THE CHC EXPERIMENT 1984-1989 A REPORT
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THE CHC EXPERIMENT
1984-1989
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THE CHC EXPERIMENT
1984-1989
A REPORT
l
I
A.
Community Health Cell-An Overview
I Thelma Narayan (TN)
B
Net Working
C.
Formal and Informal Training
I Mani Kai Hath (MK)
I
1
D
Rational Therapeutics and Drug Policy
Issues.
Prasad Tekur
I Shirdi
(SPT)
I
E.
Study Group-Integration of Traditional
Systems of Health Care.
F*
Management and Team Building Process
I K.Gopinathan
G.
A SvVOT Analysis
I Ravi Narayan (RN)
H.
Looking To The Future
I CHC Team
A preliminary document for
reflection with the wise
council# associates and senior
peers.
8TH JUNE 1990
a
y*}
A.
I
F
1.
COMMUNITY HEALTH CELL-AN OVERVIEW
(T N)
The Beginnings;
The Community Health Cell was initiated as a study-reflection
action experiment in Bangalore in January 1984. It was
established as an informal resource cell supportive of ongoing
and evolving community health actions. This was identified as
an unmet need by 2 members of the initial team who had spent an
earlier year (1982) travelling in many parts of India, reflecting
with health and development groups. The CHC started with a
small team of four, of whom, three had moved beyond a Department of
Community Medicine of a Medical College.
2.
Objectives;
The Main objectives of the Cell were:
i
i. To support NGO community health action,
ii. To provide a sound information base for voluntary health effort,
iii. To encourage groups:
-To recognize the broader dimensions of health,
-To see health as a process of awareness building
and organization among people,
-To a greater sharing among field workers and
activists to build an understanding of process,
-To see health efforts as part of a broad based
movement free of labels.
iv. To create closer links between groups so that these efforts
become part of a health awareness building process leading to a
•people’s health movement*.
For objectives (i) - (iv), the cell planned to relate particularly
to groups in Karnataka, focussing specially on the needs of the
underprivileged.
i
These objectives provided the broad approach of the cell and
represented the understanding we had 'at that time. However we were
open-ended in our approach and attempted to be responsive to emerging
needs, learning also from this process. Hence the range and scop
our activities kept evolving and changing over the years.
"
//
r
v. Very early in the experiment the cell also accepted, for two
years, the organizational and bulletin responsibilities of the
Medico Friend Circle. This is a national network of doctors and
health activists interested in making health services and medical
education more relevant to the needs of the large majority of the
population in India, who are poor and under privileged. This
additional objective took up considerable time and evergy of the
group.
3.
Methodology of Functioning;
$
i) An important component of the experiment was an attempt to
develop an internal team process which would be more participatory,
democratic and non-hierarchical. We had to continually work
towards this as it challenged styles of functioning within each
one of us which had developed in more structured situations.
ii) We also consciously attempted to play a facilitatory, catalyst
role with the Individuals/qroups who approached us, trying to
build solutions together through an exploratory process of dialogue,
interaction and reflection. This demanded flexibility in out plans,
work timings as well as in the issues we got involved in.
iii) However we did have to be selective^ especially regarding
issues which required more detailed or indepth involvement, For
this we had regular internal team reflections to decide en
priorities and directions.
iv) This experimental approach was made possible by establishing
an integral link with a social action trust in Bangalore, which
allowed us a creative autonomy and with whom we had negotiated a
participatory form of governance. These senior peers also supported
the cell as a sounding board and wise-council.
v) For the first 33 months the cell functioned from an informal
base located in a private residence.
i
vi) During the first 30 months of our involvement we were able to
deepen our understanding of the dynamics of community health
action in India and also get an overall perspective of the situation
in Karnataka. We also identified the following needs which could be
thrust areas for the future;
s
-Documentation,
-Communication and continuing education,
-Networking,
-Action research and
-More active linkages with Government.
vii) The Staff Training Phase (1986-87)
To equip ourselves further with certain skills members of the group
spent a year undergoing further training. These were in the areas
of low cost communication, personnel management and epidemiology.
One of the members spent it as a sabbatical year exploring linkages
between Agriculture, Health and Nutrition.
Considerable time was also spent writing up our experiences in the
form of a report ’’Community Heal th-the search for a process”. This
was later circulated to many of our associates and friends inviting
their reactions and comments.
viiL). (1988-89) - The later Phase.
On regrouping at the end of 1987, the cell functioned from rented
accomodation, centrally located in Bangalore. Here we had basic
facilities for the office, library and also place for meetings and
discussions. The growing team now included full timers and part timers.
i
In 1988 we concentrated on:
-Building up oui? documentation cell and getting it more organized for
easy accessibility,
-Networking with persons involved with community health action,
involving them in various initiatives or responses of the cell,
-Exploring areas of research with NGO’s, mainly in a supportive role,
-Preliminary exploration of management issues with some NGO’s.
We also continued interaction with NGO’s in community health.
In 1989,
4.
e cell initiated greater focus on the
following areas:
-Medical Pluralism,
-Health policy issues, and
-Social relevance in Medical Education.
The web of interaction;
Over the years the cell had the
wide variety of individuals and
opportunity to interact with a
groups. Broadly these includes-
i) Individuals in search of
greater social relevance in health work,
ii) Networking/issue raising groups like
medico friend circle (mfc),
All India Drug Action Network (AIDAN),
Drug Action Forum-Karnataka
(DAF-k).
a9enCleS
sector'
- m in
the“
NGO,,G0
sector,
of India (CHAI)
Voluntary Health Association
ommunity Health Action Network (ACHAN).
KaLHtaiah TJe:tS in rural S”as' tribal
arnataka and a few in other states as well.
-tan
slums in
^Development projects, networks and training centres, viz , SEARCH
xndian Social institute (isi) Bangalore and
of RCH'
and TriZl IctirTt"5
RUrS1 DeVelopment Karnataka (fevord-k)
ana iribal Action Network Karnataka.
vi) Womens Groups, particularly in Bangalore
and peoples science
groups (kssp and krvp).
V11) Interactions with the Government of Karnataka, through the
ultTtbr1''15 C""nlttee °n RUral
"Xi Xo ZhPer
P1’” CO™ittee-
through diseusslons
“a central Goveriwienfc
level also the chc participated
particinat-<=>ri in mee+H n„
meeting on primary health care
system development for the Southern Region and
another interacted
with various advisers to the
Planning Commission.
viii) Interaction with a few
funding agencies, e.g 9 Misereor,
Cebemo, OXFAM and Action Aid, sharing perspectives
on Community
Health in India.
As a response to the very wide range of requests/ these interactions
took shape through informal individual/group discussions/ field
visits/ workshops/ editing and publishing of a monthly bulletin/
lobbying/ planning of communication and learning material/ formal
and informal training sessions/ reviews/ evaluations/ planning and
policy meetings.
5• Range of issues explored in Community-Health:
i) One of the main areas was developing oan understanding and a
perspective of community health based on the rich experience of
groups responding to health needs in different situations in
various parts of India.
A critical analysis of the prevailing health care delivery system
was developed by interactions with numerous individuals/groups
especially with the medico friend circle and also through
publications on the subject.
Some related areas were:
-Interactions between community health and community development/
-Approaches to starting community health programmes/
-Evaluations of community health programmes/
-An overview of the community health effort by the NGO/Voluntary
sector in India-their projects/ training programmes/ resource
research centres.
ii) Other more specific aspects of community health that we were
involved with included:
Tuberculosis control/ Leprosy control including rehabilitation/
school health/ Mother and Child health/ Natural Family Planning
and population issues and study of the National Health Policy and
Government Health Services.
iii) Rational Drug Policy issues and Rational Therapeutics was an
area to which we gave much time.
We participated with others in
discussions identifying the role of hospitals and technology in
community oriented health care in conditions prevailing in India.
iv) An area of special interest has always been the training of
health personnel. The cell conducts a training course in Community
Health and Development during the formation period of the Franscican
Brothers of Jyothi Sadan.
We facilitated a workshop of graduates
from a Medical College who were on a rural placement scheme in
order to get feedback regarding medical education as well as
on their experience in peripheral hospitals. We participated
in a dialogue of community health trainers organised by VHAI
and one of our members was on the VHAI educational council.
Interest in social relevance and community orientation of medical
education which was our focus while in the medical college was
rekindled as we made some contributions' to the mfc Anthologyr
entitled 'Medical Education Re-examined1 (now in the press).
v) Management issues in Health Action for NGO’s were also explored.
These included self sufficiency, team functioning, team development,
inter personal relationships and personnel management.
vi) Newer areas of focus have been Medical Pluralism, Women’s Health
issues and Community Health in slums.
6.
Summing Up:
The CHC study-reflection-action experiment has helped in the
emergence of a perspective on Community Health in India, stressing
the need for a Paradigm Shift-from a medical model of health
concentrating on a package of services provided to the community
to a- social model of health focussing on enablinq/empowerin g
communities to look at health as a right and responsibility, A
number of key issues have been identified crucial to emerging
process of community health. These have been described in a series
of publications (see list elsewhere in the. report)’. The CHC
through this open ended experiment provided support to various
emerging action initiatives and has helped to sharpen the perspectives
of those with whom it has worked in partnership.
Keeoing the concept of the epidemiological triad, i.e. Agent, Host
and Environment in mind it can be said that in philosphical terms
CHC has functioned as an indirect Agent for social change focussing
on health issues and providing technical support, perspective
planning and problem analysis with all the Hosts - medical and
non-medical it has been in touch with.Al], these hosts including
doctors, health and development activists and others are working on
the environment making it r
more just and humane by tackling the
socio-economic, cultural-political
- and ecological issues that
have caused the situation <of under privilege and marginalisation
in our society-using health-i as an entry point.
However the entire process has been two ways-with the CHC team
not only providing support but also learning and enriching its
own perspectives in the process,.
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B.
NET-WORKING
(1*1 K)
During the years of functioning of Community Health Cell, CHC
developed links with many health resource people in Karnataka.
There was no forum where people could attend as individuals
rather than as representing institutions. So net-working was
started as a attempt to bring together individuals in the
field of Community Health, to exchange ideas and facilitate
interactions which could result in working together among such
individuals. Eight meetings were conducted by CHC for the past
two years. The earlier ones were full day affairs and later on
become half day sessions.
MEETINGS
(1) First Meeting was held on Sundayf the 7th February 1988 6
The goal was:
1. Get to know each other and our work.
2. Hear about ideas and experiences in the field of
health and development.
3. Brain storm about the ideas presented in the CHC report.
Fifteen people attended, shared their activities and plans, It
was conducted in an informal, exploratory, participatory way. A
letter was drafted by the members to the newspapers regarding
Mysore University stopping publications of the book "Where there
is no Doctor”.
(2) Second Meeting was held on 6th March 1988
Twenty members participated which included eleven new members.
Ten out of the eleven were doctors who had gone in their work
beyond the traditional role of the doctor. The meeting focussed
more on community based health action. The issues that emerged
were-1. Socio-cultural-political understandings in health work.
2. Multi sectoral approach that was needed.
3. Health was lesser priority among people as compared to
land ownership, wages etc.
4. Awareness creation to demand collectively right to health.
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The actual plans that arose were the following
a) To study priority issue in health in Karnataka.
b) Document the health status of people of Karnataka.
c) Undertake a study on Government Primary Health
Care System in Karnataka.
d) Explore integration of systems of health.
e) Prepare a memorandum to be submitted to the
committee on university health sciences.
(3) Third Meeting was held on 23rd April 1988
Thirteen members were present,
the following:-
The goals of the meeting were
a) To collate information of activities and realities
of Primary Health Care in Karnataka.
b) To look at the pattern and distribution of Government
as well as Non Government Organisation’s health
services.
c) To collate Non Government Organisation’s experiences
as a feed back for health policy makers.
SUMMARY OF THE DISCUSSIONS
The Primary Health Care System is functioning poorely; the budget
was inadequate; professional consciousness was poor; people’s
involvement was poor; planning was defective; all efforts were
geared towards curative expectations; there was no awareness at
the Government level about ground realities.
The consensus of
opinion was that alternative approaches need to be explored/ health
personnel needed training and awareness building/ there was need
for improving monitoring and evaluation.
Participants felt NGO
group needed to give active feed back to the Government.
It was
felt that groups with credibility could initiate a dialogue with
Government which could later be even at the district level.
(4) Fourth Meeting was held on Sth December 1988.
Fifteen Members were present and they shared their experiences
in community health action. It was decided to establish formal
contact with FEVORD-K and VHAK so that individuals in the network
could offer support to these association of projects in Health
and Development«»
(5) Fifths Meeting was held on 21st July 1989.
Twenty eight Members were present, which included health
committee members of FEVORD-K and CHAK Executive Committee
Member^. This was so as to enable them to share their plans
and network members could offer support. This meeting was
visualised as a step towards evolving the future activities
of the net work amd moving it from a net work of individuals
to a forum of individuals and associations. The out come of
the meeting were the following:
a) The net work to take the name of Community Health
r orurn.
-1
b) T^eJ?,eXt meeting was to be held under the auspices
of
1EVORD-K, VHAK where the dialogue would continue.
Of FEVORD-K,
Following themes were suggested as focus for
subsequent meeting:
a) Integration of Traditional systems of medicine.
b) functioning of Government health system at the
Primary Health Care level.
c) Exploring health priorities in Karnataka.
The forum would function in an informal way and common actions
would take place through the existing co-ordinating agencies like
VHAK, FEVORD-K. it was decided that CHC would facilitate next
wo meetings and beyond December 1990, the forum needed to evolve
its own directions and organising structure.
During, afternoon session discussions were held to evolve
a training
strategy in Kannada for grass root activities.
Sixth Meeting was held on Sth September 1989, at Vidya Deep.
During this meeting the viability and the future directions of
the forum was discussed but it ended inconclusively. Subsequently
a questionnaire was circulated by Smt.Vanaja Ramprasad and
Sri. Mani Kai Hathi to forum members to clarify their perspectives
and expectations ;so that fruitful discussion could be held about
the future of the forum.
(7) Seventh Meeting was held on 11th December 1989.
Responses of 14 respondents to the questionnaire was discussed.
Their views were as follows:
a) Forum was seen as place for sharing of ideas
and experiences so as to evolve a wider
b) Xs
“ : an opportunity for working together perspective,
and for
supporting grass root organisations.
cms a rorum of support to each other
and for learning
from each other.
The majority wanted the forum
to be informal without a definitive
common ideology and manifesto or binding actions. The membership
could be open and the forum could respond/dialogue around different
needs, Many wanted the involvement of members and responsibilities
to be rotating some of the problems based on the two year
experience were identified as membership mostly from Bangalore,
lack of continued involvement and commitment, differing levels of
awareness among the participants and the bias towards only
particular actions.
During the meeting it was decided to get the views of the
remaining members since only half the number had responded.
—Meeting was held on 3rd February 1990.
The attendance at this meeting was poor and sufficient interest
did not seem to be there among the members. Only one of the
regaining members had responded.
It was decided to continue at
present only as a discussion forum with a member offering to lead
a discussion or presenting his/her experience for collective
reflection each time.
Paresh Kumar suggested that he would like
to share about his experiences in teaching Medical. Sociology at
the next meeting.
The meeting was fixed for 12th March 1990 but
could not take place due to a VHAK-FEVORD-K dialogue with
Government arranged for the same day.
The experience of Networking has been discussed by the CHC team
over the last few months.
The positive features were;-
i) It was a good opportunity to bring together most of our
contacts who are providing individual support to community health
action.
ii) There
’was evidence that some degree of working together and
?
interactions have taken place beyond the framework of the
meetings called by CHC.
iii) In addition CHC team were able to involve many of the
network associates in their initiatives. However there was
an apprehension that the experience had some negative features
as well.
iv) Networking was not seen as a need by itself and
v) There did not seem enough energy in the group to sustain the
process, if the CHC stopped facilitating the meeting as a group.
The net work was also perceived as just one more thing dto do.
vi) Experience of trying to link the network of individuals to
ongoing coordinating groups like FEVORD-K and VHAK were also
not successful.
Even if the network of individuals were to metamorphose into a
discussion forum entitled Community Health Forum, the organisational
dynamics and continuity of the forum remained an open question
4'
The CHC team has now decided to circulate a summary of the
questiohaire survey and a list of all the potential network
associates to all concerned and to let individuals in the
group take further initiative beyond June 1990.
•#»
3. TRAINING - gQRMAL AND INFORMAL
( M K)
The CHC team did not plan to get involved in formal training
at the start of the experiment. Moving beyond a medical
college, it focussed its attention on individuals and project
teams sharing and learning in informal, mutually supportive
ways.
4
In the first phase 1984-1986, it did participate in a few
sessions in ongoing training programmes organised by Community
Health training centres or NGO resource groups.
In 1988 at the begenning of the Phase 1988-89, the CHC team
decided to respond to a request by the Franciscan Brothers
(Jyothisadan) to coordinate a training in Community Health and
Development integrated with their formation studies. The team
agreed to be involved so that members of the CHC tearr^ would
continue to improve their training skills. The CHC team also
decided to use this opportunity to experiment with more
participatory approaches focussing on small group work,
pulling*in methods and ‘interactive* and problem solving
approaches. As this experience evolved, the CHC team also
undertake a few shorter workshops for voluntary agencies using
similar approaches.
Some details of the dynamics of the Jyothisadan Course and the
workshops for Karnataka groups (VHAK - FEVORD) and Tamilnadu
groups (OXFAM) are given to highlight the approach and the
process.
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□YOTHI SADAN BROTHER'S TRAINING
Background
Upto 1984 seven brothers had attended the community health
workers course of St.John's Medical College which is for
three months.
In the same year a workshop for formators on ’social Apostalate
of the Church* was held under the auspices of CNFCE attended by
the formator of Jyothi Sadan also, in which the importance of
Health/bevelopment dimension in formation training is emphasised.
In November 1984 a refresher course for the seven CHWs were
organized with the help of CHC, Prof.Rama Rao and the community
medicine faculty of St.John’s Medical College. Based on the
reflections and recommendations of these brothers it was decided
to integrate community health training into the scholastic studies.
Follow up planning was done by the CHD section of CHAI,
Prof.Rama Rao and CHC and in 1986-87 the training was co-ordinated
by CHAI-CHD team. In 1987 due to certain circumstances this
training did not take place but the brothers were sent for the
two weeks Deacon’s course at St.John’s Medical College. In 1988
CHC took over the co-ordination and 1988 and 1989 has been done
by CHC.
The Community Health Training of 1988r 1989 Batches Included Uie
Following phases
a) Phase I of Theory and discussions with both the senior and
Junior batches totaling about 30 scholastics spread over a
period of two months.
b) Thalavady rural camp (1988 batch)
c) Phase II - two weeks intensive course at CHC for the senior
batch of ten brothers (1988 batch).
d) Rural posting to Manantavady,(1989 batch) and
e) Phase II- an intensive course at Jyothi Sadan for the Juniors.
(1989 batch)
2.
content OF
THE COURSE; This has evolved through the 1988-89
Experience as follows:
—ase 1 (a) The flrst two weeks of the course is spent exploring
the meaning of Community, Health, Development and evolving a
social analysis using case studies, audio visuals, simulation
games and other participatory methodologies. The course outline
is built in a participatory way. Introduction to low cost media
and skill training in street theatre, poster making and puppetry
was also included.
Phase I (b)
0
Human Biology, Ailment management. First-aid, Leprosy
and Alternative Systems of Medicine and overview on MCH and
nutritions, communicable diseases and Environmental Sanitation.
Phase II Rural postings for the brothers in a rural area/tribal
area to study and understand the development and health dynamics
of the community.
During the x*ural postings, visits were made by CHC team emembers
and associates to the rural camp to facilitate, concurrently, their
understanding of the experience. When they get back they make a
presentation on the experiences of the rural posting using
techniques of street theatre and other media apart from group
reports.
Phasfe III Community health situation analysis, simulation game
on poverty. Drug issues, working with the community. Mother and
child health, communicable diseases, visits to health programmes
Health education methodologies, mental health, school health,
community based rehabilitations and evaluation of the training.
METHODOLOGY;
It was attempted to reduce didactic lectures as much as possible
and to use participatory methodology. However with a large group
of 25-30 trainees this was not always easy. Methods used to
facilitate the training include usage of simulation games, case
studies, discussions following a slide presentation, demonstrations,
visit to projects where the community health concepts were put to
practise and written assignment to be completed by the trainees,
individually and in groups.
• •3
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EVALUATION
>•
Evaluation was done both to assess individual and group learning
and to assess the content, the process and the participation.
The certificate of participation was presented at the graduation
function of these scholastics.
FUTURE OF THE TRAINING PROGRAMME
With changes taking place in the goals of CHC the co-ordination of
the training programme will in future be done by the staff of
jyothi Sadan itself.
The course methodology, curricula and resource person's list would
be made available to them. In addition St.John "mbulance First-Aid
Course, and the two weeks Deacon's Course of St.John's Medical
College are also recommended which would give additional experience
and an official certification as well.
AN OVERVIEW
The Community Health Course at Jyothi Sadan Centre is among tne
first of its kind attempting to incorporate this subject as an
integral part of formation. The focus is on the social model of
health not just a medical model. The course supports the new
direction taken by many religious including the Franciscan brothers
in their social appostolate, which is now gradually moving from
institutional responses to more community based responses.
For the CHC team it has been an interesting experience in promoting
participator learning and using small group and interactive
approaches. The team have also tried to involve many of its
associates from the network, to pull in their field experiences
and perceptions for the benefit of the course participants.
(
3 (b)
'PARTICIPATORY LEARNING1 WORKSHOPS
CHC has tried to encourage a more 'participatory learning process'
in workshops, facilitated by the team on Community Health and
other topics. The participatory ethos is promoted by involving
the potential participants in planning through a questionnaire;
by redefining the orthodox division between participant and
resource persons so that every person is also accepted as a
resource person, giving priority to field experience and lessons
learnt from it; using small group and interactive approaches
in the workshop discussion; evolving follow up plans with the
participants. The workshops, then become a part of an emerging
process rather than just an adhoc event. Two such, recent
workshops in 1989 are analysed in a tabulated form to highlight
the process and the experience.
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COMMUNITY HEALTH WORKSHOPS
SUBTITLES
KARNATAKA GROUPS (FEVORD-K/VHAK)
TAMILNADU GROUP (OXFAM)
BACK GROUND
FEVORD-K members expressed a need work-shop
resulted out of the facilitation of CH forum
meant to be a preliminary to developing a
training programme for incorporating health
in their activities.
OXFAM Director discussed their initiatives
in Tamil Nadu, in health and development
and the need to help their partners gain a
wider understanding of community health
and demystify health actions. Decided CHC
would contact partners so that no expectations
of/from Funding Agency develops.
PREPARATION
Resource persons met, questionnaire sent to
member organisation, response collated.
Invited senior staff for two days.
Questionaire sent to 15 organisations.
Decided to invite from each organisation
a decision maker, a grass root worker.
PARTICIPANTS
60 members from 40 projects participate
About 35
MO. OF DAYS
2 days
3 days
RESOURCE PERSONS
FEVORD-K Health Committee/ CHC Team/
C.H.Forum resource people
KANNADA
CHC Team/Vanaja Ramprasad/Dr.Benjamin and
OXFAM staff
QUESTIONAIRE
Regarding health problems, solution tried.
Government resources available.
OTHER MATERIALS
Different types of communication materials
were gathered.
WORK SHOP
After introduction of members and
introduction of human contents were-Health
problems of communi tie s/solutions/
activities tried, usage of Government
facilities and how to improve/understanding
of health.
Regarding health problems, solution they have
tried, obstacles and causes for failure,
extend of utilization of Government and local
resources.
Different types of communication material
gathered.
Content;
. 1. Understanding of health and community health
2. Understanding and prioritizing health problem
3. Understanding malnutrition
4. Understanding health education
5. Government resources
6. Sanghams.
• •2
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TAMIL
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2.
SUB TITLES
METHOD
KARNATAKA GROUPS (FEVORD-K/VHAK)
a) Through small group discussions and
presentation and consolidating in the
large group.
b) Audio visual presentation on thought
provoking themes.
TAMILNADU GROUP (OXFAM)
small group discussion and presentations
in large* gr’oup.
Simulation game on poverty to understand
malnutrition.
Learning health education through material
produced by participants.
After the first day course planning most
of the workshops was done in a participatory way.
Daily evaluations done.
SUMMARY
OUT COME
Available in workshop report.
Decided following areas need to be stressed
in subsequent workshops.
1. Health Education/Awareness
2. Cooperate/pressurize Government health
3. Local activists need to be trained/no
need of doctors.
4. Nutrition
5. Health as a movement
Summary of workshop available.
Participants decided to have a follow-up
workshop organized by themselves for,
-Sharing of resources among themselves,
-especially in traditional systems of medicine.
-Greater utilization of Government resources
-Share experiences of greater community
participation in health.
-Evaluating their work by themselves
EVALUATION
It was experienced as a very useful workshop.
Participants recognized a lot of their
activities were health promoting. Decided to
meet again to outline training programmes for
two years in a participatory way.
During daily sessions-were about content,
methodology, materials and whether meeting
up to expectations.
Regarding method of conducting workshop
majority felt it was participatory.
General Impression:
First effort by Shirdi, Mani and Gopi to facilitate
a participatory workshop-there is a need for
greater co-ordination and pre-planning among us.
*
D.
RATIORAL THERAPEUTICS AND DRUG POLICY ISSUES.
(SPT)
CHC’s role in the area of Rational Therapy and Drug Policy issues
has been primarily catalytic.
The starting point was a group discussion organised by the Science
Circle of the Indian Institute of Science and led by Dr.Zafrullah
Choudhary of Gonoshasthya Kendra, Bangladesh on "A people oriented
Drug Policy" in December 1933. CHC-MFC facilitated the visit and
prepared a background file on Gonoshasthya Kendra Project and
Bangladesh for circulation.
of the Catholic Hospital Association of India
The annual convention
on the
the same
same topic
topro was facilitated by CHC in November 1934.
Preparation for this convention was through three earlier workshops
with over 20 people who were trained as resource persons to
facilitate group discussions during the workshop. The drug issue
was explored in this convention through an exhibition, small group
discussions, paper presentations, street theatre, slide-show and
also liturgy. A special issue of the magasine 'Medical Service
was also edited by CHC.
At the mfc Annual Meeting on Tuberculosis at Bangalore in January
1985, the All India Drug Action Network also organised its meet.
CHC Invited some of its contacts to this meeting and the idea of
was bom. two or three associates of CHC took up the
challenge to evolve a forum of Individuals and groups interested
This
in promoting Rational Drug Policy and ratnlonal therapeutics,
, health workers,
issue was further explored in meetings with doctors
interested in
development activities, consumer groups and persons
daf-k
this in Karnataka.
As the Drug Action Porum evolved CHC team members participated in
the core group and CHC was made a document resource centre or 1 .
The subsequent involvement of CHC in Drug Action wort has been
primarily through the evolving initiatives of the DAF-K.
/
\
LIBRARY ''Aqj
AND
>£
documentation j >-
'VGA Co
and were in favour of involved action alongside these discussions.
The next two meetings are centred around this aspect, when the
study group plans to visit two centres where medical pluralism is
being practiseid and areas of study could emerge from these
interactions. One is a charitable clinic on Bannerghatta Road,
and another, a community health program off Kanakapura Road, which
is just starting.
Another area of action envisaged was the preparation of short
course on herbal therapy for common ailments to be imparted to
members of FEVORD-K groups who plan to incorporate ’health1 in
their development activities. This is still under discussion and
will be part of a larger training programme on Health for
Development activists.
Members of the study group have been attending various workshops
and conferences like:*The Holistic Health Workshop-Bangalore
*The National Convention on Traditional
Medicine and MCH-New Delhi
*The Tribal Medicine Workshop at Heggana
Devana Kote (VHAK)
*The National Workshop on Medicinal Plants
at Dharwar
*The IASTAM Conference at Bombay.
In addition to the above activities of the study group CHC team
members have also explored this dimension of Medical Pluralism
in many other ways which include,
A training in Acupressure for minor ailments for community
health workers in B.R.Hills. (SPT)
* A two part article on 'Medical Pluralism' to begin a dialogue
on this theme in the medico friend circle bulletin (RN;
★ An exploration of the role of Tibetan Medicine and the possible
areas of integration during a CHC team assessment of community
health priorities in Tibetan settlements in Karnataka (SPT)
*.Participation/facilitation of a 4 day short course on orientation
to Medical Pluralism in the MSC Community Health Course at the
London School of Hygiene and Trppical Medicine m 1987. (RN)
(RN)
*
Over the years the initiatives of the CHC in the production of
background materials and audio-visual aids on the theme have
included:
a) A slide set with audio on the Drug Policy of India called
“Ramakka’s Story** with media unit of the CNFCE.
b) Special bulletin, issues:
i. Bulletin of Sciences (Science Circle,
Bangalore)- 1984.
ii. mfc bulletins November 1984 and December
1985.
iii. “Rational Drug Use** in Health Action,
August 1988 (A H.A.F.A. Publication)
c) Resource file on Bangladesh experience, in co-ordination with
I.S.I. Bangalore and Science Circle.
CHC has also been a resource person on Rational Drug Policy at the
St.John’s Diploma Course in Health Care Administrative and a
resource centre for articles (by journalists) on drugs in newspapers
and also related articles in consumer columns on “mosquito
repellents*1, “Cosmetics** etc..
Members of the CHC also participated in workshops of the Drug-Action
Forum of Karnataka, like
*Drug workshop (3 days) for voluntary agencies
in the health sector in Karnataka.
*One day workshop on Drug Policy and Rational
Therapeutics for students at Mysore from the
Medical, Pharmacy and Ayurvedic Colleges.
*Seminar on Rational Drug Policy for members of
Indian Institute of Science a rd Factory and
Industrial Labour Welfare Officers-a group
called*Scientists and Engineers for Peace*.
Contacts with consumer forum like 'Grahaka Jagruthi" and Science
Forum like ’The K.R.V.P.’ have also been made.
It may seem surprising that so much effort has been spent by a team
interested in Community Health-on the issues of Rational Therapeutics
and Rational Drug Policy. This is however not 'accidental1. It is
our firm conviction that ’drugs and prescribing’ form a major
component of health care at all levels and are an important part of
■■
i"
,—__________
the expectations of the lay consumers and general public .
Since most professionals and health care action initiators
have some knowledge in this area, we have found it a good
starting point for social analyses and to understand the
broader social-political-economic-cultural faction that
determine drug availability, affordability, accessability,
use and misuse in society. It is a relatively non-threatening
field and of equal interest to health professional and
consumers. It is also an area in which some action can be
immediately undertaken within a health care organisation.^
E. STUDY GROUP-INTEGRATION OF TRADITIONAL SYSTEMS OF HEALTH CARE (g p p)
The idea of a study group (consisting of professionals from various
systems of health care and those practising medical pluralism) to
get together and discuss scope, areas and possibilities of
"Integration” took off at a formal meeting on 6th March 1989 at
CHC. There have been regular meetings since then (10 so far) and
this is an attempt at putting the process on paper.
Initial meetings were mainly centred around discussing the scope,
capabilities and need for such a group, and the activities which
could help clarify the goals of individuals and the group. The
active promotion of Traditional Systems of Health Care by networks
like LSPSS, VHAI and individuals and organisations who were
integrating at practical levels was considered worth studying
together. Towards this end, all material available about these
efforts was collated and in addition a compendium of addresses
was made.
A need was then felt to understand the basic/underlying philosophies
of various systems to find areas of integration. Three meetings
were devoted to understanding these aspects from presentations on
the philosophies of Ayurveda and Homoeopathy which were the
dominant non-allopathic systems in prevalence.
Since all the members of the study group were interested in
“Integration1* towards a practical9 workable objective, the training
manual for the CHW published by the Government of India, where
simple remedies from systems like Ayurveda, Siddha, Unani,
Homoeopathy and Naturopathy were advocated for use, was the next
objective of study. Only Ayurveda and Homoeopathy were studied
again, basically for lack of Unani and Siddha practitioners in the
group.
Efforts are being made to expand the group to include
members of those systems also.
k few members of the group felt uncomfortable with just discussions
* Promotion of the concept of Herbal Medicine and an exhibition
on this topic during the CHAI-rAnnual Convention on a •People
Oriented Drug Policy’. The resource persons for these were
Fr.Joseph Chittor and Sr. Innocent of Gudalur.
*
Introduction of a short course on orientation to minor ailment
treatment by alternative systems of medicine in the Community
Health Course at Jyothisadan. (SPT)
* Peer group support to the evolving plans of the Traditional
Systems unit of Voluntary Health Association of India, New Delhi.
>E=<
F.
CSNAGEMENT^AND^TEAM^ByiLDING^PROCESS^gF^CHC
K Gopinathan
n•
F(l) MANAGEMENT DYNAMICS
I • Background
CHC was formed by a small group in 1984. The main objective
of CHC was to build up an overview of community health by
interacting with various groups including individuals involved
in community health work in Karnataka. Me decided to play a
catalyst role. Me did not want to create one more centre nor
start a project of our own. Additional responsibility was to
undertake the organizational functions of a national body
called ’medico friend circle’ for the initial two years.
II• Link up
CMC was linked to STAND (Student Training and National
Development) Trust initially and now to CNFCE (Centre for
Non-Formal and Continuing Education) Trust, both Jesuit Social
Action Trusts, headed by one of our wise counsel, Fr Claude
*
* D’Souza, with autonomy to function on our own.
Ill. Accommodation/base
For the initial period of two and a half years the Cell
functioned informally from Koramangala. As we grew in number,
in 1987,> we moved to a centrally located place in the city
(Holy Cross Brothers, St Mark’s Road) on a rental basis.
In this place, though we established basic office facility,
library and documentation centre and a place for meetings and
small group discussions, we preferred to consider it a contact
point rather than a formal institution.
"r-'ih-'' -
IV. Funds
Funds required for the Cell were received through the
CNFCE Trust. CHC team prepared the budget annually and the
proposal was submitted through the Trust. Periodical statements
of accounts were submitted to the Trust. The expenditure incurred
under various heads during the period January 1984 to December 1939
were as follows (rounded off to nearest rupee):
1. Meetings
4
2,700
2,740
0.5%
0.5%
4. Educational Materials
5,760
7,890
1.1%
1.5%
5. Office equipment
6. Travel
7. Honoraria
13,160
13,900
16,875
2.5%
2.6%
3.2%
8. Postage/stationery/
telephone/xeroxing
29,000
5.5%
9. Furniture
30,800
5.8%
10. Rentals
11. Salaries
49,175
3,60,800
9.2%
67.6%
2. Staff Development
3. Office expenses and
others
Total...Rs.5,33,000
Average monthly expenditure Rs.8880 (calculated on 5 years
expenditure, 1 year being training period for staff)
The expenditure on Books and Educational Materials was low
because ue received a lot of materials gratis. The expenditure
travel, meetings was also low because we received support
on
from many local institutions and projects. The overall emphasis
of the experiment was to establish a low cost ethos and seeking
available support, facilities or resource materials from other
organizations and centres—-in short tapping all the available
local resources without duplication.
The total (Rs.5,33,000) represented actual funds received.
It is difficult to compute all the materials resources we were able
to tap from local institutions and associates as well as
coordinating agencies and others.
•• • o
V• Documentation/Library
Me brought together more than 1500 books and reports on
various subjects like agriculture, appropriate technology,
child health, community health, education, drugs, environment,
medicine, traditional medicine, occupational health, nutrition,
management etc. Apart from this we received over
bulletins,
newsletters, journals and magazines--both national and foreign.
Me are also members of the DOC POST service (articles, paper
clippings) of CED, Bombay. The Documentation Centre was
managed by a part time team member.
V I. Management
Ue managed our own affairs through an experimental
participatory, non-heirarchical team decision making process.
Ue identified three senior persons as our Wise Counsel
to share our plans and ideas with a view to getting their
feed back. They were a sounding board and we met them informally
as and when required and formally atleast once or twice a year.
'•
Though we governed our own affairs this arrangement enhanced
our own accountability.
F(2) TEAM BUILDING PROCESS
An important dimension of our experiment was our attempts
at evolving a team process based on our past experience. Even
during the years in St John’s Medical College, there had
been attempts at such a process through a series of annual
reflections termed "staff development workshops”. The process
at that time was only partially effective because of various
factors such as too large a team with divisions of status,
prestige, professionalism etc. However, the earlier process
was encouraging. Since ours was a small but heterogenous team
ii
we experimented with this idea further using participatory,
non-hierarchical, equitous, collective, functional (leadership)
method#
We discovered that having worked in an institutional
set up in which much of these divisions-professional/nonprofessional; thinker/worker; medical/non-medical; technical/
non-technical; intellectual/manual—-are entrenched, we ourselves
had internalised some of these values# Just a desire to wish,
them auaywas not enough but had to be confronted and changes
in attitude to be gradually accepted.
We believed that team work was greatly helped not just
by participatory decision making process but by also
internalising the whole value system into the social/economic
relationships within the team#
We also believed that every member of the team was important
and was responsible for the achievements and failures#
Collectivity in our efforts had to be recognised and enhanced.
A brief account of how we functioned keeping in
mind the above team building process are given
below:
1.
We saw that as far as possible, all the team
members were involved in the planning and decision
making process. Each one’s suggestions and ideas
were sought and utilised#
2.
Responsibility was shared by each team member,
in accordance with his capability#
3.
Regular sharing of experiences (after attending
a meeting, workshop etc) was done# This has
encouraged learning from each other.
4,
Initially two levels of salaries were fixed
for more experienced/less experienced team
members. Annual increments, TA/DA were equal
for all members so that over a period of time
there was a move towards greater equity.
5.
Team concept was emphasised in correspondence
and interactions with contacts. All team
members could sign for CHC team and CHC contacts
and associates were encouraged to interact
with all the team members.
6.
The team had regular meetings to review progress
of work; to consider new assignments and requests;
to fix responsibility for each function; to fix
a time schedule for completing the work.
7.
Plans were made in such a way that they were
flexible to meet emergencies.
8e
Me believed in delegation of authority accompanied
by responsibility and accountability.
9e
Additional team members were recruited in consultation
with ths team.
10.
The new younger members of the team were given
an orientation to the programme, the ways of
functioning and staff relationship after joining.
11*
Staff development programme to all staff was
encouraged. Staff were encouraged to attend
courses of long duration, short duration and
workshops, seminars etc. Participation in various
initiatives of the CHC, even if not primarily
involved, was also encouraged.
12.
The team supported individuals needs and ideas at
both professional and personal levels.
13.
The team also supported movement from office
based skills to NGO oriented skills, ie., staff
who joined as support to office work were
encouraged to develop skills that would be
supportive of field based NGOs.
14.
Review of ©ach one’s effectiveness was done
informally with a view to help him/her improve
performance and feed back was provided.
Personal hindrances to performance was sorted
out with'the help of colleagues through
non-threatening discussion. .
15.
All team members could seek the help of their
colleagues in undertaking an urgent or difficult
task.
16.
In addition to full time and part time team
members the network of associates facilitated
by the CMC were also encouraged to participate
in various initiatives and responses. During
this participation no difference was made
between team members or associates in terms
of sponsorship, TA/DA or making available
facilities of the Cell. This flexible approach
to non-team members enhanced collectivity.
17.
Locally available NGO resources were utilised
for the various programmes and initiatives
to reduce expenses as uell as to build contacts
and promote collectivity.
Some positive features that contributed to the
team building process
2a
The group was small
The group had sufficient time for
’participation ’ especially in the initial
years.
3.
There was trust in each other’s ability,
involvement and commitment.
4.
Members were known to each other for a
long period of time.
5.
All were in one way or the other experienced
in group effort.
6.
The members had no professional ego
7.
The members had interest
in the experiment.
8>
The team had openness in communication.
9>
Even before forming the team, a few members
to participate
of the team had established wider personal
contacts in India. This was shared with
all the team members gradually and the
contacts were deepened.
10. We have received support from many groups
irrespective of their ideological differences
ie., the team received acceptance and
encouragement.
, !
Problems and some issues for further thinking
While the overall experiment was very satisfying for
the team, the participatory management process was
not always easy nor ideal* Many problems were experienced
and issues faced, which are listed:
1.
Participation is time consuming and time demanding*
It brings pressure on an individual to cope with
the demand as well as delays the timing for
response by the group.
2>
Sometimes certain ideas/suggestions were accepted
by the team without going into detailed discussions
due to shortage of time or urgency of the matter,
ie., because of the demands on a catalyst group
full team participation was not possible always
in every decision*
3*
Attendance at meetings, workshops was encouraged but
it was doubtful if equal interest was shown by
all the team members in participating at such events*
This showed that though opportunity may exist
in a group process but it may not always be exploited
by individuals^
4.
Sometimes too much time was spent on discussing
minor issues/experiences. This led to unnecessary
delays in the work*
5.
Providing equal salary/increment was not realistic*
Some team members received less and some more than what
was offered in the open market for their skill* In
the latter case it has raised expectation of team members4,
Conversely some team members expected more out of
others. Unmet expectation was an unovoidable problem*
I
6.
We had team members from part time associates to
full timers. Among part time associates, we had one
who comes every afternoons, another who comes in
alternate weeks. This flexibility lead to delayed
decision making. Creative participat ion from all
members of the group cannot be sought in such a
flexible circumstances. This forces the full timers
to take more decisions»
7.
The team became involved in wide ranging areas without
considering the availability of time* This reduces the
time to share experiences of individuals*
8.
CMC had no projects of its own. The experiment was
based on catalyst support to ideas/projects, initiatives
of others. This lead to a feeling of lack of’continuity
or concreteness * in the work for some team members.
Since processes which we facilitated ultimately
depended on the motivation of the CHC partners,
there was some dissatisfaction with lack of follow
through or follow up.
9.
Unless there is a personal level contact with various
groups,» utilising locally available resources does not
work well. Though it reduced duplication and brought
down supportive costs for the experiment, the liaison
work required was time consuming.
10. We are yet to clarify certain issues like what is the
idea behind staff development? Is it for the individual
only or for both the individual and the organization as
well?
We gave a lot of freedom in the choice which was not
always related .to the emerging needs in the process.
u
Finally an objective description on the successes
and failures of our participatory management process
and the features of the non-hierarchical, equitous,
collective and functional leadership style is yet to be
adequately documented. Different team members
experienced different phases. Each one came with
different previous experiences or expectations on
’participation’; hence the evaluation of the process by
I
each is different. We have to consider ways by which
a more ’objective’ evaluation of this dimension of
the experiment is made possible before we can present
definitive conclusions *
G.
A SWOT ANALYSIS
(R N)
Though reflecting on the past year and planning for the next
has been a continuous cycle in the CHC experiments^ the CHC
team, since July last year has been reviewing the experiences
of the last five years to explore the strengths and the
weaknesses, the opportunities and threats that were part of
this process.
5
While some members of the team have been part of the process
since the beginning, others joined later in the experiment
and hence the perceptions and experiences were different.
Like most processes there have been varying phases of intensity
and challenge and periods of uncertainty as well. The purpose
of the informal team discussions was to build up some consensus
of the main experiences inspite of the vaiied experiences and
expectations. The SWOT listed below represent the key issues.
G (a)
Strengths/Opportunities
G (b)
Weakness/Threats.
-xxxxxxxxxxxxxxxxxxxxxxxxxx-
G (a)
STRENGTHS/OPPORTUNITIES
Established a 'live' contact with individuals, groups, project
teams, activists, resource centres, coordinating groups and
networks, trainers, policy makers and research groups involved in
*
Community Health in India, in the 1980s.
I
* Participatedin various ongoing and emerging initiatives in
India at different levels and in different capacities especially
with mfc, CHAI, VHAI, AIDAN, CMAI, CSI, VHA-K, FEVORD-K, ISI'S
and ACHAN.
* Have provided a ’Peer Group* support to a large number of
individuals and groups interested in exploring Community Health
Action in India particularly in the South.
* Have reached out to a wide variety of individuals and groups
of various ideological orientation and have managed to establish
credibility through the open ended dialogue.
* The CHC Team has managed to do all its work in the last five
years through a process that was relatively non-institutional,
low cost, facilitatory flexible, open ended and supportive
available resources for a wide variety of activities and
facilities was tapped from the local network of training and btte..
centres.
* Team relationships and group process were given much importance
during the experiment and CHC was able to establish a non
heirarahical work culture supported by personal interest in each
other's workz regular feed back and participatory decision
making within the constraints of time and our flexible management
style. Staff development was also emphasised and supported. We
attempted to grow beyond the divisions that divide our present
organisational ethos, e.g. professional-non professional.
c
medical-non medicalt technical-administrative, superior-inferioi*
and so on and build a collective style of functioning, focussinc
on CHC Team and not individuals.
* Used every opportunity at Bangalore/Regional/National level to
bring together individuals and groups irrespective of ideological
and constituency differences, as long as they shared and interest
in Community Health. While the long term effect of this effort
may be difficult to measure, this stimulation to ‘networking’ has
generally been in a positive direction.
* At a conceptual level we have tried to take community health
beyond the orthodox medical model, characterised by a providing
ethos and structured by just technological and management
innovation to an alternative social model characterised by an
enabling/empowerment ethos and structured by socio-economiccultural -political realities. A series of issues have been
identified and highlighted that strengthen the process dimension
of community health action.
G (b)
WEAKNESSES/THREATS
* Due to the open ended catalyst ethos the diversity of issues
explored and the varieties of initiatives in which we were
involved were very large. New members of the team were often
at a loss with this diversity.
I
* The follow up on ideas/processes generated by our interactions
depended entirely on the CHC partner because we wished to remain
in the role of the catalyst only. This did result in a growing
feeling of lack of continuity, consistency and ’concrete1 action
among many CHC team members.
* The focus was on the Community Health action initiator and not
the people/community in which health action was initiated. Some
of us did feel that we were losing primary contact with the
reality of working with the people. In the initial years since
we were basing our work on a decade of intensive field experience
in St.John’s, this was okay but from a long term point of view
this did seem a growing lacunae in our work.
The load of requests and the demands on us increased rapidly
with out increasing credibility. This affected both the quality
of our response as well as reduced the time available to us to
grow as a team in our group/collective analysis and understanding.
There was need therefore for a greater focus, better time management
and a more organised style of response and follow up which was not
*
always possible.
* We were rather idealistic about our initial ’salaries’ and
security system. While at individual level (free lancers) it
may be possible to function in this way. It is not viable when
a team is being built and supported while we did become a little
more realistic by the end of the experiment there were tunes of
insecurity for different members of the team. Also for such a
type of work to be effective there has to be viable base with
basic facilities and this always needs an additional, core
support which is continues.
* Just as in the
•e-'
case of the community we needed to be able to
reach those vzho need us most and could not reach us or afford us
so easily.
There was therefore an increasing need for
discernment and ’prioritization ’ to ensure that we do not respond
in our overall enthusiasm to those who make greater demands on
r
us but have resources to seek elsewhere as well.
This was not
always an easy decision.
* While v/e realised that there was a need to remain small so
that our responses could be flexible, diverse, creative and need
based we scould not completely get rid of some degree of
routinization, stereotyping and formalization.
This balance was
not always easy to maintain especially since it was inevitable
with the growth in demands on the cell.
We did attempt a
concurrent critical review of this dimension but were not always
successful in preventing it.
★ While
we did manage to build up a management and work ethos
which was relatively more participatory, non heirarchical and
creative than that prevailing in established institutions and
systems it was not also always ideal nor easy. A wide range
of factors affected this process, including personality and
styles of functioning of team members, expectations and styles
of CHC-contacts, the haziness between individual responsibility
and the collective, and the problems of confusion between equity,
equality, equal opportunity and responsibility.
This led to the
problem of unmet expectations among team members at different
levels.
-XXXXXX2OCXXXXXXXXXXXXXX-
$
I
H.
I
LOOKING TO THE FUTURE::
* From July 1989 the CHC team began a series of internal
reflections, to identify and clarify individual goals and
to explore group goals as well, beyond the end of the
experiment (December 1989). The experience of the five
years was also reviewed critically to understand various
dimensions and learning experiences from the experiment.
This reflective evaluation was also extended to initiatives
such as the network, the integration study group, the
participatory course in Jyothi Sadan and other initiatives
which have a future beyond the CHC experiment.
* From January 1990, the CHC has moved into a post experiment
transition phase when individual team members move on to more
focussed goals and roles.
The overall conclusion is that the CHC needs to:
(a) Establish a more definitive, long term identity made
possible by registering a community health trust or
(b) Negotiating a viable relocation with a larger institution
or coordinating agency where much of the creative autonomy
and style of governance is retained.
Alternatively individual team members, some or all may relocate
or relink with other similar initiatives, and continue the
work with a different base.
* In terms of focus, while open ended, catalyst, technical support
role with NGO’s has been very interesting and enriching, there is
need to allow team members to initiate more focussed policy
research efforts primarily under their control to enhance the long
term commitment and work satisfaction of the team process.
* Policy research has emerged as an important priority area
because this is a major lacunae in present day NGO/Volag efforts.
yoy*
LIBRARY
£
AND
A DOCUMtNTATION. / ' •
X..
UNIT
'y' /
A' A".
G A!
I
J
There is need to take a reflective overview on the diversity
of experience and the wealth of options that have emerged in
NGO effort at the micro level and evolve large macro policy
guidelines that can strengthen the 1 Social Relevance1 thrust1
of the evolving National Health Policies.
*Building on the wealth of experience developed through its
I
catalytic work the CHC team is now gearing up to this newly
emerging focus in the coming year. Team members plan to
focus on three key areas that have policy implications, viz.,
i) Community Orientation/Social Relevance
in Medical Education
ii) Medical Pluralism and Child Health
Hi) Community Health issues for Urban Slums.
4
REPORT OF THE C>H.C. -5 YEAR REVIEW MEETING
I! Jo
Held on 8th June 1990
1
The C.H.C. Team met with their Wise Council, some associates
and senior peers on 8th June 1990 to report on and discuss
the C.H.C. study-reflection-action experiment between 1984 to
1989, and to clarify ideas on the future of the. C.H.C.
I
The format of discussion was:
I
i)
Presentations by members of the C.H.C. Team on different
aspects of the experiment,
ii) Interactions on these with the group assembled.
The members who attended this meeting were:
I
1) Dr. C.M. Francis
- Director, St.Marthas Hospital,
Sangalore
2) Prof. George Joseph
3) Dr. D.K. Srinivasa
- CSI Ministry of Healing, Madras
- Professor of Community Medicine,
JIPMER, Pondicherry
4) Prof. R.L. Kapur
- Director,
National Institute of Advanced
Studies, Bangalore
55 Dr. Paresh Kumar
- Department of Sociology,
Mysore University
6) Dr. H. Sudarshan
- Vivekananda Girijana Kalyana
Kendra, B.R. Hills,
7) Ms. Maria Zillioli
- Community Health resource
Person, Mysore
The C.H.C. Team members present were:
1) Dr. Ravi Narayan
2) Dr. Thelma Narayan
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3) Dr. Mani Kalliath
4) - Dr. Shirdi Prasad Tekur
5) Mr. K. Gopinathan
6) Mr. John
7) Mr. Nagaraja Rao
Others who were invited but could not attend included:
1) Fr. Claude D'Souza (Centre for Non Formal and Continuing
Education, Bangalore)
2) Fr. Percival Fernandes (Director, St.John's Medicafl.
College Sc Hospital, Bangalore)
3) Fr. B. Moras Sc Dr. Mario D* Souzaf Administrator and
Assistant Administrator,
St.John's Medical College)
4) Fr. Thomas Joseph (Ex Coordinator, Community Health
Department of CHAI)
5) Ms. Valli Seshani . (Consultant, Development Trainer, SCI) Sc
6) Dr. Gerry Pais . (Coordinator, DEED, Hunsur).
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The C.H.C. had developed a wide circle of associates and contacts
in the last 5 years but a smaller compact, select group was invited
for the review representing a]l the main sub groups of our circle/
network.
Thelma Narayan presented an overview of the CMC activities,
dwelling on the beginnings of C.H.C., Its objectives, methodology
of functioning and the phases in C.H.C.‘s development. She touched
upon the range of issues explored in community health, as well as
the individuals, groups and organisations with whom interactions
took place. She summed up her presentation, stressing on the role
of health and development-professionals and activists as agents of
social change. Her presentation was animated by charts.
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Mani Kalliath presented C.H.C.rb attempts at networking with
individuals in the field of community health. He spoke of the
positive as well as negative aspects, and the attempts to
metamorphose the network into a Community Health Forum- - the
organisational dynamics and continuity of which were still somewhat
unclear.
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He also detailed the dynamics of the Community Health Orientation
course for the scholastics of Jyothi Sadan, Bangalore (Franciscan
Brothers) during their formative period. He also highlighted the
approach and process of workshops conducted by C.H.C. for Karnataka
Voluntary groups (organised by VHAK and FEVORD-K) and those for
Tamilnadu groups (organised by OXFAM).
Shirdi Prasad Tekur presented the efforts in forming a study group
towards Integration of Traditional Systems of jPJ pt 1 ‘f*ti r c
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outlined the dynamics of the study group meetings so far. and some
aspects of the evolving process.
He also linked this to the C.H.C. efforts in promotion of Rational
Drug Therapy at various levels, <and with different groups and
through different types of initiatives. The evolution L
of the
Drug Action Forum of Karnataka from these efforts
(which
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planning to register itself as a Society and had developed a core
and working group of its own) were also highlighted.
Vi<?hlighted the Management and Team building process
r including positive and negative aspects and the problems
and issues therein.
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Ravi Narayan did a SWOT analysis of the C.H.C. process, thereby
looking at the Strengths, Weaknesses, Opportunities and Threats in
the functioning of the C.H.C.
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In a look at the future of C.H.C. Lbeyond the experiment, ideas
about the future options available,, the need for a long term
identify, focus of activity. etc., were explored.
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Each presentation was interspersed with discussions and, compiled
below is a resume of the ideas,/ <opinions
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and directions which
emerged in the interactions at the meeting.
1) The need to maintain independence of C.H.C. Team to enable it
to continue its flexible style of functioning was stressed.
Registration as an independent Society was deemed necessary
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However C.H.C. should continue interaction with all groups/ .
institutions with which it had established links and support
their initiatives as a catalyst, while at the same time
■developing a sharper Policy Research focus in its work.
21 The range of issues and organisations which C.H.C., initiated
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and interacted with expressed the need, for such activity in
the Voluntary Sector. Even with the evolving research focus
of the C.H.C., a continuing ”cpen-ended" approach to fill a
need was thought to be necessary and C.H.C. Team could keep
this in mind while evolving their future plans.
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31 The networking attempts and metamorphosis into a forum was
appreciated. The need for a longer period of nurturing to
get the Forum active was suggested. Also the need to open
more channels of communication between the Forum members,
e.g., through a newsletter or some such initiative was
emphasised.
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41 In the formal and informal training attempts, laying down
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>. initially and evaluation at the end against
w of- objectives
these objectives was to be considered. Also, the
communication of ideas, such that the participants would
“Learn to Learn” was to be further explored.
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5) The formation of an independent Drug Action Forum of Karnataka
implied a supportive and resource unit role for the C.H.C. in
the area of Rational Drug Policy and Therapeutics.
6) In the continued attempts at fostering a study-group for
Integration of Traditional systems of Health Care, the evolving
areas of consensus, avenues for research and active involvement
of larger groups in these activities was to be further explored.
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7) The experiments with the team building process and participatory
management seemed relevant for a small group. Its applications
and utility in larger non-homogeneous groups was to be explored
in the voluntary sector. This dimension needed continuing
experimentation/adaptation in the context of C.H.C’a own
evolutionary, process.
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8) The sal ary/compensation structure evolved by C.H.C. was not
consistent with outside realities, and hence unrealistic. A
more realistic structure was to be planned for the future in
the context of continuing long term involvement of team
members in such a process.
9) In the evolving management style of C.H.C. there should be a
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continuing flexibility in staffing, linkages and project/
process evolution. This ‘flexible1 and ’adaptable’ approach
should continue to be stressed and further strengthened.
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10) Apart from continuing its catalyst role the C.H.C. Team
should now seek support from organisations willing to
collaborate with it on areas of mutual interest. This
support could be- financial as well so that C.H.C*. could
build up concrete local support also. .
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On the whole the review group was appreciative and supportive of
the efforts made by the C.H.C. Team to develop a resource cell
responding to the multi-dimensional needs of the evolving
Community Health Action in India especially in the South, Most of
the suggestions were however focussed on making the C.H.C.
experimental process and structure more realistic in the context
of Continuity and long term stability. While some formal
structure and more focussed objectives were inevitable at this
stage the group supported the continuing experimentation with
ideas/attempts to build in a more participatory ethos in the work
that would be supportive of community health cell's response to
ongoing initiatives and emerging needs.
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BEYOND THE REVIEW : HOVING INTO 1991
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The 5 year (1984-89) Review Meeting organised by C.H.C. on
8th June 1990, with the wise council, associates and many senior
peers, led to the identification of many ideas, options and
directions outlined in the minutes of that meeting (enclosed).
In the period July^-December 1990, the C.H.C. team has further
explored these ideas and ±he following developments have taken
place.
1 . Registration of Society:
xciico©, Research and Action is
A Society for Community'Health Awareness
being registered with some of our associates/network agreeing to
participate in the formalities, The C.H.C. will now be the
functional unit of this Society.
2. Policy Research Focus:
a) The Policy Research Focus had already been establised with
C.H.C. and C.M.A«I. collaborating on a project to explore
Community Orientation and Social Relevance in Medical Education.
This project is also being supported by CMC-Ludhiana and
CHAI with the additional part-icipation of CMC-Vellore,
CMC-Miraj and St. John1 s_ Medical. College-. This project
initially was'from April 1990 to March 1991 but will now
extent till Dune 1991.
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b) Some policy research initiatives for 1991-92 are being explored
with CHAI (Study of‘Church Health Sector), NIAS (Health
Training of Panchayat Leadership and Building up of
Decentralised Health Information System), VHAI and CMAl(NG0
response to Educat ional _Pol icy Health Sciences
Institutions).
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3. Community Health Forum:
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4. The Community Health Course:
A questionnaire on the scooe/functions/objectives of the
Community Health Forum which had been sent to all the members
of the informal community health network was compiled.
Dr. Shirdi Prasad T-ekur* of C.H.C. will now coordinate regular
discussions/dialogue of the forum for a year starting from
February .1991. The forun will focus on individuals not projects
or institutions. The dialogue will be on special interest
areas and initiatives.
While the remaining sessions of Phase II, for the 1990 batch
will be completed by March 1991, the community health course
at Dyothisadan is being reviewed systematically and the three
year informal exoerience is being evaluated to draw up a more
definitive curriculum with specific objectives and
methodological guidelines.
5. Supporting Networks:
The C.H.C. will continue to participate as resource in three
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networks
networks in
in Karnataka
Karnataka — Drug.. Action Forum (Karnataka),
FEVORD (Karnataka) and Voluntary Health Association of Karnataka.
Dr. Shirdi Prasad Tekur will be resource person for the ongoing
plan of regional workshops on Health for Non-Health groups.
6. Exploring Pluralism:
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The study grouo experience is being documented and reviewed and
the scope of integration of systems in an ’alternative medical
curriculum’ (ref: CHC/CMAI project) will be explored. The
study circle has remained dorman-t since Dune 1990 due to changes
in the personal work situation of many participants.
7. Dccumentation Centre:
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C.H.C. had collected a uide variety of published and unpublished
initiatives
---- ------------------documents and reports, through its interactions, iand
This
entire
with the NGO network in Health and Development,
collection has now been accessed/indexed and classified, so that
it is available for reference by researchers, action initiators
and health activists. A guide to this collection is being
prepared.
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8. Participatory ^ansoement?
The participatory and flexible management style of C.H.C. □ill be
continued but adapted to the new organisational structure.
Simultaneously the salary-security system for staff of the
Society will be made more realistic in the context of longer term
involvement by team members.
9.
’Learning’ from the experiment:
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Documentation of the ’Learning experiences’ and ’perspectives
gained’ by the C.H.C. team during its 5 year study-reflectionreports focussing
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action-experiment is an ongoing task. Shorter
initiatives
are being
on Ikey themes from the wide-ranging C.H.C.
as
well.
put together and uill be suitably animated
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