main objectives were
to sharpen competencies In designing a training pro
gramme, to enhance trainer skills in conducting train
ing, use of various iearnlng-training methodsand to
build a deeper understanding of key content areas in
training. A report has been prepared by PRIA.
More than 100 crore people In developing
countries live In poverty. In World Develop
ment Report 1990, the World Bank analyzes
global poverty. (Qtusan Konsqmer, Malaysia)
Demand for a Separate Legislation for Construction
Workers
Management of Women’s Economic Activities
A camp for women leaders, representing different
women's groups In West Bengal was organised at Taj
Mahal, in collaboration with Development Dialogue,
during April 25th, to 28th,, 1991. Twenty five women
leaders attended this camp. Participants tried to
develop their understanding on various aspects of
management of women’s economic activities.
PRIA organised a training programme in Hindi for
functionaries representing NGOs, at Gandhi Bhavan,
Puneduring May 7-14,1991. Thirty four participants
from sixteen organisations attended the programme.
The focus was to enable participants to strengthen
their Managerial Capacities In managing women's
economic activities, A Report Is being prepared In
Hindi.
A Camp was organised for women leaders of the
primary Mahila Samltles of Tejpur Dlst. Mahila Samttl,
Assam, from June 19th. to 21st, 1991. Twenty eight
women leaders representing twenty one Mahila Samb
ties attended this camp. The main focus was trying to
develop and enhance an understanding of the man
agement of women’s economic activities.
Training of Mahagujarat Kamgar Union
PRIA conducted a two day tralning programme for Mahagujrat Kamgar Union of Baroda on 1-2, June, 1991,
R was the first phase of three phased training pro
gramme which will cover the various mines of trade
union eg. strength, unity, broader approach towards
problems, effective negotiation and bargaining, vari
ous Acts and Regulations, In this training programme
15 members of the Union participated,
The first national conference of construction workers, or
ganised by the National Campaign Committee was held at
Gandhi Darshan in Delhi on July 2nd, 1991. The focus was
on the need to regulate employment in the huge and
unorganised construction sector. This forms the second
largest labour force in the nation (the largest force being
agricultural labourers and farmers).
They have no
legislation to protect them or regulate employment, taking
into account the unique nature of their job. For one, the
nature of the construction industry is unorganised.
Second, there is no permanent employer - employee rela
tionship. Third, in other industries the product is mobile
while the producer is stable, while in the construction
industry it is the other way round. These make any
legislations immensely difficult to implement. The NCC
has suggested establishing tripartite construction labour
boards at the National, State and District levels. The
primary function of these boards would be to regulate
employment.
Regional Training of Trainers
Phase II of Round I of the Training of Trainers Programme
in Hindi, organised by Sahbhagi Shikshan Kendra, Lucknow,
was held at Dak Pathar, Dehradun, (U.P.), during 19-26
June, 1991. 19 participants attended this programme. The
main objective were to sharpen competencies in designing
a training programme, to enhance trainer skills in conduct
ing training, use of various learning-training methods and to
build a deeper understanding of key content areas in train
ing. A report is being perpared. For details contact: Sahbhagi
Shikshan kendra, 13/96, Munshi Pulia, Indira Nagar, Lucknow226 016, U.P.
VIEWS OF INTEREST
The Imperialism of Northern NGOs
During an international conference on Third World devel
opment, a Latin American participant stood up and said:
"Once upon a time, we were a free nation, with our own
culture and development process. Then, the Spanish
came and conquered us. We were defeated because
they had horses. Later, our people fought the Spanish
until we gained independence. But are we really
independent? Even now foreign countries dictate to
us economically, culturally, politically. And they do not
need horses to conquer us now, because we have NGOs."
For some people, especially members of non
government organisations, this may sound like an exag
geration. It is not. The role of NGOs in promoting
people’s welfare and rights needs to be questioned. So
does the notion of imperialism. Not only are many Third
World NGOs agents of imperialism, but there is also an
imperialistic attitude in the relationship between First
World and Third World NGOs.
Anybody working in the development and environment
field recognises issues such as sustainable develop
ment, social forestry, management of national parks,
women in development and, most recently, the conserva
tion of biological diversity. It was First World NGOs that
put these issues on the agenda without consulting us.
Third World NGos, including my own, took them up gladly
because they spell money and support.A good example of agenda-setting was the way a
prestigious Northern NGO devised its campaign for
"sustainable logging in tropical forests by the year
1995", For people in this NGO, conservation is a
business; for Third World people, it is a matter of life and
death. No sustainable logging in an economic, ecological,
cultural or democratic sense has ever been proven. Yet
these so-called conservation experts dared to say that
there should be sustainable logging by 1995.
The concept of sustainable logging was challenged by a
friend ata recent meeting in Australia, “sustainable for
whom?" she asked. For the logging companies, per
haps. But for the people, logging becomes sustainable
only if they have control over resources and are given
secure rights to the land.
In my everyday activities, I often ask myself why we
should spend our precious time, energy and resources
on issues such as the Tropical Forestry Action Plan
(TFAP), the International Tropical Timber Organisation
(ITTO), the conservation of biological diversity, buffer
zones around national parks and a dozen other program
mes.
Most Australian NGOs receive money from the
Australian Internationa! Development Assistance Bureau
(AIDAB). They cease to ask questions about how AIDAB
uses its money in the Third World. They refuse to criticise
oppressive governments supported by their own govern
ment for fear of not being given funds. They do not mind
operating in countries where human rights do not exist
or are constantly violated.
To get support from them is to go by their book. And to'
go by their book is to steer clear of all critical issues such
as human rights, land disputes and democracy.
The approach of US NGOs is even less comprehensible. *
I have always maintained that they are more concerned
about projects and campaigns than about the actual,
needs of Third World NGOs and communities. Many
receive money from the US Agency for International
Development. USAID is a big agency. No small Third
World NGO can cope with its technical requirements such
as reports in English, sophisticated account-keeping,
and strict project deadlines.
Because they follow USAID priorities, US NGOs are
prevented from supporting innovative actions and end up
doing trivial work such as income-generation projects
which hardly change the condition of the people.
When I expressed disappointment at this, I was told by a
member of a US NGO with officers in Indonesia: “We are
in no position to change our ways. If this does not suit the
indigenous NGOs, they can look for other partners". And
yet, they and other First World NGOs can secure
financial support in the name of "having partners in the
Third World".
First world NGOs often arrogantly asks. "How can we
help you?"When I say: "Educate your own public," they
claim that it iswhatthey have been doing. But they have
no answer when I say that the public should be educated
to the point of taking action againsttheir own government,
the transnational companies and the oppressive system.
A campaign for stopping military aid, for instance, would
be welcome by pro-democracy groups in Third World
countries. As would be another on the impact of
Western-dominated international Trade.
The time has come for them to
put emphasis on action-oriented
public education in the North rather
than to continue supporting proj
ects that maintain the status quo
of oppression.
ref.- Hire Jhamtani
works for SKEPHI,
(The People’s Net
work for Forest Con
servation in Indone
sia).
I
RESOURCE MATERIALS
^innnnr.y.irrn B t gee >
t
We Make the Road by Walking :
Conversation on Education &
Social Change
n December, 1987, Myles Horton
and Paulo Freire, two pioneers of
education for social change, came
(together to ‘talk’
a book about their
experiences and
ideas.
Though
they came from
different environ
ments,
they
shared a vision and
a history ©fusing
participatory edu
cation as a crucible
for empowerment
of the poor and powerless. Here,
hey discuss the nature
of social
change and empowerment and their
own individual work. For both men,
real liberation is achieved through
popular participation. The themes
they discuss illuminate problems faced
by educators and activists around
the world who are concerned with
linking participatory education to the
practice of liberation and social change.
How could two men, working in such
different social spaces and times,
arrive at similar ideas and methods ?
These conversations answer that
question in rich detail and engaging
anecdotes, and show how, underly
ing the philosophy of both is the idea
that theory emanates from practice,
and that knowledge grows from and
is a reflection of social experience.
(For details contact: Highlander Re
search & Education Center, 1959
Highlander way, New Market, Ten
nessee-37820 U.S.A.)
seemed no more than another student
movement.
It ventures into the
ultimately more significant role of
China’s workers, and particularly the
trade unions, in the unrest of 1989.
The material in the book reveals a
serious contradiction between the
governments' social rhetoric on the
one hand, and the realities of daily life
and the consciousness of the people
on the other. It includes a collection of
profiles of some of the leaders of WAF,
and consists of interviews with organ
isers of the WAF. It is hoped that this
will give the readers an opportunity to
judge the true character of these
members, described by the Chinese
authorities as "social scum", "hooligans",
and "thugs", and also give a clear
understanding of their role in political
development in China. (For details
contact: AMRC Ltd., 444 Nathan Road,
8-B Kowloon, Hong Kong.)
A Moment of Truth
This book bears historical witness to
the Workers' Autonomous Federa
tion (WAF) that
rose to promi
nence during the
1989 Democ
racy Movement
in China. It looks
deeper than the
A Moment
established
of Truth global
media
analyses which
generally pres
ent a rudimentary picture of what
1
» » i
r» • •
> r
Understanding Voluntary Organ
isations : Guidelines for Donors
Voluntary development organisations
have demonstrated substantial com
parative advantage in developing coun
tries. Their capabilities are a function
of their values, special skills, small
size, limited resources, flexibility , and
freedom from political constraints.
Their weaknesses are a function of
many of the same characteristics. In
this paper on what makes NGOs tick,
L. David Brown and David C. Korten
suggest that it is inappropriate to
critique the voluntary organisations,
Government organisations or the com
mercial organisations. In relating to
NGOs, they say that donors should
avoid the danger of equating small with
simple. The strongestofVOsand POs
respond to a good deal more than fi
nancial incentives. (For details contact:
Dave Brown, IDR, 20 Park plaza, Suite
1103, Boston - 02116-4399, U.S.A.
Education for Democratic
Participation
This work presented as a Ph.d disser
tation to the University of Cape Town
in South Africa, focuses on the devel
opment of non-formal education theory
within community organisations. This
book deals specifically with self-edu
cation within a set of organisations in
» • • • • • • • ♦
Cape Town where a primary con
cern was the promotion of demo
cratic participation among their mem-------------------------- ibers.
The work
| contains three rich
and diverse case
studies which give
EDUCATION
important insights
FOR DEMOCRATIC
PARTICIPATION into the working of
community
or
Sbirks Walters
ganisations.
A
participatory re
search methodol
ogy was used.
The strengths
and weakness of
this approach have also been
highlighted. (For details contact: Dr.
Shirley Walters, Centre for Adult and
Continuing Education, (CAGE) Uni
versity of Western Cape, Bellville.
------
Rural Development in Eastern
and North Eastern India
This book published by the Indian In
stitute of Management, Calcutta is a
compilation of the papers presented
in the seminar on Rural Develop
ment which brought together a num
ber of researchers from Universities,
Research Institutes, professional or
ganisations as well as practitioners
from government and non -govern
ment organisations. The seminar
provided an insight into some of the
difficulties in effective implementa
tions of different programmes for the
development of the rural people and
rural section. This volume contains
thirty three papers covering a num
ber of areas such as agrarian rela
tions and social change, perform
ance of different rural development
programmes, issues relating to land
reforms, rural development, strate
gies in relation to socio-economic
development and eradication of pov
erty etc. (For details contact: Indian
Institute of Management, Calcutta,P.O.
Joka, Dist.24, Parganas (South), West
Bengal.
Society for Participatory
Research In Asia (PRIA)
42, Tughlakabad Institu
tional Area
New Delhi - 110 062.
♦
4
H 3 6 - Cj-
o
I'
»However. it is not just the religious prejudice
povrdly secular country, then what agenda
ensure an environmentally sound earth. The
that c m precipitate such conflictand in does this suggest to us in our present cusis?
author strongly advrx. ited a broad social
stability. any ethno-cub ui al di'./de can.
It is here that we need to do some critical
movement to create a culmre of permanencewhether this be religion or lanb.ii.igi'. or
soul-seuic hing How can we ivolatercligious
a way o| life that can contain use of eco
whatever. And these as we know arc mure
institutions Irom being politicised in particu
logically destructive th ngs and cultivate
‘coil .* .civd’ than ’rear.lhequcvtiimtoask
lar from being co-opted io (xvliiical party
deeper, non-material, so irces of fulfilment
really is. whether religious commitment is
inlciesls? How do we pievcnt religious
that can bring happiness.
linked to political intolerance?
symbols and myths from being appropriated
Durnmg pointed out that over a few short
E?. !:cr stud:.* based on the coriclalion of
for clccloi.il politics’.’ Can wc exp>se how
generations,
"the afllu.-.n. who constitute
psycho-stxio profiles and altitudes stem to
genuine gioup interests are sometimes obone-fifth of humanity have become car
indicate a positive relationship between the
luscalcd and misdirected, when they arc
drivers, television watchers, junk-food eat
two. But later more fine-tuned analyses began
articulated in terms of icligion. for narrow
ers. mall shoppeis and il rowuway buyers”.
to distinguish between an authentic commilchauvinistic gains? How can our religious
Meanwhile, the rest of ;ne world feels that
mcnl to religious values, and an identifica
traditions be made to suppoit and promote
the
lime has at last conx ' r it also to achieve
tion with a icligious group mobilising io
civic and democratic values?
Ihc same kind of cons- ncr life-style. The
defend or promote its interests, articulated
Positive and constructive answers io such
study pinpoints the tiends that promote
in terms of religious symbols and myths,
questions will not be found in alien, implant- • consumerism: expansii n of the advertising
tirough they may not really related to them
ed mixlcls ol church-state legislation. Iliere
industry, substitution o ihopping malls for
Religion here becomes a mobilising ideol
must be a much more urgent agenda lor us
traditional city centres rapid international
ogy. The case lor religious mlluence in
on our own ground realities. For. just as we
spread of commercial :Revision, continua
politics, however can be made in terms of
cannot have a genuinely democratic govern
tion of government st t sidies to environ
the pmport it gives and the stabilising in
ment. without democratising our social in
mentally harmlul indusi..ics and the persis
fluence it has on the civic values that sup
stitutions and ridding our communities and
tence ol the bcliel that omy the ever-increas
port a democratic participative process and
lainilics ol authoritarianism, so loo we can
ing consumption can ensure lull employ
public morality. But then not every kind of
not hope to have a truly secular state unless
ment.
religious belief or practice makes for such
we scculaiise our civil society, humanising
Doming lell that the conspicuous con
a humanising faith. Only a i leomus critiupp—.
^LX%rflH,in"f iradilions and purging them of
sumer class - one billit ri people, mostly in
of religion can assure this. Fundj
and prejudice, whctlwr this be
industrialised nations - arc responsible for.
obscurantism or religious mil
lie practice or private belief.
the release ol all the c/.mc-depleting car
tainly does nut.
tBB.A^r- In 'R’e^Ll analvsis our social and
bons (Cf Cs). two-thir^- of all greenhouse
Ilk- complete separation ft^ynl rcl^’ion Opolitieal ethi^
Hunm
ul relied our pergases, and other pilluiants that cause acid
and politics seems haidlvi '•'vsfide. even it
p^iv'autfvalues - rcligiousorotiicrrain, pesticides or even radioitctive waste.
this were desirable. For th J ic^ouDb-CMW' wise. Inched #iat we do need now is a
On the other hand he v ; s all praise for the
and commitments of a groui ^.TII fS^iofimyT JleeijcjZunru^mg faith and not a chauvinist
middle-income class lit «ig in Asia and Latin
pubhc md ptiliiical expies
,nore ruj‘ni1’ und ,css
America which causes ir less harm. Their
lion: • obtains :n an .dlb
diet ol grains and l< .•! precuco. their
modest stocksoldurabh; goods all exemplify
a lilu-stylc that is env i jnmehtally sound.
Advanced technologies. ould make that lilcstylc more comfortable but its basic outlines
Vacant K Bawa
define the environmuiii.il ideal, he added.
"Ultimately”, he said, the linked fate of
Ho«Much is Enough?: The Consumer Society mid the Future of the Earth
humanity and the nalu ul leahn depend on
by Alaxpuriung; I he WMdw.iich Environmental ,\lert Seiies, W W Norton
us consumers. We car uilail use ol eco
□nd Loni|>jy. New York. 1992.
logically destructive rings and cultivate
State of the V j ld: A Worldwatch Institute Report on Progress toward a
deeper non-malerial s< orces ol fulfilment
that bring happiness, oi v.-e can abiogatc our
. ustainablc Sociefy by L jstci R Blown and others; W \V Norton and Company
responsibilities and let car life- 'tylu nun Ihc
New York. 1993. 1994.
earth "
Gandlu.in Holistic Economics by Shashi Prabhu Shanna: Gandliian Studies and
How did this remar sable change come
about,
so that even a s:bcr and widely re
eace Research Sciics. Concept
Publishim*
Coinnrmv
Now
Delhi;
199'
’
Concept Publishing Company. Nc
spected US organisation ould identity itself
w ith a view that had hilhc'to been considered
SOON .liter the ending of ihc Global Con
"Oui caix. Mibiifbx. shopping malls. Ihiou as
radical, woolly .md lell wing? And what
ference on Environment and Dc.clopincnt
assay pio.lucls. meal and jimk-lood diet add
are the implications ol ibis change in the
held 31 Rio de Jancno. Bi.i/iI m lu.ie I’J*/?.
up io ihc nio'i k n\iionmcni.illy dcsiriKiivc
woild climate ol opinion lor the Indian elite,
a new i <>ok received wofldw.de headlines
way ol hie \ci devised". s..ys Alan Thein
not to speak of the im Hie class, which is
For ihc first lime. UM icp.m.-J ..n lul\ ZX.
Ouiiiing. author ol ll<<w
/,■ /\ /'.ih'it'^li,,
jus! beginning to say Hello’ to Zindagi'
a reputed American ruse m. h i:!viiilltr dire
Ihc Coiixu'ii, I .\.>t /( I\ ,1,1.1 il,, / uh,),- ,,f ihc
(lilc). I his i. lass is dep ndent on refr igerclly blamed the -cons, kumh ...ii.uiuchmii
I.hiiIi. In tins \ oii'iii iciisi culture’ the
aiors and two-v.heeler aspires to having
ar.d affluent lile-stylc of the Xmeinans" lor
Americans uc eiiy.-wl in a I mil less .il tempt
cars, washing machine?., air-conditioners and
being the major cause ol the en . mmmcnial
to Imd happiness m miicti.il ihmcs □nd m
miciow'.nc ovens -'all iicin.s which add to
damage, next only to popnL.h.m gromli in
ihc i.ice loi .icIh s i- oe lost latnily values.
global warmmg and a|,.Cl the ozone layer.
Alrican and Asian counti ics 1 lie
h Idw ax h
Icisuiu and social iclaiions lie called upon
We in India cannot alv ays blame all our
Institute, a Washington. DC-b oed environ
individuals to tum to the lamilv and com
pioblcuis on the indu» ri.iliscd countries,
ment. 1 leseurch Oig.inisation ..ISs that ■ tl-.e
munity ’as il h.is been proved by w isc men ..........
.. eventually • i.u the .searchlight
ami must
cons-, .•.er lile-stylc born m Amenta and
horn the Buddha io Mohammed - that money ■ fn\\ ards.
now emulated by a billion peep!.- worldw idr
cannot buy h.ippinc<C’. CommuniticN should
flic W'orldw aich Insii-ute in Washington.
Ciiiiscs tlie Imn’ , sherc.'l •.\olocu al ills. Yet.
2ko rcMiain advciliMng and other pio-conD(
has hei nine an i rportant institution
c'Bsuaipiio., is usually
i.uAcd
in
I.H.kcd
sumption lon.es Io bring about a change in
during the lOycarsofit existence. Ilsannual
environmental discussion/’
the allhicnt lil.c->i)lc which alone could
Sim,- ,>J ihf Wnihl reports 'On Progress
kowartis Sustainable Development
27JX
Economic and I’olilkal Weekly
V. 2.^y Xc?
October 15, 1994
,
toward u Sustainable Society’ are balanced,
wcll-rcscarchcd. and w-idcly read. Il is pub
's.
lisljcd by commercial publishers in some 27
x^hnguagej including Spanish. Portuguese.
french, Italian, Chinese. Japanese, Arabic,
Incic ^. sian. German, Polish and Russian.
America;: univvsities have appreciated its
"integrative, interdisciplinary approach". It
is prescribed as a tcxdxxA or as supplemen
tary reading for courses in many fields.*In
a survey conducted by Pennsylvania Slate
University. 235 'cn\ironmcnlal leaders'
ranked Stale oj the World thud on the all. lime list o! the 5(X) "most influential envi
ronmental brx'ks". next to Sand County
AlmantK by Aldo Lco|x»ld and Silent Spriny
by Rachel Carson
Articles in the 1993 edition of Slate of
the World cover such issues as ‘Facing
Water Scarcity'. 'Reviving Coral Reefs’.
Rediscosering Rail'. ‘Pte pari ng for Peace*.
Reconciling Trade and the Environment’,
and ‘Shaping the Next Industrial Revolu
tion . Articles which have special signi
ficance for third world countries are ‘Clos-
ment of the ozone layer’s health indicates
accelerating depletion”. Apart from this, “the
earth’s forests continue to shrink, its deserts
continue to expand, and a third of all crop
land continues to erode excessively. The
number of plant and animal species in the
planet is diminishing.” Perhaps the institute
is unable to go into some of the more funda
mental causes of the environmental crisis,
such as the dependence of the American
economy on the automobile, and on cheap
gas or petrol, which also dictates many ns|>ccls
ol American foreign policy towards the Gulf
countries, and to the world at large.
While the analysis in the Worldwatch
reports is nt a high level ol sophistication,
the reasoning in How Much Is Enough?
(which, as we have seen, is written by the
same people) is politically naive and sim
plistic. It seems to imply that by exhorting
the elites to give up their high consumption
life-styles, such a development is likely to
take place. The whole argument was pul
much belter by Ivan lllich in Towards a
History ofNeeds (New York. Bantam Books,
die Gender Gap in Development'. ‘Sup
1980), as follows: “The lirst enslaving illu
porting Indigenous Peoples', and ‘Providing
sion is the idea that people are bom to be
Energy in Developing Countries’. The 1994
consumers and that they can attain any of
edition also raises basic issues like ‘Re
their goals by purchasing goods and ser
designing the Forest Economy', ‘Safeguard
vices. This illusion is due to an educated
ing CXrcans’. ‘Reshaping the Power Indus
blindness to rhe worth of use-values in the
try’ and ‘Using Computers for die Environ
total economy...The illusion that economic
ment'.
models can ignore use-values springs from
During the 10 years that lhe report has
the assumption that those activities which
been coming out. there has been a more
we designate by intransitive verbs can be
precise quantification of the loss of the
indefinitely replaced by institutionally de
world's forest resources, first noted in 1984,
fined staples referred to as nouns: ‘educa
the progressive depletion ol lhe protective
tion’ substituted for 'I learn’, ‘health care’
ozone layer, which had first been reported
for ‘I heal', 'transportation' for ‘I move',
in 1985, the increase in global waiming, the . ’telesision’ for 'I play’” (pp 41-42).
threat to three-fourths of the 9,000 bird species
The economic analysis in the Durning
in the world, the dangers ol nuclear power
book is practically confined to (he 4th chapand the population explosion. The attempts . ter, entitled ‘The Environmental Costs of
made by the signatories to the Montreal
Consumption’. The World Bank economist
convention ol 1987 to sharply reduce the
Herman Daly is quoted on page 59 as saying
production ol the family of chemicals threat
that “simply stopping the growth in rates of
ening the ozone layer did evidently lead to
global pollution, ecological degradation, and
some results, we learn to our surprise.
habitat destruction - not reducing those rates,
Between 1988. lhe peak year ol production,
as is clearly necessary - would require within
and 1991. world production of Chlorofluo ~ four decades a twcnty-lold improvement in
rocarbons fell by an astounding 46 percent.
the environmental performance of current
This was partly due to lhe fact that DuPont,
technology”. Even this assumes that (I) in
the leading manufacturers of CFC’s, had
dustrial countries hall their growth of per
already been “deseloping CFC substitutes
capita consumption, allowing the develop
which would be at least as profitable as the
ing countries to catch up. and (2) that world
< ‘.emicals being phased out" [State of lhe
population no more than doubles during that
World, 1993. p 186). This Iasi statistic makes
period. This is obviously a tall order. (Daly
us realise that there is a gotxl deal that can
has since then come out with an important
be done through the regulation of manufac
book.edited jointly w ith KennethTow nsend.
turing activity, even in the most ‘advanced'
entitled Valuing the Earth: Economics,
(often definable as the most |K>lluting)econo
Ecoloyx- Ethics. MIT Press, Cambridge,
mics. Tlic pressure ol environmental lobbies
Mass. 1993. reviewed in Worldwaich. Vol 6,
in the US has been so great, it is sometimes
No 4, July-August 1993. pp 39-40.)
stated, that it has succeeded in pricing nuclear
How (’■ I rhe socialist countries tackle the
power stations out of the market
problem : Not too well, so far as the Soviet
However, according to the Wurldwatch
Union and eastern Europe are concerned.
Institute s own account, the past 10 years
Top-heavy bureaucracies laid down wellhave not seen much change in lhe situation.
meaning provisions, which were not enforced
Not only has the "concentration of giccnin practice. Pollution in the former Soviet
house gases m the atmosphere climbed higher
Union and easlcin Europe is al dangerously
each year . but “almost every new assesshigh levels. (Sec lor example, two articles
Economic and F’olimal Weekly
CX iul>cr 15. 1994
in the journal. Worldwalch. Lester Brown,
‘The Aral Sea- Going, Going..,', Vol 4,
No I. January-February 1991, pp 20-27, and
Nicholas Ixnscn, update on ‘Chernobyl,
firsthand'. Vol 7, No 1, January-February
1994, p 8.)
China can be dted as a country which had
evolved during the 50s and 60s a model of
development which combined employment
orientation with utilisation of human waste,
the recycling o( garbage, and its conversion
into lertiliscr. The low-cost, high-cmployment, recycling-oriented economic pattern
of (he Mao era has, however, given way to
ahigh-lcchnol jgy. private enterprise, wealth
producing paltcm, at least in southern China,
based on the r.'ong Kong model. It is likely .
to be as environmentally damaging in the
long run as the western model, although not
perhaps as damaging as the cast European
model might .'iavc been.
G> ohian Alternative
.
Some would feel it inappropriate to con
sider the Gandhian economic model in the
context of th< present debate. The ecological
crisis hod noi reached its present magnitude
during Gandhi’s lifetime, and his concern
for the main enance of traditional values
while transforming rural society seems to
have no direct connection with the global
economic crisis. We have to note, however,
his stalcmen ' which was quoted by the Indian
prime mini’ter at the Rio summit) that the
world has enough lor everyone's need, but
not for anyo ic’s greed. If the British empire
required to exploit such a large part of the
world to m untain its standard of living, he
asked, how much would India require? T~hat
these arc not isolated remarks, but constitute
the core of Ins philosophy, is clear from the
manner in v. Iiich one of his closest disciples,
J C Kumarappa, formulated these views in
detail in th-: Indian context. (See his book.
The Lcono ny of Permanence. Sarva Seva
Sangh Pral .ishan, Varanasi, 1984.)
The Garjhian model has been put forth
once more in a volume, based on a PhD
thesis, by Shashi Prabha Sharma, entitled
Gaiulhian Holistic Economics. This volume
constitutes a valuable introduction for those
who are unfamiliar with the philosophical
loundalio: f of Gandhian economics. Quot
ing the late V K R V Rao, the author puts
forth Gandhi's ideas as an alternative which
could oveicomc the failures of both capital
ism and communism, to a world ‘‘attracted
by the possibility that the circle can be squared
with economic growth, social justice, full
einploym< nt, economic and social equality,
political democracy and individual freedoms
all forming components of a harmonious
social onler” (p 21). The second chapter
contains j reasoned critique of the basic
paradigm underlying modern economics,
while the third outlines the economic crisis
of the prcjcnt day, citing problems like the
depletion of non-rencwable resources, the
need to maintain an ecological balance,
inequalities ol. income, unemployment.
2739
, No
I
dehumanisation and the icst In this t tiiticxl,
Sharma cites some ol the writings ol the
Amer i in biologist. Batty (’ommonei, the
Etitis.' economist. E E Schumachvr t whi’-c
ideas wcic formulated al I'-.ru partly in India,
under the inlbi.r'cc of Jay a P'ak.ish Naray an),
ar. J the Club ot Rome icpott (pp 17- So ) She
pub forth ?_s an answet io the crisis the
Gandhian holistic approach, which seeks to
reconcile 'economic ends' with holistic
means'. To those lamiliar with Gandhi.m
thought, there is little that is new m the
volume, although the case is pul with accu
racy and simplicity.
What one misses in the volume is an
analysis of the implications ol the Gandhian
approach for the present world crisis. With
Marxists often al a loss to explain current
global bends, or to provide answers to the
c.isis, at d with capitalism facing internal
contradictions, one would have expected
the Gandhian economists to be in the fore
front of new economic (xilicy-making exer
cises.
One ha.s become used to the lip-service
paid to Gandhi’s ideas by public figures.
Sometimes an economist would go further,
as diiithe late V K R V Rao in his Foreword
to a bobi by Shanti S Gupta. The Economic
Philosophy'^-T Mahatma Gandhi (Ashok
Publishing I loU' Delhi, nodale, 1968-69?).
He said there that kA Ihian economic ideas
‘‘aregeinqfo influence bt>: ■dlici.il economic
policy", he, among other factors, to the
"hard facts of Indian economy such .is dearth
of capital, implic.‘,»ons of foreien aid. domi
nance of unemployment in rural areas, and
consequent waste of labour power, the
Imperative need for economic improvement,
the example of New China in the skilled use
of labour power..."
It is unusual to come across a direct attack
on Gandhi’s ideas such as the following:
"ThcGandhian path is/n»r an alternative path
of reaching the goal of economic develop
ment which the country has pursued in the
past 30 years. It is a path leading to an
alternative goal of human life and existence;
a human society which is unmoved and
immovably unchanged and unchangeable,
using the s«mc kind of plough as existed a
thousand years ago. living in the same kind
of cottages as there were in times immemo
rial and educating its people on the same
system as ever before; a society whuh limits
and minimises its material needs and one in
which every one earns his daily bread by a
full day’s physical labour seeking happiness
is a mental condition detached from the
objective material conditions of life I shall
not saj) that goal is necessarily utopian. I
have a simpler point, namely, that the
Gandhian goal is not acceptable II one is
alktng In the rime of the common man and
tying to meet his aspirations, it is important
) recognise that the Gandhian goal is not
tlevanl" (V M Dandekar. ‘Gandhian F.coomic System: A Path to Non-Economic
ioals' In B C Das and G P Mishra. Gandhi
t lixlay's India, Ashish Publishing House.
• ew Delhi. 1979. pp 91-92.
40
Il ib <Ji I litull to (cl')le D.wv.lck ir's ;ir,:ilysis,
as it is on a study of Hind Sssarnj,
which, as he points cut, Gandhi never re
pudiated. As against this view, however, we
have the impoitant study by Ainril.manda
Das, entitled (■ ounilaiions of Gundhian
l-\unoniii 3 (Allied Publishers, Bombay
1979). which ' ceks to put forth a 'Gandhian
model ol dev elopmcnl i elcv.mt to the present
day. including such concepts as mvcAmenl
patterns and foreign trade A/i/ however
fuels that such models would deviate Iron)
"Gandhi’s laudable goal ol a non-cxploitalive economic system" (j) 9b)
Among the problem a Inch have been
neglected by Gandhia.. economists is the
impact of population growth on pollution.
In spite of its adverse effects on the environ
ment, could we have fed our burgeoning
population w ith out the green revolution and
its contribution to the food production of the
country? Narmada may Ise harmful, but will
small dams provide adequate irrigation for
the countryside'7 What will this alternative
require in terms of investment patterns, and
what will it achieve in terms of employ ment
potential? Will such a thrust slow down the
rush to the metropolitan cities, and develop
small and medium towns instead?
Considering the strength ol the interest in
alternative models of development by those
wishing to avoid the pitfalls both of capi
talism and socialism, one wishes Indian
economists would apply their minds to these
problems in greater numbers, and helpevolve
a developmental model which would lace
the issues raised by the global ecological
crisis, as well as the problem of distribution,
which clearly is not going to be solved by
the globalisation pattern which holds the
field today.
An important article by RamachandraGuha
in the EPW (‘Prehistory of Indian Environ
mentalism: Intellectual Traditions’, January
4-11. 1992. pp 57-6J) highlighted the con
tribution of precursors ol modern Indian
environmentalism, men like J C Kumarappa,
Patrick Geddes, RadhakamalMukerjee. and
Venier El win. “Kumarappa". Cuba says,
"was virtually the only economist ol his
generation to question the centralised and
resource-intensive path ol development
adopted in independent India. . Hollowing
Gandhi loo in questioning the feign ol modern
man. Kumarappa went on to challenge
modern civilisation for disembodying the
economy from its ethical and cultural moor
ings - a decade before Kail Polanyi was to
lend intellectual respectability to such criti
cism" (pp 5M-59).
ITcre seems little doubt that J C Kumarappa
and others who developed the Gandhian
eci'iioiiiie iihhIcI deviated lium Mahatma
Gandhi’s views as stated in Hind Swaraj.
While they were loyal to the basic philoso
phy ol Gandhi, they evidently fell it was not
necessary to accept literally every word that
Gandhi ever said or wrote. In an article
entitled Gandhian F’concmiu System. Ils
Relevance to Contemporary India’, /MhIuI
A/1/. of the Instiime of Soc ial and Ikonomic
Change, Bangalore, draws a distinction
between "Gandhi’s economic system" and
"the Gandhians’ economic system". He
argues (hat the latter strategy ‘‘envisages a
path for growing rather than a stagnant
economy as envisaged by Gandhi", as it
provides for "an appropiiatc rate of savings
for future growth ol the economy" and of
employment opportumlie v There is a clear
cut link between production and consump
tion cuntius. and one cannot be allowed to
outstrip the other.
Alvful A/izscumstolx- I'lorthodox Gandhi
follower, rejecting what he calls "the
Gandhian path of development" for "devi
ating from Gandhi’s laudable goal of a nonexploitalivc economic system", by seeking
to "divert a portion of the resources to high
capital-intensive projects with a view to
ensuring high savings rate, nd future growth"
(Abdul Aziz, in V T Patil (cd), Studies on
Gandhi, Sterling Publishers, New Delhi.
1983, pp 95-96.)
One mayconcedethatGa.udhi’sown views
have been at least partly outdated by events
(his views on birth control and prohibition,
for example, need to be re-examined).
However, it is no longer acceptable to reject
all Gandhian economic ideas simply on the
ground that technology has changed beyond
recognition in the last two hundred years,
and more so since Gandhi’s death. The
importance of the environmental question
clearly makes it essential to consider alter
native models which are not based on (he
"latest technology", in winch our bureau
crats and industrialists have such touching
faith.
BagaramTulpule,whodel veredtheKunda
Datar Memorial Lecture at the Gokhale
Institute of Politics and Economics, Pune in
1989 (’Technology against Poverty or Pov
erty through Technology?') argued that
‘‘technology is not value free, nor neutral to
the socio-economic and power structure. It
is. therefore, dangerous to adopt it as an
ideology or an article of faith ..” We have
to choose technologies which are benign,
non-polluting, and capable of being utilised
in a constructive way. he [Kriiled out. Eor
example, he opposed the use of nuclear
power,‘‘as the Greenpeace International
and so many others round the world are
urging" (p 38).
In the opinion of this writer, wc must
seriously consider a choice ol technology
based on criteria other than i tere producti
vity - criteria like environmen’al impact, the
location and widespread distribution of in
dustry, its employment potenl’al, and (he
extent to which it serves "the lait man in the
queue, the puniest of the poor m India and
the rest of the thiid world". (Sec V K Bawa,
What Kind of Development? Industria
lisation, Technology and the Environment'
in John S Augustine (ed). Sirate^ies for
Third World l)e\elopmeni, Sage Publica
tions, New Delhi. 1989, p 150. These ideas
arc further developed in V K Bawa (ed),
EnvironnienttmdDrvehfpnu-nt: A Gandhian
Approach, B R Publications. New Delhi.)
Economic and Political Weekly
Ociulxr 15, 1994
V. 2.7 z /v/o Zj Z.
CATEGORIES OF
SUBSCRIPTION FORM
MEMBERSHIP OF SPEQL
a) Ordinary Annual Membership (Individual)
Rs. 50/- Per annum.
b) Life Membership (Individual)
Rs. 500/- Per annum.
c) Corporate or Institutional Annual Membership
Rs. 1000/ Per annum.
d) Corporate or Institutional Permanent Membership
Rs. 10,000/-
I would like to subscribe to the bi-monthly Hyderabad
Bachao - Save Hyderabad for one year. I enclose cash*/
D.DTM.O., for Rs. 30/- in the name of Society for Preservation
of Environment and Quality of Life, 3-6-369/A/20, First
Floor, St. No. 1, Himayatnagar, Hyderabad-500 029.
Please send the magazine to the following address:
Name:
e) Student Membership : Rs. 25/- Per annum.
(Associate)
Address:
Note: Members of SPEQL will receive one complimentary
copy of "Hyderabad Bachao - Save Hyderabad".
Tel. No.
Signature
Note : * Please do not send cash by mail.
APPLICATION FOR MEMBERSHIP
Date
To,
The Honorary Secretary
Society for Preservation of Environment & Quality of Life
3-6-369/A/20, 1st Floor,
Street No. 1, Himayatnagar,
Hyderabad - 500 029.
Sir,
l/We request to be admitted as--------------------------------------------Member of the Society for Preservation of Environment & Quality of
Life. The following are my/our particulars for your record.
1) Name
5) Areas of Interest
6) (In case of Institutional Members) our Nominee (or Nominees)
to the Society is/are (not more than two nominees):
I/We agree to abide by the Memorandum of Association and Rules
and Regulations of the Society.
Membership Subscription of Rs.
only)
(Rupees
is being paid by ‘Cash/D.D. No. -
dated-------------------------------of
2 a) Address & Telephone No :
Bank/Money Order No. (Receipt No.
dated
.)•
b) Address to which the magazine should be sent (if different from
above)
Telephone No:
Yours faithfully,
Name
3) Profession/Educational Background
4) Time l/we can spare for the Society, if any
Designation
Note : ‘Please do not send cash by mail
(Signature)
V*
JMT'3'
REPORT
OF
f
c-
STATE LEVEL CONSULTATION
ON
"SUSTAINABLE HEALTH CARE OF PEOPLE"
29th & 30th JUKE 1995
VENUE : C.D. FOUNDATION
COMMUNITY DEVELOPMENT CENTRE
641 201
CHETTIPALAYAM, COIMBATORE
REPORT PREPARED BY
P. SAMINATHAN
A.S. SANKARA NARAYANAN
ANNE MJT. ENOS
M. MOHAMED USMAN
ORGANISED BY
NETWORKING FOR ALTERNATIVE MEDICINE SYSTEM
- TAMIL NADU)
NETWORKING FOR ALTERNATIVE MEDICINE SYSTEM NAM-TAMILNADU
Dear Friends,
We are happy to share with you this report of Networking for Alternative
Medicines Systems (NAM) - Tamil Nadu with a view to get your ideas, comments and
suggestions to strengthen the indigenous systems of medicines> as people’s movement,
NAM - Tamil Nadu is a common forum believing in collective effort and process of
working together.
This has been initiated towards promoting and revitalising
alternative (People's) Health Care Systems.
Those who believe in People's Health and interested to have partnership
with this effort of working together are welcome to join hands with NAM - Tamil
Nadu.
This report deals with the Proceeding of the two days "CONSULTATION ON
SUSTAINABLE HEALTH CARE OF PEOPLE" held at Community Development Foundation,
Community Centre, Coimbatore.
It also contains the suggestions and recommendations
of participants present and the views of the resource faculties.
We are grateful to all the sponsoring organisations and individuals, who
have provided their ideas, contributions and support to organise this consultation.
Our thanks are also due to the resource faculties and participants who have
contributed their views, ideas and experiences for the successful completion of the
beginning of the above effort.
It was unanimously
i
decided by the participants present in consultation to
follow up the consultation
j
.
-- ----- 1with practical
and useful
activities and given the man
date to the organising committee to continue to function.
-----*—
It was decided to follow up
the consultation with a meeting at RDO-Coonoor, inviting more NGO's and experienced
individuals to join.
We wish to acknowledge, appreciate and whole heartedly thank all those
who have directly and indirectly helped in organising this first meaningful
endeavour.
In Solidarity
Dated : 09.08.1995
Place : Madras-94
CONTACT ADDRESSES :
P.SAMINATHAN
1/103, Bazaar Street,
Paradarami - 632 603
N.A.A. District,
Phone : 04171/47269
G. NAMMALVAR,
7, Ezhil Nagar,
Keeranur,
Pudukkottai
Pin 622 502
Phone : 04339/6377
A.S.SANKARANARAYANAN,
2/232, Somayanoor,
Thadagam,
Coimbatore - 641 108.
Phone : 0422/858349
M.MOHAMED USMAN
On Behalf of NAM - Tamil Nadu
"Haseena’s Nest'
4, Sowrashtra Nagar,
Fourth Street,
Choolaimedu,
Madras 600 094.
Phone : 044/4836953
1
INTRODUCTION
Basic health care of people is an essential determinant
factor for the effective development of any society. In the
Indian context, the poor, common folk are deliberately kept
away from the nature of health care and services they really
need and afford. A few decide what they assume to be good or
what is needed for the common folk.
It is becoming very clear that health care has to become
a people’s movement, so that there can be participation and
involvement of the people, the NGOs, the Government and the
practioners of the different Indigenous System of Medicines at
all levels. The different Indigenous systems such as Siddha,
Ayurvedic, Naturopathy, Yoga, Accupressure, Unani, Homeopathy
and Local Health traditions (Tribal Medicines) need to be put
in proper perspective. All these systems should come together
under a common forum and arrive at a common understanding of
how they will
collectively or complement ar ily be able to
become involved in the promotion of sustainable Health Care of
People.
The overall purpose of this two day consultative meeting
was to make an attempt to bring about a clearer understanding
among the NGOs involved, Govt., various professionals, health
and medical practioners of the various indigenous systems and
the
supporting
partners
involved
with
sustainable health care of the people.
the
promotion
of
2
CONSULTATIVE MEETING
The
two days
state
level consultation on sustainable
health care of people was held on the 29 & 30th June ’95 at
the
C.D.
Foundation,
Chettipalayam,
Community
Coimbatore.
Action
Programme
System
(NAM
workers
of
of
Centre,
This
consultation was
a
Net working
for Alternative
Medicine
Tamil Nadu).
Joint
It was attended by Development
practioners
NGOs,
Development
of
indigenous
medicine
professionals and activists from various districts in Tamil
The medium of language used at the consultation was
Nadu.
Tamil,
although there were
a
few presentations
and views
expressed in English due to the limitations of the resourcde
faculties.
DAY 1 DELIBERATIONS
The
first
day
began with
the welcome
and
Inaugural
address. In his welcome address P.Saminathan, Director, POETS,
welcomed the gathering. In a brief introduction he outlined
the objectives and purposes of this consultation.
a.
To
discuss
the
evolution
and
the
historical
background of the indigenous system of medicines.
b.
To
review
the
status
of
Indigenous
system
of
medicines in the context of primary health care and
new economic policy.
c.
The
role
and
responsibilities
of
the
NGOs
and
social Action Groups in promoting and revitalising
the Indigenous Systems of Medicine.
3
He
further
added,
that
and hoped
from the
days
two
interactions, dialogue, exchange of ideas and views - it would
be possible to advance towards a more meaningful understanding
of activating sustainable health care so that it would bring
about the following:
a.
Strengthening
and
promoting
of
a
net
work
of
Traditional Health Care workers.
b.
Revitlisation
of
age
old
positive
care
health
practices.
c.
Organising
a
group
of
professionals
health
to
impart training on the use and practice of simple
herbal medicine.
d.
opportunities
Providing
for
understanding
and
exchange of ideas.
e.
Development
of
community
nursery
of
medicinal
plants and also a production unit for simple herbal
formulae,
that would
to
cater
the
basic
health
Dr.M.Aram,
M.P.
needs of the target population.
INAUGURAL ADDRESS
The
President,
HIGHLIGHTS
consultation was
inaugurated
Santi Ashram, Coimbatore.
by
In his address, Dr.M.
Aram briefly traced the history of various health traditions
and their contributions to modern science and technology,
particularly the influence of science on every aspect of life
of which health care
is paramount.
He
stressed
the need
understanding of the concepts, strategies, practices of modern
medicine
its
outcome
and
the
need,
for
more
empherical
4
experimentations to conceptualise and understand the local
traditional health systems.
He
continued his presentation by sharing some
some of his
views and ideas on the Central Government Health Schemes, He
concluded by expressing his opinion that vast health care
needs of our rural population still remain unattainable. It is
in this context that he felt NGOs have a crucial role to play
individually and collectively to initiate and strengthen the
sustainable health care activities through indigenous systems
of medicine.
HIGHLIGHTS OF THE PRESIDENTIAL ADDRESS
In
the
Presidential Address
Social Action Movement,
Rev.
Convenor,
Y.David,
Tamilnadu expressed
the
need
for
people to come together as a movement so as' to bring about
effective health care of people. He opined that the
integration of
both Alopathic
and
Traditional
Systems
of
medicine are extremely essential to meet the health care needs
of the people whereever possible. It
It is
is not
not a question of
rejecting one system for another
another but
but understanding these
medicine systems in their proper context of health for the
people. It is paramount that the rule of nature is upheld and
in the given context of today where nature and the environment
are endangered, nature needs to be safeguarded. With these two
address, the pace for the consultation was set.
5
TECHNICAL SESSIONS
At the technical sessions, during which four professional
experts
in
the
field
of
indigenous
system
of
medicine,
presented four different aspects of these systems of medicine.
Two of the technical sessions were presented in the morning
and the forenoon and two technical sessions in the afternoon.
The following were presented during each of the technical
sessions.
1.
EVOLUTION AND HISTORICAL BACKGROUND OF INDIGENOUS SYSTEMS
OF HEALTH CARE
This sessions was delt with by Dr.R.T. Rajan, Director,
SOLAI, Katpadi.
HIGHLIGHTS
He has highlighted the points that
The emphasis should be on a proper perspective and
concept of what health really should be.
In general people identify their state of health as
good or bad interms of medicines. Health dosehot
mean only medicines and health has to be taken in
the
context
traditions
and
of
the
local
practices
with
condition,
health
reference
to
environment of the people.
Health infact is a search for survival.
the
6
In this context women have tremendous energy and
are the sources of all creations. This
aspects
should not be forgotten.
Sustainable health of people are in their own hands
there
is
no
need
to
go
searching
for
new
approaches and alternatives, when we already h^f^
our own rich health traditions within the easy
reach. Therefore it is our moral responsibility to
revitalise
our
own
systems
of
medicines
and
preserve our cultural heritage.
2.
IMPORTANCE OF SIDDHA IN THE 20TH CENTURY
Dr.R.Kannan, Honorary Siddha Consultant to the President,
Government of India has delivered a speech on this subject. He
has highlighted the following points:
Siddha has it’s original among the people of Tamil
Nadu. The basic foundation for Siddha
is based on
human beings and their environment, their babbits
and lifestyles, these contitute the main elements
that decide whether the person is healthy or not.
The role of meditation, accupressure and water are
merely
tools
to
achieve
good
results
in
the
practice of siddha.
If Siddha system are to be utilised in bringing
about sustainable health care, there should be
recognition and respect to the people involved in
the system and there will also be the need for
further exploration.
7
3.
INTEGRATION OF INDIGENOUS SYSTEMS OF MEDICINES
Dr.Brahamananda
Swamigal
a
Siddha
specialist,
at
Coimbatore has stressed the need for integration of all the
indigenous health care system.
The need of the hour is a
better understanding and interaction of all the indigenous
health
care
systems
among
themselves
developed into sustainable health
before
care.
they
can
be
There are various
medicinal plants and they have a variety of uses in various
preparations for the day today simple treatment of various
ailments. The practical strategies and action plans should be
worked out for the integration of these systems.
4.
THE AVAILABILITY AND UTILITY STATUS OF LOCAL RESOURCES TO
MEET THE PRIMARY HEALTH CARE NEEDS
Dr.G.Gangadharan, Executive Secretary, LSPSS, Coimbatore
and Dr .A. S. Sankara Narayanan, NMCT, Coimbatore have jointly
presented
their
views
and
ideas
towards
this
technical
session. The following were the highlights of their speech
There are treamendous medicinal powers in water,
flora, and Fauna. Knowledge of these are with the
local indigenous people. They have a knowledge of
all the medicinal species and their uses for common
ailments.
It is this knowledge that is a rich resource and
has to be communicated and passed on to people so
that they can make use of them for their health
care.
8
No
where
else
medication,
in
the world
poison
is
used
as
If given in the right proportion and
through proper administration it is very effective
i.e
Mercury
is
used
in
ingridients
in
siddha
treatment
combination with
in
the
other
cure
of
certain oilements.
In
the
context
today,
the
and
acting
essential
for
and
local
of
thinking
globally
principal
it
is
revitalisation
use
importance
is
locally.
the
on
This
effective
resources
to
in
traditional health practices to bring about lasting
improvement in the health. Status of people.
The days sessions was very efficiently and effecitvely
moderated by Prof. Ratnanatarajan, SIPA, Madras and concluded
with questions from the participants on the various technical
sessions and a summing up of the days proceedings.
DAY 2 DELIBERATIONS
On the second day of consultation (30.6.95), there were
two
technical
sessions.
These
were
followed
by
group
discussions and a plenary session and was followed by the
velidictry function. In the technical session the area covered
included.
1.
THE
NEW
ECONOMIC
POLICY
AND
IT’S
IMPLICATION
ON
INDIGENOUS SYSTEMS OF MEDICINE
Dr.Manjunath from Mysore has contributed his views and
ideas on this topic.
9
Human
being
ecological
is
an
essential
spectrum many
component
aspects
of
of
the
traditional
health care practices have been taken for granted
and we
are
too.
indifferent
What
is
needed
is
health empowerment and the provision of the basic
health amenities
and preventivbe health care
is
most important, but today Government has reduced
their
on
the
provision
implementing
programmes
expenditure
of
these
amenities.
NGOs
just
without
realising, whether they are pro-people or against
ant
the
effects
these programmes might have
on
people. The role of the NGOs is therefore to bridge
the gap between the Government and the people. NGOs
also
have
a
role
indigneous medicine
to
play
in
systems but
developing
are NGOs
the
really
ready and prepared to take up the challenge and
start
the
fight
and
the
strucggle
against
the
exploitation.
With the advent of the market economy, there is a
price on everything and thereforewhat is needed is
that community based, people’s centred health care
and selfreliance have to be developed.
An NGO need to be flexible and has to suit the
needs of it’s target populations.
The new economic policy is attempting a marriage of
2 technologies but at what cost and what then would
be it’s impact on indigenous medicine and this is a
serious situation that has to be carefully studied.
10
People are going to be increasingly alianated from
the
use
of
their
own medicinal
resources.
Indigenous people will have to pay higher prices
for their indigenous medicines prepared by multi
national companies. There is potential danger for
indegenous knowledge system arising out of pattent
rights.
2.
ROLE OF NGOs IN PROMOTING AND REVITALISING
INDIGENOUS
SYSTEMS OF MEDICINES
Mr.Nammalvar, Secretary, KUDUMBAM and Mr.C.R.Bejoy have
shared their views and ideas with regard to the role of NGOs.
Mr.Nammalvar was of the opinion that the
nature has got all
medicine to cure most of the disease,
Only man has to take
advantage of the locally available natural
resources to cure
their ailements. Mr.C.R.Bejoy
Mr.0•R.Bej oy invited the participants to
think deep in to the New Economic Policy and the involvement
of multi-national companies in deciding th price of the Indian
drugs.
If the focus is to be on cash crops in place of naural
food crops, how can health for all by 2000 be possible further
there is no connection between primary health
care systems and
services and primary health care planning.
Basic
fundamental needs
are
the
fundamentals
human existence and these basic needs
of
should be
obtained without exploiting nature, unhealthily.
11
Nature
has
been
exploited
in
various
ways
and
therefore the crucial responsibility now rests on
the
shoulders
of
the
NGOs,
to
prevent
the
exploitation of the indigenous systems of medicine
under the new economic policy.
NGOs
should
also
need
to
a
find
appropriate
solution towards developing more sustainable health
care for people.
GROUP DISCUSSIONS
The technical sessions were followed by group discussion.
The participants were divided in to 5 groups. To facilitate a
more specific discussion a few guidelines were presented to
tthe groups. The questions included in the guideliness we are
1.
What need to be done to revitalise health care in
the context of the New economic policy?
2.
What is the role of NGOs?
3.
How
can
they
facilitiate
and <see
that
is more
sustainable in the long run?
4.
The time given for the group discussion was 45
minutes. All the groups actively particpated in the
discussions and in depth and the general outcome
indicates that :
1.
They
are
aware
and
agree
that
participation at every level is essential.
people’s
12
2.
In the context of the role of the NGOs they felt
that
it
could be
achieved by developing a
meaningful partnership with people,
other NGO’s,
Govt., and support groups at different levels.
3.
The NGOs involved in the
health work should get
not only get clarity in thier approaches but also
assess
and
understand
the
people’s
needs
with
regard to health.
4.
While the outcome of the group discussions
were
general
the
specific
health
issues
and
intervensions relevant to the local environement
need to be developed in follow up consultations and
plannings.
VALEDICTORY ADDRESS
The consultation came to an end with the veledictory
address
delivered
by Dr.Rajammal
Dr .Raj annual
Devadas,
Chancellor,
Avinasilingam Deemed University, Coimbatore, She pointed out
that in India today, there is a growing tendency to be
indifferent and ignore traditional values and imitate the
values and life style
of the west. In the context of the
consultation she further pointedout that the traditional
system of medicine based on herbs and vegetarianism have stood
the best of time. Research study conducted in the west have
shown that diseases of the heart, eye and lungs are increasing
due to the non-vegetarian diet.
13
She critically examined the use of synthatic chemicals
such as lipstick, nail polish that are harmful to the skin.
The traditional use of turmeric and "mehindi" has been proved
to be healthy for the
She concluded the address by
skin.
calling upon the active involvement of the NGOs together to
the
popularise
of
use
low
cost
and healthy practices
of
traditional systems of medicine. This was followed by vote of
thanks by Mr. M.Mohamed Usman, Director, ROAD. While thanking
each
and
every
present he
one
the need
stressed
for NAM
continuing to be a democratic organisation to sustain the
interest of the members of NAM to work together
towards
sustainable
health
to
the
particpants
to
interest
by
of
people.
the
to
continue
appealed
He
their
sustain
internalising the importance of coming and working together
for the cause of the poor and their sustainable health. He
further
added
experiences,
Tamilnadu
and
that
NAM
failures
and
India
in
members
should
learn
from
the
suscesses of
other
networks
of
to
from
strengths
to
order
grow
strengths.
SUGGESTIONS/RECOMMENDATIONS FROM THE CONSULTATION MEET
The
Government
to
provisions
should
support
make
and
more
budgetery
recognision
for
the
efforts of indigenous health practitioners.
The Govt.
should allocate funds for research and
infrastructural facilities to promote ISM.
Community herbal plant nurseries/ Gardens using the
approach
of
joint
community
established and promoted.
management
should
14
Provisions should be made for relevant training in
medicine
indigenous
systems
to
the
target
population and personnale.
NGOs
should
medicine
in
integrate
their
traditional
formal,
systems
non-formal
of
education,
health and development programmes.
Use of the media to create awareness and publicity
of the traditional health practices might ensure a
larger audience coverage and the realisation of the
importance of ISM.
The
traditional health care
practices
should be
incorporated adequately in the primary health care
progammes.
The exchange of ideas and experiences should not be
confined to the net work memebers alone but should
be shared widely.
Field studies/ research in ISM to be conducted and
findings should be shared with others.
Steps
should
be
taken
to
bring
together
the
practitioners and the professionals of different
indigenous
health
care
systems
and
the
NGOs
involved in the health programmes to interact for
proper perspectives.
Specific areas of primary health care need to be
taken up for indepth analysis interms of indigenous
system
of
medicine
should
be
made
workers.
so
that
available
to
relevant
the
materials
health
care
15
CONCLUSION
This consultation has been a beginning made to bring
together the various practioners of ISM and NGOs involved in
the health care programmes. It was also a begining for NGOs
themselves to start seriously reviewing the impact of the new
economic policy and plan for alternatives.
In conclusion NAM - Tamilnadu was given a mandate to:
Prepare guidelines for the functioning of NAM -TN
and its development.
Preparare a these based resource mainnual for the
use of the concerned, in vernacular.
Develop a comprehensive primary Health care kit for
the
level
village
Health workers,
supported
by
exchange
of
relevant trainings and followups
Promote community murseries
for the
herbal resources and preserving bio diversity.
NAM-Tamilnadu should create common plat forms to
the
practioners
interested
in
of
ISM
health
NGOs
and
care
of
involved
people
or
through
workshops, seminars, conferences, consultations for
exchanges
of
ideas,
experiences
and
sharing
of
expertice.
A
data
base to
be
collecting
datas
relating to local specific herbal plants,
health
created
by
traditions, practices and identifying traditional
health experts for documentation and dissemination
of information and guidance for wider use.
16
We are grateful to all the sponsoring organisation
and
individuals
who
contributions
and
consultation.
Our
resource
faculties
have
provided
support
to
thanks
and
are
their
ideas
organise
this
also
due
participants
to
who
the
have
contributed their views, ideas and experiences for
the successful completion of the above effort, We
wish to acknowledge appreciate and thank whole
heartedly all those who have helped in organising
this first meaningful endeavour directly and
indirectly.
17
ANNEXURE
I
GUEST SPEAKER/RESOURCE PERSONS
1.
Dr. Kannan
Hon. Siddha Doctor to President, Government of India
2.
Dr. M. Aram, M.P.,
President, Santhi Ashram, Coimbatore
3.
Dr. R.T. Rajan
Director, SOLAI, Katpadi, N.A.A.Dt.
4.
Rev. Y. David
Social Action Movement, Trichy
5.
Dr. Brahmananda Swamigal,
Sidha Specialist
Coimbatore
6.
Dr. G.T. Gangadharan
LSPSS, Coimbatore
7.
Dr. T.N. Manjunath
Mysore
8.
Mr. C.R. Bejoy
Coimbatore
9.
Dr. Rajammal P. Devadas
Chancellor,
Avinasilingam Deemed University,
Coimbatore
10.
Prof. Ratna Natarajan
SIPA, Madras
18
ANNEXURE - II
MEMBERS OF THE ORGANISING COMMITTEE
1.
Dr. Guna
Secretary
Education for Workers Development
Pollachi Tkad’ AnSalakuruchi’
Pin : 642 007
2.
Mr. M. Mohamed Usman
Director
ROAD, "Haseena’s Nest”
No.4, 4th Street
Sowrashtra Nagar
Choolaimedu
Madras 600 094
3.
Mr. S. Balasubramanian
Director
Rural Development Organisation
Gramiya Bhawan
P.B.No.7
Aruvankadu 643 202
4.
Dr. R. Muralidharan
Secretary
WEAL Organisation
P.B.No.48
114, Palaniapp a Nagar
Pudukottai 6zz 002.
5.
Mr. G. Nammalvar
Secretary
KUDUMBAM
7 > Ezhil Nagar
Keeranur
Pudukkottai 622 502.
6.
Dr. A.S. Sankara Narayanan
Medicare Charitable Trust
2/232, Somayanoor
Thadagam (Via)
Coimbatore 641 108.
7 ,
Mr. P. Saminathan
Director
Society5(PO^TS)Sati°n Education and Training
1/103, Bazaar Street,
Paradarami 632 603
Guidyattam Tk. N.A.A.Dt.
PROGRAMME CO-ORDINATORS
1.
Mr. P. Saminathan
2.
Dr. A.S. Sankara Narayanan
19
ANNEXURE
STATEMENT OF ACCOUNT OF NAM
I.
III
TAMIL NADU SEMINAR
P.
DONATIONS AND CONTRIBUTIONS FROM:
Rs.
TNVHA, Madras
10,000.00
RIDO, Dharmapuri
5,000.00
SIPA, Madras
5,000.00
VHAI, New Delhi
5,000.00
ROAD, Madras
5,000.00
RDO, Coonur
2,950.00
LRSA, Chenglpet
2,000.00
SEED, Tirupattur
2,000.00
VRDP, Salem
2,000.00
CDAWS, Madras
2,000.00
NMCT, Coimbatore
2,000.00
POETS, Gudiyattam
2,000.00
Dr. P. Vijayakumar, Coimbatore
1,500.00
Dr. Manjunath, Mysore
500.00
TEAM, Dharmapuri
200.00
Dr. Seethalakshmi, Trichy
200.00
Mr. Y. David
100.00
2,780.00
Registration Fee
Total
50,230.00
20
EXPENSES
Rs.
P.
I.
PRECONFERENCE ARRANGEMENT
5,523.00
II.
VENUE ARRANGEMENTS
2,255.00
III.
PROGRAMME MATERIALS :
Printouts, Certificates
Files, Pads, Pens,
Bedges etc.
12,313.00
IV.
HONORORIUM AND MOMENTOS
3,716.50
V.
CATERING ARRANGEMENTS
11,836.00
VI.
TRAVEL AND INCIDENTAL EXPENSES
4,031.00
VII.
STATIONARIES, POSTAGE, TELEPHONE
818.00
VIII.
MISCELLANEOUS
1,221.00
IX.
FOLLOW-UP MEETING
1,225.00
TOTAL EXPENSES
42,938.50
TOTAL INCOME
50,230.00
BALANCE
7,291.50
50,230.00
Comm J
'
■
{
H - 36
ft
I I WORLD HEALTH ORGANIZATION
FIFTY-SECOND WORLD HEALTH ASSEMBLY
Agenda item 4
A52/DIV/9
18 May 1999
Health in development
Keynote address by Professor Amartya Sen,
Master of Trinity College, Cambridge,
Nobel Laureate in Economics,
to the Fifty-second World Health Assembly
Geneva, Tuesday, 18 May 1999
I feel very honoured - and of course delighted - to have the opportunity of giving this lecture at this
extraordinarily important conference. I feel triply privileged, first because the occasion is so significant
(the World Health Assembly is a gathering of people who can influence the health and longevity of billions
of people in the world), second because the agenda is so momentous (we have just heard the priorities that
have been outlined by the Director-General for “a year of change”), and third because it is so wonderful
to be here on the invitation of Dr Gro Harlem Brundtland for whom I have the greatest of admiration.
I have been asked to speak on the subject of “health in development”. I must take on the question the very difficult question - as to how health relates to development.1 At one level the question admits of
a simple answer: surely the enhancement of the health of the people must be accepted more or less
universally to be a major objective of the process of development. But this elementary recognition does
not. on its own, take us very far. We have to ask many other questions as well. How important is health
among the objectives of development? Is health best promoted through the general process of economic
growth which involves a rising real national income per capita, or is the advancement of health as a goal
to be separated out from the process of economic growth seen on its own? Do all good things go together
in the process of development, or are there choices to be made on the priorities to be chosen? How does
our concern for equity reflect itself in the field of health and health care? I shall have to go into these issues
also.
However, to motivate what is perhaps the most basic issue, let me begin with the report of a very old
conversation between a husband and a wife on the subject of earning money. It is, of course, not unusual
for couples to discuss the possibility of earning more money, but a conversation on this subject from around
the Sth century BC is of some special interest. As reported in the Sanskrit text Brihadaranyaka
Unpanishad, Maitreyee and her husband Yajnavalkya are discussing this very subject. But they proceed
1 In answering this - and related - questions, I draw on my forthcoming book. Development as Freedom, to be
published by Alfred Knopf, in September 1999. This lecture also has considerable affinity with my keynote address (entitled
“Economic progress and health”) to the 9th Annual Public Health Forum at the London School of Hygiene and Tropical
Medicine, on 22 April 1999, which too draws on my forthcoming book. Development as Freedom.
A52/DIV/9
rapidly to a bigger issue than the ways and means of becoming more 'wealthy: how far would wealth go
to help them get what they want?1 Maitreyee wonders whether it could be the case that if “the whole
earth, full of wealth” were to belong just to her, she could achieve immortality through it. “No”, responds
Yajnavalkya, “like the life of rich people will be your life. But there is no hope of immortality by wealth”.
Maitreyee remarks, “What should I do with that by which I do not become immortal?”
Maitreyee’s rhetorical question has been cited again and again in Indian religious philosophy to
illustrate both the nature of the human predicament and the limitations of the material world. I have too
much scepticism of other worldly matters to be led there by Maitreyee’s worldly frustration, but there is
another aspect of this exchange that is of rather immediate interest to economics and to understanding the
nature of development. This concerns the relation between incomes and achievements, between
commodities and capabilities, between our eeonomic wealth and our ability to live as we would like. While
there is a connection between opulence, on the one hand, and our health, longevity and other achievements,
on the other, the linkage may or may not be very strong and may well be extremely contingent on other
circumstances. The issue is not the ability to live forever on which Maitreyee - bless her soul - happened
to concentrate, but the capability to live really long (without being cut off in one’s prime) and to have a
good life while alive (rather than a life of misery and unfreedom) - things that would be strongly valued
and desired by nearly all of us. The gap between the two perspectives (that is, between an exclusive
concentration on economic wealth, and a broader focus on the lives we can lead) is a major issue in the
conceptualization of development. As Aristotle noted at the very beginning of the Nicomachean Ethics
(resonating well with the conversation between Maitreyee and Yajravalkya three thousand miles away):
“wealth is evidently not the good we are seeking; for it is merely useful and for the sake of something
else”.2
The usefulness of wealth lies in the things that it allows us to do - the substantive freedoms it helps
us to achieve, including the freedom to live long and to live well. But this relation is neither exclusive
(since there are significant other influences on our lives other than wealth), nor uniform (since the impact
of wealth on our lives varies with other influences). It is as important to recognize the crucial role of wealth
on living conditions and the quality of life, as it is to understand the qualified and contingent nature of this
relationship. An adequate conception of development must go much beyond the accumulation of wealth
and the growth of gross national product and other income-related variables. Without ignoring the
importance of economic growth, we have to look well beyond it.
The ends and means of development require examination and scrutiny for a fuller understanding of
the development process; it is simply not adequate to take as our basic objective merely the maximization
of income or wealth, which is, as Aristotle noted, “merely useful and for the sake of something else”. For
the same reason economic growth cannot be treated as an end in itself. Development (as I have tried to
argue in my forthcoming book. Development as Freedom) has to be primarily concerned with enhancing
the lives we lead and the freedoms that we enjoy. And among the most important freedoms that we can
have is the freedom from avoidable ill-health and from escapable mortality. It is as important to understand
the qualified and contingent nature of the relationship between economic prosperity and good health as it
is to recognize the crucial importance of this relationship (qualified and contingent though it may be).
1 Brihadaranyaka Upanishad, II, iv, 2-3.
2 Aristotle, The Nicomachean Ethics, Book I, section 5; in D. Ross’s translation (Oxford University Press, 1980),
p. 7.
2
A52/DIV/9
RELATIVE AND ABSOLUTE DEPRIVATION OF AFRICAN AMERICANS
Let me illustrate the conditional nature of the relationship with some empirical examples. It is quite
remarkable that the extent of deprivation for particular groups in very rich countries can be comparable to
that in the so-called “third world”. For example, in the United States of America, African Americans as
a group have no higher - indeed have a lower - chance of reaching advanced ages than do people born in
the immensely poorer economies of China or the Indian State of Kerala (or in Sri Lanka, Jamaica or Costa
Rica). Since I do not have the opportunity of showing you any overhead projection in this hall, you have
to imagine the picture yourself. I presented charts on this in my article (“Economics of Life and Death”)
in the Scientific American in 1993, which show how the African Americans as a group are overtaken in
terms of the proportion of survival by some of the poorest people in the world.1
Even though the income per capita of African Americans in the United States of America is
considerably lower than that of the American white population, they are, of course, very many times richer
in income terms than the people of China or Kerala (even after correcting for cost-of-living differences).
In this context, the comparison of survival prospects of African Americans with those of the very much
poorer Chinese, or Indians in Kerala, is of particular interest. African Americans tend to do better in terms
of survival at low age groups (especially in terms of infant mortality) vis-a-vis the Chinese or the Indians,
but the picture changes over the years.
It turns out that Chinese men and those in Kerala in India decisively outlive American black men in
terms of surviving to older age groups. Even African American women end up having a similar survival
pattern for the higher ages as the much poorer Chinese, and decidedly lower survival rates than the even
poorer Indians in Kerala. So it is not only the case that American blacks suffer from relative deprivation
in terms of income per head vis-a-vis American whites, they also are absolutely more deprived than the
low-income Indians in Kerala (for both women and men), and the Chinese (in the case of men), in terms
of living to ripe, old ages. The causal influences on these contrasts (that is, between living standards judged
by income per head and those judged by the ability to survive to higher ages) include social arrangements
and community relations such as medical coverage, public health care, elementary education, law and order,
prevalence of violence, and so on.2
’•
The contrast on which I have just commented takes the African American population as a whole, and
this is a very large group. If instead we consider African Americans in particularly deprived sections of
the community, we get a much sharper contrast. The recent work of Christopher Murray and his colleagues
shows how very different the survival rates are for the American population in different counties.3 If, for
example, we take the African American male population in, say, the District of Columbia, St. Louis City,
New York, or San Francisco, we find that they fall behind the Chinese or the Keralan at a remarkably early
age. And this despite the fact that in terms of income per head, which is the focus of attention for standard
studies of growth and development, the African Americans are much richer than the poor population with
whom they are being compared in terms of survival patterns.
1 These and other such comparisons are presented in my “The Economics of Life and Death”, Scientific American,
266 (1993), and “Demography and Welfare Economics”. Empirica, 22 (1995).
2 On this see my “Economics of Life and Death”, Scientific American, April 1993, and also the medical literature
cited there.
3 C.J.L. Murray, C.M. Michaud, M.T. McKenna and J.S. Marks, U.S. Pattern of Mortality by County and Race:
1965-1994 (Cambridge, MA: Harvard Center for Population and Development Studies, 1998).
3
A52/DIV/9
These are striking examples, but it would be right also to note that, in general, longevity tends to go
up with income per head. Indeed, this is the case even within particular counties studied by Chris Murray
and others. Is there something of a contradiction here?
There is really none. Given other factors, higher income does make an individual or a community
more able to avoid premature mortality and escapable morbidity. But other factors are not, in general, the
same. So income is a positive influence, and yet - because of the variation of other factors (including
medical facilities, public health care, educational arrangements, etc.) - there are a great many cases in which
much richer people live much shorter lives and are overtaken by poorer people in terms of survival
proportions. It would be just as silly to claim that higher income is not a contributory factor to better health
and longer survival as it would be to assert that it is the only contributory factor. Also, on the other side,
better health and survival do contribute, to some extent, to the ability to earn a higher income (given other
things), but then again, other things are not given.
GROWTH-MEDIATED HEALTH DEVELOPMENT
Perhaps the relationship between health and survival, on the one hand, and per capita income levels,
on the other, is worth discussing a bit more, since the literature on this is sometimes full of rather
misleading conclusions. The point is often made that while the rankings of longevity and per-capita income
are not congruent, nevertheless if we take the rough with the smooth, then there is plenty of evidence in
intercountry comparisons to indicate that by and large income and life expectancy move together. From
that generalization, some commentators have been tempted to take the quick step of arguing that economic
progress is the real key to enhancing health and longevity. Indeed, it has been argued that it is a mistake
to worry about the discord between income-achievements and survival chances, since - in general - the
statistical connection between them is observed to be quite close.
Is this statistical point correct, and does it sustain the general inference that is being drawn? The
point about intercountry statistical connections, seen in isolation, is indeed correct, but we need further
scrutiny of this statistical relation before it can be seen as a convincing ground for taking income to be the
basic determinant of health and longevity and for dismissing the relevance of social arrangements (going
beyond income-based opulence).
It is interesting, in this context, to refer to some statistical analyses that have recently been presented
by Sudhir Anand and Martin Ravallion.1 On the basis of intercountry comparisons, they find that life
expectancy does indeed have a significantly positive correlation with GNP per head, but that this
relationship works mainly through the impact of GNP on (1) the incomes specifically of the poor, and
(2) public expenditure particularly in health care. In fact, once these two variables are included on their
own in the statistical exercise, little extra explanation can be obtained from including GNP per head as an
additional causal influence. Indeed, with poverty and public expenditure on health as explanatory variables
on their own, the statistical connection between GNP per head and life expectancy appears to vanish
altogether.
It is important to emphasize that this does not show that life expectancy is not enhanced by the
growth of GNP per head, but it does indicate that the connection tends to work particularly through public
expenditure on health care, and through the success of poverty removal. Much depends on how the fruits
1 Sudhir Anand and Martin Ravallion. “Human Development in Poor Countries: On the Role of Private Incomes
and Public Services”, Journal ofEconomic Perspectives, 7 (1993).
4
A52/DIV/9
of economic growth are used. This also helps to explain why some economies such as South Korea and
Taiwan have been able to raise life expectancy so rapidly through economic growth, while others with
similar record in economic growth have not achieved correspondingly in the field of longevity expansion.
The achievements of the East Asian economies have come under critical scrutiny - and some fire in recent years, because of the nature and severity of what is called the “Asian economic crisis”. That crisis
is indeed serious, and also it does point to particular failures of economies that were earlier seen mistakenly - as being comprehensively successful. Nevertheless, it would be a serious error to be
dismissive about the great achievements of the East and South-East Asian economies over several decades,
which have radically transformed the lives and longevities of people in these countries. I go into the
positive and negative aspects of the East Asian experience more fully in my forthcoming book,
Development as Freedom, but will not pursue them further here.
For a variety of historical reasons, including a focus on basic education and basic health care, and
early completion of effective land reforms, widespread economic participation was easier to achieve in
many of the East and South-East economies in a way it has not been possible in, say, Brazil or India or
Pakistan, where the creation of social opportunities has been much slower and acted as a barrier for
economic development.1 The expansion of social opportunities has served as facilitator of highemployment economic development and has also created favourable circumstances for reduction of
mortality rates and for expansion of life expectancy. The contrast is sharp with some other high-growth
countries - such as Brazil - which have had almost comparable growth of GNP per head, but also have quite
a history of severe social inequality, unemployment and neglect of public health care. The longevity
achievements of these other high-growth economies have moved more slowly.
There are two interesting - and interrelated - contrasts here. The first is the disparity between
different high-growth economies, in particular between those with great success in raising the length and
quality of life (such as South Korea and Taiwan), and those without comparable success in these other
fields (such as Brazil). The second contrast is between different economies with high achievement in
raising the length and quality of life, in particular the contrast between those with great success in high
economic growth (such as South Korea and Taiwan), and those without much success in achieving high
economic growth (such as Sri Lanka, pre-reform China, the Indian State of Kerala).
I have already commented on the first contrast (between, say, South Korea and Brazil), but the
second contrast too deserves policy attention as well. In our book, Hunger and Public Action, Jean Dreze
and I have distinguished between two types of successes in the rapid reduction of mortality, which we
called respectively “growth-mediated” and “support-led” processes.2 The former process works through
fast economic growth, and its success depends on the growth process being wide-based and economically
broad (strong employment orientation has much to do with this), and also on the utilization of the enhanced
economic prosperity to expand the relevant social services, including health care, education and social
security. In contrast with the “growth-mediated” mechanism, the “support-led” process does not operate
through fast economic growth, but works through a programme of skilful social support of health care,
education, and other relevant social arrangements. This process is well exemplified by the experiences of
economies such as Sri Lanka, pre-reform China, Costa Rica, or the Indian State of Kerala, which have had
1 On this issue see my joint book with Jean Dreze, India: Economic Development and Social Opportunity
(New Delhi, New York: Oxford University Press, 1995).
2 Jean Dreze and Amartya Sen, Hunger and Public Action (Oxford: Clarendon Press, 1989); see particularly
Chapter 10.
5
A52/DIV/9
very rapid reductions in mortality rates and enhancement of living conditions, without much economic
growth.
PUBLIC PROVISIONING, LOW INCOMES AND RELATIVE COSTS
The “support-led” process does not wait for dramatic increases in per-capita levels of real income,
and it works through priority being given to providing social services (particularly health care and basic
education) that reduce mortality and enhance the quality of life. In a comparison on which I have
commented elsewhere, we may, for illustrative purposes, look at the gross national product (GNP) per head
and life expectancy at birth of six countries (China, Sri Lanka, Namibia, Brazil, South Africa and Gabon)
and one sizeable State (Kerala), with 30 million people, within a country (India). Despite their very low
levels of income, the people of Kerala, or China, or Sri Lanka enjoy enormously higher levels of life
expectancy than do the much richer populations of Brazil, South Africa and Namibia, not to mention
Gabon. Even the direction of the inequality points oppositely when we compare Kerala, China and
Sri Lanka, on one side, with Brazil, South Africa, Namibia and Gabon, on the other. Since life expectancy
variations relate to a variety of social opportunities that are central to development (including
epidemiological policies, health care, educational facilities, and so on), an income-centred view is in serious
need of supplementation, in order to have a fuller understanding of the process of development.1 These
contrasts are of considerable policy relevance, and bring out the importance of the “support-led” process.2
People in poor countries are, of course, persistently disadvantaged by many handicaps; the picture
is one of diverse adversities. And yet, when it comes to health and survival, perhaps nothing is as
immediately important in many poor countries in the world today as the lack of medical services and
provisions of health care. The nature and reach of pervasive deprivation of biomedical services is brought
out most vividly by Paul Farmer’s recent study. Infections and Inequalities: The Modern Plagues} The
failures apply to perfectly treatable diseases (such as cholera, malaria, etc.) to more challenging ailments
(such as AIDS and drug-resistant TB). But in each case, a major difference can be brought about by a
public determination to do something about these deprivations.
THE ECONOMICS AND POLITICS OF HEALTH CARE
Surprise may well be expressed about the possibility of financing “support-led” processes in poor
countries, since resources are surely needed to expand public services, including health care and education.
The need for resources cannot be denied in any realistic accounting, but it is also a question of balancing
the costs involved against the benefits that can be anticipated in human terms. Financial prudence is not
the real enemy here. Indeed, what really should be threatened by financial conservatism is the use of public
resources for purposes where the social benefits are very far from clear, such as the massive expenses that
now go into the military in one poor country after another (often many times larger than the public
1 On this see my “From Income Inequality to Income Inequality”, Distinguished Guest Lecture to the Southern
Economic Association, published in Southern Economic Journal, 64 (October 1997), and “Mortality as an Indicator of
Economic Success and Failure”, first Innocenti Lecture to the UNICEF (Florence: UNICEF, 1995), also published in
Economic Journal, 108 (January 1998).
2 See also Richard A. Easteriin, “How Beneficient is the Market? A Look at the Modem History of Mortality”
mimeographed. University of Southern California, 1997.
3 Paul Farmer, Infections and Inequalities: The Modern Plagues (Berkeley, CA: University of California Press,
1998).
6
A52/DIV/9
expenditure on basic education or health care). It is an indication of the topsy-turvy world in which we live
that the doctor, the schoolteacher or the nurse feels more threatened by financial conservatism than does
the General and the Air Marshall. The rectification of this anomaly calls not for the chastising of financial
prudence, but for a fuller accounting of the costs and benefits of the rival claims.
This important issue also relates to two central aspects of social living, in particular the recognition
of the role of participatory politics, and the need to examine economic arguments with open-minded
scrutiny. If the allocation of resources is systematically biased in the direction of arms and armaments,
rather than in the direction of health and education, the remedy of that has to lie ultimately in informed
public debate on these issues, and ultimately on the role of the public in seeking a better deal for the basic
requirements of good living, rather than efficient killing. Nothing perhaps is as important for resource
allocation in health care as the development of informed public discussion, and the availability of
democratic means, for incorporating the lessons of a fuller understanding of the choices that people in every
country face.
The second issue is that of economic scrutiny. It is, in particular, important to see the false
economics involved in an argument that is often presented against early concentration on health care. Lack
of resources is frequently articulated as an argument for postponing socially important investments until
a country is already richer. Where (as the famous rhetorical question goes) are the poor countries going
to find the means for “supporting” these services? This is indeed a good question, but it also has a good
answer, which lies very considerably in the economics of relative costs. The viability of this “support-led”
process is dependent on the fact that the relevant social services (such as health care and basic education)
are very labour intensive, and thus are relatively inexpensive in poor - and low-wage - economies. A poor
economy may have less money to spend on health care and education, but it also needs less money to spend
to provide the same services, which would cost much more in the richer countries. Relative prices and
costs are important parameters in determining what a country can afford. Given an appropriate social
commitment, the need to take note of the variability of relative costs is particularly important for social
services in health and education.1
A CONCLUDING REMARK
So what conclusions do we draw from these elementary analyses? How does health relate to
development? The first point to note is that the enhancement of health is a constitutive part of
development. Those who ask the question whether better health is a good “instrument” for development
may be overlooking the most basic diagnostic point that good health is an integral part of good
development; the case for health care does not have to be established instrumentally by trying to show that
good health may also help to contribute to the increase in economic growth.
Second, given other things, good health and economic prosperity tend to support each other. Healthy
people can more easily earn an income, and people with a higher income can more easily seek medical care,
have better nutrition, and have the freedom to lead healthier lives.
Third, “other things” are not given, and the enhancement of good health can be helped by a variety
of actions, including public policies (such as the provision of epidemiological services and medical care).
While there seems to be a good general connection between economic progress and health achievement,
the connection is weakened by several policy factors. Much depends on how the extra income generated
1 This issue is discussed in Dreze and Sen, Hunger and Public Action (1989).
7
2^r
A52/DH</9
by economic growth is used, in particular whether it is used to expand public services adequately and to
reduce the burden of poverty. Growth-mediated enhancement of health achievement goes well beyond
mere expansion of the rate of economic growth.
Fourth, even when an economy is poor, major health improvements can be achieved through using
the available resources in a socially productive way. It is extremely important, in this context, to pay
attention to the economic considerations involving the relative costs of medical treatment and the delivery
of health care. Since health care is a very labour-intensive process, low-wage economies have a relative
advantage in putting more - not less - focus on health care.
Finally, the issue of social allocation of economic resources cannot be separated from the role of
participatory politics and the reach of informed public discussion. Financial conservatism should be the
nightmare of the militarist, not of the doctor, or the schoolteacher, or the hospital nurse. If it is the doctor
or the schoolteacher or the nurse who feels more threatened by resource considerations than the military
leaders, then the blame must at least partly lie on us, the public, for letting the militarist get away with these
odd priorities.
Ultimately, there is nothing as important as informed public discussion and the participation of the
people in pressing for changes that can protect our lives and liberties. The public has to see itself not
merely as a patient, but also as an agent of change. The penalty of inaction and apathy can be illness and
death.
8
ORGANIZING PEOPLE FOR HEALTH
1^1 I I 1'1 I l" IT l 'ATT I J J’TT'T
J < I »
-Problems and Contradictions.
Dr. •Anan.t R. S.
In this brief note, I would .like to share a few
arguments and opinions on this unresolved . issue, They are
based on the experience of v.ork in a henlth-educationconscientization project in a fevz rather remote, backward
villages hear .Pune; and on- the debates, discussions in the
Medico-Friend-Circle.
Elaboration' can be done , during the
course of discussion in the Seminar.
General Perspective on Health-work
•Most of the major determinants of the health status
cf a population-food, water, sanitation, shelter, \7ork-. environment, cultural relations
are far beyond the
control of health workers.
But Medicos can, with the help
of the ’community, organ ice preventive and therapeutic
( symptomatic or curative ) services, can do health-edueation
and advise the planners on health-implications of di_*ferent
socio-economic interventions.
The’se medical interventions
•are very valuable to prevent certain deaths and diseases, to
relieve human suffering. But they have only a marginal role
,
in improving the overall health-status of the population®
For example, infant and child mortality can be reduced with
immunizations and ORT...etc® but no health-programme has
abolished mainourishment in children of a nation.
...The department of health aiming to improve the health
of the people through-so many national disease control programmes,
and now through the programme of ’Health for all by 2000 AOD.’
is therefore a utopian, misleading idea. As a part of a
thoroughgoing socio-economic change, medical interventions
can be a very.good supplementary tool to improve the overall
ex- e C-C-.Q-S *•
iS^
V-
aG-•
<A
Q
>2.
But the idea that “Health for
health-status of the people.
all by 2000 A.D.” would be delivered by the health-ministry/
health projects by the 1’GOs,though'very attractive, is a
misleading one. All that health-people can hope to achieve
is
“ Health-care for all by 2000 A.D.”
This is not sterile semantics. There is a strong
reason and a context for making this distinction. There is
a wide-spread technocratic, and managerial illusion that
improvement in Health of a nation, which is in reality,
primarily a function of socio-economic development, can be
achieved with technological, managerial interventions. Lay
people are made to believe that the beneficient State through
its Health-Programmes, or the Health-Projects run by the NGOs,.
would improve the health of the people with the help of modern
science and technology.
These slogans are being promoted in
the context of the continuing crisis in the economy leading
to increase in poverty, unemployment, inflation, drought and
ecological disaster. Other basic element required by for
the success of " Health for All ii" - improvement in socio
economic situation of the people—is in practice, missing
due to this economic crisis, What remains is the misleading
idea of
’•
Health for all
”
to be achieved by the efforts
of the health-workers.
Those who undertake health-work primarily with an
intention of not ’giving a few pills’ but of doing some
’ basic-work’ can, in fact, make very valuable, basic work.
Many improvements- and' some thoroughgoing changes are needed,
many new ideas,' practices have to be founded and developed,
many vested interests to be fought in -the field of organizing
medical care and health-education. This is not a purely
technocratic work. There are many sociological, ideological,
technical, practical issues to be resolved. Health-work, done
se
with the aim of taking up one of the/many challenging issues,
can be very valuable, basic work, a historical need today.
.3
But in the existing socio-economic frame-work and its crisis,
let there be no illusion of really improving the overall health
of the people through health-work.
Hea1th-work alone ?
Anybody, who has any idea of the situation at the grass
i
root level, would agree, that in the rural-areas, it is not
possible to build an organization of the common people around
health-issues.
The problem of poverty and of paucity of basic
amenities is so overwhelming that rural poor are.not in a
position to rally round exclusively for health.
Those,
whose basic needs are met, can perhaps form an organization on
issues like occupational health. Recently, in Pune, a Citizens’
group has been formed to discuss an ? work even on tne. issue Ox
mental health. In rural areas, and in the unorganized sections
in the cities, however, things are quite different. But at the
same time, unless poor people become aware of health-issues an;
actively seek, influence medical services, these services w^uld
continue to be cut off from the people, and would continue to
serve the interests primarily of those who make them available,
rather than the interests of those who need these services.
In
other words, ” health-care for all ” can not be realized in its
true spirit unless it is “Health by All"—unless the people
themselves actively participate in the decision making and
implementation. Even if it is not possible to build an org-nization of rural poor exclusively on health, health should *-.e
one of the activities of/group trying to organize the rural
poor for justice and for developmento
It is with this perspective, that a health-education-cum
conscientizetion work is being done for .a st seven yesrs in a
rather remote, backward area near Pune. Neither the Village
Community Development Association, on whose behest this wor^
o
!•
.4.
is being done nor the local organizations are health-orga
nizations as such.
Health-work is considered a part of a
broader work of education, conscientization, organization
on a range of socio-economic issues.
Health is considered
neither the main issue nor a mere entry point.
Even with
a limited aim, and with the support of the broader social
work done by the local organization, the process of increasing
the hea1th-awareness amongst this marginalized population
and of fostering collective self-help has been very gradual
one and beset with many problems.
Achievements, problems,
contradictions
Our health-v/ork consists of training of Village
Health Workers ( chosen by the- marginalized people them
selves.)
in the diagnosis .and treatment of routine viral
fevers, malaria, diarrhoea, conjunctivitis,
scabies, wounds,
skin infections ...etc.; and distribution of iron and vitamin-
A supplements to children and pregnant vzomen. These elementary
curative services are used to :
(i) establish the credibility
of the Village Health Workers;
(ii)
.with the people,
the people.
(iii)
as an occasion to interact
an attempt to meet the felt-need of
Rural* poor are not much interested in general
health-education; . given the arduous life they live.
But a
rural poor is more inclined to listen to why*s and how1 s of
diarrhoea-control-, when he/she is suffering from diarrhoea
and effective treatment is given by the same person who gives
health-education about diarrhoea.
Hence the strategy of
coupling health-education and therapeutics.
The result of this strategy is a mixed one.^
Let me give
some examples of positive experiences and then of some problems
and difficulties :
.5
Our V.H.W.s-
have a much greater support from the
community than what the Government’s VHW has. They are
trained much better because both the trainee and the trainer
are really interested in this work and its philosophy.
These VHWs soend a lot of time for this work; attend frequent
meetings, participate in other programmes of the organization,
travel to and camp at other villages.
All this is .possible
because of a sunport from the community- The honoraritm of
a mere Rs.50/- p.m. does not explain the interest, efforts
of these VHV,:s.
( Many of the VdWs . even do not get any
monthly honorarium). The quack practice of some traditional
therapists and that of the compounder-tumed-doctor, has
been considerably curtailed.
Some dent has been male in
the ’ injection-c11 Ip,:re.1 People have collectively appro-ached the health-authorities to complain about some specific
grievances about delivery of health services.
(for example,
a Morcha about a case of injection-palsy; representations
about below par functioning of health-services at the grass‘ root level. .-etc.)
Slide-shows organized by VHWs on prevalent
diseases like scabies, diarrhoea are quickly being sought
after. More than one hundred women from different villages
had walked for a fevz kilometres and had waited patiently
for hours to See a slide—$how on women* s reproductive- health.
This indicates the interest of rural women in knowing about
their own body and health-. Discussions in meetings and
Shibirs about nutritional requirements of labourers, and
of women; about the relation bet ween water-supply and health
has had an impact. In.the consciousness of a section of the
people in the organization,this new health-knowledge has given,
an additional justification for the demand of higher minimum
• wages, of leave from hard work durin g pregnancy, for impro
vement in water-supply.
These developments are i’n a way collective attempts
towards control over health-care activities* are rudimentary
forms of organized efforts around health-issues. However,
alonqwith such achievements, there are some knotty-problems
.6.
which show that. it.is still a long way to go before the
awareness of the hea1th-problems increases to such an extent
i?5b.
that people start influencing the health-services and policies
in accordance with their own needs.
i) There is a tremendous gap between the consciousness
of health-workers and that of the people. People are prima-rily interested in medicines; rather than knowledge. There
is a strong tendency of going to the commercial quack for an
injection, pay him five or ten rupees. But when it comes to
paying ten paise for the tablet taken from the VHW, there is
a tendency of not paying for this self-help, even though over
a period of time, people have realized, that these tablets are
as effective as these injections. .There is less Of a tendency
to see that this process of self-help becomes self-reliant,
the dominant tendency is either to seek free treatment■from
a beneficieht authority or to seek a commercial treatment.
It is not easy to go beyond the stereotype responses conditioned
by the dominant-culture.
ii) Many people as yet see the work done by VHWs, notkind of social work/dOnrepresentatives of the people,
as a
M any feel that these VHWs work 'because they do not need to
work at home'
or ' because they must' be getting something
from the agency.'
This is in spite of the fact that .these
VHWs were chosen by the people in a.meeting; their help and
advice is sought; a call for a meeting, Shibir or even for a
Horcha is positively responded to.
But still the idea of . a
movement has not taken real roots.
iii) The Government health structure his cooperated by
providing medicines, sending their health-personnel at request
etc. In one remote area, a few of our illiterate VHWs were
incorporated as Government's 11 Village Health Guides " (because
the PHC doctor was very much impressed by their knowledge),
even though the minimum educational qualification required
for this post is Sth standard,
(This mutual cooperation
helps the health-authorities to fulfil their targets far
But the Government-authorities (all male.)
remote are as.)
dislike the questioning attitude, ” rud.e manners
Oi our
women-VHWs.
When,
When our VHWs
VHWS asked a PHC-doctor/ in a meeting,
about the budget of the PHC,
different heads,
and the expenditures under
he got infuriated.
Relations were also
strained because a Morcha was organized to demand justice
in case of an injection-palsy in a boy after an injection
in his arm.
Any attempt to take
’ democracy seriously/
to know and to question some of the practices in the PHC
1beneficient authority1
obliges by
are frowned upon.
The
cooperating as long as its hegemony is not threatened.
" People’s participation “
is a nice slogan, but when it
fashion.
is taken seriously in-a critical fashion,
despised.
such attempts are
This in turn dampens the already low initiative
of the prople for asserting their own rights.
Such are the problems and contradictions in the
Both from
process of
1 organizing people for heaIth-c -.re.1
a -theoretical as well as practical view point/ there is no
doubt, that without the collective participation/ control
by the people in fulfilling their health-care needs/
needs, the
health-delivery system will not really serve the people.
But the process is a very complex. slow and difficult one.
It is easier to talk about nice things, but very difficult
to achieve them,
A lot of practical and analytical work has
to .be done before we can confidently.talk about a strategy
"health-care by the.people "
or under the control of
of
the people.
oo o
o o o
III
t
Ho-^'e
Go 03 H -
>r
world faiths devtj.gfwf.vt l-f.-w ^guf
vv'iVIcl,/7'F"£iII■ ocT coTii
cl/
iit^D^/Zvvvv^v
cr*^ ulx
--------- NO. 15 Jiiiv 2004
j j::^ r'jj^re of
_New !Jelhi VV nr.kshop
zir Their meemp in jime the frn^tees or
WFDD
move the WFDD office
la Wa^kiiigiori USA after :ry lehrmo::: as
Director on 31 ' Juty. ivieanwhile WFDD s
e-mail address remains the same as does
.. .. _ - see. 3::r
be informedaboiu a
new uvstui address, leieyhune and iax
numbers as soon as these have been
arranged.
i he workshop was held as planned, on 910 Fcbniaiy under the joini ausme
Vikrsxn Sarabhai Fouudado...... id WFDD.
Eleven case studies from 4 faith traditions
(Buddhist Chnstian Hindu and Muslim)
were presented and discussed. In addition
tv the case siudv wmcis. lepie'seniaiivcs of
the UK government’s Department for
Imenietienal Dev elopment end of the
Vvv!Id Bank wcjv invited. Twenty-Ivtu
people participated including two Trustees
and 3 members of slaff Etienne Zikm
liom Cariieiuoii was preveiiteu from
attending at the last minute due to security
procednses
My
...... -
ov v?
personal
e-mail
is:
...................... .......................... - -
it)
in tuliCn.
•’‘’■d
Trie. Irfsf
Oeerr
wrtrh/trt
• \ hare not
Ihsrf
trtK,ir
vr>//1L if r r f t S
thtt
iriCy
hnva amo heen hin nt interest: opportunity
enriching experientms rmd m/jny new
i • ie> m.‘j/ r.r.
;
camr.cccd ffi me
inmorTance and fruiffijiness of jocv.sing
inieifaith dialogue and ca-operanGn
round key imman issuos like poverfs
reduction and deveiopmenr. / am grateful
s p affix m for your interest in the
............. . .... .s
to
and far cs::r
vracncalsuunon .
•
fi f • ✓ y« r 1 . r
i
i
■
T»1
»* •
■
-.......................................................................................................
/ » M I > 1 I • / . < !.-1 /
—................................................................................................
•
- ••
5 t ' f « i
.
/ » I 4
f \
»*\ / I
.....................................................
leavsn^ wrUD on ? i July. She has made
an immense contribution in all sorts of
-.............. . .
___2g ...
...
....... ..:..
JieiCOvur k
in
AtriCu
iu
Or guniSitig
intemationa! seminars and workshops. 1
and C' 1'DD co-; c i'rr :t big debt oj
X'; i-'f
li'
'’fife.
f~:-'yi1
‘) \i:,.‘!i'l f'!(/.• QQ'ii'l U
t'~> \ f~fij !'?/.<
Michael ray'nr
.
ihe following paragraphs are exrracts
from ihc Director’s final report to the
Trustees m June.
#
JJ,
The workshop turned out to be an
extremely
intere sting
occasi on
characicriscd by a high level of listCiiing
and ieamino dnd a common vision of a
holistic approach to development taking
full account of its spiritual dimensions.
x Wendy i yndnie wroie up two reports one
of them thematic which have been
circulated to participants and trustees and
posted on WFDDs website.
Wendy
Tyndale is also pursuing the possibility of
incorporating the insights gained into a
book oi iiei own.
Project; Faith hi
Economic System.
iiiv
KTiObiii
V
Vmeeta Shsnker is now well into her
second year of work on this project, fully
fuiided by the Allan and ?4esta Ferguson
Trust. T owards the end ot the first year
she pieseiFed
weh-received pap*r ro >»
oeiTunar jorndv SpOi5 5i>rtd bv the Centre
for the ’Study of tiiobai Ethics in the
Hhiverxity of Birmingham TT< ^nd
vvTUD.
it SCt Gtii SOiiiv Gi iiCi tiildiiigb.
after a senes of visits and inren-iervs m
Africa and Asia, about how different faith
uaditiGus relate both positively and
ne<?ativeiv to rhe economy
‘ lc
1
•
Her visit to the UK also provided staff
(with the help of colbeagritw in the Global
Ethics Ccmrc) with aii oppurtumiy to
review rhe protect and plan the second
years wor k. It was agreed to narrow its
scope to two faith traditions: Islam and
Buddhism and to iimir me number of
countries to be visited in order to make
realistic use of limited resources and
deepen refieciion on die issues.
Development Gateway
WFDD received a gram of SUS3O,5OO
iwm die Dcvcivpuiciii Gatcvvay iv build
on the fieldwork earned out last year in
Ghana, Uganda, Tanzania and Malawi.
Ihe iieluwoikei speiit live weeks iii
Tanzania gathering information about the
achyilies of faiih commumlw^ m poverty
rcduviivli aud uCvvlvp»HiCiii ill the hvpv vi
providing Ail)A (Accessible information
on Dcvr-lopmem Activities) with a
complete set of mibimation to be added to
its database.
I he Dcvclopmcni Gateway is a website
incorporating vast amounts of inf ormation
on development programmes and issues
and * ViDA is one pan of it.
The WFDD exercise, seen as
coniribuiion io efforts io 'scale-up' the
piogiauimcs ui iaiih uoiuiuumiics. has
thrown up a number of questions (es about
the size of programmes, me ddslmclion
between faith vOuiiiHuiiueS auu faith-based
K the benefits of the database to taith
eftiHiW'it »e<) whirl* were raised with
AiDA's Siccnilg Group, of which the
•director is a member, in Bonn on 29 June.
Seminar
Leaders
African
for
Vsifh
It became clear from the workshops in
Ghana and Tanzania (200^) that many,
liiOUgii
iiOt
«u.
iHiiii
iCaxiCiS
iOviiKt
ii
difficult to engage m. discussions greatly
affecting their people, on issues relating to
poverty reduction strategics, because of
Their uniamiiianTv' with The workings of
rhe macro-economic order. As a result rhe
Director asked the Rockefeller Foundation
if ii would agree, as it did. to WFDD using
the remainder of its grant for the
workshops to fund a seminar for /‘drican
faith icadeis auiied at uiuicasmg
knowledge and understanding (rather than
polemics) of the global economy and us
impiivdiiviis iui
povciiv i eduction and
human development.
Ihe seminar had been aiiauged (with a
great deal ot help from the Ad! Africa
Coiincii of Cl!!!! 'lies) foi September 2004
ui Nairobi for about 50 leaders. Due io
changes in WPDD’s personnel, however,
and the derision to move to Washington
the sciiiiiiai has been postponed until a
later dare
Pi! rii?i meiif
of
ine
Wo rid
Religions
The Director was invited to a preparatory
meeting, arranged by the Council for a
PariiamenT of the World s Religions in
Kcricho in Kenya in March, to explore
among other things the issue of
iniemationai debt. He also accepted an
invitation to a pre-Parliament Assembly in
Montserrat 1-7 July and to the Parliament
meeting m Baicciuna 7-13 July wiiexc
WFDD arranged a dialogue session
between an mtemaiional, mierfaith group
ui vuu’ig people (with iucu expenses paid
bv SHU MEI: a Japanese Shinto spiritual
oigamsaikm) and fuiili leaders such as
Suiak
Sivaraksa
on
Rrs/urrs
o/
Development.
- Vx rai vf uiC yvuug pCOpk CouiC uOmthc
commiinities represented at the New rjeihi
vvorkshop They sat in a circle with Snlak
and surrounded bv several other eiroles of
2
interested listeners who later joined in the
convc-rq^non Snlak litTened csrefblly and
then responded to w hat they had to say
about meir commitments and hopes for the
hitnre. Tie said they had made him feel
young again.
The Director had a major commitment to
the workshops on international dob: ar
both
ivloniserrai
and
Barcelona.
Monserrat. just over an hour’s drive from
Barcelona, is an acti'.e Benedictine
monasiciv pciched on a mail ivekv uiaa
and was itself an inspiration. At tlie
Parliament he also shared in a panel
uiscussioii With Kathei iiic ivlai SiiHii of the
World Bank and Sulak Sivaraksa which
attracted about 2 GO people. Hie panel
aUcmpltd to drriv» them into the *vrk of
WFD1) as it encourages dialogue and coor^rahon on r^verty r^din tion and b.HnWJ
development betv» vCii taith eommumOcs at
the intematinr.al. national and local levels
and between those
and
hiicrnatiGnal insduiuous like the World
Bank 1 he official theme of rhe session
was Faith or EcGrtamicd but wc preferred
to call it
ana Eoanatraed and
explored the relationships between the
two
\ a rinns
aj WFDErs contribution to the World
Development
Ko.port
?0<M
was
ovcritually published, along with others,
on a CD-rom with apologies that they
had not been acknowledged in the Report
itself.
b) The Seminar Series on ’Alternatives’ to
global capitalism, run jointly with, the
Centre for the Study of Global Ethics in
the University of Birmingham UK. to
which Vineeta Shanker made a
couinbuiiuu. was completed uu 7 June.
c) The website has been kept up-to-date
by vveiidy Tyndaie with the help of
Sarah Bovs.
Aendv Tyndale wvrkvu um; ^sqmvaitni
of one day a week, mainly in the early
iThontbs of the year and on rhe Yew Delhi
workshop.
With the Director she
attended a meeting in January at the UK
Treasury in London hosted by lord
Carey and addressed by Gordon Brown
and lim wohensohn among others, in
June she represented V*TDD at the
inaugural meeting of the Parliament of
C ui tures
in
Ankara.
i urkev.
JuEi published
■
■
Mind Hear! and Son! in the Fight against Poverty
Edited bv Kmiiciuic
World Bank 2004
anu Luuv Kcvah
Stones from around the world ot faith communities working together
with iieiv n>ntnef< tr? fight poverty atid unpfove the 1ive< of
CviBiliUiinlvS.
3
- Media
RF_COM_H_36_SUDHA.pdf
Position: 1185 (7 views)