CHRISTIAN MEDICAL ASSOCIATION OF INDIA COMPREHENSIVE EVALUATION EXECUTIVE SUMMARY
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CHRISTIAN MEDICAL ASSOCIATION OF INDIA
COMPREHENSIVE EVALUATION
EXECUTIVE SUMMARY - extracted text
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CHRISTIAN MEDICAL ASSOCIATION OF INDIA
COMPREHENSIVE EVALUATION
EXECUTIVE SUMMARY
1997
A. PADMANAHHA
CONSULTANT- COORDINATOR CMAI EVALUATION
MANAGEMENT CONSULTANT
BANGALORE
PROF. P. RAMACHASDRAN
CONSULTABT CMAl EVALUATION
DIRECTOR IMSTITUTE FOR COMMUNITY
ORGANISATION RESEARCH, MUMBAI
DR. SUKANT SINGH
CONSULTANT-OFFICER-IN-CHARGE
CMAI - BANGALORE
J
2
CONTENTS
Part A : findings and recommendations
Page Nos.
Preface
3
Acknowledgements
4
Members of cmai evaluation advisory committee
5
Chapter I - The study and Strategy
6-7
Chapter 11 - Past and the Present
8-26
A. Down memory lane
B. Current Programmes and Activities
Chapter III - Emerging realities - cmai functions
A. Objectives
B. CMAl’s Regular Activities
C. Formal Training Programmes
D. Serving the Christian Interest
E. Gender Bias
F. Expected Benefits from CMAI
G. Members Institutional Challenges for CMAI
RESPONSE
H. Strengths of CMAI
I. Weaknesses of CMAI
J. Fund Raising
K. The Future Scenario
Chapter IV - Cmai’s Organisational form
A. Membership of cmai
B. Sections and Their Effectiveness
C. Financial Management
D. Management Se-tup, Style and Form
Chapter v - The Pointers
A. Evaluation Terms of Reference - Findings
B. Recommendations Prioritised
8
18
27-41
27
28
29
30
31
32
33
37
38
39
40
42 -52
42
43
44
48
53-68
53
59
Part B : selected data base for reference (basis for part A)
List of Charts and Tables Given in Part B
3
PREFACE:
The dynamics of an organisation compares well with a flowing river, deriving its
energising power from the catchment areas, traversing along its beaten path,
some times roaring, some times serene, dropping from heights, joining
tributaries, breaking new paths and enabling the parched lands alongside its
course to be productive, during its endless journey to fill the sea.
In these patterns of the river behaviour, the under currents of change taking
place flows unnoticed beneath its serene surface. It is difficult to realise this,
unless efforts are made to identify its natural course, the contour’s, the depth,
the erosion, the silt deposit, the swirls, the lands, the flora all along its banks,
and the forces deep inside. Collecting such valuable information alone can lead
to realisation of its full potential and to harness it to be more productive during
its journey to the sea.
Christian Medical Association of India (CMAI) is one such useful river
maintaining its continuous journey to fill the sea - The Kingdom of God through the corridors of the healing ministiy. The history of CMAI tells the saga
of its journey so far, depicting its response to the needs along its path, like that
of the river.
CMAI has stood the test of time for over 90 years, striving in its own way, to
relieve human suffering in different parts of the country, training personnel and
nurturing the Christian spirit in its endeavour to assist the healing ministry
through its members. Looking forward to celebrate its centenary shortly, CMAI
was rightly concerned about the impact of the sweeping changes in all spheres
of life breezing past at an increasing pace.
This report is a result of the decision taken by the Board of Management of
CMAI to assess whether and to what extent they have and are canying out their
objectives. Further, in the given set of changing environment, to take stock of
the situation as it obtains and to arrive at pragmatic approaches to maintain
and improve upon its assistance to the Healing Ministiy.
We were privileged to have had the opportunity to take a dip into this reputed
river and swim around to trace and identify the positive as well as the negative
currents in flow within and around it. More importantly, to recognise the
hidden wealth of its potential through the evaluation processes. It was an
exciting experience.
We do hope our findings will stimulate the CMAI fraternity to harness the
positive dynamic forces within and beyond, to cause a more copious flow
towards the sea - The Kingdom of God.
July 7th, 1997
PADMAKABHA,
RAMACHAMDRAN,
SUKAHT SIKGH.
4
acknowledgme:
QUR GRATEFUL THANKS TO:
FOR
l.CMAI
THE OPPORTUNITY TO BE ASSOCIATED
WITH THE STUDY AND THE SUPPORT
2. CMAI EVALUATION
ADVISORY & CORE
COMMITTEE MEMBERS
(LIST ENCLOSED)
THEIR TIMELY AND VALUABLE
ADVICE WITH ENCOURAGEMENT
AT VARIOUS STAGES OF THE
STUDY
3. MS. ANNIE SOANS
MS. AMMURANI
MS. MALA
MS. MANIMEGHALAIPAULRAJ
MS. SUZANNA
THEIR DELIGHTFUL
DEDICATION, COMMITMENT fc SUPPORT
4. MR. PAUL RAJ. S
HIS READINESS TO HELP &
PARTICIPATE IN THE STUDY
MR VARUGHESE K. MANI
MR JALAL MASIH
DR SHADLENDRA AWAIT
PARTICIPATION IN THE STUDY
5. MR JACOB BERNARD
MS. ELSY JOHN
MS. KUMUDINI VINOD
MS. MERCY JOSE
MR RAJAN. K
MS. SARASWATHL D
ADMINISTRATIVE SUPPORT AT
BANGALORE
6. MR J.F. THOMAS
MR BABYKUTTY
ALL HELP FROM CMAl DELHI
7. MS. GEETHARAO
(JOURNALIST)
TRACING THE HISTORY
8. MR GEORGE KOSHI
(CONSULTANT)
FINANCIAL MANAGEMENT
EVALUATION REPORT
9. MR MAURICE A COUTINHO
SUPPORT FROM ICOR, MUMBAI
10. ALL RESPONDENTS
THEIR COOPERATION fc
CONTRIBUTION
11. REV. DR IPE JOSEPH
GENERAL SECRETARY -NCCI NAGFUR
PROVIDING ACCESS TO NCCI ARCHIVES
12. DR RAVI NARAYAN
SECRETARY - COMMUNITY
HEALTH CELL, BANGALORE
ALL HELP EXTENDED
13. DR CHERIAN THOMAS
GENERAL SECRETARY - CMAI
NEW DELHI
EVERYTHING
PADMABABHA, RAMACHANDRAH, 8UKANT SINGH.
5
I
MEMBERS OF CMAI EVALUATION ADVISORY
COMMITTEE
DR. P.3.8. SUNDER RAO
-FORMER PRESIDENT OF CMAI
DIRECTOR, SCHIEFFELIN LEPROSY RESEARCH a
TRAINING CENTRE, KARIGIRI.
DR. CHERIAN THOMAS
-GENERAL SECRETARY OF CMAI
DR. V. BENJAMIN
-RTD. PROF. AND HEAD OF THE COMMUNITY
HEALTH DEPARTMENT CMC - VELLORE .
PRESIDENT SOCIETY FOR COMMUNITY HEALTH
AWARENESS RESEARCH & ACTION
DR. C.M. FRANCIS
-FORMER DEAN, TRIVANDRUM MEDICAL COLLEGE
&ST. JOHN'S MEDICAL COLLEGE.
DR. ABRAHAM JOSEPH
-DIRECTOR, COMMUNITY HEALTH AND
DEVELOPMENT, CHRISTIAN MEDICAL COLLEGE,
VELLORE
REV. A.C. OOMMEN
-FORMER DEAN, RELIGIOUS WORKS DEPARTMENT,
CHRISTIAN MEDICAL COLLEGE, VELLORE.
DR. DESMOND A. D'ABREO
-CONSULTANT, INDO-GERMAN SOCIAL SERVICE
SOCIETY, LODHY ESTATE, NEW DELHI.
PROF. P. RAMACHANDRAN
-RTD. PROF., TATA INSTITUTE OF SOCIAL SCIENCES.
DIRECTOR, INSTITUTE FOR COMMUNITY
ORGANISATION RESEARCH, MUMBAI
MS. PADMASINI ASURI
-NUTRITIONIST AND CONSULTANT, ADVISOR TO
DANISH INDIA DEVELOPMENT AGENCY FOR
WOMEN, YOUTH TRAINING AND EXTENSION
PROJECTS.
MS. SARAMMA SAMUEL
-RTD. PRINCIPAL, P.G. INSTITUTE OF NURSING
EDUCATION, CHANDIGARH
PRESIDENT, TRAINED NURSES ASSOCIATION OF
INDIA THIRUVANANTHAPURAM
DR. (MRS.) NIR MALA MURTHY
-DIRECTOR, FOUNDATION FOR RESEARCH IN
HEALTH SYSTEMS, AHMEDABAD
DR. K.C. ABRAHAM
-DIRECTOR, SOUTH ASIAN THEOLOGICAL RESEARCH
INSTITUTE, BANGALORE
MR. A. PADMANABHA
-MANAGEMENT CONSULTANT - BANGALORE
DR. SUKANT SINGH
-CONSULTANT-OFFICER IN CHARGE, CMAI,
BANGALORE
PART-A
Findings & Recommendations
CHAPTER I
THE STUDY AND THE STRATEGY
6
A) The Board of Management of CMAI having taken the decision for a
comprehensive evaluation of the organisation, set up an advisory
committee and a core committee to put in motion the evaluation process
in April 1995. After due deliberations, the committees agreed upon the
terms of reference for evaluation as under :
1. What have been the activities of CMAI to achieve its mission, vision,
goals and objectives as enuniciated periodically from its inception, and
particularly during the last decade? How and to what extent has CMAI,
as the health wing of the National Council of Churches of India, been
able to serve the Church in its Ministry of Health, Healing and
Wholeness?
2. What have been the contributions of CMAI towards the newer concepts of
health care and innovative interventions ?
3. How far has CMAI been able to coordinate and make relevant the various
training programmes in the Healing Ministry medical, nursing,
paramedical and others ?
’
4. Two important functions of CMAI have been identified :
a) Building spiritual, professional and social fellowship among the
members.
’
b) Promoting social justice, total well being, family welfare, and
building health communities.
How far have these been achieved ?
5. What is the likely future scenario affecting the health of the people ?
What will be the major changes ? What are the opportunities and
threats? How can CMAI meet the challenges and make use of the
opportunities and help the Church to respond effectively to the changes ?
6. The following additional dimensions were added subsequently in April
1996, for coverage by the evaluation to the possible extent;
a. Whether Gender Bias in India was a social justice issue ? If yes,
what are CMAI and Churches doing about it
b. Review of CMAI organisational structure.
B) The terms of reference were operationalised by the study team, into the
following objectives :
1. To trace the history of CMAI from its informal beginnings in the 189Os,
when the seeds of the organisation were sowed, to 1995 when the
decision to undertake this evaluation was taken, and focusing on its
direction of growth, of services over the years.
2. To undertake critical examination of CMAI performances in the last five
years vis-a-vis its constitutional obligations and especially programmes
and activities and ascertaining the views of its members - both
mdividuals and institutions, as well as other ‘actors’ who could be having
a role on effectiveness of CMAI .
°
7
3. In the light of the critical understanding of the past and present work of
CMAI and keeping in sharp focus the evolving scenario in the health field
within the socio - economic - political climate, to recommend to CMAI
various options before it, for further growth and continuation as a
pioneering institution in the country.
Relevant information for fulfilling the objectives of evaluation was gathered
through a four pronged approach detailed below :
1. Interactions with members of the five sections, and office bearers of the
CMAI, provided the necessary base for construction of appropriate
instruments of data collection from a variety of respondents;
a) Individual members
b) Institutional members
c) CMAI staff
d) Top officials of Churches of various denominations
e) NGOs (other than members)
f) Government Officials
g) Educators from Nursing and AHP training institutes affiliated to CMAI.
2. The responses obtained were <critically reviewed and deliberated upon at ;
a) Five workshops held for individual members and
b) Workshop for Institutional members
c) Consultation with the office bearers of CMAI
d) Periodic review by the evaluation advisory committee and the core
committee.
3. Additionally, secondary data were sourced and collected from the
National Council of Churches in India, Nagpur, CMAI library. New Delhi,
United Theological Library, Bangalore, The British Library, Bangalore,
Community Health Cell, Bangalore, Foundation for Research in Health
Systems, Ahmedabad and Bangalore.
4. All data were subjected to computerisation to facilitate processing and
analysis of the voluminous information
The respondent profiles are appended in Part B.
8
CHAPTER II : PAST AMD PRESENT
A. DOWN MEMORY LANE : A CHRONOLOGY OF EVENTS IN THE HISTORY
OF CMAI
Like all big ideas, the beginnings of the Christian Medical Association of
India (CMAI), were very modest. Perhaps the very first members never ever
imagined that the Association would take firm root, develop into such
stature and standing, influence events and estabfishments, or direct several
programmes. At that time its mission was evangelism coupled with service.
That the Association had to weather many a storm, and lose some of its
importance sometimes, and carry on nevertheless, in its ninety odd years of
eventful existence was perhaps inevitable. The fluctuation of fortunes,
brought about by the wheels of change have not always been to the liking of
many institutions of long standing.
Prom its origin to the present, the CMAI has been witness to two world wars,
the rise of nationalism and
Independence of India, the partition, its
aftermath, and democracy in India. At some points, it has enjoyed the
support of the Church. It has experienced its neglect or oversight too. It has
also witnessed the movement of union among churches in India, the
formation of the Church of South India, Church of North India and the shift
of ownership of centres of healing from overseas mission boards to the
Indian Church. The association has had many occasions to rethink, to
introspect, to replan and to change its course in accordance with the
vagaries of the times.
The history of CMAI may he reckoned in five phases of significance :
Phase I : 1905 - 1925, Phase II : 1925 - 1947, Phase III : 1947 - 1963,
Phase IV : 1963 - 1983 and Phase V: 1983 to date
1. PHASE I : 1908-1925 - THE BEGINNINGS AND MEDICAL INITIATIVES
This phase started with the very formation of the Medical Missionary
Association (as the CMAI was then called) in 1905, and spread over a span
of 20 years to culminate in the change of the name of the association to
Christian Medical Association of India. The CMAI was registered as a non
profit charitable organisation in 1926.
This period was one in which the spotlight was on the formation and
organisation of the Association, though, alongside, there was attention given
to medical work too. During the phase, the CMAI had an amicable
relationship with the Church.
9
The first reference to CMAI is made in 1905. However, the background to
the association goes back to the time when missionaries were being sent by
their Churches to India, “to preach, teach and heal,” and to establish the
Kingdom of God in India using their skill in relieving human suffering.
Missionaries were also sent for medical relief work from countries like the
USA, Canada, the UK, Norway, Sweden, Denmark, Germany, Australia and
New Zealand.
Working so far away from each other (in India, Burma, Sri Lanka, Pakistan,
Bangladesh and China) limited the interaction between these medical
professionals. They therefore wanted to get together to exchange views and
to discuss issues in their field. There were no formal meetings at this stage.
It was only later that the idea gathered momentum, and was translated into
a formalization of the Association. Thus, the Medical Missionary
Association, or MMA as it was then called, was bom in 1905. Later, in
1912, it was suggested that the Association be brought into organic relation
with the National Missionary Conference Council (the present NCCI).
Provincial sections of the same Association could be related to the Provincial
Representative Councils.01 Dr. Wanless of Miraj Medical School became the
first Secretary of the MMA and its first treasurer. The Association launched
its own quarterly journal of which Rev. J.M. Macphail was Editor.
Medical Work
During this phase, there was some attention given to Medical work too. The
CMA reported in medical missions, gathered information on happenings,
research and development in the Medical field.
Regarding Tuberculosis, the concern of the CMA had its impact in the
establishment of several sanatoria, the most important one being the Inter
Mission Sanitarium at Madanapalle in 1914. This initiative, with
components of research, training, promotion of knowledge and skills, has
been recognized by the government.
Emphasis on village work, public health and preventive medicine also was
given early in the history of the CMAI.
As early as 1912, the medical missionaries showed an interest in the area of
ophthalmic work. It was considered necessary for all preparing for medical
work to undergo special training in ophthalmic and general surgery, and in
diseases special to the tropics. Regarding work with the feeble-minded, Dr.
Lankester in 1915 reported on the need for institutions for the control and
care of such children.
O1 National Council of Churches in India - Extract: 1, Page 30
10
CMAI - CHURCH AXIS
Leprosy too received the attention of the Association as early as 1917. The
MMA emphasised upon the local government the importance of enforcing
the regulations regarding segregation of lepers.
By 1917, the Secretary of the MMA was presenting reports on Medical work
at the NMC Conferences. Finally in 1925, the NMC accepted the MMA as the
Medical Committee of the Council. Important changes were made in the
constitution of the Association. Accordingly, Christian doctors who were not
missionaries became members. The MMA’s name was changed to CMAI or
Christian Medical Association of India.
2. PHASE II : 1925-1947- APEX ROLE - CMAI ESTABLISHED
FOCUS ON TRAINING IN PREVENTIVE MEDICINE
If the first phase (from 1905 - 1925) sowed the seeds for future medical
work, the second phase in the history of the CMAI spanning a little more
than twenty years actually saw the firution of such activity. The second
phase placed prime focus on medical education, training, Institution
building Hospital management, primary health care and preventive
medicine: CMC Vellore scaled new Jheights despite crisis. Nurses Auxiliary
grew from strength to strength, hospital management: was given a
professional approach, training of nurses and allied health professionals
assumed importance, fresh paths were taken in preventive medicine and
Community Health. Many of these secured attention as a direct result of the
Survey of 1925.
Some major events and one person dominated the scene during this span.
One event was the stabilization of the college at Vellore, in which CMAI
played a very significant role. Another event was undertaking the epoch making survey of efficiency and co-operation, under the instruction of the
CMAI and with the approval of the NMC. The person who worked
indefatigably almost throughout the twenty years, offered leadership and
direction to the CMAI and medical matters was Dr. B. C. Oliver.
Alongside, CMAI also continued to play the role of reporter on medical
missions and to serve as a forum for fellowship and exchange of information
for medical professionals.
THE SURVEY
The Survey was mooted in 1925 out of a concern for the lack of method in
medical work. It was to clarify the aim of medical mission work and “to
investigate its efficiency, its relation to other medical aid and to the needs of
the whole field.”
11
What was obvious from the survey was a lack of medical policy. It threw
light on various aspects of medical work. Its findings seem to have been a
turning point for Medical Mission Work, with a more focussed approach
thenceforth.
THE NURSES AUXILIARY
Nurses felt the need for an organisation of their own as early as 1911. It was
felt that a graduate Nurses’ Association should be formed within each
Hospital or Mission, by means of which a fellowship could be maintained
with those in other service.®2 Finally, the Nurses Auxiliary of the CMAI was
formed at the conference at Arogyavaram. By the middle of Feb. 1931, the
actual formation of the Auxiliary took place. 3
Dr. Frimodt Muller, the Chairperson of the CMAI in 1933 observed that “the
Church in India should take up the ownership of the healing ministry The
pioneering day of overseas mission boards is almost over.” Consequently,
the local Church rose to the occasion to own medical mission in India
TRAINING AND STANDARDIZATION
CMAI continued its effort in training and standardization. By 1944, the
CMAI had standardized the technician training course and provided for a
diploma after examination for hospital technicians. This was considered a
pioneering service in India.
THE FIRST CEO AND NCCI
For the first time a full time Secretary of the CMAI was appointed in 1933
Dr. Oliver also became the Secretary of the Medical works of the NCCI
paving the way for a closer relationship between the two.
By 1940, Hospital Sunday became an annual event to celebrate and pray for
mission hospitals and the healing ministry of the Church. The hospital
supply agency was set up to provide reliable drugs.
With the induction of Nursing administrators in mission hospitals, initiative
was taken for the formation of the Indian Nursing council in India. Other
achievements around this time were a post-graduate course in nursing
1946.
*
UPGRADED MEDICAL EDUCATION FOR MEN - A CMAI INITIATIVE
It was during the second phase, that the CMAI’s brainchild, a medical
college for men was mooted. Both the Christian Medical Colleges at
Ludhiana and Vellore were established exclusively for women. The Miraj
Medical School trained men only to be hospital assistants. The need was
therefore felt for a Christian Medical College for men.
02 National Council of Churches in India - Extract 21, Page 16
03 National Council of Churches in India - Extract 37, Jan 1933
12
Initially, it was decided to start the College at Allahabad. Later, an
amalgamation with the already established Christian Medical College at
Vellore, was preferred. After much discussion and negotiation, with CMC
(Vellore), finally, 1947 saw the admission of male students there.
In the entire exercise, CMAI played the role of initiator and negotiator. It was
the dynamism of the CMAI that saw the resolution of the crisis°4 at Vellore.
3. PHASE III : 1947-1963 - THE STABILIZING ERA
THRUST - INDIANISATION, EDUCATION - PREVENTIVE MEDICINE
With India gaining independence, many changes were brought about in the
history of CMAI. The strong missionary hold on foreign institutions was
Indianised.
The time span of sixteen years (from 1947 to 1963) was notable for CMAI’s
thrust on fighting tuberculosis, upgrading Ludhiana, training in pharmacy
and paramedical courses in preventive medicine.
This was also a period in which the CMAI enjoyed a close association with
NCCI, sharing its office space at the council lodge with the new head
quarters of the CMAI established at Nagpur.
CMAI continued its roles of reporter on medical events, pioneer of medical
education and preventive medicine, resource mobilizer, and fund distributor
(with NCCI) for fighting Tuberculosis and for establishing paramedical
education.
In 1950, CMAI offered membership to Christian students studying
medicine. In 1953, the Christian Medical College at Ludhiana came into
being. It had started giving inportance to Family Planning and Sex
Education by 1963.
Dining the first phase (1905-1925), much work was done regarding
Tuberculosis. In the second phase (1925-47), importance to stabilization at
Vellore and other events eclipsed the work done on Tuberculosis. In the
third phase (1947-63), however, there was a resurgence of interest in the
field.
In 1948 the CMAI’s committee for training laboratory technicians drew a
detailed syllabus for the course, and extended the course from nine to twelve
months. Alongside, the number of training centres for X-ray technicians
increased from six to nine. Paramedicals became members of the CMAI
during this phase in 1961.
04 National Council of Churches in India - Extract 21, Page 68
13
Around this time, the focus shifted to preventive medicine and community
health. Indian independence had an impact on providing health facilities
and services on a mass scale. The CMAI too was involved with the
production of Jet series of Health Aids. This was subsequently recognized by
the UNESCO. Also, it was resolved that every Christian Medical institution
should include preventive medicine according to the need in its area.
The reorganisation of the CMAI took place in 1952. Regional Executive
Committees of the CMAI had now been set up in Bengal, Bihar Gujarat,
Northwest India, Mid India, Uttar Pradesh, Andhra and Tamil portions of
Madras, Kerala and Orissa. In most areas, these functioned as the Medical
Committees of the provincial council. Arrangements were being made to
estabfish similar committees with Regional Secretaries in Maharashtra,
Karnataka, Hyderabad and Assam.
TRAINING IN PHARMACY
The Government of India had intended to abolish the grade of compounder,
and to substitute a more advanced course for pharmacists. Since hospitals
could not teach the more advanced subjects, the training was to be imparted
<ft one the Christian hospitals.®1 CMC Vellore offered a diploma course in
pharmacy under CMAI’s influence in 1955.
Some breakthrough was made in the field of Tuberculosis. A joint
Tuberculosis fund was set up by NCCI - CMAI in" 1955 to raise and
distribute funds to fight against Tuberculosis.
Towards developing Primary Health Care workers at the grassroots level,
community health guides were trained in 1956 in partnership with Christian
Fellowship Hospital, Oddanchatram and the Madurai Ramnad Diocese of
the Church of South India.
October 1955 saw the moving of the CMAI Secretaries into the NCC office in
Oliver House Nagpur. In 1957, Dr. Claine Thomson, former acting Secretaiy
of the CMAI, became the Secretary of Preventive Medicine of the Association.
She shifted her office to Nagpur in 1958, for purposes of centralization of
the Secretariat.
Attention was beginning to be given to Family Planning at this stage It
considered the strong recommendations made by some state governments
on sterilization as a method of family limitation. It also appointed a special
committee made up of doctors, nurses, social workers and clergy to make
recommendations regarding the subject.
1960 reported a definite concern regarding family planning among Churches
in India. “Sterilization as a method of family planning” was under study.
01 National Council of Churches in India - Extract 66, Page 35
14
In 1960, a request was made from nineteen paramedical workers [This
section belonged to the MMA from the very beginning] to form an
organisation for themselves along the lines of the Nurses Auxiliary. Approval
was given for the formation of the section.02 The term “section” was to be
used instead of “auxiliary”. By 1962, the number of paramedical members
increased to thirty one.°3
The field of Preventive Medicine continued to do good work with visits to
hospitals, talks, and production and supply of health aids.
In all, the period was one in which CMAI notched up several achievements.
4. PHASE IV : 1963- 1983 THE FAMILY PLANNING ERA ■ CMAI - NCCI
COMBINED COMMITMENT
At the beginning of this phase, the Nurses Auxiliary became the Christian
Nurses League. In 1964, the Nurses Auxiliary became the Christian Nurses
League. It was around this time that CMAI became known for its Family
Planning Programmes. In fact, the programme dominating the span of
seventeen years, was spearheaded by CMAI, collaborating with the
government and NGOs . The CMAI Family Planning Project was started at
Ratlam in 1966 under Mr. Jessy Russell. It was transferred to Bangalore in
1967. Dr. Isaac Joseph became its first Medical Director in 1969 under the
section of preventive medicine. Financial support from Sweden continued up
to 1983, when the funds dried up. However, in those seventeen years, much
work was done in this area. Since funds were in plenty, the CMAI attracted
many institutions and individuals who joined the Association and became
its members. The CMAI also conducted many training programmes on
Family Planning. The government too focused on Family Planning from the
late sixties to early seventies. So, CMAI assisted the government in its
Family Planning Programmes. Thus, it carved a niche for itself in this area
of service.
In 1973, the NCCI - CMAI joint project on planned parenthood was
launched. Since institutional membership had started in 1971, many CMAI
member institutions launched community health programmes. The
Association was aware that Medical care at established hospitals were
expensive. Because of this, people turned to community health. Therefore,
during this phase, there was a conscious and deliberate decision to
abandon the existing model of an urban and elitist centered health care and
to create instead a viable and economic alternative suited to the needs and
conditions of millions of our people who had long been neglected and
forgotten.01 CMAI performed an advisory role with its member institutions. A
notable event in the history of the Association during this phase was
02 National Council of Churches in India - Extract 79, Page 20
03 National Council of Churches in India - Extract 77, Page 44
01 National Council of Churches in India - Extract 100, Page 47
15
institutional membership in 1971. CMAI amended its constitution to include
institutional membership in 1970.
In 1972, the preventive medicine committee was fused functionally with the
Family Planning Committee with full integration of activities. Thus, it
became the Community Health and Family Planning Project. In 1980, for
greater unification of the Community Health and Family Planning Project
with the CMAI, Dr. Daniel Isaac moved to Bangalore and a separate
Treasurer was also appointed that year.°2
Several grants from abroad were to be stopped in 1973 or 1974. It implied
that NCCI would face a financial crisis.°3
In 1975, the Association advocated a three - tier health delivery pattern
involving effectiveness, efficiency and viability. In 1976, the CMAI completed
fifty years of service to the nation as a voluntary health agency of the NCCI.
The Vice-President of India inaugurated the function where thirty fraternal
delegates and eight hundred national delegates were present. By now, CMAI
had assumed an advisory role to institutions.
At that time, CMAI had four kinds of membership besides institutional
membership, individual membership came from Christian Physicians,
nurses, paramedicals and Hospital administration sections. Each section
had its own chairperson and secretary.
Besides institutions, since 1972, the Central Ministry too approached the
Christian Hospitals to assist the government in meeting the health needs of
the rural community.
In 1977 it invited all voluntary health agencies including the CMAI to
examine means for promotion of health and, family planning. In the
preceeding three years, CMAI had planned with institutions for their
development.
CMAI continued its thrust on itraining,
* ‘
in laboratoiy
radiography, medical record technology and Hui'sing.
technology,
The experience of the joint programme carried on by the NCCI and CMAI on
planned parenthood was published in a book entitled as "Family in the
purpose of God” in 1979.
Child survival programmes were also focussed on up to 1980.
In 1980, the executive committee decided to evaluate the CMAI - NCCI, joint
project. The CMAI executive committee accepted the evaluation committee’s
recommendation to wind up the project as it was on Dec. 1, 1980.
02 History of CMAI - draft by Dr. Desmond A. D’Abreo - 1996, Page 37
03 National Council of Churches in India - Extract 81, Page 20
4
16
Finally, financial support for CMAI’s Family Planning Programme stopped in
1983.
Hospital administrators were invited for the first time to the fellowship and
the hospital administrators section came into existence.
5. PHASE V. 1981-TO DATE - NEW INITIATIVES - ASSET FORMATION
From 1980 onwards, it was yet another turning point in CMAI initiatives
than in its earlier years. CMAI continued to be a related agency of the
council.
The major event that dominated the period after 1980 to date, has been the
CMAI’s efforts in the community based health programmes and special
focus on AIDS with the formation of an AIDS Desk contributing to training
of doctors and professionals to combat HIV.
Though the emphasis remained on AIDS, some Family Planning
programmes were continued by the Association. Therefore the Family
Planning programmes were merged into its main activity in 1984 and the
preventive medicine section assumed a new name - Community Health
Department in 1986.01
In 1986, the CMAI instituted the Chaplains Section under which Chaplains
became members of the Association. This was done mainly to fill an
observed void in the healing ministry. Doctors and Nurses continued to
work at physical healing in a patient, but psychological and spiritual
aspects seemed to be amiss. Hence, Chaplains whose primary concern was
to provide for spiritual healing were admitted as members.
EFFORTS TO COMBAT AIDS
Around 1993, CMAI perceived the need to work in the field of AIDS, and
turned its attention towards it.
The HIV was first discovered in 1986 in Tamil Nadu. This spurred the
Association on to start the AIDS desk in 1993 under the Department of
Community Health. The desk provides training to Doctors, Nurses,, AHPs
and Pastors. The Desk designed a Blue print for its AIDS programme: “ Case
detection, prevention, control and management at all levels from Community
layman level to experts at the top in Medical Colleges.”
Based on the blueprint, doctors were trained at Vellore at the departments of
Microbiology and Virology in blood safety and blood banks. The government
too supported the programme. Subsequently, CMAI conducted a training
programme for fifty five District Medical Officers and Senior Physicians of
Mission Hospitals.
01
History of CMAI - Draft by Dr. Desmond A. D’Abreo - 1996, Page 93
17
It also conducted a programme at Vishwa Yuvak Kendra, Delhi, funded by
the Government of India, with facilitators from Geneva and Africa who were
sponsored by WHO.
Further, in 1992, WHO requested the Association to provide training at the
National level. After this, in 1993, CMAI sent twenty two trainers to
Zimbabwe and Uganda, where they visited nine Church related hospitals
and provided training, which was supported by the Government. In 1993,
CMAI conducted Regional Workshops, through which 1228 physicians were
trained in HIV control and prevention in four phases in a period of six
months. Later, it concentrated on training lab technicians on HIV screening
In 1994, the AIDS desk conducted a two-day Workshop for nurses at
Kolencherry in Kerala.
CMAI’s efforts in the field are now recognized by all health directorates in all
districts.
Rev. A.C. Oomen in “The Role and Vision of CMAI as we prepare for the 21st
Century” which he submitted at the 33rd Biennial Conference in 1994,
reflects the position of CMAI now.
CMAI made good progress in asset formation through investments in useful
real estates and wise financial management. These actions have helped to
stabilize the Association with its own asset base. The Head Quarters of the
CMAI was established at New Delhi. The community Health Department got
established, the Communication Centre was initiated, and the association
got more involved with people, starting programmes and commenced
addressing several issues in the society relating to health.
B. CURRENT PROGRAMMES AND ACTIVITIES
CMAI 1991 ■ 1996-AN APPRAISAL
18
BACKGROUND
CMAI implements its activities and programmes largely through its formal
set-up of:
1. Sections
2. Community Health Department
3. Regional Secretaries
4. Area Offices
Whereas the structure in sections and regions have remained unchanged>
there has been changes in the Community Health Department and area
offices. These changes occurred when the need arose.
Two area offices at Delhi and Bangalore operate under the leadership of
their respective Area Manager entrusted with the responsibility of promoting
all activities of the CMAI, including
monitoring projects under the
Community Health Departments . The area office infiastructure is as
follows:Area Manager
4/
Assistant Area Manager
4/
Three Programme Development Officers
CMAI ACTIVITIES - 1991-1996
On analysing the activities carried out during the period 1991 to 1996 the
following are observed: Each section is under the leadership of a hill time
Secretary and is supported by the respective Executive Committees’ advice.
DOCTOR’S SECTION
The section organised three National sectional conferences, twelve
workshops on rational drugs and other topics of professional interest to
doctors. Apart from this only two retreats were conducted in 1996.
NURSES SECTION
During the period, this section organised three national sectional
conferences, one regional retreat exclusively for Nurses and only 2
workshops and two retreats at the National level. (Detailed report on Nursing
Education is appended at the end of this section).
HOSPITAL ADMINISTRATION SECTION
The Administrators section organised sixteen workshops during this period,
most of which are on specific topics as personnel management, finance
management and material management, besides five National workshops on
health and hospital management. It also held three National sectional
conferences.
19
ALLIED HEALTH PROFESSIONAL SECTION
This section has been able to organise a total of nine iretreats
'
only
during 1991- 92. Twenty five workshops were conducted of which ten were
during the year 1993. Three national sectional conferences were held .
CHAPLAINCY SECTION
This section organised ten retreats during the six years , five in 1991 and
five in 1996 and none in the other years. They conducted 420 visits to
institutions within six years, organised fifteen programmes exclusively for
medical students and twenty four seminars region wise most of which were
held in 1994.
COMMUNITY HEALTH DEPARTMENT (CHD)
The Community Health Department through the two area offices have been
able to conduct sixty four sessions of informal training to promote the
knowledge and skill of health workers involved in community based health
delivery systems most of which were held in 1993 and 1994. The CHD
conducted eighty nine workshops during the six years which seems to have
gradually picked its momentum from no workshops in 1991 to twenty nine
workshops in 1996. These workshops covered topics like Sustainability of
Community Based Projects, Writing up project proposals, Monitoring of
Primary Health Care, AIDS Management and Prevention of HIV Infections,
Concientisation of congregations on Emerging Health Issues, Women
empowerment and Development, Addiction
and Counselling etc. Six
meetings of the Chief Executive Officers of our member hospitals and four
meetings of Church leaders were organised to publicise the programmes of
the CMAI and identify areas where CMAI can participate as a partner with
church groups in India to promote the Healing Ministry.
It is also noticed that there has been no forward annual planning in the
CHD. Activities and programmes are organised in response to a need and
demand made by projects, progammes and member institutions.
Analysing both the sectional and other activities of the CMAI, it appears
that many more activrties can be initiated by Sections and Community
Health Department to reach out to the grass roots level i.e. congregations,
hospitals and people. There is a need to develop more intensive link with
people to involve them in healing ministry of the church. An analysis of the
region wise activities makes the point obvious.
REGIONAL ACTIVITIES
Under the mitiative of regional honorary Secretaries, regular Regional
Conferences were organised every two years in each region, with the
exception of Gujarat, Rajasthan and M.P. Other activities like workshops
and retreats are barely held except in A.P., Karnataka, Kerala, Maharashtra
and North East India. As a matter of fact, no retreats, workshops or
seminars were held during these years in Gujarat, Rajasthan, M.P. , Orissa
and West Bengal.
20
There is adequate scope to work out well planned time specific need based
programmes to promote fellowship and professional skill at regional level,
with the CMAI infrastructure especially at the sectional level. The
effectiveness of activities organised by sections and community health
department are not by and large assessed or reported. Several efforts were
made by the Community Health Department to initiate, assist and promote
member institutions and congregations in various community based
activities in the countiy. It is gratifying to note that out of 197 Community
Based Projects, initiated by the Community Health Department, 132 are
continuing and serving
the community after the financial help was
withdrawn by CMAI. This works out to be more than 60 % . Results of
evaluation conducted on specific projects of the CMAI are as follows
1. COMMUNITY BASED FAMILY PLANNING PROJECT OF THE CMAI
(1987- 1992)
Out of twenty four Micro Projects initiated in 1987 almost all are continuing
the programme in the field.
Recommendations from the Evaluations are :
a. The project has potential to serve even greater population.
b. The CMAI should explore ways to increase the project’s cost
effectiveness.
c. The CMAI should find ways where the project may sustain its family
planning programme after the financial support is withdrawn.
d. Integration of family planning into other health out reach programme
of the hospital or securing funds from the community or from the
govt, or other partners to continue the project.
2. COMMUNITY BASED PRIMARY HEALTH CARE PROJECT
(CBPHC 1988-1994)
The CMAI was involved in educating training and providing assistance, to
enable the member institutions to understand and take up community
based primary health care as one of their programmes. This project was
directed to provide technical and financial assistance to members enabling
them to reduce morbidity and mortality among women and children in
select communities, and there by to enhance the survival of children and
social development of the people. The strategy involved is FIONA PLUS.
FIONA stands for Famify planning, Immunisation, Oral rehydration therapy.
Nutrition education and Vitamin A, and the PLUS stands for other
components in Primary Health Care such as water supply and sanitation
etc.
Out of 60 Micro Projects sanctioned by the CMAI, twenty five have survived
till date despite withdrawal of CMAI financial support. On evaluation of
these projects, it was observed that:
a. Understanding of community Health in most members has been as
primary health care or as primary health and development of
people.
21
b. The concept of community empowerment and people’s
participation is still new for many.
c. The CBPHC project has established good primary health care
system focusing on mother and child care and an appropriate
model in Fiona Plus.
d. Some micro projects have begun social and economic activities
either with government funds or funds from other agencies
e. The project has benefited greatly and community participation has
been good.
The evaluators have recommended that micro projects which are striving for
sustainability should be further supported with funds, technical and other
services of the CMAI. Where the process of enabling and community
empowerment are not in evidence and top down approach was evident, such
projects were recommended for closure.
3. CHILD SURVIVAL AND CHILD DEVELOPMENT PROJECT
a) First Phase (1988 - 1991)
This Project which was initiated in 1988 with a commitment to help
congregations and non-medical Christian
social and d evelopm ent
organisations, has gone beyond the tradition of helping only institutional
members of CMAI. Thirty nine micro project holders were invited to take up
this programme. Thirty one are continuing this project even after the CMAI’s
assistance was withdrawn. The objective was to promote knowledge and
skill of implementing agencies in child development and growth in order to
effect reduction in morbidity and mortality among children especially under
five years in a chosen community.
The evaluator observed at the end of three years of these projects that,
i. This is a successful innovative programme in community health
and
ii. It has been a new experience for the CMAI in promoting health
with non-health groups who have not dealt with health matters so
far.
iii. This is a well conceived concept having freedom and flexibility
which helped non-health agencies
iv. That the expectations in health return within a short time of three
years, having responsibility for training and monitoring health
activities centrally, has been helpful.
b) Second Phase ( 1994 - 1997)
Since the evaluation reports of the CSCD projects showed that it is a
successful innovative programme, another set of twenty five new CSCD
micro project were taken up during the subsequent years starting in 1994.
Mental development of the child as one of the important components was
recognised and included.
22
4. WOMENS HEALTH AND DEVELOPMENT
CMAI has been favourably biased towards issues relating to women such as
women health and development. It is recognised that a perspective plan for
women’s development
within CMAI should be related to the plan
perspective for national development. A decade debate on women and
development has culminated in the national perspective. The staggering
figures available with us is an evidence of lack of equality and vulnerability
of women. Over 70 % of women are illiterate, 90 % women are working in
the unorganised sector, 65% of pregnant mothers are anemic. One out of
eighteen mothers die out of delivery etc. This led the CMAI to focus on
women s health and development project in 1986. This has been a training
and technical assistance programme besides financial assistance aimed at
improving women’s health standards, economic status, and the literacy
level to bring about awareness about the political right and social status. In
implementing the programme, twenty member institutions were invited of
which fifteen are continuing the programmes after CMAI’s finance was
withdrawn. The evaluation of the project was done in 1991 and the
observations were as follows :
a. With limited extent of facilities existing within the institutions, there were
positive efforts towards implementing the programme for the welfare of
women.
b. Women who were isolated and silent observers, had come out of their
shelter to participate in the awareness programme through functional
literacy.
c. Some of the institutions had adopted programme contents to suit the
people and their culture and made it meaningful. The programme has
been helpful drawing the hidden potential in women even though few in
number.
d. Given the limitation of the institution, its structure and the legacy of
missionary approach, there were positive trends in involvement and
thinking away from curative care.
Recommendations made by the Evaluator
a. To recognise some long term and short term strategy and dialogue
with member institutions.
b. To initiate work for development of the community in an integrated
manner recognising the place of women in the development process.
c. To network with organisations which are involved in the same area.
d. To move away from top down approach of delivering services and
towards empowerment approach recognising the role of women in
development.
e. To utilise the need of women on which to build a service support base.
f. To identify indicators such as sex ratio, female infanticide, child marriage,
as well as non-quantifiable indicators to determine the status of women
which differs from one state to another. These exercises will help CMAI to
identify status and priority in which member institution would be involved
in the process.
g. To focus on women among low income group living in tribal and
backward areas, urban slums, migrant women, widows and destitutes
23
5. BIMAROU ASSISTANCE PROGRAMME
The health scenario appears bleak, and the biggest task facing an health
agency like CMAI and its members is to evolve a creative multidimensional,
multidisciplinary and people based response, to meet the challenges. India
is a vast continent with the prospects of 1000 million people at the turn of
century, with different cultural habits, languages, religious practices, beliefs
and life styles. As a national organisation, the CMAI is making conscious
effort to prioritize need based action plans depending on each institution, its
capability and capacity to deal with the problems. Hence, the following four
areas have been recognised for the thrust:
a. Geographical areas, BIMAROU states and North East India have
been recognised as priority states. BIMAROU stands for the states
Bihar, Madhya Pradesh, Rajasthan, Orissa and Uttar Pradesh.
b. Issue based programmes, such as empowering women and HIV infectionits prevention and Management and Combating Substance abuse, etc.
c. People oriented programmes such as urban slums, primary health care
programmes for people who are marginalised and programmes for
elderly and terminally ill, people suffering from AIDS , physically and
mentally disabled etc.
d. Promoting alternate systems of medicines which are safe appropriate
and available at grass roots level.
BIMAROU assistance programme is an outcome of the CMAI’s priority to the
people who need relief in the Country. In this programme CMAI is involved
in creating awareness among people relating to promotion of health and
development, educating people to start community based Primary Health
Care programmes in BIMAROU states.
Hence, the programme emphasises education on Family Planning, women’s
health, child care and promoting Socio Economic Development of the
Community with special focus on Womens Development. There are twelve
micro projects in BIMAROU area started in 1993. The programme is
initiated by the local church groups and was evaluated in 1996. The
Evaluator observed that :
a) Each micro project has been able to concentrate on different areas
like Agriculture, Education, Economic development. Most Projects
have tried to include some health work.
b) There is a need for back up support, supervision, appropriate
referral in all sectors in the programme
c) Project staff need to be provided with greater skills in
communications, Health Education, Community Organisation and
Management.
d) Issues relating to congregation based healing, health and
wholeness need to be more widely discussed in churches and
projects.
e) CMAI should continue to foster the micro projects even though
there may not be any financial commitment.
1
6. CHOTA NAGPUR HEALTH AND DEVELOPMENT PROJECT
24
More specifically as a people and the place oriented health and development
programme, Chota Nagpur Health and Development Project was initiated in
1995 in an area consisting of parts of Bihar, Bengal, Orissa and M.P.
Being recognised as most backward areas, with about 99 % tribal people.
Parameters of health and socio-economic status are desperately low,
compared to National level. So the CMAI has deliberately attempted :
a. To Promote Health and Development of people in partnership with the
church groups especially among tribals in this area.
b. To establish fifteen micro projects covering a population of 1,50,000
people.
The CMAI has been responsible to create awareness among people, train and
educate them from church groups in Chota Nagpur area, in establishing
community based health and development programmes. CMAI aimed at
training forty five leaders with technical, financial and administrative skills
to support rural community and to seek solution to their struggle to better
health and development. Seventeen micro projects were established in the
area so far. An interim study of this project shows that:
a)
Most of the church Heads/ representatives felt the project to be
helpful and that they should continue.
b) People are beginning to feel empowered. They “ feel good” about
themselves in what they are trying to accomplish.
c) Women are assuming more effective roles in committees and in the
community.
7. PROGRAMME TO COMBAT SUBSTANCE ABUSE
Considering the most pressing and emerging issues in our country, the CHD
made attempts to implement schemes for comprehensive health care and
combating substance abuse. Conscious efforts are made to respond since
1989 through :
a. Awareness building
b. Forming action group at regional and national level
c. Networking with other voluntary organisations
d. Establishing training centres on counselling
e. Establishing de-addiction centres
Workshops on “substance abuse” and training programmes on counselling
were started having two Post-graduate counselling centres on counselling
and substance abuse, at Kottayam and Calcutta. Other programmes are:
a. Substance Abuse prevention and management workshops
b. Regional ecumenical reflection on substance abuse
c. Formation of Christian agencies to combat substance abuse
network (CACSAN)
25
&
8. CONGREGATION BASED HEALTH CARE ACTIVITIES
CMAI’s mandate is to serve the church in healing ministry. It is committed
to help the church to understand and to cany out its mission of healing. Its
objectives is to help those who have lost their vision to re-discover it, to
enable those who have a vision to enter into relevant activities to promote
healing ministry. In order to carry out these objectives, CMAI has initiated
the programme called as Congregation based health care activities project in
1992. its activities are:
a. To reflect on Healing Ministry, its dimension and scope followed by
actions
b. To build awareness relating to the Health problems and needs in
the Community.
c. Educating and training the congregation to build its capacity to get
involved in bringing Health and Healing.
d. To develop leadership at congregation level to develop health team
concept
e. To help the congregations to initiate and sustain healing ministry
activities
f. To support congregations to promote the health, healing and
wholeness with technical, advisory support and in some cases if
necessary with small grants.
Fifty eight Workshops/Seminars for congregation members conducted in
and with church groups in India, focusing on emerging Health Issues, Role
of Congregation in Health and Healing, Project proposal writing, Monitoring
congregation based programmes etc.
9. To address specific Issues as emerged in the national scene, the CHD has
created two desks as follows :
a) AIDS DESK
This was established in 1992 with the following objectives :
i. To build capacity of our members for control of HIV infections by
training health workers such as doctors, AHP, nurses etc.
ii. Creating awareness in our network and among church groups in
collaborating with other sections of CMAI and desks and programmes
of CHD.
iii. To strengthen the ability of churches by organising meetings and
consultations with church leaders
iv. Control of AIDS infection in the hospital
v. Building up of CMAI data base on HIV infections
On invitation from the Government of India and with partnership of WHO
and NACO, this desk launched
programmes to
train 1500 senior
physicians from all over the country, collaborating with state and central
government offices. Eighty seven lab technicians were trained on Blood
safety methods from member mission hospitals.
I
26
Several consultations were organised with church leaders, helping them to
draw up policy statements on caring for victims of HIV infections. The
largest group for such consultation was from the Seventh Day Adventist and
Methodist church of India which met at Surajkund. CMAI also represented
at CHAI Workshops in designing the future policy of CHAI for control of HIV
Infections.
I
b) WOMEN’S DESK
This desk was installed in 1992 as a special concern for women in India to
address appropriately to issues relating to women.
1. To promote knowledge about existing problem relating to women in the
society in general.
2. To find suitable innovative method to meet special needs.
3. To empower women to organise themselves.
Topics like HIV and women, girl child, women literacy, medical termination
of pregnancy, early marriage etc. are taken up by the desk at different
forums. Bible study materials have been prepared on such issues and
networking with other NGOs is encouraged.
AREA OFFICE ACTIVITIES
Two area offices, one at Delhi and the other at Bangalore, are responsible to
implement all CMAI activities in their respective areas . In order to promote
CMAI activities, area offices are entrusted with the responsiblities of
making contact visits, problem solving visits to member institutions within
their jurisdictions and to organise programmes as per the directions of the
association.
I
CHAPTER III : EMERGING REALITIES
27
A. OBJECTIVES
The CMAI constitutional objectives are ;
1. Prevention and relief of human suffering irrespective of caste creed,
community, religion and economic status.
2. Promotion of knowledge of the factors governing health.
3. Coordinating activities for training Doctors, Nurses, Allied Health
Professionals and others involved in the ministry of healing.
4. Implementation of schemes for comprehensive health care, family
planning and community welfare.
5. Rendering help in calamities and disasters of all kinds
IMPORTANCE GIVEN FOR CMAI OBJECTIVES INDIVIDUAL MEMBERS AND STAFF PERCEPTION
8
H
h
81“
90-i— 5---
80 70-
60 50-
H
ii 2010--JJ
40 --1
30 - —j
g
£
SC
I
a
"iK
;l
J
■fw
I o 4—I
£
□ INDIVIDUALS
■ STAFF
OBJECTIVE 2 OBJECTIVES OBJECTIVE 4 OBJECTIVE 1 OBJECTIVES
Individual members and the staff of CMAI through their responses
confirmed that:
a) Their awareness of the organisational objectives is quite high
b) While the first four constitutional objectives have been accorded fairly
high degree of importance, the fifth objective has received the least of
attention.
c) Even though it is not a constitutionally proclaimed objective, there is
great emphasis in the members perception on the “Nurture of Christian
spirit” as the raison d’etre of CMAI. ( Please see data on Perceived
objectives in Appendix)
d) The organisation began as a fellowship of Christian health professionals.
The first constitutional objective was “Prevention and relief to Human
suffering”. Over the decades, additional objectives were incorporated, as
well as five sections were established within the constitutional frame
work to give an impetus to growth of professions. While these
developments have influenced a greater degree of professional direction
they seem to have been gradually receding “Nurture of Christian Spirit
and values” in CMAI focus.
28
B. CMAl’8 REGULAR ACTIVITIES :
Retreats, Sectional Conferences, Workshops, Regional Conferences, Healing
Ministry Week and Biennial Conferences are regular features of CMAI
activities. The study elicited information on the frequency of participation
and usefulness of these activities from individual and institutional members
and staff. Their advice for continuing the activity was also analyzed. The
results were startling.
Members and Staff Perception Scores By Ac1
■ table
I(Maximum Scorr 100)®*
Positive
scores
Retreats
Sectional
CONFERENCE
Workshops
Regional
CONFERENCE
Healing
Ministry Week
Biennial
Conference
Individual
Members
34
35
36
36
34
31
Institutional
Members
30
34
41
35
31
28
Staff
64
41
54
34
52
41
1. While the general consensus in respect of CMAI activities as valued by the
respondents leaves much to be desired, a few observations should be in
order.
a) There is generally a gap between the perceptions of those who provide
the service (Stall) and those to whom it is offered. Consumer response
shows low enthusiasm, and they are not going to miss these activities,
if discontinued,
b) Of the activities, workshops gathered better scores from the members.
2. The main draw-backs highlighted in conducting the activities can be
classified as;
a) Organisational
i. Deficiencies in organisation/ communication
ii. Inadequate support interms of facilities
iii. Inconvenient venues
iv. Incompetent Faculty
v. Lack of action follow up.
b) Methodology and Import
ii. Weak design and content
iii. Lack of Participative approach
iv. Lack of creative approach
°4 SCOre " .
23+49+31
[Example:Individual rating of Retreats:Participation's, UaefulneasMQ, Advice-31, Score=*34 ]
3
29
The accent on improvement primarily is on planning, effective
communication, and efficient organisation. The emphasis for improvement
is more on efficiency in organising the retreats, workshops and healing
ministry weeks, whereas for sectional, regional and biennial conferences, it
is on design and content of the activities.
C. FORMAL TRAINING PROGRAMMES
As in the case of regular activities, the positive perception scores were
computed for the formal training programmes of CMAI - by combining the
perceptions on usefulness, and advice for continuation of the courses.
Positive Perception Scores tabt.r
(Max 100)
1
General
Rurcing
2
Medical Lab
Technician
3
Medical
Radiology
4
CAMS
5
ARM
MPHW
6
Medical
Records
7
Hospital
Auxiliary
8
Opthol
Tech
9
Rehab
Tech
10
Addiction
Counsel
Individual
Members
43
43
35
38
34
33
25
24
23
23
Institutional
Members
39
44
39
37
35
38
25
27
24
24
Staff
50
50
46
40
44
48
35
34
27
38
1. Though positive scores analysis on lormai
aining courses project a
formal Tr
training
better appreciative perception than CMAI activities, the scores point out
to the immense scope for improvement. The general points emerging are ;
o) The maximum appreciation score is only 50 %, meaning either the
rest are not enamoured by these programmes and/or are not aware
of their usefulness.
b) Invariably, the providers of training (Staff) have better appreciation
for the courses than the consumers.
c) Of the ten, courses 1 to 6 received distinctly better degree of
appreciation than the others, with general nursing and Medical
Laboratory Technician courses topping the list.
2. With the exception of the AHP course, most of the institutions running
the training programmes have not opted for affiliation to CMAI
programme. The reasons for non-affiliation cited are :
a. Lack of government recognition of courses
b. Rigidity in CMAI rules
c. Lack of awareness about the programmes
d. Inadequate presence of CMAI
30
3. It is clear from the evaluation responses that :
a) CMAI training programmes should be seriously reviewed, involving
“consumer” institutions and respond to the changing needs of the
practitioners.
b) Liaison with government/employers/Universities in India or abroad to
ensure recognition of the courses which will add value for the trainees.
c) Lack of Publicity to programmes should be dealt with and frequent
communications/ visit to member institutions should help increase
awareness of programmes.
D. SERVING THE CHRISTIAN INTEREST
The responses to the evaluation have brought out the prioritised future role
for CMAI in definite terms.
Expected Role of CMA1 - Prioritised
1.
2.
3.
4.
Agency for integrating Christian
Spirit in the Health Field
National Organisation for Christian
Medical Profession and Institutions
Agency for creating community
awareness on health issues
Influencing and Propagating
professional health service
Individual
Members
Staff
%
%
93
97
58
44
41
47
3
2
The institutional expectations are for CMAI to play a key role in enhancing
the Christian distinction in Institutional service and in upholding Christian
values.
The need for advocacy on health issues with the Churches is covered under
the future scenario.
As of now members do not perceive of any significant support by CMAI to
Healing Ministiy, whereas the staff think otherwise.
Response
Whether
CMAI is
providing
any
significant
support to
Healing
Ministry
Members Staff
yes
43
72
No
57
28
31
In the final analysis, the role expectation of CMAI goes back to its moorings
- the 'Christian Spirit’.
1) The role definition is unmistakably to be the integrating agency for
Christian Health services.
2) To be the voice of Christian health profession and Institutions at the
national level
3) An agency for enabling and creating community awareness about health
issues.
Interestingly, however, the role of mere propagation of professional health
service is not a role expected of CMAI.
Arising from the data are the following :
1. There is an urgent need to operationalise the Christian spirit and interest
in and towards professional health services
2. Greater involvement of Church Officials in CMAI Activities and
Programmes at all levels
3. Involvement of Church Officials in the CMAI decision processes
4. Propagation through CMAI publications, individual, team and
institutional experiences reflecting Christian spirit and values in the
health field.
5. Facilitating grass roots interactions on health issues and Christian spirit
through motivating congregation and CMAI members.
6. At the level of institutional members special programmes like staff
retreats, interactions with management and staff, providing broad
guidelines for operationalising Christian spirit, values and ethics, should
be initiated by CMAI.
E. GENDER BIAS
The question of gender bias has been probed only to a limited extent in the
evaluation - and that too with the CMAI staff and the Church officials.
The investigation has clearly revealed that :
1. Gender bias exists as a general malady in the country and is deep
rooted in all spheres of activity including religion.
2. It is a social justice issue in the country.
3. The responses from the Churches have been minimal and that too
mostly internal, in terms of allowing ordaining of women,
reservation for women in Church decision making bodies etc.
32
CMAI has been addressing the issue to an extent through :
1) Articles in its publications focused to educate professionals
2) Arousing community awareness through community health
programmes mostly on women’s health, collaborating with CASA,
VHAI and Churches in the North East India
3) Conscious decision to provide equal opportunity for women in
CMAI employment.
4) Discussions on Women’s issues in forums of Theological Societies.
5) Establishing a women’s desk at the central office.
6) Discussions on CMAI policy framework on “Gender Bias” - process
before proclamation.
The role expections for CMAI are;
1) Identifying CMAI specific areas for positive action.
2) Initiator of debates on gender issues in the matters of health at the
National and Church level.
3) Building awareness about the issue through publications and
publicity
4) Enabling and encouraging women’s literacy and education
5) Continuously develop new and innovative programmes to
counteract gender bias in the field of health.
F. EXPECTED BENEFITS FROM CMAI
1. Individual members
a) The individual members of CMAI basically expect to benefit from
reinforcement of Christian spirit and values through their membership
in CMAI. This particular expectation surfaced at various other points
of the evaluation, emphasising this as the most important factor
encompassing CMAI.
b) The second most expected benefit is getting government / employer /
institutional recognitions for the professionals and their attainments c) The third benefit is in terms of organisational support for personal
problems.
2. The institutional expectations are basically :
a) Financial support
b) Support of data bank
c) Training of their personnel and
d) Services to strengthen managements.
33
The strong emphasis on expectation for “Nurture of Christian spirit* is a
major focus area for CMAI planning for the future. As regards the
expectation on financial support, CMAI would do well to correct this
distorted expectation, through effective communication of its pokey, that it
is neither a fund raising agency on behalf of its members/churches, nor a
channeling agency for funds. (See CMAI policy statement Page 14)
As regards recognition for CMAI training, strategic approach to influence the
respective governments needs to be worked out.
CMAI could explore possibilities for individual member group insurance
schemes to provide innovative support to members in old age. These are
current features in some of the commercial corporations and clubs. CMAI
also could explore possibilities for support through banks to members for
continuing education.
G. MEMBER INSTITUTIONAL CHALLENGES FOR CMAI RESPONSE
1. The major concerns of mission hospitals are in respect of:
a) Recruitment and retention of Qualified personnel
b) Professional management of Institutions
c) Infrastructure and
d) Finances.
2. The suggested initiatives for CMAI to support the institutional members
were,
a. Personnel (i) Bring about a uniform code for mission hospitals on
service conditions of personnel. Improve existing conditions
(ii) Create avenues for growth of personnel.
(iii) Train personnel in a spiritual atmosphere.
(iv) Church leaders to be involved in training.
(v) Improve opportunities for professional interaction and
network.
Hindrances to personnel retention is seen in terms of
i. Unrealistic expectations placed on health professionals serving in
mission hospitals - without reference to changing environment.
ii. Career opportunities for growth is highly limited in mission
hospitals. A way out has to be found.
CMAI initiative could be in liaising with owner Churches to
examine the real issues to bring about a possible coordination
among Churches to plan for professional development and
growth for their employees.
34
t>. Improving Institutional Management
i. Here again CMAI’s role expectation is one of influencing the owner
Churches to change their management attitudes - current low level
participation and freedom to professionals in management of
hospitals needs correction to inject efficiencies,
ii. CMAI may work out model constitutions for hospitals and initiate
liaison for acceptance by the Churches,
iii. Train hospital managers in “efficient management” through
planning processes, human resource development and finance
management
iv. Initiate indepth studies of hospitals to identify corrective actions
needed to make them viable and to seive the poor. Liaise with
owner Churches.
v. Identify dynamic leaders in the Christian health professionals
firatemily and encourage them to accept challenges of turning
around sick units.
c. Infrastructure
i. The institutions need help from specialists to examine innovative
cost effective approaches for maintenance and improving existing
infrastructure. CMAI may set up a volunteer panel from its
members and others to help institutions in need.
ii. CMAI can help co-ordination between Institution, Church, Banks
etc, to optimise resources flow and utilization.
d. Finance
(i) CMAI can propose ways and means of raising funds and other
resources to owner Churches and Institution Managements.
(ii) Experts’ pool of CMAI in finance management may be formed
which can provide necessary guidelines to institutions.
The basic issue arising in the need for a more close knit relationship
between institutional managements and CMAI and the owners of hospitals.
This calls for CMAI assuming the role of the initiator of needed changes
through continual interactions and professional expertise inputs in various
areas of management.
e. Governance
“The study on the factors determining sustainability of Christian
Hospitals in India - based on six case studies” by Dr. P. Zachariah
et.al 1997, has identified the three essential factors for success of
Mission hospitals.
35
(i) Good governance - a constructive and principled governing board
would ensure greater chances of sustaining good administration
(ii) Nurturing, cultivating young professionals early in their careers as a functional responsibilify of the management.
(iii) Setting up autonomous governing boards for a set of hospitals to
achieve economy of establishment and operating costs and good
governance.
f.
The Church officials have confirmed that closed hospitals should be
revived. Also, that by and large, Church resources are favourable and
growing.
The statistics show (Please see page 36) that the majority of closed
Protestant mission institutions between 1937 and 1995 are
dispensaries than hospitals, Most of the currently operating
hospitals are in urban areas. There is thus an indication that
Protestant Christian health institutions have withdrawn from their
rural presence.
All the above leave plenty of scope and opportunities for CMAI initiatives largely that for initiating changes in protestant Christian health services.
A COMPARTTIVE STATEMENT OF NUMBER OF PROTESTANT CHRISTIAN HOSPITALS
& DISPENSARIES IN INDIA
1937
Sl_no STATE
1937
H
1954
1995
1954
1 ASSAM
y
D
9~
T
12
2 ANDHRA PRADESH
50
12
3 BIHAR
15
4 DELHI
1995
H
D
T
y
1
62
56
17
32
16
1
0
1
1
5 GUJARAT
8
3
11
7
6 HIMACHAL PRADESH
1
0
1
4
7 HARYANA
2
0
2
2
8 KASHMIR
7
0
7
2
9 KARNATAKA
10
6
16
17
10 KERALA
8
9
17
23
11 MANIPUR
1
1
2
1
12 MAHARASHTRA
30
33
63
38
13 MADHYA PRADESH
32
41
73
14 MEGHALAYA
3
0
15 MIZORAM
2
16 ORISSA
9
H
9
D
1
3
59
27
2
18
0
Difference 1937_1995
T
10
H
~6
D
-8
T
-2
3
30
-23
-9
-32
19
2
21
4
-15
-11
1
3
3
6
2
3
5
0
7
6
0
6
-2
-3
-5
0
4
4
0
4
3
0
3
0
2
2
0
2
0
0
0
1
3
1
0
1
-6
0
-6
2
19
21
4
25
11
-2
9
1
24
35
1
36
27
-8
19
0
1
1
0
1
0
1
39
29
0
29
-1
-33
-34
38
2
40
28
0
28
-4
-41
-45
3
3
0
3
3
0
3
0
0
0
0
2
0
0
0
2
0
2
0
0
0
4
4
8
7
1
8
7
1
8
3
-3
0
17 PUNJAB
25
12
37
15
1
16
6
0
6
-19
-12
-31
18 RAJASTHAN
9
2
11
6
0
6
2
0
2
-2
-9
19 TAMIL NADU
44
25
69
44
1
45
42
7
49
-2
-18
-20
20 UTTAR PRADESH
40
3
43
26
2
28
22
0
22
-18
-3
-21
21 WEST BENGAL
19
18
37
9
1
10
11
0
11
-8
-18
-26
22 GRAND TOTAL
314
195
509
323
19
[ 342
280
22
302
-34
-173
-207
H = HOSPITAL
D = DISPENSARY
T = TOTAL
-1
SOURCE : CMAI
&
H. STRENGTHS OF CMAI
37
The strengths of CMAI identified by individual members, the staff, the
Church Officials, as well as the NGOs are in the following order of
importance.
1. Quality of service
2. Quality of training
3. Forum for spiritual nurture and integration
4. National Identity for Christian health professions
5. Infrastructure of CMAI
However, the Church Officials considered CMAI publications as one of its
important strengths, but none others endorsed it. Likewise the NGOs
considered 'Networking’ and CMAI staff 'Competence’ as strengths but all
the others rated these features very low.
Among the strengths of CMAI -though not reckoned as such by the
respondents, but arising out of the data available- are the following;
1) Members are distributed all over the country though with a
majority presence in the south.
2) Nearly half of the individual members are post-graduates.
3) Institutional Members’ infrastructure can be made use of in joint
programmes.
4) CMAI is a related institution within the Church fraternity - whose
resources are considered bright and growing
5) Church leaders willing to be actively associated with CMAI
6) The financial management of the organisation operates within a
defined system with adequate safe guards and is well managed.
7) CMAI is known to most Government Health Officials and to a
majority of health related NGOs.
8) Government health officials foresee future CMAI role in Community
and Preventive Health Services.
9) One third of all members are employed in
i mission hospitals of
which nearly 20 % are functional heads.
10) CMAI is Non-Denominational and cuts across denominations.
While there is near unanimity among the individual members and the staff,
a slight distortion is noticed in the strengths stressed by the NGOs, Church
Officials and the members.
It is time for CMAI to improve its effective communications with the
members including the Church Officials and the NGOs. Of particular
interest is publication and networking with health related agencies. CMAI
needs to project its strengths and thereby its image through planned
publicity and contact programmes.
I. WEAKNESSES OF CMAI
38
The individual members and the staff almost unanimously identified the
following as weaknesses listed in order of importance;
1) Poor pubhcation and publicity
2) Lack of efiicient service to members
3) Poor communications
4) Lack of recognition for CMAI - from the Government.
The Churches and the NGOs highlighted two other points namely;
1) Low influence on Church and Church related institutions
2) Inadequate focus on the poor and the marginalised
These responses bring out the following implications:
1) CMAI should work with the Churches and related institutions to
change any distortions in its image.
2) Based on the suggestions received, detailed planning with action
plans should be evolved and prioritised, for corrective actions.
3) Service to members should be vastly improved, but this can
happen only if a review system is evolved for the management team
to coordinate on issues and take quick decisions.
The weaknesses surfacing from other observations are :
1) On the financial front, the organisation is still heavily dependent
on foreign funds - exposing itself to the risk of increasing
restrictions of both donor and receiver countries.
2) The organisation has not focused seriously on raising internal
resources through fund raising. Planning and competence building
in this area is necessary.
3) There is a felt need for improving the effectiveness of all sections of
CMAI.
4) There is no mechanism for evaluating the performance of CMAI in
terms of input and output. As a professional organisation, CMAI
should evolve parameters for measuring performance of each
section/department and of the organisation as a whole.
5) The current set up of CMAI is not conducive to focus and develop
CMAI presence in various parts of the country.
39
J. FUND RAISING
1.
a) The question of raising internal resources by CMAI was responded
to by the members, staff and the Church officials who offered
suggestions to raise funds. These were ranked by the frequency of
endorsements from each source.
8UGGE8TION8 FOR RAISING FUNDS
Ranking by
Members
Staff
1. Approach individuals /
congregations
Church
Officials
I
11
II
2. Better management of assets /
funds
II
I
3. Through Churches
III
III
I
4. External Sources within India
IV
VI
V
5. Internal Resources
V
IV
III
6. Service based programmes
VI
V
IV
b) Interestingly, the members advocate raising funds through
individuals / congregations, the staff through better management of
assets and the Churches advising to approach them. The emphasis
from all is basically to approach congregations and Churches.
2.
It is conceded that current efforts to raise funds for CMAI is
negbgible, though there is considerable improvement th rough efficient
fund management. It is, however, clear that CMAI’s dependence
mainly on external resources is fraught with uncertainties of the
future.
3.
CMAI may consider using some expert resources within the
organisation as well as in related circles to address this issue to
propose short term/ long term strategies, assuming alternate
scenarios. For example ;
The current level of activity (i) Steady and not much of an increase, except inflationary
pressures for increased revenue.
(ii) Increase in activity and budget at about 20 % per annum
b) External Resources - (foreign funds) - Time related variation /
status-quo.
c) Preparations as condition precedent for launching CMAI internal
fund generation
d) Cost of fund raising and targeted revenue.
a)
K. THE FUTURE SCENARIO
40
The future scenario for health service in the Country is mind boggling in an
expanding horizon.
This is best summarised in the words of Dr. Deepak Paul of Christian
Hospital, Shadoland Dr. George Joseph of CSI.
QUOTE
With present political instability and lack of political will, we must be seriously
concerned. This country has only 2^2 % of the worlds area, but constitutes 16 % of
world population, has an ever increasing mass of people draining the country's
resources with no sign of abatement in sight. Today approximately 30 % of
Country's population tives below the poverty line. 135 Million people do not have
any access to health services and 171 Million people are without a safe source of
drinking water, 640 Million have no access to sanitation. The adult literacy rate,
which stands at 51 %, is one of the lowest among the developing countries...... All
illiterate women put together in India surpass the total number of illiterate women in
rest of the world. Six children out of every Hundred work as Child Labour. While
360 Million people spend 90 % of their earnings to buy food, their priority remains
food, not health. Malaria is on the come back trail and there are now more than Two
Million case of Malaria each year causing colossal man-hour loss to the
Country...... The incidence of Tuberculosis is also increasing and about 18 million
are presently suffering from it. They are joined by 3 miltion more each year and each
year half a Million die. The disease is also associated with HIV infection. It is
predicted that by 2000 A.D. AIDS deaths among men in their prime age will leave
Ten Thousand widows each day
UNQUOTE O1
QUOTE
It is crucially important that policy planners and health administrators have to take
serious note of the changing pattern of health and disease in the Indian context
partially attributable to fast-changing life-styles and behaviour, more pronounced in
this country as compared to other developing countries. Among the determinants,
the major age-shift - the population pyramid with a wide base and now with the
'bulge' towards the top - (large proportion of the elderly), significant rural-urban
migration are easily discernible. Other factors to be reckoned with are new
technology - misinformation ’ included, and the rise in level of general awareness
about issues and problems related to community health. There is also a positive
trend, that is emerging, to be encouraged and nurtured that people's health should
be in people's hands, health and wellness becoming a people's movement.
It may sound paradoxical that a realistic epidemiological appraisal of the present
health scenario in India would reveal a 'strange mix' of health problems, diseases
and disabilities of under-development co-existing with host of emerging morbidity
problems characteristics of affluent societies, hypertension, cardio-vascular
diseases, accidents, cancer to name a few. This is true of urban as well as rural
communities, there is an imperative need to evolve care models that are relevant in a
given sociocultural setting in keeping with the overall mission of the Church
UNQUOTE°2
Dr. Deepak Paul - in Shadol hospital News letter 1996
Dr. George Joseph in “Perspectives on futuristic role of Church run -health Care Institutions - CSI1996
41
The UNDP Human Development Report of 1997 has warned India of “worst
forms of human poverty* and urged urgent action to “eliminate illiteracy,
malnutrition and to provide safe drinking water.” It further warns that poor
people will be increasingly marginalised.
A new development gaining momentum is the new methodology of
development - community initiated demand based approach, where
development agencies (Both Govt, and NGO) participate and support peoples
initiatives, as opposed to centralised financing and managing of
programmes which are supply driven. °3
The detailed recommendations from the responses to the study, however,
envisage CMAI thrust to be multidimentional; in the sense that CMAI’s
direct action plans should be aimed at:
1. The congregational/ community level,
2. The Christian institutions/ Church level and
3. At the national level.
It is also clear from the interactions with Church Officials, that;
1) The Churches generally do not have specific policies on Healing
Ministry Activities directed either to their own congregations or to
their net work of Churches.
2) There is an urgent need for an apex body to initiate, coordinate and
effectively integrate all Christian efforts to optimise assistance to
the Healing Ministry through prevention and relief of human
suffering.
3) Health is definitely a social justice issue in India, but the Churches
response to charging Health scenario in dismal.
4) CMAI is looked upon favourably to take on the role of the apex
body.
The projected scenario, the expectations and the recommendation on CMAIs
future role envisages its first priority to be in community health services - a
major thrust area of CMAI in the last ten years, inclusive of preventive and
promotional services. Health Education and training continue to be the
expected services from CMAI. There is a major concern for initiatives to
involve the Chinches and to improve CMAI - Church relationships - to
optimise coordinated Christian Healing Ministry effort.
It is imperative, therefore, that an organisation like CMAI has to make a
careful assessment of the various needs, identify such areas which are
effectively manageable within its objectives and current competencies for a
short-term approach, and work out perspective plans for medium (five years)
and long-term (ten years) with concurrent action to develop its own
competence and network to gamer needed resources and support.
03 Abstract from ‘Participative Research in Health’, edited by KORRIE de KONING et al. Vistaar Publications
- A division of Sage Pubheations - New Delhi, 1996
42
CHAPTER IV : CMAFs ORGANISATIONAL FORM
A, MEMBERSHIP OF CMAI
1. The membership of CMAI in confined to Christian Health Professionals
and Christian health Institutions. However, the eligibility for doctors is
restricted to practitioners in allopathic medicine.
The Individual members profile reveals;
a) Even the total claimed membership of around 3400 is abysmally
low. The membership records are not updated at CMAI.
b) Reciprocity of contacts and responses between CMAI and its
members appear to be on low key.
c) CMAI efforts do not seem to attract the younger age group
members, excepting in the case of nurses.
d) Nearly half of all members are post-graduates.
e) Three fourths of the members are employed in private
organisations, of which nine out of ten are in service with mission
hospitals. Nearly one in five of those serving in private institutions
occupy heads of functions or higher positions.
I) As expected, more than half of the members are in South India.
g) Nurses and Doctors are the predominant groups in CMAI
membership, and are mostly in urban areas.
h) Membership appears more or less equal in sex distribution.
i) Church denominationwise CSI and CNI are the largest groups.
2.
It is acknowledged that the membership should be enlarged. Towards
this, suggestions made are :
a) Extend the reach through personal and institutional contacts to
eligible Christians in all walks of life,
b) Extend eligibility to Non-allopathic practitioners or other workers
serving the healing ministry c) Conduct membership campaign.
d) Improve efficiency of membership desk at head office to provide
prompt service to members
e) Decentralise Administration, through creating/encouraging CMAI
teams at all levels.
43
B, SECTIONS AND THEIR BFFBCTIVBNE88
1.
Responses from individual members and the staff of CMAI were
sought on their perception of “How effective is each section of CMAI”
in its activities. The summarised data is given below.
F1OUKBB DI % OF RBBPON8KB
Perceived
SECTIONS OF CMAI
WEIGHTED
AVERAGE
EFFECTIVENESS BY
MEMBER/8TAFF
DOCTORS
NURSES
ADMINISTR
ATORS
AHPS
CHAPLAINS
Poor/
Dont
know
Members
37
33
50
54
47
44
Staff
49
21
28
19
35
34
Good/
Very
good
Members
20
25
12
9
14
16
Staff
4
25
2
18
7
18
2.
The outcome of this exercise is that :
a) While none of the sections are perceived effective by both staff and
members, nurses’ section has the relatively best scores for
effectiveness.
b) There is a member/staff perceptional difference - indicating
possible lack of in built feedback mechanism - thus keeping the
staff away from ground realities.
c) There is evidence of lack of intersectional communications.
3.
Consequently, the emerging suggestions for improving CMAI sections
effectiveness are;
a) Improved communication between
sections disseminating
information on sectional plans, programmes and achievements.
b) Vast improvement in contact with members to improve
participation in programmes and feedback
c) Improved efficiency in making sectional performances perceptible
d) Emphasis on professional planning and activity assessment
processes within CMAI.
C. FINANCIAL MANAGEMENT
44
1.
Introduction
The financial and accounts function of CMAI is structured and operated
within a fairly defined system which is objective, reasonable and has a
flexible framework of rules, authorities, control and audit.
2.
Branches/ units/ establishments covered
The branches, units and establishments of CMAI that have been covered
in the evaluation are the following:
• Project Office - Ranchi
• Mid-India Board of Examiners Office - Nagpur
• Board of Nursing Education (South India Branch) Bangalore
• Branch Office - Bangalore
• Head Office - New Delhi
Each of the offices mentioned above receive funds from the Head Office
to meet their day-to-day expenditure. Such expenditure is met with the
approval of the person in charge of the office. The accounts of all the
offices, including the Head Office,, are audited by H.P.Salve, Chartered
Accountant.
The CMAI also has a Central Education Board with several training
centres. It appears that the accounts of the CEB and its training centres
are not integrated with the accounts of the CMAI as they ought to be.
The Head Office of the CMAI has no record of the receipts or expenses of
the CEB or its training centres. This is a serious matter needing
immediate attention.
3. Authorities
The authorities exercising powers in relation to financial matters are:
• The Finance Committee
• The Treasurer
• The General Secretary
• The Deputy Finance Manager
• The Heads of Departments / Sections / Branches /
Projects (within their individual departments / sections
/ branches / projects)
It is necessary that the financial powers and responsibifities of each
authority be clearly specified. Similarly the discretionary and emergency
powers of these authorities should also be clearly spelt out.
4.
Funding
CMAI had a fturnover of Rs. 1,32,48,444 in the year 1991-92 and this
increased to Rs.2,94,16,985 iin the year 1995-96. The break up of this
turnover is as under:
SOURCE
Foreign grants
Indian sources
- Interest
- Others
Total
45
1991-92
1995-96
%
%
88.78
69.75
10.24
0.98
100.00
14.23
16.02
100.00
As is clear from the above, CMAI has been and continues to be heavily
dependent on fforeign sources for funding. However, the extent of
dependence has been reducing over the years.
In view of the increasing restrictions being placed under the Foreign
Contributions Regulation Act on receipt of foreign donations it would be
advisable for CMAI to increase the quantum of locally generated binds
and aim at becoming self sustaining.
5.
Expenditure
The following is a break up of the expenditure incurred by CMAI:
Area of expenditure
1991-92
1995-96
Community health
Special programmes
Human Resource Development
Regional and membership
Communication, advocacy and
networking
General administration
Total
%
%
16.28
38.24
15.48
9.75
5.87
18.82
30.04
27.28
7.70
6.01
14.38
100.00
10.15
100.00
There have been fairly significant variations from budgeted figures under
a few expenditure heads but, in general, the overall expenditure has
been within budget limits. One of the principal reasons for such
variation is that the budget is prepared for a period of five years at a time
and there is no annual review of the budget on the basis of changed
circumstances and current needs. It is suggested that the present
system of preparing the budget for five years at a time may continue but
there should be an annual review of the budget and, based on the
requirements of the time, budgeted amounts may be permitted to be
reappropriated from one head to another.
6.
ACCOUNTABILITY
As is stated in item 3 above, heads of departments, sections, branches
and projects exercise the authority to spend amounts budgeted in
relation to their individual departments, sections, branches and
projects. Along with such authority, it is necessary that such persons
should also be made accountable for the amounts spent by them. For
this purpose a review of performance vis-a-vis expenditure is essential.
Similarly, the other authorities specified in item 3 above should also be
made accountable for amounts of expenditure approved by them.
7.
46
Assets and liabilities
The CMAI has a well thought out investment approach and its
investments are in secure yet high yielding areas. Most of the
investments are with the Unit Trust of India, scheduled banks, and
government companies. Considering the limitations on investment
placed by the Income-tax Act, 1961 and the Bombay Public Trust Act,
1950, the investments are very good and earn a reasonable return.
CMAI has invested a fairly large amount on purchase of immovable
properties and these properties have appreciated considerably in value
over the years. However, the investment in other assets has not been
very significant. The amounts invested in other assets over the years
have been Rs.6.72 lakhs in 1991-92, Rs.8.97 lakhs in 1992-93, Rs.5.36
lakhs in 1993-94, Rs.4.77 lakhs in 1994-95 and Rs.8.07 lakhs in
1995-96.
CMAI has hardly any liabilities except for the security deposit received
from the bank which has rented its premises and the amount due in
respect of the staff pension scheme.
8.
Internal generation
The overall income generated internally has gone up from Rs. 15 lakhs in
1991-92 to Rs.89 lakhs in 1995-96. This is an increase of nearly 500
per cent The other noteworthy points are:
• Interest’ which accounted for 91.3 per cent of the total funds
generated internally in 1991-92 has substantially reduced in relative
importance and accounts for only 47 per cent of the funds generated
in 1995-96. However, the quantum of interest earned has gone up
three times over in the same period.
• Fees, donations and grants have now become fairly important sources
of income.
• No amount has been received from churches or from Government.
9.
Observation on qualitative aspects of funds management :
In our opinion, funds have been well managed by the CMAI. Our
reasons for this opinion are as under:
• Expenses have, by and large, been within the overall budget. The
year 1992-93 is the only year when total actual expenses have over
shot the budget.
• The investment in immovable property has been very wise and has
paid rich dividends. The current market values of the immovable
properties of the CMAI are good. We would suggest that further
investments be made in good immovable properties as the returns
are likely to be very high.
• The investments made (other than in immovable properties) have
also been in legally permissible, safe and high yielding areas.
47
10. CMAI FINANCIAL STANDING :
In our opinion the CMAI enj°ys a fairly good financial standing.
However, in order to improve its financial muscle the CMAI needs to
become more financially self reliant. This is possible only by increasing
its local earnings substantially.
The CMAI should also explore the possibility of raising funds from other
sources abroad particularly to fund those plans of the CMAI which the
existing sponsors may not like to cover. Other donor agencies may be
contacted and the possibility of undertaking consultation work in the
areas of its expertise (imparting training in the fields on nursing, etc.)
should be explored.
°
11. Audit
The accounts of CMAI are audited regularly by a firm of chartered
accountants (H.P.Salve, Chartered Accountant, Duty Mahal, Sitabuldi,
Nagpur). There have been no significant audit observations over the
years.
12. Impact of inflation
CMAI has done well financially over the years. Despite inflation, the
organisation has improved its financial position and strength. Each year,
the growth in income generation has been in excess of the increase in
expenditure. The annual surplus has also been continuously increasing.
The impact of inflation has not, therefore, been very significant so far as
the CMAI is concerned.
13. Statutory limitations and opportunities
So far as management of financial resources are concerned the CMAI
has to contend with the provisions of three statutes, viz., The Bombay
Public Trusts Act, 1950, The Income-tax Act, 1961 and The Foreign
Contribution (Regulation) Act, 1976. The main limitations and
opportunities are as under:
• Foreign contributions can only be accepted by the CMAI in accordance
with the provisions of the Foreign Contribution (Regulation) Act, 1976.
CMAI is currently registered under the FCRA and is permitted to receive
foreign contributions. The returns required to be submitted are regularly
being submitted by the CMAI.
• Investments can be made by the CMAI only in areas permitted by both
the Income-tax Act, 1961 and by the Bombay Public Trusts Act, 1950.
This places substantial restrictions on the investment possibilities.
Within the limits placed by these enactments, the CMAI has invested its
funds wisely.
• Investment in immovable property is permissible and substantial
investments have already been made in this area in New Delhi and
Bangalore.
48
D. MANAGEMENT SET-UP, STYLE AND FORM
1. CMAI as a legal entity is a registered charitable, nonprofit, Christian
education society.
2. Its Membership is open to Christian medical and health professionals and Christian medical and health institutions.
3. The “Biennial Assembly” is the power house of the organisation
consisting of all enrolled members, who meet once in two years, and
elect honorary members to the General body, the Board of management
and other constituent bodies, and also appoints the General Secretary.
4. The General Body meets annually to make policies, take stock and issue
directions. The General Body Consists of thirty six members, who are;
a. Five Office bearers of the Association , b. Thirteen Regional Secretaries,
c. Ten Chairmen and Secretaries of Sections, d. One General Secretary
of NCCI, e. Elected Members from the Assembly, f. Three co-opted
Members by the General Body.
5. The Board of Management consists of the President, the Vice President,
the General Secretary, Treasurer and the Editor, along with six other
members namely, a. Three Regional Secretaries - Nominated by the
Assembly, b. Two from out of ten Sectional Representatives, c. One
either elected or co-opted member from the General Body.
6. Constitutionally, CMAI’s structure includes five professional sections
namely Doctors, Nurses, Administrators, AHPs and Chaplain. Each
section is headed by a full time paid Secretary. In addition four other
Heads
of
Departments,
namely
Administration,
Finance,
Communications and Community Health Programmes, are appointed as
shown in the Organisation Chart of 1997(Enclosed).
The Heads of Departments as well as the Sectional Secretaries report to the
General Secretary - administratively. But each of these heads of sections
and departments are functionally under the direction of their respective
Executive Committees, each headed by an honorary chairman elected by the
assembly. The organisational structure shows the current lines of command
and control.
The organisation has evolved over a period of decades, slowly transforming
in terms of additions of sections, departments and replacement of volunteer
personnel by full time paid personnel. Some changes over the years, it was
observed, took place as a response to a sudden spurt of activity like family
planning in late sixties, which led to establishment of Bangalore and the
North India Offices. With the receding of the FP activities, the structure
again contracted peripherally. The main form of Assembly, Governing
Board, CEO and the sections, as well as the Central Secretariat functions
have remained intact.
49
EVALUATION OBSERVATIONS
1) A special feature of the existing structure is that the Secretaries of
sections report administratively to the CEO and functionally to the
Chairmen of Executive Committees. They are also full fledged members
of the General Body.
2) The second feature is the fragmented functional responsibilities, with
most of the executives answerable to respective Committees.
3) In view of the autonomy of sections due to structural freedom,
Organisational integrated approach to “assist healing ministry” , “ relief
to human suffering” seems to have receded over the years.
4) Annual Secretaries’ reports only state what was carried out and not what
was set out to be done, what was done and why the variation - in other
words “accountability” is silent.
The feed back from various respondents shows that the organisation has
distanced itself from the grass roots - members and the people institutions, the clergy and the like minded NGOs. This situation is quite
palpable from other observations.
a.CMAI training programmes appear mostly centred around professional
development activity rather than u concerns for health and healing n to
which the professionals have to respond, b. Sectional effectiveness is
perceived to be poor. c. Communication deficiency has been highlighted by
members, d. Excluding workshops - all other activities have drawn
lukewarm reception by the members, e. Awareness to health issues among
the churches appear dim. f. CMAI’s contribution to Healing Ministry is not
seen by members as significant, g. Community Health Programmes” - a
department having seperate identity in the structure, and apart from
sections, has received appreciative feedback from the constituents - and the
members endorse CHP as important in CMAI’s future role.
5) The positive features of current set-up. a. Flexibility and autonomy to
each constituent at the executive level, b. Participation of members as
volunteers at various levels- mostly in advisory capacity. At the
executive levels all are full time employees, c. Involvement of Volunteers
in the structural hierarchy has many benefits, 1) The contributions in
terms of efforts are free, 11) Enables pooling of expertise to support the
organisation. Ill) Helps wider network of contacts, iv) Since they are
elected posts, injects “new blood” through rotation, v) The efforts are
more in the spirit of service for self fulfilment.
Objectively examining the positive and the negative aspects of the set-up,
it appears that the present structure is not conducive to use its full
potential for effective contribution to the central purpose of the organisation,
namely “Relief to human suffering” and “ to assist the Healing Ministry’ Training of personnel which is a “means” to achieve the goal - seems to hog
50
the limelight in terms of efforts - with no scope for measuring the extent of
contribution towards the main purpose .
The Structure of today, all the while when it was evolving must have
served the organisational purposes of yester years, but now it appears
to be reaching nowhere - at the executive level.
6. A new approach appears imminent to release the real potential of the
organisation - particularly through more people oriented integrated
approach, than profession oriented sectional approach.
The Objectives for changes in organisational form should.
a) . Meet the expectations of members to “decentralise* the
organisation.
b) . Provide an integrated CMAI in operation at “local* and “Regional
levels*.
c) . Enable sharing executive responsibilities through a team approach
with accountability - relieving the CEO to concentrate on planning,
reviewing, leadership initiatives - vigorous networking at policy levels
and directing the organisation.
d) . Pave way for clear cut performance parameters for executives and
accountability at all levels for organisational growth and success.
MAN POWER
From the profile of the staff of CMAI, the following points need
consideration.
1. Out of the eighty seven staff employed - eighteen are attenders, drivers
and cleaners.
2. The organisation reflects almost a perfect inverted pyramid with
people at A Grade being the highest number, followed by B and C
( bottom grade for white collar staff) .
3. Qualification wise, nearly half of the staff are post-graduates, but
those qualified in medicine are significantly less.
This needs attention from the point of view of organisational competence.
The point has been stressed by the staff and the members both institutional
and individual.
4. General Administration accounts for the highest number deployed-
followed by Community Health. Among the sections, Nurses
section takes the first position and the Chaplains the second in
terms of numbers employed.
51
Since this evaluation was not directed towards assessing manpower
needs, Job specifications or workloads - there is no ground to analyse
this aspect for a possible review. But the following points may be
relevant.
1) Prima facie, it appears that the number of drivers, attenders
and cleaners are too many to serve a complement of sixty nine staff
members.
2) Personnel competence needs to be assessed against organisational
challenges ahead, long-term and short-term plans and expectations.
Plans for structured internal training to improve competence needs
to be evolved.
#
l
f
AND
documentation
J r
ORGANISATIONAL STRUCTURE
1997
ASSEMBLY - BIENNIAL
GENERAL BODY
______
<■
4*
BOARD OF MANAGEMENT
4*
*
! NATIONAL
FINANCE
! .ADVISORY
COMMITTEE
j COMMITTEE. ON
: HEALTH HEALING & i
i WHOLENESS
I
4*
4*
COMMUNICATION i COMMUNITY
ADVISORY
j HEALTH
COMMITTEE
! COMMITTEE
*
4*
REGIONAL
SECRETARIES
! EXECUTIVE COMM
OF CHAPL SECTION
4*
EXECUTIVE
COMM. OF
NURSES
LEAGUE
*
4>
4*
EXECUTIVE
COMM. OF.
ADMN.
SECTION
EXECUTIVE
COMM. OF
DOCTORS
SEC.
EXECUTIVE
COMM. OF
AHP
SECTION
i
GENERAL SECRETARY
4>
41
| ADMN MANAGER I FINANCE
i .MANAGER
4*
j HEAD
I COMMUNICATION
| CENTRE
: HEAD COMMUNITY
■ HEALTH DEPT
*
I CHAPLAIN
i SECTION
NURSES
LEAGUE
♦
ADM
SECTION
4*
4*
; DOCTORS
; SECTION
AHP SECTION
4*
BNE SIB
) MIBE
CAMS: CHRISTIAN ACADEMY OF
MEDICAL SCIENCES
CENTRAL EDUCATION
BOARD
NJ
CHEATER V ; THE POINTERS
53
A. EVALUATION TERMS OF REFERENCE - FINDINGS
Reference 1 : What have been the activities of CMAI to achieve its mission,
vision, goals and objectives as enunciated fiom time to time from inception
and particularly during the last decade ? How and to what extent has CMAI,
as the health wing of the NCCI, been able to serve the Church in its ministry
of health, healing and wholeness ?
Finding 1. In general, since its inception, CMAI has responded to needs
arising out of problems of people’s health.
a. From Iwceptiow
It responded to perceived needs at different phases through :
i. Providing a forum for Christian health professionals to exchange
and update knowledge,
ii. Responding to training needs of health professionals from time to
time,
iii. Collaborating with Churches in India in their concerns and
actions relating to health of people with special reference to the
poor and the marginalised.
iv. To the extent possible, initiating actions in public health in rural
areas, as well as responding with preventive and curative services.
v. Advising and collaborating with Governments on issues of health
and programmes
vi. Being a catalyst for initiating of action in health related matters by
the Churches and related institutions.
vii. Bringing out its own pubfications to promote knowledge as well as
a common communication link with its constituents.
viii. At times, co-ordinating resources for Christian health institutions.
The above stated generalised CMAI response activities have contributed
towards its goals and objectives in varying degrees at different periods in
CMAI’ s history. However, precise quantification of its contribution eludes
measurement. Yet, there is no doubt that CMAI in its history of ninety years
has estabfished its responding capabilities in times of crises, in training of
health personnel and medical/ health relief work, with close relationship and
collaboration with Churches and related institutions.
b. Since last decade
Specifically in the last decade, CMAI’s activities to fulfill its objectives have
been more in terms of:
i. Continued activities to promote fellowship among Christian health
professionals and promotion of knowledge, along with nurture of
Christian values and spirit.
54
ii. Continuing established formal training programmes and new
programmes for AH P’s and on “substance abuse”.
iii. Innovative and self sustaining community and congregation based
health programmes with special emphasis on woman and Child.
IV. Conscious efforts to bring about a meaningful association with the
Churches and related agencies for a more effective assistance to the
healing ministiy
v . Responding to request from government and other health agencies for
support in combating HIV/A1DS, by designing and implementing
programmes of training health professionals, health workers and
congregations.
vi. Continuing its publication activity.
vii. Inducting Chaplaincy section to focus and
and support nurturing
Christian spirit and wholistic health.
viii. Raising resources to sustain its current level of activity.
c. Current Assessment
The Evaluation findings, however, bring out the current status of CMAI
fulfiling its objectives.
i. In so far as CMAI’s service to the ministiy of health, healing and
wholeness is concerned, there are perceptible changes over the
past decades. The CMAI - Church strong collaborative
relationships of the past appear to have become passive and
distant. The Churches are looking for guidance and professional
support.
ii. CMAI training programmes have retained their stamp of quality
and the training objectives have been endorsed as being fulfilled to
a great extent, though fewer institutions are seeking CMAI training
affiliation.
iii. Nurture of Christian values and spirit among health professionals
is looked forward to by members as the raison d’etre of CMAI Other CMAI activities need radical improvement in their vision,
planning and implementation.
iv. CMAI s community / congregation based programmes have been
assessed largely by members as contributing towards relief to the
poor and marginalised. This also finds support from the increasing
number of programmes that were initiated by CMAI, continuing to
be active and sustained even after CMAI withdrew its support.
Thus CMAI is contributing substantially to its objective of
comprehensive health care and community welfare/
v. CMAI has responded to the call of the nation for combating newer
challenges to health like HIV/AIDS, substance abuse through its
training programmes - networking with the government agencies A major contribution towards “Prevention and relief of human
suffering,,, irrespective of caste, creed, community, religion or
economic status.
vi. CMAI’s response to its objective of rendering help in calamities and
disasters has not been significant.
55
Rbference 3: What have been the contributions of CMAI
towards newer
concepts of health care and innovative interventions ?
^mj”° : E CMAI has contributed substantially in the development of
Nursing and Allied Health Professionals through training programmes to
meet new challenges for health.
2. CMAI programme for continuing education of practicing doctors is an
innovative training intervention.
3.
CMAI
is
contributing
through
the
new
concept
of
community/congregation based health programmesthus enabling
communities to take responsibility for their own health. This iis an area for
greater focus and expansion.
Reference 3: fHow
’
~ 'has CMAI been able to coordinate and make relevant
far
the various training programmelcs in the healing ministiy, medical, nursing,
paramedical and others ?
Finding: 1. Three formal training conrses namely; i. The laboratory
technician icourae, ii. The general nursing course, iii. The radiology course
have been endorsed
---------- useful and hence retain their relevance
2. Most of the other courses have attracted reservations from members
either in terms of their current relevance and/or value/utility in terms of
recognition.
3. Most of the Christian training institutes have refrained from seeking
affiliation to CMAI training programmes, except for some of the courses for
AH P’s.
4. Thrust and co-ordination efforts from CMAI need improvement to raise
level of demand for and relevance of the training programmes
Reference 4: How far has CMAI achieved building spiritual, professional
and social fellowship among members ?
Fihdiwg ; 1. CMAI’s inadequate service to members and
communication have been identified as its current weaknesses
Lack
of
2. CMAI’s low sectional effectiveness and sectional activities reflect sporadic
unplanned efforts and lack of co-ordination.
3. There is large scope for expanding the membership base of the
organisation.
4. CMAI s current organisational set up is not conducive to render
co-ordinated service towards this objective.
56
Reference 5: How far has CMAI achieved promoting social justice, total well
being, family welfare and building healthy communities.
Fimdiwg:
1. CMAI indeed is addressing these issues in different ways
and the degree of effectiveness vary and are often difficult to
assess.
2. In so far as the social justice issue is concerned, CMAI’s
efforts have been;
(a) Establishing a women’s desk at its head office to specially focus
coordinating CMAI programmes to include special attention on
women and child health.
(b) Conscious efforts to develop its own poficies on issues of social
justice.
(c) Creating awareness through its pubfications,
to gender
discrimination issues affecting health and well being of women and
children.
3. As far as total well being, family welfare and building healthy
communities are concerned, CMAI has launched several community j
congregation based programmes in the last decade in different regions of
India. Evaluation of projects till date have been encouraging. There is
evidence of increasing self sustenance of these programmes
Till about 3 years ago, the programmes on family welfare and child survival
were concentrated more in southern parts, whereas the women and
community based development programmes of recent years are more in the
central region.
In brief, 1) CMAI has commenced addressing problems of Social justice,
and is evolving its poficies.
2) Community based progranunes of CMAI seem to have made
an impact in enabling the participants to learn the skills of
implementing self sustaining Community /Congregation
based participative programmes to promote and build healthy
communities. However, these programmes are confined
to certain parts of the country.
Reference 6; What is the likely future scenario affecting the health of the
people? What will be the major changes? What are the opportunities and
threats?
How can CMAI meet the challenges and make use of the opportunities, and
help the Church to respond effectively to the chang<;es.
Fihding : The Future scenario for health services in India seems like opening
Pandora’s Box. Future events can be briefly classified as follows.
57
1. Prevalent infectious, communicable diseases related to nutrition, quality
of life, environmental deterioration and poverty will increase with the
population, needing greater emphasis on preventive and curative services.
2. Special diseases like HIV/ AIDS, drugs and substance abuse will continue
to rise at an alarming pace demanding services to create community
awareness and counselling.
3. Stress and pollution related
non-communicable diseases will be
increasing the load for preventive, curative and promotional services.
Services to prevent Accidents and Geriatric care / rehabilitations will call for
greater efforts.
4. Economic liberalisation policies will push commercialisation of services at
a greater pace - malting it increasingly inaccessible to the poor, particularly
health and education. There will be inequitable distribution of resources.
5. A large population of small farmers, unorganised and landless labour and
other poor classes will become poorer.
6. Issues of social justice in health, education, employment, and gender bias
will be looming larger.
7. Demand for quality health care will increase along with consumer
awareness - leading to increased legal implications.
Opportunities And Threats:
1. These changing scenarios would demand more and more collaborative
network of operations. There will be increasing demand for innovative,
planned and definitive responses from the Church and the Christian
Community, particularly for the rural poor and marginalised sections of
society.
2. There will be shortage of qualified personnel, particularly in
church/mission related institutions, as more and more investment
oriented commercial hospitals mushroom everywhere.
3. The non-profit oriented traditional, curative service institutions will face
severe competition from commerciahsed institutions - since those who
can afford will move away from non-profit institutions for their care.
Sustainability of such institutions will be under increased threat
4. In view of inaccessibifity of secondary and tertiary services for the poor,
the demand for primary health care services will increase with better
community response to preventive and promotional activities. This will
open greater opportunities to NGOs.
Chai Response Options:
58
1. The pressures on the healing ministry would open opportunities for
CMAI’s professional advisory role to the Church. Unlike in the past,
CMAI will have to seize the opportunities for services, particularly
utilizing the resources of the churches, related institutions,
congregations, with the support of CMAI members. The Churches are
aware of the enormity of the problem and are looking-up to an apex body
to integrate resources and optimise services. They favourably look upon
CMAI to play this role.
2. CMAI should be proactive in projecting the future health scenario with
detailed dimensions and implications of the problem. It is time for
planned initiatives to set in motion processes of integrating the Christian
resources for health services.
3. CMAI needs to address the proble:ms at different levels of operations.
a. At the national level - proactive advocacy role based on authentic,
researched data to arouse public awareness and Co-operation to
health priorities. To Influence the policies of the government to
protect and improve health related services to the poor and the
marginalised. To this end CMAl needs to create a research and
documentation unit.
b. At the Church and related institutional level - to bring about a
proper understanding of issues and problems to evoke positive
responses to optimise resources support. Help review resources
status and viability of hospitals to determine management options
to improve viability and service levels.
c. At the congregational and Community level to encourage and
enlarge Community based wholistic health initiatives, for long-term
sustainable people initiatives. The purpose should be to make
available services to prevent ill health and promote health of the
poor at their places of residence to overcome the problem of
inaccessibility. This should reduce considerably the need for
secondary and tertiary care services which are very expensive.
d. CMAI should continue training of health professionals with
necessary modifications in methodology, content and develop
appropriate nurturing of the young professionals.
e. Members expect CMAI to integrate the church and related agencies
to regain the vision of the healing ministry, redefine the policies to
suit the changing times in tune with the Christian Values and
spirit. Use the collective Christian voice to highlight and mitigate
the suffering of the poor and marginalised.
f. Improve upon the current positive image of CMAI in the
Government circles and NGOs for future network.
g. Restructure CMAI functionally and administratively to increase its
active presence in various parts of the country through volunteer
member initiatives.
B. EVALUATION RECOMMENDATIONS - PRIORITISED
59
1. Functional areas. CMAl to initiate ohanga
Nn^turing the Christian Spirit in the health professionals.
Members seek this from CMAI as first priority.
There is an urgent need to operationalise Christian spirit and values
in health profession.
CMAI may consider setting up a task force to identify areas for
resurgence of Christian spirit and values in health service areas.
With the help
of experienced professionals and practical
theologians develop meaningful and pragmatic approach and
attitudes that practitioners can follow. Hospital CEOs and young
professionals should be involved in the process.
ii. Steps should be taken to attract more young professionals into the
CMAI membership fold, which itself needs to be enlarged.
iii. Periodic retreats on “practical work” should be held at all regional
levels cutting across “professional sections” and more often
through member initiatives.
iv. Illustratively, CMAI may consider making it a policy to invite for
every program/ activity, at its cost, a professional who is well
known, in service, competent, who can articulate and share
Christian experiences in practice which gave her/him value
satisfaction. For every activity, programme CMAI may invite a local
Pastor/ Bishop/Theo logist (by rotation to avoid denomination
sensitivities) to share Christian messages which practitioner's can
relate to their work.
v. As a process for integration and nurturing Christian spirit, CMAI
may consider getting senior ofircials nominated from Churches of
various denominations by rotation, on CMAI general body, in
addition to the NCCI nominee, perhaps three more members.
CMAI also should seek representation on Church decision making
bodies - particularly in healing ministry.
vi. Provide special designated space in “Health for all: and other
publications, for members to narrate actual “incident” based
experiences which gave them satisfaction of fulfilling Christian
commitment to “Healing”.
vii. Members attending “retreats”, “workshops” and “Conferences”
should be encouraged to visit nearby mission hospitals to
“experience” and share their ideas for improvement.
Similarly members’ visit to a nearby Church, with a planned
special service, may be a helpful process for both “nurturing”
and “integration”.
i.
60
b) Institutionalising Planning and Review systems
(i) The evaluation has brought to surface the sine qua non for any
effective management - Planning and review system, with evolved
parameters of Input, Output and outcome, as well as process
guidelines enabling periodic monitoring and evaluation. CMAI
should identify a planning resource within, for co-ordinating and
institutionalising the process and annual calendar for planning.
(ii) Illustratively, the recommended steps are :
A detailed organisational annual plan be evolved from each
section/department, with specific time schedules for all activities,
in the last quarter of the previous financial year.
• The plans, inter alia, should specify each activity, venue, number
of expected participants, the agenda, and why the activity is
necessary at the specified venue.
• The detailed budget (including fund generation).
• Expected benefit for the participants and how such participation
would enhance the 'Christian’ and ‘professional’ value of the
participants, their organisation and in what ways it serves CMAI’s
purposes
• Feedback and follow-up plans.
• Schedule for quarterly review and recommendations.
• While deciding or fixing an agenda and/or a theme for an activity,
the views of some of the potential participants be pooled well in
advance, so as to make the activity relevant and 'Contemporary’ to
meet the needs of participating members.
• CMAI may find it worthwhile to explore various possible ways of
reaching the members - to overcome the deficiencies in
communication pointed out by the members.
• It may be worthwhile to evolve a standard format, specifying all
points to be covered in communications on 'activities’ to members,
to avoid omissions.
• A detailed plan of publicity for each type of activity be evolved and
circulated to the 'organisers’ to follow, so as to "optimise” effective
reach to prospective participants.
• A minimum lead time - say one month, be fixed as a rule - for
completing necessary process before an activity is conducted and such lead times be incorporated in the plan.
•
Sectional/Departmental plans so developed, dehberated and finafised by
the CMAI Executive be incorporated within CMAI annual plan and budget
for approval of the Board of Management.
61
c) To address the emerging issues
It is imperative for CMAI to examine in detail the emerging issues and
identify areas for continued thrust and new initiatives.
(i) As a first step, identify a handful of competent professionals from
among Christian fraternity and outside to help develop short term
and long term strategies on the following lines. (Illustrative) perhaps by the end of 1997.
Crucial here and now” issues which are within the framework
of objectives, current competencies and resources of CMAI.
Suggestions for effective implementation.
- Issues which need advocacy for awareness and influencing
policy - (Government/Church/Funding agencies), for which
CMAI can pool and enable experts with contacts at various
levels to represent CMAI on specific issues.
Issues which can be addressed through coordination and
support of Churches and Congregations in the next two or thrce
years.
Long term issues which need to be addressed in the next five
years or more, with preceding planned preparations for
developing internal competencies, and network to gamer needed
resources and support.
Emphasise more and more on participative approach to support
congregations and communities. Make ‘Health’ a people
movement. Move away from central decisions, as much as
possible, and as and when enabled people can take
responsibility. CMAI members and Churches are willing to
support this change. Involve them.
ii. The recommendations of the expert pool be deliberated by CMAI
management and decisions taken incorporated in the CMAI plans
commencing from March 1998.
iii. Responsibility for various emerging issues incorporated in the plan
be distributed among CMAI executives with freedom to act and
defined accountability. Accountability should be in terms of co
ordinating and developing action plans with set time and resources
parameters, monitoring implementation, results, reporting and
review.
62
iv. For special focus on “Gender Bias” make a policy decision to have
a session on Gender Bias in all activities and training programmes
of CMAI - to keep the members and trainees abrest of
developments and scope for service.
d) Towards an apex body to assist Healing Ministry of the Church
Several factors are pointing to the felt need for an apex body, which can
integrate, influence and converge efforts of all Church bodies, Christian
hospitals, Congregations, donors and every Christian health professional to
optimise the level of Christian Concern and contribution to “Teach preach
and heal” - the command of Christ. They are mainly,
~ The difficult times ahead for the poor and marginalised, for
sustenance, health, education and welfare
- Protestant health institutions are increasingly crumbling under
various pressures; Low rural presence.
- Lack of trained personnel to serve the healing ministry
- Acknowledgment by Churches that policies are not framed to assist
healing ministry work - and Church response to changing health
scenario is poor.
- Churches want an advisory apex body, and favour CMAI to play
the role since it is non-denominational.
(i) CMAI to be effective, should initiate steps for inter-denominational
consultations immediately seeking participation from among
- Bishops,
- Church Medical Board Representatives,
- Theologians,
- CMAI representatives,
- Institutional representatives,
- Experts from Health, Education, Economics, Sociology,
Social work etc., and
- Christian Health NGOs.
(ii) Immediate Consultations may be organised on focused limited issues of
health, with facts and figures. Participants views be invited on what they
can contribute to needed efforts. The process should be so guided as to
avoid conflict of interests and evolve consensus on priorities and
commitment.
(iii)CMAI would do well to install a “data bank” to help gather data to
support its multidirectional and multidimensional responsibilities.
CMAI’s investment in computerisation being in place, this would need a
good resource in statistics as support. Initially this cell should first
address itself to current issues providing support of authenticity to
CMAI’s initiatives from secondary sources - while parallel actions to
design and develop specialised data bank for CMAI.
63
(iv) CMAI should identify and co-opt from its members and others
knowledgeable persons to continually assist CMAI to succeeded in its
endeavour to integrate Christian resources
(v) CMAI management should periodically examine the precess critically and
be proactive in directing its efforts for integration.
e) Support to Institutional Members
The various issues brought up on CMAI support to Institutional members
need critical review by the management to evolve a pragmatic action plan.
Suggested actions are:
(i) Constitute an expert committee (of Christian professionals of
standing) to evaluate the current status and future challenges, of
selected few willing institutions, in two or three regions. Detailed
SWOT analysis be made by the committee on each case and
recommendations translated into action plans in terms of:
Needed structural and operational changes to be viable
and to support its commitment to healing tuned to future
challenges.
Needed resources - Personnel, finance, infrastructure,
and networking.
- Training and Development needs.
-
(ii) Develop proposals for owner managements on actions needed,
clearly stating the support CMAI can offer. Persuade through
consultations,
Institutional
Managements
to
implement
recommendations, monitor and nurture the institutions to viability.
(iii) Develop a few turned around institutions as models for replication.
(iv)CMAI can, with the available data, evolve a practical uniform
personnel policy with guidelines on tenns and conditions of service
to attract and retain trained personnel in service. Through a
consultative process persuade owners to adopt the model
personnel policies.
(v) Continue formal training programmes. In close association with
institutional staff, feedback from trained members and keeping in
view professional challenges of the future, periodically review the
content and methodology of training.
(vi)Take steps to effectively publicise and communicate on each of
CMAI s training programmes to potential trainees and employers.
Seek and obtain recognition for the courses from the Government,
Universities and employers.
64
(vii)As a long term plan, CMAI may consider being an agency for
accreditation of professional skill, on USA model.
(viii)CMAI can help evolve model standard work loads for professions.
(ix)CMAI can explore and evolve a policy for Institutions to offer
alternate systems of medical care.
(x) Develop a directory of Protestant Christian Health Professionals to
enable institutions to seek support when needed.
(xi) Compile a manual of model hospital management for mission
hospitals and publish.
(xii) Involve the institutions in increased focus on primary community
based services and away from tertiary care calling for heavy
investments to benefit relatively small number.
f) Publicity, Publications and Communication
These functional areas of CMAI need to be refurbished to provide greater
customer satisfaction.
(i) Appropriate efforts should be made for CMAI’s activities to be
known outside mission hospitals.
(ii) Publications of CMAI to be enjoyed by members in general, has to
address the problems of language, regional content, professional
content and members participation in journals.
(iiiJFor effective communication, the members’ lists with addresses
need updating regularly. Efficiency in communication and follow
up cannot be overemphasised.
2. Organisational Form And Set-Up
(a) Objectives
(i) Among the current objectives of CMAI "Rendering help in
calamities and disasters of all kinds” is identified as getting low
attention.
- CMAI management should identify reasons for this
situation.
- CMAI should develop a "disaster” management manual
clearly stating the steps to be taken to activate relief
when need arises.
- CMAI should seek and announce the list of volunteer
members and institutions willing to participate in CMAI
response to Calamities and Disasters, in their respective
regions.
65
Seek, nominate and publicise a regional disaster
coordinator among the volunteers to spring to action in
leading the local team of CMAI.
- Nominate and pubficise an executive in CMAI who will be
responsible to monitor and support local team to respond
to the need. Nominate the second in line and a contigency
support team at Head office.
- Provide for contingency funds in the budget to facifitate
quick financial response.
- Liaise and concretise understanding of co-ordination and
cooperation with other Chnstian speciafised agencies for
helping in calamities and disasters, on what CMAI can do
and the support it needs.
— Seek and keep ready a list of supplier donors who are
willing to support CMAI with medicines/materials in such
emergencies. Intimate regional co-ordinators.
- With the current donors, negotiate agreement for
diverting a percentage of funds to meet such situations
without reference. It would be ideal if a special budget
provision for “release on call” is agreeable by the donors.
ii. There is need to include “Nurturing the Christian Spirit in
Health Professionals” as an official objective of CMAI, to bring in
to focus the raison d’etre of CMAI and to give an official status to
the widely believed objective of CMAI.
iii. A word of caution in adding the new objective - In view of the
possible sensitivities that may arise under F.C.R. Act and the
income tax act, legal advice may be obtained in wording the new
objective suggested, to ensure no adverse reaction.
-
b) Membership Issues.
i.
Responsibility for membership co-ordination desk at CMAI - Head
office should be with a senior executive. CMAI is an association of
members and the base needs attention and service - First, update
membership and subscription information. Computer environment
should make the task none-too-difficult once updated.
ii. Responding to members and growth of membership in different
regions should be shouldered by the members of the management
team at Head Office for effective communication and service.
iii. In view of the growing recognition to non-allopathic systems of
medicine, CMAI may consider extending membership to accredited
non-allopathic practitioners (Doctors) to enlarge the scope for
service. Some Institutional members are offering non-allopathic
system of treatment anyway.
66
iv. CMAI should launch a membership campaign, involving current
members, to enlarge its membership now clustering around
mission hospitals. Non-mission hospitals sectors should be
vigorously reached to enlarge its area of contacts and influence
v. CMAI may examine ways and means of making its membership
useful to members by publicising benefits to members.
vi. A plan to encourage local chapters in different regions, on the
model of chartered secretaries. Engineers, Accountants etc. to
facilitate larger CMAI presence and relevance to individual
members through encouraging local activities on voluntary basis.
vii.Such local chapter may be given status support through intimating
local Government officials, Churches, NGOs and other Church
related institutions, about the local chapter, its office bearers that
they are CMAI representatives.
viii.CMAI may consider identifying annual “Health Themes’ for
members participation - with broad guidelines on implementation.
Financial support may be considered on a “percentage of matching
grant” against local resource generation by members.
c) Effectiveness of sections of CMAI
i. The present organisational set-up on the lines of professional
responsibilities needs review.
ii. It is necessary to effectively involve each section in the development
of CMAI as a whole and to increase interdepartmental and
intersectional communication on plans and progress.
d) Management set-up, style and form
i.
Increase the number of members on the General Body by three
more members, to develop an axis of help and co-operation with
the Churches. Senior Church officials of various denominations
may be nominated by rotation for the three posts.
67
ii. In order to create effective presence of CMAI in different parts of
the Country, identify five zones demarking the physical areas.
Responsibifity for developing each zone in terms of CMAI presence
by activity co-ordination, membership and service networking with
Churches in the area, be assigned to each sectional secretary in
addition to the sectional responsibilities. This would also enable
inter-sectional co-ordination and support. It reheves the CEO to
focus his/her time and energy on policy, planning and
coordination. (Please see enclosed chart for suggested changes)
iii. All sectional secretaries, functional heads and the general secretary
should form the “management forum” and be accountable to
implementation of all approved plans. The CEO should have the
deciding powers over the forum.
SbGGEorEJ^
REORGANISATION
CHRISTIAN MEDICAL ASSOCIATION OF INDIA
ORGANISATIONAL SET-UP
ASSEMBLY - BIENNIAL
I
GENERAL BODY
1
GOVERNING BOARD
FINANCE &
ADMINISTRATION
COMMITTEE
COMMUNICATIONS
& PUBLICATIONS
COMMITTEE
COMMUNITY
HEALTH
COMMITTEE
NATIONAL ADVISORY
COMMITTEE ON
HEALTH HEALING &
WHOLENESS
REGIONAL
SECRETARIES
EXECUTIVE
COMMITTEE
CHAPLAINCY
EXECUTIVE
COMMITTEENURSES
LEAGUE
EXECUTIVE
COMMITTEE
HOSPITAL
ADMINISTRATION
EXECUTIVE
COMMITTEE
DOCTORS SECTION
EXECUTIVE
COMMITTEE AHP
SECTION
CHIEF EXECUTIVE OFFICER
GENERAL SECRETARY
V
FINANCE
MANAGER
HEAD
COMMUNICATION
CENTRE
HEAD
SPECIAL
PROGRAMS
ADMINISTRATION MANAGER
EXECUTIVE FORUM
SECRETARY
CHAPLAINS
SECRETARY NURSES
LEAGUE
SECRETARY
DOCTOR SECTION
SECRETARY
AHP SECTION
&
&
&
CMAIZONE I
&
&
CMAIZONE II
CMAIZONE III
CMAIZONE TV
CMAI ZONE V
I
BNESIB
ZONES
SECRETARY
HOSPITAL ADMINISTRATION
~
MTBE
'I
CAMS : CHRISTIAN
ACADEMY OF
MEDICAL SCIENCES
I
CENTRAL
EDUCATION
BOARD
STATES
(ILLUSTRATIVE)
ZONE I = J&K, HARYANA, H.P. DELHI, PUNJAB, U.P., CHANDIGARH
ZONE II = GUJRAT, RAJASTHAN, MAHARASHTRA
ZONE III = ORISSA, BIHAR, M.P.
ZONE IV = ASSAM, MEGHALAYA, MIZORAM, NAGALAND, MANIPUR, W.B., SIKKIM, TRIPURA
ZONE V = A.P., T.N., KARNATAKA, KERALA, PONDICHERRY, GOA, DAMAN DIU, ANDAMAN/NICOBAR
c\
00
PART-B
SELECTED DATA BASE For Reference
69
CONTENTS
PART B - LIST OF TABLES & CHARTS
CHART/TABLE NO.
CHART 1
i
CHART 2
:
CHART 3 :
CHART 4 :
CHART 5 :
CHART 6 :
CHART 7 :
CHART 8 :
CHART 9 :
CHART 10:
CHART 11:
CHART 12 :
CHART 13:
CHART 14:
CHART 15 :
CHART 16:
CHART 17:
CHART 18 :
CHART 19 :
CHART 20 :
CHART 21 :
CHART 22:
CHART 23 :
CHART 24 :
TABLE 1
TABLE 2
TABLE 3
TABLE 4
TABLE 5
TABLE 6
TABLE 7
TABLE 8
TABLE 9 :
TABLE 10 :
TABLE 11 :
TABLE 12 :
TABLE 13 j
TABLE 14 :
TABLE 15 :
TABLE 16 :
TABLE 17 :
TABLE 18 :
TABLE 19 :
TABLE 20 :
TABLE 21 :
TABLE 22 :
TABLE 23 :
TABLE 24 :
TABLE 25 :
TABLE 26 :
TABLE 27 :
TABLE 28 :
TABLE 29 :
TABLE 30 :
TABLE 31 :
TABLE 32 :
TABLE 33 :
TABLE 34 :
CONSTITUTIONAL OBJECTIVES OF CMAI
IMPORTANCE GIVEN TO EACH CONSTITUTIONAL OBJECTIVE BY CMAI
AS PERCEIVED BY INDIVIDUAL MEMBERS & STAFF OF CMAI
DISTRIBUTION OF MEMBERS BY SECTION
INDIVIDUAL MEMBERS QUALIFICATION BY SECTION
REGIONAL DISTRIBUTION OF MEMBERS BY EDUCATION
EMPLOYMENT SETTING OF CMAI INDIVIDUAL MEMBERS
MEMBERSHIP DURATION OF INDIVIDUAL MEMBERS
CMAI MEMBERS BY CHURCH DENOMINATIONS
AGE OF MEMBERS
CMAI STAFF BY QUALIFICATION
STAFF - LENGTH OF SRVICE IN CMAI
SECTION / DEPARTMENT WISE DISTRIBUTION OF STAFF IN CMAI
CMAI STAFF MEMBERS BY RESPONSIBILITY LEVELS
STAFF r AGE DISTRIBUTION
INDIVIDUAL MEMBERS PERCEPTION ON CMAI ACTIVITIES
STAFF MEMBER PERCEPTION OF CMAI ACTIVITIES
INDIVIDUAL MEMBERS PERCEPTION ON CMAI TRAINING PROGRAMMES
STAFF PERCEPTION ON CMAI TRAINING PROGRAMMES
DISTRIBUTION OF CHURCH OFFICIALS BY DENOMINATIONS
REGIONAL DISTRIBUTION OF RESPONDING CHURCH OFFICIALS
RESPONDING CHURCH OFFICIALS - AGE DISTRIBUTION
RESPONDING CHURCH OFFICIALS - DURATION OF SERVICE IN CHURCH
CMAI INSTITUTIONAL MEMBERS - NATURE OF RESPONDENTS
RESPONDENT NGOs - FIELD OF SERVICE
PAGE NO.
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
CMAI ACTIVITIES BY SECTION - PERIOD 1991 - 1996
94
BIRDS EYE VIEW OF CMAI PROJECTS
95
PERCEPTION OF IMPLIED OBJECTIVES - BY MEMBERS
96
EFFECTIVENESS OF CMAI SECTIONS - MEMBERS VIEW
97
EFFECTIVENESS OF CMAI SECTIONS - STAFF VIEW
97
CMAI ROLE IN REPRESENTING CHRISTIAN INTEREST - MEMBERS VIEW
98
CMAI ROLE IN REPRESENTING CHRISTIAN INTEREST -STAFF
____
VIEW
98
ARE THERE HINDRANCES FOR GROWTH AND DEVELOPMENT OF WOMEN
IN INDIA - STAFF VIEW
99
MEMBERS EXPECTATION OF BENEFITS BY SECTION
99
STRENGTHS OF CMAI - MEMBERS VIEW
100
STRENGTHS OF CMAI - STAFF VIEW
100
WEAKNESSES OF CMAI - MEMBERS VIEW
101
WEAKNESSES OF CMAI - STAFF VIEW
101
CMAI INSTITUTIONAL MEMBERS - PROFILE - NATURE OF INSTITUTIONS
102
REGIONS BY NATURE OF INSTITUTION
102
YEAR OF ESTABLISHMENT BY - NATURE OF INSTITUTION
103
ALTERNATE MEDICAL SYSTEMS AT MEMBER INSTITUTIONS
103
TRAINING PROGRAMMES - AT MEMBER INSTITUTIONS
104
TRAINING PROGRAMMES & CMAI AFFILIATION
104
STAFFING PATTERN IN MEMBER HOSPITALS
105
DECISION MAKING IN INSTITUTIONS
106
INSTITUTIONAL PROBLEMS
106
EXPECTED SUPPORT FROM CMAI BY INSTITUTIONS
107
INSTITUTIONAL PARTICIAPTION IN CMAI ACTIVITIES
107
CMAI TRAINING - INSTITUTIONAL PERCEPTIONS
108
ISSUES OF HEALTH & HEALING MINISTRY CHURCH OFFICALS RESPONSE
109
FUTURE PROSPECTS - CHURCH OFFICIALS RESPONSE
109
CHURCH OFFICIALS WILLINGNESS TO BE ACTIVELY
ASSOdATED WITH CMAI
110
CHURCH OFFICIALS VIEW - SHOULD CLOSED
HOSPITALS BE REVIVED
110
CHURCHES RESOURCE POTENTIAL
110
PROFILE OF NGO RESPONDENTS - FIELD OF SERVICE
111
NGOs KNOWLEDGE OF CMAI
111
AWARENESS OF CMAI - GOVERNMENT OFFICIALS PERCEPTION
112
SPECIAL ROLE FOR CMAI - GOVERNMENT OFFICIALS VIEW
112
70
CHART 1
CONSTITUTIONAL OBJECTIVES OF CMAI
2
3
CO-ORDINATIONS
ACTIVITIES FOR
TRAINING
DOCTORS, NURSES
AHPs & OTHERS
INVOLVED IN THE
MINISTRY OF
HEALING
PROMOTION OF
KNOWLEDGE OF
FACTORS
GOVERNING
HEALTH
1
PREVENTION & RELIEF
OF HUMAN SUFFERING
IRRESPECTIVE OF
CASTE, CREED,
COMMUNITY,,
RELIGION <fc ECONOMIC
STATUS
4
IMPLEMENTATION OF
SCHEMES FOR
COMPREHENSIVE
HEALTH CARE, FAMILY
PLANNING &
COMMUNITY WELFARE
5
RENDERING HELP
IN CALAMITIES &
DISASTERS OF ALL
KINDS
71
Chart 2
IMPORTANCE GIVEN TO EACH CONSTITUTIONAL OBJECTIVE BY CMAI
AS PERCEIVED BY
INDIVIDUAL MEMBERS
STAFF OF CMAJ
16%
r
PROMOTION OF
KNOWLEDGE OF
FACTORS GOVERNING
HEAI.TH
23%
r^%i
20%
(
CO-ORDINATING A
ACTIVmESFOR
TRAINING DOCTORS,
NURSES & OTHERS
INVOLVED IN THE
\MINISTRY OF HEALING/
75%
26%
< IMPLEMENTATION OF A
SCHEMES FOR
COMPREHENSIVE HEALTH
CARE, FAMILY PLANNING
AND COMMUNITY
<
WELFARE
J
25%
[~75%|
' 51%
'PREVENTION AND RELIEF'
OF HUMAN SUFFERING
IRRESPECTIVE OF CASTE,
CREED, COMMUNITY,
RELIGION AND ECONOMIC
<
STATUS
>
RENDERING HELP IN^
CALAMITIES &
DISASTERS OF ALL
KINDS
43%
74%
□ MODERATE/
HIGH
0POOR/DON’T
KNOW / NR
>
DISTRIBUTION OF MEMBERS BY SECTION
CHAPLAINS
7.5%
AHP
14.1%
DOCTORS
35.4%
.^•5
ADMINISTRATORS
6.8%
NURSES
36.2%
o
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CO
* *4
73
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CMAI MEMBERS BY CHURCH DENOMINATIONS
N.R.
8.3%
CSI
22.2%
OTHERS
26.0%
CNI
16.2%
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6.1%
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6.3%
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6.5%
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8.4%
a
!
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AGE OF MEMBERS
30
7.4
25 -
23.6
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18.2
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s
17.0
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------ 1------
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30-39
40-49
50-59
60 +
RESPONDENTS AGE IN YEARS
« 3d
CMAI STAFF BY QUALIFICATION
(ONLY HIGHEST QUALIACATION)
UG - NON MEDICAL
12.1%
PG - MEDICAL
12.1%
Sw8^
!
'SBSii
iti?
iflti
Us
GR - NON MEDICAL
36.2%
S3
GR - MEDICAL
3.4%
fSHs
PG - NON MEDICAL
36.2%
s
I
O 'o
80
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siNaoNOdsau jo 3oviN33H3d
SECTION / DEPARTMENTWISE DISTRIBUTION OF STAFF IN CMAI
ms
COMMUNITY HEALTH
26.2%
GENERAL ADMINISTRATION
27.9%
■
w
gig
.
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.
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;
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.JHHi
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CHAPLAINS’ SECTION
8.2%
p
COMMUNITY CENTRE
9.8%
j| w
AMPS’ SECTION
4.9%
FINANCE DEPT.
4.9%
DOCTORS’ SECTION
3%
NURSES’ SECTION
14.8%
a
I
CMAI STAFF MEMBERS BY RESPONSIBILITY LEVELS
GRADEC
22.8%
.s
■
Ofc ®Kffi
:
SB
GRADE A
43.9%
■
GRADE B
33.3%
a
JT
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STAFF - AGE DISTRIBUTION
t
35
31.0
30 -■
27.6
25
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20 --
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15
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30-39
40-49
AGE (IN YEARS )
50 +
I
Aw
PERCENTAGE OF RESPONDENTS
o
o
8
o
£
g
o
23
RETREATS
49
31
□
io
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23
WORKSHOPS
jo
30
g
<
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3
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WEEK
m
w
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m
o
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29
I is
24
2
m
2
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2
m
49
SECTIONAL
CONFERENCE
51
30
□
I
o
m
s
o
I
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51
31
22
BIENNIAL
CONFERENCE
25
ST XHVHQ
frS
o
REGIONAL
CONFERENCE
o
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PERCENTAGE OF RESPONDENTS
o
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s
62
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RETREATS
7
n
52
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51
WORKSHOPS
w
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66
44
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HEALING
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59
47
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m
3
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m
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xx >:>::. >x x >: x x x I
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33
SECTIONAL
CONFERENCE
48
ss
41
o
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m
3
s
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£
29
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REGIONAL
CONFERENCE
<
38
m
co
34
o
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o
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-
36
BIENNIAL
CONFERENCE
47
39
91 XMVH3
$8
PERCENTAGE OF RESPONDENTS
o
S
o
g
£
g
8
J9
GEN NURSING
27
LAB. TECH
27
48
RADIOLOGY
X
22
□
g
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47
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28
w
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44
22
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38
HEALING MINISTRY
19
co
o
5
HOSPITAL AUXILIARY
1
16
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OPHTHALMOLOGY
TECHNICIAN
REHABILITATION
TECHNOLOGY
ADDITION
COUNSELLING
98
co
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u
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29
16
29
17
g
2
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m
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16
PERCENTAGE OF RESPONDENTS
o
2
o
£
o
o
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65
GEN NURSING
34
63
LAB. TECH
36
60
RADIOLOGY
□
32
I
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48
w
32
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£
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RECORDS
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s
28
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16
47
3
DISTRIBUTION OF CHURCH OFFICIALS BY DENOMINATIONS
CSI
19.2%
OTHERS
32.7%
ONI
13.5%
XV
METHODIST
11.5%
rj
BAPTIST
11.5%
LUTHERAN
11.5%
S
!
REGIONAL DISTRIBUTION OF RESPONDING CHURCH OFFICIALS
NORTH
17.0%
IFflllglliBIigll!
- -
WEST
2.0%
SOUTH
39.0%
H -Jfl
1
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7
Midi
EAST
42.0%
a
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90
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RESPONDING CHURCH OFFICIALS - DURATION OF SERVICE IN CHURCH
40
36.5
35 ■■
30 -M
H
Z
a
25
o
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20 --
15
10 ■■
9.6
5 -■
0 --------LESS THAN 10
—i—
—I—
11-20
-I
21-30
31+0
DURATION OF SERVICE IN CHURCH (YEARS)
I
►0 “
CMAI INSTITUTIONAL MEMBERS - NATURE OF INSTITUTIONS
MISCELLANEOUS
8%
HEALTH EDUCATION / TRAINING
6%
MOTHER & CHILD HEALTH CENTRE
7%
GENERAL HOSPITAL
79%
I
S'®
CO
PERCENTAGE OF RESPONDENTS
o
o
III
1
7.6
S
3
5
g
o
10.0
z
zo
11.8
2.8
liillllliiiBiBliiliiiiliB
5
a
o
20
z
X
m
S
z
5
71
m
□
$
30.0
TO
70
o
m
46.2
s
§
“0
o
O
63.9
5
o
n
CA
O
m
70
Z
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m
0
T1
m
z
o
5
10.0
o
T1
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5
5.9
5
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m
7)
<
2.8
o
m
IIM
46.2
50.0
co
O
29.4
30.5
JLHVH3
£6
z
o
m
z
-4
Z
Q
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§
I□
m
w
52.9
94
CMAI ACTIVITIES BY SECTION - PERIOD 1991-1996 - TABLE - 1
YEAR
ACTIVITIES
DOCTORS
1996
RETREATS
2
WORKSHOPS
1
SECT. CORF
1
NURSES
SECTIONS___
ADMINISTRATORS AHP’S
5
1
1
INST. VISITS
STUD’T PRO
1994
WORKSHOPS
4
SECT.CONF
1
1992
1
1
5
5
160
160
6
6
3
7
1
4
70
70
STUD’T PRG
6
6
RETREATS
1
3
1
1
2
6
12
SEM/R.CONF
16
16
INST. VISITS
130
130
STUD’T PRG
3
3
RETREATS
1
1
WORKSHOPS
1
1
2
10
14
SECT CONF
1
1
1
1
4
4
4
1
7
RETREATS
WORKSHOPS
6
SECT CONF
1991
3
INST. VISITS
WORKSHOPS
1993
7
1
SEM/R.CONF
1995
TOTAL
CHAPLAINS
1
1
RETREATS
5
WORKSHOPS
3
SECT CONF
1
1
5
10
5
4
12
1
1
4
SEM/R.CONF
3
3
INST. VISITS
60
60
469
551
TOTAL
18
8
INDEX: SECT.CONF = SECTIONAL CONFERENCE,
SEM/R.CONF = SEMINARS/ REGIONAL CONFERENCE
INST. VISITS = INSTITUTIONAL VISITS
STUD’T PRG = STUDENTS PROGRAMME
19
37
BIRDS EYE VIEW OF CMAI PROJECTS : TABLE - 2
Name of the project
SOUTH
North
WEST
East
Central
Total
objectives
Evaluation and Recommendations
AFTER CMAI
Financial support
was withdrawn
CBFP started between 1987-92
upto - 1 year
2-4 year
5 & above
TOTAL
CBPHC started between 87 - 93
upto - 1 year
9
5
10
9
5
10
24
24
4
13
3
2
8
1
2
6
1
6
8
9
16
35
TOTAL
23
13
9
15
60
CSCD started between 88-91
upto 3 years
19
2
8
6
39
TOTAL
19
2
8
4
6
39
CSCD started between 93-94
upto 3 years
12
1
1
7
4
25
12
1
1
7
4
25
2-4 year
6
5 & above
TOTAL
4
11
9
20
TOTAL
11
9
20
12
12
12
12
17
17
17
17
63
197
BIMAROU started
between 93 - 96
TOTAL
CHOTA NAGPUR started
between 95 - 97
TOTAL
78
16
Potential to serve greater population.
Funding period is too short
To reduce mortality & morbidity
among women and children
Understood concept of CBPHC,
Established rapport with community
Institutions benefited and staff had good
commitment to work.
To reduce IMR to 60/1000 live births
Successfill innovation in community
health oriented interventions. New
experience for CMAI to work with non
health groups. Well conceived, freedom
of flexibility. Too much expectation in
short time.
To reduce IMR
WHD started between 86-94
upto 3 years
GRAND TOTAL
To promote Family Welfare Service
& temporary FP Methods
29
11
On going project
To create awareness among women
and to increase literacy to improve
status of women
Suggested more integration in
development process with special focus
on weaker sections. Linkage with other
NGOs.
To enable church and related
agencies to implement CBPHC in
BIMAROU States
On going project
Promote the Health and Development
of people at the grass root level. To
establish 15 micro projects to cover
1,50,000 people
On going project
7
25
31
25
15
12
17
132
96
PERCEPTION OF IMPLIED OBJECTIVES - BY MEMBERS
Table - 3
________________ All figures in %
Implied Objectives
PERCEIVED BY
INDIVIDUAL
Staff
Members n = 984
m = 61
1. Nurturing Christian Spirit
77
67
2. Funding Agency Programs
59
62
3. Church Programs
59
61
4. Support To Hospitals
57
59
5. Govt. Projects
55
61
6. Poor & Marginalised
55
59
7. Debates On Health Issues
65
48
8. Fund Raising For Hospitals
39
20
97
EFFECTIVENESS pp SECTIONS - MEMBERS VIEW - Table 4
PERCEPTION
Regions
Doctors
Nurses
Adminis
TRATORS
ahp
POOR/DK
NORTH
WEST
CENTRAL
EAST
SOUTH
TOTAL
NORTH
WEST
CENTRAL
EAST
SOUTH
TOTAL
39.1
31.6
28.2
38.1
42.3
37.0
21.8
18.4
30.0
19.0
18.7
20.2
34,6
35.0
30,2
43.0
34.0
33.0
28.6
23,5
35.0
20.2
23,4
24.7
41.1
53.0
43.6
69.0
54.0
50.0
14.3
9.2
19.0
17.0
10.8
12.4
43.0
62.0
59.0
51.2
57.0
53.5
10.5
9.2
5.3
8.3
10.0
8.6
V.GOOD
N = 1016
CHAPLAINS
WEIGHTED
AVERAGE
PERCENTAGE
37,6
39.1
54.1
47.1
51.0
42.4
39,3
48.9
51.2
47.5
46.9
44.1
18.0
18.6
13.3
14.7
16.0
21.4
14.3
15.7
13.0
15.1
13.8
15.9
EFFECTIVENESS OF CMAJ SECTIONS - STAFF VIEW - TABLE - 5
N = 57
--------------- ---------------- --------------------------- ------------ - ------------- ------------Figures in %
SECTIONS
PERCEPTION Level of Doctors Nurses Adminis ahp
Chaplains WEIGHTED
STAFF
TRATORS
AVERAGE
(Grade)
PERCENTAGE
POOR/DK
A
56.0
12.0
32.0
12.0
36.0
38.8
B
42.0
27.0
21.0
26.0
43.0
34.3
C
46.0
31.0
31.0
23.0
23.0
33.1
49.1
21.1
28.1
19.3
35.1
34.4
4.0
36.0
4.0
28.0
12.0
26.9
TOTAL
V.GOOD
A
B
C
TOTAL
21.0
8.0
8.0
3.5
24.6
16.0
1.8
17.5
18.8
8.0
8.0
7.0
17.9
98
CMAJ’S ROLE IN REPRESENTING CHRISTIAN INTEREST
INDIVIDUAL MEMBERS VIEW TABLE - 6
N = 1016
_ ________Figures In %
EXPECTED
SECTIONS
REGIONS
ROLE OF
CMAI
Doc.
Nur.
Adwin
AHP’b
Chp
North
West
Central
East
South
Average
96.7
89.1
94.2
94.4
92.1
97.0
93.9
96.0
91.7
93.8
93.1
62.2
52.2
50.7
65.0
53.9
57.9
68.4
45.6
57.1
59.5
57.6
Community
Awareness
29.2
51.6
40.6
44.1
42.1
37.6
48.0
49.0
35.7
41.3
41.1
Influencing &
Propagation of
Health Services
2.5
2.2
1.4
3.5
2.6
0.8
4.1
3.4
3.6
1.7
2.5
Agency for
Integrating
Christian spirit in
Health Field
National
organisation for
Christian Me dical
Profession 6b
Institutions
Cmai’s role in Representing Christian
interest - Staff view Table - 7
Except column total figures in %
EXPECTED
ROLE OF
CMAI
Agency for
Integrating
Christian spirit in
Health Field
Community
Awareness
RESPONSIBILITY LEVEL
Grade A
Grade B
Grade C
Total
100.0
100.0
84.6
96.5
40.0
47.4
61.5
47.4
48.0
42.1
38.5
43.9
7.7
1.8
13
57
National
ORGANISATION FOR
Christian Medical
Profession 6b
Institutions
Influencing 6b
Propagating
Health Issues
Total
25
19
99
ARE THERE HINDRANCES FOR GROWTH 8b DEVELOPMENT
OF WOMEN IN INDIA - STAFF VIEW - Table - 8
N= 61
Except Column totals figures IN %
STAFF GRADES
RESPONSE
A-grade
B-grade
C-GRADE
NA
TOTAL
Yes
88.0
57.9
61.5
75.0
72.1
No
8.0
31.6
Dont
4.0
10.5
38.5
25.0
15.8
25
19
13
4
61
13.1
KNOW/No
Response
Total
MEMBERS EXPECTATION OF BENEFITS BY SECTION
Table- 9
[ % Figures Based On The Sectional Totals ]
SECTIONS
Expected Benefits
Reinforcement of
Doctors Nurses Admn
AHP
Chaplains
Total
86.4
70.7
76.8
73.4
85.5
78.1
58.6
63.6
59.4
58.0
57.9
60.3
Organisation support Personal
27.2
54.9
47.8
53.1
28.9
42.4
Opportunity to
CONTRIBUTE
25.3
14.7
20.3
17.5
34.2
20.7
Organisational
support - Professional
6.7
11.4
17.4
14.7
17.1
11.0
Total (No.)
360
368
69
143
76
1016
CHRISTIAN SPIRIT &
VALUES
Professional
RECOGNITION &
KNOWLEDGE UPDATE
100
STRENGTHS OF CMAI - MEMBERS VIEWS
Table- 10
N
Identified Strengths
1016
No
%
1. Recognition for Quality of Service
784
77.2
2. Recognition for Quality of Training
771
75.9
3. Spiritual Integration
649
63.9
4. National Identity for Christian health profession
597
58.8
5. Built in Infrastructure
453
44.6
6. Quality of Publications
366
36.0
7. Net Working
223
21.9
STRENGTHS OF CMAI - STAFF VIEW
Table - 11
Except Column totals figures in %
STRENGTHS
A-Grade
B-Grade
C-Grade
TOTAL
Recognition for Quality
Service
80.0
94.7
76.9
84.2
Recognition for Quality
Training
88.0
57.9
76.9
75.4
Spiritual Integration
72.0
68.4
61.5
68.4
Infrastructure
28.0
84.2
76.9
57.9
National identity
52.0
57.9
53.8
54.4
Quality of Publications
28.0
36.8
46.2
35.1
Networking Capabilities
16.0
5.3
N =
25
19
8.8
13
57
WEAKNESSES OF CMA1 - MEMBERS VIEW - Table- 12
101
Endorsed by
NO
%
1. Publications & Publicity
709
69.8
2. Deficiency in Service to members
635
62.5
3. Management of resources
487
47.9
4. Communications & followup
453
44.6
5. Organisational Identity & recognition
447
44.0
6. Influence on Church & Related
Institutions
373
36.7
7. Organisational competence
337
33.2
8. Focus on Rural & Marginalised people
218
21.5
WEAKNESSES OF CMAI - STAFF VIEW - TABLE -13
-------------------- —
Except Column totals figures in %
_____ __________ _________ LEVEL OF RESPONSIBILITY
WEAKNESS OF CMAI
A-Grade
B-Grade
C-Grade
TOTAL
Publication & Publicity
68.0
78.9
53.8
68.4
Service to members
72.0
57.9
76.9
68.4
Resource management
80.0
73.7
30.8
66.7
Organisational
Competence
48.0
57.9
46.2
50.9
Communication &
Follow-up
48.0
47.4
61.5
50.9
Recognition identity &
Political influence
40.0
31.6
38.5
36.8
Influence on Church
INSTITUTIONS
32.0
26.3
46.2
33.3
FOCUS ON
RURAL/ MARGINALISED
8.0
10.5
15.4
10.5
25
19
13
57
N =
®
/
/° A
o >4°
102
CMAI INSTITUTIONAL MEMBERS - PROFILE - NATURE OF
INSTITUTIONS - TABLE - 14
%
General Hospital
77
Community Health Centre /Project
30
Training centre
26
Maternity Centre
*
24
Mobile Clinic
20
Mother A Child Care Centre
20
Health Education centre
17
Dispensary
16
Leprosarium
14
Tuberculosis Sanitarium/centre
6
Eye Hospital
5
Cancer Centre
2
De-addiction-rehabilitation Centre
Research Centre
2
—-
2
REGIONS BY NATURE OF INSTITUTION (NATINST)- Table - IK
Gen
Hosp
Mch
Centre
Northern
8.4
16.7
Western
7.6
Central
Except column totals figures in %
Hlth Edu /
Training
Miscella
Neous
Total
14.3
10.2
16.7
7.1
7.8
16.0
8.3
14.3
14.4
Eastern
6.1
8.3
10.0
Southern
61.8
50.0
70.0
64.3
61.7
Total
131
12
10
14
167
%
79
7
6
8
100
20.0
6.0
103
Year of Esta^ushment by natinst - taele - 16
Year
Gen
Established Hosp
Mch
Centre
No Rebp
9.9
16.7
Upto-1900
16.8
8.3
1901-1950
43.5
1951-1975
1976+
Except column totals figures in %
Hlth Edu /
'miscella
Neous
Total
21.4
10.8
20.0
14.3
16.2
25.0
10.0
42.9
40.1
24.4
25.0
30.0
7.1
23.4
5.3
25.0
40.0
14.3
9.6
Total
131
12
10
14
167
%
79
7
6
8
100
training
SERVICES AND FACILITIES
ALTERNATE MEDICAL SYSTEMS OFFERED AT MEMBER INSTITUTIONS
Table- 17 N = 165
--------------------------------- - ----------------------------------------------------------------------------------------- EXCLUDING 2 NR
Allopathy___________ _________________
Allopathy fc Ayurveda
Allopathy & Herbal
Allopathy & Naturopathy________ ______ _______
Allopathy & Acupressure/Accupuncture______________
Allopathy & Homeopathy
Allopathy, Ayurveda & Herbal
Allopathy, Ayurveda & Homeoptahy____________
Allopathy, Naturopathy & Acupressure /Accupuncture
Allopathy, Ayurveda, Herbal & Naturopathy__________
Allopathy, Ayurveda, Herbal a Homeopathy__________
Ayurveda, Herbal, Naturopathy,
Acupressure/Accupuncture & Homeopathy
%
89.7
1.8
1.2
0.6
2.5
0.6
0.6
0.6
0.6
0.6
0.6
0.6
104
TRAINING PROGRAMMES - AT MEMBER INSTITUTIONS Table- 18
Except where% indicated figures are absolute numbers
NATURE OF INSTITUTIONS
Training
Gen Mch
Hlth Edu /
Hosp Centre Training
Miscella
Neous
Total
N=
131
12
10
14
167
%
79
7
6
8
100
Nurses
56
4
3
Ahps
20
1
4
Doctors
7
3
2
Administrators
4
4
Chaplains
3
3
Chws
18
2
63
1
26
12
4
24
Training Programs & Cmai Affiliation - Table- 19
Except where% indicated figures are absolute numbers
Training for
No. or Institution
Having Programs
No. Affiliated
to Cmai
%
Affiliation
AHP’s
26
17
65
Nurses
63
22
35
Administration
4
1
25
Doctors
12
2
17
Chw’s
24
3
12
Chaplains
3
105.
STAFFING PATTERN IN MEMBER HOSPITALS - Table - 20
IN PATIENT RANGE PER ANNUM
UPTO
501 -
2501 -
5001 -
10001 -
500
2500
5000
10000
20000
27
25
43
26
27
9
NIL/NR
No.OF
Inst
Figures in numbers
20000 +
TOTAL
10
167
Staff No.41
D
nil/nr
6
1
o
1-5
14
21
34
10
4
1
1
85
c
6 - 10
2
3
7
12
6
1
2
33
T
11- 20
1
2
4
9
1
3
20
o
21- 30
1
4
3
1
9
R
31 +
3
2
3
3
11
N
NIL/NR
7
u
1 -5
8
20
8
1
R
6 - 10
4
5
15
1
5
8
11- 20
3
19
11
1
E
21- 30
1
1
6
4
8
31 +
4
5
14
NIL/NR
9
6
2
3
5
A
1 -5
13
8
22
8
6
H
6 - 10
5
10
10
p
11 -20
6
5
’8
21-30
31 +
2
3
2
2
9
3
12
1
1
39
30
2
1
37
3
15
5
34
1
26
2
2
61
7
1
2
35
3
3
4
3
26
2
1
3
2
2
1
3
6
8
2
11
note : Administrators & chaplains being SMALL IN NUMBER ARE NOT INCLUDED IN THE TABLE - THE COMMENTS APPLY TO
THEM ALSO.
(.
106
DECISION MAKING IN INSTITUTIONS -TABLE - 21
Except where % indicated figures are absolute numbers
Nature Of Institutions
Decision Makers
Include
Gen
Mch
Hlth Edu/ Miscella Total
Hosp Centre Training Neous
%
N =
131
%
10
14
167
79
12
7
6
8
100
CONQREGATIOH
77
5
3
8
56
Local Committee
56
6
5
5
43
Health Splst
36
5
3
2
28
Govt Officials
13
1
3
2
11
Others
32
2
6
24
PROBLEMS OF INSTITUTIONAL MEMBERS - TABLE - 22
%
Personnel
80
Infrastructure
74
Finance
59
Poor Service Conditions
8s Facilities
20
Management &
Administration
Tough Competition
10
Patients/ Community
5
Lack of Autonomy
3
Government Apathy
1
5
107
EXPECTED SUPPORT FROM CMAI BY INSTITUTIONS
Type of Support- table - 23
N=167
%
Financial support
59
Data Bank
38
Training
28
Strengthening of Management
24
Program support to Communities
17
Update Knowledge/ Techniques
8
Publications / Communications
8
Net work
7
Developing infrastructure
5
INSTITUTIONAL PARTICIPATION IN CMAI ACTIVITIES - Table - 24
Except column totals, figures in %
_____________________ NATURE OF INSTITUTIONS
Level of
Gen
mch
Hlth Edu/
Miscella
Participation
Hosp Centre Training
Neous
Total
Nil
52.7
41.7
70.0
50.0
52.7
Low
24.4
25.0
30.0
14.3
23.9
Moderate
19.8
33.3
14.3
19.2
High
3.1
21.4
4.2
Total
131
12
10
14
167
%
79
7
6
8
100
(N CMAI ACTIVITEf
108
CMAI TRAINING - INSTITUTIONAL PERCEPTIONS - TABLE -25
Figures in %
_______ _
Training
N=167
Usefulness of Programs/services
Very good Good
Satis
Poor
Lab Tech
33.5
27.5
3.0
Gen Nursing
30.5
22.2
1.8
Radiology
24.6
26.9
1.8
Med Records
21.6
26.9
3.6
PG-Prg Doctors
24.0
22.2
3.0
ANM- MPHW
22.8
22.2
3.6
Healing Ministry
18.0
17.4
2.4
Ophthalmology Tech
15.0
19.2
2.4
Hospital Auxiliary
11.4
19.2
3.6
Rehab Tech
12.0
16.8
2.4
Addiction Counseling
12.6
16.2
1.8
0.6
0.6
109
ISSUES OF HEALTH AND HEALING MINISTRY
CHURCH OFFICIALS RESPONSE - Table - 26
N =52
All Figures in %
Health Issues &
Concerns
Denominations
1.There are
specific Healing
Ministry Policy
Guidelines
csi
CNI
27.3
42.9
2. Health is Issue
for Social Justice
100.0
100.0
83.3
90.0
85.7
Yes
54.5
No/
DK
No/
D.K
3. Gender is a
Social Justice
Issue
4.Are Churches
Responsive to
CHANGING HEALTH
Scenario
5. Are Churches
RESPONSES TO
CHANGING HEALTH
Methodist
Lutheran.
Baptist
Others
Total
16.7
29.7
23.1
66.7
100.0
88.2
90.0
100.0
83.3
50.0
94.1
86.5
42.9
60.0
33.3
64.7
48.1
45.5
57.1
40.0
66.7
100.0
35.3
51.9
100.0
85.7
100.0
100.0
100.0
82.4
90.4
SCENARIO ADEQUATE
FUTURE PROSPECTS - CHURCH OFFICIALS RESPONSE - Table - 27
N = 52
Figures in %
1. Is THERE a need for an apex body to
assist Churches in h.m. policy and
implementation?
2. Should the apex body recommendations
BE OBLIGATORY FOR CHURCHES TO FOLLOW ?
3. Who should constitute
THE APEX BODY
4. Should congregations be activated to
PROMOTE HEALTH OF COMMUNITIES ?
*
Yes
No
90
10
40
60
Health
Professionals
2
Yes
73.1
Church
Officials
8
No
3.8
Combination
79
Don’t Know
23.1
110
Table -38
N = 52
Figures In %
DENOMINATIONS
CHURCH OFFICIALS
Yes
WILLINGNESS TO
BE ACTIVELY
ASSOCIATED WITH
CMAI
CSI
CNI
Methodist
Lutheran
Baptist
Others
Total
90
71
83
50
83
83
81
17
17
6
6
6
13
No
Can’t
Say
10
29
17
33
Table - 29
N = 52
Figures in %
CHURCH
OFFICIALS VIEW
SHOULD CLOSED
HOSPITALS BE
REVIVED
DENOMINATIONS
CSI
CNI
Methodist
Lutheran
Baptist
Others
Total
Yes
80
71
67
83
83
82
79
No
10
Can’t
Say
10
2
29
33
17
17
18
19
CHURCHES RESOURCE POTENTIAL - TABLE - 30
N = 52
Figures in %
CHURCHES RESOURCE
POTENTIAL
Bright & Growing
C8I
CHURCH OFFICIALS DENOMINATIONS
CNI
Methodist Lutheran Baptist Others
Total
70
43
59
60
12
5
6
10
23
25
33
Stagnant
67
83
17
Declining
io
29
17
Cant Say
20
28
50
16
17
Ill
NGO PERSPECTIVE OF CMAI
PROFILE OF RESPONDENTS - FIELD OF SERVICE - Table - 31
Except column total all figures in %
Nr
Region
Health
Non-Health
Relatee
Related
Northern
7.6
46.2
Central
10.0
30.0
Eastern
11.8
Southern
Total
Both
Total
46.2
17.1
10.0
50.0
13.2
52.9
5.9
29.4
22.4
2.8
63.9
2.8
30.5
47.4
5
41
3
27
76
NCOS KNOWLEDGE OF CMAI - TABLE - 32
Expect row total all figures in %
CMAI :HEARD-ASSOCIATED
Region
NO-NO
YES-NC
Northern
69.2
15.4
Central
40.0
60.0
Eastern
41.2
41.2
17.6
17
Southern
38.9
41.7
19.4
36
N =
44.7
39.5
15.8
76
YES-YES
Total
15.4
13
10
112
GOVERNMENT OFFICIALS PERCEPTION OF CMAI
AWARENESS OF CMAI TABLE - 33
N = 25
-_________ _ ___________
Figures in %
AWARENESS
Age in Years
Know*
Know
INVOLVED
NOT INVOLVED
Less Than 50
44
56
51 +
56
44
SPECIAL ROLE FOR CMAI - Table - 34
%
Community Services
56
Prevent diseases
48
Control Al Ds
40
Train Personnel
28
Promote health
20
Support govt. Programmes
12
Provide leadership
8
Support Mission Programmes
4
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