Asma S : Learning from Collective Teaching Session and Field Visits
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- Asma S : Learning from Collective Teaching Session and Field Visits
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2014-2015
2015
Community Health Learning Programme
A Report on the Community Health Learning
Experience
ASMAS S
COMPANY
555-543-5432
5432
www.yourwebsitehere.com
SOPHEA
REPORT
SOCHARA SOPHEA
2014 – 2015
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Table of Contents
SL.
NO
1
Titles
2
Acknowledgement
3
4
Why I wanted to do the Community Health Fellowship Programme
My Learning Objectives
5
Learning from collective teaching sessions and field visits
6
Learning from field work [Case Studies / Reflections]
7
8
9
Research Study Report
Overall Learning / Conclusions
Reading List (The articles, books etc read by you during your fellowship)
10
Photographs (Optional; photos of you interacting with communities NOT
group photos)
11
Quotations / Poetry (Optional; feel free to express your thoughts)
12
Research Report
13
14
Results
Discussion
Title Page
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2. Acknowledgment
I say to thank my dad and mom, for letting me chance my dreams and their unconditional love
and support and who have helped me in every sense of the term throughout.
In my journey through the wisdom in community health at CHC, I would like to thank first of all
Dr. Thelma Narayan, a successful woman in public health, her in-depth analytical and
intellectual lectures were extremely helpful to think through myself during the fellowship.
I would like to thanks Dr, Ravi Narayan for his commitment, humbleness and openness to learn
and to make me learn. Truly he is an inspiration to continue the journey with confidence.
I would like to thanks my mentor Mr. Prahlad for his commitment, passion and his support in the
fellowship.
I would like to thanks Mr. Mohammad, Mr. Chander, Mr, Kumar K.J, Dr. Rahul, Mr. Sabu to
make me learn and their support in the fellowship.
Overall, I am thankful for all the resource people, which the CHC team worked hard, bring to
share their experience with the one year of us. Such a rich experience sharing and wisdom is
difficult to get even if one is ready to spend any amount of resources.
I would like to thanks MY Field mentors Dr. Manohar Prasad from SVYM organization & team
and Dr. Bagyalakshmi Sakhi Trust during my field work for giving me the wonderful
opportunity to spend 6 months with them and to learn from their organization and their personal
experiences. Their dedication, innovativeness, hard-working nature, approach and simplicity
were truly inspiring and encouraging to me. I thank them for the time and comfort they gave me
and will carry with me the wonderful memories and learning’s I got from there.
Another learning experience by observation is the staff of SOCHARA truly I saw an invisible
structure without any hierarchy. I would sincerely thank all the staff at CHC who helped me feel
friendly and comfortable during the course of the learning program.
I am indebted to thank my fellow friends each one of them from different background and
experience shared so much of knowledge and a true friendship helping me to realize ‘together we
can’.
I also acknowledge and thank all the directors of the projects I visited and the time each one took
to share with me their immense knowledge and experience in the field they are.
I would like thank to my field mentors, the organization and the staff of that I visited for giving
me the opportunity to learn.
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3. Why I wanted to do the Community Health Fellowship
My academic background is a MSW (Master of Social Work) which I completed in 2011. My
first two years of experience in Bellary after college gave me the confidence that I can work with
communities. Being part of a grassroots organization (ST. Mary’s Hospital) that gives to care
and support for People Leaving with HIV . I learnt about the complex challenges in PLHIV and
began to understand how health care could be one of the leading causes of debt among the
PLHIV
When I heard about the CHLP I thought it would be an opportunity to learn about the
relationship between public health and community health (even while the word community was
riddled with ambiguity). Being from a completely non-health or science related background, if I
were selected I knew this was going to me a foundation on how health related to development,
and that was crucial for me.
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4. My Learning Objectives
To understand and learn Right to Health. Right to health care and approaches to it.
1. To understand the various strategies for realizing health rights. (With people’s Health
movement)
2. To understand/critique the NRHM from an entitlement/rights perspective
A) How Health entitlements /Rights has been incorporated in NRHM
Policy
Implementation
People’s perspective
B) To understand the limitation of health entitlements Health entitlements/rights within
the NRHM.
C) To identify opportunities for enhancing Health entitlements/rights within the NRHM
Learning objectives
How
1.To learn and understand Reading, to attend training
Right to Health
program,
placements,
involving with community to
understand their needs.
2.Various
strategies
for Meeting PHM activities, going
realizing health (special study through literatures review,
of PHM)
books/ journals, previous
works, placements.
3.Understand /critique the Meeting people working with
NRHM as entitlements/rights
the
policy
formulators,
organization
placement,
research
work
training,
Advocacy training, Engaging
in policy-making activity.
Why
To become a trainer in health
rights and work community to
realize their rights.
To be a health activist and
understand the role of
movement in realizing health
rights and entitlements.
To understand the intricacies
of
policy making,
it’s
shortcomings,
To lobby with governments to
take people’s perspective
while policy formulation.
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5. Learning from collective teaching sessions and field visits
Orientation
The six months orientation period for the Community Health Learning Program 2014 was
technical, pragmatic, and theoretical but above all dangerously thought-provoking. These new
points of view were refreshing, disturbing and guilt-inducing, recurrently jolting me into a state
of mental and physical paralysis. Why? Because at times the scale of poverty, the complexity
and depth of suffering and the dearth of visible change can be that disillusioning. In some ways I
was left feeling ‘what can one individual really do when the rules of the game are inherently
inequitable’? Nonetheless, it built a strong frame of reference, a value system if you will, that I
will hold steadfast. Below I highlight the broad concepts that impacted me the most.
Health
Health is a state of complete physical, mental and social well being and not merely the absence
of disease. – Alma Ata Declaration, 1978
Physical Health
Physical health is an essential part of Community. The overall health which includes everything
ranging from physical fitness to overall wellness which makes an individual mechanically fit to
carry out his daily activities without any problems.
Mental Health
Mental health is a sense of well being, confidence and self – esteem. It enables us to fully enjoy
and appreciates other people day to day life and our environment. When we have mental peace
we can:
Form positive relationships
Use our abilities to reach our potential ………………..???
Deal with life’s changes
Social health:
Social health is your ability to create and maintain healthy and flourishing relationships with
other people. Healthy relationships are based on respect, mutual trust and equality.
Spiritual:
Generally Is something everyone can experience
Helps us to final meaning and purpose in the things we value
Can brings hope in times of suffering and loss
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Encourages us to seek the best relationship with ourselves, others and what lies beyond
Confronting the existing super structure of medical / health care to be more people and
community oriented.
The community health approach evolves action from the community outwards and upwards
confronting the various components of the existing superstructures of health services.
Ex – PHC, Hospitals, teaching & research institutions.
Medical, nursing, public Health teams & professional trainings
Health programmes & health institutions under government or NGOs.
1978 – ALMA ATA DECLARATION
Health for all
Primary Health Care
Health is a Fundamental Human right
Equity
Appropriate Technology
Inter – sectoral Development
Community participation
After ALMA ATA
G – Growth monitoring
B – Brest feeding
I – Immunization
F – Female Education
F – Family Planning
O – Oral Rehabilitation
8 Components of Primary Health Care
Adequate Nutrition
Water and Sanitation
Health education
Prevention of endemic diseases
Mother & child health
Immunization
Treatment
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Essential medicines
What is Community Health?
“Community Health” as I have understood from the orientation programme and from the
placement is empowering people to have the power to demand their right and it involves
community participation, community mobilisation and community involvement in reaching this
goal as very important components. More to my understanding on community health it is more
than just “medical” everything that comprises the well being of a community is health. Again
“wellbeing” i.e. “health” should come to a community through all dimensions of their daily life.
This is what I feel is community health.
A) Health must be looked at in the context of class, gender and caste:
When looking at health for the marginalized, three fundamental factors play a vital roleclass, gender and caste. These three socially constructed conditions have everything to do with
an individual, a community’s capacity to be healthy.
Quite Often, the health of an individual suffers because of a societal structure or norms. For
example a woman’s nutrition can also affected by her social status in that society and therefore is
an issue of gender inequality reasons why she’s malnourished.
When looking at occupational health, one needs explore why some working communities are
more at risk than others to hazards or poor health. Why are certain communities by and large in
certain professions? Who occupies the highest paying, most power yield jobs in terms of class,
gender and caste? Why and how? When being a health worker, the anatomy of a social illness
can’t be overlooked in order to understand the physical health of individuals and communities.
B) Awareness, Availability, Access, Affordability and Capability
The foundation that SOCHARA establishes in understanding health involves first looking at it as
“a state of complete physical, mental and social well-being and not merely the absence of
disease….
‘Health as wellbeing’ is a far more comprehensive framework that encourages us to look deeper
into the social determinants of poor health. From what I understand health isn’t achieved (broad
and immediately) because of problem of awareness (about a disease/infection/illness), if the
knowledge/demand exist, it could be the sheer lack of necessary medical support or availability.
If various reasons including distance. Further pricing and affordability is a huge factor in
preventing access. And finally, capability is imperative. Capability involves cross-cutting, social
factors that are not conventionally addressed. A prime example given was an unmarried or
widowed woman who does not get treated for a reproductive tract infection. She knows- that
there is an infection that needs medical treatment (awareness), where the services are readily
provided and how to reach it (availability & access), that the treatment is free or is able pay for it
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(affordability) yet she still does not get treated because of the social misconception that RTIs are
only contracted through sexual activity. Therefore stigma and discrimination can sometimes be
the primary reason people do not avail of certain medical services and suffer from poor health.
The importance of the public sector:
Looking at the private sector as, in principle, compensating for the lack of a fully functioning
public sector is and comfortable view for those who can afford to entirely depend on it. Merely
looking at the increasing accessibility of the private sector masks the inequitable processes that
make it so. However, it could very well be a chicken-egg debate. Is it because the public sector is
dysfunctional that the private sector can thrive; or is the uncontrolled rise of the private sector
that further enables public inefficiency? Although I felt the CHC view being somewhat binary in
its view of the private sector, it was nevertheless essential to look at facts such as public
spending on health, the pharmaceutical industry’s profit margins, and let them speak for
themselves.
An important initiation was to begin to understand why the Indian public health system doesn’t
meet demands – starting with budget allocation for health, to state responsibility of planning, to
every level of implementation. The vast shortage of staff and major gaps in infrastructure
emphasizes the need for intersect oral efforts if the health system is to ever get healthy. E.g. A
doctor posted to a remote PHC will only be motivated to remain there if his or her basic needs
such as water and sanitation, quality education for his/her children are met
The growing solidarity of the people’s Health Movement and its specific country chapter plays a
key role in bringing health back to public agenda. On a national level the introduction of the
National Rural Health Mission promises involved community in its planning monitoring and
evaluation. For the government to mandate this, at least in theory, is promising. Further, hearing
about lessons from some pilot states for community monitoring proved that inroads are being
made to strengthen the health system from within.
Ultimately, no NGO or numerous networks of NGOs or other private actors can make
themselves accessible to over 500.000 villages. The government is the primary and the largest
service provider. Efforts to support and improve public system are the only sustainable option to
improve the health of this country.
Globalization is really making the poor poorer:
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The role of international institution in regulating national government cannot be emphasized
enough. And it wouldn’t be reductionist to say that their function is more exploitive than
beneficial.
Structural Adjustment Programs (historically) and their failures
The stipulations of the World Trade Organization and its direct effect on farmers and other small
stakeholders
The establishment of New Institutions in governance that private’s basic amenities on the basis
of efficiency but deny universal access
International targeted/vertical funding interventions that don’t improve the overall health of
communities
The monopoly of allopathic and the lobbying power of the pharmaceutical industry
These products of globalization have exacerbated not abated the problems of the poor.
Balance between theory and practice:
The CHLP helps you strengthen the application of theoretical knowledge, as well as to challenge
the validity of certain kinds of knowledge through substantive exposure to ground realities.
Further, engaging with communities must lead to new frameworks of understanding poverty and
marginalization. Translating that experiential knowledge to bigger picture change, for me is also
an important thrust of this programme. Knowing (to some degree) before doing/acting; and
conversely doing to learn more should be a balanced cyclical process, which I see CHC enabling.
My inner learning’s from CHLP
Communication and participatory skill with Community
Stage fear decreased
In the beginning I was so scared while talking English with everyone, now I improved
English speaking
I gained more knowledge about health
learned new Software applications in Research I learnt about cultural differences
between states
Group Learning
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Another tremendous strength of the CHLP is the group learning sessions, when we reconvened
after our various placements to share our experiences, debate and learn from each other. Our
placements were diverse, learning objectives wide-ranging too, yet the information gathered
through these sessions was always relevant and useful.
It was also an opportunity to express concerns, fears and support each other through a subtle or
considerable paradigm shift, and negotiate new understandings.
Finally it was an enjoyable way to learn about the incredible work going on all over the country.
To learn of various other inspirational people and organisations than you had a chance to see
yourself, to hear of all the different approaches of brining about ‘health for all’. That certainly
enabled a multifaceted understanding of community health.
You are mentally ill – if you are “CASTE” bound
I acknowledge and appreciate such powerful words from Dr. Ravi, “You are mentally ill – if you
are CASTE bound”. I could experience his words in many humiliating instance i personally see
in the lives of my friends who belonged to SC community. And during orientation of CHLP, we
also witnessed the same in our field visits to villages in Raichur District.
NIMMA – NAMMA Test
People have to experience you in the community as someone belonging to them. For instance if
we say we are community worker, the community that we work with should say he/she is OUR
person and not the NGO’s staff or person. This is a crucial and strong lesson that I have learnt,
but truly to express sometimes I have reverse discrimination for being negative to work among
HIV positive people’s networks. But still, it’s important for me to be unequal to be equal to all.
Vimochana
We visited to Vimochana (a women’s rights organization that primarily deals with domestic
abuse) and better understand how organization can impact matters in the private spere of
women’s lives. We spent one day in Vimochana learning about their interventions.
During my time with there I saw how they conduct crisis interventions with victims of domestic
abuse, and methods of negotiations with their families. I learnt how incredibly strong women are
even when they have been brutally controlled.
One of the lessons I learnt from Vimochana is that enabling change in one woman’s life is as
important as influencing national and international dialogue on women’s ights. Their strength is
that they work at micro and macro levels simultaneously- never out of touch with ground reality,
yet also trying to change the large system of patriarchy.
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Seva-in-Action
Seva-in-Action is a voluntary organization working since 1985, towards developing an inclusive
society which value the abilities and potentials of persons with disabilities and consider them as
contributing members of the society. 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.
SIA’s mission is to develop an inclusive society through inclusive education. SAI believes in
empowerment of with disabilities and its families and ensure their human rights. To achieve this,
the organization works with parents association of children with disabilities, persons with
disabilities, persons with disabilities, community members and the government system.SIA has
three pronged activities: firstly the direct services and through resource centers in rural and urban
areas, skill development, secondly capacity building through various training programs and
thirdly working with the government system through National Trust and Education sector to
reach out to unreached in Karnataka.
KAIROS
(Kannur Association for Integrated Rural Organization and Support)
Kannur Association for Integrated Rural Organization and support (KAIROS), a Registered
Society under Society Registration Act XXI of 1860 is the Social work department of Diocese of
Kannur. KAIROS was unofficially wing of Calicut Diocesan Social Service Society. It started its
independent involvement in 1999. The area of operation covers the northen civil district of
Kerala i.e., Kannur and Kasargod. KAIROS is working with Dalits, Fisher folk, Marginal
farmers, Agricultural laborers, Women, Children, Tribal & HIV/AIDS infected and affected.
KAIROS collaborates with many development agencies through planning and extension of
various programmes of Government and Panchayath Raj Institutions.
VISION: Create a society of justice and peace based on true human values.
MISSION: The mission internalized by KAIROS is capacitation of the people in all aspects to
generate and carry out development at their own level in a participatory and sustainable manner.
SHANTHI PAIN & PALLIATIVE CARE SOCIETY
HISTORY:
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A registered charitable society established in June 2004.
An organization of medical professionals and volunteers dedicated to the community
based palliative care.
MISSION:
We believe that individuals and families coping with life-threatening illness such as
Cancer, paraplegia, HIV+, PVD, CVA, Psychiatry, Kidney and old age ailments deserve
efficient access to services that are designed to enhance their quality of life and also
enable them to receive care in the setting of their choice.
The society endeavors to popularize the concept of palliative care in this part of the world
HOME CARE:
The society has established home care services for chronically ill, bed ridden and
incurably ill patients in partnership with family and local organizations.
Our community palliative care staff provides help, support and advice about their illness
in the comfort of their own home.
This could be one visit or several over a period of time whilst they need our
support.
This one-day per week ‘Home Care Program’ became operational in June 2004.
The society has three teams
One led by a doctor
The other by nurses and volunteers
And the third by community volunteers
Out Patient Clinic
The society runs an outpatients clinic at the Kalpetta since 2004
Patients with curable and incurable conditions like cancer, HIV – AIDS, PVD, CVA,
psychiatric problems,
Kidney diseases, old age and chronic pain are attended to.
The clinic not only provides medical treatment for but also extends social psychological
and economic care.
Community health and working with communities
Community as a source of knowledge
I learnt that to work communities one must begin with humility and the sensitivity to
acknowledge that you may come with formal education but not the wisdom and experience the
community has. Distinguishing between harmful traditional practices and practices that can be
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harnessed and developed for the community is valuable. There has to be a mutual exchange of
knowledge and skills and drawing and building on their on their existing knowledge rather than
replacing it with completely new forms is crucial. My decree is to not go in with all the answers,
and accept that learning more about the community will incite more questions.
Social illness
Community health is about critically examining the social determinants that prevent a
community’s ability to be healthy. This means not only addressing the medical conditions people
face but understanding their root causes, which are often within the societal structures. Therefore
without an anthropological approach to looking at health issues, meaning an effort to understand
the caste, class and gender dynamics that could underlie a health problem, the cure will only be
superficial.
The right to health is embedded in the right to education, livelihood, gender equality etc,
understanding the interconnectedness of these rights is essential to achieving the right to health.
Process enabling
During the orientation period Dr. Ravi Narayan said the CHLP intends to make process
managers of us, not programme managers, and that stayed with me through the programme. I’m
now clear that the key to sustainable solutions for problems of the marginalized is to enable
processes that increase their own capabilities primary lies in the assertion of a wide range of
rights.
Since rights are not given and must be claimed, social organization becomes a key process for
enabling the assertion and attainment of rights. I never fully understood the power and
importance of social organization before the CHLP. I relegated it to the practice of a certain
brand of activists. Today I see that social organization in smaller and larger ways is the essential
to changing in a process begins to change a system. Naturally systematic change takes much
longer but is the only path to sustainability.
6. Learning from field work [Case Studies / Reflections
Swami Vivekananda Youth Movement (SVYM) Organization – Mysore
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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
nationals ideals of Swami Vivekananda. It is working in the sectors of Health, Education,
Community Development, Training, Research and Advocacy & Consultancy Services. It is
engaged in building a new civil society in India through its grassroots to policy-level action in
Health, Education and Community Development sectors. Acting as a key promoter-facilitator in
the community’s efforts towards self-reliance and empowerment, SVYM is developing local,
innovative and cost-effective solutions to sustain community-driven progress. SVYM is also
rooted to its values of Truth, Non-Violence, Renunciation and service, Which is reflected in its
program design and delivery, transactions with its stakeholders, resource utilization, disclosures
and openness to public scrutiny. Buying in support from the community, working in healthy
partnership with the government and corporate sectors and sharing its experiences with likeminded organizations have been the hallmark of Swami Vivekananda Youth Movement.
The organization has about 50 projects in the sectors of health, education, community
development and training located in all the districts of Karnataka state. It runs two hospitals (80
bedded and 15 bedded) for rural and tribal people in H.D.Kote taluk, a mobile health unit
tribal’s, and various tribal, rural and urban development projects focusing on housing, hygiene,
sanitation, microcredit, community based health, education & rehabilitation, governance and
human rights.
The organizations innovativeness in initiation & execution of the programs have been
recognized and appreciated by Governments & Non-Government agencies.
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Vision:
A caring and equitable society, free of deprivation and strife
Mission:
To facilitate and develop processes that improves the quality of life of people
Core Values:
Satya - Truthfulness
Ahimsa - Non Violence
Seva - Service
Tyaga – Sacrifice
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CHA – Community Health Activities
The health intervention focuses on providing an interdependent and complementary community
based and institution based services. The community based services focuses on awareness
generation, community mobilization, preventive and primitive health with home-based follow up
care for curative health. The institution based services (Vivekananda Memorial Hospital,
Saragur) focuses on 24*7, guaranteed backbone for early detection of health concerns, patient
and family counseling, institution based high quality comprehensive curative treatment and
personalized prevention and rehabilitation measures.
Objectives
Address the unmet health needs of the community
Familiarize the community with the range of services offered by the health centers
Enhance community participation
Establish efficient healthcare network and referral mechanism
Projects
Outreach activities
Field based maternal and child health program
Community based rehabilitation of persons with disabilities
Water and sanitation
Community based diabetes program
Mental health initiative
“Health for All – Health Everywhere”
Community based primary health care its essential for the community members, health
awareness about catching disease, environment and individual clean, safe drinking water,
nutrition food, minor disease of treatments, family welfare, women and child services these are
main components for primary health care.
Sub centers:
Basic health facilities for all people, from women and child welfare office 4 to 5 thousand
populations or 4 to 5 villages 1 sub center facility is there, in this sub center 2 staff like 1 female
and 1 male health workers is there.
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Primary health care:
Primary health care for 20 thousand populations one PHC is there, in this PHC duty doctor,
lab facility, deliveries room, emergency ward facility compulsory, so in this PHC give the
services like Preventive & Health Promotion. In Taluk and district levels hospitals provide the
curative services.
Health organizations in Karnataka:
Above 8,870 sub centers
2,310 primary health centers
326 community health centers
NRHM Program:
The National Rural Health Mission (NRHM) is an initiative undertaken by the
government of India to address the health needs of underserved rural areas. Founded in April
2005 by Indian Prime Minister Manmohan Singh, the NRHM was initially tasked with
addressing the health needs of 18 states that had been identified as having weak public health
indicators.
The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural
population throughout the country with special focus on 18 states, which have weak public
health indicators and/or weak infrastructure.
GOALS
Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
Universal access to public health services such as Women’s health, child health, water,
sanitation & hygiene, immunization, and Nutrition.
Prevention and control of communicable and non-communicable diseases, including
locally endemic diseases
Access to integrated comprehensive primary healthcare
Population stabilization, gender and demographic balance.
Revitalize local health traditions and mainstream AYUSH
Promotion of healthy life styles
Objectives:
Promote access to improved healthcare at household level through the female health
activist (ASHA).
Health Plan for each village through Village Health Committee of the Panchayat.
Human resource support and management
Basic infrastructure for sub center, PHC etc.
Economic Decentralization
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Community participation and accountability
AYUSH services for PHCs.
NRHM Programs:
Janani suraksha yojane (JSY)
Madilu kit program
Prasuti aaraike
Taayi bhagya
Janani - shishu suraksha yojane
Taayi bhagya plus
Janani Suraksha Yojana (JSY)
JSY aims to reduce maternal mortality among pregnant women by encouraging them to
deliver in government health facilities. Under the scheme cash assistance is provided to eligible
pregnant women for giving birth in a government health facility. Large scale demand side
financing under the Janani Suraksha Yojana (JSY) has brought poor households to public sector
health facilities on a scale never witnessed before.
Janani suraksha yojana:
Regarding this program, for home deliveries they will provide 500/ For urban living women’s, from health institutions will give 600/ For rural living women’s, from health institutions will give 700/ Registered and sesirien deliveries in private hospitals for them 1500/ For this facilities Adhar card & bank Account it is necessary
Prasuthi bhatya:
For 4 to 6 months pregnancy women’s 1000/ After delivery 300/ For urbans 400/ This scheme not include in kolara & dharawada district.
Madilu kit:
Who will take the delivery in government hospitals for them they will provide the
madilu kit. These kits will mainly helping for mother and child, in these kit 19 things is there.
Beneficiaries:
BPL/SC & ST
Deliveries in government hospital
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Only for 2 children’s
Who have mother card
Taayi bhagya yojana:
After delivery when delivery patient will go to the home at that time they will give the
250/ For helpers 75/Taayi bhagya plus:
For rural pregnancy patients they will register in the government hospitals and they will get
the delivery in that government hospitals for them they will provide the 1000/- regarding this
scheme.
Accredited Social Health Activists
Community Health volunteers called Accredited Social Health Activists (ASHAs) have
been engaged under the mission for establishing a link between the community and the health
system. ASHA is the first port of call for any health related demands of deprived sections of the
population, especially women and children, who find it difficult to access health services in rural
areas. ASHA Program is expanding across States and has particularly been successful in bringing
people back to Public Health System and has increased the utilization of outpatient services,
diagnostic facilities, institutional deliveries and inpatient care.
ASHA Program:
For 1000 population 1 ASHA worker is there, according to NRHM Program between
community and health ASHAs identification, giving trainings so they will give the importance
for community, in this state nowadays approximately 33,000 ASHA volunteers will do the
peoples services.
Objectives:
Giving importance for community
Who have knowledge about community with them will give the health services
Health organizations and community with them will do the work, take care of community
health
Giving importance services for mother and child and reduce the infant and maternal
mortality rate.
Assignable for ASHA worker
7th class pass, knowing reading and writing likewise leadership quality.
She has 2 children’s as 2nd child minimum have above 5 years.
ST/SC and BPL family for give the importance.
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ASHA Workers Responsibilities:
ASHA will give the health awareness for the community
Doing work in the organization as community member
Nutrition, health, sanitation and hygiene about that will give the awareness for
community
What are the facilities are available in the health center for that giving awareness for
community, for those facilities will take like helping for community
Registration for pregnancy women and for poor women helping for BPL card
Delivery preparation, safe delivery, feeding milk, safe sex, disease, sexual disease, child
care about these topics discuss as giving counseling for the women’s
Pregnant women’s and health services necessity children near health centers will do the
registration/taking facility for them.
Immunization facility
Minor diseases for that giving first aid
Keeping first aid kit facility
Village health and hygiene members, anganawadi workers, ANM, and with SHG village
health and hygiene program about that giving information and doing implementation.
Anganawadi workers and ANM with them monthly once or twice celebrating health day
Anganawadi workers appropriate the mainly services like iron tablets, ORS, sanitary pads
for that giving support for them.
ASHA workers will not get the salary with government.
My Key Learning’s from Field WorkI learnt participatory skill and
communication with Community people
I understood non adjust mental attitudes
In group discussion I got a clear idea about community problems and facilities
I understood Tribal ( Haadi) people’s attitudes and their culture
I understood the difference between tribal and non tribal's
I understand primary, secondary and tertiary prevention of health care services
I We learnt PPT report writing skill
SAKHI TRUST (Hospet)
21
ABOUT SAKHI
Sakhi is a youth Resource Center 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 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.
The important objectives of this process were:
Empowerment of women , children and youth affected by economic and social
exploitation
Promotion of education of youth particularly young women
Supporting the higher education of girls from vulnerable communities for their
empowerment
Sakhi has been working among…
Girls dropped out of schools and young women initiated into labor
Girls from Devadasi (a practice still rampant among the Madiga caste) families who are
forced into becoming Devadasis themselves.
Girls who were sexually abused and from families at risk
Girls from SC/ST and other vulnerable groups whose livelihood was at threat due to
various reasons in the context of socio-political and economic situation of Hyderabad
Karnataka regions.
Sakhi’s Strategy:
SAKHI has adopted two-pronged approach of prevention (of drop-out) and promotion (of
education). The strategy of preventing the drop out of girls from the educational and higher
educational institutions due to socio-economic and cultural factors included addressing the issue
of discrimination and corruption in hostels, addressing the issue of quality of education in
colleges by giving them additional inputs in some subjects like English.
Intervention with the families of girls who wanted to pre-maturely marry them forcefully,
exposure of girls to different conferences, motivating sessions, giving them opportunity to
participate in perspective building sessions etc. The strategy to promote education in these
communities involved in creating a space in SAKHI for girls for sharing, counseling, providing
information of various educational courses and possibilities available and helping them choose
relevant courses suiting their aptitudes, finding out economic support and scholarships for the
educational expenditures etc.
22
As against the earlier context where the number of girls who dropped out due to various
unfavorable conditions in colleges and hostels, lack of adequate facilities in hostels etc. Was very
high, due to the intervention of SAKHI and constant follow up, the retention became very high
and SAKHI also intervened in situations where the girls had problems in hostels, colleges in their
own families or personal life.
Sakhi Programmes:
Sakhi works with youth from rural areas, urban slum, college going youth and school/college
dropout. Currently Sakhi has two programmes; first is child care centers aimed at supporting
working women from the slums (supported by TDH Germany), second is higher education
support for youths from families at risk (supported by SDTT). Sakhi’s main office is in Hospet
and a field centre is in Kampli.
Working with youth envisages having Meetings with youths, providing support for higher
education, English tuitions, library support, special lectures for Youth groups, computer
Training, counseling and counseling classes, gender training, tuition support for school dropout
slum youth, theatre workshops, field studies and Sakhi student’s magazine.
While Working with Urban slum Women and children, Sakhi has started day care centers for
children from slums, supporting college fees for girls from the slums, vocational trainings for
school dropout young girls, dissemination workshops for young girls and women, formation of
young girls and women SHG’s, medical camps for families at risk in the urban slums along with
networking and campaigning for issues related to women and girls of the slums.
Total sakhi students comes from
1.
2.
3.
4.
5.
07 Taluka
25 Villages
02 Hostels
05Colleges
15 slums
Sakhi has empowered human resources through different programs:
Fashion technologist and tailors
Lab technicians
Drama, Music, Art Teachers
Social Workers, Counselors, Teachers for special children, Bala Sevika (pre-primary
teachers),
College Lectures
Nurses
Computer operators
Beauticians
Community Health Fellows
23
Potnal:
The field visit to potnal, Raichur
Raich during the field placement in Sakhi Trust was a short but
concentrated thrust into some of the complex realities people face, especially in regard to caste
and gender. Double and triple marginalization were some of
of the issues exposed, meaning the
multiple burdens of class, caste and gender. It was encouraging to learn how dalit women’s
group such as Jagruthi Mahila Sangatana have demanded and to some extent established their
rights. The power of social organization and solidarity was also palpable.
District profile – Bellary
Information:
As per 2011 census the population of the district stood at 24,52,595 (Male : 12,36,954, Female :
12,15,641). Rural Population is 15,32,356
15
and Urban population is 9,20,239. Scheduled Castes
population is 5,17,409 and Scheduled Tribes population is 4,51,406.The geographical area is 8447 sq.
km. It has 2 revenue sub divisions, Ballari subdivision and Hospet subdivision, which in all have seven
taluks. The Ballari subdivision has 3 taluks, while there are four taluks in Hospet subdivision. There are
27 hoblies, two CMC's, one town municipality, seven town panchayats, 542 revenue villages, and 436
thandas/habitations. The rural populations constitute
consti
62% of the total population. The density of
population is 290 per sq. km.The scheduled caste/scheduled tribe populations constitute 39.50% of the
total population. The sex-ratio
ratio was 983. The normal rainfall is 639 mm. The major occupation of this
district
rict is agriculture and 75% total labor force is dependent on agriculture for its livelihood.
24
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State
Highway
¸ÀASÉå
Number
Area
«¹ÛÃtð
(ZÀ.«ÄÃ)
322
242595.86
gÁdå
ºÉzÁÝj
(KM)
Bellary
588.57
Major
District
RoadÛ
(KM)
982.20
25
Hadagali
427.49
822.34
117
41386.51
Raichur
1073.27
1520.07
639
217971.14
Koppal
709.02
1503.65
251
71377.70
Total
2827.51
4841.86
1329
573331.21
My personal journey
It’s hard to put into words what the CHLP has done for me. I believe it has impacted me on a
very fundamental level, an actual amendment to my world view. Whether or not I like it, the
learning now feels primordial, and I can only build odd it. Perhaps all of life’s learning is
incremental but the point is, it had been internalized in a way that the core cannot be altered.
When I enter a community now I wish to understand why things are the ways they sure, why
people behave the way does. So my skills in social analysis have improved. I am also more
aware of the systemic problems that impede health. Keeping in mind systems, both tangible and
intangible, has helped greatly has helped me see the multiple layers of marginalization.
Overall, on a personal level, I feel much stronger, more independent and more secure in myself.
I’m more open to people, new experiences and I’m not afraid of a challenges. There’s a
confidence in me that I too can contribute to realizing the dream of “Health for all”.
Looking Outward –
What did I Learnt about the community?
Go to the people
Live among them
Love them
Learn from them
Start from where they are
Build upon what they know
But of the best leaders,
When the task is accomplished,
26
The work completed,
The people all remarks:
“We have done it ourselves”
Lao Tsu
LEARNING and REFLECTIONS:
The orientation programme began by providing the basic definition of Health, but with
the progress of the session’s the multi dimensional aspects of health, which is beyond just
“physical health” for the very first time, was introduced to me in such explicit manner.
While understanding the concept of society and social determinants of health. I
understood that the society is thoroughly stratified in to various strata’s and it is the
power structure dominated by a few, who decides. It is because of the resources available
to this few, which make them the dominant class. The SEPC analysis gave a better
picture on the social determinants of health.
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 farmers in real situation also made
me realize the daunting difficulties which the farmers has to overcome.
Community Health Learning Programme - Orientation report
The orientation programme gave an extensive understanding on various aspects of health,
the programme dealt with various concepts as listed below:
Understanding the concept of health. (Definition community health, core components
and health as human right)
The monsoon game, understanding society, social determinants of health.
The alternative paradigm in community health, skills and values needed for community
health
Historical overview of health care system.
Introduction to public health system, its structure and functions. Public health approach
to control of diseases – role of health system.
What is primary health care? How do PHC components get translated to practice?
The story of Alma Ata to present time
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National Rural Health Mission (India’s effort to strengthen health system and improve
people’s health)
What is globalization? Various aspects of Globalization and its impact on health
Understanding Gender distribution system.
Overview of national programe on vector borne diseases
Alternative system of health
Commercialization of drugs
7. Research Study Report
Title:
“A Study on Occupational Health Problems associated with the Women
mining laborers and the health system response to it in Danapura community,
Hospet Taluk”
Aim:
This study aims to explore the occupational health problems and the safety measures
adopted by the women miners and the health systems response to it in Danaapura community.
Specific Objectives:
To identify the occupational health problems associated in the mining activities
To understand Knowledge, availability and usage of safety measures
To understand Perceived occupational health services and facilities among women
workers
Methodology
Study design
Mixed method study (Mixed method using qualitative and quantitative)
Type of study
Descriptive study
Sampling unit:
Women mining workers, ASHA workers, PHC staff, Danapura village, Hospet Taluk, Bellary
District.
Techniques and tools
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In-depth interview
Discussion with PHC staff and ASHA workers
Tools
In-depth interview guideline
Observation
Consent form
Recording
Photos
Planning of Data collection:
People plan
interviewed
to
10 Women mine workers
02 – Discussion
be Methods used
In-depth interview
ASHA Workers
PHC Staff
Results:
Background of community and work
In my research I had 10 respondents in that 6 people were Devadaasi and another 4 people were
married. Devadaasi was their traditional system so they are continuing that. These people are
working in mining Company from many years because Devadaasis have to take care of their
father mother and children so they are working here. And they have to take care of children’s
studies. Many respondents said if they won’t go to work they can’t survive without money
because they are taking care of their family.
Type of work in the mines:
Segregation of iron pieces:
They do iron work, they refine iron pieces from mud and waste iron materials also, and they
keep it in fire after that it will be melted by machine and they will get big iron pieces and also it
becomes iron angler pieces. So here they won’t waste any small piece of iron, this is their daily
work. This iron pieces are taken by magnet and keep in another machine there it will change to
big iron raads.
29
1. Occupational health problems associated with mining:
a. Commute/transport associated problem:
They work on contract basis so they don’t have bus facility. It’s 3 KM from their home so daily
they have to go by walking and so it’s very difficult for them so they feel bad for that. They get
leg pain and body pain. They don’t have any problem in working hard but the problem is
distance between work place and home.
b. Accidents and injuries
From this research I understood that before accidents and injuries occurred to people commonly
but now it’s seen very rarely.
Ex:
R: For 6 years I had to carry 280 kg bags on my back and the company gave free treatment for
the people suffering from back pain, from many hospitals I took treatment and some of the
hospitals I took treatment are Hospet hospital, Tirupati hospital. I was admitted for 3 months in
city hospital and 2 months in Hostur hospital all total 6 months I was in hospital. Then I went to
a specialist for a year and I didn’t even pay a single penny for that treatment, company paid it all,
when I was admitted in hospital they paid 300 rupees per week for food and encouraged me to
recover and also they pay us 350 rupees per week as salaries.
R: it’s 7 months back while I work in constructions site one stick fall down on my head that time
I got severe headache, that time they took me to company doctor, and they did scan on my head
by god grace I was saved so I am very happy for that and I didn’t even pay a single penny for
that treatment. Company paid it all, now I don’t have headache but sometimes I get body pain
and legs pain that’s it. Many years ago accidents and injuries were common but nowadays it’s
reduced.
C. Musculo-skeletal pain and tiredness
- Field work - When they work in field work, where they refine mud from dust particles,
small iron pieces, stone pieces and they take out the waste materials and keep it another
side and they clean that places, they face cough, cold, headache, fever, breathing
problem, throat pain, and back pain and also they feel tired frequently and sometimes
they go to the company doctor, here they will give free treatment and free medicines, if
they get severe pain they have to go to private hospital in Mariyammanahalli village.
30
-
Office work – when they do office work they have to walk more and employees what
they will tell they have to do it. If they have heavy work in office they get leg pain and
they feel tired.
-
Canteen workers – when they do in canteen they wash the plates, wipe, mop and serve
food for 700 employees, 4 to 5 people have to work in canteen. When they do canteen
work if anyone takes leave then sometimes two peoples have two do all work, then they
get heavy work then I feel difficult and they feel tired and sickness.
Construction work – sometimes they work in road department there they do construction
of roads and buildings, helping in the construction work. While working if any health
problem like stone falls down to their leg or
any injuries caused means they take them
to company doctor here they give free
treatment to them.
2. Knowledge, availability and usage
of safety measures:
a. Awareness/knowledge/training:
Here they won’t give any trainings and awareness programs but all they say is this is for your
safety because you people are doing mining work so dust will go inside your mouth and eyes so
you have to wear these things and they say that if you use the safety measures you can get
healthy, and they didn’t tell about the side effects of working in mining sites so we don’t have
any awareness about the health hazards caused from working in mining sites and sometimes they
shows us the screening movies about safety.
b. Availability:
Safety Measures like shoes, mask, glasses, helmet, and hand gloves and these items are provided
by the company once in a year. Daily they provide hand glove. Glasses sometimes if they lost, if
stock is there they provide otherwise if lost means they scold them. Sometimes if they lost any
safety things they give old equipments of people who already resigned. Otherwise they take 1 or
2 months to give new things or else they have to take their own money. Sometime when they
show bill they pay back their money, from company these types of facilities is there for them.
c. usage of safety measures:
while they work in field they use shoes, mask, glasses, helmet, and hand gloves and these items
are provided by the company once in a year and they use it while working with stone and mud
31
work so they will have to use it compulsory, if they are doing the canteen work and office work
then they don’t have to use these things.
d. Monitoring of workplace safety:
Daily safety workers come to them and they check their safety equipments and if they didn’t
wear safety they will scold them and they throw out them from their work. So they have to wear
safety in work time otherwise they get injuries and when it’s heavy sun light that time they get
sweat so sometimes they remove their safety. So they tell them if you remove your safety in
work time sometimes you get injuries and so we tell for your safety like that they tell them.
3. Perceived occupational health services and facilities among women
workers
-
Company
From 10 respondents I got this information like there they have monthly checkups like blood
checkup, BP, eye checkup, weight checkup and if they get sickness that time also doctor will do
these checkups. Two doctors will go daily and one doctor works for the company another one is
from karingnoor village. 3 visits that are alternative days they will go and treat them, here they
will give free treatment and free medicines. When labors fall sick if doctor is not there they will
take them to the hospital in office vehicle or ambulance otherwise they refer to private hospitals.
-
Local hospital:
If they are not recovered in one day by the doctor next day also they will go there and they will
take new medicines. If again it’s not recovered next they will go to private hospital in
Mariyammanahalli village, then they take 50rs for consult fee. If they need more injection or
medicine they have pay more money from their pocket. Within 2 or 3 month they have to go
private clinic. Otherwise they won’t get cure. Sub center is there in that village but they don’t
have any facilities. Sometimes if they get fever they take fever medicine from ASHA workers.
-
ESI & Insurance:
They don’t have ESI & insurance
services because they are contract
workers.
Discussion:
32
What are the reasons for the findings? Why?
The Company is not providing bus facility and hence the employees are getting tired
before reaching Company.
They don’t have weekly leaves and hence the employees are irritated with this.
In that village sub center don’t have any facilities for labors so the labors has to go to
nearby village which is somewhat far from their village.
The employees are very much satisfied with the work and salary what they are getting.
They are not providing food facilities, rest room facilities and toilet facilities during field
work. Management is not providing proper awareness about dust related problems.
Strengths and weaknesses of the study
Strengths:
The main strength of the study was the whole hearted corporation of the responders even
in their limited time.
I conducted the whole interviews alone for all respondents and I collected the maximum
details I can in limited period.
Weakness:
As leaves are not available and due to busy work shift of the employees I was not able to
conduct FDG even though I previously I planned that. Even Sundays are not holidays for
them.
Since I conducted the interviews alone I feel like data that I collected incomplete and
would have been better if I had a companion.
Since I conducted the interviews in the evenings it was difficult for me come back
because of transport problem.
Note: No respiratory problems as they are using mask
References:
1.Bhanumathi, K. (2002). The status of women affected by mining in India. Tunnel Vision:
Women, Mining and Communities, 20–25.
2. Donoghue, A. M. (2004). Occupational health hazards in mining: an overview. Occupational
Medicine, 54(5), 283–289.
9. Reading List during my fellowship
Where there is no doctor
Jana Arogya aandolana
33
Samate mattu asamaanate
Health rights
NRHM programmes
10. Participated the following workshops, assembly, training programs
Water and Sanitation workshop
Devadaasi sampurna nirmulane mattu agatya kramagalu (Hampi University)
Field Photographs
Group Discussion
34
PRA
35
36
Community Health Learning Pro
Programme
gramme 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: 1552 (4 views)