Empowering Women for Health Process Documentation of Dissemination of Health Information to Rural Women
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Empowering Women for Health
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Process Documentation of
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Project Sponsord by
Ministry of Health and
Family Welfare New Delhi
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Documented by
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Funded by
World Health Organization (WHO)
New Delhi
May 2000
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Empowering Women for Health
Process Documentation of Dissemination of Health Information to Rural Women
Project Sponsored by
Ministry of Health and Family Welfare, New Delhi
Funded by
World Health Organization, New Delhi
May 2000
Documented by
CHETNA
Women’s Health and Development Resource Centre
Chaitanyaa
The reality that borrowing money for seeking health treatment is the second largest cause
ot indebtedness is grim in majority of rural areas Most of the money is used for seeking
treatment only for men folk although women sutler from various mental, physical and
psychological disabilities. They do not have adequate access to health care services and
this problem is compounded by lack of health information.
J context, the Ministry of
—. I..
In this
Health and Family Welfare, Government of India undertook
--------- ; a challenge to train and
disseminate health information among village- based women’s groups. This effort was
initiated on a pilot basis in 15 states.
The uniqueness of this project lies in fthe active
'
tparticipation of governmental
organizations, NGOs and experts at every stage of planning Ind implementation. The
NGOs working in the area of women’s health and development were invited to draft a
state level training manual covering 23 topics related to women’s comprehensive health.
CHETNA contributed in finalizing this manual which became a rich reference material for
it to develop training modules for district and village level trainers. The district level and
village level training modules> were translated and adapted by NGOs in other states.
Once the training modules were done, NGOs were identified and involved to build
capacities of master trainers to carry out training programmes. Five master trainers were
selected and trained from each district which totaled to 25 master trainers from each state.
CHETNA coordinated the process of training master trainers in the states of Gujarat and
Rajasthan. The trained master trainers were made responsible for training women group
leaders. Thus, in each district, 144 women leaders representing 72 women’s self-help
groups were trained.
The training process was participatory and people involved in imparting training had
extensive grassroots experience. Debates, group discussions and exercises on self-analysis
were conducted to help women explore the meaning and draw perceptions about their
lives, identify and discuss issues related to gender discrimination, health and violence.
Use of audio visuals, folk media and role play was used extensively at these training
programmes.
As a training institute, CHETNA felt the importance of assessing the impact of the training
imparted to master trainers through supportive follow up and took the initiative of making
visits while the training of district and village level leaders was under way. CHETNA
team members provided necessary guidance and support during district level training
sessions. The training skills of master trainers were observed and necessary feed back was
provided to them. The team observed that the master trainers were able to develop an
enabling environment at these training sessions by generating an informal, conducive
atmosphere and encouraging everyone to participate. They made use of participatory
training methods and of the various training modules as reference developed in the initial
phase.
2
Empowering Women for Health
Cll ETN 1 Ahmedabad
The project was a learning experience for CHETNA The way NGOs and GOs partnered
in this process set an example of how active and constructive partnerships can change
perspectives for the better. Moreover, the participatory process was a holistic one, starting
from developing manual to training and follow-up at all levels. The structure of the
training programmes enabled information to percolate to the grassroots level. This project
succeeded in reaching out to a considerable number of women at the district as well as the
village level and has started the process of empowerment of women. Self help groups by
virtue of their exposure through training to health and development issues have the
potential to become focal points of addressing women’s health and development concerns.
In view of the success and enthusiasm generated by the project, it is suggested that this
effort should be replicated in all other states of the country. Orientation training should be
organized on the regular basis to upgrade the skills and knowledge of district and village
level trainers. In addition, training and education material for perspective building in areas
of violence and women’s health, mental health and panchayati raj and women’s health
needs to be developed. A module on older women’s health needs to be prepared and added
to the existing module. Additionally, all government functionaries who are involved in
improving women’s health at the state, district and block level need to be trained and
furnished with the finalized modules.
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Empowering Women for Health
CH ETN t Ahmedabad
Introduction and Context
There is an increasing concern that disadvantaged and marginalized women sulTcr from
various physical and emotional health problems but have little access to early diagnosis,
cure and treatment from the primary health care system. Due to lack of access to
information and services, women tend to suffer more and often needlessly, and also spend
their scarce resources seeking health care, wherever they can access it usually from
exploitative private practitioners. In view of the above, it is believed that if women are
empowered with information on why and what causes illnesses and diseases and where
and how to find assistance through which they will be able to live healthier and more
productive lives. Through this process of empowerment, access and information of
services established by the government and public sector may also improve.
With this vision in view, the Ministry of Health and Family Welfare (MOHFW),
Government of India embarked on an ambitious project to train and disseminate health
information among women’s groups in rural areas. Collaborating with non governmental
organizations and supported by the World Health Organization, MOHFW initiated this
project on a pilot basis during 1998-2000. The project envisaged to disseminate health
information among village- based women’s groups.
Geographical Area and Population Coverage
The pilot project was initiated in 15 states of the country and from each of these states, 5
districts were covered (refer figure 1). From each district, a minimum number of 72 self
help groups (SHGs) and 144 village leaders were expected to be trained through this
strategy.
Outreach Strategy
Participatory training of the trainers was the key strategy to reach out to the disadvantaged
and marginalized rural women for disseminating health information. The details of the
events are given in Annexure I.
Development of Training Manual and Modules
Training manuals were developed for three levels of training. The representatives of the
NGOs working in the area of women’s health and development were invited to draft a
state level training manual covering comprehensive topics related to women’s health.
CHETNA contributed in preparing this manual and also took the responsibility of
coordinating the process. Based on this manual, CHETNA developed district level and
village level training modules which were translated and adapted by NGOs in other states.
1 There arc an estimated 2.5 lakh women groups (40 lakh adult women) constituted by the Department of
Rural Development and almost 6000 villages under Mahila Samakhya's womens empowerment
programme being implemented by the Department of I ducation (Government of India). In addition there
are several women’s groups organised for micro cicdil bs the Depaitinent of Women and ( hild
Development.
CHETNA Ahmedabad
4
Empowering Women for Health
cl Process of developing state level training manual
The development of training modules went through various stages. Efforts were made to
make the process as participatory as possible The following steps were followed in
developing the manual:
• Needs identification: The Ministry of Health and Family Welfare (Department of
Health) in collaboration with WHO convened an expert group meeting in November
1998 to identify and develop a training manual which would provide basic information
on women s health concerns and the methodology of implementing it with women’s
groups. The responsibility of coordinating the process was entrusted to CHETNA and
a guideline was sent to selected organizations to draft the chapters and maintain a
uniform framework to ensure easy compilation (for details on guidelines and list of
organizations refer Annexure II and III).
o
Drafting of the manual: A workshop was organized by CHEfNA at Ahmedabad in
January 1999 to elicit feed back and comments from experts on the chapters written
and to collectively develop a framework for the remaining chapters.
Review of draft training manual: A workshop was organised by the Ministry of
Health & Family Welfare at New Delhi in March 2000 to review and finalise the draft
chapters of the manual and to develop a timeframe for conducting state and district
level training programmes.
•
Finalization of the training manual: The chapters were later sent to the experts for
review as well to the Ministry. Suggestions made by them were incorporated.
Contents of the manual
•
Perspective building: To develop a women-centred health perspective among the
participants, issue pertaining to the deep-rooted gender discrimination against women
was identified as the central theme. The fact that women are conditioned to eat last,
least and leftovers, does not meet her energy requirements and results in her poor
nutritional status. The other factors which have linkages with the existing health and
social system and go against women’s health are over work and violence against them.
The first few chapters of the module provide the trainer with a comprehensive insight
into women’s health issues and factors affecting them.
®
Health topics: Women’s health topics are discussed in a life cycle approach. This
approach takes into account health information at all stages of a woman’s development
- right from the stage of conception to her development into an adolescent and later
into an adult woman. The module also contains health information pertaining to
communicable and non communicable diseases plaguing women’s health.
o
Special section: Along with each chapter, there is a section on references and
suggestions for further reading.
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Empowering Women for Health
CIIETNA Ahmedabad
b. Process of developing district level training module
I he training module for the district level was developed to train district level health
trainers on the basis of the finalized version of the stale level training manual. CHETNA
drew upon its rich experience of participatory training and converted the state level
manual into a modular form. The first edition of the module was later developed in
English language. This was translated into eight languages. CHETNA translated the
manual into Gujarati and Hindi.
This module was based clearly defined objectives. The technical information was provided
in a simple language while giving due consideration to the socio-cultural aspects of the
community. To enable the trainer to conduct training sessions effectively and in a
participatory manner, guidelines containing specific tips and training tools were also
provided in the module. Wherever necessary, methods for evaluating the understanding of
the participants were also described.
c. Process of developing village level training module
This module was developed to train village level women leaders responsible for imparting
health information to women of self-help groups and other people of the community
including women. The module was first developed in English and later translated into
various regional languages. The information given in the district level module was further
simplified in the form of health messages for inclusion in this module. Specific ways in
which panchayats, male members of the family and women’s groups could contribute
towards improving women’s health in villages were also included.
Keeping in view the level of understanding of the community, the module was graphically
illustrated. To give an overview of various diseases, illustrative short case studies and
stories featured extensively wherein the social perspective was also integrated. Use of folk
songs was also made. This method initiated a thought process and discussions among the
participants and helped them have a good understanding of issues involved.
Experiences of developing state level manual and district and village level modules
The participatory method of developing the training manual and module was an interesting
and enriching experience. It provided a space for interactive dialogue between government
and non-govemment organizations. However, the time allotted did not seem enough. Since
in the beginning, the guideline to write the training module was not prescribed, the session
writers made their own outline. To standardize each module took much more time and
human resource of CHETNA team than envisaged.
Training Strategy
Initially, state level NGOs were identified who had experience of organizing participatory
training related to women’s health These organizations were responsible for translating
the district and village level modules in local languages, print them and organize training
for master trainers. About 25 participants were identified for training master trainers from
each of the states. The master trainers had to train leaders of self-help groups who in turn.
6
Empowering Women for Health
CHETXA Ahmedabad
communicated health information to other women of the community through regular
meetings. Through this process, a total number of 72 self help groups were reached. ’Hie
criteria for selecting these groups was based on their level of involvement, rapport and
credibility with the community. Once the training modules were printed, the process of
capacity building was initiated.
a. Training of master trainers
Five master trainers were selected and trained from each district which totaled to 25
master trainers from each state. Out of five master trainers, while one was selected from
the Government department (IRDP, women and child development, health and social
welfare) the remaining four were from multi-sectoral NGOs and individuals capable of
conducting training at the district level. The master's training was conducted for 15 days.
The state level institutes were given the flexibility to organize the training of 15 days
either at a stretch or in two phases of 7-8 days each.
Participatory training methodology was the key feature of training programmes. Group
discussions, role play, structured exercises, demonstration, body mapping, resource
mapping, audio-visual methods were the major tools used for training. In order to build the
capacity of the participants, NGOs used varying and different strategies to build up the
training skills of participants.
b. Training leaders of self-help groups
The trained master trainers, were made responsible for training women group leaders. Two
group leaders were selected from 12 women’s groups hence a total number of 24 group
leaders were trained in each training programme. Six such trainings were conducted in
each district to cover 144 group leaders in each district. The training was conducted for 7
days. While some training programmes were conducted in one phase, some NGOs
conducted the training in two phases. However, the total number of days remained the
same. The trained group leaders were made responsible for communicating health
messages and information to other women members through meetings by using village
level training module.
CHETNA’S Role and Involvement
CHETNA played three different roles in this programme
® Liasioning and facilitating the process of developing state level training manuals in
in
English and contributing in writing the manual.
® Developing district and village level modules, translating, printing them into Hindi
and Gujarati and disseminating the Hindi modules in Hindi speaking states.
© Facilitating masters training in Gujarat and Rajasthan and providing follow up
support at village level ‘raining sessions in these states.
In addition, on special request, CHETNA also trained the state level trainers for Mahila
Samakhya Society trainers from the States of Assam, Bihar, Karnataka and Uttar Pradesh.
7
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CH ETNA \hmcdabnd
I raining Efforts
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Training Efforts
Training efforts included preliminary meetings with various NGOs and training master
trainers in the states of Gujarat and Rajasthan.
Preliminary meetings: In both the States (Gujarat and Rajasthan), a day’s meeting was
organized for the participating NGOs. The main aim of this meeting was to share with
them the training strategy, criteria for selecting master trainers, objectives of the masters’
training and village leaders’ training programme. The meeting was also used for
explaining the financial procedures and the budget.
Master trainers training: A 10 day training was organized for master trainers of Gujarat
and Rajasthan by CHETNA. The objectives were to:
• build perspective on women’s comprehensive health
9 strengthen their knowledge base on women’s comprehensive health
• enhance their skills as trainers and make them aware about their role in information
dissemination
A. Masters Training - Gujar at
The master trainers of Gujarat were from Self Employed Women’s Association (SEWA),
Ahmedabad and Mahila Samakhya Society, Vadodara and Rajkot. A ten days training for
master trainers was organized during November 30 to December 10, 1999. The stipulated
15 days were covered by providing a support of a shadow trainer, at the village leaders
training conducted by master trainers.
a. Background of the participants
A total number of 28 participants from 5 districts of Gujarat attended the training
programme. While 3 persons were from the government department, 25 participants
represented Mahila Samakhya Society Gujarat and SEWA. The educational level of the
participants ranged from semi-literate to graduation .
b. 7raining methodology
Participatory training methodology was the key feature of the training. Small group
discussion, use of role play, structured exercises, demonstration, body mapping, resource
mapping, slide show, screening of video films, lectures followed by discussions were
some of the participatory training methods used during the training.
To build the training skills of the participants, one participant joined the trainer team every
day by way of which the participants got an exposure on how to plan and execute a
training session. They were also given an opportunity to play the role of a trainci and
encouraged to conduct a session on the subject of their choice. This mechanism helped
them to become sensitive to the needs of the participants and develop training skills in an
enabling environment.
9
Empowering Women for llc.ilih
( IIK'I W I Ahmeilathhl
c. Expectations of the participants
fo begin with, the participants were encouraged to share their expectations from this
training. They expressed the need to acquire technical information on women’s
comprehensive health and to upgrade their skills on training methods.
cL Actual training
The district level training module on ‘Women's Health - Towards Empowerment’ was
made use of to cover various topics related to women’s health with reference to gender
discrimination, nutrition and work. These modules were discussed by encouraging the
participants to share their own life experiences. This enabled the participants to view
women’s health from a gender perspective.
Debates, group discussions and exercises on self-analysis were conducted to help women
explore the meaning and draw perceptions about their lives, and the work they do. Listing
of incorrect beliefs on food intake and cultural practices gave an idea of the deep-rooted
causes for women’s poor health.. The participants were sensitized on the issue of violence
against women and its impact on health, a subject very often neglected by health
functionaries. The participants related their own experiences of violence and were able to
realize the importance of integrating this issue with women’s health programmes. The
wide ranging topics including the one on mental health helped the participants to widen
their perspective on women’s health.
There were detailed discussions on the reasons for poor health status of women such as
lack of accessibility to health care services and ways of making use of govrnment
infrastructure such as PHCs. The participants were apprised of the merits of traditional
health practices and this was exemplified by holding the session in an environment where
they got an opportunity to observe different types of herbs and medicinal plants. A
session was held to discuss, in simple language, causes, symptoms and prevention of
common ailments and diseases related to health in general and women’s reproductive
health in particular. Prior to providing knowledge, the basic understanding on the topic
was assessed by using various participatory training methods. Participants were
encouraged to give suggestions and develop action plans on the same lines. Role of
panchayats in increasing access to primary health care was discussed as a separate topic.
e. Feedback
To elicit the participants’ views/reactions on the training subjects, methods, approach,
language and logistics employed, a steering committee comprising a few participants was
formed every day to carry out this job. The committee was also responsible for bringing
out a newsletter highlighting the major achievements and lessons learnt during the day.
Based on feedback, changes were made in the design and the logistics of the programme.
Since all the participants got an opportunity to be part of the steering committee, an
environment of openness and understanding of various aspects was created. Some
highlights on the feedback in terms of the methods and contents are as follows:
. Most of the participants expressed their satisfaction with the training sessions which
provided a holistic and comprehensive perspective on women’s health.
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Empowering Women for Health
CHETNA Ahmcdabad
Integration of gender with various health topics was well appreciated
Use of participatory training methods, audio-visual media and simple language was
well appreciated. It has inspired many of them to adopt the same methods for
conducting training of this kind.
•
.
Expressions of participants
“When I came here for ten days training, 1 was worried about how 1 shall pass ten days! But now
as training is drawing to a close, I feel sad tliat I have to live my swajan (own people). I feel more
responsible now as I have to conduct this training effectively at village level” - Ms.Saroj, Mahila
Samakhya, Rajkot.
“In seventeen years of my government service 1 have attended so many trainings, but the
experience of the training here is unique. I liked the participatory training methodology and
contents covered. CHETNA has provided us excellent facilities during the training programme”MLs'. Sheela, Government Health Department, Mehsana
“I am working with SEWA for the last twenty years. After attending th is training 1 am infused with
more courage and confidence We suggest that CHETNA should organize this kind of
trainingmore often” - Ms. Madhu. SKWA. Ahmcdabad.
B. Masters’Training - Rajasthan
The master trainers for Rajasthan were selected from CUTS (Chitorgarh), Seva Mandir
(Udaipur), URMUL Marusthali Bunkar Vikas Samiti, Rajasthan Voluntary Health
Association (RVHA) and Indian Institute of Rural Development (IIRD) and a child
development project Baran. A 10 days training was organized during November 17-27,
1999. The stipulated 15 days were covered by providing a support of a shadow trainer, at
the village leaders training conducted by master trainers.
a. Background ofparticipants
A total number of 21 participants from 5 NGOs of Rajasthan, including one government
representative participated in the training. They were of the supervisory level responsible
for conducting training in their organizations. All the trainers were educated, their
educational level varying from higher secondary to post graduation.
b. Training methodology
Apart form using participatory training methods to enhance the skills of the participants,
volunteers were encouraged to join the trainer team every day. They were involved in
planning sessions with the core trainer team and facilitated sessions on subjects they were
comfortable with. This provided them hands on experience in learning different techniques
and training methods.
c. Expectations of the participants
The expectations of the participants were solicited through the pre-registration
questionnaire administered before the training which was reconfirmed during the first day
of training. They expressed the need to acquire technical information on women’s
comprehensive health and to upgrade their skills on training methods.
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Empowering Women for Health
CH ETNA Ahmedabad
d Actual training
Debates and structured exercises were conducted to identify and discuss issues related to
gender discrimination, women’s nutritional status and health problems. Although the male
participants agreed that gender discrimination, overwork and violence, as factors affecting
women’s health, some of them did not accept it gracefully. Problems related with mental
health were regarded as important and discussed The participants were apprised of health
infrastructure provided by the government and to demand the same by creating pressure
groups at local level. Traditional health and healing practices were discussed as a strategy
to empower women and communities and enhance their self-reliance. The role of dai as a
healer and resource was also discussed. With the panchayats attaining more autonomy, the
need to involve them in addressing health needs of the community was highlighted. There
were discussions on common disease patterns, their symptoms and ways of prevention.
Participants were encouraged to express their views on these issues. In order to orient the
participants to the use of village level module, chapters were reviewed and discussed. The
participants expressed the usefulness of the module to facilitate learning at the field level.
e. Feedback
A committee was formed to provide feedback on the subject, methods, approach, language
and logistics of the training programme. The committee also prepared and shared with the
participants report and newsletter based on the proceedings of the training sessions. Some
of the highlights on the feedback in terms of the method and content are as follows:
Most of the participants expressed their satisfaction with the training sessions, which
provided a holistic and comprehensive perspective on women’s health.
Integration of gender with various health topics was well taken.
Use of participatory training methods, audio-visual media and simple language was
well appreciated. It has inspired many of them to adopt the same methods for training
village level women leaders.
Some of them suggested simplifying certain questions for better clarity. They also
suggested providing some more time during the training, to fill up the questionnaire.
The district and village level modules were found very comprehensive and useful in
imparting training.
•
•
•
•
•
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Empowering Women for Health
CHETN. 1 Ahmedabatl
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Follow Up
As a haining inslilule, ( I IE I NA was keen lo assess Ihr impact of the tiaining inipailcsl l<»
master trainers through supportive follow up. It was earlier decided that the Ministry of
Health and Family Welfare would employ an outside agency for this job. This did not
happen and therefore, CHETNA took the initiative to organize follow-up visits. The
trained master trainers planned to organize village level training within a span of two
months, i.e. January to March 2000 at each district. The objectives of the follow up visits
were to:
• provide support and guidance to master trainers and enhance their confidence
• assess the level of transfer of information and knowledge from master trainers to the
village leaders.
• observe the skills of the trainers in conducting village level training programmes
• assess the utility of training modules
Follow-up - Gujarat
CHETNA team planned to visit each master trainer at least once during the process of the
training. However, due to paucity of time and human resource it was not possible to
remain present for all seven days. To get a feel of the over all process of training, some
follow-up visits were made during the initial two days, some during the middle two days
of the training and a few during the last two days. A standardised performa was developed
to collect information and to assess the impact of training on master trainers and village
leaders/trainers, informal interview's were also conducted. Detailed schedule of follow up
visits made by the CHETNA team is given in Table 1.
Table 1: Detailed schedule of follow-up visit conducted by CHETNA team
Date
(Jan-Feb 2000)
05-07 Jan.
Organization involved
CHETNA team
Mahila Samakhya Society (MSS), Rajkot, at Gondal
10-12 Jan.
SEWA, Ahmedabad, at Sanand
17-18 Jan.
28-29 Jan.
14 Feb.
14-15 Feb.
17-18 Feb.
21 Feb.
Mahila Samakhya Society, Vadodara at Sindh rot
Mahila Samakhya Society, Vadodara at Jambughoda
SEWA, Ahmedabad, at Dholka________________
Mahila Samakhya Society, Rajkot, at Vankaner
Mahila Samakhya Society at Kadipani__________
I Mahila Samkhya Society at Mehsana___________
Ms. Gayatri Giri
Ms. Anjana Dave
Ms. Pallavi Patel
Ms. Bhanu Makwana
Ms. Bhanu Makwana
Ms. Anjana Dave
Ms. Anjana Dave
Ms. Gayatri Giri
Ms. Gayatri Giri
Ms. Bhanu Makwana
During these visits, CHETNA visited 15 trainers. The team members provided necessary
guidance and support during district level training sessions. Their training skills were
observed and necessary feed back was given. The details of the village level
trainers/women leaders who participated in the training is given in Table 2.
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Empowering Women for Health
CHETNA Ahmedabad
1’ablc 2: Profile of village level trainers
Name
of
Organization
Training
Number of Village Leaders /Trainers
Ijtcratc
lotal
Illiterate
Total
SIIGs
covered
41
53
Mahila Samakhya Society,
78
25
Vadodara (3)___________
23
53
32
21
Mahila Samakhya Society,
Rajkot (3)_____________
177
_91________ J09
268
SEWA, Gujarat (9)
173
268
137________
___________
399
Total (15)
Numbers in parenthesis indicate the number of district level trainers
Training wise details attended by CHETNA team is given in Annexurc I
Flow Chart of Masters Trainers Training Process on Women’s Health
CHETNA State Level Training Institute
Distri
evel
▼
SEW A
A hmedab ad
Mahila Samakhya Society
Vadodara
Mahila^amakhya Society
Rajkot
16 Master
4 Master Trainers
5 Master Trainers
Village leaders trained
(140)
Village: leaders trained
(140)
Trainers &
2(M) from
Rural Dev.Agency
Village leaders
Trained (268)
Selp-help groups
(109)
15
Selp-he p groups
(mahila sanghs- 74)
Empowering Women for Health
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Selp-help groups
(mahila sanghs- 87)
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Observations made during the follow-up visits
Enabling environment: It is well known that it is important for trainers to create a
conducive environment for people to learn effectively. During the follow up visit it
was observed that all the trainers were able to develop an enabling learning
environment at the district level training sessions. The positive approach of the trainers
.towards the participants, facilities provided and training methods used during the
training played a major role in creating an enabling work environment.
•
Rapport building: At the beginning of each training, the trainers used various games
to create an informal atmosphere. In all the training programs, although half the
participants were illiterate, the master trainers made special efforts to encourage them
to share their experiences. They entrusted the literate participants with the task of
helping the illiterate ones which enabled effective rapport building between the
trainers and the participants and among participants as well.
Commitment to learn: It was observed that village women were able to concentrate
more, whenever the training was organized far away from their own villages. Mahila
Samakhya Society successfully organized residential trainings, wherein late evening
sessions were held to enable women to interact amongst themselves. During this
interaction they exchanged the knowledge gained from the training sessions and
related those with their life experiences. They also spent considerable time reading the
training manual. In the non residential trainings, which were organized by SEW A,
women spent a lot of time in commuting and and the trainers had to constantly
innovate new methods to motivate women and keep their interest alive. Both, the
participants as well as the trainers showed commitment towards their responsibilities.
Sharing life experiences. Each training programme commenced with sessions on
gender, violence and nutrition. During these sessions women shared their life
experiences, feelings and pains. At the residential training, master trainers and village
trainers stayed together.
©
©
Use of familiar language: The master trainers were part of the community and in
close contact with the village trainers hence, their acceptance in a group was very
positive. The master trainers used local vernacular language, which ensured active
participation of all the village trainers.
Use of participator)’ training methods: It was satisfactory to note that master trainers
had internalized the participatory training approach, which they learnt during masters
training organized by CHETNA. An important approach adopted by them was that
they first collected information on the existing knowledge base of the participants and
built additional one on the basis of existing resource. This approach helped raise the
confidence of village level trainers and ensured their active participation.
Efforts made by trainers: Most of the trainers developed the training design prior to
training and followed the district training module meticulously. They made efforts to
read and prepare themselves on the content, training methods and exercises given in
16
Empowering Women for Health
ciietxa Ahmedabad
the training module prior to training Since the group was hetrogeneous, it was a
challenge for the trainers to train them. Due to this, the trainers found that the time
mentioned in the session and the activities inadequate.
Use of district and village level training modules: In most of the training
programmes, the district level training module was used as a reference/guide by the
trainers. The trainers used the village level modules creatively by asking the
participants to read out the stories given in it and later initiated discussions on it. While
illustrations given in the village level module were used to explain the technical
information, in some cases, reading topics were read aloud to make the points clear.
The module was also used to clarify their doubts and misconceptions. It was observed
that participants read the village module given to them very keenly whenever time
permitted so.
Views of district level trainers: The district level trainers were asked to give their
opinion on the techniques and methods adopted in the district level training module.
o
The trainers found the training methods in the module appropriate and helpful
Participatory methods were found useful to interact with participants, understand their
training needs sustain their interest
The structured exercises were very found effective to explain and reinforce the
o
content.
The exercises were easy to adopt to the local situation.
• It provided scope for interaction amongst trainers and participants.
Views of village level trainers: The views of village level trainers/ leaders on the content
of the village level module were as follows:
They found the module very useful partly because of its being narrative
©
The language used was simple and easily understood
©
Technical information was adequate and presentations were effective. Illustrations
©
made the module interesting, and the contents easy to understand.
The module could be related to with ease because of its contents on social aspects
©
The module helped in shedding inhibitions
©
Feedback from the trainers
“it was an excellent training experience”- master trainer.
sowed neeus
needs to
^Tame je vaue che te lanai jay to saru. (What
(What you
you have
have soweu
io be
uc reaped)
Whatever we have learned from the State level trainers’ Training we want to take it up to
village trainers.” Master trainer.
‘‘Moole ropya CHETNA ea ane fanga futya SEWA na ” (seeds are sown by CHETNA and
they sprouted at SEWA.) -Master trainer
;; karya
;
; j were like blind person, illiterate; you gave us
“Ame to andhla hata tame dekhta
(we
vision). The pictures given in the module are like an asset for us. We will use it in all our
trainings.” Village trainer.
17
Empowering Women for Health
( 71 ETNA Ahmcdabml
Listening to Master Trainers
Training as a tool for empowerment: Ms. Meena Chauhan1:
“The joy of this experience of training from CI IE I NA and of being together is yet not
over. Je dab dabo die te nikali jase tyarej shant thashe (we had enjoyed training, we
have to share that experience and learning with others, without that process of learning is
not completed.) Initially I was worried, whether I will be able to impart the same quality
of training that I have received from CHETNA? The training module, which you have
provided to us, is very useful. Due to it my confidence as a trainer has increased.
After receiving the training I went for fieldwork. One woman talked to me about her
health problem. She had an ulcer in her private parts. I took her to the hospital and spoke
to the doctor with confidence which I was able to muster due to the training. I could use
health terminology. I informed the doctor about having undergone training from
CELETNA. He examined the woman and gave the necessary treatment. My enthusiasm and
information on health aspects impressed him. He told me to contact him whenever
necessary without hesitance. His faith and confidence in me was my personal
achievement. It is all due to the training.
When I showed the district level module to my friends, they got interested in acquiring
information and read the module with interest and appreciated my knowledge on health
aspects. At Mahila Samakhya Society where we have various committees on different
issues I refused taking responsibility of health committee, as I was not confident of
imparting the training. I am now ready to take on that responsibility.”
We at CHETNA also noticed great transformation in Media’s attitude towards her own body.
When she first came to the organization, she was hesitant to sit through the demonstration on the
use of condom on a banana. She even refused to eat a banana, which was served as part of the
meal. To our surprise during village level trainers’ training while explaining different
contraceptive methods and their use, she conducted the same demonstration without any
inhibitions. She informed us tliat her first aim was to teach the village trainers. She later decided to
keep all her personal inhibitions aside. According to her, this attitude of hers has helped her to be a
confident and effective trainer.
In our follow-up visit we observed that, she had taken up her role of trainer very seriously. She
was confident while imparting training. She was using vernacular language and giving due respect
to elderly women participants and their experiences. The village level trainers greatly appreciated
her as a trainer.
_ _________________________________________________
Follow up - Rajasthan
During December’99 to March 2000, CHETNA provided follow-up support to Seva
Mandir, Udaipur, CUTS, Chittorgarh and 11RD, Alwar. It is important to note that
1 One of the master trainers attended die training on women's health organized by Cl 1ETNA. She had done post
graduation and is working as a Sahiyogini with the Mahila Samakhya Society, Rajkot. Her maturity reflects when she
interacts with the village trainers/women
18
Empowering Women for Health
CH ETNA Ahmedabad
Rajasthan Voluntary Health Association (RVHA) and URMUL did not conduct the
village leaders training due to, some administrative reasons. The detailed schedule of the
follow up visits made by CHETNA team is given in Table 3.
I nblcJ: Detailed schedule of follow up visits conducted by ( HE I NA (cam
Date (Jan-Feb. 2000)
.17-18 January
18-19 January
7-9 February
17-19 February
20 February
Organization involved
Consumer Unit Trust
(CUTS),Chittorgarh_____
SevaMandir, Udaipur____
IIRD,Al war
Seva Mandir Udaipur____
CUTS,Chittorgarh
CHETNA team
Society Vd. Smita Bajpai
Vd. Smita Bajpai
Dr. Veena Dwivedi
Vd. Smita Bajpai
Ms Jyoti Gade
Observations made during the follow up visits
o
Trainers and training methods: In all the three organizations, the master trainers
facilitated most of the sessions with support from their colleagues and CHETNA team.
They handled the groups were confidently and deftly. However, they felt the need for
more guidance in session planning and conducting the training. Participatory
training methodology was used to strengthen the capacities of the participants. While
following the guidelines given in the training module, based on their long years of
work experience, the master trainers adapted to their specific situations. These
included visuals, games and stories. For example, the team from CUTS developed a
health triangle by using local grains and discussed the problem of anemia through local
bhajans (devotional songs). While master trainers from Seva Mandir created stories to
bring home various issues, the IIRD team made use of case studies to highlight
sensitive issues such as violence and infertility.
e
Enabling environment: In CUTS and IIRD, exhibition of posters and charts created
an enabling learning environment which was not adopted by Seva Mandir. A lot of
emphasis was put on the use of models and other audio visuals. One of the master
trainers pasted four blank charts on the wall. At the end of each topic, the participants
listed various points of action that could be taken at the individual, family, community
and panchayat level. The trainer summarized the key action points. It was observed
that the training venue which was away from the city, with clean surroundings offered
conducive environment for conducted training programmes.
G
Contents covered: While the master trainers meticulously followed the content
outlined in the training module, each trainer made changes based on the local situation.
While specific issues pertaining to gender, violence, panchayati raj, local health and
healing practices, RTIs/STDs, HIV/AIDs, maternal health were discussed in details,
some general topics related to diseases such as I B, malaria, could not be discussed
due to lack of time. Some of the topics pertaining to violence, mental health and
gender created a feeling of helplessness and depression.
Inadequacy of time: In all the three organizations, time was found inadequate. In
order to build capacities of the leaders, a one time training input was not considered
19
Empowering Women for Health
CH ETNA Ahmedabad
enough. Each topic had to be introduced and absotbed gradually through repealed
follow-ups. The level of comprehension of the participants was such, that a lot of time
was required to explain issues, discuss them and help them to develop action plans. In
many cases, therefore, the facilitator had to initiate and take lead in identifying action
areas.
•
Use of training modules: The module was a guide to all the master trainers and
•proved useful to the participants because of the contents were lucid and given in an
illustrative manner. The district level manual served as a reference book and helped
them plan their sessions. The participants were happy to receive a copy of the module
and after initial hesitation were able to share it at the community level. The response
generated by the module is tremendous. The module also proved beneficial to school
teachers who found the information contained in it very useful. Since the literacy level
are low, one of the participants from IIRD made efforts to overcome this barrier by
taking her daughter- in- law to the group meetings. While the daughter-in-law read out
the information, the mother in law explained the details to the group. The group
members the information useful and expressed a desire to possess a copy of the same
as well as participate in such trainings. Most trainers distributed the manual on the first
itself day and religiously used it as a teaching aid. However, in CUTS, the module was
given only on the last day with the fear that they may not come back for the training
after having received the manual. In this case, the use of module by the leaders is
questionable.
Views of the participants: As discussed earlier, the participants were experienced
members and leaders of the self-help groups. Each organization provided training to 72
women’s groups, the number of members participating from each group, varied from one
to two participants. The participants found the topics covered during the training very
useful, easy to comprehend and relevant to their area of concern. I he discussions were
found relevant and lively. However, it was not easy for them to develop action points on
their own and in most cases, the trainers helped them to identify key issues. The
participants expressed that the training has helped bring about attitudinal changes in
them. One of the participants said that she has started filtering water and after having
explained the advantages of doing so, the other village women have followed suit.
11 When we started training the village leaders, they wanted medicines. However, when
they learnt that we were offering some thing that was linked to their own needs and would
help them grow, they participated enthusiastically. The hook that has been developed is
now the community's property. From husbands to ANMs to school teachers, every one
wants to read this book and after reading, (hey are immensely satisfied that they have now
achieved something that they were deprived of".
- A trainer in Alwar District
20
Empowering Women for Health
CH ETNA Ahmednbad
‘7 fell as if you are lelling the story of our village dai. She is very similar to Kantabai,
However, we never thought of electing her as Sar/xmch. In the next election, we will make
sure that she contests the election and emerges as a winner.-” - a leader of village group
in Rajasthan.
Towards Improvement of Women’s Health: A Case Study
“Sister, I have white discharge which is foul smelling, my husband does not allow me to
consult the doctor and I also feel shy to go to him. What should I do, kindly let me know
some solution”? These are the words of a village woman shared during one of the training
sessions. After talking to them, it was realized that reproductive tract infections are very
common among them which are visible in the form of white discharge, menstrual
disorders, prolapse of uterus, and cervical cancer. I hese problems are rarely treated
because of hesitance on part of women in bringing these problems to the fore and the fact
that men do not permit their wives to take treatment.
After participating in the masters training programme conducted by CHETNA, the need to
create awareness among women with regard to their own health needs was realized.
Rigorous efforts to train women had to be made in the initial period as women were not
ready to participate in the training partly because of overwork and partly because of
reluctance on the part of their husbands to send them. Therefore, the training was split into
two phases. The first phase was of four days duration and the second one of three days.
During the training sessions, the contents covered were gender discrimination, women s
work and health, access to health care services, indigenous health practices, violence,
pregnancy, reproductive tract infections and STDs Issues of self governance and role ot
women in panchayati raj were discussed in a participatory manner.
Two months after the training, when follow up visits were made, change was visible
among village women. They have started following simple hygienic practices like filtering
the water before consumption. Some of the women have started to take young girls into
confidence and make them aware them about their own health. Women have now startec
to discuss their health problems openly in a group and taking relevant treatment. I hey
have started attending panchayat meetings, which they never did before and have become
vocal about the problems faced by them. Self help groups meet regularly and often invi e
auxiliary nurse midwives (ANMs) to their meetings. Muslim women who were imUal y
opposite contraceptives have started adopting them as a family welfare measure. Due to
encouragement of other women in the panchayats of Ramgadh and Rajagadh women wcic
elected as members and sarpanch.
Who says that women can not do anything
If she want she can grow flowers in the throne!
21
Empowering Women for Health
CHETNA Ahmedabad
Lessons Learnt, Constraints and Reeoinmendations
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Lessons Learnt
Reaching out to a wider community: The need for spreading information at the mass
level has been icnli/rd I hiotigh tlmi rlloit, n loirmlrinble inimhei of women nnd men
wcie leached al die distiict as well as die ulkiur level NGOs and technical expeils
from all over India came together to interpret women’s health concerns in the socio
economic and cultural contexts. This extended the outreach to many more groups and
•individuals, particularly in the remote and rural areas which are otherwise difficult to
access.
A comprehensive and integrated approach to women’s health: Years of working
on women’s health concerns has lead to the realization that women’s health has to
extend beyond certain phases (adulthood), conditions (pregnancy) and issues
(physical) of her life. Health and development concerns should be addressed
throughout her life and in all conditions. This concept formed the premise of this
programme.
The module covers 23 health and development concerns, from
conccptional to later years of dcvclopemnt
Empowering women: Empowerment is a widely used term and has different
meanings in different contexts. In this context, women’s empowerment implies her
ability to understand, analyse and take decisions for her own health and development,
which is information based. This project focused on enhancing women’s participation
in the panchayats, creating pressure groups to demand quality health care services and
strengthen local health and healing practices to increase self- reliance in health care.
Participatory approach gives richness and realistic perspective: Since the process
was participatory and involved people having grassroots experience therefore, realistic
and need-based concerns were incorporated in the modules and training programmes.
NGOs and GOs partnered in the process to set an example of how a positive
partnership can change perspectives and bring about desired results.
©
0
©
23
Holistic process more effective impact: This process was holistic and started from
developing manual and training programmes at all level (State, District, and Village
level functionaries).
Involvement of NGOs from the planning stage is critical: Even before the
conceptualization of the project, the GOI involved NGOs for preliminary discussions
and throughout the planning process. Therefore NGOs also felt accountable to
maintain the quality of the manual and the training programmes.
Structure of the training programmes: The training programmes were structured in
a way that they met the needs at all levels and percolated down to the grassroots level
Empowering Women for Health
CHETNA Ahmedabad
Constraints
Coordinating with a number of individuals, oiganizations and the government was an
enormously challenging and time consuming task for CHETNA. Since the project
outcome was excepted a tight time schedule, meeting deadlines often became a rushed
affair. Due to paucity of time, the training module could not be field-tested. This should be
considered in future programs.
Recommendations
Following recommendations have been drawn to strengthen the project lor the luturc
implementation.
Regular orientation training should be organized for trainers from government as well
as NGOs at the state and district level to up-date their knowledge and motivate them to
continue the process.
G
Since the process of change is slow, there is a need to allocate more time to village
level trainers to enable them to internalize the concepts and take action. Duration of
training of at least ten days is recommended to enable the trainers to cover the wide
range of contents.
Since CHETNA’s experience about follow up visits in Gujarat and Rajasthani was
been recommended
as mandatory both at district and village
positive, the same has
1-------—
©
level trainings
Self help groups by virtue of their exposure to health and development issues have the
potential to become focal points of addressing women’s health and development
concerns.
The training manuals need to be
I published after incorporating the suggestions and
made available for wider circulation and dissemination of information.
O
An additional module on older women’s health concerns needs to be developed
0
level to share experiences and plan future strategy to continue and enhance the process
of learning.
24
Empowering Women for Health
Cl!i:TK.\ Ahmcilahad
Annextire I
Development Phases
Stage
I
■
19-20 Nov’98,
New Delhi
II.
3-4 Jan’99,
Ahmedabad
III
March’99
IV.
June-99
V
July- Oct. 99
Details
Outcome
Technical experts, NGO
representatives and training
organizations identify health
education material for
women’s health and decide to
develop a training manual.
CHETNA coordinated a
meeting of writers to elicit
feedback and develop
framework for remaining
chapters
Various experts take responsibility of
writing chapters. CHETNA requested
to coordinate this effort.
Writing and finalization of
chapters of the State level
module ________________
Developing of district and
village level modules by
CHETNA_______________
Regional adaptation and
translation by different
organizations in 9 languages
VI.
Nov- Dec’99
Training of district level
trainers
VII.
Jan.-Mar.2000
VIII.
April-May
2000
Follow up and Training of
leaders of women’s groups
Reports of all the above
events
25
The number and content of each issue
was finalized. Writers took
responsibility for writing 23 chapters.
Time frame was decided and so were
the title, language, reader, and levels.
Regional adaptation and translation
responsibilities were shared. Regional
training centers were identified._____
Standardized state level modules
were finalized in English
Illustrative training modules for
district and village levels were
finalized in English_______________
District and village level modules
were developed in Hindi, Gujarati,
Marathi, Malyalam, Telegu, Oriya,
Bengali, Tamil Kannada and
Assamese.______________________
Capacities of approximately 450
trainers in 15 states were enhanced.
These were later expected to build
capacities of 144 women leaders from
each districts.___________________
Capacities of 144 women leaders of
72 SHGs_______________________
Process Documentation and Follow
up report
Empowering Women for Health
CHETNA Ahmedabad
Aniicxiirc II
Responsibilities of writing the chapters
S. No
j____
2.
Topic/Titlel__
3.
4.
5.
Reproductive and Child Health________
HIV/AIDS, RTIs and Cancer
Adolescent Health_____
Promotion of Traditional Health and
Healing Practices
Mental Health_____________________
Women and Nutrition_______________
Gender and Self-esteem
Women and Violence_______________
Tuberculosis______________________
Malaria___________________________
Rational Health Care________________
Water & Sanitation_________________
Women & Panchayati Raj
Access to Health Care Services and
other Government Programmes
6.
7.
8
9.
10.
11.
12.
13.
14.
15.
16.
______
Women's Health Perspective_________
Women’s Work and Occupational
Health
NGO responsible
Dr, Sathyamala*
SEW A, Ahmedabad
C1NI, Calcutta______________
CItETNA, Ahmedabad
CH ETNA
Dr. Saraswati Swain/ CHETNA
Jagori*_____________
Dr. Sathyamala*
CI I ETN A, Ahmedabad
Sakshi *
______
QIC, Bangalore_____
QIC, Bangalore_____
CHC, Bangalore
FRCH, Mumbai
FRC11, Nlumbaj_____
I KCH, Mumbai
^Initially, these individuals and organizations had agreed to write the chapters. However,
for some reason they were not able to do so. Therefore CHETNA team members wrote all
these chapters.
26
Empowering Women for Health
(11 ETNA Ahmrdabatl
Aiincxurc III
Broad guideline and framework for chapters of training manual
This is the general guideline to maintain a similarity in format of all the chapters in this
manual. However, you are free to ignore the points, which are not applicable for your
chapters and add if you require any new/specific point for your chapter. For the facilitation
of writing your chapter, we are enclosing two draft chapters written by CHETNA team
members: STD/HIV/AIDS, Gender, Self-esteem and Empowerment.
The chapters may be formatted in the following way
Scenario/situation/statistics related to the subject that you arc writing, particularly keeping
focus on women and gender relations.
EfForts/successes to change this situation (please give some practical examples if
possible).
B
Technical information on the subject (Fact-sheet)
■
Module for training
Content
■ Duration required to cover this topic
■ Training methodologies
■ Teaching aids required
■ List of training reference material to be referred by the trainer (for reading purpose and
useful during the training such as |particular songs, booklet, articles and teaching aids
in regional/local languages etc.)
■ List of material to be given to the participants
■ Any other
■
27
Empowering W omen for Health
C7/A7V.1 Ahnwiiabad
Anncxure IV
Following chapters/topics are included in the modules
Me and my society
Nutrition and Women’s Health
Women’s Work and Health
Women’s Mental Health
Access to Health Care
6. Panchayati Raj and Women’s Health
7. Traditional Health and Women’s Health
8. Traditional Health and Healing Practices
9. Malaria and Women’s Health
10. Tuberculosis and Women’s Health
11. Water, Sanitation and Health
12. Our Growth (reproductive system of men and women)
13. Conception
14. Adolescent Health and Growth
15. Ante Natal Care
16. Child birth and Care after Childbirth
17. Contraception
18. Abortion
19. Infertility
20. Reproductive Health Infections/Sexually Transmitted Diseases
21. HIV/AIDS
22. Cervical Cancer
23. Breast Cancer
1.
2.
3.
4.
5.
These modules include 23 topics related to women’s comprehensive health along with
training design and description of the training methods The village level module has an
added feature of roles of various stakeholders at village level to improve the health status
of women. It includes role of family, male members, panchayat members and women’s
group for each of the health topics included in the module. The illustrative module was
first developed in English and later translated into Gujarati and Hindi languages by
CHETNA and Marathi , Malayalam, Telugu, Oriya, Bengali, Kannada and Assamese y
other non governmental organisations
28
Empowering Women for Health
CHETNA Ahmedahad
*
1
(METIW
Centre for Health Education Training and Nutrition Awareness
Lilavatiben Lalbhai's Bungalow, Civil Camp Road, Shahibaug, Ahmedabad - 380 004, Gujarat, India.
Gram: CHETNESS Ph.: +91 (79) 2868856, 2866695 Fax: +91 (79) 2866513, 6420242
E-mail: chetna@icenetnet Website:
icenetnet.in/chetna
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