STUDY ON THE EFFECTIVENESS OFLINK WORKERS PROGRAMME UNDER INDIA POPULATION PROJECT VIII BANGALORE MAHANAGAR PALIKE
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- Title
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STUDY ON THE EFFECTIVENESS OFLINK
WORKERS PROGRAMME
UNDER
INDIA POPULATION PROJECT VIII
BANGALORE MAHANAGAR PALIKE - extracted text
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STUDY ON THE EFFECTIVENESS OF LINK
WORKERS PROGRAMME
UNDER
INDIA POPULATION PROJECT VIII
BANGALORE MAHANAGAR PALIKE
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CENTRE FOR RESEARCH IN HEALTH AND SOCIAL WELFARE
MANAGEMENT
861, 18 Main Road, Banashankari LI Stage, Bangalore 560070
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STUDY ON THE EFFECTIVENESS OF LINK
WORKERS PROGRAMME
UNDER
INDIA POPULATION PROJECT VHI
BANGALORE MAHANAGAR PALI KE
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CONSULTANTS
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Dr. N.S.N.RAO
Ms. VASANTI SATISH
Ms. L.N.SHAMALADEVI
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CENTRE FOR RESEARCH IN HEALTH AND SOCIAL WELFARE
MANAGEMENT
861,18 Main Road, Banashinkari H Stage, Bangalore 560070
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Table of contents
EXECUTIVE SUMMARY
1.INTRODUCTION
2. OBJECTIVES OF THE PRESENT EVALUATION
3. METHODOLOGY AND "APPROACH FOR PRESENT STUDY
4. FINDINGS OF THE ASSESSMENT
4.1. Back ground to the Link Workers programme
4.2. Profile of Link workers
4.3. Awareness of workers about their job specifications
4.4. Daily Routine of Link Worker
4.5. Training received by the Link Workers
4.6. Supervisory support received by Link Workers
4.7. Health educational Methods adopted by Link Workers
4.8. Attainments of Link Workers as compared to ANMs
4.9. Performance of Link Workers
4.10. Record maintanance and Reporting by Link Workers
4.11. Other Health Workers opinion on the Programme
4.12. Factors enabling good performance by the Link Worker
and further facilities needed to improve the services
4.13. Perceptions of the Community On Link Workers programme
4.14. Perceptions of direct beneficiaries on the Link workers programme
4.15. Networking with NGOs
4.16. Case studies of selected successful link workers
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5. OVERALL CONCLUSIONS OF THE EVALUATION
6. RECOMMENDATIONS
ANNEXURES
Sample Slums for community survey
Sample Slums for Focus group discussions
Check lists for focus group discussions
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EXECUTIVE SUMMARY
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1. INTRODUCTION
The project envisaged resident volunteers to act as link between the service providers and
community. Acting as change agents, these link volunteers are expected to mobilise the slum
communities. It is now desired to undertake an in-depth assessment of link volunteers
scheme, in terms of achieving the project development objectives and to make specific
recommendations for the remaining period of the project for continuation of the Scheme and
also to assess the relevance of such schemes for future Urban Health/FW projects, based on
the study findings. The study methodologies for this evaluation comprised of both qualitative
and quantitative approach.
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2. FINDINGS OF THE ASSESSMENT
2.1. Profile of Link workers
i.
There were 672 Link workers, ail female workers, under the Project spread over 84
Health Centres (HC), Urban Family Welfare Centres (UFWC) and Maternity Homes
(MH). While most of the Centres had about ten workers, all females, there was high
turn over rate among these workers.
ii.
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Age-wise, most of the Link workers were mature and in the prime age group up to 34
years(79%).
iii.
Many of the Workers being from the Backward and SC/ST castes they represent the
community and enable them to mix with the population in the community freely and
are well accepted.
iv.
Nearly two thirds of the Link workers were working for more than three years while
one third were of less than one year standing in the profession. The other one third
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were between one to three years of experience.
v.
Community service was the common motivating factor for joining the job (73.0%),
along with the financial problem stated by 41% of the workers. .
vi.
Most of the Link w orkers either resided in the Slum of their coverage (61%) or within
a walking distance from their area of work.
2.2. A wareness of workers about their job specifications
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Majon^ of the workers were fully aware of tbeir jOb spedfadoos, espedailv dre
■wues bke,,deadtalon of pregnan. women In .he community and referring 'them
ntenatal check up, identification of eligibie couples for family planning and
motivating them for adoption of a family planning
condoms.
dislributlon '
of oral pills and
2.3. Daily routine of a Link worker
i.
ii.
Link workers had to visit the Health Centres dady at about 9,30 in
signing in the register and receiving instructions from supervisors
In the field they take rounds of the houses having Antenaui women, Chiidren with
less than five yearn, eligible eoupie for family pI.„„i„g. They
houses ..daily
---- lane wise iii.
morning for
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Majority of Link Workers were covenng a population of around 5000
comprising of
about 90 infants, 255 under five children. 750 eligibie coupies, 32 antenatal women 7
post natal cases and 5^ other types of eases mosdy of tuberculosis disease Tbev
usually work till 1.00 p.m.
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2.4. Training received by the Link Workers / s
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Almost all the Link Workers, except those who have joined the job mcently have
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for a period of L
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their job. In a sample of 249 LWs. only 4% had not reee.ved this training
these were mostly those who have been recruited recently.
ii.
iii.
InsdtuTe foN 2^
uisiiiuie ior 1-2 days.
^Zna fT
at
reCe,Ved add,t,Onal tra,ning t0 eqU,p them for
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d'rjob onand,op,Ch,Id
C5 “Health
ke Sp“(35%),
,fe d,sRecord
easc! , kkeeping
c (20%) Capaciw
(m). Reproductive
building programmes (11%).
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These training programmes have equipped the I inb w l
knowledge reiated to the Mother and chiid Heabh as J Z '^7" ’
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-hich has enabled them to provide tai, serricesm the communC
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2.5. Supervisory support received by Link Workers
1.
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During the visits of LWs to the Health Centre, they are provided guidance mostiy on
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motivation of cases for family planning activities or work programmes.
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Link workers are directly supervised by the ANMs in their day to day activities
ii.
ANMs and other categories of Health staff, mostly Lady Health visitors and S. cial
Workers in some of the Health Centres make periodical supervisory visits to the field.
2.6. Health educational Methods adopted by Link Workers
i.
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Two important educational aids provided to them are flip charts and posters. Other
materials like handbills and pamphlets are also supplied to them during special
programmes. However, LWs mostly adopt personal contacts as a method of Health
education and rarely use the other aids.
2.7. Attainments of Link Workers as compared to ANMs
i.
All the LWs as well as ANMS were aware as to how to identify a pregnant women in
a community such as cessation of monthly periods, morning sickness etc. However, a
lesser proportion of both LWS and ANMs knew correct calculation of expected date
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of delivery. LWs (83%) were slightly better with this aspect as compared to ANMs
(74%).
•ii.
Majonty of LWs and ANMs, were aware of most of the risk factors during pregnancy,
both similar in proportion with regard to this knowledge.
iii.
Almost all the LWs and ANMs, were equally aware of the different advises to be
given to a pregnant women like early registration, minimum number of antenatal
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check up, immunisation against tetanus, consumption of IFA tablets, consultation of
qualified medical practitioner during emergency and delivery through trained persons.
iv.
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Almost all the LWS and ANMs were aware of the number of doses of Tetanus Toxoid
immunisations to be administered to pregnant women while the awareness on the
minimum number of IFA tablets to be consumed during pregnancy was known to a
slightly lesser number of LWs (79°-3') as compared to ANMs (99%).
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Regarding Family planning methods, most of the LWs (98%) and ANMs (99%) were
aware of all the methods. LWs were also aware as to when to advice a women for
permanent method (98%) or a spacing method (95%).
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knew that the disease could be spread through sexual contact, infected blood or
infected needles and syringes. Lesser number of both categories of workers was aware
of the possibility of infected women passing on the infection in the womb. The
knowledge levels were similar with both LWs and ANMs.
vii.
Vanous high-nsk signs of a newborn were not completely known to both LWs and
ANMs. Both categories of workers were almost equally lacking this awareness.
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Regarding the knowledge on the causes of HIV/AIDS, majority of LWs and ANMs
viii.
Almost all the LWs and ANMs were having a complete knowledge of different
immunising agents to be administered to an infant ( 99%). However the doses of
these immunising agents and the age at which they are to be administered was not
known completely to many of the LWs and ANMs. This lacuna was more so with
BCG immunisation.
ix.
Even though the knowledge on management of diarrhoea was good with both
categories of workers, LWs were better as compared to ANMs.
2.8. Performance of Link Workers
i.
Link workers are the one who are in direct contact with the Community and they
create awareness among the community about utilisation of vanous Maternal and
Child care services and motivate cases for various components of the care.
ii.
During the penod of twelve months, April 1999- March 2000, a Link worker had on
an average registered 86 Antenatal cases for Follow-up, motivated 71 infants for
BCG, 86 for three doses of DPT, 87 for three doses of OPV, 71 for Measles
immunisation and 71 for Vit-A prophylaxis administration.
iii.
During this period, she had helped in 34 IEC activities besides motivating 12 children
for admission to Anganwadi, 25 for admission to schools and motivated 12 women
for Innovative programmes.
iv.
During 16 months from April 1999 to July 2000, the average monthly performance of
these activities are 7.4 for BCG immunisation, 7.4 respectively for three doses of DPT
and OPV, 6.3 for Measles immunisation and 6.9 for Vit-A prophylaxis administration
of infants.
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During the same penod she had also motivated about 12 women for adoption of a
family planning method.
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There were in all, 595 mothers who were pregnant during the previous one year, and
of them, 9j.j% had availed Ante natal Check up and 66.4% were registered in the
first trimester and 93.9% had at least three ANC check up.
vii.
Of those women who were registered for ANC check up 68.6% were either contacted
or motivated by Link Worker, while this percentage was only 39% for other Health
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workers.
viii.
97.8% had the required number of Tetanus Toxoid immunisation. Of these women,
72.2% were either contacted or motivated by Link Worker, while this percentage was
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only 61.8% for other Health workers.
ix.
Of the Antenatal cases only 20% had consumed at least 90 tablets of IFA, but of them
71.4% were either contacted or motivated by Link Worker, Other Health workers had
contributed for only 56.2% of ANCs.
x.
There were in all 276 live births during the previous one year. Of these infants 82.6%
children had completed doses of all immunisations. Of these 74.6% were either
contacted or motivated by Link Worker while 47.4% by other health workers. In the
families surveyed there were 1045 girl children aged below 11 years and of them
97.1% were attending schools. Of these, 51.8% were contacted or motivated by Link
Workers for sending their children to the School while those contacted by Health
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workers were negligible (2.1%).
2.9. Record maintenance and reporting by Link Workers
i.
All the Link workers maintain Eligible couple Registers. The other register
maintained by the Worker is a daily dairy wherein they record the house number and
type of cases visited each day. However there is no format for this dairy and recording
is done on a notebook. They also note down any services rendered to a household on
the day in this notebook. . The entries in this notebook are the basis for preparing
periodical reports.
ii.
At the level of Health Centre there is an Antenatal and postnatal register on which all
services provided to these women are recorded. However this register is rarely used
for organising the follow up visit of LW in the field.
111.
In all the health Centres there are Eligible couple survey analysis registers, according
to the area served by the LW, which provide data about the eligible couples for each
area served by the Link worker, analysed once a year from the Eligible couple survey.
In some of the Centres, Eligible couple survey is still under progress and this analysis
is not available.
iv
Every week returns are prepared in the Weekly meetings, wherein the activities
performed by the LW is consolidated by the ANM and recorded in a format The
information is gathered from the dairy of the LW and the LW maintains no regular
format at her level. This sometimes, leads to inaccurate reporting. Further, there are
many women in the community who avail services from the private practitioners and
such information get mixed up. Such data is also reported as Health Centre
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achievement.
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Thus it is observed, the recording and reporting system of the achievements require
some changes. As such it very essential that every link worker is provided with a
pnnteddairywherein she records all the activities in a systematic manner.
vi.
Each LW for facilitating her follow up of the case should maintain another regist ?r of
all ANC and Infant cases. Beside other information, this register should contain
information on ANC check up availed with the place of availing.
2.10. Other Health Workers opinion on the Programme
i.
In general, ANMs felt that LWs are helpful to them in covering the area and target
achievement while others felt that LWs are well accepted by the commumty.
2.11. Factors enabling good performance by the Link Worker and further facilities
needed to improve the services
i.
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Most of the workers felt that emoluments paid to themjs meager and desired benefits
like unifoniumihB^la&etc.
ii.
Most of the Other Health Workers also felt that the job performed by the Link
Workers entails her to a higher financial emolument. They also felt that there should
be more refresher courses organised for the Workers.
2.12. Perceptions of the community on Link Workers programme
i.
There are different types of relatton ship with the commumty starting from the most
rigid to extremely co-operative community members. LWs have to do their job very
carefully as the success of the programme depends on the trust and confidence the
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community bestows on them.
ii.
By and large, women felt that the services of link workers are very much required and
they are doing a good job. However when it comes to actual treatment at the
government hospital, a good amount of displeasure was expressed. Some women
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perceive link workers as members of hospital staff while some look ai them as social
workers. The quality of services given by the link workers is evaluated more in terms
of the personal relationship and trusts developed between them.
iii.
Community members feel that the role of the link workers is to provide information
relevant to health and family planing. The community appears to have a fair
understanding of the roles and responsibilities of the link workers. In addition to this,
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it was also reported that the link workers are so close to them that they have free
interaction and clarify any of their doubts.
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IV.
Since the community is poor they cannot contribute financially. In spite of the attitude
of the community of “not giving but to receive”, link workers find ways and means to
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involve community as partners rather than being mere beneficiaries. Thus, community
members participate in their own way and in most cases help comes in kind. However
community’s perception of 'contribution’ appears to have been understood as
donating money.
v.
By and large, community feels that the programme is good and beneficial and need
based but are not satisfied with the behaviour of staff at the Health Centres. The most
frequently asked question was uwhy should we go to government hospital if we have
to pay for all the services which are supposed to be free1? ”
vi.
Thus many times efforts of link workers to motivate women to utilise the services of
the government hospital is jeopardised by lack of drugs and bad treatment at the
hospital.
2.13. Perceptions of direct beneficiaries on the Link workers programme
i.
Major benefits of link workers as reported by most of the direct beneficianes are
getting information at the right time; availability at the beneficiaries' door step to
remind them on immunisation camps, health check up camps; providing regular
follow up service regarding IUD insertions, replenish OP and condoms; and
accompanying them to health centre whenever needed. Regular contact with link
workers gives them the much-needed opportunity to confide and discuss about any
personal health problems and helps them to develop good relationship.
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ii.
It was found that the beneficianes access to information has increased considerably
due to regular contact with the link workers.
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iii.
By and large, the link workers used interpersonal communication with the community
as well as beneficiaries. Given the overall situation of the slums in terms of lack of
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space and lack of time, for women to spend time out side their survival activities, the
link workers go from house to house and contact them while they are nursing their
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children, cooking or engaged in other household chores. The strategy used by many
link workers for communication is one of persuasion than education.
2.14. Networking with NGOs
i.
By and large all the NGOs are involved in community development and health
programmes in one way or the other. Link workers and these organisations work very
closely as many of these organisations are also involved in similar activities. Due to
this common interest, there is mutual Cupertino and assistance on various aspects.
ii.
Most NGOs are of the opinion that the link worker’s programme is very useful and
much needed for educating women in contraception and promoting small families.
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2.15. Case studies of selected successful link workers
i.
Most of the link workers come from economically poor sections and so for all of them
this is a most needed job as it supplements the family income. However, the more
important finding is that all the link workers saw their job as an avenue for their/|
professional development.
ii.
Link workers are hard working and with determination exh.biting confidence, interest
and patience in interacting with a variety of people with different and often negative
mindsets.
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iii.
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These women work not only for money they have special interest in their own
professional development. Their key to success is their ability to communicate
effectively, innovative ways of persuasion, commitment to job responsibilities.
Furthermore, being close with the community they serve and a strong spirit of
empathy were other factors expressed or hinted by these link workers as the secret of
their success.
3. OVERALL CONCLUSIONS OF THE EVALUATION
What emerges strongly from the findings of overall effort is the following
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The intervention of the project through link workers has been very useful for the
community. This conclusion is based not only from the findings on their attainments and
performance but also from the opinion of the direct beneficiaries of the programme.
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participants of focus group discussions. NGO respondents, and other Health personnel at
the Health Centre.
Link Workers were mature, energetic housewives and represent the
community in the
socio-economic status and were well accepted by the community.
Link workers being residents of the community ensures continuous follow up of cases in
the community.
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Link workers not only help in achieving the targets of the Project objectives but
the community women in their personal problems.
Link workers job requires good amount of
7)
communication, considerable level of articulation
clients to alter their living styles and behaviour.
also help
skills in terms of inter-personal
in convincing and persuading their
These qualities were found in good
measure among the workers.
i)
Although link workers have support from the regular staff of the hospital, there is also
considerable pressure from these staff to reach assigned targets. Many a times link
workers overwork because they have to take up work of these staff members.
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However, there appears to be some amount of dissatisfaction among link workers about
the_way the other staff members treat them. In some cases they mentioned that they are
most vulnerable.
All the link workent expressed great concent about the palm honontnum presently
offered which is certainly not_commensurate with the nature and extent of their job
responsibilittes. Furthermore, the absence ofjob security and other service benefits were
voiced by all of them. Desp.te such harsh service conditions, most of the respondents
reported that, they liked their job and expressed their desire to continue.
All the link workers had undergone 5-day training at the time of induction. However,
there is certainly a need for strengthening the capabilities of workers to update their
awareness levels in terms of various concepts and their application in the changing socio
economic scenario. Some topics on tackling behavioural problems in the
also needed in the training.
community are
It was also found that there is a i
need for introducing more effective IEC materials,
particularly on the superstitions, wrong beliefs
; on childbirth and contraception.
The reporting and record keeping system and use
of MIS system for monitoring of their
day to activities is lacking with the Link workers.
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The findings of the present evaluation suggest that the programme of Link workers can be
replicated in other similar projects also.
4. RECOMMENDATIONS
i.
Link workers contribution to the Project activities are to be appreciated and duly
recognised in view of the good performance by them.
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ii.
The position of Link workers requires strengthening by creating a sense of security
and providing due status amongst the staff of the Health Centre and Maternity Homes.
iii.
Link workers knowledge requires periodical updating through a structured and need
based refresher courses.
iv.
The reporting and record keeping system with the Link workers is to be improved by
providing them structured daily dairies, follow up registers and training them in
monitoring of activities.
v.
Sense of responsiveness to the community aspirations from Other Health Centre staff
is to be improved to create stability to the Link workers in the community.
vi.
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Meager honorarium received by Link Workers, in the present day value of money,
should be increased keeping in view of their contribution to the project objectives.
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vii.
Link workers are to be adequately compensated for every additional work entrusted to
them.
viii.
Bangalore Mahanagar Palika should commit itself to continue the Link Workers
programme with adequate budgetary provisions after the closure of the Project, since
Link workers are the only community link with the Health Centre activities.
ix.
A suitable system should be established to monitor the performance of Link workers
based on CNA approach.
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1. INTRODUCTION
Family Welfare Urban Slum project (India Population Project-VIII), Bangalore,
supported by IDA, aims to provide rapid and targeted assistance to the vulnerable groups of
about 1.6 million poor women in reproductive age and about 8,50,000 pre school children
residing in Urban Slums. The project strategy as stated in the Terms of Reference is to:
•
Expand the coverage of Family Planning and Maternal and Child Health Services to the
previously unserved Urban Slum areas and beneficiaries through a net work of Health
Centres and Health Posts backed up by Maternity Homes for referral care.
■
Improve the quality of services delivered to the urban poor.
Increase the demand for Family Welfare Services by substantially improving the
participation of Private Voluntary Organisation and Community in the design delivery and
supervision of services to the slum communities.
)
The project envisaged rodent volunteers to act as link between the service providers and
community-. Acting as change agents, these Link volunteers were expected to mobilise the slum
)
communities. These link volunteers called as Link Workers were engaged with a monthly
honoranum of Rs.500 per month. Trained Link workers in the Urban Slums work under the
)
guidance of Lady Medical Officers of Health Centres. This programme is expected to improve"
effective delivery and utilisation of FW & MCH services, resulting in decreased rates of
fertility, infant, young child and maternal mortality and morbidity.
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2. OBJECTIVES OF THE PRESENT EVALUATION
The objectives of this assignment is to undertake an in-depth assessment of link
volunteers scheme, in terms of achieving the project development objectives, to make specific
recommendations for the remaining period of the project and also to assess the relevance of
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such schemes for fiiture Urban Health/FW projects, based on the study findings.
The detailed components of evaluation as detailed under the Terms of reference of the
present study are as follows:
Situation analysis of link workers presently working under the project
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Study of the Link workers attainment
Assessment of Link workers contribution for the Project activities
Assessment of Link workers perception of their attainment and needed
improvements in the programme
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Assessment of perceptions of Community,
representatives of local bodies, and
beneficiaries on Link workers programme
■ Assessment of perception of other full time staff of IPP VIII on Link workers
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Assessment of Impact of Link workers
programme for attainment of Project
activities
Devising proper Registers and reporting format for Link workers activities.
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3. METHODOLOGY AND APPROACH FOR THE PRESENT STUDY
The study methodologies adopted for the study comprised of both qualitative and
quantitative approach and are described below.
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The Profile of Link workers presently working engaged in the Project was undertaken
through a survey of all Link workers at all the Health Centres (HC), Urban Family Welfare
Centres (UFWC) and Maternity Health Centres (MH) under the Project.
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This sample survey of Link survey included assessment of the workers attainment in
terms of knowledge levels regarding reproductive and child health, training programmes
attended, availability of IEC materials, skills of link workers in the use of IEC materials,
capability for interpersonal communication and organising groups for motivational
programmes, the record and reporting system and also their performance of activities, during
the year 1999-2000 and part of 2000.
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The sample for this assessment comprised of three link workers from each of the Health
Centre. The sample included Link workers who had put in two to three years of service or the
senior most link workers in the newly established HCs, UFWCs and MHs.
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A study on random sample of married women aged 15-45 years was undertaken to
assess the utilisation of services of the Centres and to assess the contribution ofLink workers
for this utilisation. The sample consisted of 80 women selected on a cluster sample basis from
each of 30 randomly selected clusters of slums. The selection methodology adopted for the
clusters was the probability proportional to sample size. The sampling frame consisted of the
slums covered under each Centre, duly arranged according to the geographical location of
Health Centres. This was done to give representation to all the regions of the City. Due
representation for different socio-economic groups of households within a cluster was ensured
by dividing the cluster into four strata and selecting 20 households from each of these strata.
The clusters selected for the survey are listed in Annex. 1
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To compare the Link Workers (LW) attainment with those of Auxiliary Nurse
Midwives (ANM), a random sample of a maximum of two ANMs who were available on the
day of interview were selected from each of the Centre and studied for their knowledge and
performance in the areas of reproductive health.
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All the available Health personnel, at the time of survey in each of the Centres were
interviewed to assess their views on the Link workers programme.
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Advance planning visits by the Consultants were made to the Centres to ensure the
availability of all the Link Workers and other staff on the day of the survey.
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pre-tested questionnaires by trained Investigators under the direct supervision of the
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Community studies Specialist. The Sociological Consultant of the Evaluation undertook the
qualitative study.
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All the information for the quantitative assessments were collected on pre-designed and
The survey data were edited both in the field and office and analysis was done using
EPI-Info soft -ware.
As an important component of the evaluation of Link Workers Scheme, focus group
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discussions and Observation of Link Worker’s activities and case studies of selected link
workers, to provide a qualitative assessment of the effectiveness of the scheme, was
undertaken. Details of the methodologies adopted for the qualitative assessments are detailed
below.
i. Sample for the study
>
A representative sample comprising of slums/ communities were selected, and NGO
functionaries working in respective areas, concerned direct beneficiaries and the link workers
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in these slums were studied. For this purpose, a total of 20 slums were selected at random, 5
each for focus group discussions with (a) Community (b) NGOs and (c) Direct beneficiaries. In
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addition, five successfully performing link workers were chosen at random for conducting case
studies (Annex 2).
ii. Tools for the study
To understand the social dynamics of link workers performance, it was felt necessary to
employ a variety of tools and techniques for gathering reliable information. Appropriate
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instruments were administered depending upon the respondent’s profile. Further it also
depended on the type of information needed for the purpose of understanding the details as
well as the groups’ relationship with the programme. That is, the data collection method
!F
depended on whether the respondent was a direct beneficiary of the programme or an NGO
working in the sample slum or the link worker in charge. In view of the involvement of
4
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4
I1 °
different groups, a checklist of aspects to be covered for each of these groups was prepared
(Annex 3).
Following major tools were used.
♦
1.
Focus group discussion
ii.
Interviews
Hi.
Informal group discussions
iv. Case studies
V.
<
I
(
Observation of on the job performance
Details of the methodologies adopted under these tools are described in subsequent paragraphs.
i. Focus group discussions
Focus group discussions were intended to provide an ideal occasion to discuss issues
related to the programme and the link workers with a group of community members, focused
on the specific aspects mentioned in the checklist. In the beginning of the study, it was planned
to bring women and other community members to a designated place (central place) in the
slums and then conduct focus group discussions. However, this was not possible due to a
variety of reasons including lack of public venue/premises such as Anganwadi, school or
temple in the majonty of sample slums, inability of women to leave their infants and other
domestic chores such as cooking etc to attend the discussions. Furthermore, women were
found to be quite busy in their daily survival activities and had not enough time to spare for the
discussions. These aspects which have important bearing on the scheme, will be discussed in
the foregoing sections of the report in more detail. Therefore groups were met lane wise in
'1
small numbers mostly in one of the houses of the respondents. The number of such groups in
the sample slums differed depending on the size of the slum both in terms of the area as well as
I
the population. In each of the sampled slum, an average of 5-6 groups were met and in each of
these groups 10-15 women were involved :n the discussion. However, the number of women
in these groups as well as their participation differed considerably. Some women would come
in and talk’ their part and then would say that they have to leave as they were in a hurry, while
some would stay throughout and actively participate in the discussion. The third tvpe were the
silent women. In order to make the discussion more participatory and also to provide
5
opportunities to silent womren, care was taken to involve them in the discussion by asking
X
5
1
1
specific questions of very general type such as “ have you seen this woman? what docs she do?
1
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(link worker) etc.
Discussions in these groups were informal and relaxed. Women were encouraged to
talk generally on their health, their knowledge of family planning methods, nutrition,
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immunisation, MCH. The relationship between the link workers and definite benefit they
experience from the link workers were the major issues discussed with these women. Some
times the discussions went out of focus as women would talk about the problem of housing,
drainage etc. However special efforts were made to moderate such discussions and bring it
back to the specific issue of the programme. By and large women from the sample
communities were highly responsive to the issues and they were frank in expressing their
opinions, perceptions and also suggestions to improve the programmes.
ii. Interviews
Interview method was used in the case of NGOs, SHE club members and link workers.
I
Interviews were conducted with the help of an interview guide with open-ended questions
I
prepared before hand. NGOs were found to be working in all the five sampled slums, whereas
SHE clubs were existing in 3 out of 5 sample slums. The interviews were conducted mostly
with individuals of these institutions.
iii. Informal group discussions
Informal group discussions were mostly used for getting introduction to the study and
also to build rapport with the slum population and also to gather general information of the
slums. As soon as any one entered the slum, both men and women would ask the purpose of
the visit and as such it needs introduction as well as a general talk on the social and economic
condition of the slum and the purpose of the visit and so on.
iv. Case studies
The case study method has been used to study five successful link workers. This is
intended to get an in-depth information about the successful workers in order to know how
I
these women have been able to perform successfully. Case studies, like in other cases, were
conducted with the help of a checklist of issues covering all aspects of each link worker. One
full day was spent with each link worker winch started with informal introduction in the health
center, interview for specific information on personal data such as age, education, family
6
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f
5
background and so on. Since the Link workers were not only workers but were also one among
the slum residents, these case studies are interesting?to know how they perceiveo their jobs
$
besides being able to manage difficult situations at home and a challenging job outside (of link
workers).
v. Observations
t
In addition to talking to the link workers and in-depth interviews, field visits were made
to the slums of these workers in order to make direct observations, while these workers
performed their activities. These activities included motivation of women for sterilisation, care
c
of pregnancy, spacing children, health and nutrition education and so on.
t
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£
7
.....
*
4. FINDINGS OF THE ASSESSMENT
R
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i
3
3
The results presented in the present report comprise of the findings from both
Qualitative and Quantitative approaches.
The findings of assessments from Quantitative approach covered the following components:
4.1. Background to the Link workers programme
4.2. Profile of Link workers
4.3. Awareness of Link workers about their duties
4.4. Daily routine of a Link worker
4.5. Training received by Link workers
4.6. Supervisory support received by Link workers
4.7. Health education methods adopted by Link workers
4.8. Attainments of Link workers as compared to ANMS
4.9. Performance of Link Workers
4. lO.Record Keeping by Link workers
4.11 .Other Health Workers opinion on the Programme
4.12.Factors enabling good performance of Link workers
The findings of the assessments from Qualitative approach covered the following
components:
4.13. Perceptions of the Community on Link Workers programme
4.14. Perceptions of the direct beneficiaries on Link Workers programme
4.14 Networking with the NGOs.
4.16. Case studies of selected successful link workers
4.1. Background to Link workers Programme
The project has employed resident female volunteers, called as Link Workers to act as
link between the service providers and community. Acting as change agents, these link
volunteers perform various activities amongst the slum communities. They are engaged on a
part time basis, to work for about 3 to 4 hours a day,
with a monthly honorarium of Rs.500 per month. They
are provided training to take up various activities related
to FW & MCH services in the Urban Slums under the
i
i
Link workers are the most
peripheral workers in the
field who have close contact
with the community
guidance of Lady Medical Officers of Heilth Centres,
aiming at effective service delivery and utilisation of Family Welfare and Maternity & Child
Health services.
Thus the Link workers are the mos peripheral workers in the field who have close
contact with the community.
I
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4.
I°
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4.2. Profile of Link workers
There were 672 Link workers under the Project spread over 84 Health Centres (HC),
Urban Family Welfare Centres (UFWC) and Maternity Homes (MH). While most of the
Centres had ten Link workers, there were Centres with lesser number of workers. The turn over
rate of these workers in some of the Centres was high resulting in lesser number of workers in
in
•«
some of the centres. The number of Link workers in different Centres is given in Table 1.
Agewise, most of the workers were in the prime age group up to 34 years, 50% aged
between 20-29 years, and another 29% between 30-34 years. There were also about 20% aged
above 35 years. Thus the workers comprised of mature
<
women capable of working with the community ladies.
Most of the workers were Hindus (90%), while
the remaining were Christians and Muslims. Amongst
Hindus, 33% comprised of Scheduled castes and Tribes
while 42% were from other backward castes. Thus
I
Link workers represented the
Community in religion, caste
or education and were
married and reside in the
Slums and as such had easy
access to the community
wnnurn
majority of workers were representing the community in religion and caste which enabled
them to work freely in the community.
Nearly two thirds (70%) of the workers were educated up to High School or Higher
!
!
Secondary levels, there were about 29% with less than this level of education. There were a
few graduates.
Marital status wise, almost all were currently married while there were 4e/« who were
either widowed or divorced (Table 2).
Thus these link workers represented the community in religion, caste or education and
were married and as such had access to the Community women.
Nearly one third of the Link workers were serving the Project for more than three years
while more than half were with more than two years of standing. Those who were with less
than this duration were from those Centres started in the last two years. However, the turn over
rate of Link workers in some of the Centres was high.
Zeal for community service was the motivating factor for taking up this activity in
majority of the workers (73%), even though financial problems in the family was another
consideration. Part time nature of the work was also an additional consideration for working in
the Project.
1
1
9
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Most of the workers resided in the Slum they served or were residing in a close by
slum. Thus 75% of the workers were within one km. of their area of work. (Table 4). A few of
I
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the workers were spending around Rs.2 to 5, daily for commuting to their area of work.
-i
Table 1.Number of Link workers in each Centre
T 3
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: O
' O
£
k
k
I
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SI. No. Name of UFWC/ Maternity Home
Health Centre
i
A.D.Halli
hr
r
AdugodiAgara
r
Amrutahaili
hr
r
r
|F
r
Anjanappa garden
Ashokapuram
Attur Layout
No. of
Link workers
9
~9~
~T
~T
~F
~ K)
"To
Austin Town
Avalahalli
"To"
lio
Azadnagar
|iT
hi?
hiT
Banashankari
’To"
Bangarappa Nagara
"F
'F-
pr
(Tt’
pF
pF
pF
pF
pF
pF
Bapujinagara
Bhuvaneshwari Nagar
Bowring
C. T.Bed
Choianayakana halli
Cox Town
F“
F“
D. J.Halli
Dasappa
6~
Domalur (Kodihally)
7~
ESI, Rajajinagar
i9
Iw-
G.G.Halli
Ganganagar
To
TF
9
26~
Gangondanahalli
Gayatri Devi park
TF
To10
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4
27
Goripalya
F
Gosha
Govindrajnagar
29
30
3?
32
33
34
35~
‘F
Jayanagar
'F
'T
'6“
‘F
"io
3T
Kamakshipalya
Kodigehalli
38~
Koramangala
F
F
F
F
F
Kumaraswamy Layout
Laggere
V
F
F
Io
Io"
To
F
kT
F
F
F
F
F
44~
F
F
F
F
F
F“
F
F
F
F
F
IF
"F
58
F"
i
Hegganahalli
Hosahalli
J. P.Nagar
K. C.G Malleswaram
" K.G.Halli
F
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I
9
~3~
60~
Manavart pet
' M.R. Palya
M. S.Palya
Magadi Road
Mahalakshmi Layout
Malta sandra
Mallat halli
Mathikere
Moodaiapalya
Murphy Town
Neelmaheswari
N. R. Colony
N.S.Palya
Nandini Layout
New Baglur Layout
Old Byppanahalli
P.G.Halii
’antarapalya
’eenya
’obbathi
lo
3
F
F
F
F
F
F
F
5
11
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62
R.C.Puram
Rajajinagar
63
Rupena Agrahara
64
65
Shanthi nagar
61
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7
7
66
Siddaiah Road
Simr Park Road
67
Sirsi Road M.H.
8
7
7
7
68
Sonnenahalli
Srirampura
8
10
Sulthanapalya
T.R.Mill
Taskar Town
9
Tavarekere
Tindlu
10
10
Ulsoor
7
Uttharahalli
Vani vilas
5
8
9
79
80
Vibhuthipura
Vidyapeeta Circle
West of Chord Road
10
81
Wilson Garden
82
83
Yarabnagar
8
7
Yelchenahalli
6
Yeshwanthpura
Total
8
672
69
70
71
72
3
7
73
74
75
76
77
78
84
10
5
7
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Table 2. Profile of Link Workers
Characteristics
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£
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)
Age in years___________
15-19________________
20-24________________
25-29________________
30-34_________________
35-39_________________
40 and over____________
Religion
___________
Hindu________________
Muslim________ •_______
Christian______________
Others________________
Caste for Hindus_______
Scheduled Caste________
Scheduled Tribe________
Backward_____________
Others________________
Educational Qualification
Primary_______________
Middle________________
High School____________
Higher secondary_______
Graduate +_____________
Marital Status__________
Unmarried_____________
Currently Married_______
Widowed______________
Divorced / Separated
No. of Link Workers
(n=672)
No.
%
2
0.3
93
13,8
253
37.6
192
28,6
110
16.4
22
3.3
605
27
38
2
90,0
4,0
5,7
0.3
185
17
253
149
24.7
3
195
404
64
6
0.4
29.0
60.1
95
0.9
7
638
17
10
1.0
94.9
30.6
2,8
41.9
2.5
1.5
Table 3. Length of Service of Link Workers______
Period in years
No. of Link Workers
(n=672 )
No.
I%
Upto 1 year_______
224
I 33.3
13 to 18 months
39________ i 5.8
19-24 months______
38_______ ! 5.7
25-30 months______
60________ i 8,9
31-36 months______
68________ 10.1
More than 36 months
243
36.2
Mean service
26.6 months
13
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Table 4, Place of residence of Link Workers and distance to place of work
No.
%
(n=672)
Residence
Same slum
___________________
Other places _____________________
Distance of residence to place of work
0 kms______________________ _____
1-2 kms.__________________ _______
3- 4 Kms_________________________
5 Kms and more ■__________________
Mean distance_____________________
Daily expenditure on conveyance in Rs.
Nil_____ ~
2-3______________________________
4- 5_________________________
More than Rs. 5____________________
Mean amount
409
263
60.9
39.1
506
128
25___
13___
0.5 kms
75.3
19.0
3.7
1.9
597
26__
38__
11__
Rs.0.5
88.8
3.8
5.7
1.6
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r
4JAwareness of workers about their job specifications
Majority of the workers were aware of their duties, especially the activities like,
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identification of eligible couples for family planning and motivating them for adoption of a
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identification of pregnant women in the community and referring them for antenatal check up,
family planning and distribution of oral pills and condoms. Motivation of women for
innovative programmes or orgamsing health education programmes was perceived by lesser
number of workers as their job, as this activity is not performed at all the CentresfTable 5).
i
Table 5. Awareness of Link Workers about their duties
Job specification
No. of Link Workers
(n=249 )
No,
%
Identification of pregnant mothers and refer them for 247
99.2
Antenatal check-up_____________________________
Identification of eligible couple
240
96.4
$
Motivation of eligible couples for adoption of Family 239
planning_____________________________________
Distribution of condoms. Oral pills & ORS packets
237
Motivating mothers for immunisation of children_____ 239
iting women to take up innovative programmes_______ 160
Conducting Health education programmes__________ 219
Organising Health Education programmes
161
Refer cases to higher levels
183
96.4
95.2
96.0
64,3
88.0
64.7
73.5
14
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4.4. Daily routine of a Link worker
I*
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Link workers had to visit the Health Centres daily at about 9.30 in the morning, for
I
signing in the register and receiving instructions from supervisors. They were also expected to
1
report their daily work at the Health centre after
J
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completing daily routine work This was considered as
'I
J
an additional burden by most of the Link workers.
However, this practice is being stopped in some of the
Health Centres. Besides this daily visit, they attend the
Health Centre, for bringing F.P. acceptors or children
Link Workers take rounds
of the slum contacting
Antenatal women. Children
with less than five years oj
age, eligible couples for
family planning and have
established good rapport
with the women
for immunisation, attending meetings, assisting in
Immunisation clinics, accompany some of the cases for follow up or treatment of sick persons
etc.
More than half of the workers, visit the Health Centres over twice a week for such
purposes (Table 5).
In the field they take rounds of the slum visiting families having Antenatal women.
I
Children with less than five years and eligible couple for family planning. They visit about 2030 houses daily, lane wise. They cover the entire Slum in rotation. It was observed in some of
the Slums, that there is a large turn over of families and as such during their visits they update
the Eligible Couple register. However, they rarely visit houses without beneficiaries. As such
in most of the slums. Link workers have established good rapport with the women
beneficiaries but less with other women. Link Workers wind up their work in the field by about
1.00 p.m.
Majority of Link Workers was covering a population of around 5000 comprising, on
average, 90 infants, 255 under five children, 750 eligible couples, 32 antenatal women, 7
postnatal cases and 5-6 other types of cases mostly of tuberculosis disease. The mean number
of different categories of beneficiaries served by a Link worker is given in Table 6.
l
15
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Table 6. Average no. of beneficiaries served by Link Worker
No. of Link Workers
Type of beneficiary
(n=672)
Median
Average
4824
5000
Total population served
90____
Antenatal women_____
101
1 to 4 years__________
281
255
674
750
Eligible couples______
39_____
32____
Ante-natal women
Post-natal women
7_____
10_____
6
1
Others
4.5. Training received by the Link Workers
Almost all the Link Workers, except those who have joined the job recently, have been
trained at Project Training Centre, Kodandarama Puram, for a period of five days. This is an
initiation training wherein they have been
trained in all functions related to their
activities. The training was imparted adopting
different methods
like classroom lectures,
demonstrations and field visits. In a sample of
249 LWs, only 4% had not received this
LWs
equipped
the
Link
Workers
to
acquire a basic knowledge related to
the Mother and child Health, which
has enabled them to provide quality
services to the community.
training, who were recruited recently.
Further 54% of the
Different training programmes have
have
received a second reorientation training at the above Institute. The period of this training was
for 1-2 days.
Some of the LWS have received additional training to equip them for better
performance on activities like, providing follow up of Specific diseases like Tuberculosis and
t
Leprosy (80%), Reproductive and Child Health (35%), Record keeping (20%), Capacity
building programmes (11%).
These training programmes have equipped the Link Workers to acquire a basic
knowledge related to the Mother and child Health, as detailed in further paragraphs, which has
enabled them to provide quality services to the community.
—t
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4.6. Supervisory support received by Link Workers
1
Link workers are directly supervised by the ANMs in their day to day activities. During
the visits by LWs to the Health Centre, they are provided guidance mostly on motivation of
cases for family planning activities or work programmes^
ANMs and other categories of Health staff, mostly Lady Health visitors and Social
t
Workers provide periodical supervisory visits to the field.
4.7. Health educational Methods adopted by Link Workers
Link Workers were trained during their initiation training on use of different Health
education materials. Two important educational aids provided to them are flip charts and
posters. Other materials like handbills and pamphlets are also supplied to them during special
programmes. They rarely use models. However, LWs adopt only personal contacts as a method
of Health education and rarely use the other aids. Further details on this are provided under
results of qualitative studies, later in this report.
4.8. Attainment of Link Workers as compared to ANMs
The knowledge level of Link workers
on various components of Mother and Child
v
Health was ascertained from a sample of 249
Link Workers as well as from a sample of 130
ANMs, working in the same Health Centres. A
The level of Knowledge amongst
Link workers was similar to that of
ANMs in all aspects of Maternal and
Child health concerns which enabled
them to educate the community
satisfactorily
comparative assessment has been made in the
subsequent paragraphs.
L Knowledge on Reproductive health concerns of women
>
v
All the LWs as well as ANMs were aware as to how to identify a pregnant women in a
community such as cessation of monthly periods, morning sickness etc. However, a lesser
proportion of both LWS and ANMs knew correct calculation of expected date of delivery.
V
LWs (83%) were slightly better with this aspect as compared to ANMs (74%).
Majority of LWs and ANMs were aware of most of the risk factors during pregnancy.
■;
The proportion of ANMs and LWs with this knowledge was same. This enabled the Link
workers to perform better in out reach activities.
17
Almost all the LWs and ANMs, were aware of the different advises to be given to a
pregnant women like early registration, minimum number of antenatal check up, immunisation
against tetanus, consumption of IFA tablets, consultation of qualified medical practitioner
during emergency and delivery through trained persons.
Most of the LWS and ANMs were aware of the number of doses of Tetanus Toxoid
I
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immunisations to be administered to pregnant women while the awareness on the minimum
number of IFA tablets to be consumed during pregnancy was known to a slightly lesser
number of LWs (79%) as compared to ANMs (99%) (TableT j.
Regarding Family planning methods, almost all the LWs (98%) and ANMs (99%) were
aware of all the methods. LWs were also aware as to when to advice a women for permanent
t
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£
£
I
method (98%) or a spacing method (95%).
Regarding the knowledge on the causes of HIV/AIDS, majority of LWs and ANMs
knew that the disease could be spread through sexual contact, infected blood or infected
needles and syringes. Lesser number of both categories of workers was aware of the possibility
of infected women passing on the infection to the baby in the womb. The knowledge levels
were similar with both LWs and ANMs (Table 8).
Table 7. Comparative Awareness of Link workers and ANMs on Reproductive health
aspects of mothers
Reproductive health aspects of women
Link workers (n=249)
A.N.Ms (n=130)
No.
%__
No,
%
Correct identification ofPregnant women
248
100.0
129
99.1
Expected date ofdelivery
207
83.1
96
73.8
High Risk factors during pregnancy
Short stature of women
209
83.9
113
86.9
Age of mother less than 18 vts.
213
85.5
111
85.4
Age of mother above 35 yrs.
197
79.1
107
82.3
Severe anaemia
192
77.1
105
80.8
Toxaemia / edamsia
64
25.7
$65
50.0
Frequent pregnancies
186
74.7
81
62.3
Too many children in succession_____
149
59.8
68
52.3
Advises to be given to pregnant women
Early registration for ANC
246
98.8
129
99.2
At least 3 antenatal check ups
239
96.0
129
99.2
Immunisation against tetamrs
239
96.0
124
95.4
Consumption of IFA tablets
234
94.0
123
94.6
Consultation in case of any danger signs
127
51.0
68
52.3
Delivery through trained personnel
228
91.6
120
92.3
No. of doses of Tetanus
241
96.8
127
97.7
No. of IFA tablets to be consumed during
pregnancy
196
78.7
127
97.7
18
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Table 8. icomparative Awareness of Link workers on causes of HTV /AIDS
ARMS
Link workers
Causes
No.
%
No.
Having multiple sex partners
128
97.6
243
Homosexual
43
23.7
59
Use of infected syringes and needles
130
96.0
239
Use of infected blood
128
93.2
232
Infected pregnant women to child
98
75.5
Shaking hands / kissing / staying with infected 188
persons
8.4
______________________ _ 21
7
%
98.5
33.1
100.0
98.5
75.4
5.4
ii. Knowledge on Child health concerns
Various high-risk signs of a newborn were not completely known to both LWs and
ANMs. Both categories of workers were almost equally lacking this awareness.
Almost all the LWs and ANMs were having a complete knowledge of different
C
immunising agents to be administered to an infant (99%).
However the doses of these
immunising agents and the age at which they are to be administered was not known completely
to many of the LWs and ANMs. This lacuna was more so with BCG immunisation.
Even though the knowledge on management of diarrhoea was good with both
I
£
categories of workers, LWs were better equipped with this awareness as compared to ANMs
(Table Sy4.9. Performance of Link Workers
Link workers are the one who are in direct contact with the Community and they spread
awareness among the community on various Maternal and Child care services and motivate
cases for various components of the care. In the
foregoing paragraphs results of analysis of the records
of the Link Workers about their performance,
pertaining to different Maternal and Child health care
services, during the period April 1999 to July 2000
o
I
Link workers were contributing
substantially for achievements oj
the Health Centres in providing
MCH services to the Community
besides contributing in other
innovative programmes
have been presented.
A Survey of 2387 currently married women in the Community was also undertaken to
know the present levels of utilisation of MCH services and the contribution of Link Workers in
this utilisation. Findings of this survey are also presented below.
19
1
i. Findings from the analysis of records
During twelve months of the year, April 1999- March 2000, a Link worker had on an
average registered 86 Antenatal cases for follow-up, motivated 71 infants for BCG, 86 for
three doses of DPT, 87 for three doses of OPV, 71 for Measles immunisation and 71 for Vit-A
prophylaxis administration.
During this period She had helped in 34 EEC activities besides motivating 12 children
for admission to Anganwadi, 25 for admission to schools and motivated 12 women for
i
Innovative programmes.
During Id.months from April 1999 to July 2000, the average monthly performance of
these activities were 7.4 for BCG immunisation, 7.4 respectively for three doses of DPT and
OPV, 6.3 for Measles immunisation and 6.9 for Vit-A prophylaxis administration to infants.
During the same period she had also motivated about 12 women for adoption of a
family planning method.
Table 9. , Comparative Awareness of Link workers and ANMs on Child health concerns____
Child health aspects
I
t
3
3
Link workers (n=249)
No.
%
Advises to be given to women after delivery about care of
new bom
Administration of colustrum to new bom
233
Breast feeding within ‘A hour of birth
243
Continue breast feeding for at least 6 months
221
Keeping the child and mother together
229
Feed the child whenever child desires
188
Sterilisation of utensils / bottles
131
Avoid nipples or any sucking materials______________ 121
High Risk signs of a new bom
Pale or bluish colour of the new bom Child
155
Child not crying immediately after birth
183
Irregular breathing of the child
130
No movement of legs and arms
135
Abnormal size or very softness of the Child__________ 69
Immunisation schedulefor urfants
All Immunising agents
247
Doses of all immunisations________________________ 162
Advicefor mothers on diarrhoea
Administer more fluids
222
Administer O.R.S.
240
Administer O.R.S. or fluids with every
204
bout of diarrhoea
Continue feeding during diarrhoea
190
If diarrhoea persists take the child to the doctor__________ 234
Preparation of ORS
Correct
94
Partially correct
120
Incorrect
35
A N Ms (n=130)
’
%
No.
93.6
97.6
88.8
92.0
75.5
52.6
48.6
124
130
112
105
88
74
59
95.4
100.0
86.2
80.8
67.7
56.9
45.4
62.2
73.5
52.2
54.2
27.7
88
88
81
56
47
67.7
67.7
62.3
43.1
36.2
99.2
65.1
127
96
97.9
73.8
89.2
96.4
81.9
97
102
87
74.6
78.5
66.9
76.3
94.0
73
97
56.2
74.6
37.8
42.2
140
58
58
14
446
44.6
10.8
20
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£
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Table 10. Performance of Link Workers as per record analysis________
Activity
Average no. per month
During the During the
year 1999- period
2000
April
to
ANC cases motivated___________________
No. of children motivated for
immunisation
BCG
3 doses of DPT
3 doses of OPV
Measles
VitA_______________________________ _
Cases motivatedfor F. P. methods
Female sterilisation
Vasectomy
Oral pills
Condoms
IUD__________________________________
Children motivated for Anganwadi ________
Children motivated for Schooling__________
Women motivated for Innovative programmes
IEC Activities
86
July 2000
33
71
28
86
87
71
33
33
30
71
30
38
5
22
31
34
12
25
12
34
16
1
11
13
13
5
9
5
14
ii. Findings from Community survey
Community survey undertaken in a random sample of 30 clusters comprising of 2387
currently married women in the age group
15-44 years of age revealed the following
MCH indicators.
The surveyed population consisted of
In the conununity Link Worker is the
first level worker and was a constant
source of information as well as
motivation for MCH care as compared
to other health workers
74% Hindus and 19.4% Muslims besides
6.4% of other religions, mostly Christians.
Amongst Hindus, 55.6% were from Scheduled castes and Tribes.
9
3
3
There were in all, 595 mothers who were pregnant during the previous one year, and of
them, 93.3% had availed Ante natal Check up and 66.4% were registered in the first trimester
and 93.9% had at least three ANC check up.
21
Of those women who were registered for ANC check up, 68.6% were either contacted
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or motivated for registration by Link Worker, while this percentage was only 39% for other
Health workers.
97.8% had the required number of Tetanus Toxoid immunisation. Of these women,
72.2% were either contacted or motivated by Link Worker, while this percentage was only
61.8% for other Health workers.
Of the Antenatal cases only 20% had consumed at least 90 tablets of IFA, but of them
71.4% were either contacted or motivated by Link Worker, Other Health workers had
contributed in only 56.2% of ANCs.
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Table 11. Religion and caste of respondents surveyed amongst
_______ currently married and aged 15-45 years___________
Religion and caste
Women aged 15-45 years
(n= 2387)
No..
%
Religion
Hindu
Muslim
Christian
Others
Caste ofHindus
S.C
S.T
Backward
Others
1772
463
151
1
74.2
19.4
6.3
0.1
867
118
714
73
48.9
6.7
40.3
4.1
Table 12. Age distribution of respondents surveyed amongst
_______ currently married and aged 15—45 years
Age in years
No.
%___
15-19
174
7,3
20-24
746
31,1
25-29
617
25,7
30-34
411
17.1
35-39
297
12.4
40-45
152
6,3
Total
2397
100.0
!
!
22
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Table 13. Maternal care practices amongst mothers delivered during
previous year and person motivating them for the practice
% of women
Ante-natal care particulars
(n=595)
Had Ante-natal check-up_______________ 93.3
Motivatedfor ANC by:_________________
ANM________________ 2.2
Link worker__________________________ 68.6
Other health workers___________________ 36.8
Gestation period atfirst check up_________
1st Trimester_________________________ 66,4
33.2
2nd trimester
'
0,5
3rd trimester
Had at least three ANC checkups_______ 93.9
No. of pregnant women who had TT 97.8
Immunisation________________________
Motivatedfor TT by:___________________
ANM_______________________________ 5.9
Link worker__________________________ 72.2
Other health workers___________________ 55,9
Consumed IFA tablets_________________ 20.0
9.8
Consumed at least 90 tablets of
Iron folic acid tablets during pregnancy
Motivated for IFA tablets consumption
during pregnancy by:__________________
ANM_______________________________ 5.7___
Link worker__________________________ 71.4
Other health workers___________________ 50.5
382
Adopted F.P. practice in the last two years
women
Motivated for adoption for F.P. practice by
(n=382):____________________________
ANM_______________________________ 6.5
Link worker__________________________ 70.7
45.8
Other health workers
There were in all 276 live births during the previous one year. Of these infants 82.6%
children had completed doses of all immunisations. Of these 74.6% were either contacted or
motivated by Link Worker while 47.4% by other health workers.
In the families surveyed there were 1045 girl children aged below 11 years and of them
97.1% were attending schools. Of these, 51.8% were contacted or motivated by Link Workers
23
▼' T
!' 5
for sending their children to the School, while those contacted by Health workers were
negligible (2.1%).
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Table 14 .Child care practices amongst mothers delivered during
previous year and person motivating them for the practice
Child care particulars
%of
women
(n=276)
No. children completing immunisation 82.6
schedule______________________ _
bfotivatedfa
ANM_________ .________________ 43
Link worker__________________ _
74.6
Other health workers_______________ 43.1
No. of mothers sending children to 74.2
Anganwadis____________________ _
No. of mothers sending girl children to 97.1
School_______________________ _
Motivated for sending children to
School by: (n=1045)_______________
ANM
0.3
Link worker_____________________ 51,8
Other health workers
1.8
4.10. Record maintenance and Reporting by Link Workers
All the Link workers maintain Eligible couple Registers. These registers are prepared
during the Annual survey during each year. There is a lot of mobility of Families in the Slums
and as such these registers are updated during the visits of the LW to the family. However,
since the LW do not visit the houses where there are no ANCs or Children or eligible couples,
the chances of up dating the register in such families is rare. In fact the Link workers visit the
households with eligible couple register as their basis for visits.
The other register maintained by the Worker is a daily dairy wherein they record the
house number and type of cases visited each day. However there is no format for this dairy and
recording is done on a notebook. They also note down any services rendered to a household on
the day in this notebook.. The entries in this notebook are the basis for preparing periodical
reports.
At the level of Health Centre, there is an Antenatal and postnatal register on which all
services provided to these women are recorded. However this register is rarely used for
organising the follow up visit of LW in the field. In a few Health Centres, LWs have
24
......
£
........... .................................
...
maintained such a register for their use in the field. But there was no uniform procedure or
instructions for maintenance of such registers.
In all the health Centres there are Eligible couple survey analysis registers, maintained
according to the area served by the LW, which provide data about the eligible couples for each
area served by the Link worker, analysed once a year from the Eligible couple survey. In some
of the Centres, Eligible couple survey is still under progress and this analysis is not available.
Every week returns are prepared in the Weekly meetings, wherein the activities
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performed by the LW is consolidated by the ANM and recorded in a format The information
is gathered from the dairy of the LW and the LW maintains no regular format at her level. This
sometimes, leads to inaccurate reporting. Further, there are many women in the community
who avail services from the private
The recording and reporting system
practitioners and such information get mixed
in the programme of Link workers
up. Such data is also reported as Health
is not very satisfactory and needs
improvement
Centre achievement.
Thus it is observed, the recording and reporting system of the achievements of Health
Centres require some changes.
It is very essential that every link worker be provided with a printed dairy wherein she
records all the activities in a systematic manner.
Different columns of this dairy should have the following information.
i. Date of visit
ii. SI. No. of House visited
iii. Services provided by the worker in the field for the Household
iv. Services provided by the Household at the Health Centre
v. If the women or child has taken service from other agencies the name of the agency
providing such a service.
Each LW for facilitating her follow up of the case should maintain another register of
I
all ANC and Infant cases. Besides other information, this register should contain information
on ANC check up availed along with the place of availing such services.
4.11. Other Health Workers opinion on the Programme
Opinion on the Link Workers programme was ascertained from Medical Officers, Lady
Health Visitors, ANMs and Social Workers on a self-administered questionnaire. In all, 138
different categories of health workers responded.
I
25
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In general, ANMS felt that LWs were helpful to them in covering the area and target
and also that they were well accepted by the community.
Table 15. Opinion of other health workers on Link workers programme_____
Opinion
ANMs
Other health
workers
No.
%
No.
%
(n=130)
(n=138)
Helpful in coverage of area______ 70____ 53.8
34____ 24.8
Target achievement for ANC & FP 50____ 48.5
28____ 20.4
Well accepted by community
45____ 34,6
50.4
69
Ensures supply of OP & Condoms
7_____ 5,4
Help in DEC activities__________
17____ 13.1
15
10.9
Help in outreach programmes
16
12.3
17
12.4
4.12. Factors enabling good performance by the Link Worker and further facilities
needed to improve the services
The information was elicited from the Link worker herself, and according to them,
acceptance from the community, initial training and recognition in the community and
cooperation from Health staff at the Health Centre were the topmost factors enabling them to
perform their job efficiently (Table 16 ).
Most of the workers felt that honorarium paid to them is meager and desired benefits
like uniform, umbrellas etc (Table 17).
Most of the Other Health Workers also felt that the job performed by the Link Workers
entails her to a higher financial benefit They also felt that there should be more refresher
courses organised for the Workers.
Table 16, Factors enabling link workers good performance
Factors
i No.
%
(n-249)
Proper initial training______________
233
93,6
Periodical refresher courses_________
117
47,0
Efficient guidance from supervisors
167
67,1
Co-operation from health centre staff
198
79.5
Co-ordination of work from health staff
175
703
Encouragement from project officials
123
49,4
Recognition from community________
218
87,6
Acceptance from the community
228
91.6
!
26
Tablel?. Additional facilities desired
Facilities
5
3
r
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t
No.
(n=249)
Financial benefits to compensate for their 225
other activities performed by them
Educational kits ____________________ 7
Minor drugs________________________ 6
Stationery__________________________ 32
114
Personal benefits
%
90.4
2.8
2.4
12,9
45.8
Table 18. Opinions of staff for improvement in link workers programme
Other health
ANMs
Opinion
(n=130)
workers
(n=138)
No
%
No
%
52.9
Honorarium to be increased___________
119
91,5
73
Timings should be increased___________
15
14.5
11.5
20
57
49.3
Training on diseases to be given________
43.8
68
29
More stationery should be given________
22.3
8
5.8
Should be made permanent____________
17
6
4.3
13.1
Personal benefits like uniform etc., needed
44
33.8
22
15.9
4.13. Perceptions of the Community on Link Workers programme
i. Socio- economic condition of the sample slums
Although most of the slums were mixed groups in terms of language, occupation,
religion and caste and other social customs and habits many of them had its own peculiarities.
The slums visited for the study were not homogenous and exhibited variations not only
i
i
i
between the slums but also within a slum variations
existed in their socio-economic as well as cultural
characters. Each slum had it’s own history as to how and
why it has come in to existence. Many of the slums,
which were originally villages (for example Puttenahalli,
Aswathnager and Gangondanahalli), retained their rustic
The
slums
are
not
homogenous and exhibited
variations not only between
the slums but also within a
slum variations existed in
their socio-economic as
well as cultural characters
environment to a large extent. Some of the slums were part of the old village while the poor
localities, mostly Harijan colonies of the village have turned into slums and the larger parts
have developed in to a middle class locality. Typical examples of this are AK colony of
Adugodi, Jardalli of Rajajinagar and Suitanpalya. Pipe line slum of T.R Mills and Milk colony
of GD park have improved so much that i is difficult to classify them as slums. These slums
27
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It
it
are small in area with 2-3 lanes and hidden behind the high-rise buildings. In these slums, the
majority of the residents are still Harijans. Although the area is small, the density of population
is quite high with cluttered ramshackle dwellings. Being the part of the urban residential area,
the land value is high in these locations, residents of these slums rent out portion of their
houses and this was reported to be a major source of income for many families. Besides, this
has made possible for other caste people to gain entry in to these areas. Some of the sample
li
l>
slums visited had a different history to narrate. The slums like flower garden (Anjanappa
garden) and Milk colony at GD park came up as a result of the migrant labourers, mostly Tamil
and Telugu speaking. One of the residents of the Flower garden informed that “ I am 60 year
old. My father came from Tamil Nadu to work in Binny Mills while some others came to work
in Minerva Mills, the entire area was a big irrigation tank. Anjanappa was the owner of this
lr
area who slowly converted this in to a residential place”.
a. Caste composition
By and large, the sample slums are found to be multi-caste agglomerations. However it
is also found that one or two religious caste or language groups dominate. As mentioned
i
earlier, while in some slums migrant Tamilians dominate, Muslims or Harijans are in majority
in some others. For example, in Kankanagara and
Surabandepalya, majority of the residents were
Muslims while the slums of Flower Garden,
t
Arundhathinagar, Aswthantranagara, MR Palya
have mostly Tamilians, Maya bazaar and GD park
slums were having more Telugu speaking people
and Sultanpalya had more of Kannada speaking
The composition of slums with
different social groups had some
influence on women and young girls.
For example in Tamilian slums it
was understood that majority of the
marriages were love marriages and
most of the girls get married as early
asfifteen to seventeen years of age
residents. Other slums had people with a mixture
of different language and caste character. The composition of these social groups had some
influence on women and young girls. For example in Tamilian slums it was understood that
majority of the marriages were love marriages and most of the girls get married as early as
fifteen to seventeen years of age. This is mostly because men and women work together in
construction sites. Women have more mobility and freedom compared to others. On the
contrary, Muslim women work at home.
28
b. Occupation
s
it
In almost all the sample slums people were engaged in relatively low paid and casual
occupations. These include petty business such as vegetables and fruits vending on carts,
drivers of auto rickshaws or lorries, construction-related workers such as painters, masons,
floor polishers and so on. As an exception at Vinayak Nagar slum a majority of them were
devangas. They work as weavers for master weavers from Cubbanpet and other places. One
cannot escape the noise of power and handlooms as one enters this slum. While some have
looms at home, others work at the work-sheds. While men work as weavers, women assist men
in the pre-weaving activities.
c
t
c. Job pattern of women
Although women, like men, worked in construction and similar jobs, it was revealed
that women s job situation is slightly different from that of men in these slums. Moreover, the
kind of jobs they could afford to take up was influenced by various social factors such as age,
marital status, family compulsions and religion besides location of the slum, and more
important, the availability of jobs. Large number of women from Tamilian households from
Arundhathi Nagar, Flower garden and Swatantra Nagar, work in building construction
activities. At the same time younger women with some background of schooling work in
garment factories.
It was found that a majority of women work at home on agarbatti rolling, pappad
making, beedi rolling and so on. Muslim women especially with small children combine
household chores and the above mentioned income generation activities. Another major
occupation of women from most of these slums is to work as housemaids in the neighbouring
economically better off localities. It should be mentioned here that women in almost all the
slums are the backbone of the family both in terms of economic support as well as day to day
running of the family. However, men spend most of their earnings on liquor and other
!
pleasures whereas women spend all their earnings to run the family and to bring up children.
ii. Relationship between the community and the link worker
I
I
j
The relationship between the Link workers and the community was ascertained by
talking to Link workers, observing their interaction with the community and by talking to the
29
It
community members regarding various aspects of the programme in general and about the
Link workers in particular.
The Link workers’ relationship with different sections of the community was not
similar. It should be mentioned here that the Link workers main points of contact are the target
■t
i
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group or what is called as the eligible couple and more specifically the women with whom link
workers approach and develop contacts. However it is also interesting to note that many a
“ I want some method that my mother in law does not come to know therefore I will optfor
copper Tt and I will convince my husband saying it is goodfor the child's health and
development"
times, women are not directly approachable since their elders, husbands and in- laws control
them. Thus it becomes important for the link workers to go through these people to gain access
to women. Some times, this poses problems since the interests of elders and that of target
women are in conflict, i.e., while most of the eligible women want to adopt some birth control
measure, the elderly ladies at home (at least some) want to control younger women from taking
any decision. Therefore there are a few instances where the younger women of the house is
forbidden to interact with Link workers, lest the latter should enable the former to take freedom
in decisions on adoption of a family planning method etc.. Such situations, at times, make the
job of the Link worker difficult. However, some mothers and mothers- in- law who have
realised the importance of the programme have volunteered to convince the men folk and have
become SHE club members to help the programme. Thus there are different types of relation
ship of the Link worker with the community starting from the most rigid to extremely co
operative community members. It was interesting to know how the link workers and women
overcome this kind of problems. This can be well reported through live examples. During the
field visits of the Consultant, while walking on the street, - r. young women with a small child
of 8 months came running behind us and said “ Look sister, my mother in law has gone out of
station. My husband will come only in the evening, I think this is the best time for me to know
how I cannot get pregnant for 3or 4 years" and when the Link worker accompanied her
5
inside and after all the options were explained to her by the link worker she thanked the Link
worker for giving her the information and said,
truly I did not know that there are so many types of methods to space children, if my mother
in law come to know about my meeting you she will be veryfurious.”
30
I
As one of the Link workers told, “ We have to work in very difficult situation in these
circumstances. If this is the case of mother in law, we have number of cases of husbands who
think that we give information to their women and make them independent. Men say that we
spoil their women. While I say that we are friends ofwomen who wants to control births, some
men and elderly women consider me as an enemy99
There are also
i
i
incidences of conflicts
between community members and link workers
particularly when the latter talk of vasectomy.
However situations can be tackled, when they talk of
tubectomy and other women methods. Many Link
There are incidences of conflicts
between community members and
link workers. Many link workers
informed, that they have to do
theirjob very carefully as the
success of the programme depends
on the trust and confidence the
community bestows on them.
workers informed, that they have to do their job very
carefully as the success of the programme depends on the trust and confidence the community
bestows on them. However, as a worker put it, “But you see, I have to have a lot ofpatience. I
o
have to understand people’s moods, their beliefs, values and so many other aspects”.
In this context, it is important that the Link workers are imparted some training on
tackling with behavioural problems.
!
iii. Community perception of quality of services provided by the link workers.
t
During the focus group discussions, many aspects of services of Link workers and the
perceptions of the community on the
quality of the services rendered by Link
workers were discussed. Most of the
discussions were held with women who
had
received
assistance directly or
indirectly from these workers. When the
women were asked as to what type of
The quality of services given by the link
workers is to be viewed more in terms of the
personal relationship and trust developed
between them and the women. Job of the
link worker does not end at just motivating
the women. They have to take them
physically to hospital, assist them with their
domestic work, spend for autos some times,
follow up after the operation and so on.
services were given and what they have
to say about it, different types of reactions came through. By and large, women said that the
services of link workers are most required and they are doing a good job. However when it
comes to actual treatment at the government hospital, a good amount of displeasure was
expressed. Some women perceive link workers as members of hospital staff while some look at
31
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07 702
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f
them as social workers. The quality of services given by the link workers is evaluated more in
terms of the personal relationship and trust developed between them. As many women
informed,
I was very scared of operation. Moreover, I did not know how good the treatment
at government hospital would be. Because of the sister(link worker) every thing went on well I
am alright now
A positive impact of the extent of trust gained from community is the demonstration of
the effect it has on other women. Furthermore, with growing faith with the Link worker, many
i
t
• c
women have been of good help to the workers, especially in motivating other women in the
■ o
community. During the focus group discussion, one of such women looked at another lady
who had three children and said, ‘ I would have become like you if I had not undergone
operation.. I would have conceived two times by now1*. She looked at the Consultant and said,
‘ W/ credit goes to sister who personally took me to hospital, looked after my child whole day,
and gave me all the information and support I needed**. As a reaction to this, the Link worker
t
informed, yes, ourjob does notfinish at just motivating them. We need to take them physically
to hospital, assist them with their domestic work, spend for autos some times, follow up after
!
the operation and so many other things **
t
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C
iv. Levels of community's awareness of link workers roles and responsibilities
During the focus group discussions and informal talks with the community members,
they were asked to mention what they understand as the roles and responsibilities of the link
workers. Majority of the women reported that the link workers are:
■
one of the staff of the Government hospital
■
they inform us about the dates and venue of
the immunisation
■
i
they inform us of the venue and date of
ANC, PNC and operation
■
they also advice us on small family
■
they distribute tablets to get strength and
blood
The community members have a fair
understanding of the roles and
responsibilities of the link workers.
Besides link workers are so close to
them that they have free interaction and
clarify any of their doubts. Many times
they convince the elders and husbands.
Above all, they take responsibility for
the problem of women for which
Hospital staff do not have time or
patience.
■
they give mrodh, and Oral Pills
"
they go around the slum and survey the families
■
they accompany us to the Health Centre in need.
32
I »
i«
Many of the community members informed that the role of the link workers is to
provide information relevant to health and family planing.
Thus, the community appears to
have a fair understanding of the roles and responsibilities of the link workers. In addition to
this, it was also reported that the link workers are so close to them that they have free
interaction and clarify any of their doubts, 'they have time for us. Many times they convince
our elders and husbands. Above all, they assure us, take responsibilityfor the problem ifany.
!«
Hospital staffdoes not have time or patiencefor all this\
I«
V.
i
Information regarding the extent to which the community has been able to involve
in
the programme was inquired during focus group
discussions, interviews with SHE club members,
NGOs and also with direct beneficiaries. By and
large, the community feels that they have a stake in
the programme as beneficiaries of the programme.
Since this is a government programme, this
understanding is all the stronger among the sample
population. Most women expressed that since we
One could perceive an extensive
level of community participation
in
the
programme
in
immunisation, health check up,
conducting
meetings
and
information dissemination Link
workers find ways and means to
involve community as partners
than
being
mere
rather
beneficiaries
are poor we cannot contribute financially. In fact, it appeared that accepting the contraception
itself is for the benefit of Link workers and government, so much so that almost all of them
I
expect free service and also some compensation. However one could perceive an extensive
level of community participation in the programmes like immunisation, health check ups,
conducting meetings and information dissemination. In all these programmes some households
provtd space, particularly an NGO or community leaders who had some space. Women and
elderly children also participate in cleaning the premises, provide chairs for the staff to sit.
Many times some one or the other provide tea also. Most of the times the SHE club members
and the community also mobilise and motivate the mothers and pregnant women.
In spite of the attitude of the community of “not giving but to receive”. Link workers
find ways and means to involve community as partners rather than being mere beneficianes.
Most link workers talk to SHE club members to find out the resources available in the slum,
they meet local leaders and explain the programme and also tell them that they should actively
participate in the programme. Many Link workers said that people think that they are poor and
3
33
4
1 3
cannot help but they have large heart and are very affectionate. At Bhuvaneshvari Nagar slum
the link worker showed a house which had a large room which is used for health check ups
and immunisation. The woman of the house said that “ / am very happy to give my house to
this good deed, when the Link worker came and asked me to provide this place for helping
people we agreed readily. You should see on the day of the programme I provide space, some
people help to clean the place, others get water ,or tea. After all these programme is for our
benefit*
Thus, community members participate in their own way and in most cases help comes
to
in kind. However community’s perception of 'contribution’ appears to have been understood
as donating money. Most of them say “we don't contribute any thing" because they don’t
contribute in cash. However, Link Workers who are from the local community can be viewed as
a contribution ofthe community towards the achievement ofthe Project objectives.
vi. Community’s perception of the limitations of the programmes.
Although the community members felt that the programme is very useful and Link
c
c
c
i
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workers as beneficial they also pointed out many limitations of the programme. By and large,
community feels that the programme is good and beneficial and need based. However, when
actual treatment by the staff at the hospital is concerned, they feel it needs improvements.
^The Link workers promise us good andfree treatment, but when we actually go to the hospital
people at hospital are very rough and treatment is not free. When we go with out any money,
it becomes very difficult for us to mobilise funds at the last minute
Many women complained
that the hospital does not provide medicines. Instead doctors prescribe medicines and are to be
purchased from the market. The most frequently asked question was “why should we go to
government hospital if we have to payfor all the services which are supposed to be free ?
Thus many times efforts of Link workers to motivate women to utilise the services of
the government hospital is jeopardised by lack of drugs and bad treatment at the hospital.
Another important factor mentioned by some of the slum dwellers was that the Health
centers were far away. However, efforts are made by Link workers to serve these beneficiaries
during out reach Clinics organised by Health Centres.
34
<
4.14. Perceptions of direct beneficiaries on the Link workers programme
The direct beneficiaries of the programme are those who have received services from the
concerned link workers directly. The experiences of these women would throw ample light not
only on the type of services provided but also on the quality of service offered by the Link
workers. Furthermore, direct beneficiaries are expected to comment clearly on the
i
effectiveness of the health service as they are the ones who have used such services. Direct
beneficiaries included:
■
Women motivated for contraception
■
Women with children eligible for immunisation
■ Pregnant women receiving iron and folic acid tablets as well as TT injections
■
Users of different types of contraceptive devices including oral pills, condom, copper -T
and sterilisation.
3
Direct beneficiaries were chosen from five of the 26 (including the case study slums)
sample slums.
L Type of services received by the beneficiaries
The beneficiaries interviewed were contacted mostly at their houses or at Anganwadis.
In each of the above sampled slums all the categories of beneficiaries were interviewed. Many
of them explained the role of Link workers and the type of benefits the programme has brought
to them. Broadly speaking, the major benefits derived from Link workers as reported by most
of the direct beneficiaries were,
(a) They provide useful information at the right time;
(b) They are available at the beneficiaries’ door step to remind them on immunisation camps,
health check up camps;
(c) They provide regular follow up service regarding IUD insertions, replenish OP and
condoms;
(d) They accompany us to health centre whenever needed.
As a woman explained,
“Z have three children and my husband is a drunkard. I don *t remember the dates of
immunisation or health check ups. Every day is a problem for me as my husband beats me up.
Ifeel like committing suicide but you see I have to live for the sake of my children. If I die they
will become orphans. This sister has came like a Goddess to our area She comes almost every
35
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day and gives us information about the immunisation. She even helps us to take children to
health centres. Last yearjust after one year after my third child was born, I got pregnant. I did
not want any more children... when I have no strength to feed these three, how could I have
one more? At this time this lady (link worker) visited and convinced me that I could get
aborted and then undergo operation immediately. After I had my operation done, she came
almost every day to enquire about my health. I am fine now.99
Most of the women in the slums had almost similar attitude towards link workers. A
large number of the sample women confided that they had very vague ideas of contraception
as there was nobody to provide correct information on such topics. However, they said that,
link workers have been of great help to get information on the appropriate method of birth
control.
It is interesting to note that women at large, do not want to have more children or bear
children with closer intervals. But there are a good amount of obstacles to maintain this. The
major ones that could be identified were:
i
i
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Lack of required information for these
women
Inhibitions and false fears
■
Discouragement
including
from
husbands/
men
male
folk
family
members and others
■
Fear that any attempt to limit or space
children would incapacitate them to face
Regular contact with link workers gives them
the much needed opportunity to confide and
discuss about any personal health problems
and helps them to develop good relationship.
Each time the link workers visits a lane, she
makes it a point to remind women to use
tablets besides enquiring about their health
and other matters. This not only increases
their compliance levels but also help instil a
sense of seriousness of the need for utilising
the services offered by the link workers
day- to-day problems of running the
family.
Those women who get condoms and oral pills supplied at their houses are very happy. Link
workers not only supply the contraceptives they also follow them up regularly. Each time the
!
link workers visit a lane, she makes it a point to remind women to use tablets besides enquiring
about their health and other matters. This not only increases their compliance levels but also
!
help instil a sense of seriousness of the need for utilising the services offered by the link
workers. Moreover, the regular contact with link workers gives them the much-needed
I
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opportunity to confide and discuss about any personal health problems and helps them to
develop good relationship.
36
ii. Beneficiaries access to information
o
It was found that the beneficiaries
access
to
information
has
increased
considerably due to regular contact with the
link workers. The knowledge so earned gives
them enough confidence to deal with their
husbands and mother in laws. Many women
t
c
t
said that the worker is like their own 'family
Link workers act as facilitators
for their clients to make informed
decisions. Many women reported that
the link worker is like their own
family girl9 and feel free to talk to
her intimately.
girl’ and feel free to talk to her intimately. Elderly women unduly scare younger women about
complications of Copper T, sterilisation operation or oral tablets. Link workers have a major
role in clarifying these by explaining how these are only false beliefs. Link workers act as
facilitators for their clients to make informed decisions. Many women reported that the link
worker is like their own 'family girl’ and feel free to talk tOzher intimately.
iii. Difficulties of link workers in accessing benefits to the community
Any social intervention activity such as Link Workers Scheme would entail a huge
effort on the part of those directly involved to gam social acceptability from the community.
i
Most often^ the process is painful and disappointing for the workers who spend all their skills
and patience to gain people’s trust and confidence. This is especially so when the clients are
women who are mostly semi-literate, very poor, major family earners with lots of mouths to
feed and take on the responsibilities both at home and outside. In the light of such situations,
most of the Link workers appeared to have more or less crossed the major formidable bridge of
being accepted by their clients. However, it is just one of the obstacles. First of all, almost all
link workers have experienced a variety of problems to gain social access and acceptance from
the community. They had to spend quite some time to build up the trust, which is so important
in their daily routine.
As mentioned earlier, the situation of women in these slums is so critical that the link
workers have to work hard to make women feel the need for the services or create demand.
This process is not only difficult but takes a long time. The exact time required to achieve the
results cannot be estimated. However, the pressure of target given to them does not take these
things in to consideration.
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iv. EEC strategies adopted by the Link workers
Besides the information collected from Link workers and reported earlier on this
0
aspect, during the field visits with the Link workers, an attempt was made to find out the types
of communication strategies employed by the link workers and their effectiveness. By and
large, the link workers used interpersonal
3
communication with the community as well
Given the overall situation ofthe slums in
as beneficiaries. Given the overall situation
terms oflack ofspace and severe lack of
of the slums in terms of lack of space and
timefor women to spend time out side their
lack of time, for women to spend time out
survival activities^ the link workers gofrom
side their survival activities, the link
house to house and contact them while
workers go from house to house and contact
they are nursing their children, cooking, or
them while they are nursing their children,
engaged in other household chores.
cooking, or engaged in other household
t
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chores.
An important spot where women could be easily met is the Anganwadi. Most mothers
come here to receive bread every day at noon. Link workers use this opportunity to discuss
vanous topics such as nutrition, immunisation or motivate for contraception and so on.
Link workers strongly feel that the interaction with women should be at one-to-one
level as the entire programme depends on gaining individual trust. Accomplishing this feat at
the outset would greatly help in addressing their other important strategies, namely:
■
Clarify doubts
■
Clear up false notions
■
Remove unfounded fear
■
persuasion
One of the link workers poignantly described the plight of her clients thus :
I
None of these women want to have more than one or two children. But very rarely do
they come on their own for any birth control measures. We have to go and tell them so
!
many iWmc It is not because they want more children but-most of them live in such
i
miserable conditions that they don rt plan any thing at all in their lives., so why plan
birth control ? If economic problem is one big problem there are social pressure oj
getting male children. Ifthey have boys then there is pressure for girls.99
38
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Link workers are given a flipchart and a set of reading materials for their regular use.
Although many link workers said that they regularly use these for educating women, many did
not appear to have used them often. Many women did not remember to have seen this being
used by the link worker.
•
\
The strategy used by many link workers for communication is one of persuasion than
education. When a pointed enquiry uas made about the communication strategy “frequently
used and why”, the reactions of the
>
link
workers
were
interesting.
'Simple talking to them in their own
language, showing our faces every
day and repeatedly saying the same
thing with out losing patience*
Simple talking to women in their own language,
showing theirfaces every day and repeatedly
saying the same thing with out losing patience
appear to be the major communication strategy
adopted by the Link worker
appears to be the major steps.
►
Many link workers informed that, *we refer to the flip chart whenever we feel that
women need some visuals to understand. But however often we show them, they forget9.
I
4.15. Networking with NGOs
!
NGOs play an important role in the success of any community development
programme. It is extremely important for the time bound projects such as the present one to
strengthen the local NGOs for accomplishing sustainable results. With this in view, the project
has tried to collaborate with NGOs operating in the slums. Furthermore, new women’s clubs
referred to as SHE clubs (Social, Health and Environment clubs) have been set up under the
project which is expected to enhance the communication levels among the beneficiaries as well
as address their problems more effedrvely. In the following paragraphs it was attempted to
discuss the types of NGOs working in these sample slums and their functional relationship
with the programme.
For the present study NGOs operating in the five slums Sarabandepalya, Flower
garden. Milk colony, MRS palya, Vinavaka Nagar were selected.
SHE clubs were established in ±ree of the five slums only. In all the five sample slums,
one or the other NGO was working. While Flower Garden had three of them, Sarabandepalya
had only one NGO organised by a moscue.
39
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L Characteristics of NGOs
To some extent, these NGOs differed with each other in their character and functions.
On the other hand, SHE clubs are women’s groups set up and organised under the programme
with the initiative of the Link workers and the staff of the Health centers. The broad objective
<
of these clubs is to strengthen women in slums to participate in the programme more
effectively.
t
t
Masjid llahi is an organisation established for the welfare of Muslims and is
particularly engaged in religious activities. Presently they run Koran classes and other religious
discourses. However they plan to take up other development activities for the slums in future.
Mahila Milan, reportedly started with government initiative for organising women for
savings and credit. There are paid volunteers from the slum itself who would organise Mahila
Sanghas and implement small savings schemes. It seems that there are more than 500 women
from the area engaged in this activity.
Maya is an NGO with the main goal of eradication of child labour. They organise
women into sanghas and educate them on the value of sending children to schools, run
vocational educational programmes to children in the age group of 15- 20 years and run Creche
for younger children.
Milk Colony Club has been originally a sports club which has extended its activities to
income generation for women through tailoring and nutrition classes. This is essentially a
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resident association.
Karnataka State Council for Child Welfare (KSCCW) is a registered body under the
Social Welfare board and is well known in the field of Mother and Child Health. They train
Anganwadi workers, implement community health programmes, and train women in various
I
health issues. KSCCW has a child sponsorship programme in the sample slum.
Rastrothana Parishat is an organisation involved in educational programmes. The
NGO runs informal education programme for women and school dropouts. A woman works on
part-time basis in the slum and is paid an honorarium of Rs, 400 per month to conduct literacy
classes in addition to develop good habits and clean environment in the slums. Free books and
other materials are distributed to the needy under its non-formal education programme.
Shantha Jeeva Jyothi ( SJJ) is another NGO implementing both government and other
donor funded projects. SJJ has a vocational training center for training women in typing. They
i
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■
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also run a Health center in the slum with a part time doctor and other support staff SJJ is also
involved in community health, family planing and women’s development programmes.
ii. Functional relationship between the NGOs and the Link workers
By and large all the NGOs are involved in community development and health
programmes in one way or the other. In all the
sample slums, the NGO representatives and
SHE club members were interviewed with the
help of a checklist comprising specific issues
related to the nature and extent of their
Link workers and these organisations work
very closely as many ofthese organisations
are also involved in similar activities. Due
to this common interest, there is mutual
cooperation and assistance on various
aspects.
collaboration with the link workers and the programme.
Link workers and these orgamsations work very closely as many of these organisations
are also involved in similar activities. Due to this common interest, there is mutual co
i
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operation and assistance on various aspects. For example SJJ is directly involved in
immunisation and antenatal care. They have a building to conduct activities of health check
ups, immunisation, women’s meeting s and so on. The health worker happens to be the ex
employee of the organisation and has been able to get good co-operation from them in terms of
identifying the eligible couple, providing space and staff for the weekly immunisation and
health check ups and also in distributing the oral pills and condoms. SJJ has three animators
who also work like link workers. They are together in almost all the activities. Similarly
Mahila Milan and KSCCW too have such volunteers.
Discussion with NGOs particularly regarding the quality of the programme and the
co-ordination at the programme level revealed there were some apprehension regarding the
!
functioning of government health staff members. Most NGOs are of the opinion that
“ We have had bad experiences in the past We have no
!
problems of assisting them in any manner. It so happened
that with great difficulty we motivated some women and
1
referred them to government hospitals for delivery and
other services. But these women were not treated
properlyn. When it was probed as to what they meant by
I
st^ is not vay kdpful
inogranm^
ts wtty
s^itavg
to
idatttfy orndvo wta
tho ■J^.:;-govemn^
Dftnnmmme.
not treating them properly’, they explained that:
41
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l<
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'£
"When we motivate our clients, we assure them ofgood treatment. But the moment they go to
government hospital the staff don t respect them as human beings, and are very rough with
them. When we go to their houses they respect us and offer us tea. But when they come to us
what right do we have to treat them badly? Should they have to put up with such bad
I*
l<if
t
treatment?
One important aspect of all these NGOs
is their contact with the grass root level and the
way they combine health and income generation
programmes which has a potential to get more
co-operation from people. For example the
Mahila Milan programme provides access to 500
The NGO representatives also
expressed the fear that the link
workers should not become like
typical hospital staff Furthermore,
they should be allowed flexibility and
freedom and should be encouraged to
continue working with the same
attitude.
women, one of the KSCCW programme caters nearly 1000 women. It was evident from the
discussions with the link workers that they realise the advantage of collaborating with the
i
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NGOs and they are making all efforts. The NGO representatives also expressed the fear that
the link workers should not become like typical hospital staff. Furthermore, they should be
allowed flexibility and freedom and should be encouraged to continue working with the same
attitude.
However, most of the NGOs feel that the link worker’s programme is very useful and
needed much for educating women in contraception and promoting small families.
iii. SHE Clubs
Inferences in this section were collected not only from the three SHE clubs in the
sample, but consolidates the general information collected from all the 21 sample slums
!
through informal talks with the link workers while walking through the slums or while waiting
for the respondents.
!
During the talks with link workers and the SHE club members it was found that almost
all of them knew very little about SHE clubs. Surprisingly the link workers did not even know
I
what does SHE stands for. Most of the link workers understood SHE club as a team of
community leaders who could help them in establishing links with the community and also
assist them in their day to day work. When the link workers were asked to identify the SHE
club members in one slum they would say that there are only two members, in another three, or
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in the third she could remember only one because the second one has been totally inactive.
42
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However, in all the three sample slums, SHE club members did work as link between
the community and link workers. They assist link workers in identifying pregnant women,
newly married couple, women who have come back after the child birth and also new comers
in the slums. They participate in immunisation and other programmes in motivating people and
safe guard link workers from anti-social elements and other untoward situations which are
bound to be encountered as being women on the move.
The majority of the active SHE club members reported to be some sort of natural
p
leaders. They carry some weight in the community. Women come to them for advice on
r ■
various issues. Many of them have even received some orientation from the hospital staff.
’ o
!
These persons did not remember the details of the orientation in terms of what was taught to
them and who and for how long. All that they could report after recalling with great difficulty
was:
i
u we were asked to do some social work, motivate women for contraception, and help the link
workers. I think it was the sister and the doctor who spoke to us about the small family and the
importance ofgood health".
Gowramma, a SHE club member who was interviewed, is an elderly women aged
about 50 years. She is a widow, has three children all grown up and earn for themselves. She
i
has studied up to 5th standard. Looks ven- confident and strong. According to her, U1 am
doing some help to people not only after 1 became SHE club member but before that also. I
take people to hospital if they are sick and do not have any one to accompany them. I help in
bringing up small children like giveing them oil bath. I also help in admission of children to
schools. In our street all are Tamilians and respect me. If I ask the parents to get their child
immunised, theyfully co-operate andfollow what I say. They all know I do it as a social work
for their own good. When I was asked to become member of hospital club I said * yes ’ because
I am already doing similar work".
!
!
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4.16. Case studies of selected successful link workers
Case studies of five link workers were conducted to understand how they could become
successful in their efforts compared to others. Specifically, efforts were made to find out
strategies employed by these workers, how they manage their social life along with their
responsibilities as link workers, and what does this job mean to them, among others. Each case
i
>
was drawn from different UHFWCs with the list of successful workers provided by the Project
office. Selection of only five workers for the case studies had given rise to some concerns and
questions about picking the selected ones and studying them. Some of them had already made
inquiries with their medical officers as to why they were subjected to this special study and
I
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whether it had any implication on their job situation ? Therefore, the first task was to
convince them that they were selected on a random selection basis for the sake of case studies
as all the link workers could not be studied. Secondly it was made clear to them that all the
information collected will be kept strictly confidential and no where their names or any other
identification will be revealed. This explanation helped them to be relieved of any
apprehensions and also made them to be free and frank. In the following sections, cases of five
such link workers are narrated Needless to mention, the names of the link workers are not real
and have been changed to maintain the confidentiality.
Case 1 Seetha
i. Socio economic background
Seetha is 32 year old and has two children of 16 and 14 year of age. She has studied up
to SSLC and is married for 17 years. Seetha has worked as link worker for 3 years. Her two
children are studying in school. She has lived in Bangalore all through her life, and her
husband works as a mason. She is a lady of confidence. She looks strong and has bright eyes
and a healthy look and is smartly dressed. It is difficult for one to fathom the type of problems
she undergoes by just looking at her. Seetha had never worked before. This is her first job.
She comes from a big and economically not a well-to-do family.
ii. Training and other exposure
She has been given five days on-the-job training at Kodandarampura training center.
This is her first exposure to a professional activity. She again underwent a refresher course in
44
0
the same place. Both the times she was taught various aspects of health and family planning.
0
.Seetha said that at the time of the training she had a mixed feeling. She was excited because
she was imbibing a new job, new information and knowledge, interacting with other women
3
and the health staff. She was also scared because of the challenge she had to fulfil both at home
and on the job.
‘7 myself did not know any thing about the subject. I underwent a sterilisation operation soon
(rfter my second child I was very scared at that time, my mother and sister stood by me. I have
even forgotten about those days now. But one thing is very true... I did not want to have more
children".
Seetha says that she was taught the following in her training programme:
i
■
Contraceptive methods and their usage.
■
How to interact with the community and motivate them for the services
■
Enlisting the eligible couple
■
Nutritional requirement of pregnant women and children
■
Care of pregnant and lactating mothers including the immunisation.
■
And many other related aspects.
She has read all the booklets and reading materials given to her and even now refers to them
when needed.
iii. Reasons for taking up the link worker job
In the case of Seetha, joining this job has been quite an effort She said,
“From the beginning I did not want to while away my time. Both my children are grown up
and go to school. What am I to do at home ? Moreover I need money. My husband has been
always against me working out side home. When I came to know about this job I did not think
that I would get it. I came secretively and met the 'sister I was interviewed by the IPP staff
and got the job. Then my problem was how to inform my husband ?. I made up my mind to take
up the job. I simply told him that I am going to work from tomorrow. My husband is a
drunkard. Every day he comes home fully drunk. Any trivial thing can become complicated and
children can get beaten up. In the beginning I had lot ofproblems. I have promised him that
nothing goes wrong at home because of my job and the day my job comes in the way of his
comforts I would quit.
i
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iv. Dual role management
Seetha manages her house and the job very well. It is no doubt, hard and long hours of
work. Her daily routine begins at 5 am. She narrates :
" I get up at 5 am and wake up my children. My son goes to distribute newspaper and my
daughter helps me at home. I start cooking, cleaning, and washing side by side. I prepare
for my husband's bath and for his breakfast. He goes for a walk. My son comes back by
I
7.30 am. Both children get ready for school.. I prepare their lunch boxes and they go to
school. By this time, it is past 8 am. I take twenty minutes to get ready which includes my
bath, dressing, closing the kitchen. At about 8.45am I leave home. It takes about ten
minutes to reach the hospital and before 9 am I am inside the hospital. The first thing I do
is to sign in the register and then if there is any writing work pending from the previous
day I finish it and wait for the doctor and other staff who would instruct me about the
day 5 work At about 9.30 am I leave for the field, my slum. In the beginning it took some
time to introduce myself and get accepted by the people. But now people know me so well
that I do not have problems interacting with them. I cover about 45 houses in a day. I visit
houses lane-wise and cover the following activities:
t
"4
(a) Follow up pregnant women;
(b) Inform about time and venue of immunisation programme;
(C)
Follow up T B cases;
(d) Motivate for sterilisation;
(e) Distribute condoms, OP, ORS, FS;
(D Inform about outreach IUD camps;
(g) Meet women at Anganwadi and assist Anganwadi worker in nutrition education and
also address women in mothers’ meeting
By this time, it is 12-30 PM. Although I plan to go back to hospital invariably women wait
for me to accompany them to hospitalfor treatment. I take them there and request the staff
to attend to them. I then begin filling my daily records and return home by about 2 PM. I
have lunch at home and complete any household chores left out in the morning by which
time children return from the school. 1 attend to them and begin my evening routine of
cooking dinner. My husband returns at about 7 PM, fully drunk The entire home is so
tense. We talk in very low tone. I sene dinner to him first and then my children and I
partake. In spite of being very carefuL my husband loses temper for flimsy reasons and
46
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creates a big scene in "which the children are the victims. In the beginning, I was also
beaten up for trivial reasons. Nowadays, he hesitates to beat me. I think that my earning
status and interacting with outside world may have prevented him from such actions. After
dinner, I give myfull time to children fs studies. Then I clean up kitchen and attend to other
chores at home and go to bed around 11.00 PM”.
vl Job satisfaction and expectations
Seetha is very much satisfied with the job she has at hand. She needs this job not only
for economic reasons but also to have diversion from her household problems. She says
aI can earn thrice the amount of what I get here
if I take up work as a housemaid But I will not
have the satisfaction. Now I have a feeling of
achievement and I want my children to lead
ffnlffi^ft fftVScV^ i tUS nfffr K^ Mtr.w tJuT 0
good amount qfsatirfaaiM tmd seif
AdMU^u^.-
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better lives and hence the type of exposure and
the job I do is extremely important. I feel that the job I do will help women to have at least
some control on their lives. More important, it is the amount of exposure and knowledge I
have gained myself has given me a good amount of satisfaction and selfconfidence. And this,
to a great extent, has equipped me to carry out my work with courage and conviction. I feel
elated when people call me as 'doctor ’ when on duty and ask for information on immunisation
dates or other matters related to their health. To this extent, I am quite satisfied with the nature
ofjobldo.”
While Seetha is extremely satisfied with her job as link worker, she also says that her
!
job is not only insecure but is devoid of many benefits which would have given her great
strength to perform much better.
On the job front, Seetha feels that the scope of her activities has widened since her
joining the project She says that many tasks, which were not included in her responsibilities in
the beginning, have been added. These include more paper work and many times the health
staff pushes a lot of their work on her. Besides, she is also given additional assignments in
immunization and other camps. Seetha feels that these additional responsibilities is in no way
are compensated either monetarily or through any other benefits.
vL What makes her the best worker
1
Seetha has innate capabilities. She said ** I always find my way to success. Even in school I
was recognised as a leader. I make a good bargain. Whenever my family members go for big
47
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p
I ~
it
it
p
1^
shopping for marriages I will be taken to make good selection and bargain the price,t. **1 have
been able to perform better because Iforget my home the moment 1 get out of the house. I only
think of my Job, my people and other
aspects.
In the beginning I had lot of
problems primarily due to the indifference
of people. The hostility of men used to
depress me the most. When once I spoke
" one should retain the ofthe people
Generally people are very trust good. Ifthey
come to know that we workfor their benefit
they definitely will co-operate with us.
about vasectomy to a family where the
3
women was a heart patient and already
had 3 children, some men as well as women became furious. They told me not to enter the
slum. For some time 1 did not go in to the slum. It so happened that women had an abortion
and the case became serious. Exactly at that time I decided to go and find out the situation.
They immediately askedfor my help. I helped her to get good treatment and recover. Although
it was only a coincidence, this brought me very close to the community. However one should
retain the trust. Generally people are very good if they come to know that we work for their
benefit they definitely co-operate with us'\
According to Seetha, “ a good link worker is some one who has a smiling face, has
capabilities of understanding peoples problems, has patience to listen to others, interest and
commitment in the job and never lie with them However, finally for the treatment we have to
personally accompany them to hospitaF.
Seetha also said that, in order to establish good rapport with the community, she helps
her women clients, in personal matters. These may include running petty errands like
I
physically helping women or their
children and even to guide on
matters such as availability of
ration in the fair price depot, and
the like. With regard to the attitude
and the quality of the staff at
a good link worker is some one who has a
smilingface, has capabilities of understanding
people's problems, has patience to listen to others,
interest and commitment in theJob and never lie
with them9.
Health Centre, Seetha had apprehensions and refrained from further elaboration.
48
...
t
t
Case 2
I
Tara
i
i. Socio-economic Back ground
Tara is 39 years old with a pleasant, yet serious face. She talks fast but firmly. She has
studied up to SSLC and is married to a government employee. She has a daughter studying in
college. She had earlier woriced as a tutor at home, teaching primary school children. As a link
worker she has worked for 4 years. Tara has a good milieu at home and an encouraging
husband.
ii. Reasons for taking up the job
Reasons given by Tara to take up the present assignment can be elaborated in her own
words.
*j joined this work as a coincidence. The area ANM had come to survey our area and
met me and asked if 1 am interested in the link workers job. I spoke to my husband about it. He
!
was very keen that 1 take up this job. Next day I went to meet the doctor who referred me to
IPP office, 1 was interviewed and got the job" Tara was always interested in the job involving
public contact. Tara’s husband always advised her to do some thing to widen her knowledge.
She thinks this job gives her this. She says, *T also want to earn my own money. Whatever my
husband earns is sufficient to run the family while I spend my earnings for my daughter and
i
myself9.
iit Training
Tara underwent link worker’s training at Kodandaramapura for five days. She says that
i
she was trained in the areas of understanding, interacting and motivating community members
to participate in health programmes including family planning methods, immunisation etc,
besides other aspects.
iv. Daily routine
Tara wakes up at 5.00 am has a wash and makes coffee for herself and her husband.
Then she immediately goes for bath . she said, ‘7 do pooja every day, as we are Brahmins this
is important. Only after pooja I start other chores. I take about 3 hours for cleaning the house.
49
ju
!^.~-~y- •.-.- .Trr-il- ■--
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i
washing clothes and vessels, and cooking. I have to do this every day. Ours is a small house
and I want the entire work to be completed by 8.00 am in the morning. I get ready and leave
home at about 8.40 am. and walk up to hospital. I am always at the hospital at 9.00 am. As
p.
soon as I reach the hospital I sign in the register, wish others, wait for the doctor and sisters
r
for their instructions ifany, and leave for thefield”.
I
i.
I 5
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F
Tara is a veiy active person. During the visit with her in the field it could be seen that
she is very familiar with each and every women in the field. Tara speaks Tamil, Hindi besides
Kannada, which is her mother tongue. As she moves from one lane to another she changes her
i
language spontaneously. Whenever she approaches Muslim women she speaks in colloquial
Urdu and the moment she sees a Tamilian women immediately she switches over to Tamil. She
I
explains her field programme to me. She concentrates mostly on eligible couples and move by
lanes and attend to each and every house in that lane. During the visit gives information on the
I
immunisation and health check ups. And follows up copper T and sterilisation cases wherever
they are. She was narrating “... I go to houses having pregnant women and inform them for
check ups. I once again repeat and tell them that they should eat greens, sprouts, ragi without
fail. I go to houses where women have not yet made up their mind to adopt any contraceptive
method. I sit with them and try to motivate them by talking with them intimately”.
i
i
During the visit to a family with her the reaction of a mother was, uYou are back again
!! Didn’t I tell you not to come and spoil my mood ? Look., my daughter is still young I have
only one daughter and we want more children. It is our family matter ... we somehow work
hard and bring up our children... we will not send them to beg in front ofyour house”. Tara
stood and smiled at her and began to talk to her daughter totally undisturbed.
According to Tara this kind of cases are common every day and they face this kind of
situations. She also said this takes lot of her time. She said ,“We have to be very patient” . At
about 12.30 PM. she winds up her fieldwork and goes back to hospital. She writes her daily
report, reports to the sister’ and doctor on the day’s work .By this time it is 1.30 PM.
v. Job satisfaction
Tara is very happy with her job as it
I
involves contact with women and helping them.
!
'whenpeople recognise me on the road and wish
me Ifeel nice that I am doing some thing important
1
» .
I ’
*
J. —
...... " The best part of this job is
the exposure to women's life in
slums. If I can help one women
to control birth I feel greatly
satisfied, because I know how
much suffering it causes tn her".
50
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and useful. People give me lot of affection. Moreover, this job has given me lot of knowledge
I
and selfdevelopment. I was as ignorant as the slum women were. Now Ifeel I know some thing
that I can share with others and this gives me lot ofgoodfeeling. The best part ofthisjob is the
exposure to women's life in slums. If I can help one women to control birth I feel greatly
satisfied because I know how much suffering it causes to her
Tara, like Seetha, feels for increasing honorarium and other benefits essential to keep
3
3
3
t3
their commitment and motivation intact
According to Tara
a good link worker
u...a good link worker is one who
understands the objectives of the programme
is one who understands the objectives of
the programme. We should not be just target oriented. We should have interest in the job. It is
extremely important to adapt to the effective communication strategy. We should not have
superiority complex and make them inferior. We should build confidence in them. I try to
follow this in myjob ”.
Case 3
Usha
i. Socio-economic background
Usha is an young lady of 32 years with a child of 6 years. Her husband works in a
private factory. Usha has studied up to 9th standard . Her dream was to study and become a
doctor as she comes from a large and educated family. Unfortunately she lost her father when
she was in 9th standard and nobody took care of her. She had to discontinue her education.
Before coming to work as link worker she worked with an NGO involved in literacy
programme for 2 years. She is working as a link worker only for lyear 6 months.
She has been trained in Kodandaramapura institute for 5 days. She was trained in community
survey, care of pregnant woman and childcare, contraception types and uses, immunisation and
interpersonal communication and general health issues. This was a good exposure. uAs I had
no knowledge ofany thing, this training gave me a basis for myjob
Z>
ii. Reasons for taking up the job
Usha took up this job for various reasons. She explains ** this job is giving me many
things, when I got married I was very young, my brother made a statement that I should not get
51
1
WH' 17-0
U7702
__
■■ L
............................. .. ............. ......
v .
pregnant for some years. I wondered why he said that and how to avoid getting pregnant?
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t
I
Immediately I got pregnant. I did not how to take care of my self in 9th month and had a still
birth. This was a turning point in my life. When I came to know about this job through afriend,
I thought I should not give up this opportunity and immediately took up the job. Besides this,
there is money aspect to it... I need money to run the family. Whatever my husband earns is
insufficient to run the family and also the schooling ofour child”.
iii. Daily routine
Usha’s day begins quite early in the morning at 5.00 am. She has a hectic schedule. She
I
explains, “Both I and my husband start the work together. I have a very understanding
husband who helps me in looking after the child and also household work.
By 8.30 am all
three of us leave home the child goes to school and we both, to work. At 9 'O clock, I reach
hospital, as usual sign in the register, wish the colleagues, take instructions from the seniors
and leave for the field"
Usha spends a lot of time with the women educating them and giving them information
I
I
about their health. She thinks this is very important as women lack access to right type of
information on their own body
functions such as menstruation,
pregnancy
and
child
birth.
There
are
lots
of
misconceptions
notions
about
and
wrong
female
body
Usha spends a lot of time with the women educating
them and giving them information about their health.
She thinks this is very important as women lack access
to right type of information on their own body functions
such as menstruation, pregnancy and child birth.
among these communities. According to Usha it is extremely important to address these during
their interaction with the community.
She explains that her routine is a mixture of so many things, like survey and registration of
pregnant women, motivation for contraception,
information dissemination, follow up of cases
who have undergone operation or copper T and
so
many
small
things
which
comes
In principle, all women want small
families but their situation is such
that they cannot get out of the
problems so easily and act quickly.
Women lack support in all respects.
unexpectedly.
In order to make the work more manageable, Usha says that, “ I have divided the area
in to different units, 1 make it a point to go to all the houses of my target group in each unit.
52
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Each unit may cover 40- 50 houses
'J
n
r
women, children for immunisation, some times, for the same women I have to convince about
the contraception either for copper T or oral pill or condom or immunisation of her child. In
the case of a women with 2 or more children I have to motivate her for the operation. This is
not easy always... these women have lot ofpractical problems. In principle, all women want
I J
II
small family but their situation is such that they cannot get out of the problems so easily and
act quickly. Women lack support in all respects.
Men here don't bother about anything
because no men think that they have any responsibility for bringing up the children. On the
I
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She explains “Zn each ofthese houses there are pregnant
contrary women can never shirk from this responsibility in any circumstance. This has put
women at a most disadvantageous position. This has a lot of bearing on our job profile. We
have to talk to women, I don't know how many times, to get out of this vicious circle and get
5
operated or advise them to stop giving birth to more than one or two children"
)
If she enters the slum around 9.30 in the morning she works up to 12.30 p.m.. In the
3
slum , the time allocation with regard to each household or each part of work depends on the
situation. She said “some cases take lot of our time, even to take the child to immunisation we
have to go and remind them several times. Some are easy... they come on their own if we give
I
the time schedule just once. Similarly for contraception some come voluntarily while for some
s
others I spend a lot of time convincing the husband, mother in law father in law and who
else.... ”, she smiles.
uBy about 1.00 PM I wind up the field work and get back to hospital. Hospital is only 5
minutes away from the house. When I get back I need to write my report on the day's work go
back home by about 2.00 PM. When we have immunisation, health check ups I work longer
hours. In those occasions, it becomes extremely difficult to make some arrangement for my son
to stay with some one. I get home extremely tired Moreover, my workload has increased
compared to what we used to do in the beginning ... a lot of record writing work has been
given to us".
i
iv. Job satisfaction and expectations
When Usha was asked what is the level of job satisfaction she experiences and why?
she thought about it for a minute and said “Z wanted a job which would increase my knowledge
about my self useful for my life. If it were only money I could have earned in some private firm
ofsome otherjob. For me this job gives satisfaction because, there is recognition, respect from
53
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the community andfeeling of being helpful to women. Greatest satisfaction I have is that I have
self-development along with helping others. My only dissatisfaction in this job is low financial
gain and total absence ofother benefits. For the work I do what I get is nothing, I can proudly
tell you that whatever achievements this programme has been able to achieve is because of the
link workers.99 She remembered that many of her colleagues left the job on this grouse.
3
3
v. What makes her a good link worker
According to Usha the job of a link worker requires certain special personality qualities
as well as skills. Three things essential for the link worker to posses are patience, convincing
ability and empathy.
Case 4
Uma
i.Socio-economic background
Uma is 30 years old looks tired and worried. She does not look straight and talk She
stares at the floor and replies. Listens carefully and answers. She has studied up to SSLC. Uma
i
>
has worked as a teacher for 3 years in a private nursery school before joining as link worker.
I
I
She has three children, aged 14, 12 and 11 years. All three are studying. Uma has already
worked for 4 years as link worker. Her husband works in a private company. He has studied up
to 8th standard only. She has a lot of family problems due to her alcoholic husband.
i
•
i
i
She was trained on the job at Kodandaramapura institute for five days. As the area of
health itself was new to her, this training gave her a good basis to start the work. She
remembers that she was taught about different types of contraception and their uses, how to
detect pregnant women, care of the newborn, and immunisation schedule. She was also taught
to conduct community surveys for eligible couples and methods of interacting with the
community.
I,
it Reasons for taking up the job
For this question Uma said, uWhen I got my last child I was not able to continue my job
I was sick... family condition was very bad... I tried to do some oddjob or the other to get some
i.
f
I
54
I
money. After some years I decided to take up regularjob and I started looking around. / came
to know about this job. I met the doctor of this hospital who referred me to IPP office. There, I
was interviewed and eventually got theJob. I am one of the senior most members ofthe team.
n
For Uma this job meant many things, “Since my home situation is bad I wanted a job,
which would provide me both money and satisfaction of doing some thing. Besides, it also
r
provided opportunity to improve my social interaction with people outside home
iiL Daily routine
Uma has a long day of work Bringing up all the three children is on her shoulders. She
o
is determined to give good education to her children. Her day begins at 5.00 am, with a bath,
lighting a lamp to God and her work begins. “From 5.00 to 8- 30 am, I do all the work such as
cleaning, washing, cooking, shopping and all.. I take just 10 minutes for my self to get ready
and leave for hospital. I take about 15 minutes to walk down to the hospital... By 9.00 am, I am
3
there. I sign in the attendance register, wish my colleagues, meet the doctor and sisters, take
specific instructions ifany, and leave for the field.
At field she has a different situation to face. The major portion of the area is not
typically slum. A good amount of the families in the area belong to middle class and the area
has all the infrastructure like road, drainage and water supply to individual houses. Many of
them are in service sectors.
Uma has been involved in the work of two areas because two of them work together. In
the past she and other link workers have had problems of men misbehaving with them. She
explained:
“ Since houses are big, we have problems. It is not like working in slums where houses are
i
1
small and close by. There if we sit in any house every body can see us. More over the people in
the slum respect us as educated women, while in big houses situation is different. If there are
no women in the house some men either look down upon us or try to take advantage of the
situation. °
“From 9.30 a.m. to 12. 30 p.m. we visit houses and attend to various activities. In the
past few months, we did the survey of eligible couples, motivate for contraception , inform
mothers for immunisation, inform pregnant women for health check ups, distribute condoms.
Oral pills and iron tablets “ We make use of mother s meetings in Anganwadi to talk about
specific subjects such as nutrition, immunisation, contraception and the like. ”
55
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1W1—™ I. J'1.....
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Like the other link workers, Uma also divides her area in to different lanes and attend
I
p
to in a cyclic order. But those patients, who have under gone operation or inserted copper T,
are visited in whichever lane they are, for a few days after the operation. By about 12.30 PM
she winds up the field activities and returns to the hospital. As a routine they sign in the
attendance register write in their report book and walk back home. By about 1.30 PM., she
i
reaches home.
iv. Job satisfaction and expectations
►
For Uma, this job has given a great deal of diversion from her family problems. Since
1
>
i
the job requires lot of concentration and community contact, the job has helped her to get out
of her problems. She said “ the job has helped me develop confidence. I had become totally
depressed and weak before joining this job and this job has given me lot of exposure to outside
world. I feel great when people recognise me as a health worker and ask for my advice'*.
I
However, she also stresses the financial part of the job very strongly and said “ For the past 4
years I am working without a single rupee increment, what do you say about this? I very much
•0
want increase in the honorarium and some benefits too
v. What makes one a best link worker
’Q
I
I
' id
!
According to Uma, all cannot become good link workers. A good link worker needs a
smiling face and a friendly disposition. One should earn the good will of the community. They
should be convinced that link worker is there for their benefit. "JFe should study the situation
and act accordingly therefore we should have different strategiesfor different set ofpeople. ”
i
I
Case 5
Raja mm a
i. Socio-economicBack ground
Rajamma is a lively and robust looking women and talks in an as-a-matter-of-fact
i.
manner. She is aged 36 years and has studied up to 9th standard. She has already worked for 3
years as a link worker. Rajamma lives right in the center of the slum, she is in charge of. For
about 30 years she has been living in the same house. Thus she knows each and every one in
the slum. Rajamma has three sons aged 13,1 land 10 years. All of them are studying. Before
i
56
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p
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v
r--
joining as a link worker she worked in an Ayurvedic medicine company’s packing unit. Her
husband works in a private firm.
ii. Training and other exposures
Rajamma was also trained in Kodandaramapura institute for five days. She says that
she learnt many things in this training for the first time in her life. She said, “ In the beginning I
I
was scared to know so many things. But as I went along and performed my duties, gradually it
became easy. We were taught about health aspects of pregnant and lactating mothers,
contraception methods, community survey method, how to interact with the community and so
on «
Although training has given a good basis for discharging her job well, she get lot of
doubts. Rajamma talks to regular staff and gets clarifications. If she has any problems doctors
and other senior staff help her by giving information and other support.
HL Reasons for taking up the job
3
The Health Center was just next to Rajamma’s house and as such it was not difficult for
her to know about the job opportunity. She went and requested the doctor. The doctor asked
her to go and see the IPP staff where she was interviewed for the position and got it. She said,
□
“ I took up this job to get diversion from my family problem and to get some money for the
family. If I had some one to tell me about birth control, I would not have had this problem...
brining up three children is very difficult. I also want to help poor women in this respect
I
iv. Daily routine
Rajamma’s day begins at 5-30 am. She narrates her routine “ I wash and pray Godfor
five minutes. When I finish all household
I
work it becomes 8.00 am. I get ready and
leave home latest by 8-30 am. I have io
take a bus and reach the hospital. Hospital
" ...in my slum there is nobody who says no
to my words, some men try to create
problems but Igo directly to them and talk to
them and convince. My words carry some
respect here.99
I
i
i .
I,
i
I.
has been shifted to a far off location and
takes about one hour by walk
Rajamma gets tired by the time she reaches the hospital. As soon as she comes to
hospital she signs in the attendance register and waits for the doctor. This gives her some time
57
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a lESSUJUJ____ L ---------
to breathe, according to her. Once again get back to her slum where she lives. She feels this is
not very convenient for her. She spends both money and time just to do this. She gets back to
slum by about 10.00 a.m. and starts her work. She covers 40- 50 house visits every day. She
said, “ as far as the work is concerned I have no problem because I know every body in the
i
slum and I don't have to make special efforts to build rapport or introduce myself.
1
She is familiar with each and every one, on her way in the slums she called them by their
I
1
I
names and asked them how things are after the copper T insertion, sterilisation operation,
whether the child has been immunized and so on. They all answer her very politely. She asserts
i
i
that, “ in my slum there is nobody who says no to my words, some men try to create problems
but I go directly to them and talk to them and convince them. My words carry some respect
here. " She carries on follow-up of operation cases, distribute oral pills and condoms, inform
the time and venue of health check ups and immunisation and motivates for contraception
every day.
5
She continues to work up to 12-30 p.m. and there are some women who would like to
I
go to hospital with Rajamma for some treatment or the other. Rajamma takes them and once
3
again goes to hospital. She says she walks up if she has company. She has to sign in the
I
□
□
!
register, write in the daily report book and return home. By this time it is already 2.00 p.m.
v. Job satisfaction and expectations
Rajamma says, “this job has given me satisfaction in terms ofgiving me an opportunity
to serve people. It also relieves me from the house hold tensions. People call me as a social
!
worker I feel nice about it. I feel my services have some value to people. The money I earn is
important to educate my children. However some ofthe aspects of the job has to improve to see
1’
I
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1 .A
I,
I
that we work in the same manner. In my case the distance is a concern. It is good if they do
not insist on going twice a day. I also feel that there has been increase in our workload. Our
Job situation is such that we cannot complain about any thing
vL What makes her a good link worker
According to her a good link worker is one who has good temperament, has interest in
community work, lot of patience and commitment in the job. She said.
Whatever may be my problems and
worries Iforget all that. I listen to them
^... earning trust is important Ifpeople lose
trust in us, that is the end of our work"
58
decision. Earning trust is important, ifpeople lose trust in us that is the end ofour work,f.
Conclusion from Case Studies
The case studies presented above provide a broad idea of the socio-economic
background of link workers and as to how they carry out their duties. Most of the link workers
r
come from economically poor sections and as such, for all of them this is a most needed job as
i
it supplements the family income. However, the more important finding is that all the link
I
r
workers saw their job as an avenue for their professional development What is remarkable
about most of the link workers, is the dextrous manner in which they handle their household
chores with all family-related problems on the one hand and the challenging task of their job
outside the home on the other. Most of the respondents said that their work activity made them
realise how ignorant they themselves were in making momentous family related decisions.
Perhaps this can be seen as a driving force for them to cany out their responsibilities more
efficiently. This may also be a powerful instrument in evoking positive attitudes toward small
i
i
ia
family norms, better hygiene practices and giving importance to healthy way of living on the
part of women and others in slums.
The insight one gets from these case studies is the hard work and determination of the
Link workers in their work. These five workers are examples of strength and commitment to
work. What is more striking is the confidence, interest and patience they have in interacting
with a variety of people with different and often negative mindsets. Equally heartening is that
they keep their family problems out of their jobs. These women work not only for money but
have special interest in their own professional development An important hope for them was
J
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their great desire to educate their children. According to them, the key to success as link
workers, are ability to communicate effectively, innovative ways of persuasion, commitment to
job responsibilities. Furthermore, being close with the community they serve, and a strong
spirit of empathy were other factors expressed or hinted by these link workers as the secret of
their success.
59
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5.0. OVERALL CONCLUSIONS OF THE EVALUATION
i
What emerges strongly from the findings of overall effort is the following:
■
The intervention of the project through link workers has been very useful for the
community. This conclusion is based not only from the findings on their attainments and
performance but also from the opinion of the direct beneficiaries of the programme,
participants of focus group discussions, NGO respondents, and other Health personnel at
the Health Centre.
■
Link Workers were mature, energetic housewives and represent the community in the
socio-economic status and were well accepted by the community.
■
Link workers being residents of the community ensures continuous follow up of cases in
■
the community.
Link workers not only help in achieving the targets of the Project objectives but also help
the community women in their personal problems.
r
■
Link workers job requires good amount of skills in terms of inter-personal communication,
considerable level of articulation in convincing and persuading their clients to alter their
living styles and behaviour. These qualities were found in good measure among the
Mb
■
workers.
Although link workers have support from the regular staff of the hospital, there is also
considerable pressure from these staff to reach assigned targets. Many a times link workers
overwork because they have to take up work of these staff members.
Mb
■
However, there appears to be some amount of dissatisfaction among link workers about the
Mb
way the other staff members treat them. In some cases they mentioned that they are most
4
vulnerable.
All the link workers expressed great concern about the paltry honorarium presently
■
offered which is certainly not commensurate with the nature and extent of their job
responsibilities. Furthermore, the absence of job security and other service benefits were
voiced by all of them. Despite such harsh service conditions, most of the respondents
reported that they liked their job and expressed their desire to continue.
■
All the link workers had undergone 5-day training at the time of induction. However, there
is certainly a need for strengthening the capabilities of workers to update their awareness
levels in terms of various concepts and their application in the changing socio-economic
60
scenario. Some topics on tackling behavioural problems in the community are also needed
in the training.
■
3
It was also found that there is a need for introducing more effective IEC materials, particularly
on the superstitions, wrong beliefs on childbirth and contraception.
■
The reporting and record keeping system and use of MIS system for monitoring of their
day to activities is lacking with the Link workers.
3
■
The findings of the present evaluation suggest that the programme of Link workers can be
replicated in other similar projects also.
3
6.0. RECOMMENDATIONS
5
i.
Link workers contribution to the Project activities are to be appreciated and duly
recognised in view of the good performance by them.
ii.
The position of Link workers requires strengthening by creating a sense of security and
providing due status amongst the staff of the Health Centre.
iii.
I
refresher courses.
iv.
The reporting and record keeping system with the Link workers is to be improved by
providing them structured daily dairies, follow up registers and training them in monitoring
i
I
i
i
Link workers knowledge requires periodical updating through a structured and need based
of activities.
v.
Sense of responsiveness to the community aspirations from Other Health Centre staff is to
be improved to create stability to the Link workers in the community.
vi.
Meager honorarium received by Link Workers, in the present day value of money, should
be increased keeping in view of their contribution to the project objectives.
vii.
Link workers are to be adequately compensated for every additional work entrusted to
them.
E
Er
viii.
programme with adequate budgetary provisions after the closure of the Project, since Link
workers are the only community link
ix.
1A
1
Bangalore Mahanagar Palika should commit itself to continue the Link Workers
the Health Centre activities.
A suitable system should be established to monitor the performance of Link workers based
on CNA approach.
61
-
V'
J
-
■
ANNEX 1.
Sample of slums for Community survey- Link workers
Population
Slum
SI. No. UFWC
No. of
Houses
J.P.Nagar
r
Marehalli
3060
245
Bapuji slum
2000
216
Byrasandra
9222
1434
Surebandepalya
6846
1265
Kumbar Gundi
6024
240
Janata Colony
5600
900
Flower garden
5302
1305
Cholara palya
16472
4288
Maruthi nagar
5300
850
Chamundi Huts
8720
1026
Vijayanand nagar
5350
1050
Resaldar Street
2530
513
Gopalpura
5870
962
R.G. Nagar
2400
360
Kanteeravanagar II
4150
750
1
Yarabnagar
i
2
Jayanagar
3
Banashankari
4
Pobbathi
5
5
Azadnagar
3
6
Anjanappa garden
7
!
Hosahalli
8
I
Bapujinagara
9
Rajajinagar
10
Ashokapura
i
1
11
K.C.G Malleswaram
12
Okalipuram
13
Hegganahalli
14
Nandini Layout
15
62
■
scenario. Some topics on tackling behavioural problems in the community are also needed
in the training.
■
✓
It was also found that there is a need for introducing more effective IEC materials, particularly
on the superstitions, wrong beliefs on childbirth and contraception.
I
■ The reporting and record keeping system and use of MIS system for monitoring of their
day to activities is lacking with the Link workers.
■ The findings of the present evaluation suggest that the programme of Link workers can be
replicated in other similar projects also.
6.0. RECOMMENDATIONS
5
i.
recognised in view of the good performance by them.
i
3
Link workers contribution to the Project activities are to be appreciated and duly
ii.
The position of Link workers requires strengthening by creating a sense of security and
providing due status amongst the staff of the Health Centre.
iii.
!
Link workers knowledge requires periodical updating through a structured and need based
refresher courses.
iv.
The reporting and record keeping system with the Link workers is to be improved by
providing them structured daily dairies, follow up registers and training them in monitoring
of activities.
v.
Sense of responsiveness to the community aspirations from Other Health Centre staff is to
be improved to create stability to the Link workers in the community.
vi.
Meager honorarium received by Link Workers, in the present day value of money, should
be increased keeping in view of their contribution to the project objectives.
vii.
1
Link workers are to be adequately compensated for every additional work entrusted to
them.
viii.
Bangalore Mahanagar Palika should commit itself to continue the Link Workers
programme with adequate budgetary provisions after the closure of the Project, since Link
workers are the only community link with the Health Centre activities.
ix.
r
A suitable system should be established to monitor the performance of Link workers based
on CNA approach.
61
.
•
p.. -1-
J*
3
Ganganagar
16
t
Papanna Slum
2151
480
Modi road
5100
981
Manorayanpalya
15000
5000
Mattadahalli
1963
460
New lingarajpuram
15179
2107
Babusab colony
3154
568
Sudam nagar
5081
1628
Nehru puram
5753
865
Sree Rama Nagar
4298
615
Sathya Velu slum
1000
150
Gutta palya
2508
651
L.R.Nagar
15800
2320
Adugodi Bande
4760
760
Basaveshwar Nagar
2154
322
Vinobhanagar
5200
1000
D.J.Halli
17
Sulthanapalya
<
18
M.R. Palya
(
19
New Bagalur Layout
20
i
Ulsoor
21
Bhuvaneshwari Nagar
i
22
Taskar Town
23
Domalur (Kodihally)
24
Shanthi nagar
!
25
Wilson Garden
i
26
Koramangala
27
Adugodi
28
Chellaram
1.
29
1
K.G.HaIli
30
■
*
u
63
I
3
ANNEX 2.
Sample of Slums for Focus group discussions
UFWC/SIum
Pop.
H.H.
Yelchenahalli
9835
150f
J.P.Nagar
2050
448“
Banashankari
6846
1265
Gangondanahalli
3600
810”
Anjanappa garden
5302
1305
Rajajinagar
2267
365“
Srirarapur
8762
1857
Community
NGOs
Beneficiaries
Kanakanagara
Putlehalli
S urebandepalya
Arundhati nagar
Flower garden
Jadrahalli
Swathantra
Nagar
Okalipuram
P.G.Halli
5870
6870
962
1374
Sulthanapalya
M.R.Palya
Austin Town
Vibhuthipura
Shanthi nagar
15000
2826
5370
3010
5000
7000
517“
691
582
1300
Vibhuthipura
Adugodi
2400
355
A. K. Colony
Gopalpura
Muneshwara
Block
Sulthanapalya
M.R. Palya
Ashwathnagar
Vinayaka
nagar
i
I
i
*
!
1
I
J
J
J
64
i
3
!
!
t
i
i
I
I
ANNEX 3.
Checklist for focus group discussions {community}
■ The relationship between the link workers and the community
■ Quality of services of the link workers as perceived by the community
■ Type of services link workers are expected to perform ( awareness of the
community the job chart of the link workers)
■ Regard and trust of the community in link workers
■ Kind of information given by the link workers to the community( areas as per their
job chart)
■ Effectiveness of the methods used by the link workers in terms of making the
community understand the messages.
■ Response of the community in the programs of the link workers
■ Involvement of the community in the activities( provide space, money,
encouragement and other aspects
■ Increased access to the services due to the efforts of the link workers
■ Community’s perception of the difficulties of link workers
■ Suggestions of the community towards improving the services of the link workers
■ Limitations of the services of the link workers ( as perceived by the community)
Checklist for NGOs
■
■
■
■
■
■
■
■
■
■
■
The general working pattern of the NGO
Type of work performed by the organisation in the slums
The awareness of the functions of the link workers
Co-ordination and support from the NGO for the activities of the link workers
Abilities of NGOs in assisting link workers in their job such as community
mobilisation, IEC, space, and other aspects
Role of NGOs in solving the problems of link workers
Level of communication between the NGO and the link workers
Perception of the representatives of the NGOs on the performance of the link
workers
Level of involvement of the NGOs in the day to day work of the link workers
NGOs awareness about the problems of the link workers
The suggestions of the NGOs to improve the performance of the link workers
Check list for the direct beneficiaries
i
I
I
I
Type of services received by the person
■ How did they come to know the service
■ Who motivated to avail the service
■ How did they make the choice of the type of the service
■ The type of the follow up received
■ Kind of problems experienced by the persons received the service
■ The role of the link workers in motivation, follow up, education, confidence
building and other things.
■ Opinion of the beneficiaries regarding the role of the link workers
■ Experiences of the sample beneficiaries in availing the services
65
i
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