Yashoda G : Learning from Collective Session and Exposure Visits.
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- Yashoda G : Learning from Collective Session and Exposure Visits.
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2014-2015
2015
Community Health Learning Programme
A Report on the Community Health Learning
Experience
Yashodha G
COMPANY
555-543-5432
5432
www.yourwebsitehere.com
SOPHEA
1
Community Health Learning Program
Jan 2014 to Jan 2015
A Report on My Community Health Learning Experience
Yashoda Ganiga
Community Health Fellow
2
Contents
Sl. No
Particulars
Pages
1.
Acknowledgement
3
2.
My Ongoing Journey
4 -5
3.
Why I wanted to the community health fellowship
6
4.
My Learning objectives
7
5.
Learning’s collective session and exposure Visits
8 – 20
6.
Learning’s from field visits
21 – 25
7.
Appendix and Photos
26 – 28
8.
Research Report
29 – 45
9.
My Learning’s from SOCHARA
46
10.
Reading list
47
11.
Reference
48
12.
Photographs
49 - 50
3
Acknowledgement
First of all I would like to express much indebted thanks to my parents, family
members for their encouragement and support to complete this fellowship
programme.
I would like to thank full to JEEVA PROJECT team for their encouragement
and support to complete this fellowship programme.
I am heartily indebted to Dr. Thelma Narayan and Dr.Ravi Narayan and
Mr.Chander and all other SOCHARA members for providing me an
opportunity.
I thank Mohammed, and Kumar KJ, Sabu, Dr.Rahul for the sharing their
wonderful experience with us and for always being there to guide us.
I thank my field mentor Dr. Manohar Prasad Swami Vivekananda Youth
Movement (SVYM) Sarugur Mysore district. And Dr. Bhagyalakshmi (SAKHI
Trust, Hospet Taluk) and my team mentor Mr. Prahlad for their guidance during
my field work
The SOCHARA library (CLIC) and librarian Mr. Swamy who have been of
great help to me for my reference and studies during my CHLP.
I am heartily thanked to Nagenahalli Danapura and Hanumenahalli Asha
Workers and other community members who has been rendering their full
support to the end of this my research project.
I Thank My all co- fellows the wonderful time we’ve had together, teaching me
a very valuable lessons and sharing their journeys with mine.
4
My ongoing journey:
I was brought up in a middle class Hindu tamilyan home in Darooji village of
Bellary Dist. Darooji my ground mother home, but native is Hulikere village
Kudligi taluk, Bellary Dist. My father is a Farmer, and mother home maker, and
I have one elder brother, elder sister and one younger brother. We are happy in
our village set up.
I did primary school in village, that time in my village and I went to
Kanamadugu village for my 10th, PUC and BA this village near to my village 4
km distance. During my studies from Primary school to PUC I was interested in
studies and I failed in my PUC exam and started learning tailoring and was
interested to create new design on tailoring. When I had discussion with my
parents about continuing tailoring they suggested continuing my education with
DEd training. As I was not that much interested in teaching field after in passed
PUC with first class marks I was joined Bachelors of Arts. During my BA. 1st
semester I got good marks in class room, my family members were very happy.
That to my father. When I saw my father happiness I decided to continue my
education with the aim of becoming a good teacher. But during my graduation
one of our senior spoke about the Post Graduation Social Work (MSW) . After
my graduation I stated learning Tailoring because I was very much interested in
tailoring profession. But when I got results I was passed with the distinction and
my father and other family members were very happy and with the support and
suggestion from my father I joined MSW course from Gulbarga university PG
centre Nandihalli. .
Nandihalli is a village where I studies my MSW. During our studies on MSW
we had lot of problem because of lack of proper guidance from the faculty on
studies and research related activity but with the support from seniors and other
we completed our MSW.
5
After my completion of Post graduation I joined Myrada NGO where I use to
travel two hours to reach organization to do work and I have to Change two
buses to reach the office I was working as a community organiser, here saw
different field area and I learnt differences between MSW field and working
field areas, starting one or two months field work was difficult for me. I
completed six months in Myrada project and then I joined JEEVA Project.
Jeeva Project: I was worked as a FRA (Field Research Associate) from 20th
Jan 2012 to 31st Jan 2014 In JEEVA Project under Mahila Samakhaya
Karnataka (partner NGO) Kudligi Taluk Bellary Dist. Through Jeeva project we
working at five areas Kenchobanahalli, BAnavikallu, Hurulihal, Ayyanahalli,
Chikkajogihalli Tanda, worked with Mother and Child, mainly Dai surveys,
before joining was not aware of hospital deliveries, home deliveries, pregnant
time celebrations, after Dai roles, and two time I observed hospital deliveries
that time nurses behaviours, sometimes they used bad words, at the time what I
felt in my delivery time I never go hospital, delivery time is a rebirth for every
women’s, they have that much pain, after delivery mother she is a happy
because reason for child, and I had a wonderful experience working in this
project.
6
Why I wanted to do the community health fellowship
Before I start writing on “Why I wanted to do the Community Health
Fellowship” so I wanted to something about why to joined for community
health learning programme, we are four members in our family, now My father,
mother, younger brother is a student and me, my elder brother he went separate
family. I saw my father in my childhood he worked hard for our family. I want
do help for my father. I did my MSW and I joined work Jeeva project three
years project only. whenever I got this information January 2014 CHC class
will be started, my project March 2014 project closing date mail is came our
office, so one thought came in my mind after closing this project what do, I
want search job otherwise I want do this fellowship programme like this, full of
confutation in my mind. I don’t have that much information about this
fellowship. At the time I discussed with my co worker and our senior fellow
Savithri 2005 batch, and all Jeeva team members so they said you do CHLP
fellowship programme, all are told positive things only about this CHLP.
So I thought so I strongly believe this fellowship is more useful for me for
getting knowledge in the community health sector and future this is help full for
me for dedicating my community, with utilization of knowledge and I will work
with our people regarding health problems. So this is the main motto to me to
join this fellowship. I was keen to learn about Community health because I am
from social work background some way it related to social works in the way to
serve but the strategies and approach to the community health.
7
My Learning objectives
To learned about the whole process of this CHLP
To learned about the community
To Understand the NRHM goals and frameworks
To Understand about the different field area and their problems
To learned about the level of Health Care services
To Understand the social determents of health
8
Learning from collective session and Exposure visits
After being selected for the Community Health Fellowship programme In
Community Health Cell Bangalore,
B
my first session was started Ravi Narayan
sir class. This is one year fellowship programme,
programme, during this time we went
through the various aspects of Health, Public Health, Community health,
primary health care services,
vices, the people health movement, and we also went to
the field to visit various programs
programs.
Health
Public
Health
Community
Health
Health –Health
Health is a state subject. Is not only the absence of the disease, but
well being of social, economical, culture, political, spiritual, and mental
conditions
Public Health: Is whatever the services are providing by the government.
Like sanitation, water for daily use, light, housing,
housing, safe drinking water,
employment,
ployment, primary health care, act.
act. Concerned with the public health. This is
the prime responsibility of govt. To assure all of these services for community.
It is the organized of a society for health through government, voluntar
voluntary
organizations and civil societies act.
9
Community Health:
Dr. Ravi Narayan took session for us is a process to the community to take up
responsibility in providing services for their own health, and demand health as
their fundamental human right
In this process of Community Health, communities come together, set their
priorities, demand for services according priorities, and after getting it, they take
the responsibilities to monitoring it. These services cloud be education, primary
health care agriculture, sanitation, safe drinking water, etc.
Primary Health Care:
Is many peoples, organization, and institutions were working for primary health
care (basic health care) by 1970’s besides the definition of WHO on health after
the Alma-Ata the idea of Primary Health Care came as a revolution.
In the Alma Ata (1978), primary health care defined. It recognized the
limitations of the medical science and emphasized the need for equity and social
justice in health care services. It emphasized the greater decentralization and
involvement of local habitants in decision making, planning, implementation,
10
and monitoring of health care system and services, according to the social
economical, political and cultural condition
Health System:
Dr. Thelma madam took session for us Health system comprises all
organizations, institutions, and resources devoted to producing action whose
primary intent is to improve health. She explains to the three levels of health
services primary level. Primary level is (PHC, CHC, Sub centre) Secondary
level Tuluks, District hospitals and thirdsery level super speciality hospitals
different between three level of hospitals this session I got clear idea about
health system .
Effects of globalization on health:
Mr. Prasanna took session for us. Globalization has brought along with it
industrialization, and consumerism. One sees that a number of people have lost
their jobs. Recently due to recession and it is easy to understand its impact on
mental and emotional health. This has had an adverse effect on the economic
situation, throwing life out of gear. Globalization has not only affected health,
but social, political, culture, agricultural system as well.
Monsoon Game:
Dr. Aditya he took session we had Monsoon game. The monsoon game made
me realize, though we say or belief that fight with situation, come out social
barriers ,and bindings, a simple game taught me how difficult it is to fight out
the social norms, the structure, the power plays, the rules. Poverty,
marginalization does not allow you to question. But game thought me if one
does not question the norms, the norms would always oppress only a section of
society. The role play as one of the farmer family and the situation, which was
the put forward for the game, was extremely unjust and is very much faced by
11
farmers in real situation also made me realize the daunting difficulties which the
farmers has to overcome.
Social exclusion:
Mr. Sabu took session for us several social groups exclude based on cast class,
gender, and lesbian, gay, homosexual. They have their own health problems but
feared by disclosed identification, keeping them on lagging behind health. Busy
social lives due to both working partners in the nuclear families have bad effect
on mental health of the child.
These challenges can be overcome by only community building, and through
community building various activities can be carrying out to get the solution of
health problems. It must be clear in mind that we are not against the
development, but it must be on the cost of poor people, we can’t think of
development with any part of the community. Only together we can realize
development.
Qualitative Research:
Mr. Sabu took the session for us he talks about qualitative research is a new
leaning because in my MSW part we had qualitative research but at the time I
didn’t get clear idea about qualitative research. This fellowship in research class
I learned the qualitative research is more useful to know the in deapth interview
uncover the deeper incidence, insight story, we can get into stream of conscious,
empathetic understanding and good relationship with respondents. And focuses
discussion is another way to know the problem of the community and get the
way as to where exactly the problem lies and how to tackle with the problem.
12
Quantitative Research:
We had a session with Mohammad sir on quantitative research he explain
research do not arise when there is one solution
solution to the problem. Quantitative
research is classified into survey research, correlation research, experimental
research, causal comparative research. Quantitative research the sample size is
and yet we can get lot of information from the people end anal
analyzed it later for
knowing the problem at the grass root level.
Anubhava Series:
Rangabelia Comprehensive
rehensive Rural Development
Project” (RCRDP)
Really I like this project RCRDP started in the year
1975-76 by Tushar Kanjilal Padmashree as a
programme director. This is related empowerment
concept. Here they started women’s Industrial
cooperative society, Women’s training cum production center, Gram ssanghatan
this only. Before reading this Anubhava series so many thinks I don’t know
after reading a was understand different aspects of work expels Agriculture,
Agro services, Mahila samity and special collaborative programs. In my MSW
part I didn’t read this type of book.
13
Occupation Health:
Dr. Aditya took the session for us to understand occupational health has created
several determinants of health, including rick factors from their work place like
it leads to circulatory diseases, accidents, respiratory diseases, communicable
disease and others. Causes for diseases. People working in chemical factories
has also bad health condition because they never take protection to cover
themselves when the gas is tested and the waste coming from the industries is
affecting the people in general through water or air.
Communication:
Mr. Krishna took the session for us in BA and MSW part I had this
communication class but this Krishna sir class very different he didn’t use
power point, block broad he did different way of the class two days we did
sound
communication,
action
communication,
activities
and
gdrams
communication every person having different type of skills sometimes this class
we all area participate all activities we had really very good class.
Alternatives:
Dr. Shiridi Prasad took the session for us he explain about the Alternative is the
fast, advanced, Scientific, this alternative easily available but allopathic is a not
scientific. History of hospitals this related to the Gowthama dudda and Jeevaka
story also.
The health components of alternatives much has been written on
many of them and hence giving a detailed list of sources would suffice what is
more important, however, is to identify the broad components of the care
emerging in these alternative.
14
An attempt to
integrate Health with
activities
Components of
Alternatives
Increasing
Community
participation
Search for an
appropriate
technology
Initiating community
organization
Preventive and
Promotion
Orientation
A quest for financial
self-sufficiency
Promotion and
utilisation of local
resources
Education/ or
health
Training of village
Conscientisation and
political action
based health cadres
15
Learning’s from Exposure visits and Workshops
Rajendranagar slam:
We visited to the Rajendranagar slam this my first urban visit before going
usually slums I have seen only television and movies and heard lot about it, I
was extremely excited to go for a slum visit and get to learned so much from the
and their living condition. In this slum we did PRA social mapping and we
collected slam information peoples help to us for our work, we don’t know
about that area history, total families, and area facilities and problems when we
did PRA at the time we know about the slam and some of the family last 30
years living this slam only and some of them peoples they don’t have
Permanente houses but no documents also. All caste peoples living with tougher
no centesimo slam peoples they celebrate all festivals Hindu, Muslim both.
There is peoples going government and private hospitals for treatment they feel
private hospitals provide better treatment they sending more money because
service the good. This slum is a mixed community of Tamilyan and Kannada
people are living in this slum.
Snehadan Organization:
This Organization work with the people living with HIV/AIDS, our day visit
have taught me a lot on about HIV/AIDS. Learned on how the organization take
care of the people suffering from HIV provide them medical treatment plus
healthy food and room for them to stay. I really empathize to the people who are
living with a dreadful diseases and maximum of the patient said they got it from
their partners, they are being rejected and isolated from family and friends,
thrown out of the houses which is very painful of scenario if think about. But
still they love their life and each children’s have aims and goals it is really a
positive side to feel about it gives me hopes to on how to live a wonderful life.
16
Vimochana:
This organization started by 1979. Vimochana has been working with the
vision of the making violence against women unthinkable and creating a
violence free world for all. Vimochana organization activities Campaigns,
Community support groups, net working, and vision of women. Vimochana
mainly working with women’s this helpful for women’s resistance to violence
both within the home and within communities, culture and political. To make
families, communication and the state responsible for and responsive to the
growing violence against women. To create alternative spaces and for a public
debate and dialogue to bring about attitudinal and institutional changes on our
society discriminatory attitudes towards women. To make visible the deeper
connection between increasing violence in the personal sphere of the home and
the increasing brutalization of the lager public policy.
SEVA IN ACTION- (SIA)
Is a voluntary Organization working in since 1985, working with disabilities.
Developing an inclusive society which value the abilities. SIA is working with
Community Based Rehabilitation program integrated and inclusive education
program, training in disability areas and inclusive education besides working
with government system. Seva In Action has resources centres in Bangalore
Rural and Ramanagara district in partnership with local communities, families
and people with disabilities. The services conducted in the centre- Early
Intervention, medical Rehabilitation, Home based education, Vocational
trainings, formation of parents group. Rachana- Skill development unit and
enterprise, National Trust, Research and dissemination. We some met they all
are physically disabilities but they are not disables because all are have different
skills. What I felt we are all also disabilities no one not perfect.
17
Association of People with Disability (APD)
We visited the APD. Working with disabilities, this one the community based
rehabilitation, centre. And education based rehabilitation centre also. Here I
observed
different type of disabilities
Childers with locomotors, hearing
impair, speech impair and some children mental illness at the early stage of life.
There were more mentally retarded children in the school. They providing
formal and informal trainings. Their focus Health, Education, livelihood, social
and empowerment and Bangalore, Davagere, Kolar, Bijapur, Chittamani,
Ramanagara working in different area. Some kids spoke with us they talented
and they helping nature also one disability child he helped to other disability
child, whenever I saw in APD really I felt we are not real human beings,
physically we are not disable peoples but mentally and some other way we are
disable peoples.
FRLHT (foundation for Revitalisation of local Health Tradition)
We visited the FRLHT, this organization focus on the local traditional practices,
nowadays went with allopathic medicine but Ayurvedic, home remedies only.
Here observed so many Ayurvedic plants only separate garden is there, herbal
medicine related books there in library. FRLHT are basically acting on few
themes which are given below : Conservation of natural medicinal resources
Information technology and traditional knowledge
Bridge between traditional knowledge and science
Scientific repositories of natural resources
Revitalisation of folk healing system, research hospital, Botanical
repository, scientific research, clinical services, rural livelihood.
18
I sent one day at FRLHT where the focus was on ayush. Here I learned how
important the local herbal medicine is. In a family some herbal plants can be
planted and this can be a source of remedy for some disease like cloud, stomach
pain, vomiting, diarrhea, skin problems all this medicine our grandmother
medicine.
KAIROS:
“Kannur Association for Integrated Rural Organization and Support”
Is a Social Services Society. It started its independent involvement in 1999.
The area of operation covers the more then civil disnstricts of Kerala Kannur
and Kasaragod. Kairos working with Dalits, Kairos collaborates with many
developmental agencies through planning and extension of various programmes
of government and Panchayat raj institutions. Organization doing many
developmental activities, environment, water and sanitation, watershed
management gender and development, and conducting HIV awareness
programme. Useful so this visit very for me because we don’t other state
community activities and Kerala visit I observed lot. Here we had different food
and housing types, compare to man’s women’s education is high.
Shanthi Pain and Palliative Care Society Kerala:
we visit the Shanthi Pain Palliative Care society this is community based
rehabilitation centre, and working with chronically ill, bad ridden, and incurably
patients, such as cancer, Paraplegia, HIV, PVD, CVA, Psychiatry, kidney and
old age peoples. The society has three teams one lead by a doctor, the other by
nurses and volunteers and third by community volunteers. The society run an
outpatient clinic at the kalppetta, the clinic not only provides medical treatment
for but also extends social psychological and economic care. We are community
health fellows but sometimes this organization related our work. This visit I
understand different between NGOs.
19
Work shops
Topic - Access to Toilets, Gender, and Mental Health perspective’
organized in Bangalore from September 18-9-2014 To 19-9-14 first day we did
welcome address followed by the self introduction done by the all participations
organization here first session Nagaratnna bhat she took Nirmal Bharath
abhiyana concept, Aim off the NBA and objectives and total budget of water
and sanitation. Here she explains about the House toilets, Anganawadi toilets
and school toilets and sanitation personal toilets important of toilets we discuses
about the waste management. Government only not responses NGOs and
community peoples responsibilities. We had Argam session, Prahlad took the
“Millenniums Development Goal” he explain six main goals. And Dr. Thelma
took session about the Access to Toilets women’s Health and Gender Issues this
we disuses some fundamental questions this related women’s health status and 7
to 8 organization they sheared works and experience. I understand what are the
challenges facing the community this workshop I got clear about toilet, gender
and how to affecting its mental health.
MFC Meeting:
I am starting the very first day of the orientation class about Medico friend
circle. Ravi Narayan sir took the session at the I am in wrote an only the
Important points that I notated during the session. This session begun by
providing the basic meaning of the MFC and Dr. Ravi Narayan sir explain about
MSC and the existing of the health care, we have realized, is not geared towards
the needs of the majority of the people, the poor. The sessions gave me a
deeper understanding what is MFC and goals and activities. But I didn’t
attended the MFC this is good an opportunity for me.
20
Medico friend circle 2014
Topic – Mental Health
Medico circle annual meeting (41th) organized in Hyderabad from August 8th to
9th 2014. On first day we did welcome address followed by the self introduction
done by the all participations.
The theme of the MFC meeting is about the Metal health and the topics
discussed during the meet are
Rights and care of the mentally distressed
Experience sharing of basic needs India
General practice, and mental health
Global mental health movement and alternate forms of care
Community care initiatives
Addictior, from caste and tribal perspective
LGBTQ and perspective on mental distress
Psychotropic drugs from a pharma activism perspective and other insight,
ideas for meet
Cares perspectives
Statement on ECT
In MFC meeting I observed that the intellectual people who were present there
were enthusiastic and how responsive I debating on the topic and different
issues relating to mental health.
21
Learning from Field experience
Swami Vivekananda Youth Movement
Movemen (SVYM)
My first field work I want Swami Vivekananda Youth Movement Is located at
Sarugur Mysore District. And my field are was B. Matakere Sarugur taluk
about 18 km. history of SVYM. Inspiration of SVYM, Vision, mission and
values
Background of the Organization
Swami Vivekananda Youth Movement (SVYM) is a
registered
non
Government
development
Organization. Started in 1984. by a group of medicos
inspired by the teachings and national ideals of swami
Vivekananda. It working in the sectors of Health,
Education,
Community
development,
training
research
ch and advocacy and consultancy services. 80
Bedded Hospital in Sarugur and 15 Bedded Hospital
in kenchanahalli. This organization focuses by the
Tribal Communities in tribal
tribal community four types Jeenu Kurubas, Betta
Kurubas. Soliga and Arava. It is working in the sectors of Health
Health, Education,
Community Development, Training, Research and Advocacy. And Consultancy
Services. Our Inspiration-Swami
Inspiration Swami Vivekananda & Mahatma Gandhi
Gandhi,
Our
Vision- A Caring and Equitable Society free of deprivation and strife Our
Mission- To Develop and facilitate processes that Improve Quality of life of
people. Four Values of SVYMSVYM Satya-Truthfullness, Ahimsa
Ahimsa-Non Violence,
Seva-Service, Tyaga-Saerifi
Saerifice
22
Objectives:
To address the unmet health needs of the community
To familiarize the community with various government schemes as well
as various health, education and development related services of Swami
Vivekananda Youth Movement
Leaning from
To undertake, and collaboration Behaviour Change Community activities
in order to catalyze demand generation in health, and contribute to
positive behaviour change
Learning’s
I learnt participatory skill and communication
I understood non adjust mental attitudes
In group discussion we got a clear idea about community problems and
facilities
I learnt Haadi people’s attitudes and their culture
I learnt the difference between tribal and non tribal's
Reflection:
Swami Vivekananda Youth Movement Really Community based hospital. This
SVYM working in the sectors of Health, Education and community
development. They running community related projects Arogya Vahini
Nairmalya Vahini, Vatsalya Vahini Chaitanya Vahini, SEEP (Socio, Economic,
Empowerment, Program) Diabetic Project.Before going field I don’t know
different types of tribal’s, they language. SVMY conducted Health camps,
street plays, role plays, programs in tribal area 30 years back tribal’s they don’t
know Hospital, institutional deliveries, now they aware about Institutional
deliveries. Tribal another word Haadi, first time this field work I heard about
this word. And two times we visited MHU(Mobile Health Unit) here we saw
23
tribal areas, tribal peoples they don’t have proper house sing facility
facility, drinking
water
er facility, and main toilet facility. At the what I felt lack of awareness, lack
of education.
Learning’s Second Field SAKHI TRUST
Background of the Organization:
Sakhi Trust works among youth in the
Hyderabad-Karnataka
Karnataka (HYKA) region which
comprises of six districts of Karnataka – viz.
Bidar, Gulbarga, Yadgiri,, Raichur, Bellary and
Koppal. The HY-KA
KA region is
the most
backward part of Karnataka in terms of human
development
indices.
The
Nanjunadappa
Commission Report (2003) submitted by the
High Power Committee to Study Regional
Imbalances constituted by the government of Karnataka has sketched in detail
the aspects of the backwardness of this region.
This region stands out as a single unit and shares a similar socio
socio-cultural and
economic stream due to the fact of being ruled by the Nizam of Hyderabad for
over 400 years and got liberated from the Nizam only in 1948. The neglect of
youth, especially in education
education and employment, is highlighted in the report
report.
Sakhi is a youth Resource Centre working for enabling the human resource
within youth in Hyderabad Karnataka region with a specific focus on the girl
students of vulnerable communities. Dr. Bhagyalakshmi, who had finished her
doctoral studies, initiated this centre as a part of the SAMVADA
SAMVADA youth program
and took up the challenge of working since 2002 for enabling girls to become
important human resource for their own empowerment and the development of
the region.
24
The important objectives:
1. Empowerment of women , children and youth affecte
affectedd by economic and
social exploitation
2. Promotion of education of youth particularly young women’s
3. Supporting the higher education of girls from vulnerable co
communities for
their empowerment.
JMS (Mahila
Mahila Jagrutha Sanghatan Raichur dist)
dist
In second field work we went to Sakhi Trust at
the time three days we visited JMS Raichur
organization conducted Women’s valance work
shop. so we had two sessions related Gender
issue and women’s Education and we selected
Amareshwara camp and did toilet surveys and we
identified using
ng Non using toilets and cause.
cause This
is a women group working on empowerment,
savings and livelihoods. The women are from the
lowest rung society – Dalits.
Dalits Hence they had
been the most oppressed lot. Through JMS the women have become aware of
their rights, they publicly protest incidents where women have been abused,
have brought better roads to the villages and also sanitary toilets. They are also
becoming economically empowered through lively hood initiatives like
terracotta jewellery, herbal medicines and Neem seed fertilizers. Living with
them for few days was a great opportunity to learn about their lives, the issues
the women face, how JMS has empowered them and how the health care
facilities are functioning in their area.
area
25
Learning’s
o learnt about tucation profile method
o I understand about school dropout children’s different types of causes
o In second field work we collected district profile our own district I don’t
know but I got clear idea about district level sectors
o I learnt primary, secondary and tertiary prevention of health care services
o I learnt PPT report writing skill
26
Appendix 1: Acronyms
CHC – Community Heath Cell
NRHM – National rural Health Mission
NFHS – National family House Survey
NRC – National Rehabilitation Centre
NRLM – National Rural livelihood mission
NBA – Nirmal Bharath Abhiyana
ACHAN – Asian Community Health Action Network
SAP – Structural Adjustment Programme
IMF – International Monetary fund
DALY – Disability Adjusted life years
PHA – People Health Assembly
CSDH – Communication on social determinants
LPG – Liberalization, Privatization, Globalization
PHC – Primary Health centre
CHC – Community Health centre
NGO – Non Government Organization
SEPC – Social, Economical, Political and Culture
IPHS – Indian Public Health Standard
VHSC – Village Health Sanitation Committee
27
NSSO – National Sample Survey Organization
CHAI – Catholic Hospital Association of Indian
CSU – Central Service Unit
WHO – World Health Organization
WB – World Bank
ICE – Information Community Education
UIP – universal Immunization Programme
TRIPR – Trade Related Intellectual Property Right
CDC- centre for diseases control
NCPHI – National centre for Public health information
NEPHT - National Environmental public Health Tracking
KIDROP – Karnataka internet Assisted Diagnosis Retinopathy of Prematurity
WHP - World Health partners
ICT – Information Communication technology
GOBIFF:
G – Growth Monitoring
O – Oral Rehabilitation
B – Brest Feeding
I – Immunization
F – Female Education
F – Family Planning
28
KAIROS Visit
SHG Meeting
Tribal’s Meeting
Group Discussion
29
PART –B
RESEARCH
30
Title:
“A Study on the Barriers affecting the functioning of ASHA
Workers in Danapura, Hanumenahalli and Nagenahalli
village of Hospet taluk”
Introduction:
ASHA Worker program in India
The National
Rural Health Mission (NRHM) lunched by
the
government of India in April 2005 has laid out an important agenda to
systematically invest and improve the quality of primary healthcare in rural in
India, especially based women health volunteers to be known as Accredited
Social Health Activists( ASHAs) The ASHA has re-focused attention on a long
history of community health worker initiative and challenged to state
governments and civil society innovators to facility and sustain community
mobilization for health on a large scale across the poorest regions of the
country.
Accredited Social Health Activists (ASHAs) are community health
workers instituted by the government of India’s ministry of Health and family
welfare as part of the mission began in 2005 full implemented there is to be an
ASHA in every village in India, a target that transtsates into 250.000 ASHAs in
10 states. The grand total number of Ashas in India was reported in January
2013 to be 863.506.
The sub centre is the most peripheral level of contact with the community under
the public health infrastructure. This caters to the population norm of 3000 5000. The worker in sub centre is an ANM who is directly involved in all the
health issues of this population, which is speeded over the wide area of many
kilometres and covering 5 to 8 villages. Many a times the villages are not
connected by public or private transport system making her more difficult to
31
achieve the objectives and goals of providing quality health care for the poor
and oppressed sections of the society. So the new band of community based
functionaries, named as Accredited Social Health Activist (ASHA) is proposed
in the NRHM who will serve the population of 1000 and 500 in hilly and desert
terrene.
ASHA is the first port of call for any health related demands of deprived
sections of the population, especially women, children, old aged, sick and
disabled people. She is the link between the community and the health care
provider.
Department of Medical and Health at State and at Centre is looking at ASHA as
a change agent who will bring the reforms in improving the health status of
oppressed community of India. The investment on ASHA will definitely result
in to better health indicators of state and at large the country.
ASHA worker program in Karnataka
As part of the National Rural Health Mission, recruitment of rural health
volunteers called ASHA (Accredited Social Health Activist) has been functional
since 2007 in Karnataka. Along with the Karnataka State Health Systems
Resource Centre (KSHSRC) and the Department of Health & Family Welfare
(DoHFW) of the Government of Karnataka (GoK), we undertook an evaluation
of the ASHA programme using a mixed methods approach (quantitative and
qualitative research techniques) to understand the ‘functionality’ and
‘effectiveness’ of ASHA workers in 3 districts (Chamarajanagara, Kolar &
Haveri) in Karnataka. By studying the healthcare workers and community
beneficiaries, we identified their primary role as link-worker/facilitator, and to a
lesser extent as that of health functionary and as social activist. We also
identified several strengths and opportunities for enhancing the program in the
continuum of care that they offer to mothers, children and families through
32
antenatal care, safe delivery, postnatal care, early childhood nutrition & care,
routine & sick child care, care for common communicable diseases, and family
welfare.
I want to study with Mariyamanahalli and Nagenahalli village Hospet taluk,
Bellary District
Rationale:
In India one of the biggest challenging today is the dismal state of social
determinates of health leading to increasing health inequity. The National Rural
Health Mission in 2005 NRHM is accepted as an example of comprehensive
primary healthcare with Accredited Social Health Workers (ASHAs) as one of
the main components. The maintains are women volunteers and the maintain
programme aims to undertake family level outreach
services community
organization building and mobilization on health and its determinants along
with advocacy for improvement in the health system in India. AHSA workers
faced, socio, economic, political and service related factors and barriers in
community this research hope to fill this gap to a small extant by giving
insights into to the process including challenges and facilitating factors this
research will also be useful to current ongoing on the future role of the in both
maintain ASHA worker programme.
Aim of the Study:
The study aims to understand the Barriers affecting the functioning of ASHA
Workers in Danapura Hanumenahalli and Nagenahalli village of Hospet taluk
33
Specific Objectivities
1. To understand the roles and responsibilities carried out by the ASHA
Worker
2. To identify the barriers affecting Ashas worker
3. To assess community’s perception about Ashas roles
4. To identify the Health System Response to ASHA functioning
Research Design
Type of Study – Descriptive Study
Method of data collocation – Explain the mixed methods
This study will be mixed method using a Quantitative and Qualitative methods
for data collection.
Quantitative: Quantitative research is the numerical representation and
manipulation of observations for the purpose of describing and explaining the
phenomena that those observations reflect.
Definition: `explaining phenomena by collecting numerical data that are
analyzed using mathematically based methods (in particular statistics).'
-By 1994Creswell
Qualitative: ‘Qualitative Research…involves finding out what people think,
and how they feel, what they say they think and how they say they feel. This
kind of information is subjective. It involves feelings and impressions, rather
than numbers’
34
Sampling
I have selected 8 ASHAs from two villages (Mariyamanahalli, Nagenahalli) in
Hospet taluk Bellary Dist.
Community peoples
2AMS
2 medical officers
ANALISYS:
General Information of ASHA
Family
type
Number
of
children
Education
SC
(Harijana)
Joint
1
SSLC
6
Hindu
SC(Harijan
a)
Joint
3
SSLC
6
Unmarried
(Deevadasi)
Hindu
SC(Harijan
a)
Joint
2
SSLC
6
Married
Hindu
OBC Lingayat
Nuclear
2
PUC/ ITI
4
Joint
2
PUC
6
Age
Marital
Status
Religio
n
Caste
Respondent
#1
28
Unmarried
(Deevadasi)
Hindu
Respondent
#2
25
Unmarried
(Deevadasi)
Respondent
#3
27
Respondent
#4
31
Respondent
#5
35
Respondent
#6
37
Respondent
#7
39
Respondent
#8
Married
Married
Musli
m
Hindu
OBC
Nuclear
3
PUC
4
Hindu
SC(Harijan
a)
Nuclear
2
SSLC
6
Hindu
OBC
Joint
2
PUC
6
Married
30
Married
Work
Experience as
ASHA
35
To understand the roles and responsibilities of the ASHA Workers
The number of year’s experience of respondent as Asha worker ranged from 6
years to 4 years Asha worker in the community. Most of the respondents said to
major role and responsibilities
Role: ASHAs is considered to be a healthcare facilititator and provider of a
limited range of healthcare services. Health rights would be integral her work
and would be focused in the areas of community mobilisation to improve health
status, access to services, and promote peoples in health programmes.
Responsibilities:
motivating women to give birth in hospitals, Bringing
children to immunization clinics, encouraging family planning, Treating basic
illness and injury with first aid, keeping demographic records, improving village
sanitation. And then other
roles after
delivery seven times PNC visits,
providing tablets for community peoples, Blood smear, identify the HIV and TB
patients and follow up, conducting Mothers meeting monthly one times,
Nutrition food for mother and child, mother card entry, maintain the ANC and
PNC registers, control the communicable diseases and larva survey.
Our responsibilities in community Identify to TB and HIV cases, Pregnant
women’s checkups,
TB and HIV, Follow ups,
health
related surveys,
Hospital deliveries, Awareness for government scheme, after delivery PNC
visits, mother and child health care services, provide to tablets, iron tablets for
pregnant women’s, control to communicable disease and immunization clinics.
“Shilpa ASHA Worker said (Name changed )
36
To identify the barriers affecting Asha worker Role
Family:
The numbers of the respondents suffer due to family commitments and their
job and gender identify
then family restrictions therefore ASHA Workers
faced more problems while going Night time delivery cases these follows.
Education of the c Children’s: Usually ASHA workers mine problem
children’s education and before joining this work some of the respondents they
did evening tucation class for their children’s and whenever joined this job any
time busy, they don’t have free time, they can’t consternate to the children’s
education, and carrier and in exams children’s got less marks. And if comes
night time delivery cases that also big problem because some of the Asha
workers having one year, two year, five month children’s also so at the time
they can’t go live children’s.
Elderly peoples: Most of the respondents living with joint family. In that
family elderly parents, father in low and mother in low also so they elderly
peoples usually evening time they can’t see. They can’t do any work, and
cooking. Woking place and home same place ASHAs they can manage but
some of the ASHAs they have different field area so evening time if Ashas
comes to the home that elderly peoples scolding and they get angry.
Yes ma not any time sometimes family, I am livening with father mother they 60
-70 years old my children’s also 7 and 4 years. My parents evening time they
couldn’t see because they elderly peoples, If I come late they shooting me, why
late, who make cooking, we do that work, we cont see evening. “Roopa ASHA
worker said” (Name Changed)
37
Low Income (Deevadasi) usually all respondents suffering from money
problems. some of the Asha workers they did tailoring training if they have free
time at the time they doing tailoring work, agriculture land labour work and
some of the respondents they don’t have husband so there are community
deevasis this deevasis having a many problems, elderly parents, they want
manage children’s education. but this job they didn’t get proper monthly salary
also so respondents do tailoring, land labour work, Deevadasi work.
Non supporting: Most of the ASHA workers having a family non supportive
problems. Ashas they can manage all problems but Night time delivery cases if
they go late night and if comes late at the time family Mother in low and father
in low they will ask more questions and night time don’t go outside, this is not
good some of the village peoples say something’s, Muslim community they
can’t allowed night time for women’s. We can’t sleep properly, you didn’t
monthly salary, left it job, if you do land labour work you daily got 200 to 300
rupees, and sometimes husband also he will ask where is your salary at the time
husband also scolding them.
“Yes in my family they can’t allowed out said in my childhood, college days
also I didn’t go any ware, when I was finish my colleges studies I was married
immediately after marriage also I didn’t go coli, and my land works. But when I
joined this work night time delivery time if I go with cases at the time my
husband and our parents, they shooting me don’t go night like this. But I want
go wok because our father and mother 60 years old, my father he can’t do
works, my only he dork that is not sufficient”. Swetha ASHA worker said”
(Name changed)
38
Domestic violence: In my interviews I found due to Domestic Violence takes
place by the middle age ASHA. Normally it is difficult for her, he is drunker, he
can’t do any work, if she attending night time delivery at the he where did you
go outside, you don’t go this job, and you have relationship with others her
husband having a doubting for this women. Sometimes he was biting to the
children’s and wife.
“my husband also drunkard he didn’t living me what to do, when I joined this
he beating, shooting me he have, dough ting staring If I go night time delivery
cases why you’re going night time outside you have relation someone, you are
not my wife go like this every day he was beating me” Ratnamma ASHA worker
(Name changed)
Community:
Gender: all most all respondents having gender discrimination problems this is
main affected to Motivation skill. Because in community peoples all are don’t
have same attitudes. ASHA worker they can manage ANC and PNC cases but
they can’t manage TB and HIV patients, because they can’t go hospital, they
can’t drink tablets and some of the poor illiterate family they did home delivery
only, so many convened them, ASHAs used from the all motivation skill but
community peoples their neglected because she is women this also reason to
them.
“In Community peoples all are not same but some peoples they didn’t give good
reposes, if we provide quick services that time only, if late scolding to the Asha
workers. We can’t motivated that is big problem for us” Shanthi Asha worker
(Name changed)
39
Caste discrimination: In my interview I found due to caste Discrimination this
is related to social discrimination. In community Four of them respondents
having this type of problem, because all Ashas castes different but some of the
Ashas faced by the problem in the community. If Ashas visit ANC and PNC
houses and surveys at the time Upper caste peoples they can’t allowed inside
home and sometimes upper and rich caste peoples they didn’t give good
responses. They don’t believe government hospital deliveries and treatment
these problems for them.
“Community perception they have caste discrimination because we went ANC
and PNC home visits upper caste peoples they can’t allowed inside home at the
time we feel bad I delivery time they didn’t call to Asha workers they going
directly private hospital, because some people rich almost they don’t believe
government hospital” Shilpa Asha worker (Name changed)
Lack of coordination: Lack of coordination one of the main problem for
ASHA Workers. Because in community peoples they can’t give good respect
from Ashas and some of the peoples they can’t believe hospital treatments, and
less then community peoples having a poor responses for Asha working,
sometimes ANC and PNC women’s they don’t have good coordination with
Asha workers and Panchayat members and Asha workers if respondents having
a community level problems at the time they can’t give proper responses for
Asha workers, Anganawadi teachers, ANM, Asha to Asha they don’t have good
coordination this affecting to Ashas work.
40
Lack of awareness on Public Health System/ Home delivery: Most of the
peoples have health awareness but some the respondents shared community
peoples they don’t have awareness, Ashas giving a Health education for
community peoples but less then peoples they didn’t follow, they don’t know
how to do clean in house and some of them peoples conducting home deliveries
poor and illiterate peoples like this. If Ashas give awareness but peoples doesn’t
that much information for health system.
Blaming: Most of the Asha workers they suffering to the Blaming because after
delivery JSY, Madillu kit sometime systems improper implementation schemes
at the peoples they didn’t get schemes at the time blaming to the Ashas and in
hospital delivery normal delivery also nurses ask 2 to 3 thousand rupees money
that time peoples are blaming to Ashas and slow delivery of the system that
time peoples give pressure for Asha worker.
Culture – Belief: in my interview I found due to Belief system. In community
peoples they have culture belief system, home delivery, some of them peoples
they can’t put for children’s injections if put injection children’s get fever so
this also problem for Asha workers.
JSY, Madilu kittu, is a big problem peoples pleaser and night time delivery case
but peoples they don’t know delivery pain and normal abdomen pain simply call
If we go and saw just we come back home but we can’t sleep, can’t eat that
much tension, normal delivery no problem but complication in government
hospital nurses they ask more money community peoples blaming for us,
convincing also challenge, in community people’s less then peoples they don’t
have health awareness and so many times we use different types motivation
skills but no use, in immunization time so many times we call to mother and
child they didn’t come early and in our community two or three mother they
41
having a 5 to 6 children’s we informed to the women’s but they now also didn’t
do family planning operation really who to say we don’t know. “Bhavani Asha
worker (Name changed)
Deevadasi System: In my interview I due to found by Deevadasi system. Three
of the respondents deevadasis they community this also problem for them
because less of the peoples they identify to Ashas they are deevadasis in
community at the time Asha workers feel bad and this is affected to they work.
Alcoholic influence: Most of the Ashas they want go night time delivery with
cases. So this cases some of their drunks, husband, brother, relations. But
sometimes night they full
Health:
Lack of facilities in PHC: Most of the Asha Respondents having a Health
system problem. Ashas major and main problem in PHC level they don’t have
any facilities, No rest rooms, No drinking water, and no toilets because night
time delivery they want go with cases at the time they can’t eat, sleep, and PHC
one or two common toilets patients, nurses, doctors, all are using same only
very dirty. This also problem for Asha worker.
“in PHC we don’t have rest rooms, in drinking water, no toilet facilities, we use
only patient toilets, all are using same toilets its very dirty” Roopa Asha
worker (Name changed)
42
No salary: In my interview I due o found by salary problem all respondents
having a same problem because Asha workers they didn’t get monthly salary,
they fill reports end of the month but this also not coming in time and incentive
also cut of payment, no holidays. But some the Ashas want social services, but
some the Ashas they want manage, family, children’s education, so health
system didn’t give monthly salary this also main problem for the Asha workers.
“we submit monthly report and our TA amount and other work total work
amount but they didn’t give monthly payment but after 3 or 4 month that amount
come my account we fill four or five thousand rupees but we get two or three
thousand rupees only how we don’t know if ask they many reason what to do.
No stratification for this work. Without salary we do this work” Asha worker
Non coordination: Most of the respondents suffer to coordination problem
because Asha to Asha, Asha to Nurses, Asha to doctor, Asha to community
peoples they don’t have good communication and coordination, some the
respondents said sometimes nurses they don’t give respect for Ashas and
unnecessary they give complete also, so many times they didn’t inform for
trainings and meeting dates suddenly call to them that time they go because they
family, children’s. others respondents they have different field areas no
transport facility so that time they want to go by walk if they reached late,
seniors they can’t understand problems scolding to Ashas.
“ANM and Asha to Asha workers we don’t have good relationship in working
time, sometime Anganawadi teacher also not support to our work, If we one day
do larva survey that time they give complete to Male worker and doctors this
also big problems for us. Field area different but proper bus facility at the we
go by walk if we late they scolding for us” Asha worker
43
Corruption: in my interview I due to found by Corruption. Some of the
respondent’s shard about corruption. In government hospital nurses in delivery
time they ask more money for delivery cases, if rich peoples they will give but
poor and middle class peoples they can’t give. community peoples they
government hospital is free delivery and free treatment peoples believe to
hospital and Asha worker but nurses want money at the time Asha suffering to
this problem.
“Delivery time hospital nurses they asking 3 thousand to four thousand rupees
for one delivery but they didn’t ask directly patients family they pleaser to the
Asha workers, how can we ask to the patient family government hospital
peoples wants free services at the time we felt irritate nurses behaviour not
good this also main problem for us”(27 old ASHA Worker)
Rude Behaviour: Most of the respondents faced to the problem in government
hospital nurses they can’t give good responses for patients, and Asha workers.
Asha workers any information at the nurses they didn’t say smoothly, they
speak very loudly and some rude behaviour if they conducted delivery they use
warts language also. And sometimes 108 ambulance drivers dunkers really they
feel bad.
Poor responses: Most of the respondents having a health level problems Ashas
workers in Asha monthly meeting and training they shared about this problems
but in Asha facilitator, Mentor and male workers l officer then medical officer
they didn’t give proper responses to Ashas problem and if you have interest
you do this work, this not your permanent job your contract workers, otherwise
you live this job seniors speak like for Asha workers.
44
“In hospital Nurses they didn’t give respect for Asha workers, any time doctors
not available in PHC only nurses, If ask any they didn’t give proper responses.
We sheared our problem in Asha meeting this not your permanent job if have
interest do this work otherwise left it they give responses like this only” (30
years old Asha worker)
In proper implementations of the schemes: In my interview I due to found bi
in proper implementation of the schemes because after delivery they suddenly
they didn’t schemes an but community peoples they can’t wait at the peoples
they stress for Asha workers.
To assess community’s perception about Ashas roles worker
In this research I due to found by the community perceptions most of the
responses they give good words for Asha workers, Asha workers they advise
the pregnant women and their families for institutional delivery, they gave
health education form the community peoples, delivery time they contact with
108 ambulance, she providing tablets for elderly peoples and TB, HIV and
pregnant women’s. Before joining Asha job community peoples they don’t
know government schemes and facilities after joining Asha peoples aware about
hospital delivery and facilities. Community peoples and Gram Panchayat
members also gave good support for them. Peoples have good opinion for them.
To identify the Health System Response to ASHA functioning
In my interview I due found to by system Reponses ANM. Anganawadi teacher,
male worker most all respondents giving same opinion for them. whenever
Asha joined this job 95% hospital deliveries. Asha they abele to do all workers,
they identified more Tb and HIV cases also. But they didn’t get monthly salary,
if they get monthly salary they will do very well.
45
Discussion:
The study that has been conducted was focus on Barriers affecting the ASHA
work role in Danapura, Hanumenahalli, and of the Nagenahalli villages.
Almost all ASHAs are resident of local community and so a very effective link
person in the delivery of health services ASHAs gave good health massages.
The ASHA has to work in the community for the rural poor. She has to motivate
every household and generates awareness in the community. In general ASHAs
are satisfied and happy with the training. Their perception about their job
responsibilities appeared to be incomplete and improper. Most important
motivational factor for the ASHAs is the financial gain and hope of being
absorbed in government job. In general, monitoring and supervision of the
ASHAs by MO through ANM and AWW was satisfactory. But ASHAs were
not functioning. properly and even their relation with ANM and AWW were
not satisfactory. Four of them Asha workers faced by the caste discrimination
Most important motivational factor and four of them upper caste Asha worker
and non cooperation also big problem for them. but whenever I interact with
community people satisfactory for them work all peoples shared about positive
things only. But health system didn’t give proper responses if they provide good
facilities and ASHA workers do very well
46
My learning’s from SOCHARA
I feel am very wrathful to join the fellowship and I knowledge I received from
the collective session and all the field experience is a rich knowledge and has
help me personally to be strong and motivate myself
to work for the
community level.
I learnt about How to interact with community people ‘s
I learnt about differences between Community health and Public health
I learnt about observation and reflection skill
I am able to understand English and Hindi, I am able speak English
language
In this training I got friends different states (Meghalaya, MP, Kerala,
Raipur, TamilNadu, Rajasthan and UP)
I had on opportunity to learn a lot from the group
I learnt about reporting skill
I got clear idea about how to use computer applications for this
fellowship
Self confidences
Learnt about communicable disease and Non communicable diseases
Daringness, Patience, smiling and Tension free
Presentation skills
I leant about music and dance sing
47
Reading list:
NRHM common review mission report- Dr. Anbumani Ramadoss
Health Practice research and formalized Methods- F. Grundy and W.A
Reinke
ASHA Modules – NRHM
Qualitative Research – David Silverman
Anubhava Series:
Rangabelia Comprehensive Rural Development
Health for All
48
Reference
http://in.ask.com/wiki/Accredited_Social_Health_Activist?lang=en
Main article: Nationalhttp://swapsushias.blogspot.in/2013/05/roleof-asha-and-anm.html
Rural Health Mission of India
ASHA roles and Responsibilities
Budget proposal brings cheer to ASHA workers
Fee Scholarship Program - 100% Free Medical Coaching Exam
Enrol @ Aakash ANTHE on 23-Nov-14.www.aakash.ac.in/Enrolfor-ANTHE
Government of India (2006) , Annual Report 2005-06, Ministry of Health
and
Family Welfare, New Delhi
Government of India, NRHM-ASHA (2005) Guidelines, Ministry of Health
and Family Welfare, New Delhi
49
ASHA Worker Interview
50
Community People Interview
ANM Interview
Community Health Learning Programme is the third phase of
the Community Health Fellowship Scheme (2012-2015)
(2012 2015) and is
supported by the Sir Ratan Tata Trust, Mumbai.
School of Public Health, Equity and Action (SOPHEA)
SOCHARA
# 359, 1st Main,
st
1 Block
Block, Koramangala,
Bangalore – 560034
Tel: 080-25531518
25531518;; www.sochara.org
Position: 3262 (2 views)