Banrin Kynti Shisha Diengdoh : understand the relationship between the people and the health personnel
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- Title
- Banrin Kynti Shisha Diengdoh : understand the relationship between the people and the health personnel
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A Report on the Community Health Learning
Experience
CONTENTS
Page no.
Part A
Chapter 1………………………………………
5
Chapter 2………………………………………
6-8
Chapter 3………………………………………
9-10
Chapter 4……………………………………….
11-20
Chapter 5……………………………………….
20-22
Chapter 6………………………………………..
23-24
Chapter 7…………………………………………
25-27
Chapter 8…………………………………………
30-40
1
ACKNOWLEDGMENT
First and foremost I like to thank my parents who supported me and encourage me to join
the programme even though they did not have any knowledge about the organisation.
I take this opportunity to express my profound gratitude and deep regards to all the
facilitators for their guidance, monitoring and constant encouragement. The help and
guidance given by them time to time shall carry me a long way in the journey of life.
I am obliged to the Community Extention Unit Staffs for the valuable information
provided by them. I am grateful for their cooperation during the period of my assignment
in Perambalur District.
My sincere thanks and gratitude the staff’s members of IIPH Shillong and the staffs of
Bethany Society help the researcher in conducting various interviews and support in giving
guidance on how to carry on the research.
My thanks also go to the Swasthya Swaraj Society Team for welcoming me to be with them
in Orissa for my final field work.
Last but not the least I thank my batch mates for helping me and for being there with me
always. Thank you so much.
2
REASON I JOINT SOCHARA
Community Health Learning Programme to me sounds like the programme for the people
works related to health like the ASHA. the ANM and the Anganwadi Workers.
I came to know about SOCHARA from the local newspaper, The Shillong Times, it came
through our university Martin Luther Christian University Shillong, I did not know
anything about the programme to make it sure me and my friend Sabeena went to talk
about this to our Vice- Chancellor Dr. Glen Kharkongor just to be sure about this.
I was surprise to see that they recruits the social worker too, but I was happy to see there is
research and action also include in the programme, this was one of the cause I joined the
programme.
3
MY OBJECTIVES
To know about health in the community
To understand the various determinants of health
To have a good knowledge of research
4
Chapter 1
First time in SOCHARA
I was surprise to see an open class with no benches and tables, the person who took the session
of our first session here is Sam Joseph, I was so happy to see and get to know his experiences,
Social Mapping is not new to me I have done it before during my Master but what he taught is so
correct the first thing that make me so interest in his session is his saying that the NGO only
knows how to empower the people but never ask them what they want and never want to work
with them. I felt guilty because I was one of them and I was doing that during my whole master
degree.
First time with the fellows
All are so nice hard working and well informed. But the best are my co- fellows we are like
sisters and brothers we eat together we laugh together the most important we learn from each
other sharing things which we don‟t know and helping each other when we are confuse.
First time with facilitators
The facilitators here are super well informed, seeing them the spirit of helping and working with
the community inspires me a lot. What I like most of them are that they never see us as their
students but as there co-learners
Field visits
FRLHT the visit to Foundation of Revitalization Local Health Tradition is very nice it was my
first time visiting such place. I am amazed to see such place. We visited many departments there,
the one which they have the names of various plants and have software to translate the names to
the local name is very interesting. I like the place where we stayed it is very relaxing and calm
away from the city and the noise. One main thing I like most is encouraging the traditional way
of treatment and I could see that this place have that.
5
Chapter 2
My first field visit was in Siddapura slums
This is my first experience visiting the slum; my impression on the slum is dirty but it was
completely different. The slum is located behind TB hospital near NIMHANS hospital, there is a
public toilet the temple is an Aganwadi there, and the inner part of the slum is cleaner compare
outer part of the slum
Visit to Dommasandra PHC visit met Block Medical Office
We visited Dommasandra PHC we found out that there was no doctor there was only a nurse, we
met the block education officer she is responsible with giving awareness programme in the area.
The day we visited was an immunization day there were many pregnant mothers, I observed that
the ANMs were in an immunization room immunizing the babies; it was my first time seeing the
immunization card.
Snehadan visit
During the visit we were giving the responsibility to distribute food to the people there, there
were many people there. what I don‟t understand in this institute is that they them self says that
apart from giving them services they also try to awake people about stimatisation, but the staffs
there have their own dining hall which is more organize and clean, what I have in my mind is
that they could eat in the same room and if they do not want to share their food or so they could
have their own timing. Over all the experience of visiting there is a good idea but I feel bad for
the people there since they might think we went there how an AIDs patient look like.
Nimhans wellness center
I like the wellness centre there and the idea of having a community centre,
since it will help many people who cannot support the expence of going till NIMHANS.
6
Nimhans Sakalwara community mental health center
During the visit we met the supervisor Dr. Daniel Chisholm; it was my first time seeing a PHC
who gives interest in mental health, what is unique about this center is that we all know about
NIMHANS and its work in the urban places but this is the first center I have known that reaches
the rural people also.
Basic Need India
My experience with BNI I s by visiting the member‟s house. During the visit we went to the
member house who is mentally ill she have a son who is also mentally ill, the mother develop the
sickness because of over stress this happen after her husband died, she also shared that she faced
problem in the schools as the people there mistreat her son badly.
This is a first opportunity for me to be expose and learned about Community Mental Health
intervention.
NUHM launch
It was a big opportunity for me to be able to get a chance to attend the launching of the National
Urban Health Mission health in Bangalore. There were many people there and people get to sit in
front there is no special place for the invitees or the common people as such. What I like the
most there was the man who walk around dress himself on a costume with the types of noncommunicable diseases written all over himself, It is very interesting and a very good effort since
it create a sense of an awareness on the various illness as well.
Head Stream SGH mela
The Mela was held in
A.Narayanpura, the mela
was
organize
by
Headstream, in this mela
the members of the SHG
came
together
to
celebrate
they
were
giving opportunity to do
what they want they
perform dance and sing
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on the stage, there are various skid perform the one capture me is the home remedies skid
perform by the member of Headstream, but what I like most there is seeing the children
enjoying and applause for their mothers.
FEDINA rally
This is my first rally in Bangalore; the rally is from NIMHANS Hospital to The Labour
Department Office, there they have speeches and skids showing how the domestic workers are
being violated by the people who employ them.
Headstream summer camp
We attended the last day of the summer camp in Headstream there were dances and songs and
also skids, the camp was for the SHG member‟s children, our co-fellow Madhavi and Anusha
volunteer the camp, they were very enthusiast and they have the connection with the kids.
Monsanto Rally
I feel really good to get an opportunity to participate in this rally protesting against Monsanto
which is one of the horrified companies that want to take over trade and cultivation in many
countries. The protest was held in a very interesting way all the protesters were walk backward
to show that Monsanto should step back in producing the Genetic Modified Crops, many
participated we were all enthusiast and so into the rally there were some wearing gas mask we all
have stickers on our faces. They were all so nice the rally was properly planned, they were
distributing waters bottles, and on that bottle there is a coca-cola tag. What I am thinking here is
we were protesting against the company and we are using and distributing water that was made
by that company, I felt bad to see that happens and I think that should not happen it is not wright
and it looks odd and funny when people knows about this.
Community Extension Unit (CEU) visit
The visit to Community Extension Unit in Chennai is exited and I came to know about
Communitisation process from the visit we had a session about the project, I get to know first
from here about the pooling in the Sub Center. We visited Arulsclvi Community Based
Rehabilitation Center, there we observed the community people coming together I was surprise
to see that they know about the Patients‟ Rights.
8
Chapter 3
medico friend circle (mfc)
The medico friend circle (mfc) was formed in the year 1974, by a group of friends that comprises
of four doctors and a social worker. These friends was motivated by Jayaprasad Narayan a
Gandhi follower, this circle was registered as an organization not as an association , since all the
people here are equal and distribute ideas freely. The difference between mfc and other
association and organization is that there is no hierarchy distribution between them but the only
have a convener who served two years, the convener takes care of organizing the meeting twice a
year and an editor that published the articles given by the members. Then again the best articles
were selected and published in a formed of a book, these includes1. In search of diagnosis
(analysis
of
present
system of health care)
ealth care which way to
go?
ealth and Medicines
under the lens
edical Education
examined
Re-
The main aim of this circle is friends coming together interchanging ideas and re-motivating
themselves in working with the community, their aim is Health for All they also work for
educating people in need and their rights. Medical pluralism is also one of the areas they
concentrate.
The members in this circle considered themselves small that is the reason the names and the
letters do not have a capital letter. The interesting things here is that anybody can join and be a
member of the circle, they welcome individually not as an organization.
I enjoy talking with Imrana ma‟am a lot I feel like I can connect with her instantly, she is so nice
an so good she corrected some of my views regarding the meeting and the purpose it was
formed.
9
WorkshopsClinical Establishment Act workshop
In this workshop for first time I realize about the importance of the public health sectors and how
to strengthen them, I came to know about the Patient‟s Rights. There were many light minded
people in the workshop contributing their thoughts and ideas some agree and some disagree with
some, my favorite was a presentation by Abhay Shukhla about the horse and the elephant, the
elephant signifies the private sectors and the horse signifies the public sectors that was one of the
good example of understanding the power of the private health sectors, this shows that the
Government should be responsible enough to be able to strengthen their health services.
Social Justice and Equity workshop
The workshop starts by a welcome speech from Mr. Chander, the theme in this workshop is
mostly about the Universal Health Coverage and about working together from the lower level to
the higher level on various determinants of health in different field like the urban health,
environmental health, mental health and also privatization of health care.
I was with the urban health group the group members shared about the problems of the slums
dwellers n Bangalore and also in some of the places where the members are, slums dwellers are
the main topic here since they are under urban setting, they have mention about the National
Urban Health Mission that will be launch soon that it will cover about 779 cities and a coverage
population of 7.75 lakhs, like in the NRHM here there will also be an ASHA but probelly will be
call as USHA.
Chapter 4
Times in Tamil Nadu
During our stay in Tamil Nadu we stay in a room in Bala Mandir, we visited Gomanapundi
village and went to the Anganwadi center, we also had a meeting with the Animator in the
10
Panchayat office, later we went to the old VHN (Village Health Nurse) house she is old and have
retired from her work, there is no VHN there and we observed that the there is no sub center in
the village. The Anganwadi is clean and well ventilated there were posters written for the kid‟s
learning there.
A field work report from 23rd October, 2013 to 23rd November, 2013
Catholic Health Association of Tamil Nadu is situated in Tiruchirappali District; it is a
district nodal office for the CAH project it concentrates two districts namely Perembalur and
Ariyalur District.
CHAT is a registered under society regulation Act 1997, as the Non- governmental
organization, the agency has been serving the people in Tamil Nadu since 1962. Till 1983 it runs
the name of Catholic health Association of Tamil Nadu it later change its name to Catholic
Health Association of Tamil Nadu because of the shift of medical care to health care.
It vision on the Health for all, the society envisioned and equitable where people‟s health
is in the people‟s hands. The organisation moves beyond from being a network of individual
practioners to promoting network, advocating and lobbying to broader determinants of health.
CHAT works with three local NGOs: - DAWN Trust, Udaya Trust and Gandhi
Gramodaya Sangam were focusing 86 Panchayats. CHAT provides various meetings for the
animators and the committee members through these local NGOs. At present CHAT is working
with the Tuberculosis Project, same like the CAH project this project also implemented through
the local NGOs.
The pilot phase for 86 Panchayats was started in the year 2007, this project function from
NRHM (National Rural Health Mission) from the Ministry of Health and Family Welfare. The
CAH- project aim at improving Government Health services and encouraging the participation at
large in the health system to provide substantial, qualitative and integrative health for its citizen.
The CAH project was initiative by the Central Government in the name of Community
Monitoring which meant to improve the community ownership, which again people participation
in evaluating and monitoring the programme together with the health providers.
The Village Health Water Sanitation Nutrition Committee (VHWSNC) was formed in the
panchayat, it is an important unit of operation and interaction it has about 25 numbers of
volunteered members from different section of the village, it also include the social sectors like
the Anganwadi Workers, the Village Health Nurse (VHN) and the Panchayats leaders. The
11
VHSWNC develop the village health plan by rapid assessment of the burden of diseases,
treatment, it also monitor the health services to be offered at village level.
Block Primary Health Centre Visit
ObjectivesTo interact with the Block Medical Officer
To understand the functions of Block Medical Officer, medical Officer
To know the services provided in the Primary Health Centre
To understand the relationship between the people and the health personnel
Observation
During the visit in Ammapayalam Block PHC, I observed that the centre is divided into
two buildings one is for the general patients the other is for the delivery system. There are two
staffs for registration. The PHC is situated near the road and bus stop; there were many people
and students coming for check- ups.
Learning Outcome
We visited the Block Primary Health Centre in Ammapayalam Panchayat, met the
Laddapuram PHC Medical Officer, Dr. Vijay Anand and Block Medical officer Dr. Mrs.
Vasantha. Ammapayalam Block PHC covers 20 panchayats with the population of 97639.
During the visit I learned that the schedule has been divided specifically for the doctors and the
VHNs in the respective PHCs; in which every 3rd Tuesday of every month a Block Review
Meeting with the VHN and the ICDS workers; Anti Natal Care check-up is being carried every
Tuesday in the PHC, the doctors also visited the school for students check-ups; then in the Sub
Centres the VHN give immunization to both pregnant mothers and babies every Wednesday.
Health Sub Centres visit
Objectives
To meet the Village Health Nurse
To know the facilities provided in the Sub Centres
12
To understand the relationships on with the people
To know the VHNs opinion regarding the implementation of the CAH Project
Observation
During the visit in Ammapayalam Sub Centre, I observed that many under 5 babies and
pregnant mothers came for immunisation. I also observed that every mother have the
immunisation card with them, this card help the VHN, Mrs. B. M. Raja Mani, to follow- up the
type of immunisation been given. The VHN also help the pregnant mothers in filling up the Dr.
Muttu Laxmi Reddy Schemes form, this scheme is a scheme only for the pregnant mother this
schemes encourage the mother to deliver their child in Government Hospitals, an amount of Rs.
21000 is been given to the mothers. They are firstly registered in the Sub Centre by the VHN
Rs. 4000 is first given during the Anti Natal Check-Up, another Rs. 4000 is given when the
delivery been done in the PHC and the last amount of Rs. 4000 is been given during the Post
Natal check-up.
The visit in Aesanai Sub Centres we met Mrs. Gomati the VHN of Aesanai panchayat, I
observed that the Sub Centres is situated near the road and near the bus stand, the surrounding in
the Sub Centres is not that healthy nor clean there are stagnant waters around the sub Centre and
no proper dumping place in the panchayat. The Sub Centre have two rooms, one room is for
storing the medicines the other room is for check- ups, the Sub centre is not being clean properly
the walls and the roof of the building were not being properly maintain, I also observed that the
is no electricity connection in the Sub Centre.
Learning Outcome
I learned that the VHN in Ammapayalam ,
Mrs. Raja Mani, did not stay in the village since her
house is nearby, Ammapayalam is the only
panchayat she is responsible, the Sub Centre is open
only in the immunisation day since there are many
work in the PHC, she also mentioned that she is
given overload work in the PHC she have to take
care of the paper work. Over load work is the reason
she cannot attend the people in the village, the
13
pregnant mothers. I also learned that the PHC is a rented house and the panchayat pays the
money from the fund to the house owner every month. When asked about her opinion about the
CAH Project she said that the project is very good project in which she gained respect and trust
from the people which is important for building a good communication with the people.
Mrs. Gomati, is the VHN Easanai Panchayat, during the visit I learned that most of the
people in the village were having fever, I also learned that VHN did not stay in the Sub Centre
since there is not proper facility like no proper bathroom, no water and no electricity in the Sub
Centre. When asked about the reason of these entire things she said that the Government did not
give importance on maintaining the Sub Centre properly. When asked about the CAH project she
said that she is very much happy that the project was ended since there were many works for her
to be done and that she is responsible for the village‟s health.
From both the VHN, I learned that there were no meeting conducted since the project is
over, there opinion on the project is that it help the to have a good relation with the people but it
is very hectic for them since they have to cover 5 or more villages doing their work in the
panchayats and in the PHC is a huge task for therm.
School visit
Objectives
To know the function of the Health Committees in the school
To know the importance of the doctor visiting the schools
To understand the responsibility of the teachers towards the health of the students in the school
Observation
We went for a school visit in Easanai and in Laddapuram Panchayat, here I observed that
the doctors are scheduled to visit the school every Thursday of every week, In Easanai
Government High School we met Dr. Prakash the MO of Aelamvalur PHC, during the school
visit I observed that there were three VHNs from Vanakam Madavi, Mrs. Vimala Kelakarai
VHN and Easanai VHN helping the MO in the school, the girls student from class viii till class x,
were distributed 3 packets of sanitary napkins. I also observed that the doctor also examining the
students both boys and girls the medicines were distributed to the student. The school maintain a
School Health report for each students in the school the students or the old cases of the particular
student were follow-up by the doctor and the VHN.
14
In Laddapuram Panchayat, I observed that the teachers are very co-operative, since it is
not a school health programme day there was neither the VHN nor the doctor visits the school, I
observed that the school is divided into two parts; one is the primary school and the other is the
high school. The school is situated near the public distribution shops and near the village bus
stand; there is no proper toilet facilities and no proper drinking water in the school.
Learning Outcome
From the school visit in Aesanai Government School, I learned that the school maintain
the School Health Report, the doctor follow up the cases of each student in the school from this
report, I learned that the serious cases were refer to the Block PHC in Ammapayalam Panchayat
and in Perembalur District Government Hospital. The sanitary napkins of three packets each
were distributed once in every three months to the girls of class viii to class x. 20% of the
students in the school are anemic.
In Ladapuram Government School, I learned that the VHN or the Medical Officer visit
the school once in every three month, during the visit they distribute sanitary napkins and iron
folic tablets to the girls students. We interacted with the teacher name Indira Gandhi, from her I
learned that the PT teachers is responsible and was trained for first aid and to recognized the
problem or sickness of the student in the school.
Panchayat visits
Objectives
To understand the relationship of the Panchayat President and the Committee members
To know the reason of not continuing the meeting
To know the function of the VHSWNC in the Panchayat
Ammapayalam Panchayat :- This panchayat is one and half hour away from Perembalur District,
during the visit in this panchayat I observed that the Block Primary Health Center is situated near
the bus stand, during the visit I observed that the Village Administration office, Public
Distribution System, Panchayat Office, Anganwadi School. We also visited the VHSWNC
member‟s house Mrs. Muttu Laxmi, I learned that the VHSCNC in the village were very active
in demanding their rights in the Panchayat, they did not conduct any meeting since the project is
over they said that they were very motivated and empowered during the project phase. We met
the Panchayat Thallaiva‟s house Vallarmadi we interacted with her, she is co-operative with us,
she mention that the project is very good for the village she also mention that committee
members function in the panchayat is very good since the people themselves engaging
themselves in improving village health. We met the Anganwadi Teacher and visited the
15
Anganwadi in the village I observed that there is a separate room for cooking and storing, I
observed there is one weight measurement machine, when interacted with her; I learned that she
is responsible to register the pregnant mothers in the panchayat. There are 22 children in the
Anganwadi they came at around 8‟o clock in the morning and leave at 4‟o clock in the evening,
they are given egg and rice in the morning and afternoon the nutritional powder is given in the
evening
Aesanai Panchayat:- during the visit we met the president Mr. Ram Dev, and some of the
Committee members we also held a meeting with the committee members in this panchayat we
have Mr. Raj as our resource person during the interaction with them I observed that they were
very angry with the NGO and the animinator of not visiting them they demanded that money,
even though we tried explaining them about their role in the village and about their roles and
their responsibility in their own village. We also visited the Anganwadi centre and observed that
the Anganwadi is dirty and small, we interacted with one of the villager their and found out that
she never sent her children there because the food is not properly clean.
Laddapuram Panchayat :- during the second visit in the village we start with the Transect Walk,
we start the work from the auto stand we ended the walk in the same place. During the visit I
observed that the schools, village banks, distribution shop, village library, village toilet, cow
sheds are all situated in the other side of the panchayat where as the village houses on the other
side. The village is clean and properly planned every two houses have one tap in front. We
conduct the meeting here 10 members came we had a discussion on the reason the discontinue
conducting the meeting there answer is that even though the meeting is not conducted but
whenever there is a problem in the panchayat they discussed with the Panchayat President which
is very co-operative with them.
Velur panchayat :- we visited the PHC there we met doctor Venketesh the newly appointed
doctor in the PHC, during the visit I observed that there are information boards like the Citizen
Charter Board in the PHC. The doctor is very co-operative and informed us about the facilities in
the hospitals and when referral cases needed for the patient they are sent to the District Hospital
in Perembalur or to the Block PHC in Ammapayalam. But, when asked about the VHSWNC and
about NRHM he mentioned that he is not responsible with that and that he did not have any idea
about the committee since he is new there.
The village in Velur is clean we met two committee members we found out that the
project is very helpful to them there are many improvement in the panchayat during the project
one of the example is the street lights and the water starts function when the Committee was
formed. They are all very active and motivate with the project.
We also visited Varunasi VHSWNC members about 20 members came for the meeting we
interacted with them on their work and function in the village they are very motivated and have a
good relationship with the VHN and the President. As the committee members they also works
16
as the referral agents for the TB project they still conduct the meeting every month with or
without the VHN.
Programmes attended
Blood donation camp in Arumbavur panchayat, from this programme conducted by one of the
private clinic, there were about 50 villagers came for giving the blood in the camp. I later found
out that the blood that has been collected is been sold in the blood bank shop in Perembalur with
an amount of Rs. 1200 per bag.
TB meeting in Ammapayalam and in District Government Hospital in Perembalur, this meeting
was held to give awareness about the services in the Government Hospitals and also on how to
prevent it from spreading most of the participants are quarries workers.
Activities conducted and Activities Plans from 25th November, 2013 to 8th December, 2013
24th November 2013- Attended a Regional Workshop on Clinical Establishment Act in
Thiruchirapalli
During this visit I observed that the local NGOs came together they were discussing about the
people difficulties faced in the health centers and the hospitals. It is very good to see this
especially since we have attended the National workshop regarding this same topic it is good to
see that they took the discussion to the regional level also.
25th November 2013- Interaction with the ex- animator Mrs. Vallarmadi
Mrs. Vallarmadi came to the office we had a talk with her regarding the project, she was very
happy during the project phase and also feel good since the villager know her and respect her and
her work. She is working now as a staff in Dhan Lakshmi College, she left the NGO ( Dawn
Trust) since the project has ended.
26th November 2013- Visited kelakarai Panchayat
The main crop of this village is cotton they cultivate cotton and sent it to Trichy, Madurai and
some other places. Previously they were very happy cultivating cotton since the demand is high
but at present they have to sell at a very low cost of Rs. 40 per kg, the people faced lots of
difficulty with this they also mention that they have not faced problem because of the price but
when they try to change the crop the soil becomes very dry and unfertile.
27th November 2013- Visited Udhaya Trust in Ariyalur District
17
We met the secretary of the Trust he is very enthusiast person and hard -working he takes care of
the Trust and the project at the same, the Trust now like Dawn Trust they are now working for
TB project, this project also use the animators to go to same villages where they concentrate
before, he like the CAH project very much since it deals with all the people in general and also
feel encourage and empowered as they were recognized by the health officials and could get a
proper dialogue with them regarding their functions because of this project.
28th November 2013- Discussion with Dawn Trust Secretary
From the discussion I learned that the Trust is owned by his family, there are nursing home,
hostel and the Trust under his family, the aim is to reach the poor people and help them in
supporting on their journey for education.
29th November 2013- Visited District Government Hospital in Peremballur
During the visit I observed that the hospital is situated near the market place it is very crowded
other thing that I observed is that the people on the hospitals before they enter the hospital they
leave their footwear outside, it is very nice to see them practice this not just at their own home
but in the important places as well.
30th November 2013- Preparation for World Aids Day Rally
We were in the office helping the staffs to prepare banner and pamphlets for the rally.
1st December 2023- Visited ex animator house Mrs. Nirmalla
While interaction with her I learned that she was also responsible of five villages like other
animators, she have to leave the project since she got married and got a baby, when asked about
the project she likes it very much because feels empowered and important in working for her
own community.
2nd December 2013- World Aids Rally in Perembalur District
We had a rally with the Nursing students; the rally was from the organization till the old market
area. The rally went smoothly we help in distributing the pamphlets to the tea vendors, drivers
etc.
3rd December 2013- Bommanapadi Panchayat
There are 20 members in the committee; the members arranged the meeting in one of the
member‟s house, during the interaction we found out that the higher case dominate the lower
18
caste, we had a meeting with them trying to find out the reason of discontinuing the committee
meeting.
4th December 2013- Meeting with Laddapuram panchayat president
The president is very co-operative and supportive he attended the meeting conducted by the
members at 5 o‟clock in the evening, we get to observed the members asking him questions
about the VHN why she cannot come even though she was there in the village for the
immunization and also about the sanitation and maintaining the water tank in the village.
5th December 2013- Laddapuram PHC visit
During the visit I observed there was an Ante natal care check up in the hospital, we could not
interacted with the doctor since he was very busy, we interacted with the mothers regarding the
facilities and about the VHN facilities.
6th December 2013- Ammapayallam VHSWNC meeting
In this village we visited the member‟s house; we also met the VHN and the panchayat president
in this village we were very surprise to know that the president is a women, we talked with her
regarding the panchayat system she explain that she was elected by the reservation quota.
7th December 2013- Bommanapadi VHSWNC meeting
We went to Bommanapadi had a meeting with the members, after we found out the reason of
discontinuing the committee all the members blame the animator of not coming to the village, we
talk to them about the project that it have limited time and that the committee should continue
even without the animator coming to the village.
8th December 2013- Advance Christmas celebration with Christian Educational Institution‟
students
The students invited us to the advance Christmas celebration, there were song performance,
dance and also dramas.
Our stay in Tamil Nadu was enjoyable and memorable we did not only learned about the project
and the organization, but we also learned about the way people lived and also about coping up
with other people from a complete background and society.
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Chapter 5
Field work report, Bethany Society, Mawkyrwat Block from 21 February to 18 th March,
2014
Weeks
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Plans and Activities conducted
Meet the IIPH staffs and Bethany staffs,
Visit Rangthong village, meeting the ASHA and visit the PHC
Visited Jakrem and interacted with the people, meeting with ASHA
Visited Pynden sakwang village and Phot-Jaud village meeting ASHA
Visited Nongsynrieh meeting with ASHA
Interactions and FGD in Mawranglang
Interactions and FGD in Rangthong village
Re visit the villages
Objectives
To understand Social health determinants in the village
To understand the community and their participation in solving their problem
To know the function of health services in the village
To explore community knowledge about health care practices
We went to visit the staffs of IIPH in Shillong there we met Mr. Lipekho a senior lecturer of the
institute, we inform him regarding the field placement, but we came to know that the institute is
not familiar with any of the villages in the district or the state so we went to Bethany Society
Shillong met the Director of the organization Mr. Carmo Norenha, we talk with him about our
field placement since we are known with the organization from our Master degree we select
South West Khasi Hills District as our field area.
There is a branch of Bethany Society in Mawkyrwat area, their target group is the differently
able people they are working on the Community Based Rehabilitation Project focusing health,
education, livelihood and rights. They are working on the rights and promoting livelihood of the
differently able people, they also educate and aware the people about their rights in the society.
We stayed in Mawranglang village with one of the eldest lady of the village, there is no sub
center in the village the houses here are far from each other, rearing animals is one of the main
occupation of the village there are three primary schools all high schools and college is situated
20
only in Mawkyrwat which is 2 hours on foot, there transportation in the village is very difficult
and expensive there are no transportation from the Government sector.
There is a Durbar in the village it looks after the well- being of the society, Durbar is local
government that consist of the „Rangbah Shnong‟ (headman), secretary and the executive
members and the village people including men of the village only, the Rangbah Shnong is
elected by the people itself, the Rangbah Shnong have to be the man the women are not allow to
join the Durbar, unlike in Tamil Nadu there is a reservation for the women as well but here it is
not like that.
There are groups like the youth group the children group in the village is very active, they have
traditional musical class and organize programmes like picnic and they also have responsibilities
during the village cleaning drive, there are women groups as well but they are not properly
function there are Self Help Groups.
The people finds difficult to get help from the health sectors, since it is very far, for minor illness
they buy medicines they buy from the pharmacies located in Mawkyrwat but for the major
illnesses they first went to the CHC (Community Health Center) and go to Shillong. Most of
them prefer to go to private hospitals since they get better service there they feel that in Civil
Hospital the staffs behavior in inappropriate.
In this village I also learned and observed that there inequity when it comes to education and
reach better health care, for instance there is no high school or good college in the village or
Mawkyrwat, their children gets to go to private schools to the capital Shillong whereas the
family who cannot support their children they have to drop out from their school this is one of
the main problem in the village, when it comes to health distribution the people who can effort
goes to the city they get better services, compare to the people who cannot effort they have to go
to the PHC or the CHC which is very far and no regular doctors.
Women in the village talks a lot about school drop- out and its impact on the society, they also
mention about the problem of alcohol even though the people cannot get the alcohol from the
Headquarter or from the village, they always got it from a near -by village.
The people in the village consume and smoke tobacco a lot, when talked about it they are alright
with that, some mention that tobacco is a part of the tradition and they cannot live without it.
During my stay there for one month there were three death suspecting cancer and tuberculosis, I
never found out the reason since people never talked about it, they considered cancer as a curse.
I have been in the village and have also travel to other villages too; I never come across school
health programme or the village health nutrition day. Even though we visited the PHC in
Rangthong village we never find any doctors or nurse there.
21
Since I came across the VHSWNC (Village Health Sanitation Water Nutrition Committee)
during my last field work in Tamil Nadu, I tried to find some information about them but I could
not no one was able to give me proper answers about the member.
I met the ASHA facilitator in Pynden- Sakwang, she is a member of Bethany Society she is a
locomotor she appreciate the society of encourage her to participate in various functions and
programmes in the community, she is very active and responsible and because of her work she
was selected as the facilitator responsible to look after 22 villages.
I am very familiar with the village since we have worked and stayed in the village before during
our Master degree fieldwork, what I realize is that we have change in many ways for instance
during our MSW fieldwork we concentrate on organizing various programme in the village
thinking that we were doing them a favour with thinking that the people or the community want
them or not.
22
Chapter 6
Collective sessions
Social mapping
The session was interesting; it was taken by Mr. Sam Joseph it is about Social mapping, we
reach when the 9 batch present their social mappings they conducted in the different part of the
slums. The main think I learned about from this session is never waste community‟s time. I feel
so right when he talk about the typical NGO worker, always think that they are doing the
community a favour, this surprise me because this is what we do during our MSW degree but
instead never think that the people want or need the NGO help or not.
Alma Ata Declaration and the People’s Health Movement
During our first few classes I always heard from the facilitator talking about the Alma Ata
Declaration I never heard about it from any one, but it is from Dr. Ravi Narayan that I came to
know that there was an International Conference of Primary Health Care of 134 countries, in
September 1978 in Alma Ata Kazhakistan, organized by the WHO and UNICEF to achieved a
goal „Health For All‟ by the year 2000. They have come up with the 8 elements to achieved their
goal, the elements includesNutrition
Education
Water and sanitation
Mother and Child Health
Prevention of endemic disease
Immunization
Treatment of minor ailments/disease
Essential medicines
These elements are not the ways to treat diseases but to prevent the mass, without any difference
rich or poor, regardless the caste, regions and background.
On November 2000, people around the world come together in Calcutta
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On the Alma Ata Declaration anniversary 2003, seeing that health For All has not been achieved
yet a group of friends belong from different organisations came, they all goes there as the
representatives of their organization but introduced as the PHM‟s members.
Paradigm Shift
Dr. Ravi Narayan took this session on how the shift of understanding and looking at things is
important for us as the community health workers. The meaning of the paradigm shift is the
shifting from bio-medical model to social model, which is the shifting of thinking of seeing the
client or a patient to a person with problems, or a person who just need help and changing of
giving importance to an individual but should see the community as a whole. This also includes
the practice of providing resources to the community rather than enabling them to handle their
own resources. As a qualified person I always think that we are fully aware of things in the
community but to be able to work and understand community we should always go to the
community as a learner not as an educator.
Qualitative Research
Qualitative Research is one of the interesting types of research, I have heard about quantitative
research and its tools but qualitative research and its process of conducting a research is very
nice. I feel that is very important and very in-depth in some of the sensitive issues that cannot be
measured by numbers or graphs.
Globalization
I was always appreciate globalization and feel proud that India open to that, but when Prasanna
taking classes about Globalisation I was surprise to see the effects especially towards the poor
people and how World Bank taking advantage of the poor country like India and it have to be
under the Structural Adjustment Programme, India gone to recession and have to go to world
bank for loan that is when the world bank asked India to bring down the currency which bring
about neo-liberation policy which is known as „ Manmohannomic‟.
And when it comes to health in globalization have grown fast in India, it starts from the Selective
Primary Health Care of the World Health Organisation to the fast growing of industries and
private sectors which affect the poor Indians.
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Chapter 7
Times in Bhavanipattnam Odisha- Swasthya Swaraj Society
18th June, Hatia Express- I miss my friends and Bangalore and also I am feeling so happy at the
same time, I was sitting in the train as it leaved Yashwantpur I realize that I am actually going to
Odisha alone. I said and smile to myself okay, this it I am actually doing it. I felt confident to
choose to go to Odisha, since it is one of the neglected place and lack in all aspect of services be
it education, health, economic and politic, I will get a good exposure there and also get to
experience the various determinants of health and able to experience on the way people lived
also get to know them.
I have heard a lot about Odisha about how unsafe and undeveloped there but nobody talked
about the people and the community there.
21th June, 2014
We went to a place called Kanigumma there is a clinic, since it was a market day many people
came even though it was raining. It was not a first time for me attending health camp but here I
could not help them since I did not understand or know the language they speak there.
There is a shortage of staffs in the clinic with many people it is difficult to maintain, I help apply
medicines to the people there, there was a girl around 17 to 18 years old she have scabies all over
the body, It was difficult to talk to them and tell them what to do and what not to not since I
cannot talk there language.
Since, Oriya is similar to Bangla and to my luck I know little Bangla I could somehow talk with
her, I came to know that she never goes to school, she helps her mother in the field whole day I
asked her the reason she got scabies she did not have any idea.
While we were in the clinic, I observed that there are
many people with high fever and many have malaria, I
observed tat bcause the people cannot read and write to
remind them on the time the should take a medicines, the
medicines were kept in the paper bags with the simple
figures that a common man will understand with out any
difficulties.
25
On the 23th June, 2014
We had a monthly meeting in the office, we had a discussion on the programs and the work
done last few weeks and we also planned for the next two weeks, the last monthly meeting was
conducted on April 30th in Kanyagumma clinic.
There was a sharing from the didis about them joining the society and how they were inspired by
the idea of forming the society. They were so inspired to work with the adwasis in Orrisa.
They were mention about the Swathya -Shathi (Well Being- Friends) they are the trained village
health workers the Society is now planning to train the village girls or boys who have passed 8
standard called the Shikya-Sathi (Education-Friends).
24th June, 2014- 27th June, 2014
We left Bhavanipatna to Karpai vllage this village is like a camp for us we kept our luggage
there and goes to villages near and far the first village I visited is Sundorgoar, the village have 10
to 12 houses, they lived a very simple life apart from agriculture they earned their livelihood
from selling dry leaves to be use in dhabas and stalls for eating food in the city they get very
little from there they are selling them Rupees 10 per kilogram.
We also visited Poddapoi village, this small village is a typical tribal place they have a small
open hut in the middle of the village there they have a fire place and a big drum tied there. Like
the other village this also does not have any electricity connection.
We went to Mahajal and Kachalekha village walking the village are situated far from the main
road there are no roads to go to the village, there is no electricity connection there they lived I
very simple life but we found out that the people were having high fever and the symptoms of
malaria. Girls are not sent to school, only one boy these two villages goes to school, the school is
in another village which is an hour or two walk for a child.
In Kachalekha village, while we were sitting with the people one person came calling us there
were crying n screaming a man with cold and clamp symptoms, the older women in the village
started singing and goes around the village singing to inform the village people about the
incident.
26
The people did not know that the government hospital does not take money, went ask why they
don‟t go to hospital for medicines. There were no roads and only one bus early morning they find
it difficult to go since they have to walk far to reach the main road.
We could not talk with the women in this village as soon as we try to approach them they would
run away to their houses; I also observed that many of the young youths in these villages goes to
school and then migrate to Kerala.
In Taradei village, there were many people gather in the
middle of the village, to our surprise we see that they are
distributing the grains equally to all the families in the
village like in other villages here also girls are not allowed
to go to school.
We also visited Shimrang Gaon, Sorgipada and Danapodar
mainly to inform the Swathya Sathis in the villages and to
conduct the survey on Educational status, like other villages the girls and the women folks are
not coming forward to talk, when here also we found out that people and children are having
high fever for a week or more.
3rd July to 12th July
This is the first meeting held in Kerpai with the Swathya Sathis there were 22 Sathis, all the
Swathya Sathis are married they came with their husbands. I observed that the ASHA also joined
the Training for some of the Sathis were very quiet but after the games and refreshment they
were open up and talk to each other and response to the training. There was a brief talk on the
roles and responsibilities of a Swathya Sathis.
The next day the doctors remain in the Panchayat office, we went to the Samapolla Goan,
Sindipodar village Alwaguda village, Konaijabi village, Konaijabi village, Jibang village and
Nichemasca village and Kuran gaon these villages are far and there are no transportation
facilities there we went to the village walking when we reached the villages the people asked us
to go away since there were military personnel camping in the forest near the villages.
Like other villages these villages being cut off from any facilities and from the main town since
there is no transportation and there are no facilities in these villages be it health, education and
goods.
27
We had a meeting on and were planning to organize a Training Programme for the Swathya
Sathis of te villages in both Kanniguma and Kerpai side. Like last week we tried to cover as
many villages for the survey and to inform the Sathis about the training to be held, half of the
group went back to Bhavanipatna and two of us stayed in the village, we stayed in the Panchayat
house in Kannigumma village that night and make a preparation for the meeting next day.
In the morning, there were not much Sathis like we expected since it was raining and there were
no transportation. Since the topic of Training was on Malaria, Dr. Aksish uses flexes to make
them more understand he drew many photos which he saw in the villages, they were taught to
check the pulse and the spleen and also the Sathis shown on how to recognize people with
anemia.
The training was two days all 27 Sathis were staying with us in the Panchayat house, next
morning the Sathis were giving a reflection on the topic and they were so amazed to see the
malaria parasite in the microscope. The women ended the training with songs and dance.
To conclude, I was shock to see the condition there, people were suffering and dying and cannot
do anything they were helpless and were left like that by the Government. It is sad to see that in
all the villages we visited most of the children and people were having malaria and so many
types of diseases that I did not know about.
I do not know what to say whether it is a good opportunity to see and experience the
„Determinants of Health‟ there or not, there were difficulties in all their sides there were no
schools in the village and if there are schools the teachers are not coming, the girls are not allow
to go to school but will be sent to work in MNREGS (Mahatma Gandhi National Rural
Employment Guarantee Scheme) and will get Half of the amount as the payment, for them they
do not know what to do with their life but will get married at a very early age. They were also
not encouraged to come out of the house whenever there are visitors in the village.
Women because they have to give preference to the children and their husband they will go to
the field early in the morning work whole day came back to their house and continuous working
till their time to sleep, i observed that most of the married women of my age look so old and
weak. Even though they have a beautiful love marriage practice which is always so nice to listen
when they talk about that but again the women are so
helpless of their men since most of them are becoming
addicted to Mohul a local wine.
The youth in the villages will go to schools till class
vii or class x, and go to Kerela for work, they work
there as daily wage laborers, since they are skilled to
make the red brick people employ them for that.
28
Around 35 villages in this area were not found in the
census of the country, so they did not proper health care
facilities like ASHA or ANMs.
Even though I stayed there for three week I get to learned
so much from the community, „Globalisation‟ is another
topic I get to learned and experience there too. This
happened in Kerpai village and in a beautiful village
situated on top of the hill Kuturmani, because this area is
rich in iron a company called Larsen and Turbro limited try to take over the area belong to the
tribal people.
Next, Gram Vikas in one of another organisation that works on water and sanitation in the
villages there, they constructed toilets and bathrooms and also introduced the Gravity Water
Flow where people can get water in their villages, this is another topic I learned there„Sanitation‟. There were toilets constructed in each of the village but what I do not understand is
that people used these toilets as a storage room, why? We never know.
I understand that education is the factor that will bring a change in these communities but when
think for that how are we expect them to go to school and sit there whole day when they are not
use to sitting idle in one place, I think we should always understand the situation of the people in
the village.
We are always amazed to see how normal when they talk about death in the family bout later I
understand that it is normal for them to die; they consider it as a part of life and someone have to
face this in their life.
Peoples in the village are so good and very hospitable, there we can see the real community
where people live together they have this common hut in the middle of every tribal village with a
fire place and drums all of them will gather there and we were asked to sit there whenever we
visited the villages, the women will just wrap themselves with a cloth showing off their tattoos
on their chest, legs and arms. What I found out the meaning of the tattoos is so touch; the tattoos
are their only jewelries they had and with them they could carry their whole life and no one will
be able to take them away from them.
I sometime feel that we go to the villages judging them because they do not know how to look
after their children when they are sick, they have a strong belief on Thakurrani (the local pujari),
I really want to meet and see how they work then we would be able to work with them together
since the community will be more comfortable with them, than with us.
We have always heard about Orissa of how sensitive and unsafe out there, but when we were in
these villages we always enjoy ourselves and get the freedom to and talk to people. We have
seen and experience the difficulties there but it is worth the pain because what they taught us of
29
living with hope and be happy with what they have is more than enough to every man, more
about them teaching me about the community and their way of life and cultures, their smiling
face inspire me seeing them welcoming us with that face despite their problems and headache is
worth staying and being with them there.
Chapter 8
An exploratory study on the functioning of ASHAs in Mawkyrwat Block, South West Khasi
Hills, Meghalaya
The Accredited Social Health Activist (ASHA) was formed under NRHM the National Rural
Health Mission in the year 2003, ASHA are the main health care providers of the community,
these ASHA workers work for the better health situation in the community, ASHA is known by
many names in all over India; she is popularly known as the Sister of Hope, she is usually choose
by the village people she acts as the health representatives of the village to the health care
services. An ASHA worker also acts as a helping hand or a bridge between the community
people and the health care services.
ASHA can be found only in rural villages, she cover a population of 1000 she was formed to
look after the health situation in the community, she focus on working with the pregnant mothers
and the children. Now ASHA are found working with the Primary Health Centre in helping with
the health workers
ASHA have a huge responsibility in the society as a daughter, a sister, a mother and also a health
worker in the community She (ASHA) is empowered to look after the community under NRHM
the National Rural Health Mission in 2003, according to the Health Institute of Family and
Welfare (NIHW, 2005) An ASHA is the health activist in the community that create awareness
on health and social determinants she also mobilise the local health planning and help in
utilization and accountability of existing health services.
ASHA modules 8 tasks and Activities
30
The tasks specified for ASHA Village health plan, Communication for health behavior change,
Linkage with AWW, TBA, ANM, MPW, Counseling, Escorting patient to a hospital, Primary
medical care
Act as Depot holder, Record and registration
Home visit should take place once a month, it is important for the pregnant mother and for the
newly born babies, this activity will help an ASHA to know and understand more about the
health issues in her own community. Attending the Village Health and Nutrition Day (VHND)
this activity is done with the ANM and the Anganwadi Workers in the village to bring the
services and making the people aware of the preventive measures. Visits to the health facility this
activity the ASHA accompanied the pregnant mothers to the hospitals or any health centers.
Holding village level meeting with the Village Health Sanitation Water Nutrition Committee and
with the people in the village.Maintain records on the numbers of birth or death that will help her
to plan and identify the health issues in the village easily.
The Community Health Worker or the ASHA faced many problems according to (Kerry Scott
and ShobhitShanker, 2010) poor institutional support and also lack of community participation
are the main problem that ASHA faced.
This study was conducted as a part of the Community Health Fellow Programme, the study
conducted was „An exploratory study on the functioning of ASHAs in Mawkyrwat Block,
South West Khasi Hills, Meghalaya’.
The study was conducted in five villages of Mawkyrwat block, Meghalaya, to understand the
functions and roles of ASHA (Accredited Social Health Activist) in the villages located in the
hilly regions. ASHA, a Traditional Birth Attendants and the women in the villages were included
in the study as well.
The staff‟s members of IIPH Shillong and the staffs of Bethany Society help the researcher in
conducting various interviews and support in giving guidance on how to carry on the research.
The main thing which STUDY is that the women who are seen as empowered women and
31
educated.women with the freedom from the society or the family have difficulty in going to their
work and more or less faced problems like most of the women in the country.
The Traditional birth attendants have got experienceforthe longest periodand are well respected
in the community, but now due to increased emphasis of the institutional deliveries system they
are being discouraged. More over the educated people often look down on them and see their
work as scientifically unsound or primitive way of working.
These two categories of grass root health care workers contribute immensely, for the health of
the society but their lack of support from their own families, society and Government discourage
them.
Methodology
Objectives OF THE STUDY
To determine the function taken by the ASHA in the villages of South West Khasi Hills
District, Meghalaya
To understand the challenges faced by ASHA workers in the villages of South West
Khasi Hills District, Meghalaya
To determine people‟s perception on the functioning of ASHA‟s in the villages of South
West Khasi Hills District, Meghalaya
To understand the relationship between ASHAs and the community in the South West
Khasi Hills District, Meghalaya
Study Setting
The study covered six villages in South West Khasi Hills District Meghalaya, the name of the
villages are Jakrem, Rangthong, Mawranglang, Phot-Jaud, Pynden- sakwang, Nongsynrieh.
These villages are situated Mawkyrwat Block, South West Khasi Hills District, Meghalaya. Each
village has of 50 to 70 households the people in the village belong to a Khasi tribe.
Study Design
32
Qualitative research method approach was used.
Sampling
One ASHA facilitator from Pynden-sakwang,
and 4 ASHA workers from Jakrem,
Mawranglang, PhotJaud and from Nongsynrieh village, 2 focus group discussions in
Mawranglang village and Jakrem Village were conducted with the women who have used the
ASHA services and also the women who have never use ASHA service before. Two in-depth
interviews were conducted with the traditional birth attendants in Mawranglang and in
Nongsynrieh village.
Data collection
Data collection Procedure
Primary data on the function of ASHA will be collected through focus group discussionand indepth interviewswith the ASHA and the women of the village. Inform consent while
interviewing andaudio recording of the focus group discussion and in-depth interviews is done
along with note taking.Two Focus Group Discussion was conducted with the women who have
used ASHA services and women who have never used the ASHA services. Five interviews were
also conducted with the ASHA workers and two interviews were with the Traditional Birth
Attendants.
Data collection tools
Focus group discussions and in-depth interviews guides were used.
Data analysis
Data collected was transcribed and then translated into English. The translated data was analysed
thematically using Atlastti.
Analysis
To determine the function taken by the ASHA in the villages of South West Khasi Hills
District, Meghalaya
33
To understand the challenges faced by ASHA workers in the villages of South West
Khasi Hills District, Meghalaya
To determine people‟s perception on the functioning of ASHA‟s in the villages of South
West Khasi Hills District, Meghalaya
To understand the relationship between ASHAs and the community in the South West
Khasi Hills District, Meghalaya
ASHA functioning on their work
The ASHA, are well aware of their role and responsibilities in their villages but they felt
discourage since the Government do not support them fully.
Lack of government support- the ASHA felt that they do not get enough support from
the government. The hospitals were they are under give less importance.
According to, ASHA 4 “ we work so hard for the society and are doing all that the Government
asked us to do, to encourage institutional deliveries but what does the Government do to help us
nothing and sometime went we visit the PHC we feel so foreign we were being looked down and
talked rude”
According to, ASHA 3 “I don‟t know what to say….. Before during our trainings we felt so good
because the Government says that it will support us, but now…. We are helpless”
According to, ASHA 2 “I will tell you this……. Now we are so much with the private hospitals
but we forgot about the public health services the government see and know about this… but it
does not care that it will affect us”
According to, ASHA 1 “I am workinghonestly even though if I never get any support from
anyone…….. At least the government should give some respect to us and appreciate our work”
According to, ASHA 5 “it is very difficult……. If you understand…….me……. sometime we are
not allow to talk in the durbar, how do they expect us to function properly…. the Government
knowing that do not do anything to improve our work”
34
Less community participation- there is less in community participation the people in the
village since most of the people prefer the clinics and private hospitals in the city.
According to ASHA 1, “it is difficult to work in the village when there is no co –operation, when
I organize programme most of the women never come they ask me to come in the in the evening
because in the morning they are busy with their work, but by that time I have to be home for my
children, people were saying it is easy to work in the village but believe me it tough”
Lack of support from the family- the women in the society finds difficulty inworking
since there is lack of support from the family members, especially the married women find it
hard to look after their job and also their household work at home, they never get the support
from the husband especially if they are to talk in public and conduct awareness programmes.
According to ASHA 5,” I have two daughters and it is a problem for me to take care of work and
the kids at the same time”
ASHA 2 “I have a problem with my husband whenever I talk publicly, he never like me doing
this”
No salary- ASHA get their incentives only if they enrolled the pregnant mother in the
public hospital, they get a sum of 250 per pregnant mothers, but they feel it is a hard job and they
deserved to be given enough by the Government.
ASHA 3 said,” You see… I am poor my husband is a farmer we don„t has enough money to buy
house hold materials sometimes well….. I think you know more about us right? We do not get
money our work is really heavy”
ASHA 1 said, “They told us first that we will not get any money the salary will be from the
registered pregnant women”
35
Growing number of private health services- the respondents are facing difficulty
mainly because there is a rise in the private service people tend to go to these services they felt
that if there has not been any private hospital they would never have a problem in money.
According to ASHA 5,” You see now a days people prefer to go to Shillong for deliveries, they
all goes to Private hospitals if the Government do something we won‟t face any problem”
People’s perceptions
ASHAs are not available in time of need- the ASHA faced difficulty in going to villages she
covered 5 to 6 villages, with difficult terrain and bad roads it is difficult for to find her in times
the people find difficulty in times of need.
According to woman who has use ASHA service 1, “I find it hard when I need something from
the ASHA she was never at home; it is difficult to work with people from other village”
According to woman who have never use ASHA service 6, “ ASHA have visited my house once
but she never visit me again that was the last time, maybe she is busy with her work but it is her
job too”
According to women who have not use ASHA service 2, “I never go to ASHA… it is better for me
to go to Mawkyrwat itself than going her house since her village is in the other side of that….
Hill it is far for a sick person and is hard to go”
Prefer private hospitals and dias-most of the women in the focus group discussion prefer more
to go to private hospitals rather than going to the public, some are totally against the institutional
deliveries they believe that the
According to woman never use ASHA service 4,”we have PHC here doctors are not there they
only on the market days…….once a week…….. There are no medicines and no nurses too, so it is
better to go to Shillong stay there before the due date”
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Forced for institutional deliveries- some of the women prefer to go for home deliveries,
but with the institution deliveries the women felt that they were not encourage and being looked
down.
According to women who have never ASHA,1 “all my children were given birth at homeare
perfectly fine, but when they got sick people especially the ASHA and the ANM they says it is
because they were giving birth at home”
Dais perception
Not giving importance- the dais are not giving importance by the peopleor the
Government and it is sad to see that they are the last generation of the Dias community in the
village with their old age they feel that their skills will disappear from the society.
According to dias 1, “I was doing this now……. for a long time now, I start doing this
since….(pause) the Britishers were here”
No respect from the providers- the dias find that they being look down by the health
providers like the nurses the ANM and the Doctors they faced this when they refer some serious
cases to the hospitals the nurse will talk bad about them in front of them calling them not
educated and untrained and un hygienic.
According to Dais 1, “there is one time you see….. I had this girl she came to me for help….. I
could not do it, we took a local taxi went to the hospital….. when we reach there the nurse were
so rude and talk so rude to me as if I have make her like that, they are all so proud working with
the Government”
Does not talk in the Women Groups any more- the women groups in the society which
are supposed to look after the women in the village are all not interested in talking or try listen to
the Dias problems.
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According to Dais 2, “previously we are very strong and well respect in the society we were
giving chance to talk about health in the village during the gathering but now, the people trust
the strangers than a person from the village”
According to Dais 1,” they all forgot about health in the village and they us the elders there is no
more respect now the world is not the same… now they all after the people drinking and selling
alcohol no one talks about health in the gathering they all talks about how to get rid of alcohol”
Discussions
The study was conducted in five villages of Mawkyrwat block, Meghalaya, to understand the
functions and roles of ASHA (Accredited Social Health Activist) in the villages located in the
hilly regions. ASHA, a Traditional Birth Attendant and the women in the villages were included
in the study as well.
It has been found out that the ASHA are also facing difficulties in different parts of the country
also for instant, Kerry Scott and ShobhitShanker, (2010) Community Mobilisation
Supplementary Issue, study have found out some of the problems which are alike with the study
conducted but the difference is that the Dias or the Traditional Birth Attendance are not include
in the study conducted by Kerry Scott and ShobhitShanker.
The Accredited Social Health Activist (ASHA) in the hilly region are seen as the women with
wisdom the people that are able to work for the community and also have to take care of the
house work despite many challenges they are facing.
It also have found out that the women including the ASHA, the women and the dais felt proud of
being from a matrilineal society but what they were saying is that the people think that we are
free and do not have any problems but we are not allow to work we are expect to be at home.
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During the interaction with the ASHA facilitators she said that it is very difficult to work
especially when she have to deal with the higher rank like the BDO or the Doctor in charge in
the CHC, they look down on her because she is a differently able person.
The main thing which the research found out from the study is that the women who seen as
empowered women and educated women with the freedom from the society or the family have
difficulty in going to their work and more or less faced problems like most of the women in the
country in which they are not allow to go work outside the village and do not get their support
from their families or from their husband in case of married women when it comes to advocating
the people in the village they are being looked down by the husband.
The study finding was that the women despite being perceived as empowered faced several
problem; they were not allowed to work outside their homes, disregard from their spouses for
their advocacy work or even lack of support from their spouses.
Recommendations
Since ASHA are the change agents of the society the need to be strengthen, the Government
need to work along with them continuously.
Strategies should be taken to increase their incentives and encourage them in working for the
community.
The ASHA faced difficulties in covering all her villages especially in hilly rural areas so
Government should see that they are able to go to their own villages.
The Government Health Sectors should respect them and should work together with her even
though she works along with the Dais in her village.
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References
Kerry Scott and ShobhitShanker, (2010) Community Mobilisation Supplementary Issue
Swain Saraswati, Swain Pushpanjali, Nair K.S, NeeraDhar, Gupta Sanjay, NandanDeoki,
(2008) Rapid Appraisal Of Functioning Of ASHA Under NRHM In Orissa
Haider. S, AdhishVivek, Gupta Sanjay, DharNeera, DattaUtsuk, Menon. S and
NandanDeoki(2008) Arapid Appraisal of SAHIYA (ASHA) in Jharkhand.
Hagopian, Amy et al, Reaching the Unreached Rapid Assassment Studies of Health
Programmes Implemented in India
NRHM, ASHA manual book 1 and book 6
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I feel so blessed being a part of SOCHARA not just because of the light minded people here and
the things I learned from here, but their appreciation of me having many confusion, it is
surprising when people says that it is good to be confuse.
Before coming here I always hesitate about what I want to say or shared ideas I use to have that
feeling that people might not like it. But after coming here I do know where i got the confident to
talk whatever I am thinking, SOCHARA have change me a lot they always encourage us to talk
it does not matter whether it is right or wrong, a thinking of learning together is very nice here.
The session here has been helpful for me personally; it was here that I realize that
decentralization is very important and the term social determinants of health are also very
interesting. As a social worker we like to work on various issues that affect the society but we
never know that we are working on the determinants of health. The idea of equity was introduced
to me by Prasanna, we always talk about equality and equal distribution, equity is the last thing
that we would be thinking of doing for the community and when I come to know about it I feel
so right and true about the unequal distribution for equal opportunities.
The other things I get to learned here is accepting other view points and also being humble and
down to earth towards others. Being courageous to one self is also one of the thing that I learn
here.
I have completed my Master in Social Work, I always like working with the community and I
understand that even thought I am not good in writing or with studies I am always confident with
working in the community, I always want a person who would guide me and helping me which
way to go I never have that and I was scared that I would lose my interest and might not know
what to do.
Joining this fellowship is like a first stepping stone for me I did not have just one mentor but a
bunch of well qualified and light minded people who are and will always be there to help me.
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Community Health Learning Programme is the third phase of
the Community Health Fellowship Scheme (2012-2015) and is
supported by the Sir Ratan Tata Trust, Mumbai and
International Development Research Center, Canada.
School of Public Health, Equity and Action (SOPHEA)
SOCHARA
st
# 359, 1 Main,
1st Block, Koramangala,
Bangaluru, Karnataka, India – 560034
Tel: 080-25531518; www.sochara.org
- Media
Banri - Final report.pdf
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