RESOURCES USED FORWOMEN'S HEALTH EMPOWERMENT PROGRAMME

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Title: RESOURCES USED FORWOMEN'S HEALTH EMPOWERMENT PROGRAMME
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RF_WH_16_SUDHA

Panchayat Raj Vis-a-Vh Women's Rights and Entitlement : A Plea for
Triadic Intervention
Empowerment is meaningless without political empowerment In pre-independence
India, Gandhiji, and various progressive forces such as the socialists and communists
had women activists in their organisations. After independence also various political

parties and voluntary/revolutionary organisations recruited women
It was observed that all these efforts towards empowerment of women had one

thing in common that the women were co-opted by the party/organisation/movement

which was invariably dominated by its male members. In the process, the rights and

powers of the women members were marginalised within as well as outside the
organisation.So much so that when the country is making a big stride into 21st
century the women cadres of a progressive party like CP1(M) protested publicly that
they were made to play second fiddle in the party hierarchy. The delay in passing

the women's Reservation Bill in the Parliament is also an eye opener to the fact
that, even the so called peoples representatives can conveniently ignore the rights
and aspirations of women who constitute 50% of population of the country.
With this backdrop when one evaluates the 73rd amendment of Indian constitution
(1993) it seems to be a revolutionary leap forward towards empowerment of women.

This landmark legislation did not remain satisfied with merely 'co-opting- the women

into mainstream politics. By giving constitutional sanction to the concept of women
empowennent, it makes women's participation in the giassroot politics mandatory.

It provides :

No less than 1/3 of the seats will be

reserved for women including

SC and ST.

Not less than 1/3 of the seats of SC and ST
and ST women.

be reserved for SC

Not less than 1/3 of the seats of Chairperson at any level be reserved
for women.

State discretionary reservation must have 1/3 reservation for women.

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Orissa Experience :

In 1991 when 72nd Amendments of the constitution was being discussed in the

parliament and

the issue of empowerment of women was still in the

air, Orissa

materialised that concept into action. In the PR. election held in May-June, 1992,
l/3rd seats were reserved for the women. Among the SC/STs also l/3rd reservation
for women was made mandatory.
A state where literacy rate of women is 29.1% electing 25 thousand women

representatives to the various tiers of the P R. system was not a matter of joke.
Orissa was also the first state to make it compulsory that if in a panchayat/
panchayat Samiti the Chairperson is not a woman then Naib Sarpanch/ the Vice
chairperson was to be a woman.

Those who feared that women in India, especially in a backward state like
Orissa won't show much interest in politics, less so in contesting elections were

proved utterly wrong. In the said year, in the municipal election out of 1430
municipal boards in 478 boards women candidates were returned and in each of the

wards in those municipalities there were 5 to 10 women contestants in the field.
There was tough competition for the post of chairperson in the municipalities. 4

seats including the prestigious Bhuaneswar seat were captured by women. Another
heartening fact about the Orissa phenomenon, on 1992 was that, while the number
of voters casting their vote in Assembly election was less than 50%,. iin municipal

election the number was more than 50%, and in
i Panchayat election it rose to more
than 75%. It proved the interest the electorate
----------- took
----- iin grassroot politics.
There are allegations of -

i)

Proxy for the women PR representatives by the male members of their
family.

•i)

Male dominance in the meetings

iii)

Capitulation easily to hooliganism and threat

iv)

Purdah and some such age-old socio-cultural snags, which create inhibition
and false sense of modesty, such as, if the father-in-law/husband/husbands

elder brother sits in the meeting the lady covers her face, sits outside
and does not participate in the deliberations.

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Though these allegations are not completely unfounded, they point at certain
shortcomings which can be considered as teething problems of a new, albeit
revolutionary system.

NIAHRD Experience :
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NIAHRD conducted some training programmes for the PR representatives

(Sarpanchs/Naib Sarpanchs/Panchayat Samiti membera^illa Parisad membera) in Niali
block in Cuttack district in Orissa during the current year 1998
The attendance of women P.R, members during the week-long P.R. Training

programme, for example, was 90% to 100% as compared to the attendance of male
trainees which hovered between 40% to 90%. The women trainees were very regular
and most punctual. None of them gave thumb impression and some had even

university degree. Atleast 60% of them were manageably articulate and 10% of
them were quite vocal vigorously participating in the discussions.
Though Purdah is still very much prevalent in rural Orissa, that has never been

a problem faced in our P.R. Programmes.
As regards the allegation of proxy by male members, it is unfortunately the
fact in some areas, but later on it is bound to change in face of the newly emerging
women leadership which people are increasingly realising.

As regards

the allegation of intimidation and capitulation it is not specific in

case of women leadership only. This is a kind of problem faced by leadership every

where, thanks to the criminalisation of politics. But back to the wall, women have
started striking back.
Regarding the male dominance in Panchayat meetings, strictly speaking it can
not be called merely a gender problem. That is a built-in lacunae of our political
system which even now respects the might rather than the rights of the participants.

In the panchayat meetings there is not only male dominance, there is also dominance
of the rich, dominace of the socially and / or politically influential, or else dominance
by the brute majority.’ Qualitative and quantitative improvement in political training,
political awareness and unity among the "have nots” will gradually remove this
culture of dominance.
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In the past Gandhiji and his followers like Vinobaji and Jayaprakashji (J.Pj
thought that, without empowerment of the people at the grassroot level effective
functioning of democracy is impossible. J.P. compared the present organisational
structure of the Indian body politic in general and the administration in particular
with a top-heavy inverted pyramid. As in an inverted pyramid the top is heavy7 and
wide where all the real power concentrates and gradually it narrows down to the
base where virtually there is no power. To change this unnatural and pernicious state
of affairs, the gandhians suggested that the villages must have sufficient political as
well as economic power which will help them in self-governance. This, they thought,
will not be possible if power percolates from above. It should, instead, be build up
from below.
In post-independence India all the reforms made in the panchayati system power
only percolated from the central and state govts, to the bottom line and the panchayats
virtually acted as branch offices of the central and state govts, to facilitate their
centralised administration.
Thus, the decentralisation till now found in the administration is a mere semblance
without much substance.

In this respect also 73rd amendment marks a watershed in the development of
P.R.system. The present constitutional intervention brings the idea of grassroot
governance closer to the original idea as encapsulated in the Gandhian concept of
’Gramraj’. Till now the reforms were imposed through executive fiat thus making the
PK.system only an extension of the stae govt. But after 73rd amendment the panchayat
bodies instead of becoming tails of the state govt, assume as much independent
constitutional status as state governments or the central government.
Thus 73rd amendment has raised the hope of the people very high. They now

dream that though very late, the real masses, especially the 'have nots” of the
Indian society like the S.Cs. and S.Ts. and the women will

now be firmly on the

saddle of power and India will stride into 21st century as a great Asian democracy.

But unfortunately when one looks at the ground reality, the whole thing seems

to be merely a pie in the sky. The PRIs are, as before, powerless and toothless,

being still the wagging tail of the rulirg party and the district administration. Needless
to say, empowerment presupposes enough autonomy in both political, administrative
as well as fiscal matters. But till now this remains a distant echo.
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Returning again to the Onssa scenario, the

finance commission

which was

formed earlier remained defunct and lately the govt, lias again set up one. The re

formed commission is yet to come up with its recommendations. The disillusioned

and disgruntled representives, especially, the Zilla Parishad members have taken to
street and threatened Orissa government with dire consequence unless the govt soon

made provision for real devolution of political and financial power to the Panchayat
raj bodies
In

our Panchayat Raj training programme all the representatives complained

about this. Even the members belonging to the ruling party fretted and fumed
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complaining that they were mere functionless cogs in the party wheel. Numerous

examples from local administration were cited to prove tliat the administration was
clogged with numerous ‘remote control’ mechanism which enabled the govt, to bypass

the local representatives while taking any important decision involving policy or
implementation.

Role of NGOs
By holding training programmes, workshops and seminars the NGOs can play

the role of catalysts between the Government agencies, P.R. representatives and the

beneficiaries engendening constant dialogue and debate among them.
To initiate certain action plans in the area, the NGOs can take lead in

creating a structurally balanced triad of Government agencies, people’s forums and
the local NGOs. But situation may arise where interest of the local vested interest;

red-tapism as well as corruption in the bureaucracy may stand as unsunnountable
stumbling blocks. How the NGOs can resolve these contradictions without taking

recourse to social action remains a million dollar question. The NGOs should
deamnd transparency at all levels of local administration and introduce social audit.

But there also they may face the same hurddles posed by the vested interest group.

In the context of empowerment of women the most relevant activity that the
NGOs can immediately take up is gender sensitisation programme. Unless the
community in general and the panchayat functionaries in particular are sensitised to
the issue of gender, mere reservation can not give enough protection or provide
enough impetus to the women members of the PRIs. Awareness programmes in this
respect should be a constant ungoing activity for the NGOs. But here also a note

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Of caution must be given. There should not be an effort to implant the concepts of
western feminism or ‘my body, my property’ kind of libertine ideas in the name of
sensitisation Women muS be encouraged to participate in public life without neglecting
their traditional roles or offending the socio-cultural ethos of their community In this

regard the women activists who participted in the freedom movement can be taken
as ideals. While they faught shoulder to shoulder with their male counterparts against
the imperialists they also did not neglect their home or hearth.
It goes without saying tliat tlie 73rd amendment by giving constitutional sanctity
to the concept of grassroot democracy and empowerment of women has propelled
a revolutionary process into action. As in any process, there will be lots of ups and
downs on the way. Through constant struggle with forces representing anti-thesis this
process will reach a state of synthesis. But this cannot happen on its own. The
people, the NGOs or the social activists can not wash their hands off and remain
conplacent by just cnticising or hailing the reforms brought about by 73rd amendment
All have to join hands and keep the ball rolling. Legal checks and balances, however
thoughtfully formulated can never be fool-proof and effective unless bolstered by
by
social irtervention. Local organisations like women's organisations, youth organisations
NGOs, and Action groups must work as watchdog oiganisations and must see that
the Gramasabhas which are supposed to be the comer stones of Indian democracy

not only become

but also de-facto weilders of their power. Not only

empowerment of women but that of the dumb masses at large is overdue and that
process can be accelerated ------ as we mentioned earlier------- only through creating
a well-coordinated triad of people’s initiative, social action and dynamism of the

govt, agencies. Atleast die former two forces can compel the later to see the
writings on the wall.

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PUBLIC HEALTH
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PANCHAYAT
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PUBLIC HEALTH
AND
PANCHAYAT
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Publisher : Dr. Indira Chakravarty
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| No portion
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I Printers:
I Laser Jet

I 59, Simla Street
I Calcutta-700 006
I Mullick & Co
124, Baithakhana Road
I Calcutta-700 009

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ex,raced, al.ered, enUrged «repnn.ed »„h™, d,e

TRQIXkilJE

Five booklets are being published tor imparting training to the newly elected panchayat
members. These booklets explain the five issues of (1) place of panchayat in legal set-up.
(2) preparation of decentralised planning, (3) implementation of programmes of rural develop
ment, (4) education, and (5) Public health in which the panchayat has a vital role to play. This
book on "Public Health and Panchayat” is one of these.

IlIt is expected that on reading this booklet the panchayat members will have a belle,
understanding of the true meaning of ‘health’ and the real causes of ‘ill-health . The book also
gives very valuable information on the health infrastructure of the government and some non
government agencies, so that they can fully utilise the services available from these agencies. I Ik
book, in general, gives an overall awareness on all issues and programmes related to health.
The endeavour of publishing this book will be better judged on the basis of its acceptability
by the members at the time of their training. Those who have compiled this book desire that the
usefulness of this is to be evaluated by those for whom this is prepared. The organisers of the
training programme may therefore use the book accordingly.
1 thank The Hunger Project, the A11H & PH and all other concerned agencies for bringing
out the publication entitled ‘Public Health and Panchayat’ which is a translation from its Bengali
Version "Jana Swastha O Panchayat", published by Hunger Project, West Bengal, earlier.

Dr. Surya Kanto Mishru

Calcutta
February ’97

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Hon’ble Minislcr-in-Charpc
Depts, of Land and Land Rclorms.
Panihayatand
Rural Development
Government of West Bengal

Preface

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The book on “Public Health and Panchayat” was first published in Bengali in the year
1993 with support from the Hunger Project. The genesis of this book was mainly due to
the fact that the State of West Bengal was going to have their 3rd panchayat election that
year and subsequent to that the State authorities had planned a 5-day training programme
for all the elected Leaders in various areas of their activities like generation of funds,
environment, agriculture, health, nutrition, legal issues, responsibilities towards the com
munity and so on.
At this point, it was specially felt that there was a lack of appropriate training material
specially on Health and Nutrition which could be used to motivate the elected Leaders of
I the community. Therefore Hunger Project, in collaboration with All India Institute of
Hygiene & Public Health, various Departments of the Government of West Bengal and
UNICEF, has prepared this manual. Presently, there is a great demand from most of the
other States as well as Government of India to make this material available in English
and other local languages, as there is an increased need to strengthen and make the
Panchayats more functionable nationally. Therefore, the present document is the English
translation of the ‘Jana Swastha O Panchayat .vu h has already been used to train more
than 84,000 elected Leaders in the State of
Bengal.

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Dated, the 26 February 1997
Place : Calcutta

Prof. Indira Chakravarty
Director Professor and Dean
All India Institute of Hygiene
and Public Health
Calcutta-700 073
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Chairperson,
Hunger Project West Bengal

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: A^NO$LED0fME^T
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This publication could not be made but for the help,
advice and direction of the following eminent personalities :
❖❖❖

Shri Benoy Krishna Chowdhury
Ex-Minister-in-Charge of Dept, of Land and Land Reforms &
Dept, of Development and Planning West Bengal

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Dr. Ashim Dasgupta
Minister-in-Charge of Dept, of Finance and Excise and
Dept, of Urban Development. Govt, of West Bengal

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Dr. Surya Kanto Mishra
Minister-in-Charge of Depts, of l.and and Land Reforms.
Panchayat and Rural Development. Govt, ol West Bengal

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Shrimati Chhaya Bera

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Ex-Minister of Slate Dept, of Health and
Family Welfare. Govt, of West Bengal
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Ms. Shailaja Chandra
Additional Secretary. Ministry ot Health and
Family Welfare. Govt, of India. New Delhi

Shri Narayan Ki ...imamurthy
Ex-( Let Secretary. Govt, of Wesl Bengal

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Shrimati Lina Chakraborty

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Principal Secretary. Dept, of Home. Govt, of West Bengal

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Shri L. R. K. Prasad
Secretary. Dept, of Health & Family Welfare.
Govt, oI West Bengal

Shri C. S. Samal
Secretary. Depl. of Social Wealfarc. Govt, of West Bengal

On behalf of the Coordination Committee. The Hunger Project,
West Bengal Council, extends their heartfelt gratitude.

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Dr. Couripada Dutta, (President)
MLA & Chairman, Health Subject Committee, West Bengal Legislative Assembly

Mr. D. K. Manav&Ian
Secretary, Dept, of Commerce and Industry, Govt, of West Bengal
Shri S. N. Ghosh
Secretary, Land & Land Reforms, Panchayat & Rural Development, Govt, of West Bengal

Mr. M. N. Roy
Joint Secretary, Dept, of Rural Development, Govt, of West Bengal

Sri Y. D. Mathur
Chief, UNICEF of Calcutta
Dr. Buddhadev Ghosh
Director, State Institute of Panchayat, Govt, of West Bengal
Mrs. Gouri Chatterjee
Spl. Secretary, Dept, of Health, Govt, of West Bengal
Dr. Ashoke Choudhury
Dean, Faculty of Medical Science, Calcutta University

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Dr. M. M. Mondal
Addl. DHS, Dept, of Health & Family Welfare. Govt, of West Bengal

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Dr. Aloke Mukherjee
Joint Secretary, Dept, of Health & Family Welfare. Govt, of West Bengal
Dr. A. K. Hati,
Head Dept, of Medical Entomology, School of Tropical Medicine, Calcutta

Mr. P. K.Lala
Joint DHS & SMEIO, Dept, of Health & Family Welfare, Govt, of West Bengal
Dr. H. Mukherjee
School of Tropical Medicine, Calcutta

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Prof. A. K. Adhya
Prof, of Sanitary Engineering. All India Institute of Hygiene and Public Health, Calcutta
Mr, Chandan Sengupta
Programme Officer, UNICEF, ^-.vUtta

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Dr. Arun Sen
Mrs. Kalyani Choudhury
Spl. Secretary Dept, of Health, Govt, of West Bengal

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Dr. Krishna Banerjee
C. C. R. C.

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Principal Coordinator
; Dr. Indira Chakravarty,
''''f^y';,. ’;^: DirectorProfessor,I>^&Head,Dei^q^'jL-^jv--

Nutrition,

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ah India Institute ofHygicneA Public Health?

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Chairperson, Hunger Project* West Bengal founcil.

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Secretariat

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Dr. R. K. Sinha, Assoc. Professor, AIIH & PH
Mr. Basanta K. Roy, Demonstrator, AIIH & PH
Mr. T. P. Bagchi, Porogramme Assistant, AIIH & PH

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Hyftene-Tiik (c-l)

:

Concepts of community
health—An Introduction

1 -3

Infrastructure of Rural
Health Services

4-7

Safe water,
healthy environment
& personal cleanlines

8 - 12

Chapter-4

Nutrition

13-15

Chapter-5

Welfare of mother &
child

16- 20

Population explosion and
family welfare

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health problems

23-28

Chapter-1
Chapter-2
Chapter-3

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Chapter-6
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Chapter-7
Chapter-8

Dr. Gouripada Dutta
Dr. M. M. Mondal
Dr. A. K. Hati
Dr. Arun Sen

Role of Panchayat in
public health

CONTRIBUTORS

29 -36

Mr. M. N. Roy
Dr. Aloke Mukherjee
Prof. A. K. Adhya
Prof. (Dr.) Indira Chakravarty

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Concepts Of
Community Health :

‘Health is Wealth’—
that is what we have
come to learn since
boyhood. Later, we
have realised as to
how it influences our
life, how it affects if we lose health. Ill-health
cuts in both ways—burdensome costs of treatment
and loss of peace in the family which has to bear
the brunt if one is sick in the house. If we take
a community in place of a family, it becomes an
issue for the community to keep track of the
prevalence of diseases in the locality anti sort
out measures to prevent the same. Community
health, thus, is one of the agenda for the
Panchayet to be conversant with the matter in all
its aspects. The inherent relationship between the
socio-economic conditions and community health
deserves to be understood sincerely. In the world
at large, it has been seen that the quality of health
care systems is much lower in those countries
which are far behind in terms of socio-economic
progress. India, unfortunately, is identified as one
. such country though it may take solace from its
I position as a shade belter than Pakistan,
| Bangladesh etc. from the bottom of the list. It
follows, therefore, that one informal yardstick of
a country’s progress is its performance in the field
of public health. People enjoying sound health
and happiness alone would have the necessarv
’ urge for serving the country in building ul
I necessary resources for development.
J The same logic applies to West Bengal whose
I position in the “ merit list” of progress has been
| computed between the 6th and 12th place among
| the 26 States of India. Some opinions suggest
J that the infrastructure set up by the State in West
I Bengal for Health and Medical care system is as
good as any other developed country, and that
s in some respects, this is somewhat belter. Yet,
I it is an enigma that people of West Bengal still
I do not enjoy health and hapiness as much as they
| apparently do in other fields of material life
| culturally, socially or economically. Why it should
J be so? There is need to go deeper into the factors
still causing wide-spread morbid sickness and
rendering people disabled for many spells. The
average age at death has gone up but the
proneness to diseases has also gone high.
As said before, the infra-structure for health and
medical services including community health care
delivery system has considerably improved over
the years- viz., the hospitals, health centres,
doctors, nurses, social workers and other para
medical personnel are more in number than ever

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before. Still the popular expectations are truly not
being met as the prevalence of avoidable diseases
continues to go up. The sole aim of these
discussions is to grasp the • realities or the
background giving rise to this phenomenon. We
must clarify for ourselves and then for others.
What really we mean by ‘Health’? What types of
diseases occur and why? Which section of people
are more vulnerable more than others ? What is
the disease-pattern ? What types occur off and
on ? Knowledge of all these vital facts is not an
one-day excise. Continuous efforts are necessary
in the collection of all relevant details. Thereby
only some steps of lasting effect might be possible
to be evolved out for routine compliance, and for
real good of individuals as well as the country as
a whole.
What is Health ?

The member-countries of the World Health
Organisation assembled in a Special conference
al Alma Ala in ihe-then Soviet Union (now the
independent republic of Kazbakstan). Alter
agenda-based deliberation in the conference, the
representatives affirmed by resolution that mere
absence of disease is not the indicator of ideal
health. Real health is the culmination of
reasonable oportunities for all in regard to
physical, psychological, social and economic
amenities. These crucial elements of life associated
vith health have to be understood in true
perspectives.
Disease or illness is a phenmenon that exists from
the day of creation of human life, it, however, is
quite necessary to keep abreast of all facts as to
who suffer, when, how and for how long or what
people do when they become sick. Who reaps
the benefits out of suffering people? Every aspe- ’
has to be gone through. Above all. we ha\
deal with the perennial problem as to why the
quality of health still tar below the required
standard.

For reasons clear by now, poverty compels people
to bear with worst possible environmental hazards.
Millions of people just have thatched huts or just
shacks as the shelter. Life in such conditions just
cannot improve without change of the
environment. Even pet animals are kept within
the shacks or al the doorsteps. Latrines or clean
water are not to be found. In fact, whatever
essential pre-requisites that are needed for
maintaining quality of life bare enough food,
potable water, tolerable environment, shelter,
toilets and drainage—are simply unseen things of
life for these teeming millions. The root cause,
ol course arc social and economic discriminations

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beget future generations for the country which , <
and/or lack of access to essential facilities, lack
come to be born with varying congenital
of consciousness about elementary health and
deficiencies of health- Such children, as they grow,
hygiene. All these arc bound to play havoc with
can hardly develop natural immunity from
health and make people easy preys to diseases.
diseases. Herein lies the over riding importance J
Ijjw Quality of Health—why ?
of setting equitable social and cultural standards
This is not difficult to explain. To run a car or
in which to bring up our future men and women
a machine, supply of energy, by any available
Since long, the women and the poor people in
fuel—.electricity or oil or coal—is an absolute
general have been deprived of right to education.
prerequisite. Similarly, sufficient supply of energy
This adversely affected the literacy rates both for
is a fundamental demand on every human being
West Bengal and India as a whole. 1991 Census
for assuring good health and freedom from
figures show that the women literacy rate in the
disease. This energy for human life comes from
State has just reached 47 percentage paint. These
proper food and nutrition. As we know the
overall rate of literacy is abnormally low among
capabilities of procuring adequate calorie-value
all sections of poor people. This clarifies the sad
of food enriched in required nutrition are open to
level of consciousness about practice of health.
the fortunate few in the population who are
As already discussed, the worst picture is for
financially sound. If the income is good,
women and children. Most women who bear
preference for better amenities of life will
-| children are not aware of what they
obviously follow. So, it becomes clear The infant mortality should know about safe motherhood
that uplift of living conditions depend rates, though seem and associated tit-bits of health. Both
upon the socio-economic status.
to be coming down, mother and the newborn have to get
It was seen in the past that cholera are still dangerously along without the minimal of nutrition
| epidemic most often used to spread high as will be seen and other health care facilities they so
I out first in or around the dwellings of from the fact that as essentially require. Such neglects of
I poor Jpeople’s localities, rather than in many as 24.3 out of girl-children have since told upon the
the areas of so-called upper caste every 1000 children succeeding generations, rather severally
population i.e. Brahmins, Kayasthas, die before they death rates for children of same ageetc. as we classify them. The story complete first five group will clearly depict much higher
was the same even if the house of years of life.
figures for girls as against the boys.
affected first were located on one side
Such vicious trends cannot be reversed
I of the village pond and that of the
unless social equity and education is
upper castes on the other side. In these days also,
as^ ’ ror women. (CSRS 1987). Appropriate
outbreak of gastro-intestinal diseases or epidemic
pre nti measures can be taken if reasons of
like fevers etc., is prevalent mostly in that section
death are already known and the mothers are
| of population which suffer from near starvation
aware of such measures. Development of proper
due to poor earning capacities. Dearth of proper
preventive measures is so extremely important.
shelter, wide-spread illiteracy, lack of health
Importance of Disease Control :
consciousness, dumping grounds close to the
‘Prevention is better than cure*—we are aware of
dwellings—all these render people easily
this
universal truth. The primary task is to come
vulnerable to diseases and infection. And, if
to
grip
with the issue at stake, viz., prevention of
without disease as such, they always pose dangers
disease.
For that matter, what it is about or what
to others as the carriers or contacts to disease at
is to be prevented and in which way it is to be
I large. This, in essence, is a recurrent problem
done. Over the years, all emphasis have been laid
always.
on the curative aspects, and not on the preventive
I Again, closer view will help us know the
ones. That means, the medical treatment
discriminatory practice even within the family
infrastructure which flourished at the cost of
units where, as routine, elders especially the elder
preventive health care organisations. The
males consume the major portion of the daily
community has had no role in this as there has
eatables, others only the remainder. The reason
been no effort to encourage them in preventive
might be that the males earn for the family. The
care programmes. Who benefits if the hospitals,
women and the girls are generally led to remain
branded drugs and laboratory instrumental tests
I content with less quantity of food. This gradually
etc., are patented, increasingly promoted in
render them ill-nourished, later to turn into
preference to preventive aspects of control
I pernicious proportions. Under these conditions, w
programme in which the community participation
! women are made to bear child and breast feed
has eminent roles ? Which overlords impose these
the new-born. For ages, perhaps, women in our
market-oriented practice on
people’s
society have come to carry on with these kind of
health ? For a discussion, we may take Diarrhoea
I deprivations and debilitations. This way, they

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as one common disease that afflicts children
mostly. This has proved a major killer of our
children. Yet, Diarrhoea can be contained, both
in its morbidity and mortality rates. Most cases
can be cured by giving O.R.S. at the earliest
moment after onset, and at home. What happens
if this initial small efforts are missed, and mislead,
shifted to a hospital or health centre ? In that
case we will require far more hospitals, health
centres, doctors, nurses and other para-medical
personnel
personnel that
that we
we have
have now.
now. All this will be
high-cost exercises which we simply cannot afford
under this existing conditions. The point therefore,
is to decide as to where should we fix the priority
in public interest-participation of the community
to serve themselves by adopting preventive
practices, State or to remain aloof from such
ideas ; use of ORS right at the home or rush to
the hospital for Glucose saline injections, etc. ?
It is always profitable to do first things first, to
make all-out effort to prevent diseases first with
all possible domiciliary care for incidental cases
of sickness. A movement is an imperative demand
of the existing realities in the community for
whose sake moves have to be initiated to
strengthen the required basic structure for disease
control programmes. Needless to say, the level of
social duties in general has to change towards
greater consciousness on preventive measures.
Regrettably, though, the : reverse is still the
situation what we observe. The habitual trends to
put layer of ointments on our deep ulcerations
goes on as usual. This serves the interested clique
only as indeed it has been happening.
So, it boils down to the point that all plan
formulation exercises should be an integrated

programme, and implemented with due regard to
the need of social and economic development,
health consciousness levels and campaign for
community participation towards good health
practice. These principles should be the basis of
all work programmes. It may be argued that
change of popular conceptions is not possible
without betterment of living conditions. Well,
should we then sit idle unless the other provisions
of life, namely, food, shelter, water, toilets and
sewage etc. are arranged ? Surely, we can not
allow the problems to multiply further and wait
till we achieve desired social changes. Whatever
resources we have—food, manpower, materials,
etc., must be used at optimum levels. We have to
be wise in the midst of scarcities, so to say. We
will get stuck in quicks and if we lose sight of
the cardinal principles. Sadly we are hovering
around a situation like that.

Clear conceptions on Public Health Disease and
Control :
Discussions on basic ideas of health, its quality
and control of disease have been made in various
perspectives. The inter-dependability of socio
economic conditions and public health have also
been touched upon here. All these issues require
to be explained before the people in pros and
cons. Information about the various development
programme and its phases of work are also
necessary. The infrastructure for implementation
of those programmes is also to be clearly known.
Then only, the Panchayats (or its member-incharge) will have clear views to decide upon the
roles to be played by themselves. For their benefit,
I various issues at stake have been deliberated,
m the succeeding chapters of this booklet.

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3

WRASTRUCTERE Of
:
Rural <
Health Services :
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importance of disease

There is one male and one female health^assislanl' in every sub-centre. The centre is kept open on
a pellicular day of the week. In these sub-centres,
all the health care facilities mentioned earlier are
available. These centres are required to create
awareness among the people regarding availability
of these facilities from sub- centres.
c t a. A f i
On four days of every week or 16 days in a 1
month the health workers will visit homes to make j
contacts with the people. They are to plan in
advance the village they will visit and shall inform
the concerned Gram Panchayat before the
particular month starts. They are to inform the
Pradhan at the end of a month, the dales and
places they visited, before they submit their
, J
monthly diary to the Block. Pradhan shall note
his comments in this diary. The Member in-charge
,1 ■ }
of public health affairs can also perform this
function in place of Pradhan.

prevention. Hence,
majority of health
workers are involved
in disease preventive
activities. Earlier there
were separate health workers for certain specific
diseases. From 1985 onwards Multipurpose Health
worker Programme has been launched, so that
one such worker can take care of all the aspects
of health. The foillowing programmes are
implemented under this scheme :
(a) Control of communicable diseases, (b) Welfare
of mothers and infants, (c) Family welfare, (d)
Prevention of diseases, (e) Nutrition, (f)
Preservation of healthy environment, (g)
Registration of births and deaths, (h) Health
Education, (i) Personal Hygiene, (j) Transference
of complicated and difficult cases to upgraded
health centre or big hospital.
For performing the above mentioned activites it
is necessary for the health workers to keep very
close touch with the people. When a person
becofiies sick or for receiving any health services,
he should contact either with a health centre or a
hospital. To build up a strong preventive
arrangement, health workers will make contacts
from house to house. The infrastructure of
Multipurpose Health Programme was evolved,
keeping in mind the above activities.
Health Sub-Centre :
Health Sub-Centre is the main pillar of rural
Health Services. There is one sub-centre for an

.IX;

The roles of health workers at Sub-centres will
be as follows :
x
— Clear knowledge of the target area and
estimated total population served in every category
(pregnant mothers, lactating mothers and children).
Service for mothers :
—Pregnant women need for al least 3 check
ups
—Need for 2 doses of TT
—Use of the disposable delivery kit and the
five ' ’s for delivery
'u< ■ supplementation-nutritiion
—early detection of complications
— Need for timely referral, transport
availability and blood donation to save lives
— Promotion of breastfeeding, early initiation
and exclusive till 4—6 months.
—Proper washing
—Service for the Child :
—Newborn care warmth and breathing
—Weighing newborn and follow up on baby’s
growth.
—Immunization—all antigens before 1 year—
importance of correct timing and the need for the
repeated doses
—Proper management of diarrhoea in the
home—home available fluids, continued feeding
and ORS at health centres
—Vitamin ‘A’ supplementation and proper
nutrition
—Pneumonia management.
Primary Hea Ith Centre (New) :
One such centre is for 6 sub-centres. There is a
doctor, one male supervisor and one lady
supervisor, one compounder, 2—3 nurses and a
few group D staff.

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This Health Centre has 10-16 beds, a <dispensary
,
and arrangements for minor surgical operations^.
Facilities for examination of blood, sputum, stool,
etc., arc also available at these centres.
Medical Officer and two supervisors of this centre,
supervise the work of these sub- centres under it
The Supervisors visit those centres/villages 16
days in a month. Tlie medical officer of the centre
reviews progress of all programmes, every
Saturday with the Supervisors.
The services that are available in these Health
Centres are as follows :
—All the services available at a sub-centre
Treatment facilities at the outdoor as well as in
indoor
—Emergency services.
—Transference of complicated and diffipult
cases to a bigger hospital, such as, sub-divisional
or dist. hosp.

Block Primary Health Centre :

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In every Block there is one Block Primary Health
Centre. There are more than one doctor and other
health workers. The following are the health
workers under each block Health Officer who
perform their respective duties as shown against
each :

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(I) Block Sanitary Inspector—To supervise
all male health workers. (2) Block Public Health
Nurse—To supervise all female health workers.

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(3) Two Social Welfare Officers—To Organise
Health Education, IEC and Public relations in the
entire block. (4)Computer—To prepare and
preserve reports, records and compile data. (5)
i nu
To assist in public health Work. (6)
Laboratory Technician—To conduct simple
laboratory tests. (7) One PMC A—To assist in
Opthalmic services. (8) One Sanitary Inspector
and one Mdlaria Inspector to help the Block
Sanitary Inspector. (9) One Public Health Nurse
to the Block Public Health Nurse.
A monthly meeting of all Health Supervisors and
Workers under the Chairmanship of BMOH is
held to monitor and evaluate the progress of work
and to coordinate the activities.
At this level, there is an Advisory Committee
consisting of local leaders.
Below is shown an organisation chart of Rural
Health services. Although there is no Govt, health
worker below the level of sub- centre, there are
voluntary health workers. There are trained Dais
and Community Health Guides. In addition,
Anganwadi workers are involved in health care
activities of mothers and infants. This
infrastructure is necessary to be utilised properly
as lot of Govt, mpney is spent in maintaining
this infrastructure.
It is not sufficient to know merely the
infrastructure, one must know the responsibilities
and duties of each type of worker at village level
and higher levels. 771656 are stated below :

Organisation chart of Rural Health Servkw Programme

bit Block level *'

Block Priin

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(h. Centre

Block Health Officer

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Asst. Second
Medical Officer

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Social Welfare
Officer

Block Sanitary
Inspector
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San. Insp.
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Malaria Insp.

LAt'Anehal level 1

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Computer

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Asst, third
Medical Officer

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Lab.
Technician

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Asst. Opthalmologist

Public Health Nurse

New Primary.'Health Centre

Medical Officer-in-Charge

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Health Supervisor (Male)

[Health

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Health Supervisor (Female)

Health-Sub Centre

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Health Asst. (Male)

Health Asst. (Female)
Trained Daima ; Anganwadi Karmi

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Block Public
Health Nurs

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Job responsil
In every Block, there is one
Block Sanitary Inspector. He
implements the health and
family welfare programmes
under the supervision of the
medical
officer.
He
investigates the reasons for
spread of infectious diseases
and takes proper measures for prevention and
control of all contagcous diseases. He registers
all births and deaths, and develops mass awareness
regarding pollution control and food adulteration.
He supervises the work of all male workers for
proper implementation of health programmes.
Maintenance of environment sanitation in village
fairs and also inspection of such places are his
responsibilities. Every month he supervises the
field workers for sixteen days (4 days within 8

organisations in lhe health programmes. The
supervise the work of the field health workerv^
for 10 days in a month. But the two officers do
the work by turn, while one attends thi. block
hospital and assist in public relations, lhe other
may go out on lour.
Sanitary Inspector

There is one Sanitary
Inspector in every block. He
helps the Block Sanitary
Inspector in epidemic control,
health progrmmc during
natural calamities and
sanitation programme in
general. He supervises the
work of health workers and monitor the progress
of health programme and collects relevant progress
reports regarding all the activities. He supervises
the work of the field staff for 16 days in a month.
Malaria Inspector :

km.)

There is one Malaria
Inspector in every Block lor
supervising Malaria Control
Programme. It is his duly lo
collect blood slides of lever
cases for examinlion and
making arrangcmcnls for
specific treatment. He makes
arragements for DDT spray operation in areas
where malarial cases are detected. He is
responsible lo.lhe Block Sanitary Inspector. He
u’ ' supervises lhe work of field sial I lor 16 days
in . month (4 days wiihin 8 km.)

Block Public Health Nurse :

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There is one Pubic Health
j Nurse in every block. She
supervises the work of all
female workers. She performs
the
responsibilities
ot
implementation of Family
welfare, mother care, child
welfare
and
overall
immunisation programmes. She participates in
family planning operation camps organised al
different places, IUD application Programme and
immunisation campaings, in baby-shows, nutrition
education camps, midwife and Anganwadi
workers training camps etc. It is the duty of the
Public Health Nurse to maintain communication
and relations with Panchayat, women’s
organisations, volumtary organisation in Family
Welfare, Mother Care and Child Welfare
Programmes. She lours and supervises the work
of female field workers for 16 days in a month
(4 days within 8 km.)

Public Health Nurse •
There is one in every Block.
She helps lhe Block Public
Health Nurse in supervising
Family Welfare. Mother care
and child welfare and
Immunisation Programme
She helps and organises baby
shows. OT camps, training of
birth attendants, etc. She supervises the work ol
field staff for 16 days in a month (4 days within
8 km.)

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Social Welfare Officers :

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Bi There are two such officers
K in every Block. They make all
I arrangements for public health
I education Programmes. Their
I duties include organising
| orientation camps, training
| programmes for health
of
different
F
__L*—i ® workers
health
gudies
towards
health
categories and
education and community communication with the
^"■ZIZT media like film shows, plays, group
help of mass t-----. meeting, etc. They coordinate and make icon^‘
and involves voluntary
with the Panchayat
1

Computer :
There is one computer in
every Block. His duly is lo
collect data from all centres,
compile, analyse and maintain
those data. He sends report lo
the sub-division and District
level. He is to collect the
following data and send

reports accordingly.

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programme, santitation, school health, birth and
death registration, training of health guide and
midwife, etc. They contact and coordinate with
the Panchayat, women's organisations and
voluntary organisations They help in providing
primary health care services in villages at “Melas"
and other functions.
The female health assistant is more responsible
for mother care, child welfare and immunisation
programme. The male assistant is more involved
and more responsible for other services.

1. Births and deaths.
2. Malaria blood slide collection, number of
Tialaria cases, report on DDT spray and
insecticides.
3. Tour and night hall of doctors and other health
workers.

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4. How many patients had been in beds inta
month.
5. Reprot on deaths by disease.
6. Family Planning Progress report.

Community Heath Guide and Trained Birth
Attendant :

7. TB cases and treatment report.

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8. Progresss of Mother and child services.

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His duly is lo point out mislakes made by health
workers in ihicr reports and lheir rectifications
and lo bring lo lhe notice of the Block Medical
Officer in case of any worker nol submilling
report.

One such guide and a birth
attendant are there for every
1000 population (1981
census). Their duty is to help
n:.v
the health workers send
reports and maintain relation
between the mass and (he
health workers. They take
“t in the health programmes for prevention ol
part
diseases. The trained Birth Attendant make
arrangements for delivery al home.

9. Progress of Immunization programme report.

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Health Supervisor :

For every 6 sub-ccnlrcs, there
is one male and one female
supervisor. They implement
the health programmes wilh
lhe help of health assistants
in
the
cpnlrol
of
communicable
diseases,
family planning, mother care
and child welfare and immunization. They
organise health education camps, contact
Panchayat and voluntary organisations. Supply of
drugs to sub-centres, collecting reports and
sending them to the block level are lheir
icsponsibilities. The lady supervisor supervises the
female workers and lhe male supervisor supervises
male workers. They supervise the health workers
for 16 days in a month in lhe field.
Health C-CsistanT)' tO CA k ei!

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Treatment of Leprosy Patients :

Generally the multipurpose
health workers arc associated
with the treatment of leprosy
patients. There is separate
infrastructure for detection
FLEPROSY
and treatment of Leprosy
o^aTMEN
cases. There are leprosy
control units at different
u £31
laces to implement the Leprosy Eradicatiion
programme. One of the features of this programiinc
is ____
muti-dnig
L
w therapy which cures the patients
completely. As the prevalence of this disease is
more in the districts of Bankura. Purulia.
Bardhaman. Mcdinipur and Birbhuln in West
Bengal, this programme has been launched in

There is one male and one
female Health Assistant in
every sub-centre. They assist
the Village Panchayat in all
programmes related to public
health.They collect data of
individual villages and send
the reports. They make home
visits for 4 days per week and run the clinic on
notified days of the week. Tour program is
finalised through discussion with lhe Panchayat.
On the last day of the week they attend meeting,
submit reports and collect medicine. It is their
duty to collect data of their respective areas and
maintain them under lhe Tollowing heads: Control
pf communicable diseases, mother care, child
welfare, family planning and immunisation

these districts.

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Most of the comrilon
diseases in our country
are water-borne. That
is, the germs enter our
■**<*w1
body being carried
through water and
nvironmknt
cause the disease.
Besides may harmful
inal leanliness
chemicals, such as,
'. arsenic, may also be present in water. Hence all
‘ water
water is not safe for domestic use. Therefore, the
I standards for usable water will necessarily depend
intended usage pattern. The related
I on its
i................
| characteristics of water are as follows :

| §AJraWATER^. .
IO^E
C
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p“—“

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How water is polluted ?
When water is precipitated as rain, it does not
contain any bacteria or chemicals, and that water .
trickles down to the rivers, canals, ponds, ditches
e?.c. and thus get stored. Most of our villages
lack proper sanitation facilities for human as well
as for animals and cattles. The people genera.^
resort to the practice of open defectation and
throwing of garbages in the field rather
indiscriminately. These are carried into the waler
as surface water run off during rains. In this way
inillons of pathogenic organisms, such as, bacteria
and viruses, get mixed and pollute the waler
sources. The same pond waler is used for washing,
ablution purposes and for bathing and cleaning
cattles, while wastes are regularly dumped into
it.
Again skin diseases are spread through pond waler
if infected persons lake bath in such water.
Use of different chemical fertilizers and pesticides
in the field for agriculture has become a common
practice these days. They also gel mixed and
pollute the waler sources.

Turbidity
Taste & Odour
Presence of Harmful Chemicals and Pathogenic
Organisms.

Among these the last two characteristics as such
cannot be very easily determind. Serveral methods
are now available to determine the presence of
harmful chemicals or pathogenic bacteria in waler
and to ascertain its safety. About 70-80% of our
diseases are directly attributed to the use of unsafe
water. Hence, judging by these two parameters,
any water which is unsafe should not be used.

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Safe Water Sources :
Ground water is the single major source ol sale
water. The soil layers act as filter and prevents

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the entry of pathogenic organisms at such depths.
But still there is a possibility of the first layer
water to be contaminated. So at least the second
layer waler is generally considered to be safe.
The ground waler to be always safe is, therefore,
not a valid statement. Sometimes the soil may
contain harmful chemicals in excess at some
places. V/ater may get polluted i’f contaminated
water percolates through the annular space around
the tubewell pipe in absence of a porper platform.
The same problem can arise if there is no concrete
platform in case of dug wells. Therefore, proper
platforms should always be constructed in
lubewells and dugwells and even then ground
water should be regularly tested, if possible.

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Only safe water sources will not do, how the
waler is being transported, stored and distributed
in the house are equally important. It is also
important to see that the water should not get
contaminated during any of these processes.
Use of safe water & supply strategies :

All of us should use safe water. It has been
mentioned earlier that standard for waler quality
is primarily determined by the use of waler
intended for. For example, the water intended for
drinking should not necessarily be of same quality
with the one used for bathing.
The water which is directly consumed either
1 -nigh drinking or through food materials should
b: tree from al! chemical impurities and germs.
All the utensils used for cooking and serving food
should be washed only with this type of safe
water which we usually get from the lubewells.
There should be one such safe waler sources for
150 persons.

Again the general concept of all water sources,
excepting ground water, to be unsafe is not quite
true. Pond waler can be upgraded and protected
to acceptable limit, even upto the lune of drinking
water quality standards. Whenever ground waler
is contaminated or saline, pond waler can be made
usuable through treatment. Water can be made
germ-free after boiling for 10 minutes. In case of
inconvenience in boiling water, it can be
disinfected by applying fresh bleaching powder.
Bleaching powder fast looses its disinfecting
property if kept in the open. Il should be stored
in a tightly lid container. Again, it does not work
if it is sprayed or sprinkled as such, instead a
pinch of bleaching powder has to be taken for
each litre of waler to be disinfected and a paste
is made by adding little water. Then it has to be
added io the required volume of water which can
be consumed safely half an hour later.

However, presently water sources are not available
in such high numbers everywhere. Therefore
water sources should be constructed in a more
prudent and pre-planned way which may be a
tubewell, a dug well or even special type of pond.
The type of sources to be adopted will depend
on the local situation But, in most of the places
the type of lubewells may vary. There are four
types of hand operated lubewells besides the
electrically operated deep lubewell.

1. Suction Handpump—which is very commonly
seen. Though cheaper in price, such pumps
become defunct when water lable goes down
during the dry periods.

Halogen tablets are also equally effective in
disinfecting water. One tablet has to be added for
one litre of water which can be consumed after
half and hour.

2. Mark-Il handpump—can pump water even
when the waler table goes 120 ft. down below
ground level.

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expectedly it will be made available within an
of upto
year. Waler can:i be drawn from a• depth
•f’
‘ of
ground
level
with
this
type
59 ft. below £
be maintained by the
handpump, It can also L- ...
village people.
So, more and more new installations ot Tara and
Mark-Ill handpumps should be encouraged as a
part of future planning. At the same t.mc
importance should be attached on their village
level maintenance by the villagers themselves.

This phenomenon, of course, has to be clearly
understood, the layer from which water is
I collected depends on how deep the filter or
I strainer has been put to. Though it may even
I extend well below 1000 ft. deep, the water eve
comes up within the pipes near the ground level
I due to atmospheric pressure. For which reasons
I water remains avilable in these hand-pumps dunng
I summer. Installation of such pumps are, however,
I quite expensive. Theyj are ideally suited for hilly
I terrains or rocky areas.
------ The apparent difficulty
■
I for its maintenance, specially by the
villagers3, is
I its major drawback.
I 3 Mark III hand pump has been developed by
I improving the Mark-II model. It can also draw
I water from a depth of 120 feet. But it has the
I ' major advantage in that it can be maintained }
I the villagers themselves. Mark-II hand pump can
be converted into Mark-HI type through a little
I
investment.
I 4 Tara Pump—It is the most ideal hand pump
our state, specially
for the plains. The cost
I for
_____
.
I involvement will be about ten thousand rupees
: I per hand pump installation. It has not yet been
| launched in the market commerciallly though,
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Rjp

Most of the people are now conscious about their
drinking water. While for other purposes the
villagers mostly use pond water. The particular
ponds whose water are mostly used, it is now
,e to upgrade their quality to the usable
possible
standard very easily. Such ponds should be
properly protected so that no wastes or tacca
matters are mixed with the water. They should
be spared from being used for washing clothes,
bathing or any other purposes. The pond waler
can be disinfected periodically by bleaching
powder. Waler can be drawn at a fairly low cost
by installing handpumps near the side ol such
nonds. But they should have proper plallorms and
di nage system so that waste water is not
^charged into the pond water. This water can
be used for bathing, washing clothes ami utensils
etc The water can also be brought near the houses
for convenience. It will be very much useful il al
least one such traditional yet perennial pond waler
sources can be protected and conserved in each
locality. But a prior calculation about the number
of families that can be covered by such schen
on the basis of 40 litres per capita per day will
be necessary to prevent the pond from going dry
due to excessive daily consumption. The waste
water can be utilised for watering crops in the

kitchen garden.
Healthy Environment :

Clean and healthy environment is essential lor
good health. In order to create such an
environment, a scientific measure should be
adopted to prevent the excreta and other wastes
from polluting the environment. This requires
appropriate system for human and animal excreta
and solid waste disposal and treatment.
Amongst these the most important one is sanitary
latrines. Such latrines can be construcled at a very
low cost of Rs.230/- only. Alter digging a pit
hke a dugwell. a’ pan with water trap has to be
tlxed. Some amount of water always remam m
the trap. The latrines are flushed by pouring waler

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after each visit and the faecal matters are
deposited in the pit below. The water in the trap
prevents bad odour, flies or germs from the pit to
come out and foul the environment. When the
pit will be filled up after four to five years, the
sewage effluent can be diverted to another
adjacent pit. The filled up pit can be cleared after
about one year, and their contents will neither
have any germ nor any foul odour. Instead, they
can be very well utilised as a good fertilizer safely
without any health hazards. Efforts should be
made so that the different materials and fittings
required for such latrines, such as pan, water trap,
loot rest, etc., can be produced in the village
itself.
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I Village masons should be given intensive training
I in this regard. Panchayats and Voluntary
I Organisations in different districts have already
I come forward to extend their help. A large number
I' of families are showing their interest to construct
I such latrines. But it should be seen that the latrines
I ire constructed at a distance of at least 25-30
I 'eet from the pond and never closer than that.
Use of sanitary latrines by only a few families
will not be enough to upgrade the quality of
■nvironment to any great heights, everybody
should start this practice. Only (hen we will be
ible to get rid of excreta-bome diseases, like
diarrhoea, ameobiasis, gastro-enteritis, cholera,

jaundice and dilferent tyjK-s of worm infections.
Io some extent. If open defecation is prasticcd
these pathogens can gel mixed with our drinking
water or with food matters being transmitted
through flies. Hence mass awareness is very much
required.

Smokeless-chullah, specific bins or pits for solid
waste disposal, soak pits etc. are also essential
for an alround environmental development. Quite
often waste water gets accummulated near the
houses or tubewell platforms in absence of proper
drainage system and thus not only pollute the
environment but makes an excellent breeding
ground for flies and mosquitoes. This waste water
can.be brought to the garden through pipelines or
else can be sent underground through soak pits at
a fairly low cost. How such soak pits can be
made has been described below.
Personal Hygiene :

One of the major reasons for the incidence of a
number of skin and other diseases is due to lack
of personal hygiene. A little awareness can help
us avoid recurrence of such diseases. Therefore,
for personal cleanliness everybody should abide
by only certain rules and regulations.

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The relevant lessons which should be taught to
the children have been described below:

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Utensils used for serving food must be washed
by clean water. They should not be wiped any
further with a piece of cloth after washing. Food
must be served by spoons, and not by bare hand.
Once after washing, hand should not be wiped
by anything just before taking food. This may
further enhance the chances of dirts or genns
sticking to the hands. Fruits and green vegetables
must be thoroughly washed with potable water
before cutting into pieces. Finger nails should
never be allowed to grow. Though the safe
tubewell water is used, the diseases can still
spread if the glass is unclean or fingers or nails
are dipped in water. It is very good to take bath
everyday. But the water used for bathing must
not be polluted. To wear clean and fresh dresses
everyday and to brush the teeth twice daily is
good for health. There is no need for costly tooth
paste and tooht brush, only Neem twigs will do.
It is advisable to rinse the mouth throughly after
taking meals so that no food particles get stuck
to the teeth. No one should go to the open bare
footed as there is chance of giardia and hook
worm infection from the soil. Cheap variety of

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slipper will also serve the prupose. Soak-pits can
be very easily made. It will be required to find a
square pit of approximately 1 cubic metre size, of
which about one-third should be filled with stone
chips of bigger diameter (10-15 cm.), then the
next one-third with gravels of smaller diameter
(1-2 cm.) and finally the rest with the same
gravels leaving a 10 cm. space in between. Now
an earthen pot of 20 cm. diameter has to be put
within the gravel layers in such a way that its
mouth should be positioned just below the drain.
The pot must have perforations of 2 cm. dia. all
around its body. Coir mesh or leaves may be
placed in the pot to screen out the suspended
rubbish in the waste water. About half (5 cm. )
of the empty space above is to be filled up by
twigs or branches. Now a gunny bag may be
placed over it and this should be covered by soil
and the surroundings levelled.

The drains may be made of concrete, earthen pipes
or else by digging out earthen canals. To maintain
an uninterrupted flow, the drains should always
be kept clean.

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We all eat, as we have
to.
Food
gives
nutrition needed not
only for keeping alive
but for steady growth
utrition
of physical strength
and stoutness of body
frame. Proper food
uplifts health, and
I nturition from food creates immunity from
I diseases and helps build up a long life-span.
I Food is the prime source of nutritional values,
I viz. (I) Protein (2) Carbo-hydrates (3) Oils and
I Fats (4) Minerals and (5) Vitamins. One or the
other food has the pre-dominance of one particular
elememt of nutrition viz. Carbo-hydrates in rice,
bread, potato, Proteins in soyabean, Vitamins and
minerals such as Iron in leafy vegtables. Milk,
however, has almost all the sources of nutrition
namely, protein. Fats, Carbo-hydrates, Calcium,
I Vitamins, etc. The left-ones (after intake) that are
I not digested pass out at Nature’s call through
urination and defecation. State of Nutrition has
I definite
bearings on our economic, social, cultural
I and psychological conditions. Food-habits differ
I from one social or ethnic group to the other. The
I moot question, however, is whether we ever have
I any faith on the importance of belter nutrition for
I the mothers and the children of our scc'ely. True
I that nutritional care varies for reasons of economic
I or other weaknesses, or for peculiar habits of taste
I and cooking practice. For example, we mostly
I drain out the starch after boiling the rice which
I is a proven source of nutrition at no cost. Then,
I there is preference for sweety foods among many
I families as against salty ones among others.

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Let us go for an idea of some nutrition specific
food articles :

Protein :
Egg, fish, meat, milk and
milk-products. These are
animal protein food items.
The vegetable proteins are
available from soyabeans,
pulses and grams, almonds,
'-t'.
and also from coms (maize),
__ >
rice, wheat and vegetables,
Animal proteins are believed to be more
wholesome but sprouted grams, wheal etc ., are
equally so rich in value. Food-value equivalent
to animal proteins can also be obtained from
combination of one or more varieties or vegetable
protein such as the pulses with rice or wheat etc
Protein helps build up body muscles, compensates
physical decays and losses, creates natural
immunity from diseases and enhances strength
and vigour.

Carbo-hydrates :
Principal items of carbo
hydrate foods are rice, wheat,
maize, coms, mi Io, potato and
similar root, vegetables,
sugarcane,
sugar
and
molasses, honey, etc. Carbo1 rates are the source of
ca ie energy to the body
astern. We get about 70% (seventy per cent) of
these vital needs from carbo-hydrate food items.

Oils <K Fats
Oils of ground nut, coconut,
mustard, rapeseed, cottonseed,
sunflower,
palm
and
Vanaspati provides for
j r-r mecessary fats in food, butter,
ghee, anima! fats and seed oils
are needed for maintaining
body heat of steady livels.
These are also necessary for smooth skin and
absorption of vitamin intake into the body system.

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Minerals and Vitamins :

T] These are present mainly in
£ milk, fruits, grains like rice,
wheat, pulses and green
vegetables. All varieties of
spinacks and drum-sticks are
rich in minerals and vitamins,
seasonal fruits, the cheaper
ones as well, should become
an essential item of daily food. Minerals and
Vitamins have an eminent role in building up
strong teeth, blood formation, proper absorption
of carbo-hydrates, proteins, oils and fats into the
body, sound health, disease control abilities and
cycling of re-productive organs.
Water :

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Waler is the other name of
life. None can survive wiihoui
waler. We need two to three
litres of drinking water per
head per day (which comes I
to 8/10 glasses). Bui for this, (
we are open to various health I

large scale movement of food articales out of the
village is an important social duty. This will
ensure belter availability for all village families
according to (heir demands and buying capacities.
In other word, it is necessary to see that the
produce of the village meets the local demands
first. Stress, however, is to be given on the special
needs of nutrition. And. on their count, the
children-infants and the growing ones as well,
the child-bearing and the lactating mothers deserve
priority attention.
4

Malnutrition & Hyper Nutrition :
Continued lack of nutrition positively leads to ill
health. It is equally so in case of excessive intake
of nutritional food. Both are a symptom of
imbalance, and thus risky. So, a balanced
approach is essential without which manifestation
of one or the other disease of malnutrition will
soon overtake health.

In our country, as against the children who mostly
fall victims to protein-Calorie-malnuirition
diseases, the growing ones and the adult girls as
well as the mothers of reproductive age suller
hazards. Water helps digestion
generally from deficiencies in minerals (csp. lion)
& Vitamins A, B <V C - viz... anaemia, tooth &
of food, keeps constipation away, drains out body
pollutants,
and
prevents
gum decay, skin diseases, loss of
In our country, as against vision, even blindness.ZA little
dehydration during summer. In
the children who
4,v fall emphasis for arranging standard
times of summer, a little bit of
victims to prote.
jrie- nutritional diet within available
salt added to water before
malnutrition diseases, the means will keep all these hazards
drinking is useful as it maintains
growing ones and the adult far away.
body fluids.

girls as well as the mothers

In essence, therefore, we must
of reproductive age suffer Discard old habits :
look for balancing our daily food
generally from deficiencies (I) Drain-out of rice-starch is an
within
various
limitation.
in minerals (esp. Iron) & avoidable wastage.
It
is
Principal food; such as grains
Vitamins
A,
B
&
C
viz.,
considerably
rich
in
carbo

(rice, wheat, pulses) fish,
anaemia, tooth & gum hydrates, protein, minerals, and
vegetables, fruits are traditional
decay, skin diseases, loss of also some vitamins. Such spoiling
village products and this aspect
should no longer be allowed. The
vision, even blindness.
can be usefully considered for
starch of boiled rice can be taken
balancing the food. Village-level alertness against
along with pulses and other curries of daily menu.

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supporting diet, such starches might actually
impair nutrition. This is true even in cases of
diarrhoeas-like diseases.

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the bigger is the egg, the higher will be the value
Inere is no difference between an egg from either
hen or a duck.
(9) Nutritional properties are best available if the
raw vegetables are washed clean before being
P’cced for cooking, rather than doing it afterwards
which is unnecessarily wasteful.
Various measures by the Stale Government are
in force for care of expectant and lactating
mothers and infants. These are :
(1) Child-bearing and Lactating mothers widely
suffer from anaemia and allied disorders. For
them, Iron-Folifer tablets are distributed free of
cost from Health Centres. ICDS organisations
have also these arrangements. 100 (one hundred)
tablets are to be taken at the rate of one per day.
(2) Children run the risk of getting into nightblindness and other vision defects for want of
Vit. A prophylaxis. State-run agencies, such as
hospitals health centres and the ICDS provide
f°r Vit. A oil for oral use at free of cost. This
facility has to be availed of to the maximum

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1. Ensuring full coverage of children below 3
years with Vitamin A prophylaxis begin as stated
in page 4
(3) In villages, poor fanners traditionally have
rice
nee carbo-hydrates as their major food, taken
along with nominal mixture of pulses, vegetables
fish or <ew
gg spieced curry form, etc. Attempts
I or
should be made
2 !° br;ng a change for better
I balancingc ofcT'Vfood
within avaiiduic
available means
means oy
by
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.as f?r. as P°ssible, the protein-vitamin| oil-tats-based items of low price varieties
Children
ynnoren sick
sick with diarrhoea or gastrointestinal
I diseases
l
kJ necessarily
5dlljy take
iaKe breast
Dreasl milk
miIk as
should
—
I UkUa j M()[hers falling ill with similar ailments
| should never deny breast milk to their babies.
Inere are no hazards in this.
I
Skipping of food altogether or its drastic
reduction at the time of fever or disrrhoea is a
I taboo which should be diacarded. Intake of
I adequate
quantity
dividedJ into small
• .
•
j of
— food wbtiwvt
|
3 time in more fre<]uencies will be.the
right procedure.
(5) Peding of green vegetables is another practice
which should not be encouraged for a day from
now. Peeled roughages, however, can be cooked
| as tasty and wholesome food item as well. But
I wastage is a loss of nutritious food.
(6) Lot of oil is used for massaging babies. The
more appropriate use part of it in the preparation
I of baby meals at the kitchen.
| (7) Taking half-boiled egg is not advisable, for
| this does make the egg free of germs or infection
otherwise. It is safe to boil the egg in right form
but never to do so hard. This, oi course, is true
in case of all raw food articles for cooking. So,
' no overboiling or less-boiling, be it hen or duck,
only right boiling.
(8) Food value of egg is related to its size viz.,

I

1- 'ring full coverage of pregnant women with
- ”n >hc Acid tablets of one tablet per day for
lUu days.
3. Monitoring the crop patterns and evolving early
warning systems in drought prone areas.This will
help in working out different strategies to cope
up with difficult food situations like setting up of
grain banks or ensuring better targetting of poverty
alleviation schemes or drought relief measures
4. Monitoring the public Distribution System/
Kation Shops and ensuring that only iodaled salt
is distributed through outlets.
5 Ensuring that the weight of the babies at
diiterent ages are collected by the anganwadi
workers and Health workers.

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Health of mother and
•child
is one of the
CHAPTER-5
primary objectives of
health
care
programme. The well
being
of
child
invariably depends
upon the level of
mother’s awareness.
In the same way, level
j of^health enjoyed
by
girl-child
be
• •
* a O
-- ..
vzv will
a good
indicator of a future mother’s health, and the cycle
goes on for the successive generations. So, all
relevant aspects concerning the health of mother
& child should be taken into strides in the
| perspective of the objevtive conditions of four
times.

°oo
ChildB

I, In our country, the current rates of morbidity as
■ well as mortality for both mother and child are
still high. Bringing down these rates, therefore is
an important target in all welfare programmes on
I mother and child. In 1990, the Infant Mortality
| rate (IMR) in West Bengal was 64 per 1000 live| births (SRS Report, 1992) when the same figure
for Kerala was 17 only (SRS Report, 1972). It
will be a great achievement if we can reach this
figure of Kerala even by 2000 A.D. For every
I one thousand children bom, 4 to 6 mothers
’ | expired due to child-birth complications. It is
| absolutely necessary to bring this rate to around
I as quickly as possible.
| The leading causes of death and sickness of
children in our country are (1) Diarrhoea and other
gastro-intestinal diseses, (2) Respiratory diseases
like Pneumonia, Bronchitis, etc. (3) attack of
measles, T.B., diphtheria. Poliomyelitis, Tetanus,
| ctc.which can be controlled by immunisation (4)
Low birth weight—weight below 2.5 kg posing
continous threats to babies well-being. Low-weight
mothers deliver children with similar deficiencies.

Sound nutrition, therefore, for child-bearing
mothers is of utmost importance for new boms.
Measures to check Infant Mortality :

Contaminated water is the source of diarrhoeal
and other gastro-intestinal disorders. It is necessary
for these reasons to keep away polluted waler by
all means. Failure to abide by the basic principles
of health lead to infection and this has been
discussed in the proceeding chapters. Diarrhoea
causes severe loss of body fluids, and
compensation of this toss is a must for saving
life. This body-fluid has various functional
activities internally—(i) it keeps the body’s inner
system clean, (ii) helps circulation of blood (iii)
prevents constipation, (iv) helps produce essential
salts etc. Fluid-loss due to excessive purgings set
in severest dehydration. Quick measures Xo stop
this condition and to generate re-hydration go a
long way to save life. Externally, of course, the
loss of these salt and fluids can be made good by
giving the patient ORS—available at all Health
Centres. These formulations are prepared as per
guide-lines of World Health Organisation. It is
advisable to keep these ORS packets at hand (in
the house) for instant use in case of an outbreak
ORS is also marketed by various drug
manufacturing firms under various brand names
These are not only priced quite high, but also
> k n ontents to satisfy the formulae fixed for
if. -r
reparation by the WHO. ORS is to be
dissolved in 1 litre of water cooled after boiling,
given to the sick child in several sips at short
intervals. Intake, it must be noted, should be of
sufficient quantity, viz. to compensate the fluid
loss in full. In fact, it is always advisable to make
sure that more ORS is consumed than the quantity
of fluid lost from the body as only that way the
conditions can be stabilised towards early
recovery. In case, ready ORS are not available,

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of fluid lost from the body as only that way the
conditions can be stabilised towards early
recovery. In case, ready ORS are not available,
home made solution will also do, provided it is
prepared in accordance with stipulated portions,
viz., 1 to 2 spoon sugar (or one & half tea- spoon
gur, or molasses) & one finger-tip of common
salt to be mixed in a glass-full of water cooled
after boiling. As said before, this should be given
to the baby as much as the child can take in. In
addition, other fluids available from curry with
very little spices, rice-starch, green cocoanut,
water soaked after dipping parched rice in it, etc.
will help much quicker recovery. Care must be
taken to seat the baby before every intake of fluid
or food to avoid risks of choking. Breast-milk
should be continued as usual.
Majority of cases will recover, if they are given*
atequate anounce of fluids. However, the doctor
and the health centre should be approached if the
baby continues to have the symptoms like :
(i) persisting dehydration as might be indicated
by sunken eyes, drying up of tears despite cries,
high thirst, etc. (ii) non-remission of fever, (iii)
purgings /vomittings almost every hour (iv) blood
in stools, (v) excessive thirst, (vi) does not get
butler in two days, (vii) eating or drinking poorly,
(viii) obstruction of urine, etc. Obstruction of urine
is a serious and late symptom of dehydration and
the family members need not wait for this sign/
symptom to appear before referring the child to
a hospital.
Protection of children from contracting cold is an
essential precautionary care for safety from
respiratory diseasses. Dampness of room is a
potential threat to child health. In case, the cold
in weather downs the baby thorough watch on
the breathing patterns is a necessity. Doctor should
be consulted the moment the baby’s breathings
get disturbed or the pulse beats are unduly rapid.
Home treatment is advisable in case of cold &
cough with locally available accepted remedies
made from household ingredients (honey, ginger,
tulsi, hot water). Fever may be controlled with
parasctamol. Adequate fluids intake & feeding to
be continued. The mother should be advised to
refer (he case to a P.H.C. or to a hospital if the
illness worsens, breathing becomes difficult or the
feeding becomes a problem.
A breathing rale of 60 per minute or more in
infants in a resting condtions suggests pneumonia.
Children classified as having severe pneumonia
or very serious disease are to be referred to a
hospital with facilties for Oxygen therapy and
intensive care unit. Danger signs which signify
very severe disease or severe pneumonia are •
(a) child stopped feeding well.
(b) child loo sleepy or difficult to wake
(c) stridor even when the child is calm

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(d) wheezing
(e) convulsions
(0 sevele under-nutrilion and
(g) a very young infant who has fever or is
cold to the touch.
It is advisable to give first dose of antibiotic if
referral is not feasible and follow closely. Young
infant is required’to be kept warm during transfer
to a hospital and breast feeding to be continued
frequently even during transfer to a hospital. If it
is not a case of pneumonia, the mother may be
advised to keep the body warm, continue breast
feeding frequently, to clear nose if it interfers
with feeding of the young infant by only saline
nasal drops. May give the child home made cough
remedy (honey, ginger, Tulsi, hot water) for
treatment of cough. Oral cotrimoxazole (pediatric)
tablets are recommended for treatment of children
(2 months - 5 years) with pneumonia at sub
centres & OPD of PHC or hospital and can be
given by paramedical functionaries, such as, the
health worker. If any sign of severe illness
appears, the child should be taken immediately
to a hospital.
Six killer diseases preventable through effective
immunisation have been descussed earlier. Timely
vaccination as per guidelines is another major
element of health care programme. The schedule
nf such immunisation time may be noted as under.

■ r expectant mothers :
As soon as possible after conception Tetanus
toxoid 1st dose and 100 tablets of iron with Folic
Acid are given to the mother during 2nd/3rd
trimester, to be taken 1 tablet per day.
One month thereafter—Tetanus Toxoid-2nd dose .

At least three antenatal check up is to be ensured
during pregnancy, for early detection of
complication. All deliveries should be conducted
by trained personnel, preferably in an Institution

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on use of such kits to ensure safe delivery. One
should also know when and where to refer the
women dunng difficult labour. The name and
address of hospitals which can provide surgical
care or blood transfusion to the mother should be
well known. It is always better to voluntarily
donate blood in such emergencies. Therefore the
blood group of relatives or family members should
be known. Arrangements should be made by
Panchayats to help such patients reach the nearest
and appropriate ‘referral hospital through quick
means of transport.
Integrated child development scheme (ICDS) :

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The ICDS is a major programme in the field of
mother and child welfare. Coverage of this scheme
in all development blocks, however, has not yet
been made possible. The aims and objects of this
scheme are:
I 1.
of all
all programmes
1. Intetgration
Intetgration of
programmes or projects on
I child welfare to ensure single-minded devotion
| towards children.
| 2. Improving the health & nutrition of children.
I 3 Reduction of child morbidity as well as the
rales.
I mortality
4. Creation of psychologial urge among children
I to go to school for education.
I 5 To fortify the base of activities towards
I development of the child physically,
I pscychologically and socially.
I 6. Provision of suitable amenities for mothers> to
I enable them to take better care of children.
I The steps so far taken to fulfil these objectives

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are :

1992-93
Howrah
Calcutta
24-Parganas(S)

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1. To provide food for additional nutritional
values.
2. Immunisation of children against six killei
diseases.
3. Regular health check-up.
4. Referral to district or higher level hospitals,
whenever necessary.
5. Non-coventional education for children
between three to six years.
6. Educative motivation among mothers for
purposeful attention to children in re,gard to health
care and nutrition.
All these activities are conducted through the
Anganwadi centres. Trained Anganwadi workers
manage these centres. Normally one such centre
is set up for every 1000 population. There is one
superviser to look after twenty Anganwadi
Centres. Her duty is to go round to supervise the
actual work in these centres. One project set-up
generally has about 100 Anganwadi centres within
its fold and one child development project olticer
(CDPO) remains in charge of one such project.

Child survival and safe motherhood
ramme :
I
T'1
Child Survival and Safe Motherhood j
Programme (CSSM) was punched by the ,
President of India on 15 August 1992. The
programme is a logical extension ot the Universal .
Immunization programme with incorporation ot
certain elements of safe motherhood and newborn
care. At the moment the programme is operationa >
in 8 districts of West Bengal and it is expected |
that all the districts of the Stale will be covered
in a phased manner as follows :

95-96
94-95
93-94
Nadia
Darjeeling
24 Pags. (N)
Hooghly
Jalpaiguri
South Dinajpur
Bardwan
Cooch
Behar
North Dinajpur
Birbhum
Maida
Midnapur
Murshidabad
are as follows :
The essential components of the programme

For Children :
home level — warmth & feeding.
1. Primary Newborn care al
100% coverage.
2. Immunisation by 12 months - 3 yrs.) 100% coverage,
3. Vitamin A prophylaxis (9 months
management.
case
4. ARI : Pneumonia therapy - correct
- correct case management
5. Control of dianhoeal diseases
F°r immunization against tetanus - 100% coverage
1.
Control of'Anaemia, during pregnancy - 100% coverag .
2.
Antenatal care - at least 3 check up tn 100%.
3.
(5 c|eans maintenance)
4. Screening & referral of high
Care al birth - promotion of clean deli y
5

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96-97
Purulia
Bankura
Tamluk

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gone up through higher rate of growth. Density is
measured by estimating the average population fig
ures within an area of one sq-kilomelre. This figure
in 1991 for West Bengal was 766 as against 267 only
for the entire country. Yet, if compared with any
other country, the India itself is in a precarious state
with its enormous population and vicious growth
rate. Australia has two and half times more than
Indis’s land area but their total population is just
equal to (he population that increases in our country
every year. And. in this the position perhaps is worst
in West Bengal because of severe density. Obvi
ously, it is beyoud the capacity of the Slate (i.e. the
Govt.) to provide food, shelter, health, education

The population of our
country has been esti
mated at 850 millions
on the basis of 1991
census reports. The fig
opulation
ures for Slate of West
xplosion
nd
Bengal were 70 mil
lions at the same time.
amily
elfare
The net increase be| tween 1981 to 1991 has been calculated as 163
This increase is equal to the figures for a
I millions.
span of thirty years between 1931 and 1961. The
I growth rale, again, is apparrently most acute in our
State. This may be seen from the fact that as against

,pHAPTER-6j
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and employment for every child being born now to
become the citizen of the country in future. These
problems will continue to multiply with
accummulative effect. All concerned, every single
adult person in fact, must rise up and become alert
about it.

the annual growth rate of 2.41 p.c. for the country as
a whole. West Bengal’s rate of increase is 2.2 p.c.
This apart, whereas the increase of national popula
tion for the decade 1981-1991 was less than that of
I the previous decade (1971-81), the picture was just
I the opposite in case of our State. A little more
I consciousness in our state would have gone a long
I way to reduce the rates of child-birth and population
increase. It is worth noting that the rate of annual
I growth
of population in Kerala during the last
I census-decade (1981-1991) was 1.34 p.c. only
which is far below the national rate of 2.14 p.c.
I During that decade, the birth rale for Kerala was 18.1
II p.c..only 18 children were bom in every 1000
| population. Seen against this, the birth rale for our
Stale was 26.7 p.c.
Birth ra/es in a population is distinctly realtcd to
social and economic advancements of the country or
I region. Till 1981, the population density in our Slate
I was
was less
less than
than Kerala
Kerala but
but this
this was
was reversed
reversed in
in the
the
I following decades when the density in this State has

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Control of Population

A simple sub-traction of annual death rate figures
from the birth rate will give the annual rate of
increase in population. The rates are computed from
the number of births and deaths occurring in popu
lation of 1000 people every year. In West Bengal, wc
still have the imbalance of high birth rate as com
pared to steady dccrese in death rale. This must
change for a corresponding decrease in birth rate. A
reasonable target should be fixed right now to bring
down the annual growth rale of population, say to 10
(ten) per lOOOor just I (one) for every 100 people by
the year 2000 A.D. Similarly, sine the annual death
rale is li'
to decrease further, it is important to

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reduce birth rates through promotion ot
contraceoptives. At least 60 (sixty) per cent of all
eligible couples should be brought within the pur
view of this control programme. The present rale ot
coverage in our Stale is about 36 per cent. This
leaves a large gap to cover and all possible quick
result bids have to be made to bring the uncovered
couples within the control programme. The aim
should be to spread out the norm of two chi Idm to the
farthest extent possible.

make every effort to bring down the annual birth rate
to around 16 (sixteen) per 1000 population.
Prime factors leading to high birth rates :
1. Marriage & motherhood of girls at early age
(average age at marriage for girls in West Bengal is
19.2 yrs and for Kerala girls, it is 21.8 yesrs—1981
census).
2. Low rale of literacy among women, (1991) cen
sus figures show that the rates of literacy among the
women were 46.56 p.c. in West Bengal and 86.17
;P-c.
-. in Kerala.
1 Lack of consciousness about the various contra
ceptive facilities, and poor adoptability to the
same.
4. Lack of access to contraceptives nearby.
5. Fear complex due to high infant mortality rales,
giving rise to uncertainties of child survival.
6. Unequal family affections for boy and girl—the
girl becoming the victim, and intense desire for
having a son.
All these factors have to be dealt with in the task of
population control. Most crucial among these, of
course, should be to attach highest attention to

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After all it is not possible to bring down birth rates
only by contraception methods, whether short or
prolonged. As already said, birth rates are related to
socio- cultural and economic conditions. All steps,
therefore, are to be taken in consideration of these
realities. Family Welfare measures will show
results only if all relevant aspects are kept in view
One’such important aspect is the maternal and child
welfare programme which has been discussed in a
separate chapter..

HEALTH

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We ail want to keep our
body and mind fit and
healthy. We do not want
diseases to occur.
But we still suffer from
diseases now and then.
Some diseases appear
suddenly in a village
and spreads. Some
other disease occur predominantly in certain seasons.
If we want to prevent these diseases then we must
understand why these diseases occur and spread.
Everybody must develop a scientific outlook and
rationale. Only then can the more common diseases
be effectively eliminated or at least reduced to a
large extent.

Origin of disease :

Viruses, bacteria, parasites—there are numerous
microorganisms in the soil, water and air. These
cannot be seen with the naked eye. They can only be
seen with the help of microscopes and other
complicated instruments.
Viruses are the smallest of these, lliey infect and
| harbour in a few cells of the bodv. And they increase
| their number and spread to the whole body' So many
can occur due to viruses. Some of them ar
I diseases
measles, chicken pox, poliomyelitis, dengue.
I Japanese Encephalitis, jaundice, rabies, AIDS etc.
I And there are bacteria, which are bigger in size than
I the viruses^ These bacteria can cause Cholera,
| Typhoid, Tuberculosis, Leprosy, Diphtheria
I "
Tetanus, Whooping
,,,
' cough,
’ Gastroenteritis,
"
etc.
There are mono-cellular parasites which spend part
I of their lives in the human body and cause disease.
I They are Amoeba, Giardia, Malaria, Kala azar, etc.
I There
______ rparasites
___ _ like thread
...-.e are also multicellular
I worms, round worms, tapeworms and Hookworms.
| Some of these can be seen in the naked eye.

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Diseases from undernutrition :

Many people are undernourished or malnourished,
particularly children. Malnutrition can cause several
diseases like Marasmus, Kwasihorkor.
Nightblindness. Nutritional deficiencies can also
cause anaemia, inflammation and ulcers in lips,
mouth cavity, beri-beri, etc.
There are also so many other causes of diseases.
There are still some diseases, little is known about
how they occur, for example, some Cancers.
Now let us discuss some common diseases which
occur in the rural background.

Water borne diseases :

■

Unclean water, that is, water that contains different
types of disease causing organisms, can cause several
diseases. In essence, the disease causing organisms,
spread to healthy human beings through the medium
of water. The^e are, diarrhoea, gastroenteritis, other
gastro-intestinal infections, cholera, typhoid.
Jaundice, Polio, Amoebiasis, giardia,conjunctivitis,
ear discharge (otitis), skin disease (scabies, impetigo

To prevent these diseases, we have not only to use
safe water but have also to be careful about fo - i
habits and food hygiene. It is better to avoid cut opv n
fruits and dirty and left over foods sold by slreet^ide
vendors. These are notorious in causing diarrhoea,
gastroenteritis, etc. The use of ORS in such ailments
has already been discussed earlier.
Another common gastro-intestinal ailment is
dysentery and giardia. These pathogens occur in
stools of people suffering from such diseases.
Excreted with stool they contaminate waler or
through fingers or vegetables infect other people.
Amoebiasis causes repeated loose motions. The
stools may be steaked with blood. There may also be
fever and vomitting. In giardiasis there is rumbling
colic with watery stool, particularly in the morning.
To prevent these diseases there is need of (1) Use of
safe waler (2) Use of sanitary latrines instead of open
defecation. (3) Proper cleaning of vegetables before
eating (4) not to allow flies and cock roaches to come
in contact with food-stuffs (5) Maintenance of
personal hygiene.

Diseases from food stuffs :

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Food stuffs can also cause serious disease. For
example, harmful colours added to foods can cause
disease. And there are some food articles which can
aggravate certain diseases—intake of excess sugar,
honey can aggravate diabetes. If excess salt is taken
by people suffering from high blood pressure, their
blood pressure would increase. Excessive intake of
fat increases cholesterol. Half cooked beef or pork
can cause tapeworm.

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Diseases caused by living habits :

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Lack of physical exercise or manual labour can
cau£e several diseases with diabetes, high blood
pressure, heart diseases, arthritis, spondylitis, etc.
Diseases of modern living :

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fertilisers is polluting the soil, air and water with
toxic substance. Toxic discharges of industries can
damage the human body. Addition of Tricrysil
phosphate to edible oil and flour can cause paralysis.
Epidemic dropsy can occur when argemon oil is
mixed with mustard oil. Excessive noise from
loudspeakers can also cause harm to the body. And
there are addiction which damage the body like.
Bidis, cigarettes. Tobacco chewing in any form,
liquor, heroine, etc. Also there are mental illnesses.

Worms :

Human beings are responsible for many of the
diseases of the present time. Use of chemical

Some worms are related directly or indirectly to soil.

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The eggs of worms are excreted with stools and are
deposited in soil. Then through wateror through any
other media some of these like round worm,
whipworm enter the human gastrointestinal tract.
Again eggs of thread worm or pin worm may stick
to dirty linen or dust, and enter the stomach through
nose or mouth. Hookworm eggs reach the s.m!
mixed with stools. Later eggs mould into larvae.
These larvae can penetrate human skin to enter the
body In the body they travel extensively before
reaching the intestine. They can easily penetrate in
those who walk barefoot.

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Diseases caused by chemicals & poisonous
substances in water :
Toxic substances that may contaminate water are
Arsenic, Cadmium, Lead, Mercury, and different
chemical fertilisers. If these enter the body in excess
amounts, then different diseases may occur. If there
is no or less fluoride in water then teeth may be easily
eroded (which is usually wrongly termed as worm
infested teeth). Again if there is excess fluoride,
fluorosis may occur, both teeth and bones are affected.
People may become crippled because of this.

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Diseases spread by mosquitoes :

1. Malaria caused by parasites, attacks red blood
cells. Generally two types of malaria occur in our
country.
I (^Ordinary Malaria : Alternate day fever, locally
| known as ‘fever by turns’, excessive chills, then
| fever, then sweating. People usually do not die but
j suffer a lot.
I (b) Dangerous (malignant) Malaria : Quite often
difficult to diagnose. Fever may occur on alternate
days or may be continuous, suddenly consciousness
'I may be lost, severe diarrhoea may occur,
I breathlessness, anaemia, blood in urine, blood
shock, etc. It can also cause death.
I vomilting,
Malaria should be thought of in case of high fever.
Health workers should be contacted. Malaria ca.i be
I detected from a drop of blood pricked from the
I finger This facility is available with all health centres.
I Malaria is spread by some species of female
I anopheles mosquitoes. They bite at night. If ' cse
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mosquiotoes bite somebody then days after biting a
malaria infected person,-malaria may occur. These
mosquitoes deposit eggs in stagnant water, fields,
ponds, drains, irrigation canals, etc.
2. Filaria :
It is caused by a type of worm. These reside in
human lymph glands. There is high fever with chills.
There is also pain and burning sensation in one part
of the body. The area becomes red and swollen
There is relapse of symptoms after a certain period.
Swelling increases, the skin becomes pink
Hydrocele may occur (accummulalion of fluid in
scrotal sac). A leg or hand or breast or genitalia may
swell up. People do not die because of these. But
continue to suffer.
Spread from man to man is affected by culcx
mosquito. These mosquitoes breed in dirty waler of
drains, ditches etc. Bite al night. Some people
suffering from filariasis have filaria eggs
(microfilaria) floating in their blood stream. They
enter the mosquito along with blood. It an intectcd
mosquito biles a person after a gap of olten twelve
days then filaria may occur. Disease may be
manifested after 1 year.
Another type of eggs are spread by Mansobnia
Mosquitoes. These breed in ponds tilled with waler
hyacinth and aquatic vegetables. 1 he eggs, larvae,
pupae of the mosquitoes slick to the roots ot the
water hyacinths.
(3)Dengue and Dengue Haemorrhagic
fever,
are caused by viruses: ItisadiseascofCalcutlacily.
Il is spread from man to man by Aedis Mosquiloc.
The mosqutoes lay down eggs in city dirty places,
waler tanks, stagnant water, flower vases, etc. Ti t
bile in the day lime.
If the mosquitoe biles a diseased person, and after a
lapseofeighttoelcvendaysbitcsa healthy individual,
then the healthy individual, may develop dengue.
Dengue causes high tever, with aches and pain all
over the body and headaches. Nobody dies. People
coming to the city from villages tor the first time
may suffer from dengue.
Dengue haemorrhagic fever occurs commonly in
children. Fever with blood vomilting. or blood in
stools may occur. Without prompt treatment patient
may die. This disease docs not occur in village.
Nevertheless, infected in the city, the disease may
manifest in the village after the person returns.
(4) Japanese Encephalitis : Disease of villages,
caused by viruses. Sudden high fever, headache,
vomilting, signs of inflammation, head tilled to the
back, limbs Hexed, shoulders hunched, irrelevant
uttering*. There is unconsciousness. Convulsions
may occur. 25 to 50 per cent die within 10 days. It is
not spread from man to man. This disease usually
occur in one individual in a village.
The disease occur during or alter the rainy season.
The disease spreads from animals and birds to man

24

The virus stays in the blood of waler based birds.
Masquitoes take up the virus. After about 10 days.

People having microfilaria in the blood must be

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Filaria control :

Lum

nnuinnn;

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C ontral of inosquitoc-borne diseases :

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The breeding places of mosquito must be identified.
The larvae must be destroyed. Breeding of fish may
be done in drains. Fish eat mosquito larvae. If the
drain has flowing waler then the larvae cannot grow.
Aquatic vegetable must be removed from ponds.
Water hyacinths must be removed. If possible,
mosquito nets should be used. Careful watch must
be kept around dwelling places, water tanks, to see
that the mosquito larvae do not grow. Water must be
drained or strained every 7 days. Drinking water
must be properly covered—otherwise mosquitoes
may breed there Mosquito breeding places in the
villages may be identified and kept clean. Steps may
be taken according to the situation.
Using smoke or smoke bomb is not at all effective in
mosquito killing. It is simply wastage of money. It is
necessary to spray DDT or other chemicals at limes.
Bathing places, living room, cattle sheds must all be
sprayed. No r(X)m should be excluded. After spraying
soil or cowdung should not be pasted in the walls.
These reduce the effectivity of the chemicals.

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biles and infects pigs. The virus multiplies in the
body of pigs. Pigs and birds do not die because of the
infection. Mosquitoes spread the disease from pigs
and birds to human. The disease may occur al an
interval of 4-14 days, after the bite of a virus infected
mosquitoe.

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Along with mosquito control, malaria patients must
also be treated. Malariacan
Malaria can be cured with treatment.

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treated. With treatment microfilaria will die. Then
mosquitoes will not be able to spread the disease. At
same lime mosquitoes must be controlled.
nc preventable diseases o! children :

/ iiberculosis :
Longcontinued dry cough, mild
fever, weakness, loss of weight,
at times bleeding with cough,
pain in chest it there is pleurisy
in addition. Tuberculosis can
also occur in other parts of the
body as in bones, skin,
intestines, meninges covering
the brain.

Diphtheria :
Mild fever, white
membrane inside the
oral cavity, over the
tonsils.
palate,
epiglottis, inside the
nose, in the vocal
cords. Salivation
occurs,
mucous
tinged with blood.
There is respiratory
distress, with moist sounds. Diphtheria membrane
can also occur in skin and genitalia.

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Whoopinfi cough :
Fever, sneeze, cough
with whoop. Deep
respiration increases
the severity of cough.
Prolonged bout of
cough can cause
suffocation. There is
respiratory distress.
There may be
bleeding in the
conjunctive or from
nose.

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Tetanus :
I May occur after cuts
I or abrasions. Mild
| fever. There is spasm
muscles, muscle
I of
tone is increased.
I Jaw is forcibly
I closed. Teeth are
I clenched. It is almost
I impossible to open
1 the mouth. There is
• a
| mocking expression
l of the face. The tone
of muscles increase. The head is retracted backwards
The whole body is extended backwards like a bow.
I Due to this, the local name of Tetanus is
I ■■Dhanustankar”. In the termianl stage there are
| convulsions, initially slowly, at long intevals, later
repeatedly.
I on
Tetanus may also occur in new-borns after an unsafe
I delivery
uchvvi _
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i.e.
if the mother was not immunised against
! Tetanus or if the cord is cut with unclean tools, or if
I mud or cow-dung is applied on the umbilical stump.
I Neo-natal tetanus cases tshould
----- be reported by the
| Panchayats to the PHC.
I Poliomyelitis :

|

This disease can cause

paralysis. In 60% cases

one leg, in 25% of cases

— af measles, there is haemorrhage from the
type
rashes. Poliomyelitis and measles are caused by
virusus. There are effective vaccines for these
diseases. Timely vaccination in children can prevent
these diseases.
Panchayats have important roles in ettective
implementation of immunisation programme.
Kala azar:
Usually a disease of the rural areas, caused by a
unicellular parasite. Symptoms are—continuous low
grade fever, a dark hue in the face and body, anaemia,
thin emaciated appearance, spleen enlarged i.e. a
large lump in the left side of the abdomen.
Man to man is spread by sand flies. Sand fly sucks
blood from a patient. The parasite multiplies in the
mosquito. A healthy individual bitten after 7 days by
an infected sand-fly may have kala-azar alter an
interact af 3-6 weeks.
Sandfly is smaller than a mosquito. Local names are
“Oani worm" or “ Habor worm". These reside in
cattle sheds, clay cottages, also in the ground floor ot
concrete houses, in areas which are dark, moist and
dirty. The eggs are laid in wastes, in cattle shed or its
sunoundings, and not in water.
There is effective treatment for this disease. Sand
flies can be easily controlled by spraying DDT. But
praying procedure must be meticulously followed
s mentioned earlier.

(hiekenpox :
Caused by virus. Symptoms are-fever, vescicles on
the first day of fever.Vescicles may appear before
the onset of fever. They are more on the trunks than
on the limbs and face. The vescicles develop pus’
within 24 hrs. Then dry up within a few days. There
is scaling and itching.
As complications, pneumonia, kidney damage, skin
infiltration and encephalitis may occur. Viruses
enter the body through mouth and nose. They spread
from man to man at the initial stages ot disease. The
disease occurs 14-20 days after entry of virus. There
is no avilable vaccine. Not much ol preventive
measures that can be taken. Drugs are not effective
against the virus. However, there is no death. Only
sickness.

one or both legs may be
paralysed. The nerves of

Small pox :
The disease is not prevalent any more any where in
the world. So vaccination is no longer nccessaary.

the face and ears may also

be paralysed.

Rabies :
Spread by rabid dogs. Stray dogs roaming in streets
must be killed. Pet dogs should be immunised againg
rabies. Different types of vaccines are available. But
they are costly It is easier to control the dog
population. Panchayats can take an important role m

■ Measles :
-- - running
nose, cough,
inflamed
ey^s' eyes,
I Symptoms
are running
nose, cough
inflamed
irritability
the eyes
eyes in
irritability of
of the
in sun light. High fever The
nose may
may be
spleen.
nose
be swollen... There
----- is enlarged
There
is
rash
in
the
body
3-5
days
after
fever
The
There is
1 rashes may enlarge after coalescing with one another
one
I The fever subsides after appearance af
a. rash.In
ras..

this matter.

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Diseases of Malnutrition :

Protein Energy Maluntrition (PEM) :
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These are Marasmus and Kwashiorkor which are
due to poverty. Occurs in protein entrgy deficiency
status. Marasmus usually occurs when the child is
almost one year old. It occurs in children who thri ve
on Barley, and insufficient amount of reconstituted
milk. This diet is deficient in protein and
carbohydrate, i.e. deficient in calories also. The
muscles become emaciated. Subcutaneous fat is
absent. The child cannot grow and has repeated
attacks of diarrhoea. The child starts refusing feeds.
Diets of Sagoo and barley cause further losss of
weight. The child becomes vulnerable to different
infections. Kwashiorkor (protein
deficiency)
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somewhat older child. The baby is usually 1/2 to
2 years old. The diet consisting of Barley^ Sago,
K
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Rice, Mild, Banana etc. is deficient in protein. The
diet has sufficient calories, but insufficient protein,
the body develops a puffed up appeaence. The face,’
abdomen, the whole body swells up. Growth is
retarded. There is muscle wasting, loss of appetite.
Repeated attacks of diarrhoea,, aggravates
_____ _
malnutrition and Kwaswiorkor worsens. A vicious
cycle continues.
cycle
continues. Vitamin
Vitamin A
A defficieny
defficieny occurs^
occurs,
resulting in night blindness and loss of vision. A lot
of children also die because of such malnutrition So,
a child needs proper nutrition. The diet should
consist of appropriate amounts of protein,
carbohydrate and fats. Only carbohydrateJ is not
sufficients. A balanced diet is> necessary.
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Folic zl cid :
Green vegetables, meat, fish, eggs, food-grains.
Cancer :

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A non healing or rapidly increasing swelling or
ulcer inside the mouth cavity, gum, tongue,
cheek, etc.

Aids :

AIDS is the abbreviated term for Acquired Immuno
Deficiency Syndrome. In this disease, the ability to
fight infection is lost. Patients become easily
vulnerable to other diseases. There is no treatment
for this disease. A type of virus is the causative
agent. The virus is transmitted from one to another
through sexual contact. Also, if the blood of an
infected person reaches a healthy person, the healthy
person may develop AIDS. Even with the virus in
the body a person can remain healthy for a long time.
From them the virus spreads. In our country,
particularly in the villages the disease has not spread
widely. Bui if precautionary measures are not taken,
a grave situation may develop. As such precautions
must be taken regarding sexual relations. To remain
faithful to the sexual partner is essential for physical,
mental and social health. This can also prevent other

Vitamin A deficiency causes redness of the eyes,
.....including
...... b
night blindness and more serious problems
r
complete iloss of
vision. There is an ongoing specific
programme of regular supply of vitamin A
supplements to all children. All must be aware of
this programme. Breast fed infants must all receive
these supplements. The schedule of oral
administration of vitamin A in oil has been described
in page ....
-

Early detection can cure
cancer. As such death from
cancer can be avoided only
by making people aware of
the early signs and symptoms
of cancer. They are—
Lump or hard nodule in breast.
Sudden change in a mole or naevus.
Digestive disturbance, and bowel irregularity
continuing for a long time.
Prolonged cough, or hoarseness of voice or
difficulty in deglutition^.
Excessive bleeding during menstruation or
irregular bleeding.
Bleeding from mounlh, nose or ears, bleeding
with urine or stools, the cause of which cannot
be explained.

Fev'er or loss of weight which cannot be
explained.
If these symptoms appear, cancer detection centres
or a doctor must be contacted early.

.

Vitamin B Complex :

|

Available in green vegetables, meat, fish, ground
nut, ground-nuroil, food grains, mixed with baked
bread.

J

Iron is one of the essential nutrilents. Deficiency of
iron
anaemia. It
It is
iron in
in tooo
food causes
causes anaemia.
is necessary
necessary for
for
pregnant
mothers
to
take
iron
and
folic
acid
pregnant mothers to take iron and folic acid regularly,
regularly.
Even after the birth of a child, the mother needs iron
and folic acid supplements. Different green
vegetables, peas, green bananas have a high contemt
of iron. These must be taken regularly. ~
Vitanin A deficiency :

------------

Nicotinic Acid:

■

_ _

Anaemia :

---------------- 1_._

Thiamin is avilable in food-grains, unmilled rice,
beans, soyabean, fish, liver, meat and eggs.
Riboflavin is available in cereals, food-grains, milk,
fish, meat, wheat etc.

Diseases occur with deficiency of several vitamins
like Beriberi in lack of Thiamine, Angular Stomatis
and Glossitis in lack of Riboflavin, Pellagra in lack
of Nicotinic Acid, Anaemia in absence of Folic
Acid.

27
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sexually transmitted diseases. AIDS is more easily
spread through prostitutes and people who travel to
distant places. Use of condoms during sexual1 acts
can prevent this disease. Before blood transfussion,
it is necessary to check whether the blood has AIDS
virus.
Even the injection needles used on AIDS patient
may transmit the virus. Thus the injection needles
must be properly sterilised.

If the bile is severe, particularly in the head or neck,
then treatment must be promptly started. Later, if the
dog survives for 10 days, then the trentment may be
discontinued. As such, doctors mist be consulted in
all cases of dog bite.Rabies can be prevented by ten
injections of anti-rabies vaccine. More developed
vaccines are availabe now-a-days, but they are very
costly. But they are safer than the conventional anti
rabies vaccine.

Skin Diseases :

Symptoms of the disease :

People in rural areas suffer from ring worms, scabies
and various other types of skin diseases. If ringworm
or intertrigo occurs, presence of intestinal worms
and diabetes particularly in elderly must be excluded.
Scabies occurs due to a variety of mile which appears
in the skin, but do not penetrate it. Scabies does not
heal without treatment.
Lice is a common problem in several areas. Il occurs
in the scalp or skin or in the genital region. Il spreads
through combs, towels, pillow covers, bedsheets,
etc. and directly from person to another. This disease
can be prevented by clean hygienic habits. Bathing.
should be done in clean water. People suffering from
this disease must be promptly treated and spread to
other persons must be prevented.
Women also suffer because of unclean habits.
Nutritional deficiency is an additional factor. Man'
suffer from while discharge per vagina. Il causes
feeling of ill health, uneasiness and mental
disturbance. Clean habits can prevent •.» bite discharge
and other sexually transmitted disease. Genital region
nust be kept clean during periods and clean pieces of
cloth should be used. Dirty cloth used for
menstruation can cause different infection.

Irritation is caused by powerful light or sound; there
is excessive salivation, watering from the eyes,
sweating, rcspiratory effort is reduced, voice becomes
hoarse, inability to swallow waler or any other
fluids. The muscles related to swallowing and
respiration becomes contracted. Just sight of fluid,
or sound or smell causes muscle spasm. The face
becomes blue and convulsions occur. People
suffering from rabies always die within a few days.
It is not poissible to save a rabies patient
Snake Bite :

The primary treatment of snake bite is reassuring the
patient that he will live. A light lourniqucte should
be applied in the thigh in case of bile in the leg and
in the arm in case of bile in the hand. The loumiquetc
must be relased every 20 minutes before
.•application. If the bite is suspected to be of a
poisonous snake, then without delay, or without
wasting time with a traditional healer, the patient
must be taken to a hospital. If promptly treated w ith
anti-snake venom, then all patients can be saved.
Panchayats should note that anti-snake venoms are
always available in the health centres.
Bites of scorpions, bees, wasps and capcrpillar •
Of these, only scorpion biles can become fata;
particularly in children. So, children bitten by
scorpions must be promptly treated. In other cases,
first aid is all that is necessary.
Dwelling houses and the adjoining areas must be
kept clean to prevent these problems.

Dog Bite :
Bite of a rabid dog (also known as a mad dog) can
cause rabies. It is caused by a virus. Usually the
disease manifests 9 to 90 days ijfter a bile. If the dog
which has bitten survives for 10 days, then rabies
will not occur. If bitten by a stray dog which cannot
be identified, then anti-rabies vaccine must be taken.

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Much have been dealt
ithe
various
aspects of public
health.
so
that
ole f aaciuyat everyone
can
understand the various
i
ublic
ealth
problems of the same.
Every citizen • should
also be aware of the
1 problems
problems to
to carry out their
responsibilities.
Again,
I the
•■•C responsibilities i~
—
increase
in case of Panchayat
| members. One of the
principal functions of
| Panchayat is to promote the health status of the
| community by collective efforts' ThereTave"^
I a tradition
___ma.m™^
c DC'
-d-n of Rijrai
Rumi indigo'
I development
by the
I the villagers. But, • active cooperation amongst
unfortunately it was disturbed
I by the British
••-.1 rulers. It
’
- is
.3 iin this
period from
| where the ppresent
health infrastructure started
| developing. But this in’fr'astructu
- ——'».wvidre was framed
without keeping in view the health problems up
of

bHAPTER-8

with

H
O P
I\ P
H

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■he general mass. Though contagious disease
were prevalent amongst the poor people 1“ “
spread amongst the rulers and rich people So a
I number of hospitals and health centres' were
| established --for the
...J treatment of general masc
I involving many physicians, nurses and health
workers. But, instead <Of- decreasing
'
tn
the demand
I for
teatment, the same increased'"due
I uprootment of the disease roots —- to nonT.'tough after
I independence
the health system
gained momentum
including an increase in the n
of physicians
are there who
I and health workers, yet manyumber
are
to their
’ ____
I not only suffering. due___
illnesses, but also
| spending a lot of money for treatment
-1. Often they
. feel helpless. People are Ilosing their efficiency
due to ill health m agricultural fields, factories
| and °lher Offices and a* a result their yields are

u^ntad'Cth neref°re' CVery Ci‘"e"
nderstand the importance of good helath
specially they should know how to prevent a

“,ra' ■

-

ery Panchayat member should take into
consideration the role of Panchayat in disease
preventton They should be aware of wh.Th
disease is caused to which category of
f p c and how n can be prevented which have
already been dealt with. It has already been
””d
relalion ot diS, “
excreta disposal, housing and keeping adjoining
places and the means of keeping those areas cleam
Also, the ttreatment and prevention system of
diseases for- the
_r. of this state has already
-e r
people
been
discussed.
Now,
.i„. d u
- it is to be observed, how
he Panchayat members implicate the system for
the benefits of the people. For this,'as it is
essential to know what does health mean which

JSS"?whY"" pre“"'

the

, t to ascertain them.

HEALTH WORKERS
A'N :

ARE OUR VERY

Ibis is to be kept i
. m jmnd that the physicians.
nurses and other health
--~:h workers are from our
Society and so tthey are our very own. To utilise
them properly we have
to establish close
relationship with them.

theV|Ta?r‘ rnd 3 l0t Of moncy

inning

the health infrastructure. These funds are beirProvded by the country people. Therefore, it is
our responsibility to sec that the health
infrastructure is sustained and properly utilised

iHeir.r

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undertake the load of work. He will also
keep a vigil on the progress of the work.
He will go through the problems and
constraints, if any, of the health care-takers
and try to solve them. He will place those
problems to the higher authorities if solving
them are beyond his reach.
He will not only assist in conserving the
health centres of the Gram Panchayal, but
also will assist the health workers in their
work. He will collect the health
programmes well in advance from them and
will either try to present himself or any
other active representative al lhe working
spot.
The Gram Panchayal should collect and
compile information on lhe following :
What is lhe rale of birth and death in lhe
village? Which particular type of disease
is occurring in lhe village and how many
times? What is lhe number of children in
the village and their ages ? Number ol
women ? Amongst them how many are
married and again, how many are
pregnant ? How many of lhem have given
birth to a child? In how many cases
abortion has occurred and how many have
aborted ? Whether they have been ligated
or sterilised? Also, how many of them are
adopting lhe various means of Family
Planning Programme, such as, using loops,
condoms, taking oral pills or other
preventive measures. Moreover, suspected
cases of Neo-Natal Tetanus and
poliomyelitis in children below 5 years of
age in the village should be reported to the
Primary Health Centre.
Gathering those information is one of the
responsibilites of the health caretakers.
Again, whether lhe babies are taking
mother’s milk or not ? If yes. for how
many years ? In addition, whether they are
being fed with milk powder or any other
food ? What the babies take during and
after they leave lhe habit of breast
feeding? Il is not possible for the
Government Officials to keep record of
these information all lhe lime. Those
information are very much essential for the
development of a village. Again, village
health planning is not possibnle without
those information. So, Panchayal member,
along with the social-workers and health
workers, should do lhe job. If required,
traditions and traditional procedures can be
changcd/broken for the sake of lhe work.
All the records of lhe village should be
kept in lhe office of the Gram Panchayal

We, ourselves have to look after our own health
system so that it remains effective.
WITH
NEED
TO
RARTIC1PATE
GOVERNMENTAL EFFORTS.

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Due to remaining in a long British rule and due
to other reasons some of us still think that
Government and general people are rivals. The
situation can be changed if we actively participate
and combine our efforts with that of the
Governmental one and this can be done by the
Panchayal which is also considered to be their
responsibility. Previsously what was being done
through orders of higher authorities, are now being
done through the Panchayats by the suggestions
of common people. These common people should
be made aware of the Governmental efforts and
for better public health they should participate
through the Panchayal.
PANCHAYAT MEMBERS SHOULD KNOW.

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Panchayal members should work for health and
for this they should know the details of health
aspects. As it is not possible for any one to know
all the details, so, at least one Panchyat member
or the Pradhan should take the responsibility
JI regarding the health problem. Again, it is not
possible for him to cover practically all the aspect *
of health problems. So, he has to select sonu
1 people who are eager or do these type of works.
I As for example, Anganwadi workers, C.H. Gs,
| trained personnel etc. Though theyi are not
servants, yet they have some
I Government
knowledge about health.
addition, there are other health workers too.
I In
As for example, multipurpose health workers, their
I supervisors, social welfare officers, computers,
nurses and physicians etc. which have been
I mentioned earlier. They also belong to our society.
Discussions and plan'of work, regarding public
...
f
I health, should be done with then. Thus, many
/- -•
___ iQfifi
of the work
| problems
problems c.
----- can be solved and there
will be better coordination.
tnprf*

. |

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WHAT ARE TO BE DONE
One member of the Gram Panchayal should
be given the health related responsibilities.
He will liaise with lhe health related
committee of Panchyat Samilies as with as
Zilla Parishad. He will not only prepare
reports on the health status and progress
of his area and transmit lhe same to
Panchayal Samiti and Zilla Parishad but
also gather instructions from them.
He will arraangc discussion on public
health problems with the health caretakers
of lhe village health sub-centres within his
Panchayal area and will discusss on their
assignments as well as the ways to

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----

----l

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"e!''p.°p'='”.o‘‘':rreo,di‘““«r
Ihe i"b
—"g ^pliXs S 'y^r"
successfully In case1 nf'”**6.

b> Puusha”. ^K"'7rorTr,,'“

remember forever if hands f

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and how it should be
kept, is discussed
later.

coose, .I™I™'

Wl11

'"'I'

Pu-Ph

movement Proper mil'
Crea,e health
institutions as ^Hl ‘ ISatlon of 'he health
will 'hen^poXe35
hea',h
_l

,■!» P«‘ Pe.«b-

Women g?OUD h '

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Rl ( ords < )i

wi) f)| A((

There is ja law for
registering the incidents of
birth and death,
«■<!
death incidents
days, to■ the birthshould be infonned, within n
death registrar.
inspector is the birthand
and.
re^lstrar SSanitary
~‘J death ;[reCg,Slrar
gi!5trar iin rural
areas. Bmh or death certir^
death certificate is i
h'mIf such incidents are not re 7' 'J iSSUCtJ
withf 2' dayS'
birth or death certificateregistered
wd ThenT"
•be District Chief Medical Officer of^t
b>'
being confirmed through inveec f Hcu'lh a,,er
cases, a fine of Rs
g?/ ,nv“t|gation. In such
Re- IA has to be paid
fee
for obtaining the cenifkam8 A
challan
SDO. through^ annlwaH \
appea' ,0 ,he
obtaining a birth or death cenificat'0
f°r
modems are not recisterpd 1 e’ 10 Case’ such
which a fine of Rs'/ t0
and f°r

Sami,-es.
the birth A^eL^incidems^^

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The way to undertake the above
mentioned
jobs are discussed below.

inconvenience due to late rea^?"13" y’ 10 a''oi‘J
‘he requrred infoX™ ^'s'rat.on. To get all
‘,'-ath incidents, two copTs .7 ‘hefblrlh and
l-'«uty programme' “d SteSt

£’XZ'«Xd EO

b*

of its ill-effectsP Again th

made aWare

»yperri,„.„1.eor"X”“erSr'"

know the actual c
Sh°U,d
About 90% ofthe diseases
diSeaSe'
disease’ Neither they are ; t are ‘Common
attended by physicians norrequired to be
for example, diarrohea It ’ hospitals. As
Whout taking a lot of i can be cured
medicines. ORS

s>“ id'^'SLd” l“1"’
"d^~^eSpX
can I
sufficient
' -"unf^dSS.^"
Though,iwe all know that no medicine are
there for cold, yet we buy a lot of
medicines when attacked. In this case,
mouth can be w<ashed by gargling with luke
warm saline water. Vapoi
” . >ur can also be
mhaled. Ginger, Tulsi leaves and Peeper
can be homogenised
with honey and
mgested. Most of the
cases of cold and
cough will be cured by it.

°sed as Annexure • A• &
°rrna arc
-alth centres will hma
■ ’ aff of sub
'he block sanitary inspecto/Tf ,h°Se proforma 10
investigate the inciderHs Hlhe>' W|H
certificates frmnThe
over the same to rho
° *
,cc and hand
Gram Panchavat Often'Gnm'p
'hr°Ugh
birth or death certificatesPanthayaI ^"es
official formalities thn »
scrves some
certificate issued by’theh block nOt'aH' BU' ‘he
is leigally valid If son,
sanitary inspector
contact the block sanl v
he
lhe purpose. Arr-ma*
mspector directly for
and every birth and dL ^anva?s,nS- so that, each
reaches ^he Gram
? ,nc,dents of the locality

death report, througHhosonfo^ir6
and
and also an annual report am'
",On'h
'here is a record of vi'i P
Kar end. As
Ranchyat, it is possibilemeT f''0" ‘he Grani
f”SSibi
t0 ca
th. b,rth and
death rate (number
of?.birth
3 lculate the
and
death
thousand population in one 1 'h CaSCS Per
year).
I' is very much essential - ‘
regarding , this rare, if this rate is high
rate stidt
effective s< aPnSdllCreaSe iL
20 or less and death i
^doshould
Mo'-v'te the people who
not be less than 8.
register the birth
and death rate.

; znr:"eT!ho have a c°™

sl IVAR A 11
IHRIH :

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I OP (Id D-

%

X
-

-tssaKi.'- &

-■i - — in-* iir'jt

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birth within 5 years (if data of 5 years is not
available, take the number of a year and multiply
the same by five). Now calculate how many
chidren have died within 5 years for birth of every
thousand children. This figure should be belcw
20 and if not, every possible efforts should be
put in to lower the figure as quickly as posssible.
The cause of child-death, that have already
occurred, should be analysed and accordingly
arrangement should be taken to lower the death
rale.
REGARDING ILLNESS :

|

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It is essential to know about the diseases from
which the people of the locality suffers most. For
this, there is no need to keep a record of every
villager suffering from various diseases and that
loo is not possible. But, health-workers can record
the ill cases which they can gather during their
schedule visit to the house of the village. Through
those information it is possible to draw a pattern
of illness of the locality per monl. These are to
be done by the health-workers. Child illness
records should be kept separately. Different
disease can occur in different time and accordingly
discuss on the preventive measures and take
approprite steps.

family of the village get safe water easily round
the year. Anange for the repair of tubewells by
die community. In some villages women have
been trained to repair the tubewells. Users take
the responsibility of operation and maintenance
of the tubewells after its installation by monthly
contribution. They even do not depend on the
Panchayat regarding this matter. This system can
be implemented in every Village Panchayat should
also take such efforts.
Now-a-days, tubewells and dugwells are generally
provided with proper platforms. Whether the water
of those tubewells or dugwells are being polluted
are monitored but the status of pond water are
never seen. Villagers use these pond water in
various ways. Il is belter to have no polluted and
dirty ponds in the village. Community pond or
pond owned by the poor can be dug by the
Panchayat under Jawahar Rojgur Jojna.

SEPARATE RECORD FOR CONTAGIOL
DISEASES :
Contagious diseases, like cholera, gastro- enteritis,
typhoid, small pox, Tuberculosis, Polio, Jaundice,
whooping cough, measels, tetanus, diphtheria,
encephalitis etc. should be recorded separately.
„
-----------. of.u.
Keep
a record
the patients suffering from the
above mentioned diseases per month and
I acccordingly take preventive measures.
I Malaria is confirmed through blood test. There is
I special (malignant) type of malaria called
I falciparum malaria which may lead to death within
days, if caused. Occurrece of malaria can be
I 3-4
recorded through the information like, how many
people have tested their blood for MP and
I amongst them in how many cases it has been
I confirmed. Again, amongst the confirmed cases
how many are suffering from falciparum infection.
| Keep this record and take all preventive measures
| through discussions. Malaria spreads through
I mosquito bite. These mosquitoes bread in dirty
stagnant water, stagnant drains etc. Involve the
community to keep those clean. Sometimes,
' people are advised to take malaria tablets after
I going through symptoms of the patient, a record
| of such presumptive treatment should also be kept.

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WATER AND SANITATION SYSTEM:
In addition to food, waler is also essential to man.
Supply of drinking waler is the responsibility of
Panchayat. It is to be seen that each and every

32

Drainage system should be perfect. Waste should
be removed and environment should be m-idclean. Proper arragngements should be there i<>i
urinals and latrines. Create consciousness amongst
the people for this. People will themselves do
these jobs once they are motivated. Funds from
the Panchayat will not be required. Latrines can
be constructed al low cost. Only lor Rs.230/sanitary latrines can be constructed. Masions arc
to be trained regarding construction of low-cost
latrines.
Some social organisations are there who impart
such training in addition to Government
organisation. The different parts of such low-cost
latrines are manufactured by those social
organisations in the village itself. Contact Zilla
Parishad if they have any information. Keep a
record of the total number of families in the
village and how many of them have sanitary
latrines. Calculate them in terms of percentage.
Also, keep a record of the number of sanitary
latrines that are being constructed per month. In
addition to personal effort, houses with sanitary
latrines are being constructed under the Indira
Housing Project. Some of the social organisations

—I—

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I maximum number of famihe!'’
Sce lhat'
I iarones. In addition to this draif" ‘h'S San"ary
I management, smokeless chufhh T'6"1' Waste
I Io he considered for use an I P' T ar oven are
|

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of the same. Construction of h S°
3 record
many added advantages R b 835 P'an,s have
.. the
BlOgas Plants can be
connected with
the / 8
°f ‘he number of bioJ'as^a13,10065' Keep a fecord
also, how many of thfm are n $
l0Calily and
brines and urinals at smtabirnl1'0^^ Conslruct

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be lepTS,
and hygienic.
CLEAN
EN VTRONMENT
HEALTHY :
keeps

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,;TV for five v '
‘Man
Vlan ccan
an survive
without fodd,
ive days without water and 'veeks
r
five
oxygen Oxygen is n
d fiVe miriutes> without
r
-bicii'7s
P^uced
by. the green s"' 'n the
'he
"
°f 'rees is also essential for health'p

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“mm°" r"* «.i» s axtz
man

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*ell ventilated and suffiH 03 ‘n ^°USeS shou,d
the rooms. Rooms should
Kgh‘ Sh°uld enler
,well ventilated
ventdated houses
house, CanT be
Such
cost Low
In.., income
‘ an
I low cost.
f- constructed at a
group of people can
| construct such hous,
—ses on loan
i
in
““
'-in.
Panchayat can help
•n this
this p'
matter. Very r—
Poor scheduled caste and
. scheduled tribe
I
for constnirrin ; . communities
• constructin of he
I under Indira Housino
"
d
rc ava
I Abries are limbed aVstTa 1
Quota or
| Poor families can only be’he'""t' unumber
nUmb of
_ > this
I Project. Panchayat should be
0Ugh
aware of the local
various families of the ] yfe of houses in which
locality dwell
fKO\ ide
keqcired nutrients •
I One of (he (
I malnutrition.

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Panchyat
in uijjj
this case
■> This
r°le of
---y
in
(
been
described in page se l‘Hh>s
7 role has
nas aiready
alrt
narrated below
However. these ' sre also

I

Working c - '
“U' ,he.degroe of malnutrition in the

'he health workers3 <and 7rnen ** ga'hered froir>
” no need 't'o'^^e v F
W°rkers' Th^e
,s no need to take
r
J
‘
’
medicines bought from the1"3 6 ,0°d “ems or
I <vhich U|areV IJ,not c I ™ n" £ " ‘0
fnJ"S
.
I malnutrition.
I village itself i
- n — ■■ -s sufbeent. Again, many are there
I who
*ho c
cannot take food
| cultivate the same. They Properly though they
|
mpm
;n .u_
them m
the market due'' are compelled to sell
malnutrition can be f 'o Poverty. Therefore
fought only by reducing
I Poverty.
So. effort should
--J be made to cultivate
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more and more c---'*
froits and madecrops,
'a^ailvegetables,
’aHr,0'",/r 8- ^' flshes
and
- available
locally~by CnSUr'ng
equitabie distribution
I
record, of
of food Hem that are Aculriva
°f the
‘ 'e quan|ity
cultivated in the
out of the vilkbroughi in ihe
brought in the
village from <
outside can be
cultivated in the
v,Hage is to be
seen. Attention
to be focussed on those pPeople who are not
gettting food-stuffs
during8 r^^
their recfuiroment.
'bough there is'no■•3problem
,s no 1
same in the ■locality
PThev c
aVa'lab'b'y o
off the
availability
the
locality. They
,hrOt,gh
Jawahar Rojgar Yojana iRnp^
regarding this matter Duri^nl
°lhCr SChcmcs

™«*. >b.«U

Rep, MXXX,'™

*ssj*;s*'™»™“!"a

shortage
and so, there may be'ma'^ rU,lr"lonal value
—e too
scarcity.
Y
manlnutrition in spite of
no
Records of Nutrnional < ■
^ality
■he locality should be kept
if of the people m
wcighl of the
agcs may be
-• percentage
calculated out They have 1t malnutrition can be
to administer vitamin
A orally which .is ^de available
from the health
centres. Pregnant
should also be given
. roviS mgard,ng -omen
"'al"'--rin

^'-rough^JK;-..

to be seen that whether i
items as Pcr requirement cveronc is getting those
and also how many of
them are getting them
monthly.
J
I AMIEY llanmnc; :

Keep 2 record of
the ccouples in you,
locality -who
■) are in
me reproductive age
group. Stall Of lhc
h1ealth
centres
should undertake
(his job. Enquire,
many families are adomin .amongsl <hem how
Family PlanninJ Ea P ngd
Var'°US
of

he included in the familv n|
should
isd 10 be seen that everj fiv"8 Pr°g,a"1",e' "
every family
advantage of the programme r"
,ake
1Programme.
*ufa,dmme. Contact thoep
families that i
information ca‘1nVChn’Oreklhan 2 children. This
can be gathered from the birth
register. Talk
worke
seThTrSOnflly
adddilion
the health
kers. These information are very
essential. What
giving birth t;
difference of
children ? A
Calculate th.tose through the information collected
round the Year. Health of the children depend to
some extent °n ‘he weigh‘ of "heir mother

<•
i

I
I
I
of the locality
I Average weight of the mother
collected and also
I dUnng ^‘^Sive^^n^realeTheir we.ght if
I effort should be g ^^ differcnce in age between
same is low.
I| the
children should be of 3 years or
two consecutive -e
>
I more. The average number of children of all the
■ , the locality should be less. Heal
I. mothers in
t.— --

t0 be made available through
kits are expected in the villages. If r«lu*r^;
DWCRA groups
; Keep a record of the
inform the health workers
died due to cause of
nwtheres who' have d:
emphasis on women education
pregnancy and give
and dignity.

Should prepare reports monthly as wen
' workers sh
I as <
I and through discussions,
I will come out.
j Increase in population,n has a direct link with age
‘th? marking couple. One should marry only
I of
after proper ^^‘“P^XVa'nKean of age
I years of age m cas
y
attained before
I in CaSec °Lside he should have an income to
' I marn,ahgX Imdy Many are there who become
I run their family.
* urilv of their growing
worried
regarding
and
I| daughters. Males can easily bath urinate
unrw

" 'b“' .St’S'"**

I
I
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I

defecate but females cani •

pregnant women m the: v.lh ge a .
[wo doses of Tetanus Toxmd s g
them. Pregnant mothers must get
check-ups by the health-workers.

Gojng oui of the-

rs
X
t. .rc xrX"
y
jsse rxrs

education, Collect annually the ageigil of average
girls who are marrying. Keep a viw of the social
I age of marriage
— See, if the cause
, can be
I system,."Tha't'Tead to early marriage
I removed.
is fixed by the
’
/
Family planning target various means. of
, ■ .
I Governmental targetl about be accepted by the
■< ||
.family
i planning- that
that 1have to
jidiiinj
'‘\l
member
of
people
is
again
.uv...— -- r ■
|,avat Collect information
Block and Oram Pa ch y
a( th.
about such targets in
m respect
r pect of your
y
beginning of a year. E ak» « you
g
- I Help the people by intoml'"g arranged by the
I there is an operauon camp a rang
y^
. j| Government. If any problem anses.

A-'
i
■

_______

Six communicable

diseases have

been n'en“°^se are Diphtheria. Tuberculous.

accordingly- Conta
Again there lies a
immunizing their c 1 r.
hddren arc not being
difficulty in cases whery^
Therefore.

Q„„

keep a record
being completaly
Panchayat and see that^^y^.^
by hc
immunized. Thos
matters month!
health workers, discuss on those
0|
and take step accordingly. C0^
tnformat.om whether^ h^
(he

is not

attended. Though
all. yet see that you work according y

/r. >■ ■ » t >U MOllli It ‘ Hi 1' '
t mentioned in details earlier. See
■ r Much have been

V'. 1 i

whether the and children are being properly
i of mother ■ Ask everv member to enquire at
implemented, rtCoffice of the locality which are
i
iAnganwadi office ~ Anganwadl workers and
i the
under ICDS programme,
™
staff of the hc
‘ J.h
information
inidwives and
I and children of the local! y
are sufficient number
aeuvery are taken,
whether their help during de ery
tha(
I Panchayat Members must al
I

Panchayet membe” ^“^population must have
village with more than 1
P P.^
jn (he
an immumsaoon ■sessi^ heallh.workers should be
asKXanisation of such session.

Health awareness sho^J ^---—

I
i

people. Health worker w
^health with them.

'ta'

34
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advantages
fo)k have

i

. Mt

r*“—

I
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(J)

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They will attend different meetings of (he
committees. Awareness amongst the school goers
in very much essential. Girls should not trail behind
others.

Awareness in the community member regarding use
of safe delivery' kit should be generated. Panchayat
members should ensure that DWCRA groups are
encouraged to produce safe delivery kits (DDKS)
Mass awareness is necessary for prevention of
diseases Literacy programme and public health
movement should go abreast. Development of
consciousnccs result
-•t in easy pcrlormance of
collective efforts.
Panchayat members should ensure that only iodated
I saIt is sold in the Ration shops in and around the
I , village. Presence of iodine in salt can be detected
| by Salt-testing kits. Use of iodated salt prevents
j Goitre.

1

1
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All health centres are to be kept clean. Places where
All health centres are to I _
for treatment should be very much neat
patients go lor
andclean. Tins can’t be done by the health workers
alone and for this they need the co-operation of the
common people. Often hospitals arc found to be
dirty. Dogs, cats, goals, cows are found sometimes
t
_______
loitering_ in the hospitals.
Those
are to_be removed
by collective efforts. Panchayat"should
„
.
, -- -------J also take
measures.
Hospital
may Environment
be made better
u.uib
oi incbuildings
local people.
of
by the efforts of the local people. Environment of
be P,omoled?y Plantation all
around. Sitting arrangememts of the patients need
to be made.

Many tit-bits of the work have been dealt with
Various records are to be kept in the Gram
Panchayal to undertake those activities smoothly and
| perfectly. Skill for analysing the records and taking
_ .. is trequired. A major part of the
| steps accordingly,
. word is to collect information and register them
properly. Those are to be done by the healthI workers. Analyse the records and discuss on them
once in a month. In addition to the health workers.
CHG, midwives, supervisors of the health worker,'
Anganwadi worker, every member of the Grampanchayat. leader of the DWCRA committee,
village physician etc. will participate in the
| discussion. Prepare the specific work schedule in
the meeting. Health workers are scheduled to wisit
I 16 days in a month to meet families so as to keep
I a continuous touch with
___the villages. Finalise the

I

lime and place Of their Visit. Also finahse thorough

|
!

discussions, when and where immunization will be
given and when family planning camp will be set
up, in a partcular month. Review the activities, as
planned, in the previous month. Similarly, annual
review should be made at the year end As various
people are associated with the health infrastructure,
it is the responsibility of the Gram Panchayat to
correlate them. If required, responsibility for
supervision can be divided to more than one person.
Sometimes, various diseases suddenly occur
vigorously, as for example, gastro-enteritis, malaria

j

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35

tic I hen. on emergency basis, make participate all
and immediate steps should he taken as per the
instructions ol the health department
HU now, what arc to be done at the Gram Panchavat
leve . have been discussed. Similarly, works arc’to
be done at the Panchayat Samity and the Zilla
I arishad Level. Review the public health records ol
the C.ram Panchayat at block level m Panchavat
Samity and at District Level at Zilla Panshad
respectively.
Evaluate the on going health and family wcllao
programmes monthly. Moreover, review’niectm-s
al the sub-divisional level should be attended by
the Sabhapati of the Panchavat Samir and
Janaswasthya Karmadhakka. Liaison between aiiotn
level is very much essential and then only pci led
corclation lor any work will occur
In addition, eveiyone has to shoulder some
col
responsibilities collectively
and also to abide by
some social law and order. Panchayat has* to take
initiative in such cases which are narrated
below :
‘ »l
li:i|

J

' n I!
I

I' I

III

>

\ X I'

To <ensure that sports and physical exccrcies
are ---held1 in every village. Females should also
be encouraged to take part in these acnvitics.
Il would be better if the schools have a
playground. In the surroundings of these
playgrounds fruit bearing trees could he
planted. Deyelopment of play grounds and
plantation of trees could be done under
Liwahar Rojgar Yojana.”
To keep one s village clean. To cnsuie (hat
mosquitoes and flics do not breed Dirty water
to be drained out from the villages hv
constructing proper drains.
Wastes not to be kept in open. These should
be dumped in sylo-pits. Ponds and ‘dobas’ to
be kept clean.
All the households to take part in the
construction of low' cost sanitary lai lines,
smokeless chullahs and soakagc pits.
Villagers arc to take the responsibility ol
supply of water in the villages. Women'folk
should take a lead in the matter. Water of the
pond which is used to be kept clean. Nobody
should be allowed to urinate, dcfaccate and
ablute on the banks of such ponds. These arc
to be noticed
Cure is to be taken to prevent pollution ol
water in such ponds through passage of waste
water or insecticides.
Intoxication of any form is injurious to health.
Health is damaged through smoking of hidis’
and cigarettes, consumption of wine, heroine
and chewing of ‘pan’, 'khaine', guraku’. jarda'
dokta*. Even taking of more lea is bad It is
belter to take some more nutritious food by
curtailing the above.
Strict vigilance is to be kept on manulaclurc
ol country liquors in the villages.

I

K

J__
■'l

I
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I

J

I
I
I
I □
I
I
I J
I
I
I J
I
' I
I
I J
I
I
I J
I
I

II

I

It impairs our ears if mikes blares out al odd
hours. Unnecessary explosion of crackers also
causes the same harm. Noise causes much
harm to patients. Il is not advisable to sit before
video cinema shows for long hours. Young
sters should nof be allowed al all. Strict
vigilance should be kept on mushrooming ot
video parlour.
One must possess elementary knowledge on
illnesses. But medication must not be done
without the advice of a doctor.
Health and mind are interlinked. If mental
peace is there, there will be little illness.
Mental peace should not be disturbed on minor

issues.
Health of mothers and infants should gel
priority. It is a crime to neglect a female child.
Marriage al young age is not good tor health.
Marriage should not be celebrated before a
girl attains the age of IS years.
Movement against dowary system is urgently
necessary. It has to be ensured that neither
physical nor mental torture iS made on

womenfolk.
Lapses of governmental health care should be
brought to the notice of competent aulhourily.
If a lapse on a particular health worker is
noticed, the matter should be brought to the
notice of appropriate higher official Cordial
relationship to be maintained with all health
workers. If the solution of a particular problem
is not in the hands of a health worker, the

I
I
I
I
I

said health worker should not be blamed, llierc
should not be any interference in the work of
Medical Officers. No health worker should feel
insecure.
.
Many lives could be saved through blood
donation. Blood donation should be
encouraged. People should know their blood
group and be ready to donate blood should
any friend or relative require it during medical/

□

□

obstetrical emergencies.
Helping hand should be stretched to an ill
person. Social responsibilities are to be
performed. Panchayal members should also
mobilise the community for transporting
emergency cases of child birth or during
serious illnesses to nearby appropriate referral

units.
Do not spit here and there.
Handicapped children should not be isolated.
They should have equal social status.
Defecation and urination here and there should
J

□
J

be slopped.
Diseases caused by the bite of mosquitoes
could be got rid of if mosquito nets are used

while sleeping.
More and more trees and shrubs are to be
planted.
,, ,
.
Il is noj desirable to frighten, scold, beat and
kiss children. Eye sight may become defective
if ‘kajaf is used.
There is risk of diarrhoea if the children are
allowed to keep nipples in their mouth.

\

1

36

$

Application Form for Registration of Births
To
The Birth & Death Registrar

Annexure—A

Sir,
My son/daughrter
village
registration certificate.

on

was horn in the
. ..Please make necessary arrangements so that 1 get his birth

i

Dated :
Yours faithfully,

Details of new-born :
1.

Date of birth

2.

Sex (Male/Female)

3

Name of the new bom

4

Address of birth place

5.

Permanent Address

6.

Birth weight fo the new bom (if known) :

7.

Details of new bom’s father :

j

a) Name
b) Educational qualification
c) Occupation

d) Nationality
e) Religion

8

Details of new bom’s mother :
a) Name
b) Educational qualification

c) Occupation
d) Natioality
e) Religion

f)

Whether two doses of tetanus toxoid were Injected. Yes/No

g) Age al the time of delivery.
h) Number of gravida.

i)

Age of earlier child, if any.

j)

Whether any doctor or trained dai attended at the time of delivery.

I

1

Annexure*. B

Application Form for Registration of Death
To
The Birth & Death Registrar
Sir,

My father/ husband/wife/ son/ daughter.

died on

Death Certificate and oblige.

due to

Please issue h

(name of disease)

Yours faithfuly,

Details of dead person :
1. Date of death
2. Full name of the dead person

3. Place of death

4. Father’s/ husband’s name of the dead person
5. Age of the deceased

6. Sex of the deceased—Male/Female
7. Marital status of the deceased
8. Occupation of the deceased

9. Religion of the deceased
10. Nationality of the deceased

11. Permanent address of the deceased
12. Reason for death
13. Doctor’s Certificate :

Name and Registration No. of the Doctor
14. What kind of treatment done :

a) Name
b) Address

!

; ’jt. •

TRADITIONAL HEALTH AND HEALING PRACTICES - A
WOMAN CENTERED APPROACH
Introduction
Traditional medicine has been defined as ‘that of whole, which includes a

holistic knowledge and practice, oral or written, functioned in diagnosis,

preventive and curative aspects of illness and disease, to promote total wellbeing/ The approach is holistic consisting of blending of Physical, mental,

social, spiritual well-being of the individual.. Its use is global. Even in the face
of the sophisticated western system of medicine the practice still continues,

because some of the methods/practices used by them are not only beneficial,
and scientifically sound, but more important, are acceptable,

accessible and

afordable. Common man, specially the women folk, who have been found to
be the repository of the system lodge great faith on this.
Therefore, though late, the recent upsurge in the use of traditional medicine

is not without any reason. So much so that WHO has taken steps to
establish collaborating centres in

traditional system of medicine. It has

survived through the ages and

is expected to be with us for years to

come. Besides its availability, affordability and cultural acceptability, it

has been a source of empowerment of the conununity and specially of

women folk, since healtli care by and large, has remained one of their

sole domains as nurse, as midwife, as supplier of home remedies and the

list can go on. Further,

it has helped them to be the friend, philosopher

and guide to women, whose access to health and medical care facilities
are extremely restricted due to various socio-economic-cultural reasons.
Moreover, the

little care the women folk receive at home are extremelv

fragmented, as it mostly centres around pregnancy and child birth situation,

the intention being merely continuation of family line. It has never touchedL
even the fringe of the women overall health problems.

It has been also been observed^the women though constitute 50% of the

population, perform 2/3rd of working hours,

own less than 1% of the

total property. They have no role in decision taking activity of the family

and hardly control over their own body. They find a support in the local

healer, whom they can confide regarding their owes, and fall back on their
advice at the time of need for relief and solace. The traditional knowledge

and skill handed down from generations

enable

to find their rightful place in the family and

the healer and advisers

also in society. It has been

found that almost 70-80% of deliveries are domicilliary, being conducted
by Dais or Traditional Birth Attendant,

who are also the primary care

physicians, providing emergency care in cases of accidents, snake bites
or providing remedies for relieving pain or tension etc. They are available

in most inaccessible and underserved areas where no other assistance is

available at the time of dire need and where

delay is dangerous.

Their advice regarding birth control measures is said to have been effective

specially, among the tribal community. This, ofcourse, needs further study.
Thus die traditional system of medicine, while enabling women to provide
primary health and medical care at the grass-root level, helps

the

community to recognise their knowledge and skill which is so important
for sustenance of health care at the community level.

Further they have been found

to be the major carriers of traditional

system of health care, their methods being user-friendly, readily available

and culturally relevant. A large number of diseases can be treated at local
level using common home remedies at almost no cost to the individual.

If this knowledge can spread in an organised way it will help in saving

our precious foreign reserve. But lack of government support is gradually
weaning them away from this precious knowledge, dubbed as 'unscientific'

and 'quackery'.
There is another danger to this aspect of deprivation

Knowledge has

always been a source of power. The traditional skill and knowledge handed

down from generations, has been a source of strength and its loss is
bound to lead an economic deprivation, pushing more and more people

■■

V'.-’

•

■

below the poverty line
The herbs and medicinal plants are usually collected from forests. But lot

are grown in the backyard by the women folk and healers, who grow the
plants, collect the required parts, process, prepare the medicine and finally
distribute tins, which enables them to be self reliant, thereby raising their

self-confidence. This promotes personal and community independence not
only in cure and care but more importantly in prevention of illness. It
fosters dignity of labour and helps family care to flourish since every one
in the family is involved in the activity.

Being healers in dealing with herbs, their concern for

environment and

plants, naturally has a far reaching consequence on protection of nature,
its beauty and bounty. Further, being in close collaboration with nature,
which has provided them with food, fuel and medicines, they assume die

role of protectors of forest and nature

and not their predators,

whose

mindless exploitation of our eco-system has proved a major threat to the

very survival of human being.

*/

Their work as healers have been acclaimed even by their male counterparts,

who had successfully suppressed them in the guise of protection, natural
in a male dominated society, where women have been equated, as in that

popular Sanskrit Sloka, with creepers which always need external support
for their survival and sustenance. In some societies, men have also accepted
their healing power. It

has not only a physical

urge but also a

psychologically satisfying influence of possessing power, which helps to
reduce their feeling of self neglect.
Even when it provides them with financial benefits, they do not become

suckers like many, so called, modem practitioners. Their income is

extremely meager depending on what the individual family can pay either

in cash or

in kind as a token of gratitude. Their interest primarily

gravitated on the patients and not on their purse. This raises their dignity
and prestige in the community, where they are constantly in demand to
offer advice. This favourably raises their own confidence and self-esteem.

By offering care and succour at the time of need they help in uniting the
community at village level which has been so fragmented these days.
Thus diseases, in their hands become a uniting rather than a dividing

factor. In traditional societies every thing is a community affair, whether
it is sowing plants in the field, mending roofs in village or attending to

the ailment in a family. Every one extend a helping hand which is so rare
in the modem society, where every individual and every home becomes

an isolated island.
Illiterate or semi-literate, they are not uneducated. The

traditional and

cultural values rank high in their life enabling them to be role-models in

3

their communities. Their social status also enables diem to acquire political
power, if they so desire, since they are always available at the time of
need. But modesty has prevented them to run into the election fray.
Men and women do possess inherant natural beauty which can flourish

and flower only in the lap of nature which adds grace, dignity and beauty
to ones physical constitution, irrespective of caste, creed, colour or gender,
where living and non living ones are interdependent for their survival and

perpetuation.

SUGGESTIONS / RECOMMENDATIONS
1.

Stringent law's be framed and enforced so that the genetic material
can not be exported out side the country come what may. They have

to be preserved at any cost, fhere is no other alternative.
2.

Since the plants/ herbs/methods have been claimed to be useful, there
is an urgent need to collect, properly identify, preserve and establish

their therapeautic use after undertaking in--depth studies, both in
laboratory and field situation.
3.

There is also need to

identify

areas where herbal gardens can be

raised since tlie herbs are geo-climate-location specific
4.

Felling of forests to be strictly prohibited

5.

In traditional societies people have tremendous respect for their

conununity leaders, who can be identified and utilised as ‘change
agents’ for the development of their own people. The women healers,
for example, are playing a great role in this regard.

-4

6.

The recent changes in Panchayat Raj system need to be fully utilised
for the benefit of the

people at grass-root level.

This is more

important as the emphasis has been laid on the representation of

J

women, who should be

encouraged to take pail in the decision

taking process of the family and community.
7.

Literacy level of both men and women have been found to be

unacceptably low. I his has to be taken care of through

various

literacy programmes including distant learning system. Literacy would

enable women to make better use of available resources.

8

Women, be given, additional medical knowledge

and skill to be

more helpful at the time of need and continuing education should be

a part of this programme. Since, they, unlike their male counterparts,
are
easily available and hence would be most useful to the
community.
9.

A great danger is facing this country.

The multinational companies

realising die values and importance of the herbal medicine and
tianeitional methods have stated acquiring and exporting the roots,

plants and rare genes to their own countries with the objective of

preserving them through high tech methods, while the rare plants and
precious roots are facing a serious threat of extinction in their countries

of origin

They are being used as private property for progress by

few nations, consuming the major resources of the globe. The
importance of these activities have assumed free dimention witli the

in-road of multinational and imposition of GATT agreement through

which some of the ‘Life forms’ have already been patented, threating
tiie very existence of this sub-continent. The superpower concept of

privatisation would strike at the root ol the cultural ethos of this

conununity where the concept of sharing, of enjoying the joy of
'giving',

of fellow feeling, which has sustained this great society,

would be lost., Gandhiji had rightly said that the country' can not
prosper if 50% of its population remain under- developed. The planners

should see the writing

on the wall.

/
f

1
RATIONAL HEALTH CARE

Health Is a personal and social state of balance and well-being in which a woman feels strong,
active, creative, wise and worthwhile; where her body's vital power of functioning and healing is
intact ’; where her diverse capacities and rhythms are valued; where she may decide and choose,
express herself and move about freely.
Health as defined above is thus a state which a person has or wishes to reach.
Rational health care, would be care that seeks to promote the above state of health, either
through preventing diseases by leading a healthy lifestyle, or healing illness by choosing the best
possible of the options available. It must be noted here that access and affordability are major
deterrents to care for a vast majority of women in our country.
Health care services are organised systems that provide information or skills or methods to
enable people to move towards a state of health.
_

In today’s world, It becomes very difficult to make choices which are the best for ones own health
for a number of different reasons. To start with the number of choices possible appear to be many
but in reality many of them are beyond the average woman’s control.
Let us start with the presumption that most people including women do not wish to suffer from ill
health. Here ill-health may be taken to mean ‘dis-ease’ or any condition that disturbs the balance
of well being and causes suffering. In order to enjoy a state of positive health (see defn in the
box) she and her family must have certain basic necessities or the means to generate these
needs of food, shelter and clothing. Following this, she should be respected in the family and
society as a useful contributing member with individual, creative talents; her lifestyle can only
then foster positive health. As can be seen from this background, there are very few women in
our country today who enjoy these conditions that favour a healthy life. To the huge numbers of
women who struggle to survive with the minimum number of calories every day after feeding their
families; illness is an inevitable part of life. To those lucky to escape this battle, there is another
set of bridges to cross, a patriarchal society that puts such little value on its women, denying her
needs, potential and limiting her freedom.
In such a situation, women probably need more than ever to be aware of the possibilities of
therapy when she or other members of her family fall in.
Health care is broadly provided by two groups of people
♦ The organised sector :
This group of people form part of the medical system that provides curative care to people all
over our country. This will include the government health care delivery system, the primary health
centres and their subcentres, the taluk hospitals and the district hospitals. In addition to this, there
are private practitioners who practice different systems of medicine such as allopathy, ayurveda
or homeopathy.
♦ The unorganised sector:
This group which is available to most people is family or extended family. Traditionally this sector
was very strong and women formed the backbone of this group as either grandmother, mother or
daughter. However as more families turn nuclear, this is less common today, especially in the
cities.
It is important to understand the different levels of the health system and the way it is meant to
function so that women can access the most appropriate level of care. Most women in India use a
combination of traditional remedies and modem ‘allopathic ‘ medicine to treat a number of simple
ailments. However, in some areas there may be very reliable traditional healers and practitioners
of ayurveda, siddha and homeopathy. It is a worthwhile exercise to explore all the possible
caregivers known locally with the women’s groups you are involved in. In many cases, the cure
for simple ailments is available at home, but for some problems, a woman may need to seek
medical advice. It is also well known that patients often use a number of healers to treat the same

2
illnesses especially if they do not meet success in treatment. Unfortunately, as most healers
trained in different systems are unaware of each others strengths and weaknesses, and are often
in competition with each other, patients do not fully disclose past or even co- existing treatments
taken. Thus, the issue of rational health care becomes even more complicated. Add to this
scenario the unfortunate but often real dimension of the greed of the medical professionals, who
wish to extract maximum gains from the consultation and the real predicament of the poor woman
who is ‘dis-eased’ is evident
What is quality health care?

There are a number of attributes that could be looked for in good health care. Some of these are
seen through the eyes of the patient, others through the eyes of the care- giver, and yet others
through the eyes of people who make decisions about our health system like the officials in our
governments. It is important that all these groups of people understand what is quality care in
order that quality can improve. The groups of women participants can try to contribute to
improving the care available in their communities by asking the following questions and seeking
answers. In brief, these are
.
,
1 Is the care efficacious? Can the treatment bring about an improvement in health and well
being, given the best possible chance?
2. Is the care efficient? Does the treatment bring about an improvement in health and well
being under the day- to day realities many of our women live in?
3. Is the care effective or in other words cost-efficient? Given a choice of two equally
effective treatments, is this the less expensive of the two?
.
4. Is the health care optimal use of resources? This means in the long run does it still make
sense to use this treatment/ care or do the costs outweigh the benefits?
5. Is the care acceptable? This important criterion includes:

(a) Is the care accessible in terms of time, distance and money?
(b) Does the care- giver have a good, mutually respectful relationship with the patient?
(c) Is the setting in which the care is given, convenient, comfortable and pleasing? Is account
taken of the fact that she will require privacy for some aspects of the care?
(d) Are the patient’s preferences as to the costs and effects of treatment heard and taken into
account?
4. , ...
6. Is the care equitable? In other words, can most other people in society access the healtn
care or treatment choice that is available to you?
You will notice that the first two of these questions will be best answered by the doctor/ healer
who is giving the treatment. The second two questions are best answered by people who are
managing the health care system- whether at local level the panchayat or elders, or at national
level the government administration. The fifth question with all its various aspects is obviously
best answered by the patients themselves, and the sixth question is one to which all members of
society are answerable. You will also notice that most patients use these criteria all the time to
assess the quality of a health service and the services that fulfill these criteria are those that are
flourishing.
Life- styles that promote health

Our ancient science of Ayurveda, says that the purpose of life is four-fold, to achieve dharma
(virtue), artha (wealth), kama (enjoyment) and moksha (salvation). In order to attain success in
this four-fold purpose of life, it is essential to maintain life not only in a disease-free state but also
in a positive state of body, mind and spirit. With this emphasis on the promotion of positive health,
it prescribes a regime of Swastha Vrutta (healthy conduct) and Sad Vrutta (ethical conduct). The
following advice by Charaka sums up the whole concept beautifully.

3

Nityam Hitaharavihara Sevee, Samishyakari Vishayetwasakthah
Datha, Samah, Satyaparah, Kshmawan, Aptopasevee Bhavet Arogah
“She alone can remain healthy, who takes regulated diet and exercise, who deliberates all her
actions, who controls her sensual pleasures, who is generous, just, truthful and forgiving, and
who can get along with her kinsfolk."

Unfortunately, conditions in today’s world often do not allow for even the first of these
requirements, namely diet or nutrition. It is vital for good health to have a daily diet that is
complete in calories (meaning that it provides enough energy to do the day’s work) as well as
balanced in proteins, fats, vitamins and minerals. In many places, women who are in poorer
families do not have enough to eat (See hand out on a balanced diet) and certainly, a majority of
women suffer from anemia. This is an illness where there is not enough iron in the body and as
women have greater needs due to pregnancy and menstruation, they often lack the necessary
stores. As the discrimination in the diet starts from early childhood, the young girl- child is already
at a disadvantage, and this deficiency grows worse as each pregnancy takes it’s toll with the
symptoms of listlessness and chronic fatigue appearing very soon. At present, 85% of women
during pregnancy are known to be anaemic; and one-fifth of mothers who die during childbirth die
due to anemia- related causes. It is a simple matter to eat plenty of green leafy vegetables, and
certainly avail of the iron tablets that are given free during the antenatal check-up at the
subcentres by the nurses. You must urge the women leaders to insist that this simple tablet is
available at the primary health centre, it is one of the most cost-effective methods to improve
women’s health.
The other very important part of the diet is water, clean drinking water which has also become a
luxury in so many poor households. Poor environmental sanitation and unsafe drinking water
together account for almost 60-80% of infections that occur in our country. One of the basic steps
to improve rural sanitation is by the proper and safe disposal of human excreta. Otherwise, this
pollutes the soil, ponds, canals, rivers and wells. This results in more people falling ill from
diseases like typhoid, dysentry, jaundice, cholera and diarrhoea. It is worthwhile discussing in
your women’s groups both the problems of^ater and sanitation (see the handout on low-cost
sanitary latrines) and exchanging notes on water management within the home.
As women are often the prime care givers within the family, it is important that she is aware of the
basic rules of diet, and the good health promotive practices, such as exercise and avoidance of
addictive habits such as tobacco and alcohol. In addition she should be aware of threats to her
own body and peace of mind and try to avoid allowing these to surface in her life. An important
message of Ayurveda is that health, instead of being ‘provided * or ‘delivered’ has to be practiced
by Swasth Vrutta and Sad Vrutta. As individuals, all of us have the power and responsibility to
keep our body and mind healthy by observing a number of simple rules of conduct and behaviour
in relation to food, exercise, sleep, personal cleanliness and by rules of ethical and moral
conduct.

Fact sheet 1- Rational therapy and essential drugs
Rational drug therapy means the practice of scientifically sound medicine that is relevant
concerned and takes into account the socioeconomic context of the patient. It recognises that in
some diseases, drugs do not have a.role, in others and alternative therapies are required,

. Irrational prescriptions raise .the cost of medical care; they waste available resources, delay
. treatment and/or worsen the conditions of.ill- health. They also change the way we spend our
. hard- earned money in our families, as our health culture changes to a philosophy of “a pill for
every ill”. Finally, they widen the existing gaps between rich and poor, as debt incurred from illhealih makes health -care even more inaccessible to the poorest among us.
WhatUs an irrational prescription?X5ne that contains:
• Banned or bannable drugs
• Multiple drugs for the same effect
• Irrational and unnecessary combinations
• Drugs that are costly because of fancy wrapping
• Underdosage or over-dosage
• Wrong indications
• Injections instead of oral preparations

Who could the irrational.^
• A doctor
• A specialist
• A nurse
• A health worker
• A compounder or a pharmacist
• An unregistered medical practitioner
• A folk healer
•' -—A practitioner in-indigenous- systems of medicine
• A family elder/contact
in’.. i < The patient tiensetf ”"
"
’
What can you as a patient do in order not to fall into this trap?
When telling the doctor your problem always mention previous treatments, show the
prescriptionsifpossible."This will prevent you from wasting time and money on a repeat
treatment. It may also help the doctor to correctly diagnose your condition.
You must have the courage to ask the following questions
Do I really need all the drugs in this prescription? Many doctors in particular, are known to
respond “ Are you the doctor or am I?” Don’t be cowed down by this response, you can explain
that you have exactly 20/100 or whatever rupees in hand so could he/she please check how
much the prescription will cost and reduce it to the essential drugs.
Whatdsdhs ^ffectdfUie di'Ugsiblimy'body? Ifthe response is “ Are you going to become a
doctor?” you can laughingly respond, “No, but I am going to take the medicines." However, insist
on an answer. Here you may expect to hear about side- effects that some drugs may have.

After receiving the prescription, when you go to the drug store to buy the drugs,
Ask specifically that the medicines are not ‘expired"- that means they are oTtr and may riot be
effective.
;
:
-

You may also ask here for the least expensive drug from a reputed company. Every drug is
prepared by a number of different companies and there is at times a significant difference in
prices.
Most drugs are cheapest in the tablet form as compared to a suspension or ‘liquid’ form. Avoid
injectables as far as possible. A needle that is not clean may give you an additional disease like
AIDS’ Remember that an injection is needed only if the medication cannot be absorbed through
the stomach, or if the condition is so serious that the drug levels must be kept at a high level with
six hourly or eight hourly injections (for a patient admitted in hospital).
These guidelines are mainly with regard to the western system or allopathic system of medicine.
With traditional remedies made from locally available herbs/ ingredients these problems do not
arise, so maybe you should reconsider going to the doctor in the first place!

Are there any other ways in which this problem can be treated?
This question may inspire the doctor to think about alternative solutions to your problem, and
occasionally he or she may refer you to someone they trust who they feel may be able to help
you. Always remember, if in doubt, you are entitled to a second opinion, although routinely
‘doctor-shopping’ or going from doctor to doctor without faith or intent to take the therapy
completely is bound to fail.
Is it a complete cure or will the problem recur?
This is a very important question to be asked, especially since the doctor’s idea of ‘cure’ and
yours expectations may be different. Ask specifically if the drugs need to be taken for a longer
time, or until a repeat check-up is advised. If it appears to be a long term treatment that you will
find difficult to follow because it is not affordable, be open and you could explore the possibilities
of less expensive alternatives together.

Why did I fall ill and how can I prevent doing it in the future?
Rational health care means paying equal attention to cure and prevention. Although the cure is
preventing the disease from progressing, it is important to prevent a recurrence or relapse, which
might be both more difficult and expensive to treat. It is important to note that in different systems
of medicine the causes of diseases are very differently understood, however in all the systems,
the doctors or practitioners will be able to give you guideline to follow in answer to this question.

You may find that your doctor or nurse finds it difficult or expresses irritation at having to
answer your questions. They are not in the practice of giving information, are often busy,
and may not take the time to answer your questions. Be respectful and patient with them
but firm. They should be able to make you understand.

PATIENT’S RIGHTS

♦

♦

♦
♦
♦

♦
♦
♦

All patients have a right to health care. This is regardless of how much money she has, what
her status in society is, what community she comes from, or what health problem she has.
The patient has a right to considerate and respectful care at all times and under all
circumstances, with recognition of her personal dignity. Care should be taken that she feels
as comfortable as possible.
The patient has a right to privacy and confidentiality at all times. This includes during the
history taking and examination, and with reference to her medical records.
The patient has a right to safety at all times.
The patient has a right to know the complete information concerning her diagnosis, treatment
and possibilities for cure. This information must be communicated in terms she can
reasonably understand. If possible, the means to prevent the same illness from recurring
must be clearly explained.
The patient has a right to ‘ informed consent’ that means no procedure can be done on her
without her voluntary and understanding consent after understanding the risks involved.
The patient has a right to a second opinion, as also to refuse care.
The patent has a right to ask for an explanation of all medical costs incurred by her.

OBJECTIVES OF THIS MODULE

Trainers understand a concept of women's health, which is holistic, and encompasses
aspects of her body, mind and spirit.
2. Trainers are well informed on what constitutes good care (considering all aspects) and can
look for these elements in the care available. As care includes the issues of life-styles, this
would also include water, sanitation and nutrition as part of the subject matter.
3. Trainers are familiar with the different groups of health care providers available to
communities and particularly women in these communities. They can share this information
and then help women to choose from these options available, the best choice to prevent
illness and/or treat the illness early, in the most rational way.
4. Trainers know about patient’s rights and can impart this to the women’s groups also
discussing possible ways in which these can be demanded or negotiated.
5. Trainers know about essential drugs (in the allopathic system of medicine) and can make
maximum use of a consultation and a prescription for drugs.
1.

Duration of session

Content of session

30 min

Discussion on ‘dis -ease’
and health____________
The importance of
prevention- nutrition and
life-styles____________
Health care providers

60 min

30 min

30 min
60 min
60 min

Quality care- what does it
mean to you?_________
Patients rights and how
to ensure them________
Essential drugs and a
prescription scrutiny

Methods that can be
used______________
Question and answers
Sharing experiences
Discussion and
sharing

Materials required

Resource persons
from different groups
and self introductions
Brainstonming with the
group_____________
Role- plays
Role- plays
Exercise with three
prescriptions

List of the essential
drugs
Three prepared
prescriptions

Note to the trainer. If you feel that the majority of your participants give you a feedback of non
utilisation of the allopathic providers, do not waste time on the last topic. Use that hour instead to
strengthen traditional practices that move towards the positive state of health.

SOURCES;
Essential drug list (As prepared by CHC along Who recommendations)
Seven pillars of the Quality of care (1987) A.Donabedian
Ayurveda and modem medicine (1986) Dr. R.D. Lele

3

'6* J
I

/

1

1 miners Information for Discussion
STD and I1IV/AIDS
Prevalence of STDs
Reproductive Tract Infection (RTls) including Sexually Transmitted Infection (STIs)
were not recognized as a health problem until very recently. Various researches
conducted in India in past few years have highlighted this problem as a public health
concern. Today the prevalence of STD is very high resulting in considerable morbidity as
well as long term complications, such as male and female infertility. Pelvic Inllammatory
Disease (P1D), ectopic pregnancy, abortion, still birth, early childhood death, birth defect

etc-

I

'•r
Prevalence of STDs

We still do not have enough data to inform tell us about the exact magnitude of
the problem.,STDs are almost as common as Malaria-more than 250 million
new cases reported each year in the world.
Based on a number,of prevalence surveys and a review of the available
scientific literature,The annual incidence of RTIs/STls in India is estimated at
5% or approximately 40 million new infections every year.

It is estimated that there are about 5% or 40 million new cases of STD in India
every year
The initial survey done show that the problem of STDs is indeed very serious
one in India.
Based on diagnosis made on signs and symptoms of STDs, however, the
prevalence rates are upon 10% in urban and 7% in rural areas. A STD survey in
Tamil Nadu has shown that the overall prevalence of STDs is 7.3%. There is
high incidence of STDs in pregnant women (9.7%). The survey also highlights
high prevalence of STDs in rural areas (5.3%).
Another survey in Culcutta has reported 81% of Commercial Sex Workers t6
be infected with STDs.
Source: S I Ds Wlwl everybody should know, VIIAI, New Delhi

I

Spread of STDs

I he reasons for the spread of disease have direct link with level of awareness among the
community imembers and other Socio cultural factors II is observed that in India
generally there is low awareness of reproductive and sexual health among the community
in general and specifically among women and adolescents Also Ihete is stigma attached
to S 1 Ds. Due to this usually people do not discuss about it nor do they take appropriate
treatment at right time.
i.

' In a country like India social norms varies geographically, religion wise and culturally.
Religious and social norms normally do not permit sex with more than one partner.
However due to feudal patriarchal society a variety of sexual activity takes place without
information to general public. These activities have no bar to age, sex and religion. Such
a scenario complexes the situation of prevention of STDs. On the other side, among some
tribal populations sex before marriage and having multiple partners is socially accepted.
In such situation, in addition and lack of information about the spread of S I Ds they fail
to prevent it at large extent. Women suffer most, as their access to non-stigmatizing
health care services is severely restricted. Whereas men seems to seek treatment from
unqualified doctors and quacks. Such behavior is dangerous, as it does not cure the
disease.

Factors Promoting STDs among Women
1 here are various factors, which promote SI D among women; they are socio cultural and
economical. Poor access to health care is also a major factor contributing in promoting
STDs. It is important to understand this relationship and act upon to improve the
situation.

Socio Cultural
I he influence of patriarchal society on women's health in India is an established reality,
however not much efforts are made to understand this relationship. Women in patriarchal
society get a secondary status where in she lacks self esteem and does not have decision
making or negotiation power. Due to this she neglects her own health. Many a times she
is not even aware that her husband or partner is suffering from STDs She fails to say no
for sex, or insist to use condom. She many time unaware that her husband is having a
multiple partners. In such a case she is a silent victim of the disease. Women tend to put
in unpaid labour within house, which hardly give her time to get expose to the outside
world. This restricted mobility leads to lack of information and lack of access to health
care.
Sonic of the common expression of women about their health will give idea about
influence of various factors on spread, prevention and treatment of S TDs and RUs.

" Sister you are talking about my illness, why don't you ask my husband. I le is having
pus coming out of his penis. " -35 years old tribal woman.

" I have a white discharge, it smells too. 1 tried to get treatment from the Bhuva, but it did
not work. Sister please let me know whom should 1 consult. Now the smell and pain is
unbearable.” 45 years old rural woman

i

” How can I afford to have treatment, we do not have enough to eat. 1 will have to tolerate
this suffering till I die.” -32 years old urban slum woman
Economic Factors
Poverty is a root course of many development concerns. Due to economic constraints
women are further forced to take up sex work. Women in this profession are prone to'
STDs, as the clients are not ready to use a condom. It is a hard reality that due to
changing socio, cultural and economic scenario, adolescent girls arc also looking at
casual sex as a tool for earning side income to satisfy their economic needs.

Due to economic constraints many times men of the family goes out for a job. They do
visit commercial sex workers. When they visit their family the wife becomes the silent
victim of the disease.
Access to Health Care

Access to health care is a contributing factor in promoting STDs among women. Lack of
access to health can be due to social factor and due to administrative factors. As
discussed above women tend to neglect her own health and do not approach the health
care system for treatment. Also long distances and lack of transport facility prevents them
to travel the primary health care. Fear of lack of privacy and non-availability of lady
doctor also prevent women to access health care.

Apart from this, lack of information among the community about availability of services,
short supply of drugs, vacancy of medical professionals etc are other reasons for the lack
of accessibility of health care.
Please refer chart I which depicts the factors promoting STDs among women.

9

Chart I: Factors Promoting S I Ds among women
Social Factors

•
•
•

•
•
•
•
•

Lack of negotiation power. Woman is not in a position to say no to
sex even to her own husband.
Women due to social circumstances tends to neglect her own health
Women arc viewed as sexual commodity. She is sexually exploited
within family and at work site.
Due to triple burden of work, women hardly get time to learn new
knowledge. She is poorly informed about prevention of STDs
Due to lack of mobility women needs some one to accompany her
to go to clinic for the treatment.
Due to social taboo, women do not discuss about the problem and
prolong treatment
Men do not prefer to use condom, nor do women have a power to
insist on its use.
Due to lack of self esteem women and adolescent girls succumb to
giving sexual favours for attention

Economic Factors
•
•

•
•

'Due to lack of financial resources women are forced to work as sex
workers
Women tend to save financial resources. She tries to prolong the
treatment till it become severe and complicated to treat.
Adolescent girls in order to earn money by easy way, some times
adopt casual sex as an easy earning way.
Health care is expensive

Availability of health cares services
• 1 lealth care is not easily accessible.
• Usually the PHC do not have facility to offer STD treatment.
• The situation of STD clinics is such that it fails to ensure privacy.
• No sincere efforts are made to promote condom as a tool to prevent
STDs

Making women more vulnerable to S TD
infection

What Need to be Done to Control S I Ds.

Efforts to control STDs needs to be made at two levels.

•

•

Service Delivery
Regular supply of drugs
Ensure privacy of patient
Gender sensitivity among the health professionals
Regular training of health professionals for the treatment of STDs
Health education and counseling with patients
Awareness Building
Inform community about basic information on STDs and availability of services
Create a social awareness among women to take care about their own health
Involve men in the awareness campaign
Introduce sex education for adolescent boys and girls.

Health and Sex Education
Communication about STD is extremely difficult, as it is necessary to discuss sexual
practice. It is therefore important that health especially the sex education is made
mandatory for the school education. It is important that sex education is given with nonjudgmental manner and with a frank and open manner. The school teachers need to train
For the same. The process of sex education can be initiated from the pre puberty age. It
can focus on the social and psychological aspects of sex and sexuality to allow students
to explore their own feelings, misconceptions and attitudes. The discussion on the STDs
and AlDs need to focus on sexual responsibility and safer sex.
While discussion the on sex and sexuality with other group it is important that we
understand the target group their possible sexual behavior prior to health education. The
person may be a migrant worker, a sex worker or a client, in such a cases it is important
to focus on the safer sex. Promote the use of condom. Please refer Fact sheet 2 for detail
information on use of condom.

Health Camp as a strategy to diagnose, treat and awareness building about S TDs

CHETNA is working in the area of reproductive health since more than 10 years. We
have experienced that women do perceive the problem of RTls, but due to various factors
mentioned above they delay the treatment. Enabling a non-threatening environment and
taking health services at doorstep, women are ready to come for treatment. CHETNA
organizes camp at the local level in coordination with govt, health department and other
local NGOs. The innovation of the camp is that it provides health information through
creative methods, like exhibition, bioscopy, slide show etc, prior to health check up. Also
group discussion are held during the waiting time to sensitize women to develop linkages
between health and Socio-economical factors. During the check efforts are made to
counsel for the prevention of disease.

I

We have received a very good response from the community in rural and urban slum
areas. Please refer Annexure I, a case study on CI lETNA’s experience in communicating
reproductive health with women.

Please refer Fact Sheet 1 to know about
basic facts on STDs

j

illV/AIDS

Today AIDS is global health concern. India also faces AIDS problem of great
magnitude. In India the HIV/AIDS epidemic is now more than 10 years old. In such a
short period it has emerged as serious public health concern of the country. The initial
cases of HIV/AIDS were reported among commercial sex workers in Mumbai and
Chennai and injected drug users in the northeastern states of Manipur. The disease spread
rapidly in the areas adjoining these epicentres and by 1996 Maharastra, Tamilnadu, and
Manipur together accounted for 77 % if the total AIDS cases with Maharastra reporting
almost half the number of cases in the country. The available surveillance data clearly
indicates that HIV is prevalent in almost all parts of the country. The overall prevalence
in the country for the population of 970 million is still, however, very low, a rate much
lower than many other countries in the Asia-Pacific region.

Prevalence of H1V/AIDS
•

•

•
•

UNAIDS estimated that, up to end of 1997, 30.6 million people
worldwide have been infected with HIV. In South and Southeast
Asia it is estimated to have 6 million, 1% of the global total.
The cumulative number of HIV infections among adults has
more than double since the beginning of decade from around 10
million in 1990 to 25.5 million by mid 1996.
By July 1996, 5.8 million people, 75% of all people with AIDS
arc estimated to have died world wide.
Studies results vary but indicate that transmission of 111V occurs
in about 30 % of pregnancies in women in developing countries!

It is important to note that estimates are revised periodically in light
of currently available information and it is important to note that the
epidemic continue to spread and is not randomly distributed.

/

Some Facts

•

•
•

About 75% of the infections occur from the sexual route (both heterosexual and
homosexual), about 8% through blood transfusion, another 8% through injected drug
user.
One in every 4 cases reported is a woman.
About 89% of the reported cases are occurring in sexually active and economically
productive age group of 18-40ycars.

What Makes Women More Vulnerable to HIV/AIDS
There are various condition and Socio -cultural and economic reasons, which makes
women more vulnerable to H1V/AIDS.

•

•
•
•
•

•
•

•

•

i

The most basic factor making women vulnerable is the social status of women. Due
to social and sexual subordination, women find it difficult to negotiate and prevent
men from practicing unsafe sex at home. Due to which women within family go
through rape almost every day. Thus lack of control over sexuality, in addition to the
culture specific submissiveness increase the chances of HIV infection in women.
1 his situation reflects at work site also. The supervisory staff or the male workers
sexually exploit women. This also increases the chance of HIV/A1DS.
At present, male condoms on which women do not have a control, are the only
means to prevent AIDS.
Early marriage expose women to II1V/AIDS at an early age.
Poverty,'unemployment and lack of education might force them to accept sex work,
increasing chances of HIV infection through forced unsafe practices.
Inadequate information, lack of mobility and poor health services increases the
chance of HIV infection by manifolds.
Inadequate law aggravates her HIV status. For example, rape law and PIT A
(Prevention of Immoral Traffic Act) are inadequate and more often the violators go
unpunished due to the lapses in the Act.
Immature cervix in adolescents and less mucus production in the genital tract of post
menopausal women may cause injury during sexual intercourse increasing their
susceptibility to HIV infection.
Since female birth passage is not visible, any lesion that may occur is not easily
recognized and treated.

Factors Increasing the Risk of IIIV/AIDS in Women
Existing Socio-cultural Practices
Lower Statu^of Women
!

No Decision Making Power

I
In Family

At Work
Places

I

Sex Behavior
No Negotiation .
Power

Sexual
Exploitation

Rape

r

Women are more
vulnerable to HIV
infection

Unemployment, poverty,
forces women to work as sex
workers

Inaccessible, inadequate
and expensive health care
services

Source: Ibklur developed by Cl II: I NA

o

It is observed that the behavior of different people including medical professionals
towards men and women with HIV infection is different. Some of the examples arc as
follows

He has HIV__________

She has HIV_________

The doctor breaks the news

The doctor breaks the news

You have tested positive for HIV. This is a
terminal illness. Be careful about your
health.

The family gets to know about his
positive status

You have tested positive for HIV. This is a
terminal illness. Make sure that you do not
conceive. It will transmit to your child and
you will be the one to blame for the misery,
which the child will suffer. In case you are
pregnant, it is imperative that you abort the
child as early as possible.
__________
The family gets to know about her
positive status

You have brought us shame. It is better that
we keep the family's honour by
dissociating ourselves from you. Please
leave the house. The wife leaves with the
husband.______ .
.
______________
The community gets to know about his
HIV status

We did not know we were sheltering a
whore in the household. Leave the children
here and before the sun rises tomorrow.
We do not want to see you here. Even your
shadow is doomed for us. She leaves alone.
The community gets to know about her
HIV status

It is unfortunate that this happened to him.
After all men will be men. They go around
sometimes but such misfortune does not
strike everybody. It is his "Karam". In any
case a bull is not a bull without its scars.

The kind of karani she has indulged in, she
has got away lightly by just being thrown
out. In our times she would have been
branded so as to be a lesson for other girls
to keep away from bad activities.

f

Source: She can cope. A paper on gendei and IIIV/AIDS
by Madhu Bala Nath. 1997

G

Fact Sheet 1
Some Basic 1 n format ion on RTls and S I ls

How can one get S I D?
Having unprotected sex with someone who has one of Sexual Transmitted Disease can
lead to the infection. Even with one episode you have sex, just once, with someone who
has a STD, you can catch it, whether the sex is genital, oral or anal. You often will not be
able to tell if your sex partner has a STD. Sometimes there are no signs that you can see.
Type of STDs
1 here are more than 20 known S FDs. 1 he deadliest STD is AIDS. Other common STDs
are Syphilis, Gonorrhea, Chlamydia, Verginitis, Genital Herpes and Genital Warts. For
more information sec the Chart 1.

Some of common symptoms and signs of the widely prevalent STDs in India
General symptoms in both men and women

•
•
•
•
•
•
•
•
•

Burning/pain during urination or deification, increased frequency of urination
Single or multiple blister and open sore on the genitals may be painful or may not be
Swollen and painful glands in the groin
Itching or tingling sensation in the genital areas
Non itchy rashes on the body
Warts in the genital area
Sores in the Mouth
Nodules under the skin
Flu like symptoms, headache, lethargy, vomiting, fever etc

Symptoms among women

•

Unusual vaginal discharge (yellow, green, curd like, frothy, pus like, foul smelling,'
blood tinged)
• Lower abdominal pain
• Irregular bleeding from the genital tract
• Burning or itching in and around vagina
• \ Painful sexual intercourse
Some SI Ds may not produce any signs and
symptoms in women. They may be healthy but
they can spread the infection

Io

Symptoms in Men

•

A drip or discharge from the penis

Treatment and Prevention

•

If you have any ol the STD symptoms listed in the chart, go to your doctor or nearby
S I D clinic right away. Do the same even if you have no symptoms but have had sex
with someone who you think might have STD.

•

Some STDs can be treated and cured. If left untreated, some STDs keep getting
worse, causing permanent damage or death.

•

Eating certain food or application of certain oils on genital organs cannot cure STDs.
Always go to qualified doctor for the treatment.

♦

If you find out you have STD, tell the persons with whom you have sex. Anyone who
has had sex with a person with STD needs to get prompt treatment. Remejubcr: even
if You have been treated or cured, you can get the same STD again, or a different one,
if you have sex. with a person who has a STD.

•

If you are an unmarried teenager and have STD, talk about it to your parents or any
adult on whom you have total trust and faith. If you are confident to approach the
doctor directly go the STD clinic and get the necessary treatment.

•

People who have sex can protect themselves by taking precautions: Do not treat sex
casually. Have only one sex partner. Be sure that you and your sex partner do not use
drugs - you can get AIDS from having sex or sharing needles with someone who has
AIDS or is HIV positive. Always use a condom, correctly. For more protection, use
contraceptive jellies and foams that contain a spermicide. You can pul these in a
condom, apply them to the vagina, or both.

Myths about S I Ds

Due to taboo attached to STD there are a variety myths attached to S I Ds
Some of them &re:

• STDs can be cured by having a sex with virgin or with young girls.
• STD spreads due to masturbation
• Person catches STD due to evil spirit, and curse of god.
• -i Person who has done sin in past gels STDs.

Chart 1: The most common S I Ds and how they can alTcct yon
Disease

Symptoms

AIDS

Long-lasting
infections, diarrhea,
night sweats, fever,
weight loss, swollen
glands, coughing,
shortness of bread)

Chlamydia

Itching or burning
during urination,
vaginal discharge,
whitish discharge
from penis, pelvic
pain, or no symptoms
at all_______________
Sores on penis or
vagina, vaginal
discharge/ ever,
tiredness, itching and
pains - •

Genital
Herpes

Effects on Your
Health___________
Immune system
damage leading to
cancer, pneumonia,
brain damage, death

Pelvic inflammatory
disease, sterility

First attack very
painful, recurrent
flareups less painful

Gonorrhea

Vaginal discharge,
bunting during
urination; most
women have no
symptoms

Pelvic inflammatory
disease, infertility,
arthritis

Syphilis

Sore on penis or
vagina, mouth, anus
or elsewhere; low
fever, sore diroat,
other sores or rashes

If untreated, can
cause damage to
heart, blood vessels
and nervous system,
blindness, insanity
and dead)

Genital
Warts

Genital itching,
irritation or bleeding;
warts may appear as
small, cauliflower
shaped clusters; may
get worse during
pregnancy

Warts grow in size
and number, may
increase risk of
cervical cancer

Effects on
Fctus/Baby______
Fetus can get virus
from mother
during pregnancy
or delivery;
immune system
damage leading to
death in a few
years____________
Baby can catch
during vaginal
birth, causing car
and eye infections,
pneumonia

Treatment

Baby can catch
during vaginal
birth causing
severe skin
infections,
nervous system
damage,
blindness, mental
retardation, death
Baby can catch
during vaginal
birth, causing
serious eye
infection,
blindness_______
Fetus can catch
before birth,
damaging bones,
liver, lungs, blood
vessels; infected
fetuses can die
before or after
birth

Symptoms can be
treated; no cure
for the disease;
flare-ups may
occur 4 to 7 times
per year

Baby can catch
virus during birth,
causing wart
growth inside the
voicebox and
blocking windpipe

Can be treated
with drugs
applied directly
to warts, or with
surgery to
remove them

No effective
treatment

Can be cured
with antibiotics

I
Can be cured
with drugs;
babies arc treated
with eye drops
after birth

Can be cured
with drugs; once
fetus is damaged,
there is no cure

l-i

I

Fact Sheet 2
How to Use Condom

1. Carefully open the package so that condom does not tear. Do not unroll condom
before putting it on. The condom should only be put on the erect penis.
2. It not circumcised, pull foreskin back. Squeeze the tip if the condom and put if on the
end of the hard penis
3. Continue squeezing tip while unrolling the condom till it covers all of the penis.
4. Always put the condom on before entering partner
5. After ejaculating (coming), hold rim of condom and pull penis out before penis gels
soft.
6. Slide condom off without spilling liquid(semen) inside
7. Throw away or bury the condom
Remember
• Do not use grease, oils, lotions or petroleum jelly to make condoms slippery. These
make condoms break. Only use a jelly or cream that does not have oil in it.
• Use a condom each time you have sex
• Use a condom once, only.(single use)
• Store condoms in a cool, dry place
• Do not use condoms that may be old or damaged.
Do not use condom if:

•
•
•
•

the package is broken
the condom is brittle or dried out
the colour is uneven or changed
it is unusually sticky

I

f

Fact Sheet 3

What is HIV/AIDS?

The disease. Acquired immunodeficiency Syndrome (AIDS), is caused by infection with
Human Immunodeficiency Virus (HIV), which enter the body’s white blood cells and
kills them. It weakens the body to such an extent that tuberculosis, cancer, pneumonia
and other infections occur and kill the person. AIDS is the final stage of disease when
HIV infected person becomes very ill and dies.
HIV is transmitted in three ways. They are:
• through unprotected penetrative vaginal or anal sex
• through sharing any instruments that can pierce the skin, for example needles and
blades that have been in contact with the blood of an HIV infected person.
• from an HIV infected pregnant woman to her baby during pregnancy, during delivery
and through breast feeding the baby after birth.
Who can get HIV/AIDS?

Any one can get Fit V infection. It does not have any age, sex, and religious bar.
Who are more prone to HIV infection?

•
•
•

Men and women who have more than on sexual partner.
Person who takes non-HIV tested blood.
People who are involved in drug act.

Prevention of HIV/AIDS
Prevention of HI V/AIDS is every ones responsibility. All individuals need to be involved
in curbing the spread of HIV and other STDs.
Safer sex is the most important way to prevent HIV infection There are di 11 ci ent
I
options to choose from
Use of condom during penetrative sex. Please refer Fact Sheet -2 for details on
use of condom.
Abstinence or not to have sex at all, is the most obvious way of ensuring that you
do not become infected.
Long term mutually faithful relationship with an uninfected partner.

•
•

Never take non-HIV-tested blood.
Be away from activities related to drug.

Apart from this there are few ways which will promote prevention of III V/AIDS. They
are as follows.

f

/A

•

•

Every one's role is important. Learn more about this disease and let others know
about it.
Discuss HIV/AIDS and other STDs with other family members and friends, as well as
sex partner. This will enable every one to behave in ways that prevent transmission of

Some Religious and moral Issues Related to HIV/AIDS
•

•
•

One should recognize that gay people exist in all culture and races. They were
initially blamed for the HIV/AIDS epidemic, but we now know that it is what one
does sexually and not one's sexual orientation that puts them in risk.
Many people have strong religious beliefs about HIV/AIDS, as well as about sex.
One must respect others right to express and discuss their beliefs and feelings.
HIV and AIDS have forced us to look at issues, which we have ignored in the past.
I he important of respect, trust that we reconsider our relationship.

Your Rights

•

•
•
•

It is your right not to become infected. You may insist that your paitncr(s) respect
you. You also need to know that you have the right to say No to sex. Being sure about
your rights enable you to act assertively.
You have the right to full information and education about HIV/AIDS other STDs
and sexual relationship.
You have the right to tested for HIV antibodies , but only after you have given your
informed consent.
If you are infected with 1IIV, you have the right to lead a normal life. You are entitled
to study towards a career and to be employed.

x

I

Design of Health Awareness Session on S I Ds
Time in hours

1/4

1/4

1/2
i

I

1/2
1/2

1/2

______ Top!£______
Understanding
Reproductive
system and
prevalent
gynecological
illnesses common
among women
Knowing common
terms used related to
STDs in the
community_
Give some basic
information about
STDs______
Factors promoting
STDs_____
Prevention of STDs

Developing action
plan to control
STDs at family and
community level

Method
Group Discussion

Material
Apron on digestive
and reproductive
system of woman
and man

Group Discussion

Discussion
Question answer

Pictorial Charts,
Slides showing
through a viewer

Role Play
Discussion
Demonstration on
use of condom
Discussion

Condom

Note for Health Educator

•
•

•

•

•

Prior to discussion on STDs at the community it is important that you read the
module in detail and also the fact sheet.
Start the health education session by a warm welcome. Begin with some general
discussion among the women, by asking them about their family, children etc. This
will help to relax them to learn new things
Ask the women about common illnesses they experience during the year. Once they
start listing ask them to tell you the specific illnesses related to reproductive system.
Also ask them to prioritize the severity of illness, and encourage them give reasons
lor the same. By doing this you will be able to judge their information level related to
STDs.
Ask them to give you various local terms they use for different R I ls. While doing
this you have to keep on asking them the signs and symptoms to know which disease
they arc referring. This will be a very useful information for you for future
communication. Communicating in their own language helps to build up the rapport
and enhance their learning
The group now will be ready to take scientific information related to S I Ds With the
use of pictorial chart in a small group explain the signs, treatment and prevention of

•

16

•

•

the disease. You can also use a simple viewer, to show them slides of S I Ds The
viewer will give them privacy to know about S I Ds. Encourage them to ask questions.
This will help to clarify their doubts
It is important to bring out various factors promoting STDs among woinen. Ask them
to perform a role-play. Once the role-play is over various factors they depicted as a
factors promoting STDs among women. This needs skills, 'fry out with different
group and you will be able to pick up.
At the end do not forget to discuss what they can do at the family and community
level to prevent STDs.

Design of Health Education Session on H1V/A1DS
Time in hours

______ Topic______
Basic Information
on H1V/A1DS
1/2
Knowing various
terminology about
sex and sexual
orientation
1
Socio, cultural
aspects related to
1I1V/A1DS
1
Prevention and
treatment of IIIV
and role of women’s
group
y———————

1/2

Method
Discussion

Material
Fact Sheet 3

Discussion

Hole play

Discussion

Fact Sheet 3

Note for the Trainer
•

Always initiate discussion in AIDS and IIIV/AIDS after discussion on STDs.

•

AIDS is a new topic for the community to learn, so start with basic information, fry
not to make them scared.
The role-play mention in this design is specifically need to be done is particular way.

•

First ask the women to divide in to groups.
After them let them make their families by selecting different characters and their daily
life.
Once they decide about their family ask them to act a onc-day schedule of the family.
After this make one of the family members with HI V infected person and then asks them
to act die behavior of the family members.
You can make different members in different group with HIV infection c.g. in one group
a women of the family, in another the men, in third an adolescent girl and so on. This will
bring out various Socio cultural factors out. Try to pull out the concept and develop
further discussion on it.

•

Always end the educational session by asking them to develop a action plan and role
of women's group in prevention of I IIV/AIDS.

<<
VO VA - W^tr

s

CHETNA

pENDER, SELF ESTEEM AND EMPOWERMENT
. (Draft Chapter for comments and
suggestions (not to be quoted without
permission)

/V

I•

Trainers Note:

Recognising Gender Imbalance in society:
relation between men SdwmeX te^rX’ig^

f01*1’™1 re,ali.ty °f any society

Thc

power in various facets of life, is culturally determined bv Jff
COntr° ’ ,nclusion. exclusion and
to understand the nature of this relationship aTd hXXnS '6 S0C,et,es 11 is "”<>ortant and useful
lives of women and men in order to develop wholesome soc'i^301 r 7° * ? conseclucnccs on Hie
important. In this context, it is necessary to also understand th d n* ' C ’ Va C b°lh sexcs cclual‘y
-”?, as they are sometimes interchangeable by used.
bCtWCCn the t<ir‘ns “«endcr”
. -''and “sex

Sex is .

y. tostart to understand the

... difterences are created by nature and these difference- ■ .
en lhese blo>ogic#il or physical
On the other hand, Gender, means socialSZ-unity.
not created by nature but socially constructed Nature nrodue f ?
T?"16'1' TheSe differences are
men and women, e.g. it is society that makes riles such as a68 a“d.f^nales> society makes them

^ay a^meXTd^on SeTLlG^dX^^

P'ay

'........

reSUk

systems, cultural beliefs and practices education henhlc-'lon’'c structures, law and legal
drectly reflms on women’s eoonomici social, pol'ilical status' *1, isfewer'lltat'i men6'"*''

affect on the womens^self-esteemSoctae ha7>? d 7 T men a"11 less 10 ’ ' society which is
women may directly
uh as household work and childcare is the sole rJShT
a"d rcsP»"siMities
family is a man. This gender division of work and higher stam°t WC‘nan a"d tlle niain earner of the
education, skill trainings, exposures and opportunitie o them ° 'i’0" 7
,csP°nsible for better
articulation, power responsible for high self-esteem In?
a ’7 ’ enllailccs
self-conlldencc
confidence impacting on their mobility articulation sSs 7nd Z; /
*7 women. Women lack
resulting in low self-esteem.
’ an a,lx,cly at family and work place, fear

1

...........

I,

k,

1

CHETNA

1

Present Status of Women: Indian Context
i

Because of the existing inside/outside dichotomy, Governmental policy and society aimed at improving
the condition/position of women has viewed them largely as passive beneficiaries of social services and
anti poverty programs. Hence, they have been targeted for certain outputs only-food, shelter and family
planning. But of late, researchers, women’s activist and governmental have realized that women need
better access to inputs economic education, training and other agents of growth and change. Fact sheet I
gives the present status of women in respect of survival, health status, economic, education, political and
social status as well as violence against women.

Socialization and self-esteem:
Socialization in turn is the process by which society trains its members to accept, and hence play their
. socially; determined roles, and begins from birth. Parents, teachers, peers, religious and cultural
institutions and the media are the main agents through which socialization is accomplished, and gender
differences constructed and sustained. Operating with the patriarchal ideology (of male dominance)
gender indoctrination and discrimination against women begins at birth further depriving their gir’
children of equal nutrition, and health care, denial of education, knowledge, deprival of respectability
and deviance., by discriminating against women in access and/or control over resources and political
power.

2

i

CHETNA

1

.

I

This process can be clearly understand by the following cycle:

Relation between Gender, Self Esteem and Empowerment
I

Gender (Social Construction):

---------------------- -------------------------

>Unequal gender relations among women and men
i
'
4
>In the above relations women have lower social, economic and political status

>Women also suffer from exploitation, oppression, subordination, and violence
' ’A-

> esults in lack of self-confidence, identity lack of dinnitv h. l r ir
articulation and always fearful.
b y’
k ol sel|-‘'"l’ui lance, lack of

----------- - ------------ |

------------------ - -----------------

LOWER SELF ESTEEM

r:Sn ,OleraK

Xkp,“e7nd
considers husband as god, eat last and least lack of nanir’1
etc. sexual harassment at the work-place. ’
P

seXLXXsuppL0™ ri8",S “

“>

nleil.la lol'l^Ie by husband and in-laws,
10 decisions 111 family, political sphere

bC",fc C““““

and as wel!
as support

>Tlns process may help to enhance self-confidence, dignity, and articulation

____

IMPROVEMENT
IN SELF
ESTEEM
---------- ------------ ----•
_
_____------------- --------------------------

>Leads to economic, social and political EMPOWERMENT
;

................

increase in bargaining power and confrontation power
>Towards equal power relations, and resource distribution

_G1

Source: CHETNA

K EQUAL1IY: Social, economic and political spheres

----------------- 1----- -

—

3

CHETNA

Though at present there are not many formal studies and researches available to show the exact imoact \
of gender construttion/relafions on women which gives her less power, resources and opportunities
compared to men leads to lower self esteem. However it is a well known fact thal when a person hWvel
.
front of^
’ CXp0^rC,lack °f developmental opportunities he/she will feel fearful Ind timid in ’'
Situation tIV °nC W1° 135 haV‘ng mOrC confidcnt and Powerful than her/him. And in the present
1
Ih‘S ‘S
,n reS?eCt t0 WOmen' Due t0 the Pafoarchal structure and ideology existing in
family and society, which gives importance and power to men.
'
f wr,

dlscriin‘nated since her birth in respect of love, health and other care and food than bovs
dlSCnr™ated in terms of education and vocational training opportunities not allowed
to go out of homes and loaded with household work, child care results in lower ceir/ct
girls since childhood. Further this process enhances due to iZaZe b"Z
LT*
*“j “ “ m"cl?lower th“ h'r ParenIal h°™: Due to lower status and lack of support fr om the parents
and other sooety members (who are also patriarchal in thinking), a woman is lictim of nl vsic m d

dZ ZoprX±„socie,y She

“,,rro'"

°f»°*

’ ■ ^omenttZV
women plays an important role which
aCh'eVe lh‘S gOal’ emP°werment of*'
resources, and challenge the ideolonv of nat ' n*1 greate| contro1 over material and intellectual
women in all institutions and structureTof society^
b3Sed d'scriminalion against

Since the ideology is the central force perpetuating unjust power structures the process

■ ££°W“Se' ‘nlell'6e”“ and Skil‘S' ”b0Ve a" frOm belie™S i" >«“ iinZtiXo^ign^
1111135 be®n.sho,^n inJhe traininss conducted by CHETNA that if women
get the opportunities to
enhance their self-confidence their self-esteem can also increases.

Women and Health (WAHI) training conducted during 1997 this training
r
supervisors/middle level workers ofNGOs mainlv from r • .
. „ • S, traiIlin8 was for the

months in three phases. EXhasewa™ o’eZ.h Ti T?,

4

’i'"' ™S '"“"S ™s lOT

CHETNA
/

,m ca'm i“"

my family. Due i
consider, myself weak will not
exploitation to like-minded groups
has also increased and now I can
(WAH! Participant 1997).

'--■’""--■^SX^S“““i='”-~

m«a I was even beshaot .oTwitht rn^on a bus" bu! ^,'£,“""’'‘'1“"

the decision-makers in my family, j have di
’ .
decisions. Now my self-confidence^as i^provedandl

'“lk

hes‘7 o^'aS gOne 1 a,n now also OI’e of

J ' resK
women. The self-help methodology of exploration dia<
i 6 Icsearc i &oal is empowerment of
other non-drug therapies. The process also helps to enhancTthe sd?1'?6'11’ Pla')lt
n,edicines
women involved.
.
P
ennance the self-esteem and self-confidence of the

immense knowledge, and thus power, by the medical profeV
11376 bCCn dis‘,(,sscsscd of an
methodology is a means of discovering aspects of us that have b"
Pfatnar^lial s*stcni- Tl* self-help
is a means of coming to terms with wholeness, a means ^reclaiming powe?3016
Cnibarrassmeilt
•

:^un^

^dettl about them own

Now they are even talking about condoms. It Jcertamlv be
workers that have become confident enough to ask theirhit "
begun asking health workers about condoms. (Sholi^NetwoA)

",eir ^ulation day.
" C(>"'rih",io'1 <>f our health

?ut due to fear, lack of'^opXndio“"ndU conX« reLlte“i™”C'' ''tf

“ ™ "CVCr

started f„ wome„ m.y mpPve her ’,'’°UBh “O"Omic
effons are needed lo enhance awareness ,o control own i„S . a
However
achieve organizing women through this process/strateav w
d demand lor own r'ghts, this may
self-esteem and support each other. So their barcaininelowv"1^! iT
eaCh °ther t0 enhance
discrimination, exploitation, subordination and^o sP?ead an lt0U d| enhanced t0 confront violence,
equality, respect, love, understanding, caring for each other l.,lip einc,lt ,tlie
values such as
famihes, work-place and society
8
lllcl1 ‘"ay ,Cild 10 healthy and happy

5

hl !l| II I n

lllhllllllllll I

I I

111 lUWBJiBJMJBBIIIIIIHMIHUaKilMII

—X-

CHETNA

X •

•

Empowerment and Women’s Empowerment:

\

Empowerment may be defined as the process and the result of the process-whcrcby the powerless
or less powerful members of a society gain greater access and control over malci ial and knowledge
resources, and challenge the ideologies of discrimination and subordination which justify this unequal
distribution. Empowerment manifests as a changing balance of power in terms of resource distribution
and changes in ideology, or ways of thinking.
’

Women’s Empowerment is the process by which women gain greater control over material and
intellectual resources, and challenge the ideology of patriarchy and the gender-based discrimination
against women in all institutions and structures of society. Empowerment, therefore, is a process aimed
at changing the nature and direction of systematic forces, which marginalise women and other
disadvantaged sections in a given context.

The goal of empowerment is to:
Challenge and transform the ideology and practice of women’s subordination.
_rans orm the structures, systems and institutions which have upheld and reinforced this discrimination
such as the family, caste, class, ethnicity, and the social, economic and political structures and
institutions including religion, education systems, the media, the law, top-down development models
aC“sses and contro1 over material and knowledge resources.The process of empowerment
.. therefore is all-embracing,,because it must address all structures of
.Power.

Strategies of Empowerment

•

Work with the poorest and most oppressed women within a selected geo-political region.
mn^Hi^lp5157?1131186 ^8entS’ lWh°
Sender-aware and Politically conscious to interact with
mobilise, learn from and raise the consciousness of women.
Create a separate “time and space” for women to be together as women-rather than as beneficiaries

to!v7lfa^e/de''elopmen, kernes. These foru„,s should euehle v,ome„T tai"
•

’

Begin with women’s own experiences and realities: Promote self-recognition and positive self
'Ser StimU 316 Cnt‘Cal thinkin8> deepen their understanding of the structure of power, includin
,"em wi,h

capabilil,K 10 aco'ss

• wXJSX ide"''fy and prioriti“ ,ssues tl’“‘afrecl lhcir ,iv“ror
’

•»

Enable women to formulate their own vision of an alternative society, including alternate models of
social and economic relations and alternate development paradigms.
^rndnvhen rVO,nen t0 indePendenlly and interdependently struggle for change in: Material

epnthuens Qf existence, personal lives and treatment in the public sphere.
•

Facilitate the formation of women’s mass organisations at local, regional, national and international
levels in order to bring about changes in the structures that undermine women’s status.

6

s.

CHETNA

f

Training Module on Gender, selfesteem and En.powennent
Participants: Women involved in i------■ncome generation activities and other poor wo.nen’s groups.
No of participants: 20-25
Objectives of the module:
• To understand the meaning of gender, self-esteem and empowerment
•

To uodeX “he

“I «

°r^Po»eme„l io improve seito.ecm .awards gender

equality

Time

'0W-Self

• 12 Hours

Method

■ Own life experiences, participatory

Teaching aids:
Overhead projector, Tr„spare„cies, Booto: Wha. is a Giri, W„a. is a Boy,

I opics to be covered:
-p±mS^

Reasons oUow se.p.es.eum, S.ra.^ „r

‘ Process

^iVBaXtn^^XSZu^hT
** Questiontobeasked:

-

™.m.es ,o each women .0 reea!, .he ineidem and .0 prepare

.he ...ieu,..^^,.

One by one ask the women about their fi
. .
rst experience in their life when
Aller having sharing of first L,.
lhey realised they arc women
incidence, if women want to share
respect. Allow some time for the
more experiences of their life in this
-J same. I ake out the elements from
hieir experiences such as:

7

CHETNA
I Yas 0 years °^’ 1 carne bnck at home at evening after playing with friends (it was little bit
dark due to winter) my father was very angry and he said 1 should not now move out of home much
and should not play with boys. However such restrictions were never put on my brother:
Restrictions on women’s mobility and play.
In this way many such points will come such as:
Discrimination against girls in food distribution, clothes, play, -health care, love, exploitation
subordination, oppression, violence, no control over resources, lack of inheritance or property rights no
inXk’ S^llty’w|omen’s body, etc. restricitions on talk, behaviour, roles-responsibilites
practices, attitudes, lack of educational opportunities for girls, burden of household work on women
and young girls, sexual harassment, wile battering, mental torture by brother, father, husband, motherin law etc.
'

Losm«,omily’work place'society-schoo,s'a,,<l |,u“c ',k'“s
Ask the group whether such incidences are regular part of their life and how they inlluences/alfect on
their life.
s.

Following may be the responses
Fear, mental tension, lack of confidence, lack of articulation and bargaining power, dependenev on
men, no information of laws and other life useful information such as regarding health, politics etc

.

Ask the group whether above feeling/ qualities affects on self-esteem
The answer may be ‘Yes’ if not trainer should facilitate the discussion by giving examples such as due
'°W s® f n X wome?never Question and feel it her duty to serve everyone and eat last and least
not bothered whether anything left for her. She never question the sex by husband against her wish and
w^Th^h116 tiat’ When(7er her husband asked for sex il is her duty to provide him according to his
what’JX8 WOmehn X the m°ne< from Pr°ductive work they don’t think that they have decision
SonX bX iiWe
ii
d aSked She 8ive k t0 him even sonie time she refuses to give
due tolack of power
d°
C°nfrOnt duC t0 loW-Sclf est"c,n

Next question could be asked Why women have such a low-dignity and low self.
Trainer should facilitate the gender and gender relations of women and men responsible for lower
status of women in family, work-place and society which is directly affect on her dignity and self
esteem adversely.
The next session could be on
empowerment strategies to enhance women’s confidence and ultimately
to enhance her self-esteem.

8

CHETNA

References a nd Bibliography
ginning to change...Gender Relations in India ^ujarat,
Rajasthan) 1998
(Gujarat, Rajasthan)

’ wZrds Br.'r G,“der

Eiiccti,en'ss °f Ge,,<ier

en and Health Training Programme. C1LETNA 1997

■'a nnws

• Convendon „„ :he E1,m,Mtlon of all f„ms of DiscrimiMion

. mZ d

by NG°S Anic,e 12: Hca,,l‘ c“re

-y C Jna ,,7 . An

Making Development Gender Sensitive : A guide for Train
u ,
Entrpreneurslnp & Career Development, 1, Tapovan Society, nLCTT T
<asta’ Satellite

Road, Ahmedabad-380015, 1996

•

Touch me, Touch-me-not, Women, Plants and Healing Shodhini Kali f
W01'lei1’ B1/8 Hauz

Khas, New Delhi 110016 1996
■

................... ............................

Delhi, 1996

•

Y CHL1NA organised by PR1A, New

•

Women’s Empowerment in South Ada •

.

Development of Adolescents CH£TNA’sPe,Spcctive, 1998

4

9

CUETNA

c^wC«i.oii/training material
•

The Oxfam Gender Training Manual, Published by Oxfam (U.K. ftnd Ireland) 274 Banbury Koah,
Oxford
OX27DZ, UK. 1991
I

What is a girl? What is a boy? Kainala Bhasin, Jagori, C-54, South Extension, Phase II, New Delhi-

110049. Available in Hindi and English. 1997
Posters on violence and song books on women’s empowerment by Jagori 1998.

• Beginning to change... Gender Relation in India (Gujarat, Rajasthan) : Towards Beller Gender
Understanding Effectiveness of Gender Sensitivity Training of CHETNA’s Women’s Training
Programme, CHETNA. 1997

•

Status of Women and Men in fndia, Gujarat and Rajasthan : A paper prepared for the Gender

Training organised by CHETNA, FAO and SWDF. 1995

’ XnAGXcr Se”si,izali0"Traini"8 ofWAHI p““pa,“! “d|;a""'y Mc",bcrs’ aubm :
Suggested Reading Material
All alternate report by NGOs on Convention on the Elimination of all forms

Against Women : Article 12 : Health Care Services available at CHETNA 1994
9

of Discrimination

women’s Empowerment in South Asia : Concepls and Practices by Sriiatha Balliwaia Copies
available . FAO-NGO South Asia Programme 55, Max Mueller Marg, New Delhi.! 10003 !994

What .s Patriarchy? Ms. Kamalal Bhasin. Kali for Women Bl/S Hana Khas, New Deihi. 1,0016.
Touch me, Touch-me-not, Women, Plants and Healing, Shodhini, Kali for Women,
Bl/8 Hauz

Khas, New Delhi.110016. 1997

io

ILLI. Ill'

Cl I ETNA

Fact Sheet -1
Sex & Gender
Defination of Sex: The biological or physical construction is called sex. The biological or physical

differences are created by nature, and these differences are the same in every family, community or
country. Thus, biologically a girl / woman is the same anywhere in the world.

Gender: Social and cultural defination of men and women are called gender, for example, it is
society that makes rules such as-a girl will stay within the house while a boy can go out or that a girl

will be given less food to eat and less time to play than a boy, that a boy will be sent to a private school
so that when he grows up, he can look after the family business or get a good job, while not much

attenuon will be paid to a girl’s education, etc. These gender differences have not been created by

nature. Nature produces males and females, society turns them into men and women, feminine and
masculine. (What is a Girl? What is a boy? Ms. Kamala Bhasin, December 1997)

Gender impact on differentiate in Ibehaviour,
‘ '
roles-responsibilities, qualities, mobility, control over
production work, reproduction, sexuality,
*»

discriminatory for women / girls.

even language, jobs, opportunities, values those are

Self-esteem: The differntiate/ discriminatory
-y

roles & responsibilities, behaviour, opportunities,

qualities, attitudes, low decision making power to women reflects on her confidence, identity, selfimportance, self-respect, dignity, courage which mayialled self-esteem. (CllETNA Team)

I

11

CHEINA

Fact Sheet - II

Social Sphere: Social Status
Though there is not much qualitative data available on this aspect, Ihis is an
important factor, which
reflects on the economic, educational, health and political status of women. Male members make ms

decans wilhin the fami.y. Tlus power is a.so passed down to .he e.des. so,

Uro fo„o„i,,g

Customs and religious beliefs give the r------* •
necessary social sanctions to such practices. Infact history had set
the stage for her secondary status in the society, which reflects i
in every sphere of women’s lives. “When
young she depends on her father, aller marriage on her husband and i
--------in old age on her son”. (“Manu
smruti Code of Conduct year).
'v

Women do not have decision-making power in their
own work within the household and outside. She
also does not have reproductive decisions. I
In many societies, women do not have freedom to decide how
many children they want, when and whether
to have them, whether they can use contraception or
terminate a pregnancy etc. Sexuality is another i—
important area in regard of lack of decision making,
Women are obliged to provide sexual services to men
according to their needs and desires and not
expected to initiate sex. Most women do not decide for
themselves when, to whom, and whether they
want to marry. The imposition of purduh, restrictions on
leaving the domestic space, a strict separation
of private and public limits. Men controls most
property and other productive resources and they pass
from one man to another, usually from father to
S°n- Even where wom
en have the legal right to inherit
women
such assets, a whole array of customary practices emotional pressure, socia! sanctions and sometimes
i
violence. !

■ Sex Rafo: The sex redo is defined as the number of women for

every 1000 men in population. In any
society, under normal circumstances, there are more women than
men at any given point of time due to
bmlofacal factors, however in India the sex ratio is in favour of men
Wo have only 929 women against
1000 men. It means 71 women are missing per thousand
men. Further to note that in India sex ratio has
continuously declined since 1901 from 972 to 929
as per census in 1991
12

C11ETNA

Nutnhon and Health: 1. is noted that in India more deaths occur among females than males

between the age of 0-9 years. Death rales among females are somewhat higher llian males in the age of
group of 15 to 29 years. These higher death rales could be due to maternal mortality. The iron intake of
Strls ts about half than the recommended allowance especially in adolescent age, the condition worsen

due to further losses because of menstruation.
Maternal mortality accounts for ! 2,5% of deaths among rural women, between ages ,5-45. The ma.ern.l

mortality rate is about 50 times that In developed eoomries. The risk of an Mian woman dying from a
maternity related cause is about 200 limes greater. 60 to 70% of pregnant women .re a„emic with

hemoglobin levels less than 10 gm. This pattern of high female mortality is also inversely related to
j women s soc.al and economic value: the cultural preference for sons results in a bias against daughters

w .ch ■„ mamfest in them neglect and their consequent higher mortality in clnldhood During
a olescence and early adulthood, the multiple burden of reproduction, social reproduction domestic

wor

and products labour placed on women results in their lower smyival. Women’s survival

”mT0” r6" “,ey PaSS

rePrOdUCtiVe Slaee’ a"d ',aVe "iBhCr

Educahon; Dcsp,tc matkcd

oyer

»

less than half the rate for nrral maies. Female’s lileraey rates falls below > 0-/. in 136 of Mia’s 386 rural

Mdl'ra PradeS"' ““■ M"dl’ya Prad“11’

/T h^T i0

Utlar Pradesh, which together, contain half of India’s

women. Female literacy is aiso

OW among scheduled castes (») and tribal poptdations (7%). Almost 60%- or 500 mUlion- „f
India s non-literate are girls or women.

Marnage: Due to lack of decision making power and choices in own i.fe, the iirst change on Her life
seems to bo marnage. The practice of early child marriage also continues in some states of India

vorage reported age of marriage for girl is 18.7 years compared to boys which is 23 4 years Ths
median ago at marnage m India is >6 years, 14 % of all girls aged ,3-19 are married footy marriage
pregnancies and motherhood resuh in acute heal,I, risks leading io mate,mil and
There have been efforts to eo-relate female lheracy
the
ago a.
,iago. child

13

dca„ls'

CHETNA

estimates and fertility rates. For example, in rural areas
i r
rr-nl
r
• i
r
oieas „ /„.y
propoitiun ol married women are
non-literate as compared to urban areas.
Adolescents: The onset of puberty produces . great deal of anxiety and questions in the ntinds of

young unprepared adolescents who are unsure of why the changes related to sexual deeelopntent occur
and do not know whom to approach for information. The practice of sinn ing of
w|m„

approach for tnfornratton. The practice of sharing of information related to puberity and associated
cliimgcn about xcx "nd sexm.l be,,,.,, |, . ........ .
............
............. ....... .. ............
gtris. 50. /. of adolescents, aged U-.5 years and residing In nrntl and urban slum areas, do know about
menstruatron um.l ns onset. Tins unawareness results in low-self imago and ultimately low-self esteem

omen and Vtolence: Violence agatnst girls and women is pervasive among all social classes and
castes tn Indta, touebmg them at every stage ofhfe. Violence against women is rooted in the badition
d sertmtnauon that has been going on foe centur.es. Rape, sexual harass.,,ent, murder, dowry deaths sati

physical and psyeitoiogieaf abuse, fema,e feotie.de and .nfauuu.du are among the nutrnel

f

vtolence against females that are increasingly being reported in India.

The Government of India’s Department of

statistically. During 1991 there was :

•

One rape very 54 minutes

•

One molestation every 26 minutes.

women and child welfare has reported the problem

One kidnapping/abduction every 43 minutes.
.•

One act of eve teasing every 51 minutes

•

One Dowry death every one hour 42 minutes.

•

One act of cruelty every 3 3 minutes.

One criminal offence against women every 7 minutes.
(The policy Unit Action Aid, India May, 1994)

14

CI1ETNA

Economic Sphere:
Employment: A much larger po„i„„ of d,c female pOpu,alio„ is ||m in
in the conventional labour force,
It accounts for 34% of rhe women in the conventional labour force Men
aie concentrated in the market

ZmfmX"’r 7"““™ °fWOrk “nd . ........ S1’'iai<:a"y

....

60/. ofthe unpard famdy workers, and 98% of those engaged in domestic work

According of UN statistics : Women perform 67% of the

world’s working houi

the world’s property. Opportunities to employ women at the higher level

side. They

s, women earn 10% of

are less due to lack of technical

tiaining s, exposure and opportunities.

Women tn Agriculture: Agriculture accounts for 37% of India's Gross National Product and
' woZ anTaboutZ

!ta'

1

ana aoout 44/0 ofthe agricultural wageworkers in India 61°/
« The past two. decades have seen a dramatic bZ

n
are

agricultural

Although, almost all rural women are involved to some

.

■

-r invevement vaHes wide, and is stronj “Z (T
background of their household Th
domestic sphere).

"

economic status and caste and ethnic
™ "■e -inside" (i e.

*

iZ'tp'Zem’Z're‘‘Z"r50% Or,"C POPUtaiO" "Ol
political philosophy that coZs Zen^X'^ZsZZ^thrXt's'her1’11

wXzxXmZZ^i'z:dwopub,ic r “ “
play as an exclusive "male domain" whTmaLuTnZ ’

>

........................... —.....

15

C0"ra"'0,,a' "0#M °f

“

a'“l

■>

VA -16-6
CHETNA

GENDER, SELF ESTEEM AND EMPOWERMENT
(Draft Chapter for comments and suggestions (not to be quoted without
permission)
Trainers Note:

Recognising Gender Imbalance in society:
Women and men together constitute the social, economic and political reality of any society. The
relation between men and women in terms of rights, duties, status, control, inclusion, exclusion and
power in various facets of life, is culturally determined by different societies. It is important and useful
to understand the nature of this relationship and its differential impact as well as consequences on the
lives of women and men in order to develop wholesome societies which value both sexes equally
important. In this context, it is necessary to also understand the difference between the terms “gender”
and “sex”, as they are sometimes interchangeable by used.

Let us start to understand the meaning and differences between sex and gender. Sex is a biological
physical and physiological difference between men and women. These biological or physical
differences are created by nature, and these differences exist in every family, community or country
On the other hand. Gender, means social cultural definition of men and women. These differences are
not created by nature but socially constructed. Nature produces males and females, society makes them
men and women, e.g. it is society that makes rules such as a woman is solely responsible of household
work whereas men should go out of the house to earn or boys can play physical games and girls should
stay at home. (For detail|on Sex and Gender see Fact Sheet No. 1).
These differences/imbalances are partly through socialization which result in discrimination in the
various institutions and structures of society (religion, media, economic structures, law and legal
systems, cultural beliefs and practices, education, health care etc). The result of this gender inequality
directly reflects on women s economic, social, political status, which is lower than men.

At present, gender relations among women and men are unequal and the Indian society which is
patriarchal in nature, gives more importance and higher status to men and less to women may directly
affect on the women s self-esteem. Society has also defined men and women’s roles and responsibilities
such as household work and childcare is the sole responsibility of woman and the main earner of the
family is a man. This gender division of work and higher status to men is also responsible for better
education, skill trainings, exposures and opportunities to them which enhances their self-confidence
articulation, power responsible for high self-esteem and is adversely true for women Women lack
r“ul'ti„e8n“
n”l”",V’ ar,iC',la"°n Ski"S- a"d a,“iCly
la,"ilV and

i

CHETNA

Present Status of Women: Indian Context
Because of the existing inside/outside dichotomy, Governmental policy and society aimed at improving
the condition/position of women has viewed them largely as passive beneficiaries of social services and
anti poverty programs. Hence, they have been targeted for certain outputs only-food, shelter and family
planning. But of late, researchers, women s activist and governmental have realized that women need
better access to inputs economic education, training and other agents of growth and change. Fact sheet 1
gives the present status of women in respect of survival, health status, economic, education, political and
social status as well as violence against women.

Socialization and self-esteem:
Socialization in turn is the process by which society trains its members to accept, and hence play their
socially determined roles, and begins from birth. Parents, teachers, peers, religious and cultural
institutions and the media are the main agents through which socialization is accomplished, and gend
differences constructed and sustained. Operating with the patriarchal ideology (of male dominance;,
gender indoctrination and discrimination against women begins at birth further depriving their girl
children of equal nutrition, and health care, denial of education, knowledge, deprival of respectability
and deviance..... , by discriminating against women in access and/or control over resources and political
power.

2

CHEINA

This process can be clearly understand by the following cycle:
Relation between Gender, Self Esteem and Empowerment

Gender (Social Construction):
>Unequal gender relations among women and men

>In the above relations women have lower social, economic and political status
Jr
>Due to lower status of women get less opportunities, exposure, education, dependency on men, lack
of mobility, discrimination in food, love, health care, clothes, attitudes, behaviour, practices, values etc

4>Women also suffer from exploitation, oppression, subordination, and violence

I
>Results in lack of self-confidence, identity, lack of dignity, lack of self-importance
articulation and always fearful.
.

LOWER SELF ESTEEM

I

lack of

'

>Due to lower self-esteem lack of decision-making capacities, women tolerate violence at family,
workplace and society. Such as beating by husband and mental torture by husband and in-laws’
considers husband as god, eat last and least, lack of participation in decisions in family political sphere
etc. sexual harassment at the work-place

>Women need awareness of own rights as human being, economic activities and as well as support
services and emotional support.
r
>This process may help to enhance self-confidence, dignity, and articulation
IMPROVEMENT IN SELF ESTEEM
>Leads to economic, social and political EMPOWERMENT

>Increase in bargaining power and confrontation power

>Towards equal power relations, and resource distribution
GENDER EQUALITY: Social, economic and political spheres
Source: CH ETNA

3

CHETNA

1 hough at present there arc not many formal studies and researches available to show the exact impact
of gender construction/relations on women which gives her less power, resources and opportunities
compared to men leads to lower self esteem. However it is a well known fact that when a person have)
less education, exposure, and lack of developmental opportunities he/she will feel fearful and timid in
front of any one who has having more confident and powerful than her/him. And in the present
situation, this is very true in respect to women. Due to the patriarchal structure and ideology existing in
family and society, which gives importance and power to men.
Girls are discriminated since her birth in respect of love, health and other care, and food than boys.
Further they are discriminated in terms of education and vocational training opportunities, not allowed
to go out of homes and loaded with household work, child care, results in lower self esteem among
girls since childhood. Further this process enhances due to her marriage because her status in in-laws
house is much lower than her parental home. Due to lower status and lack of support from the parents
and other society members (who are also patriarchal in thinking), a woman is victim of physical and
mental violence at family, work place and in society. She cannot confront violence, overburden of work
and responsibilities due to lack of self-esteem.

From the above discussion the most conspicuous feature is Power’. Unequal power relations among
women and men should lead for the equal power relations. To achieve this goal, empowerment of
women plays an important role, which means gain greater control over material and intellectual
resources, and challenge'the ideology of patriarchy, and the gender based discrimination against
women in all institutions and structures of society.
Since the ideology is the central force perpetuating unjust power structures, the process
o-Of women s empowerment begins in the mind, by changing women’s consciousness: from her very
beliefs about herself and her rights, capacities, and potential, from her self-image and awareness of how
gender as well as other socio-econmic and political forces are acting on her, from her breaking free of
t the sense of inferiority which has affected her since early childhood, from recognizing her strengths,
her knowledge, intelligence and skills, above all from believing in her innate right to dignity and
justice.
It has been shown in the trainings conducted by CHETNA that if women get the opportunities
enhance their self-confidence their self-esteem can also increases.

Women and Health (WAH!) training conducted during 1997, this training was for the
supervisors/middle level workers of NGOs mainly from Gujarat and Rajasthan. This training was for
three months in three phases. Each phase was of one month each. In this training, 28 women and 5 men
participated. Since the training was from a gender perspective, it was thought worthwhile to see the
impact of training on their confidence and self-esteem.

Perhaps the greatest success of WAH! was in building the female participants confidence to make
changes in their personal and professional lives. Some of the participants expressed that;

4

CI I ETNA

‘‘Writing, thinking and speaking skills I had in my body since the beginning, but they never came out.
When 1 had gone through the gender module, I really gained courage to speak and came to know that
the difference between women and men is only due to sex and women can do everything that a man can
do. I realized that though 1 am doing so much work nobody values my work and gives respect to me in
my family. Due to gender understanding, a new light came in my mind and 1 have decided 1 will not
consider myself weak will not be afraid of my husband, 1 will speak about my subordination and
exploitation to like-minded groups and people. And definitely I will get support from them. My courage
has also increased and now I can talk in front of even 500 people. ”
(WAH! Participant 1997).

Another participant said “ Before the gender training, 1 was not confident and was hesitant to talk to
men. I was even hesitant to sit with a man on a bus, but that hesitation has gone. 1 am now also one of
the decision-makers in my family. I have discussed with my family that everyone in the family
decisions. Now my self-confidence has improved and I do not fear to go out alone.
Another example of Shodhini’s experience. Shodhini is a network of women’s health activists from
different parts of India who are committed to understand the care of our own bodies and to discover the
efficiency of traditional herbal remedies. A feminist framework and the related critique of modes of
research and inquiry have informed the Shodhini experiment. The research goal is empowerment of
women. The self-help methodology of exploration, diagnosis and treatment, plant based medicines and
other non-drug therapies. The process also helps to enhance the self-esteem and self-confidence of the
women involved.
. .. .
The self-help movement grew out of women’s realization that we have been dispossessed of an
immense knowledge, and thus power, by the medical profession in a patriarchal system. The self-help
methodology is a means of discovering aspects of us that have been in fear, shame and embarrassment.
It is a means of coming to terms with wholeness, a means of reclaiming power.

_ After self-help groups were formed, we found our health workers became confident about their own
bodies. AU our health workers understand the rhythm method and can recognise their ovulation day.
Now they are even talking about condoms. It is certainly because of the contribution of our health
workers that have become confident enough to ask their husbands to use condoms. Even men have
begun asking health workers about condoms. (Shodhini Network)
From the above examples one can conclude that though these women had potential it was never came
out due to fear, lack of opportunities and confidence resulted in low- self esteem. However when they
got the opportunity and exposure to build their self-confidence and courage, their latent skills and
creativity came out with full potential. Therefore it can be concluded that though economic activities
started for women may improve her self-esteem automatically to some extent. However conscious
efforts are needed to enhance awareness to control own income and demand for own rights, this may
achieve organizing women through this process/strategy women can support each other to enhance
self-esteem and support each other. So their bargaining power could be enhanced to confront violence
discrimination, exploitation, subordination and to spread and implement the human values such as
equality, respect, love, understanding, caring for each other which may lead to healthy and happy
families, work-place and society.

5

CHETNA

Empowerment and Women’s Empowerment:
Empowerment may be defined as the process and the result of the process-whereby the powerless
or less powerful members of a society gain greater access and control over material and knowledge
resources, and challenge the ideologies of discrimination and subordination which justify this unequal
distribution. Empowerment manifests as a changing balance of power in terms of resource distribution,
and changes in ideology, or ways of thinking.
Women’s Empowerment, is the process by which women gain greater control over material and
intellectual resources, and challenge the ideology of patriarchy and the gender-based discrimination
against women in all institutions and structures of society. Empowerment, therefore, is a process aimed
at changing the nature and direction of systematic forces, which marginalise women and other
disadvantaged sections in a given context.

The goal of empowerment is to:
Challenge and transform the ideology and practice of women’s subordination.
Transform the structures, systems and institutions which have upheld and reinforced this discrimination
- such as the family, caste, class, ethnicity, and the social, economic and political structures and
institutions including religion, education systems, the media, the law, top-down development models,
etc. Gain accesses and control over material and knowledge resources.The process of empowerment
therefore is all-embracing, because it must address all structures of
Power.

Strategies of Empowerment
•
•
•

•

•
•
•
•

®

Work with the poorest and most oppressed women within a selected geo-political region.
Train activists/change agents, who are gender-aware and politically conscious to interact with,
mobilise, learn from and raise the consciousness of women.
Create a separate ‘time and space” for women to be together as women-rather than as beneficiaries
or recipients of welfare/development schemes. These forums should enable women to form a
cohesive collective.
Begin with women’s own experiences and realities: Promote self-recognition and positive sek
image, stimulate critical thinking, deepen their understanding of the structure of power, including
gender.
Expand women’s horizons by equipping them with the capabilities to access more information
knowledge and skills on their own.
Enable women to identify and prioritise issues that affect their lives for action, and to make
informed decisions.
Enable women to formulate their own vision of an alternative society, including alternate models of
social and economic relations and alternate development paradigms.
Strengthen women to independently and interdependently struggle for change in: Material
conditions of existence, personal lives and treatment in the public sphere.
Facilitate the formation of women’s mass organisations at local, regional, national and international
levels in order to bring about changes in the structures that undermine women’s status.

6

f:

ah

CHETNA

!

Training Module on Gender, self esteem and Empowerment
Participants: Women involved in income generation activities and other poor women’s groups.

No of participants: 20-25
Objectives of the module:
• To understand the meaning of gender, self-esteem and empowerment
• To derive and understand the reasons of own low-self esteem and its impact
• To understand the meaning and strategies of empowerment to improve self-esteem towards gender
equality
I
Time
: 12 Hours

Method

: Own life experiences, participatory

Teaching aids:
Overhead projector, Transparencies, Booklet. What is a Girl? What is a Boy?

Topics to be covered:
Meaning of self-esteem, gender and empowerment Reasons of low self-esteem. Strategies of
empowerment to improve self esteem

Process
After the initial introduction of their name, knowing personal and professional
Background the question should be asked to start module.

Questiontobeasked:
When did you realise in your life that you are a woman? Give some example/experience ofyour life.
orah 1015 minUteS t0 e3Ch W°men t0 reCa11 thC ’ncident and t0 PrePare for the articulation/presentation

One by one ask the women about their first experience in their life when they realised they are women.
After having sharing of first incidence, if women want to share more experiences of their life in this
respect. Allow some time for the same. Take out the elements from their experiences such as:

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CHETNA
When I was 10 years old, 1 came back at home at evening after playing with friends (it was little bit
dark due to winter) my father was very angry and he said I should not now move out of home much
and should not play with boys. However such restrictions were never put on my brother:

Restrictions on women’s mobility and play.

In this way many such points will come such as:
Discrimination against girls in food distribution, clothes, play, health care, love, exploitation,
subordination, oppression, violence, no control over resources, lack of inheritance or property rights, no
decision in work, sexuality,women’s body, etc. restricitions on talk, behaviour, roles-responsibilites,
practices, attitudes, lack of educational opportunities for girls, burden of household work on women
and young girls, sexual harassment, wife battering, mental torture by brother, father, husband, mother
in law etc.
These examples will come ffrom family, work place, society, schools, and public places such as road.
bus stop, travelling in train bus etc.
Ask the group whether such incidences are regular part of their life and how they influences/affect on
their life.

Following may be the responses
Fear, mental tension, lack of confidence, lack of articulation and bargaining power, dependency on
men, no information of laws and other life useful information such as regarding health, politics etc.

Ask the group whether above feeling/ qualities affects on self-esteem.
The answer may be ‘Yes’ if not trainer should facilitate the discussion by giving examples such as due
to low self esteem, women never question and feel it her duty to serve everyone and eat last and least
not bothered whether anything left for her. She never question the sex by husband against her wish and
take it in routine that, whenever her husband asked for sex it is her duty to provide him according to his
wish. Though women earn the money from productive work they don’t think that they have decision
what to that money but whenever husband asked she give it to him even some time she refuses to giv''
this money husband will beat her and take away money and she do not confront due to low-self cstcci..
due to lack of power.

Next question could be asked Why women have such a low-dignity and low self.
Trainer should facilitate the gender and gender relations of women and men responsible for lower
status of women in family, work-place and society which is directly affect on her dignity and selfesteem adversely.
The next session could be on empowerment strategies to enhance women’s confidence and ultimately
to enhance her self-esteem.

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References and Bibliography
•

Beginning to change... Gender Relations in India (Gujarat, Rajasthan) 1998

•

Towards Better Gender Understanding Effectiveness of Gender Sensitive Training of CHETNA’s

Women and Health Training Programme. CHETNA 1997
•

Convention on the Elimination of all forms of Discrimination Against Women (CEADAW). An

alternative Report by NGOs Article 12 : Health Care services. Compiled by CHETNA, 1995

•

Making Development Gendei Sensitive

A guide for 1 rainers by International centre for

Entrpreneurship & Career Development, 1, Tapovan Society, Nehrunagar, Char Rasta, Satellite
Road, Ahmedabad-380015, 1996

•

Touch me. Touch-me-not, Women, Plants and Healing, Shodhini, Kali for women, B1/8 Hauz

Khas, New Delhi 110016, 1996

•

Women’s Status in South Asia - With Special Reference to India, Bangladesh and Nepal

Paper

Prepared for the Development Management Programme by CHETNA organised by PRIA, New

Delhi, 1996

•

Women’s Empowerment in South Asia : Concepts and Practices by Srilatha Batliwala, March

1994, FAO-NGO South Asia Programme 55, Max Mueller Marg, New Delhi-1 10003.

•

Health, Education and Development of Adolescents CHETNA’s Perspective, 1998

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Suggested education/training material
•

The Oxfam Gender Training Manual, Published by Oxfam (U.K. and Ireland) 274 Banbury Road,

Oxford OX27DZ, UK. 1991
•

What is a girl? What is a boy? Kamala Bhasin, Jagori, C-54, South Extension, Phase II, New Delhi110049. Available in Hindi and English. 1997

•

Posters on violence and song books on women’s empowerment by Jagori 1998.

•

Beginning to change... Gender Relation in India (Gujarat, Rajasthan) : Towards Better Gender
Understanding Effectiveness of Gender Sensitivity Training of CHETNA’s Women’s Training

Programme, CHETNA. 1997

•

Status of Women and Men in India, Gujarat and Rajasthan : A paper prepared for the Gender

Training organised by CHETNA, FAO and SWDF. 1995

•

A report: Gender Sensitization Training of WAH! participants and their Family Members, August :

CHETNA. 1998

Suggested Reading Material
An alternate report by NGOs on Convention on the Elimination of all forms of Discrimination
Against Women : Article 12 : Health Care Services available at CHETNA. 1994

Women’s Empowerment in South Asia : Concepts and Practices by Srilatha Batliwala Copies

available : FAO-NGO South Asia Programme 55, Max Mueller Marg, New Delhi-110003. 1994
What is Patriarchy? Ms. Kamalal Bhasin, Kali for Women Bl/8 Hauz Khas, New Delhi. 110016
1990

Touch me, Touch-me-not, Women, Plants and Healing, Shodhini, Kali for Women, Bl/8 Hauz
Khas, New Delhi. 110016. 1997

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Fact Sheet -1
Sex & Gender
Defination of Sex: The biological or physical construction is called sex. The biological or physical

differences are created by nature, and these differences are the same in every family, community or

country. Thus, biologically a girl / woman is the same anywhere in the world

Gender: Social and cultural defination of men and women are called gender. For example, it is

society that makes rules such as-a girl will stay within the house while a boy can go out, or that a girl

will be given less food to eat and less time to play than a boy, that a boy will be sent to a private school
so that when he grows up, he can look after the family business or get a good job, while not much

attention will be paid to a girl’s education, etc. These gender differences have not been created by
nature. Nature produces males and females, society turns them into men and women, feminine and
masculine. (What is a Girl? What is a boy? Ms. Kamala Bhasin, December 1997)

Gender impact on differentiate in behaviour, roles-responsibilities, qualities, mobility, control over

production work, reproduction, sexuality, even language, jobs, opportunities, values those are
discriminatory for women / girls.

Self-esteem: The differntiate/ discriminatory

roles & responsibilities, behaviour, opportunities,

qualities, attitudes, low decision making power to women reflects on her confidence, identity, self
importance, self-respect, dignity, courage which may'called self-esteem. (CHETNA Team)

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Fact Sheet - II

Social Sphere: Social Status
Though there is not much qualitative data available on this aspect, this is an important factor, which
reflects on the economic, educational, health and political status of women. Male members make major

decisions within the family. This power is also passed down to the eldest son in the following generation.

Customs and religious beliefs give the necessary social sanctions to such practices. Infact history had set
the stage for her secondary status in the society, which reflects in every sphere of women’s lives. “W
young she depends on her father, after marriage on her husband and in old age on her son”. (“Manu

smruti” Code of Conduct year).

Women do not have decision making power in their own work within the household and outside. She

also does not have reproductive decisions. In many societies, women do not have freedom to decide how

many children they want, when and whether to have them, whether they can use contraception or
terminate a pregnancy etc. Sexuality is another important area in regard of lack of decision making.

Women are obliged to provide sexual services to men according to their needs and desires and not

expected to initiate sex. Most women do not decide for themselves when, to whom, and whether they

want to marry. The imposition of purduh, restrictions on leaving the domestic space, a strict separation

of private and public limits. Men controls most property and other productive resources and they p s

from one man to another, usually from father to son. Even where women have the legal right to inherit
such assets, a whole array of customary practices emotional pressure, social sanctions and sometimes

violence.

Sex Ratio: The sex ratio is defined as the number of women for every 1000 men in population. In any

society, under normal circumstances, there are more women than men at any given point of time due to
biological factors, however in India the sex ratio is in favour of men We have only 929 women against

1000 men. It means 71 women are missing per thousand men. Further to note that in India sex ratio has

continuously declined since 1901 from 972 to 929 as per census in 1991.

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Nutrition and Health: It is noted that in India more deaths occur among females than males
between the age of 0-9 years. Death rates among females are somewhat higher than males in the age of
group of 15 to 29 years. These higher death rales could be due to maternal mortality. 'Hie iron intake of

girls is about half than the recommended allowance especially in adolescent age, the condition worsen

due to further losses because of menstruation.

Maternal mortality accounts for 12.5% of deaths among rural women, between ages 15-45. The maternal

mortality rate is about 50 times that in developed countries. The risk of an Indian woman dying from a

maternity related cause is about 200 times greater. 60 to 70% of pregnant women ate anemic with
hemoglobin levels less than 10 gm. This pattern of high female mortality is also inversely related to

women’s social and economic value: the cultural preference for sons results in a bias against daughters,
which in manifest in their neglect and their consequent higher mortality in childhood. During

adolescence and early adulthood, the multiple burden of reproduction, social reproduction, domestic
work and productive labour placed on women results in their lower survival. Women’s survival
prospects improve when they pass the reproductive stage, and have higher family/social status as a
mother / mother-in-law.

Education: Despite marked progress over the last 40 years, female non-literacy remains very low,

less than half the rate for rural males. Female’s literacy rates falls below 10% in 136 of India’s 386 rural
districts. Most of these districts are in the states of Andhra Pradesh, Bihar, Madhya Pradesh, Rajasthan

and Uttar Pradesh, which together, contain half of India’s rural illiterate women. Female literacy is also

low among scheduled castes (9%) and tribal populations (7%). Almost 60%— or 500 million— of
India’s non-literate are girls or women.

Marriage: Due to lack of decision making power and choices in own life, the first change on her life

seems to be marriage. The practice of early child marriage also continues in some states of India

Average reported age of marriage for girl is 18.7 years compared to boys which is 23.4 years. The
median age at marriage in India is 16 years, 14 % of all girls aged 15-19 are married. Early marriage,

pregnancies and motherhood result in acute health risks leading to maternal and infant/child deaths.
There have been efforts to co-relate female literacy to the female age at marriage, child mortality

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estimates and fertility rates. For example, in rural areas a very large proportion of married women arc
non-literate as compared to urban areas.

Adolescents: The onset of puberty produces a great deal of anxiety and questions in the minds of

young unprepared adolescents who are unsure of why the changes related to sexual development occur

and do not know whom to approach for information. The practice of sharing of information whom to

approach for information. The practice of sharing of information related to puberity and associated
changes about sex and sexual health is virtually nonexistent amongst family members, more so among
girls. 50 % of adolescents, aged 12-15 years and residing in rural and urban slum areas, do know about

menstruation until its onset. This unawareness results in low-self image and ultimately low-selfesteem.

Women and Violence: Violence against girls and women is pervasive among all social classes and

castes in India, touching them at every stage of life. Violence against women is rooted in the tradition of
discrimination that has been going on for centuries. Rape, sexual harassment, murder, dowry deaths, sati,

physical and psychological abuse, female feoticide and infanticide are among the numerous forms of

violence against females that are increasingly being reported in India.

The Government of India’s Department of women and child welfare has reported the problem
statistically. During 1991 there was :

•

One rape very 54 minutes

•

One molestation every 26 minutes.

•

One kidnapping/abduction every 43 minutes.

•

One act of eve teasing every 51 minutes

•

One Dowry death every one hour 42 minutes.

•

One act of cruelty every 33 minutes.

•

One criminal offence against women every 7 minutes.

(The policy Unit Action Aid, India May, 1994)

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Economic Sphere:
Employment: A much larger portion of the female population is not in the conventional labour force.

It accounts for 34% of the women in the conventional labour force. Men arc concentrated in the market-

oriented side of the continuum of work and women in the statistically less visible, domestic side. They

account for 60% of the unpaid family workers, and 98% of those engaged in domestic work.

According of UN statistics : Women perform 67% of the world’s working hours, women earn 10% of

the world’s property. Opportunities to employ women at the higher level are less due to lack of technical
training’s, exposure and opportunities.

Women in Agriculture: Agriculture accounts for 37% of India’s Gross National Product and

employs over four-fifths of all economically active women. Women make up about 46% of agricultural
workers and about 44% of the agricultural wageworkers in India. 61% of all agricultural helpers are

women. The past two decades have seen a dramatic increase in women’s share of agricultural
employment. This has been due in part to the introduction of new agricultural technologies, which permit

greater use of female labour, and parity to the movement of men to non-farm employment.

Although, almost all rural women are involved to some extent in agriculture, the nature and extent of
their involvement varies widely and is strongly influenced by the economic status and caste and ethnic

background of their household. The more a woman’s work permits her to remain on the “inside” (i.e.
domestic sphere).

Political sphere: The fact that women who are almost 50% of the population are not even represented

10% in the parliament. The prevailing culture in politics is generally male-oriented and derives from a
political philosophy that confines women and women’s concerns to the private spheres of domesticity.
The ever-growing division between private and public life, as it becomes increasingly sectored and

hierarchical, has become even more inimical to women. The conventional notion of politics and power

play as an exclusive “male domain”, where masculinity is synonymous with violence, money and muscle
power. The historical under-representation of women is inextricably linked to her low and inferior status

in society.

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WAH TRAINING MANUAL
CHAPTER MOSQUITO-BORNE DISEASES ESPECIALLY MALARIA (Outline)
1. Scenario/ situation/ statistics related to malaria/ filaria/ dengue keeping in focus women and
gender relations
2. Efforts/ successes to improve the situation with practical examples
3. Technical information on malaria/ filaria/ dengue Fact sheets
4. Module for training
Objectives
Content
Duration
Training methodologies
Teaching aids required
Reference material for the trainer
Material to the participants
Any other
MALARIA - A BACKGROUND OF THE DISEASE.

Malaria, known as a disease of “high fever” has been present in India for many, many years. It
was about 100 years ago, that the connection between malaria and the mosquito was clearly
understood and since then there have been many efforts to first control, and later eradicate this
disease. There is a special National Control Programme, working for the last 45 years to fight
malaria and some of the achievements can be seen in the table below

Year

1947
1965
1984
1991
1992
1994

Population of India in
crores____________
34.41____________
46.60____________
71.00
84.00______________
86.00_____________
90.00

Number of malaria
cases__________
7.5 crores_______
1 lakh
21 lakhs________
21 lakhs________
21 lakhs________
25 lakhs

Number of deaths

8,00,000
NIL
247
421
422
1122

Since 1965, the number of people suffering from malaria is increasing, and the number of
people dying from the more dangerous form, cerebral malaria has also been rising.

In 1994, ‘95 and ‘96 there were serious outbreaks in Rajasthan, N.Eastern states and Haryana,
and the GOI brought out an operation manual for the malaria action programme. They also
appointed a special group of people to look into the problem. Both these books are listed as
references for those of you who feel the need to know more about this.
There are a number of reasons for this increase in malaria cases, would any of you know what
the position in your district and state is? Do you think these numbers reflect the situation in your
area?
Your area may not be one wherfc malaria is a problem. Do you have blocks in your district
where other outbreaks of fever have appeared in the past?

1

( See fact sheet- note on Dengue )
The National malaria control programme has very clear guidelines for the PHC and the subcentre teams regarding the follow up of cases of suspected malaria fever. The male
iu
multipurpose health worker is supposed to send the slides with blood films of patientszto the
' PHC twice a week. Here the trained lab technician is supposed to detect the malarial parasite in
the blood. Treatment can start immediately as the drugs are to be stocked with the health
worker. The malaria inspector is a key member of the team, he directs anti- mosquito measures.
The reality is that many of these positions lie vacant and many of the existing staff are not
trained in reading the slides. Combined with a poor work ethic, these excellent guidelines are
not put into practice. Thus if in your area mosquitoes are plenty, you may have an outbreak at
any time. This is particularly if there has been malaria in the past, or there are people coming in
from far off places (where malaria is common) in search of work, especially at construction sites.
The season for the maximum cases is July to September.

What is the situation of staff/ drug availability in your districts? It will be useful to ask the
participants to visit their local PHCs and meet the staff there.
If these staff positions are vacant, can the women’s groups apply pressure through the
panchayat to see that action is taken?
In places where the Govt. PHC etc does not function, people often go to the local vaid/hakim/
private doctor. What are the remedies used by these practitioners? Some of the private doctors
unfortunately treat the fever without the blood test, with too many or very powerful drugs.
Poorer families waste a lot of money on these treatments. If it is the woman of the family who is
sick, she may even delay treatment or not complete it in an effort to save the family money.
In some places there are known herbal remedies ( saptapami- Alstonia scholaris or Lata
Karanja- Caesalpinia) these may be taken traditionally for the treatment of this fever. There is
literature available on some herbal remedies. (See box). Are there any other remedies
available in your locality that people use for effective treatment of malaria?
Under the allopathic system of medicine, the treatment guidelines are to be found in the malaria
fact sheet. Please make sure that all women’s groups have it available in the local language.

A major way of preventing malaria is to control the breeding of the mosquito and avoiding being
bitten by the insect. (See Fact sheet on mosquitoes). There are at least three different types of
mosquitoes, each type causing a different disease. Each of these types has different breeding
sites, and biting times.lt is important to note that insecticide spraying and impregnated bed-nets
are not the only solutions to this problem. In fact one of the weaknesses of the national
programme has been that it relied too heavily on this approach and more ecofriendly, diverse
local methods have not been tried . It is time now to explore these options with the community
so use this opportunity to listen to the women and their ideas on the subject. Look for ways in
which this information can be shared in the villages, especially with the children. The health
education methods should be as many as possible, including folk-theatre forms, exhibitions, etc.

Finally, an important issue to discuss with the participants, is the key role that women play as
care-givers when any member of the family is sick. This includes all illnesses with fever such as
malaria or dengue. If the woman herself is the patient there is the burden of pending housework
(which otherwise falls on an adolescent daughter) and loss of wages if she is a working woman
in addition to the suffering from the illness. If the patient is a family member, she still has to
shoulder the added responsibilities of nursing.
2

Should the woman go on to chronic malaria, the resulting anemia will add to the existing fatigue
from under nutrition and overwork. Both as an equal member in family and society, and with the
additional care-giver role, this disease places a burden of suffering on the women.

Prevent an epidemic

When can you as a community expect a malaria epidemic in your area? These are some
warning signals to lookout for, otherwise many lives may be lost before action is taken.
I.
II.
III.
IV.
V.
VI.
VII.

Intermittent rainfall with gaps of 5-7 days between downpours.
History of malaria in the area.
Increase of mosquitoes.
■
u
Increase of malaria cases- fevers with shivering or fevers relapsing on alternate days
News of malaria epidemic in neighbouring areas.
No insecticide spraying activity in the past six months or more.
The larvae of the mosquito in clean collections of water, they look like tiny dots followed

VIII.

by tiny dashes.
High fevers with shivering followed by deaths

-------------------------------------- --------------

Home /Herbal /Ayurvedic remedies in the treatment of malarial fevers

These remedies are being shared from a number of sources, along with the methods of
preparation and administering. Most of these remedies are meant to abort the attack of fever or
make it mild, thus reducing suffering.
Chiretta
Andrographis
paniculata
Thulasi
Holy basil

Boil 60 grams of Chiretta in 2 glasses of water and reduce it to % glass. Add 60
gms of thulasi leaves to the hot decoction, cover and keep for an hour.
Squeeze out the leaves into the decoction. Strain and drink.
Dose: 1 cup thrice a day for 3-5 days.
10 gms of thulasi leaves juice mixed with 5 gms of black pepper powdered to
be given to the patient in the cold stage of fever. To this can be added jaggery
or sugar, the decoction must be

Guduchi
Tinospora
cordifolia

Six teaspoonfuls of the juice must be given three times a day.______________

Neem
Azadirachta
Indica

Neem bark is most useful, though the leaf has a role.
Neem bark bruised- 2 ounces, Cardomom 1 teaspoonful, coriander, water 20
ounces; boil for % hour; dose 2 ounces. Give before fever rises.
Grind 2-3 fresh neem leaves and 2-3 corns of black pepper with a few drops of
water. Give before the fever rises

3

I 3 a.Fact sheet on malaria/ dengue/ filaria_________________ _ ________________________
MALARIA is an illness caused by a parasite/ germ (Hindi - parjeevi) which is transmitted to
human beings and from one human to another by the bite of mosquitoes.

♦:* When should you think a person has malaria?
A person who has high fever with chills or shivering, daily or on alternate days may have
malaria. He or she may also complain of headache, bodyache and vomiting. The fever, after
lasting 2-6 hours comes down with profuse sweating. There is a feeling of fatigue and
weakness.
In some types of malaria, the person has a severe headache and becomes delirious, drowsy
or unconscious because that type of malaria affects the brain. This cerebral malaria is a
dangerous disease and if not promptly treated, the patient can die in 2-3 days.
How does malaria spread?
When a patient who has malaria is bitten by a female anopheles mosquito, the malarial
parasite enters the salivary glands of the mosquito and matures there. Now when this
mosquito bites a healthy person, the parasite enters his or her blood and within 2-3 weeks
he starts having fever.

❖ If someone in your community seems to have this fever, what should you do?
A person who has high, recurring fever, or severe headache with drowsiness, should seek
medical treatment from the nearest health worker, be it a malaria worker or doctor.
A
blood test (drop of blood on a glass slide) should be done. The parasite can be seen
1)
under the microscope. The health worker who does the test will make one thick and one thin
blood film on a slide
The
health worker, (a malaria worker) will give treatment consisting of chloroquin tablets.
2)
Different amounts are given for different ages (see table). This will destroy the parasite and
give relief to the patient.
3) If the blood test shows that the patient has malaria, then another round of tablets will be
given to the patient by the health worker under the supervision of a doctor, (see table 1).
This tablet is called primaquin. This is to prevent the relapse of infection.
TABLE 1: Age-wise dosage for the treatment of malaria - NMEP guidelines
Age in years

Tablet chloroquin (150 mg/ base)

<1 yr_______
1 -4 yr_____
5 -8 yr
9 -14 yr
15 yr & above

Dose
75__
150
300
450
600

No of tabs
%______

J_____

2 _______
3 _______
4

Tablet Primaquin (2.5 mg base)
Daily dose for 5 days________
No of tabs
Dose

2.5
5.0
10.0
15.0

1
£
6

Chloroquin treatment can be given to infants and pregnant women.
Primaquin is not to be given to infants and pregnant women.

4

❖ Is it important to take the complete treatment ?
People can get malaria more than once especially if they do not take the full treatment which
will kill all the malaria parasites in their bodies.
If a woman has malaria, what are the problems she faces later on in life?
Recurrent or chronic malaria in a woman can lead to abortion and still-births. These have
profound social implications in our society, where a woman’s child-bearing capacity is very
important. It can also lead to anemia, weakening further the member of the family who is
already anemic because of her diet. It will also lead to low birth weight babies, affecting the start
of their lives. Thus in addition to the suffering from the symptoms of malaria directly, she
indirectly suffers in a social context where her capacity to produce healthy living children is in
danger.

❖ How does malaria affect children, facts that women as chief care-givers in families
need to know?
Malaria affects children more severely than adults. Some children will get fits with the high fever.
Sometimes, newborn babies can be born with malaria germs in their blood if their mothers have
malaria. This will cause malaria and anemia in them. Infants and children must always be taken
promptly for treatment.
*> Can malaria be prevented?
Malaria can be prevented by protecting yourself from being bitten by mosquitoes. This might
involve
- preventing the breeding of mosquitoes near the house.
- Killing them with either insecticides (by the government health team) or burning neem or
other local leaves.
- Using repellant oils that are locally used to protect the skin from bites. Addition of a bit of
neem oil to the regularly used local oil has this effect
- Using impregnated bed nets if this is financially viable and a culturally acceptable solution.
Why is it so difficult to get rid of malaria?
Malaria is not a problem of an individual or a family. It is the problem of a community. All
members of the community need to work together to tackle the malaria problem in an area.
Groups like yours (Mahila Mandals) youth groups, farmers groups or co-operatives and the
village panchayat, school teachers and the village doctors/ vaids/ hakims must all work together
to handle the problem.
They must all work together to reduce or remove places where the mosquito may breed.
They must all work together to identify all those who are suffering from malaria to get a blood
test and prompt treatment.

The malaria programme is closely connected with the village development programme. Clean
surroundings without stagnant water; planting trees in marshy lands; putting fish in water tanks,
ponds and other collections used by the people; levelling land and filling pits that will prevent
collection of waste water from homes; introducing herbal gardens especially with neem and
thulasi; teaching children in village schools about malaria and the importance of village
sanitation are all programmes that the panchayat, women’s groups and youth groups can do to
5

tackle the problem. A village with clean surroundings is a long-term health investment against
malaria and other mosquito borne diseases.

❖ What can YOU do about the malaria problem in your area?
As a member of the community, one of the major responsibilities you have is to educate your
family and friends on the ways of preventing malaria. Use every chance you have to impress on
them these points:
1. The way in which malaria is transmitted
2. Every person with fever should see the health worker immediately for treatment
3. All patients with fever should co-operate by allowing you to take blood films
4. The community should co-operate in spraying operations and in preparing the houses for
spraying and after-spraying
5 Do not allow stagnant or slow moving water to collect near the house.
Everyone should protect themselves from mosquito-bites, especially in the evenings by covering
themselves and wherever possible, by using gauze screens or mosquito nets.
NB : The following sections need only be taken up by the trainer if she feels that these diseases
are there in the area. Please omit if not relevant.

DENGUE FEVER
Dengue fever is also caused by a germ and transmitted by the bite of a mosquito, but these are
different from the mosquitoes that transmit malaria. These mosquitoes breed in artificial
collections of water and bite mostly during the day.

Dengue fever, also called break-bone fever, starts with a high fever with chills, a severe
headache and painful muscles and joints which do not allow the patient to move. A day later
there is severe pain behind the eyes, especially with eye movements. Often this is followed by a
rash over the next few days.
In a more severe form, there may be pain in the abdomen and vomiting, with bleeding spots
under the skin. The patient may also collapse in shock.
The main treatment for Dengue is to reduce the fever and rest the body.
Dengue fever in its severe forms must be treated by health facilities that can treat shock, hence
it becomes important that all patients with fever see the health worker.

FILARIA
Filaria infection is caused by germs transmitted by the bite of the mosquito. These mosquitoes
breed in dirty stagnant water. In the early stages there may be repeated attacks of fever with
swelling in the lymph glands in the body. The late stage is the ‘elephantiasis’ picture with
swelling in the legs, scrotum, arms, vulva or breast.

It is important to take steps to get rid of mosquitoes because, this disease cannot even be
detected until repeated attacks of the symptoms occur.
6

3b. Fact sheet on mosquitoes
There are many types of mosquitoes. The type of mosquito that transmits malaria breeds in
clean water collections and streams. Other mosquitoes, responsible for the transmission of
dengue fever and filaria breed in dirty, stagnant water.
Sites of breeding can be
Wells
• Stagnant water near taps or hand pumps
• Paddy fields
• Rain water pools
• Roadside ditches and drains
• Canals
• Streams
• Irrigation channels
• Cartwheel ruts
• Hoofprints and footprints
• Tyre marks on kutcha roads
• Seepage water collections and so on
To check whether mosquitoes are breeding, you can spot them by checking the sites for larvae
which are small fish-like creatures which come from eggs of mosquitoes and which come to the
surface to breathe from time to time

(Introduce the life cycle of the mosquito here)
The malaria mosquito usually bites at night or at dusk. The mosquitoes transmitting dengue and
filaria bite in the early-morning hours.
The mosquito rests inside the house or outside the house in dark shady places and on
before and after biting.
.
We can control mosquito breeding by eliminating/ reducing their breeding places by
■ Draining water collections near hand pumps, taps and around the house
■ Filling and levelling roads to avoid hoof or cart-wheel ruts
■ Filling ditches by the side of roads and canals

ew

..

When water cannot be drained, or when collections of water in tanks and ponds are necessary
for use, then
• Introduce mosquito larvae eating fishes called guppies and Gambusia
• Spread kerosene oil or malariol on water surfaces which cannot be drained. This prevents
the larva from breathing and they die.
Mosquitoes in and around the house can also be killed by burning neem leaves or other locally
known leaves or incense whose smoke drives away the mosquitoes. Another possibility is to
screen doors and windows with juting or netting

Insecticide sprays are available, the government health team sends teams to spray the houses.
You can help by allowing the malaria worker to spray the walls of your house- in the rooms
including the store, kitchen, bathroom and cattle sheds with insecticides.
These insecticides have a lasting effect for 2 to 2 % months. Do not plaster the sprayed surface
with mud, cowdung or whitewash because this will prevent the insecticide from working.

7

There are a number of traditional practices that are used, such as smoking neem leaves or
burning 'sambrani' (in the south) to drive away the mosquitoes at dusk.

TRAINING MODULE
Objectives of this module
1. Trainers understand the signs and symptoms of malaria and be able to convey this picture
to the participating women
2. Trainers understand the way in which malaria is transmitted, the patient- mosquito-healthy
individual cycle and can share this with the women
3. Trainers grasp the importance of prevention through strategies aimed at the mosquito after
learning its lifecycle. These strategies would then be drawn up with the participants using
their local knowledge. These should simple, low-cost, eco-friendly and stress community
involvement. Wherever possible, locally used and traditionally favoured methods that have
proved useful must be shared and used.
4. Trainers are aware of the government malaria programme, its strengths and shortcomings,
so that participants can, having learned these, make informed decisions as well as lead
community pressure, where to some of the facilities are inadequate. They may also be able
to push a local NGO to take leadership and work with the community in handling this issue.
5. Trainers are made aware of some of the socio-cultural implications of the diseases or their
complications. They can raise these issues sensitively with the women, so that these
problems are expressed in the group and may be shared with care-givers also.
■
■ guidelines
• • ---------6. Trainers have access to correct treatment
and1 can give these to the women’s
group
group ,.'who must also have these in a written accessible form. Some discussion and
exposure to possible action they can take when faced with irrational therapy must be
covered.

Duration of session

Content of session

10 minutes

Review of fevers(with
a special name)
locally- link to Malaria
Malaria -signs and
symptoms________
Patient-mosquito
person cycle
How malaria spreads
Mosquitoes in the
area- behaviour,
breeding sites,
Possible interventions
Govt programme, key
team people

15 minutes
15 minutes

20 minutes

1 day
'
combine with other
programmes_____
30 minutes
-

'

Malaria-anemiamotherhood-issues
Implications on
finances of the family

Methods that can be
used____________
Group discussion

Materials required

Question and
answers _____
Qs and Ans
Group discussion

Charts/ posters
blackboard_________
Charts/
board/microscope/slid
es _________ _____
Neem oil/ leaves,
impregnated bed-nets

Group discussion,

Visit to the PHC/
Local healers

Transport

Role play/
Case study

8

Duration of session

Content of session

Methods that can be
used

Materials required

15 minutes15 minutes

Correct treatment
guidelines/ role of
other health
practitioners____

Group discussion/
Pamphlet in the local
language

Pamphlets/ posters

Adapted from and suggested further reading
1. VHAI/SOCHARA 1997 Towards an Appropriate Malaria control Strategy, Chap:Health
education in Malaria control and Appendix: Messages for Health Education
2. MRC 1996, Bioenvironmental Control of Malaria - A Holistic Approach
3. VHAI 1996 Malaria Control - Capacity-Building in Community-based NGOs/workers
4. Jana Swasthya Rakshak Manual 1995 , Health and Family Welfare Dept, Bhopal, M P.
5. Manual for Community Health worker 1978, Ministry of Health and Family Welfare, GOI,
Delhi
6. Operational Manual for Malaria action Programme (MAP) 1995, GOI, NMEP, Ministry of
Health and Family Welfare
7. Anubhav Experiences in health and community development, Booklet on malaria
8. Malaria control an attempt 1996, GOI,NMEP, Ministry of Health and Family Welfare
Material for the trainer
The following pamphlets would be useful in the kit for trainers to use as resource material in the
training:
1. Bioenvironmental Control of Malaria - A Holistic Approach -Malaria Research Centre, 1996
2. Awareness of malaria for schoolchildren, NDMEP
3. Life-cycles of the anopheles and the malarial parasites - Malaria Research Centre

I

9

Ao

Phone : 5531518/5525372
tS

COMMUNITY health cell

Fax

Email

: (080) 55 333 58
Attn. CHC
: sochara@blr.vsnl.net.in

No. 367, 'Srinivasa Nilaya', Jakkasandra, 1st Main, 1st Block, Koramangaia, Bangalore-560 034.

1st February, 1999

Malaria - An Infectious Disease

Health Education

voy-A

G•8

Messages for Woroen Leadsrs at Grassroot. levs!

Basis
*********.******************************************************

*• Simple
* Stressing bio-environmental approach
Low cost
* Community involvement and participation
•"
Gender sensitive * focus
onJ the roots of the disease not
just the
the disease
disease itself
itself
Kcq—friendly
just
:WcM:*******************************^
* (Hindi 1. Malaria is an illness caused by a 'parasite/germ'and between
is transmitted to human beings u
Parjeevi) iwhich
—
human beings by the bite of mosquitoes.

.2.

There are many type of mosquitoes. The type of mosquito that
water collections, and.
-transmits malaria breeds in clean
streams.

3a. Sites of breeding can be:
-,wells;
- stagnant water near taps or hand pumps;
- paddy fields;
- rain water pools;
- road side ditches and drains;
- canals;
- streams;
- irrigation channels;
- cart wheel ruts;
- hoof prints;
- tyre marks on kutcha road;
- seepage water collection,
and, so on.

3b. To check whether mosquitoes are breeding, you can spot
by checking the sites, for larvae which are small fish
creatures which come from eggs of mosquitoes and which
to the surface to breathe from time to time.

them
like
come

(Introduce mosquito life cycle here)
4.

Malaria mosquitoes do. flQt. breed in stagnant, polluted,
water.
The malaria mosquito bites at night or at dusk.
Society for Community Health Awareness, Research and Action
Registered under the Karnataka Societies Registration Act 17 of 1960, S. No. 44/91 -92
Registered Office : No. 326, Sth Main. 1 st Block, Koramangaia. Bangalore - 560 034.

dirty

6.
7.

orj outside the house in
The mosquito rests inside the housebefore
and after biting.
dark shady places and on the walls bc_o
eliminating/reducing
We can control mosquito breeding by
-hDrainingdwatericoTlections near hand pumps, taps and around

bile LlUUQC ,
i1 11 nt?: depressions
- filling and levelling
depressions in kitchen garden/ court
yard, roof and around the house;
- levelling roads to avoid hoof^or cart wheel ruts;
- filling ditches by the side of_ roads and canals.
in
or when collections of water
v/8. When water cannot be drained
------ for use, then:
tanks and ponds are necessary
fishes)
- introduce mosquito eating fishes (larvivorous
called guppies and Gambusia;
•
surfaces which
water
- spread kerosene oil or malariol on
larva
from
breathing and
cannot be drained, This prevents -— they die.
l also be killed by:
Mosquitoes in and around the house can
3leaves
or
other
locally
known leaves or
- burning neem leaves or other -incense whose smoke drives away mosquitoes;
- screening doors and windows with juting or netting.
helps by -sending health
to
10. The government health team L.i workers
-i ni?
spray houses with insecticides. You can help by luting the
i the
malaria health worker spray the walls of the hous.
rooms including store, kitchen, bathroom and cattle sheds
with insecticides.
to 2 1/2
These insecticides have a lasting effect for 2
months.
', cow dung or
Do not plaster the sprayed surface with mud,
from
insecticide
white wash because this will prevent the i/.
working.
worker is going to spray, all foods,
Before the health worker is going Lj to covered properly or
foodgrains should be
drinking water,
by insecticides.
that
these
are not <contaminated
-----removed,, so
spraying is
Children should also be kept outside while the
going on.
11. Using repellant oils that are locally used, like neem oils,
will also protect your skin from bites. You
-- can also protect
* j your body
yourself by the bites of mosquitoes by covering
skin
is
not
exposed, the
with clothes as women do.
If your t--- —
mosquitoes usually do not bite.

L

What are the signs and symptoms of Malaria?
' r from malaria has high fever with chills or
A person suffering
daily'or
person may also
shivering, c-- on alternate days. , The
.
vomiting.
lever comes
complain of headache, bodyache and vomiting,
down with profuse sweating. There is a feeling of fatigue
and weakness.
person,has severe_headache> and
13. In some types of malaria, the unconscious
because that type of
becomes delirious, drowsy or i------ - malaria affects the brain.

/12-

treatment
14. A person who hasj fever must seek medicalglass
slide) should be
A"blood
test
(drop
of
blood
on
a
l
‘
Ci) k „-.1

,.i be seen under a microscope.
done. The germ can
who does
The health worker v..-.
--- the
-- blood test will make one
thick and one thin blood film on a glass slide.
\ which
(ii) The doctor or health worker will give treatment
Different
of
some
chloroquin
tablets
.
E
—
—
will consist
This
given
for
different
ages
(see
table).
amounts are u
give
will destroy the malaria germ in the blood and
relief to the patient.
that the patient has malaria,
(iii) If the blood ’
test shows
t—
by the
,
then another iround of tablets will be given
(see
doctor
health worker under the supervision of a
to
This
is
This
tablet
is
called
Primaquin.
table).
prevent the relapse of infection.

Age-wise dosage

Tablet Primaquin
(2.5 mg base)
Daily dose for 5 days

Age in
years

Tablet Chloroquin
(150 mg / base)
Dose
No. of tablets

1
1 - 4
5 - ■8
9 - 14
15 &
above

75
150
300
450

1/2
1
2
3

2.5
5.0
10.0

1
2
4

600

4

15.0

6

< -

women.

3

&

anaemia,
Recurrent or chronic malaria in women can lead to
Malaria
abortion > low birth weight> still births, abortions. Pregnant
can also cause death of the baby in the womb, and urgent
mothers must always be given first preference
If the family can afford a mosquito
attention for treatment.
net, the mother and child must be given preference to use it.

•• *
’'
than
onl adults.
16. Malaria has more severe effects on children
■
*
.
»
children
will
get
fits
with
the
high
fever^.
ISometimes
—\/
Some
> —
in. their
blood
born
babies
can
be
born
with
malaria
germs
—
new
This will cause malaria and
if their mothers have malaria. r.-- --anaemia in them.
Infants and children must always be taken
promptly for treatment.
17. People can get malaria more than once especially
the
- if they do not take full treatment which will kill all
malaria germs in their body
- if they do not protect themselves from being bitten by
mosquitoes.
x48. Malaria is not a problem of an individual or a family^ It is
the problem
problem of a community. All members of the community
c_
in an
need to
work
together
to
tackle
the
malaria
problem
to i
area.
Groups like women’s groups (Mahila mandals), youth
groups,
farmers groups or cooperatives and the village,
panchayat and school teachers and village doctors/vaid/hakims
must all work together to tackle the problem
potential
- they must
i--- all
-- work
--- together to reduce or remove
breeding sites for mosquitoes
- they must all work together to identify all those who> are
suffering from malaria to get a blood test and prompt
l

treatment.
19. The malaria programme is closely connected with the village
development programme.
programme. Clean surroundings without stagnant
l
water
water; planting trees in marshy lands; putting in
tanks' "ponds and other collections used by the people;
levelling land and filling pits that will prevent collection
of waste water from homes;
introducing herbal
gardens
especially with neem and thulasi;
teaching children m
village schools about malaria and the importance of village
sanitation are all programmes that the panchayat, women s
groups and youth groups can do to tackle the problem.
A
village with clean surroundings is a permanent and long term
health investment against malaria and other mosquito borne
diseases.

4

i

20. As a member of the community, one of the major responsibili
ties you have is to educate the other members of your• commuUse every opportunity to
nity on ways of preventing malaria. l__
impress on them the following points•
i) The way in which malaria is transmitted.
—

-

•

-

•

1—

v

ii) Every person with fever should see the
immediately for treatment.

health

worker

iii) All cases with fever should cooperate by allowing you to
take blood films.
operations
iv) The community should cooperate in spraying
and after
and in preparing the houses for spraying
spraying.
slow
v) The community membersi should not allow stagnant or
moving water to collect near their houses.
from
vi) The community members should protect themselves
covering
mosquito bites, especially intheevenings^by
possible, by using gauze screens
themselves and
t— wherever
---or mosquito nets.
********************

Adanted from
Control
1. VHA1/SOCHARA, 1997 . Towards an Appropriate Malaria
and
Control
Strategy. Chapter.• Health Education in Malaria
Appendix• Messages for Health Education.
A Holistic
2. MRC, 1996, Bioenvironmental Control of Malaria
Approach. (Pamphlet).
in
Building
Capacity
(1996).
Malaria Control
3. VHAI
Commuunity based NGOs/workers.
' , 1995, Health and Family Welfare
4. Jana Swasthya Rakshak Manual,
Bhopal,
Madhya Pradesh.
Department, 1
—
- Worker,
; '
, 1978, Ministry of Health
5, Manual2. for Community Health
of India,- New Delhi.
arid Eamily Welfare, Govt. <.1

6•

6-

********************

]
,

('ol NMfcP

.x

(?|tw H I'

V

5

, |\A-in

6.

J

fMAP)

L/^YA - Ib-C)

CHETNA
!

Minutes of the Meeting on a
National Consultation to Finalize
The Training Manual on
Women’s Health for Women’s Groups

February 1999
&

EMETm

Women's Health and Development Resource Centre

Chaitanyaa

CHETNA

Minutes of the Meeting on a National Consultation to
Finalize the Training Manual on Women’s Health for
Women’s Groups
Dates:

January 3-4 1999

Co-ordinated by:

Centre for Health Education Training
And Nutrition Awareness (CHETNA)
Lilavatiben Lalbhai Bunglow,
Civil Camp Road
Shahibag, Ahmeda bad-380004
Phone - 2866695, 2866586, 2865636
Fax: 91-79-2866513
E-Mail:indu.CaDDoi@Lwahm.Net(o r)
ghclna@a4inct.cnict.in

Supported by:

Ministry of Health and Family Welfare,
Government of India, New Delhi-110011
(WHO Project)

No of participants:

20 from Gujarat, Rajasthan, Karnataka,
West Bengal, Maharashtra and New
Delhi. The list of participants is enclosed
in Annexure I.

2

CHETNA

Background
During November 19-20 1998, the Ministry of Health and Family Welfare,
Department of Health, in collaboration with WHO, New Delhi convene an expert
group meeting to identify health education material for women’s health. At this
meeting, it was decided to develop a training manual/compendium for women’s
groups on women’s health issues. The objective of the manual is to provide basic
information on women’s health concerns and the methodology of
implementing it with women’s groups. CHETNA was requested to co-ordinate
this effort. The participants also took the responsibility of writing various topics.
This workshop was organised to provide feedback and comments of experts and
experienced people on the chapter written and to develop the framework of
the remaining chapters collectively.

The Participants
20 women, including one man from six states participated. They were from grass
root and support organisations including authors of the chapters. Dr.Rita Nagpal
represented the Central Health Education Bureau, Ministiy of Health and Family
Welfare. Some of the invitees could not remain present. (For a detailed list please
refer Annexure I)

The Process
Ms. Indu Capoor welcomed the participants and talked about the background of
the workshop. The participants sought clarifications and discussed various aspects
of the manual viz. the objective, audience, content, perspective and strategies to
make it functional. This enhanced participant’s clarity on the manual and created a
common understanding. After that one chapter was selected and in three groups the
participants discussed to provide feedback on the content, presentation and utility
of the chapter. This was shared in the plenary for a general consensus and to
deliberate on controversial issues and clarifications this helped to focus on a
common line of thought while commenting and critiquing the chapters. Later on in
three interest groups. The participants provided feedback on the chapters that were
already written and prepared the framework of the chapters, which were yet to be
written. These were presented in the large group to solicit feedback of all the
participants. This process ensured participation from all and completion of task
within the stipulated time. In addition, it facilitated the input from grassroots as
3

CHETNA

well as from the authors, academic and policy level functionaries. The meeting
concluded by taking stock of the responsibilities of each member, finalizing
deadline and planning for the second national level workshop to finalize the
compendium.
Based on the discussion among the participants and to cope up with the time
constraints the participants distributed responsibility of writing the chapters.

Some of the decisions have taken during the meeting on different topics.

Women’s Health Perspective
Dr. Sathyamala has taken the responsibility to work on the WAH! approach
document. It has been decided that she will review the WAH! perspective and
finalize it for the compendium. She could not remain present during the meeting.
The group read the perspective and gave their comments, which are as follows:

.

• The balance, approach and concept of the WAH! approach document is good
• Provide a balanced perspective on Indigenous Medicine and allopathic.
• Include commercialization and malpractice of traditional medicine and its
impact on health
«
• Emphasize on women’s suffering due to repeated pregnancies.
• Include repeated pregnancies as violence against women .
• Include a section on male involvement
• Add in definition of health: where healing is intact, without fear and anxiety.
• Focus on preventive and promotive aspects
• Include eternal values of the cultural philosophy like attitude and approach to
life, spirituality etc.

The group felt that there could be resistance on certain issues like feminism, values
that come with technology, traditional systems

Other comments and suggestions:
Concept Level: This level is high for the facilitators. The translations and
adaptations could deal with simplification
Language: Needs to be simplified. Particularly in the area of feminism holistic
medicine
’

4

CHETNA

Structure: Reorganize the document. Start from Woman, her status today, her
roles and responsibilities in lifecycle approach. Rewrite in the context of the
manual

CHETNA will pass these comments to Dr. Sathayamala who will work on the
chapter.
Women’s Work, Occupation and Health
SEWA has taken the responsibility of writing this chapter. It was decided to
include information on occupational health too. The group gave suggestion on the
draft chapter written by SEWA, which are as follow:

• How to change from experiential to modular form
• Include case studies, how women have been able to insist to employers for
better working conditions and child care support.
• Minimum and equal wages fight, Mahila Samkhya training in masonry
• Mention of support from savings groups
• Women what are the facilities that need to be made available, what are the
provisions
• Positive examples and solutions needed at the self/family/community and legal
aspects
• Child care centers for the working women
SEWA will work on the chapter and finalize it.

Reproductive and Child Health (RCH)

CINI-WestBengal has taken the responsibility to write this chapter. However the
topic is too broad the group suggested dividing it in sub topics and certain tppics.
The following health concerns to be included in RCH
* Pregnancy and childbirth
* Child health and nutrition (low birth, infection, breast-feeding, undernutrition
and diseases
’
* preventable by immunization),
* RTI/STDs/HIVAIDS/Cancers
* Family Spacing
* Abortion
* Infertility
5

CHETNA

* Male involvement
r Adolescent health and development

Preliminary CHETNA was given responsibility of writing a separate chapter on
STD/HIV/AIDS, which is now incorporated under RCH. Secondly the group felt
the need to work on adolescent health. This topic will also be address under RCH.
The group worked out the broad outline for the topic. CHETNA will be writing on
this topic. Effort was also made to out line the content of topics like pregnancy and
childbirth and child health. The details are as follow:

Pregnancy and childbirth:

•

p
•
•
•
•
•
•
•
•
•
•
•

High Maternal Mortality and Morbidity
Too many too close pregnancy
Gender issues involved
Importance on male child
Infanticide and Foeticide
Nutrition and pregnancy
Beliefs and taboos
Anaemia during pregnancy
Pregnancy and Work
High risk pregnancy
Safe Child birth
Available Government facilities and Schemes

Note: Empowering and disempowering traditional healing practices would be
included as and when required. Positive case studies will be included

Child Health:
•
•
•
•
•
[•

New bom care including traditional practices like massage
Complementary feeding
Child care facilities
Immunization
Timely referral
Access to Government facilities

Note. The emphasis 'will be on gender issues and discrimination

6

CHETNA

Adolescent health:

The following framework was developed for writing the chapter.
• Focus on health, nutrition of adolescents
• Understanding adolescent/age group etc.
• Crucial aspects-transitional period of life, special needs-future adult
• Nutrition-growth spurt/menstruation/menarche/menstrual health
• Health-early marriage/pregnancy/teenage pregnancy/abortion facilities like
school/lady teachers etc.
• Education/development/self esteem, life useful skills/information
• Access/control over resources of adolescents
• Constraints:socio-cultural factors, labour, restriction lack of access/control
• Action/efforts at individual/family/community and state level
• Govt.programs/schemes-ICDS
Note: Refer NFI modules developedfor adolescent

CINI has taken the responsibility of working on other issues in this line and
CHETNA would contribute in the area of RTIs/STDs/HIV/AIDS and Adolescent
Health and Development

Traditional Health and Healing Practices (THHP)
,

Dr. Saraswati Swain wrote this chapter. She could not remain present during the
meeting. She conveyed to CHETNA that due to time constraint she would not be
able to further work on this chapter. She mentioned that if necessary CHETNA can
make necessary changes to strengthen it.

The group gave following suggestions to include in the chapter:

•
•
®
•
•
•
•
•
•

Historical perspective-Marginalisation of women’s healing knowledge '
Present scenario of THHP, how they empower women
Listing of various healers and healing techniques
Empowering and disempowering practices in the life cycle
Strengths and limitations of THHP
Frame work for assessment of THHP
Male involvement
Government schemes and facilities
The process of doing it with women’s groups
7

CHETNA has taken the responsibility to finalize this chapter.

CHETNA

Mental Health

Preliminary it was decided that Jagori would write this chapter. Since Jagori shown
its inconvenience in writing due to time constraint, CHETNA has taken a lead to
write the draft report. The group gave suggestion to further improve it. Was
CHETNA has take the following suggestions were provided on the draft chapter
written by CHETNA. The are as follow:
•
•
•
•
•
•
•
•
•
•

.

Stigma attached to mental health
Labeling of women
Establish Mind-body-spirit linkages
Mental health issues in life cycle- adolescent, menopause, post partum, response
to change
Linkage between violence and mental health
Life threatening diseases and impact on women’s mental health
Stresses particularly due to early marriage, infertility, expression of sexuality
Diagnosis, symptoms and management
Preventive aspects
Stress management- traditional methods

CHETNA has taken the responsibility to incorporate these suggestions in the
chapter

Nutrition
Dr. Sathyamala has taken responsibility of writing this chapter. Since she could not
remain present and we did not receive the draft chapter, the group developed a
broad outline for the topic.

The following framework was developed to write the chapter
• Nutrition issue focusing on woman from a gender perspective (emphasis on
women involved in food production to serving but eats less) in connection with
work at self/family/community level
• Nutritional concerns in the life cycle/under nutrition implications
© Male involvement
® Food taboos/practices/ cooking and storing practices
8

CHETNA

• Agriculture/food security and PDS-pesticides/cropping patterns/ adulteration
plenary—include coarse grains
• Dental health and food intake
• Government Schemes: 1CDS- and the services provided
o Fact Sheet: foods, food storage, kitchen garden healthy food habits, locally
available foods, hygiene.

CHETNA has taken the responsibility to pass these comments to Dr. Sathyamala. It
was suggested that the chapter could be given for comments to Dr. Shanti Ghosh
CHC, CINI, and CHEB

Violence
Shakshi New Delhi will be writing this chapter. In their absence the group
identified issues for inclusion in the chapter:

Q

Social aspect, difference in forms and experience ol violence by men and
women
Violence issues in the lifecycle from womb- lack of care during pregnancy,
repeated and unwanted pregnancies
Sex Detennination Test, discrimination/deprivation to a girl child-nutrition.
education, health etc.
High mortality in the reproductive age group
workplace/public place harassment
Taboos/restrictions, harassment (adolescent age-sexual harassment), early
marriage
Violence in family/marriage/incest/ oppressive customs
Widowhood and violence, various customs
Old age and violence abuse
Alcoholism and violence
Women support groups, access to legal aid, counseling, old age pensions, shelter
homes
What is happening in schemes for women
Role of panchayat/police

This information will be passed to Shakshi by CHETNA.

9

CIIETNA

Mosquito borne diseases

CHC has taken the responsibility of writing this chapter. Originally the title of the
topic was Malaria which was changed to Mosquito born diseases. The CHC has
developed the broad out line, which was reviewed by the group, and following
feedback was provided.
•
•
•
•
•
•
•
•

Change the title to vector/mosquito borne diseases to include dengue and filaria
What is Malaria? How to identify it?
What are its implication on women and their health
Malaria during pregnancy
Treatment of Malaria
Prevention of Malaria including traditional methods
Govermnent program for malaria eradication including drug distributing depots
In references, include infonnation book on Malaria by Govt.

Tuberculosis

CHC will be writing on tuberculosis too. The broad out line was reviewed by the
group. The chapter needs to include the following aspects
• Effect on woman from gender perspective
• Impact on women and other members if the man gets T.B in the wage earning
age
• Include do s and don’ts/Myths/Malpractice in diagnosing
• Treatment and prevention including overcrowding and lack of ventilation
• Emphasize on early diagnosis and course completion
• Community awareness and support for rehabilitation and ensuring drug supply

Rational Health Care
Dr.Mira Shiva from VHAI has taken responsibility of writing this chapter She
could not remain present during tlie meeting. It was decided that CHC would write
the chapter. Dr. Mira Shiva can send her material to CHC and also give her
comments on the draft chapter. The group suggested inclusion of following aspects:
• Definition of rational health care
® Quality care
10

Cl I ETNA

Essential drugs at the Primary Health Center and Sub Center
List of essential drugs
Cross practices
Medicalisation and commercialization of health care including traditional
medicine
• Patients rights
• Approaches adopted for rational health care: prescription audit and other case
studies, photocopies of prescriptions.
•
•
•
•

Community Health Cell (CHC), Bangalore has agreed to work on this chapter with
support from Dr. Mira Shiva, VHAI

Water
FRCH has already written draft chapter. The group suggested following issues to
be included in the chapter.
9

®
•
®
•
®
®
•
•
•

A

Politics of water
sources of water, affect of deforestation, availability of
water at home
Facts and figures
Case studies-pani samitis, pani panchayats, recycling of water
Community action,
Technical options (innovative technology)
Government programs
Water management
Caste and water
Role of panchayat,
Village responsibility

FRCH has taken the responsibility to incorporate this feedback in the chapter.

11

CHETNA

Women and Panchayati Raj and Women’s Rights and Entitlement
Dr. Saraswati Swain has written a draft chapter. Since she has conveyed her
inability to devote time FRCH will take a lead to write this chapter. The suggestion
given to strengthen the chapter was as follows:

• Focus on the role of panchayat in managing health care for community
particularly- ICDS, PHC.CHC
• Powers/functions of panchayat
• Need for community support/participation
• Case studies
• 73rd amendment-its context
• Accessing and generation resources
• Role on panchayat and community action to arrange for transport in case of
emergencies
• Politics and caste
FRCH will combine the chapters and work further

Access to Government Programs
The title of the chapter was Access to government scheme, which is now revised as
Access to government programs. FRCH-Mumbai has taken the responsibility to
write this chapter. The following comments were provided on the draft chapter.
• Change the title to: Local Government Programs
• Keep it as separate chapter in the compendium and highlight it in the relevant
issue.
• Include additional infonnation on alternate structures available.
• Include a list of places from where to access information.
• Include a section on Self-motivation for use of information person’s
responsibilities and duties.
• Include structure/programs at primary, secondary and territory level.
• Govt, has booklets on each scheme. That material needs to be collected and
included in the compendium.
• Add success stories, process of discussing this with women’s groups, flow chart
of PHC, related information and about govt, benefits like maternity benefits etc.
• Communication systems, when and where, what is available etc. need to be
defined.
12

CIIETNA

It was also decided that all the chapter writers would . ' '
emphasise
erne keeping their subject in view Whereas this mnin
i
i on access to health
various schemes directly or indirectly related to woEs
f°CUS on
URMUL Bikaner remained present during the
experience in view, the group requested them to meeting. Keeping their rich
supply the case studies for
difterent topics. They agreed for
-- the
...e same.

The summeiy of the responsible persons and NQOs l0 wit(.
follows.
1 .Women’s Health perspective
Women’s Work and Occupational Health Dr. Sathyainala
SEWA
3. Reproductive and Child Health
CINI
111V/AIDS, 1<1 Is and Cancer
CIIETNA
Adolescent Health
CHETNA
4. Promotion of Traditional Health and
Healing Practices
Dr. Saraswati Swain/CHETNA
5.Mental Health
CHETNA.
(Seema Deodhar, FRCH
r..P“ne wil1 se"d thc address
—s of Ms. Bhargavi Davar to
CHE I NA. Hie draft of Mental Health chapter
can be send it to Ms. Jayshree from
NIMHANS)
d.Nutrition
Dr. Sathyainala
7. Genders and Self Esteem
CHETNA
8. Violence
Shakshi
9. T.B
CHC-Bangalore
10. Malaria
-- doH.Rational Health Care
— do—
12. Water
hRCH-Mumbai
13. Women and Panchayati Raj and
— do—
Women’s right and entitlement
M.Access to Government Programs
- do —
1 j.Case studies
URMUL Lunkaransar, Seva Mandir

13

CHETNA

Time frame to complete the chapter writing
The chapters should be completed and sent to CHETNA byl5th Februaryl999,
Chapters have to be written in the format provided by CHETNA with addition on
access to health services, along with illustrations. If possible they should be sent to
four or five other experts on the subject.
Details on Planning for the National level Consultation

Dates: March 5-6 1999
Venue: CHETNA-Ahmedabad or New Delhi

Participants: National coverage is essential. Apart from the authors, the following
could be invited:
Ms. Jashodhara and Dr.Abhijeet, SAHYOG, Almoda, U.P
Dr. Sudarshan, B.R.Hills, Karnataka
Vinita Nayak Mukherjee from Kerala
Dr. Prakashamma, Hyderabad
Dr. Vimala Ramchandran,IIHMR, Jaipur
Dr. Sathyamala, New Delhi
Participants may send names of people who could be invited to this consultation
from other states.

Some of Other Aspects Discussed
The Title of the manual: Health Education for Community Groups

The audience: The manual is for district level facilitators who may be leaders of
women s groups-male as well as female, it is for both givers and receivers of health
care and health education.
The Content: The overall content of the manual was comprehensive. The main
text of the chapter would be written from a woman’s perspective and the technical
details and messages would go as supportive material emphasizes on prevention
and promotion. Include self-help health promotion information in a box in each
chapter

14

CHETNA

Aspects to be ensured in the manual are:
•
•
•
•
•
•
•

•
•

•
•

A broader and realistic perspective on women’s health
The focus on content as well as the process
A combination of social and medical aspects
Making the information relevant to women’s lives
Male involvement, which needs to be, spelt in the introduction to the manual as
well as keeping the tone of the manual accordingly.
Focus on Reproductive Health
Information on networking with other related power figures to be included in
each chapter. For example, interaction with other groups around agriculture etc.
Child care services as support to women’s empowerment to be included as and
when necessary.
Information on networking with other related power figures should be included
in each chapter. For example, interaction with other groups around agriculture
etc.
Health seeking behaviour of women needs to be included as a chapter cither in
the health care or gender.
Include self-care activities they can adopt to stay healthy in each chapter in a
box.

Levels
'

A common consensus emerged on the need for interventions at three levels on
various aspects of women’s health. These were outlined as:
Level I : Perspective building for sensitization at various levels
Level II: Building capacities and information for trainers
Level III: Creating awareness at tire village level
Translation and adaptation

The group was happy to know the scope for translation and adaptation at the
regional level in all Indian languages. It was felt that translation at the regional
level would be another process. It will be an adaptation with incorporation of
whatever is available at the regional level and the national level effort will be a
guide. The need for identifying representatives for each state particularly training
centers was expressed.
b

15

Discussion and suggestions on related issues

CIIETNA

?

It was strongly expressed that the issues of Adivasi/tribal people are different and
these should be incorporated in the manual. There is a need to make special
provision for these people as tliey are scattered, their issues and culture is different.
Budgetary provisions to entrust special groups to meet the needs of the people in
these areas are required.

A specific suggestion was a critical appraisal for existing material, which matches
the perspective and include it as annexures, references in the manual.

The participants were a bit concerned about the time frame of completing this task,
It was expressed that even though the time is too short, interaction with district
level can be done till the end of the year. At the community level, the process is
slow and it may take years to internalize the concepts.
A suggestion was to empower community to demand services at the community
level. In the process, there is a need to include and upgrade Government services
also. It was shared that one of the strategies was to actively involve the trainers of
ANMs/LHVs of the Govt., training centers. For example this training would
involve the ICDS training centers. Health and Family Centers and ANM training
centers. An apprehension was that the large number of functionaries at the district
level might inhibit achieving the desired impact. Unless the service providers are
sensitized to this issue, it may not be able to meet the demand generated. One
positive aspect felt was that this being a Government initiative, sensitization of the
service provider is possible and the ministry has taken the responsibility of seeing
that this module goes in to the main stream service provider. NGOs can put in thenefforts in whatever is feasible or tangible.
A caution was raised to guard against tire dilution of the punch in women’s health
issues.

It was felt that at the community level, there is a need for decentralized process in
preparing the workbook. This can be done by involving local women and letting
them decide what they want to develop. A suggestion was to develop
messages/material etc in the district level facilitator’s training.

16

CHETNA

Conclusion

The meeting was successful in meeting its objective. Through interactions at
various levels valuable input was collected to strike a balance between the
academic and the grass root experiences, thereby making the effort relevant to the
issues at the ground level. This also enhanced clarity and ensured participation
from various organizations and individuals.

17

Annexure -1
List of Participants
Sr.
No
1.

Name of the Participant

2.

Dr.Rita Nagpal

3.

Ms.Swati Patel

4.

Ms.Seema Deodha

5.

Dr.Rumeli Das

6.

Dr. Roopa Devadasan

7.

Ms.Jhansi Eswaraka

8.

Ms.Suja Soni Joseph

9.

Ms.Ramrathni

10.
11.

Mr.Satyanarayan
Ms. Mittal Shah

12.

Ms.Christina Sullivan
Sarabhai

13.

Ms.Poonam Kalhuria

14.
15.
16.
17.
18.
19.
20

Ms.Indu Capoor
Ms.Pallavi Patel
Ms.Minaxi Shukla
Vd.Smita Bajpai
Vd.Laxmi Bhatt
Ms.Sadhana Makhija
Ms.Urmila Joshi

Dr. Shanti Ghosh

Name and Address of the
Institution__________
Consultant

Central Health Education Bureau
(CHEB), Dte GHS, Ministry of
Health & Family Welfare, Kotla
Road, New Delhi-110002
Phone: 3239943, 3235867
Seva Mandir, Fatehpura
Udaipur-313001, Rajasthan
Phone: 560047
Fax 294-560047
FRCH, 85, Anand Park, Aundh
Pune-411007
Phone: 387020; Fax: 381308
CIN I-Child In Ineed Institute
Post Box No. 16742
South 24 Paranganas, Vill.
Daulatpur, Calcutta-700027
Phone: 4678192/1206
Community Health Cell
Sreenivasa Nilaya, No.367, 1st
Block, l8t Main, Jakkasandra,
Bangalore-560034
__
National Dairy Development
Board, Anand-388001

Residential Address

5 Sri Aurobindo Marg
New Delhi-110016________
11 UP Babar Place, Bengali
Market, New Delhi-110001
Phone: 3755170

7 Mayur Complex, Panerio Ki
Madri, Udaipur, Rajasthan
Phone: 0294-461210
Block No. 99, MHADA, H6
Laxminagar, Paravati, Nilay
Apartment, Pune410007
Phone: 547542
679 D-H Road, Hindustan park,
CalcuUa-34

Flat 202, Citadel, Bird Cross,
Hird Block, Koramangala
Bangalore. 560034

4A Suva Society, Behind R^j
Mahal, Vyayamsala Road
Anand-388001_____________
Sunshine Building, Mota Bazar
V.V.Nagar, Anand-38820

w

Urmul Trust, Bikaner
Lunkaransar-3 34603
Phone: 2238822804/22556
H

431/1 Jethabhai's Pole, Khadia
Ahmedabad-380001

Sewa, Sewa Reception Centre
Ellisbridge, Nr. Victoria Garden
Ahmedabad-380001
Phone: 5506477/5506444

802 anchandeep Apartment
Satellite Road, Ahmedabad380015; Phone: 6425119
B-2 Sunshine Apartment
Ahmcdabad
Phone: 6443610_________

SWATI
Dhrangadhra-363310, Gujarat
Phone: 50338______________
CHETNA
Lilavatibcn Lalbhai’s Bungalow
Civil Camp Road. Shahibaug
Alunedabad-380004
Phone: 079-2866695/2868856/
2865636, Fax: 2866513
Email: indu.capoor@lwahm.net
(OR) chctna@adinct.emelin

I

CKJETKliB
Centre for Health Education, Training and Nutrition Awareness
Ihdla’ 'Phone ■Sessse9 2866695,1 MeMsT’' Fex^?1
Gram : CHETNESS

Enriil • Indi/rnn.

‘

T GU'a,S1’
79“^n66513 and 91-79-6420242

<- r oor^Lwahm.Not (Or-^) chetna^aclinet .ernot.in

o c XtH'0/ 3'99^

A DISCUSSION ON THE WOMENS* HEALTH MODULE
Sl.No.
I.

_________ Name & Address
V

Signature

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Signature

vzO H ) b -I V)
CONCEPTUAL FRAI'Ea'ORK FOR ASSESSING WOMEN’S HEALTH NEEDS

Thelma Narayan*
Introduction

It is now more widely accepted that during the past few decades the

health system in India, in its planning and health careservices, has viewer
the health needs of women primarily in terms of their child bearing or
i

reproductive function,

^ost health programmes for ’.-.’omen ’have focussed on

family planning and mother and child health services.

The main interest

seems to have been to evolve methods by which the reproductive function
of women could be controlled, so as to serve the needs of the nation, of
society, of demography, of the child or perhaps the family. Even child
■ survival strategies were evolved to ensure that the small family norm was
acceptable to people. There is probably a consensus among people oriented
health workers that this has been a narrow and limited view concerning
It does not take into consideration sur "iciently the
women1s health.
personhood and the wholeness of women.
There is also a growing and anxious realization that this approach has
not even been able to serve the
tne purpose ror
for wmcn
which ir
it was intended, namely
of pooulation icontrol
(Control.. However in the process of evolving alternative
approaches, the basic assumptions concerning the position of women in Indo

society and their resultant health status, on which the earlier approach

rested, have not been challenged or cuestioned by the health system.

Therefore, the same philosophy, with the same underlying goals have been
repackaged or extended to cover more than just the child bearing age group
of women. They now also cover the girl child and the adolescent girl, wit;

the hope that these efforts would bear fruit during the crucial childbearing or motherhood period.

International public health experts and

agencies have also floated various package deals like GOBI-FFF ana Safe
Motherhood, which again are narrower and more verticalised versions of the
earlier Mother and Child Health Services.

The other cause for deep concern in India has been the declining sexratio as is revealed by the decennial census, ever since the turn of .. 2

^Community Health Cell, Society for Community Health Awareness, Research
and Action, 326, V Main, I Block, Koramangala, Bangalore - 560 034o
Prepared for the Workshop on Women's Health conducted at the Child-In-Heed
Institute (CINI), West Bengal on the 23rd and 24th of April 1993.

2O
the century.

Levels of other indicators regarding the health status of

women like the Maternal Mortality Rate, levels of anemia and malnutrition

etc., are also unacceptably high. This has occured inspite of at least
four decades of planned health interventions through an expanding health

infrastructure.

It has occured even though there has been an overall

slow improvement in other health indicators of the population in general.
There is therefore, clearly a need for a “rethink1’ and for evolving new

approaches.
Redefining health needs of women

If new policies, strategies and approaches for the improvement of the

health of women in India have to be developed, there is a need to under

stand and define anew what the health needs of women are.

A few ideas are

being raised in this regard.

A woman is a ijunnam perscra situated in society and her health tjas to be

viewed with an integrated wholistic approach.

Several non—medical, societc.-,

socjo-economic, political and cultural factors determine her health status.
Using the >.140 definition of health itself, there is e reed to include the

physical, social, emotional and intellectual (mental) and spiritual aspects

in understanding the health status and needs of women, when evolving health
strategies.

When considering physical health, while her reproductive system does
influence the fundtioning of her body and may be a cause for ill health,

women also suffer from morbidity and mortality resulting from disease in
any or all the other systems as well. Availability and access to good

asic and comprehensive health services is therefore essential.
a
There is also/close interplay of all the aspects of health mentioned
in the WhO definition.

The most crucial fact, cutting across class lines

is that being 'woman' straightaway categorises all women to an inferior,
unimportant social status in India.

When considering the sizeable prop

ortion of women (30-40% by official estimates) living below the poverty
line, their health and social status is far worse than others and would

derive from the following life scenario.

Being poor they are likely to
have a large number of live, stillborn and aborted children, They are
also susceptible to a variety of physical sicknesses, most or which are

preventable.

They undertake exhausting work at home in poor environmental

■

-

:

conditions.

At work too they have the dirtiest, most tiring jobs with

inadequate remuneration and rest.

They have lower levels of literacy and

less access to existing health services.

Life in this situation also maker

for a poor self-image, low self esteem, lack of self confidence and to
unrecognised emotional problems during the several episodes of life crises
that are experienced.

Viewing women, particularly poor women, surviving in an inhuman situ
ation, primarily in terms of their reproductive function, therefore does

them no justice, and not surprisingly, does not meet the targets set by

the health system,, and even much less caters to their total health care

needs. There is evidence infact that this targetted approach with the
indiscriminate and unscientific use of numerous family plarhing procedures,
re an added iatrogenic cause of ill-health for women living under these
adverse circumstances.

Therefore it is imperative that the health needs of women should be

viewed from a broader and a more humane perspective.
Her value cs a human rerson of dignity and worth needs to be
emph a hi s ed. This is to be de-linked to reproduction or production
of any tyre.
★

This crucial aspect* is not measurable or quantifiable.

Her total health needs in the context of her circumstances should
be considered.

* Positive indicators of physical, emotional, intellectual and social
health need to be used.

* Periods of l|fe crisis in womens1 lives are to be recognised.

This

method can build on the strengths and infrastructure of the MCH
approach and extend not only to the girl child and adolescent but

also to the postchild bearing period.
Indicators to assess health/oiseese

The assessment or the measurement of the health status of women is an

important yardstick for us to know where we are in our efforts to promote
the health of women.

It helps us to make a situation analysis, to measure

the extent of the nroblem, and also the effectiveness of strategies used.

..<>4

4.

Commonly used health indicators most often give us information about

levels of disease and death among the population.

These are a result of

general living conditions, access to health services etc., which are thus
indirectly indicated. The sex specific Crude Death Rates, sex differential5

in Infant Mortality Rates, Maternal Mortality Rates etc., based on studies
of sample populations, are well known indicators of deaths occuring in
different groups of the population,

also reflects the overall health

Life expectancy

at birth or at 1 year

status and conditions under which people/

women live. The sex ratio is the number of women per 1000 men and its
trend over the decades speaks volumes to us of the situation of women in

the country.

If one could disaggregate and study these rates by geogr

aphical region, by urban/rural/tribal location, and by class and caste,
enormous differences would be revealed.

It is necessary to do this if

che health statusof those in greatest need has to be recocnised/assesed
and also for the monitoring and evaluation of health and related strategies

that are employed.
Inspite of certain limitations and cautions that are necessary when

undertaking such an exercise, comparison of rates between Districts, States,
South Asian Countries, Asian Countries, developing countries and developed
countries are useful.

Some indices from South Asian countries are given

below to illustrate the differences revealed by such comparison.
Maternal Deaths

Female Life

Proportion of

per 1,00,000
Live Births

Expectancy

Births Attended by
Trained Staff

1. Agghanistan

690

42.0

8%

2. Bangladesh

600

50.4

Co^

3. Bhutan

1710

47.1

7%

4. India

360

57.9

3 3%

5. Nepal

830

50.3

6%

6. Maldiyes

400

61.0

25%

7. Pakistan
8. Sri Lanka

400-600

56.5
72.5

24%
87%

Country

f

60

(Years)

Source: 2
...5

5.

Information regarding sickness (morbidity rates) among women are more
hard to come by at the national or State level.
community based epidemiological data.

This is even more true of

Studies of nutritional levels reveal

that levels of malnutrition among girls/women continue to be high though
there may be a gradually declining trend. Studies by the National Nutrition

Monitoring Bureau showed no evidence of improved height and weight among
girls from 1955 to 1979. One third of babies born are low Ipirth weight
(less than 2.5 KG)/ which results from poor maternal nutrition, Other

studies reveal inadequate calorie and micronutrient intake.
Community based studies by Rani Bang/ et al./ have found that the

prevalence of Reproductive Tract Infections (RTl) are very high.

Contra

ceptive use in the presence of RTIs have been found to aggravate the

problem.

Occuoational or workplace related health problems of women in

che tobacco industry/ among tea pickers and in a host of cottage industries

in the unorganised sector also reveal high sickness rates.

Hazardous effect

of rollutants on women during childhood/ adolescence/ pregnancy and lacta

tion also heed to be studied.

A study by Sathyamala/ et alj. , found that

the toxic gases at Bhopal adversely affected reproductive health and repro

ductive outcome in Bhooal.

»7e have an indication about the extent of

violence against women in Indian Society from the media/ and from the
experience of groups working with women.

A few studies regarding mental

health indicate a higher proportion of suicides and suicidal attempts
among women than among men.
It is necessary to integrate and pool all available data concerning

uhe different aspects of health of women to get a composite understanding

of the situation.

This needs constant updating and continuing studies.

When putting different studies together/ it is also important to keep in
mind that there may be differences in concepts and definitions used and
in the methods employed.
Need for new indicators

While accepting that having some indicators/ however imperfect/ are
better than none/ health workers/activists have been feeling the need for
indicators that could gauge decision making opportunities and capacities of
women/ their levels of participation in health and societal life/ their
. . .6

6.

levels of autonomy, their role in provision of health care in the family/
their levels of knowledge and practice of traditional methods and systems
of healing among others. There is much scope for further work in this.
Indicators of health related issues

These include figures regarding levels of literacy (formal, non-formal),

income/wages, percentage below the poverty line, employment/unemployment ,
participation in different sectors of the workforce, purchasing capacity,
housing, food intake, access to safe water and sanitation. These are also

crucial factors that impinge on the health status of woren.
Health care indicators

These would indicate access to primary and secondary health care,
stance to nearest health facility etc.

Utilisation (of services) rates and coverage rates are "v"ilable for some
services eg., immunization coverage and immunization status, The proporticn of births attended by trained personnel .’.2 also a useful indice.
of effectiveness and utilirudy of in and out—
saticn of services is illusurated by a few examnles.
patient records showed that for every 3 men who utilises 7-edical services

The need for measurement and assessment

J

Male staffing of facilities was a deterrent to
utilization (Ref. Health Status of Indian Peer le. 1968., Foundation for

only 1 woman did so.

Research in Community Health)
Another recent study by the paediatric Department of Maulana Mzao
edical College in 150 slums, covering 22/181 households in the capital
city of Delhi found the following:
* 45% mothers did not avail of antenatal services

* 16% had the ootimal

four antenatal checks

* 12% smoked even during pregnancy
* Awareness regarding health, nutrition, and awareness of

possible complications curing pregnancy was ooor

51% received iron and folic acid tcble-S
63% mothers ,were immunized with tetanus toxoid.
82% delivered at home, untrained birth attendar.os

conducted most deliveries.
Source: 3

.. .7

7.

I

J

Caution in the use of indicators

When using any health indicators# it is important to keep in mind the
methods of data collection and quality of data before deriving conclusions

from them.

Questions should be raised regarding methods of sampling used

viz.,£re they representative of the population.

Are findings from one or

two studies conducted in relatively defined geographical areas being
extrapolated or generalised to the entire population.

There is thus a

need for a critical appraisal of any data and. rates.

It is also important

to keep in mind that the health situation ir. the community is dynamic and
changes continuously as a result of several factors.

It may also not be

all that easy to draw cause and effect conclusions
a particular health
intervention and possible health outcome. The role of other factors that

ould cause a bias or be confounding will have to be considered.
1

However#

inspite of all the above there is scope to build further and net to just
abandon what we already have.
as

we look at new perspectives emerging in health/ new indicators

need to be developed.

References

1. M.Hanrnond and J Gear/ 19 86
Measuring Community Health - Workshop 1
Oxford University Press.

I

KIMFIT (National Immunization Mission Feedback Information and
Technical Update )# 1992#
Ministry of Health & Family Welfare# GOI# New Delhi#
Issue No. 24# June 1992.
3. Puri R.K. and Sachadev H.P.S.# 1992#
MCH Services in Delhi Slums
KFI Bulletin# April 1992# Vol. 13# No. 2.

4. Shatrugna V. (undated)
Women and Health# Current Information Series 2
Research Unit on V/omen* s Studies# SM DT Womens University.
5. World Bank, 1991
Gender and Poverty in India - A World Bank Country study#
The World Bank# 1818 H Street# N.W. # Washington D.C. , 20433/ U.S.A.
r

wil?

vo H ■“ \ b - I \

RATIONAL HEALTH CARE MODULE

Content
Healing and Health Care were usually seen as 'service' and not as
'trade' and 'business' in ancient India. Rational Health Care is
appropriate use of the existing health care systems of non drug
therapies with appropriate efforts at preventive, promotive,
curative and rehabilitative dimensions of health care. It
attempts at addressing, physical, mental social economic
spiritual aspects of health in a way which is gender sensitive,
culturally sensitive.

The criteria to be kept in mind in choosing options are :
1.
2.
3.

4.
5.
6.

Effective
Safe
Low cost/Reasonable/appropriate cost
Locally available/or encourage
Easy to administer
Technological self reliance

Health Care today is in a deep crises in terms of the increasing
gap between health care needs and health care services. There is
an increase in diseases of poverty and rapid urbanization,
waterborne diseases,
vector borne, air borne diseases and also
life style diseases. Most of these require an epidimiologically
appropriate public health response. As curative care is replacing
preventive and promotive health care efforts, increasing use of
pharmaceuticals is taking place. With health care budget
continuing to be inadequate and actually decreasing. With 80% of
health care being provided private sector from trained by
qualified doctors to R.M.P's.

The spiralling medical care costs in diagnostics, drug costs as
well as doctors fees has resulted in medical care emerging as a
major cause of rural indebtedness amongst the rural poor.
With inadequate attention being given to existing local health
practices and traditional system of medicine in national health
policy and national health programme, the promotion of western
medical model which isr^eductionist in approach that looks at a
part (an organ) rather than the whole has taken place. Holistic
approach which promotes balance not merely within parts of self
i.e body mind and spirit but also between self and other being
self and nature.

1

In a country with 4 0% or so people below poverty line and
^increasing disparities between countries and within countries.
The World Health Organization (WHO) IN 1995
included a new
International Classification of Diseases called Z 59.5.
It
stands for 'extreme poverty' with increase in extreme poverty.
The diseases of poverty are bound to increase. As the burden of
disease on developing countries increases with increasing
disparities, economic recessions with increasing unemployment,
decreasing purchasing power of local currency, environmental
degradation, rapid urbanization, collapse of public health
services, increasing privatisation and commercialization,
pharmaceuticalization of health care, more and more amongst the
poor willbe unable to pay for the medical services.
Experience in Latin America and Africa has shown that with ' Fee
for Service' the utilization of medical services by the poor who
needed them most was negatively affected.
To have an appropriate mix of the public sector, private for
profit and private not for profit is required, which is based not
just on western medical model but allows a pluralistic approach
with appropriate use of Indian Systems of Medicine of Ayurveda,
Siddha, Unani, Homeopathy, as well as simple home remedies folk
medicine for trivial health problems, based on herbal medicine
and non-drug ^therapies of therapeutic massage, acupressure and
acupuncture^ Rational health care is based on the principles of
priority of primary health care, with appropriate us^ of
secondary and tertiary care for referrals when needed r X-t is
rooted in the principles of equity and ethics in health care with
appropriate gender sensitivity not merely where health care
seekers are concerned but also where human resource development
is concerned, ensuring that women health care providers are
available to address to women's health care, needs specially
their reproductive health needs but also where women are given
opportunity to be position of decision making to genuinely
address gender issues, where gender disaggregated data is
collected and gender health concerns are addressed fl Parameters
and criteria for assessing women's health status and the trends
need to be developed besides demographic criteria where
management information system attempt at looking for, collecting
appropriate data, into causes and trends e.g of poisoning, burns
and violence of against women where not merely prescription
audits are done as part of self monitoring by the institutions
themselves but medical audits social audits are also done of
major health programme and criteria.

2

©

Rational health care includes Rational use of drugs as well as
rational drug policy based on essential drug concept. 90% of
medical problems can be addressed by 250 drugs - out of the
existing 60,000 brands in the market. "The acceptance of the idea
that a limited number of drugs can cater to over 79% of the
pathological problems in developing countries has with one bold
strokes, swept away the very carefully cultivated (and promoted
at high cost) the often spurious justifications for the large
number of brand named drugs. Now the list is short. The choice is
clear if its not made it is either the result of ignorance or
inability to face the pressure of pharmaceutical interest."
Criteria for selection of essential drugs is based on whether the
drugs ;
1.

meeting real medical need
medical care.

2.

Have significant therapeutic value i.e drug should
claims made.

3.

Be acceptably safe i.e likely benefit must be more than the
risk involved.

4.

Offer satisfactory value for money.

i.e improve quality and extent of

fulfill

Other criteria to be kept in mind while choosing drugs is :

- Assured therapeutic efficacy
- Cost of entire course of treatment not mere unit cost
must be kept in mind.
- Quality assurance.
- Limited potential of misuse of drug
- Ease of transport and storage
- Ease of administration
- Single ingredient medicine as far as possible
The concept of essential drugs
primary health care concept.

is a crucial component of the

A Rational Drug Policy would require formulation of a national
essential drug list. The essential drug list should be the basis
of production distribution, prescription and consumption of
drugs. Graded essential drug list depending up on the competence
of health personnel, diagnostic and referral and specialist
services available based on the disease pattern of the area must

3

be drawnup. Delhi state formulated a state essential drug list as
a basis of bulk purchase which it did for the various Delhi
Hospitals making a saving of 30% cost and using the savings to
purchase more essential and life saving drugs.

Priority Drug list is a drug list drawn from Essential Drug list
based on drugs required for diseases causing

-greater mortality (death)
-greater morbidity (illness)
-Severe sequelae (after effects)
-communicability or spread potential
e.g (TB, Cholera)
Essential Drug list may ]be subrjivi^d^d
following manner.
{xUmIuxJL

into \$ub Xist>s/dLn^th<e
er the counter drugs

1.

Drug to be sold without prescription
(O.T.C)

2.

Drug constituting about 10% of essential drugs
drugs for symptomatic relief and preventive use.

3.

Drug reserved
physicians.

4.

Drugs reserved for highly
restricted for use there.

5.

Vital (life saving) drugs for emergency, supply of these
drugs should never be interrupted. e.g. insulin digoxin

for general hospitals

and

specialized

comprising

for practicing

hospitals

and

There is a need for monitoring major mortality and morbidity
patterns and the trends to ensure that the drug production drug
distribution,
drug availability prescription and use is as a
response to this health need and not
as a response to falsely
created drug market with aggressive marketing and unethical drug
promotion.

IRRATIONAL AND HAZARDOUS DRUGS.
We have over 70,000 drug formulation forming the Pill Jungee
formulation in the market. Large number of drugs in the market
are irrational, overpriced combination drugs. The drug Technical
Advisory Board and Drug Consultancy Committee and the Centre and
State Drug Control machinery is supposed to ensure the
identification withdrawal of weeding out of irrational hazardous
drug.

4

Since 70% of the drugs in the market are estimated to be non
essential, irrational air hazardous - it is a tremendous national
economic wastage as well as economic exploitation of patients.
Ten crore medicines were sold at the time of national
independence. At present it is over Rs.15000 crore with over
7.20.000 pharmaceutical units, around 250 big and medium size
rest small scale.
Many drugs if taken during pregnancy can cause congenital
malformation of the foetus called teratogenic effect (blocks) of
drugs, On taking many drugs drug interaction with other drugs can
occur. There is a need for setting up Adverse Drug Reaction
Monitoring Cells to monitor drug sales and drug use and to know
more about this so as to warn doctors and patients for
prescribing and consuming these drugs.

QUALITY CONTROL

Due to inadequacies in the licensing mechanism, many manufactures
are issued license who are not capable in maintaining Good
Manufacturing Practices (G.M.P)
Inadequate drug testing labs with facilities for biological as
well as chemical testing in adequate number of honest drug
inspectors has resulted in substandard and spurious drugs
reaching the market. The Lentin Commission to investigate 17
deaths with contaminated glycerol in JJ hospital Bombay, 30,000
IV fluid in Delhi with fungus, Sura Tragedy in Delhi with Sura
being sold as Ayurvedic drug
adulterated with methyl alocohol
are few such examples.
Demanding for good quality control both in private and public
sector is very important with withdrawal of drugs found to be sub
standard or spurious from the market.

Latrogenic disease
In US, with srict drug control and strong consumer protection
laws 10% of admission in hospitals are with latrogenic causes i.e
Drug and Doctor induced In India this figure could be higher.

It is important to buy medicines from reliable medical shops
always look at the medicines bought for the name of the medicine
brand as well as generic content.

5

-name of the manufacturer,
-batch number
-Expiry date

To keep a cash memo specially if life saving drugs are being
bought.
UNBIASED DRUG INFORMATION.

The myth that there is a "Pill for every Ill" must be
discouraged. It is important to know the medicines being used by
us. It is important to look at the content i.e generic name
usually given in very small size and in very pale colours besides
the big brand name. Since there are 60-80000 brand names all, are
not known to all doctors, specially when referral of a sick
patient is required. It is important to create public awareness
to
promote
awareness
about the drugs being used. "Know your
medicines" at least the demand for unbiased drug information for
doctors, patients has long been made - doctors needs to be given
information, indications for use, contradictions, adverse drug
reactions/toxicity/special precaution, Dosage of drugs, Duration
for drug use, method of use etc.
The patient must be
drugs.

given

clear guidance about

the

usage

of

e.g on an empty stomach etc..or never on
-how to take it
an empty stomach as with aspirin, chloroquin, anti malaria.
-when to take - 4 times or before sleeping
-for how long - 5 day course for antibiotics
one year for TB
-Effect of drugs on pregnant women
Information about commonly used medicine for common health
problems is available in the green pages of "Where there is No
Doctor’' by David Werner, in "Family Medicine Book" by Dr Bapna.
If indiscriminately large number of drugs continue to be
introduced with large number of them being combination drugs, it
is not possible to ensure quality control.

-fix drug prices
-provide drug information
It is important to ensure that all new drugs in the market are :
-selected on basic of scientific documentation
-efficacy/toxicity ratio is weighed against the severity of
diseases

6

new drug is more effective than the drugs already in the
market
-There is a single ingredient drug rather than multiple drug
combination
-There is a clear-cut medical need for the drug

clause'' that was applied in Norway to
This is. a "medical needs clause
the
entry
of
new
drugs
to only better, safer, cheaper and
limit
more effective drugs.

DRUG PRICE

With the formulation of the Drug Policy in 1986 and then its
revision in 1994, the drug prices have significantly increased,
even up to over 100% for many drugs This drug increase for drugs
of national health programmes
e.g. TB and Malaria is bound to
increase the cost of these drugs and result in default.
With the removal of drug price control and the change in patent
regime further increase drug price is bound
to occur,
it is
therefore important to ensure that only essential life saving
drugs are prescribed and consumed and use of non-drug therapies
and medicines from Indian system of medicine are also used when
needed.

Early Diagnosis and Early effective treatment is essential for
Rational Drug use. Ensuring availability of simple diagnostic
facility at the peripheral level with trained lab peripheral
level with trained lab personnel is very important for diagnosis
of certain diseases :

e.g. Falciparin malaria, Pulmonary TB, STD smear
So as to
treat early and radically to avoid mortality, to diagnose and
treat effectively for patient's sake and as public health
measure. Urine for protein and sugar testing for antenatal care
Good History Taking Clinical examination done respecting patients
sense of privacy and dignity must be done to reach clinical
diagnose and to start Rx. This is done both in western medicine
and in Ayurvedic practice sometimes patients are unable to use
appropriate words to explain their problem and health personnel
are to insensitive to learn the appropriate terminologies,
understand the existing belief and systems and local health
practices for rational health care, understanding, the gathering
of knowledge of this is important. e,g, what constitutes hot and
cold disease, and which hot and cold foods are appropriate that
can be given to.\

7

With increasing privatisation of health care, increasing
medicalization and increasing distortions with all its associated
implications
are bound to take place. It is important to work
towards a rational drug policy and promote rational drug use so
as to see that those who need medicines and treatment get them at
the earliest and wastage on irrational drug is avoided and side
effects and adverse drug reaction, use of hazardous and
irrational
drugs avoided by weeding out these drugs from the
market.
Amongst the drugs
commonly misused are antibiotics because of
which drug resistance is emerging so that the medicines become
ineffective when needed for life threatening situation.

Steroids which are life saving
but when used for prolonged
periods have severe side effects for conditions not requiring
painkillers specially those which negatively affect white cell
counts and bone narrow
must be avoided. Cough syrups
and
tonics and vitamins when home remedies, good food for same cost
equivaled if not better is available.

Oral medicines are cheaper than injections. Many people demanding
needless injection even when oral medicines would be good enough.
Use of unsterilized injection, needless can cause Hepatitis B and
Hepatitis C, HIV AIDS use of sterilized needle or disposable
syringe are important.

Use of half tablet broken from a full one is cheaper than a full
tablet of same content e.g. Bronchodilator tablet of Salbutamol
is available in 2mg as well as 4mg tablet. Taking half of 4mg
tablet than taking 2mg tablet is cheaper.
Sometimes same drug is available with many different brands and
varying content, different concentration, it is very important to
read the directions before use or have it read and explained.

I

Demand of consumer caution is key to demand for ensuring Rational
Drug Use and Rational Health Care.
Efforts have to be made at the level of opinion makers at village
level by creating general public awareness with Panchayat members
teachers developing workers, provide information to Doctors ANM
etc. many of whom have not been given due information or training
in this area.

8

Social control on the health care and drug market is essential
specially in the
era of globalization where Globalization of
prices would take place without simultaneous globalization of
income making essential and life saving drugs unavailable.

Protection of indigenous knowledge and indigious resources by
actively conserving them and using them by integrating them in
health care is specially important when changes of Indian Patent
Act have been forced upon us by Technologically advanced
countries.
India is rich in biodiversly with availability of personal and
natural resources known for their healing value. They are locally
available and can be regenerated by local initiative.
OBJECTIVES OF THE MODULE

Recognizing distortions, socio economic and politics of drug
trade in medical care to understand what constitutes rational
health care and rational drug use ? what is the concept of
essential drugs? what are irrational and hazardous drugs? what
kind of unbiased drug information is needed ? what is happening
to the drug prices, how to avoid wastage of money on needless
poor quality control of drug, appropriate use of other systems of
medicine?
women involved

Nature of participants
activities.
No of participants
Time

in income generating

20 -25
9-10 hours.

Teaching aids.

Samples of hazardous drugs, WHO's essential drug list, national
essential drug list 'where there is no doctor' green pages
Handouts - giving statistics related to drugs news paper articles
on drugs shortage, tragedies.

Film
: "In the Name of Medicine" by Media Collective dubbed by
Safdar Hashmi in Hindi.
Topics to be covered

Understanding health healing and disease medical care and health
care.

9

Rational Health care
Rational Drug Use
Essential Drugs/Life saving drugs
Irrational and Hazardous drugs - side effects and toxicially
quality control
Drug prices, economic wastage in the name of medicine
Indian systems of medicine
Ayurveda (Yoga)
Siddha Unani etc.

Non drug therapies
Learning about home remedies and medicinal plants understanding
ethics, economic and politics of drug use medical care
protecting oneself from exploitation in the name of medicine
Responsible use of drugs and medical care
PROCESS

Introduction of toftic

Quick feedback from the group about illness within last one week
or one month. How diagnosed? medicines used, information given,
expenditure on medical care, knowledge about how these illness
could have been prevented, and what other systems had to offer,
Whether there were alternatives what the group thinks should be
the components of a rational health policy and rational drug
policy what they could do about improving their own health and
communities health, Know your medicines value your medicinal
plants, women and pharmaceuticals

+++++
Mira Shiva MD
HOD Public Policy
Voluntary Health Association
of India

file:ppu/mira/care

10

V
women end

C/ti
■ Fz
r.
/ • Objectives
• Content
• Duration
• Training methodologies
• Teaching aids required
• ' Reference material for the trainer

•
•

Material to the participants
Any othov

(uil4i^B!AiABACKSS^^

a ana, known as <a disease of;'“hiah fever” hac
years a

I

disease. There
malaria and
Year

.1947
1965
1984
1991
J992~
1994

^1994

—----------------------------1———_ _____________

TPopulatiorToThdia in

__________ crores
____ _--------- 34.4*1

_____ ____ 46.60

----------

~7i7oo

__________~8<00~
__________~86?00
________ _~90^00

---- ------

“
'

Number’ofm^ja'ia
cases
7.5 crores
~1 lakh :
^1~iakhs
~21~iakhs
21* lakhs
"
25~iakhs

Number of deaths

_ 8,00,000
’nTl
~--------247
-----_ 421
_~422
”

ru22

~~~

number
ol „
9erOUS,Orm'“retal™1-i^-^U^.
,£ 4i
‘eeft-RS*og. )s «.Ut>

<Vs-

.U. -l^ere other

have

In your district
1

1
•

/

J

' (See ractjsheet-Hete-OR penguej^ '

/

The National fti^laric^ontr^,-.
-------- hasfvery, clear guidelines for the PHC and the suLh>
1 programme
-■■7-r-■ cases)of
—ses)of suspected
malana/fever. flretfale
centre teams regarding the(follow
zup of
s^spectedj^anan^
fs
suppesod
to^end
fi^
^Fdes
wiS'^lood
fiii^$
;
nin/y SLpatrdms^o
wi
'.i^y the__
______
■ multipurpose health v^o^er > SUpptJbUU LU/bCIIU’ Uictniuco wnr
VCaJ |U
^electlhe malarial parasites SV Acs Vo
' PHC twice a weeM=ter«4^ drained lab techniciai>-isouppoood-to
.
"
'
■
.................................................................. i
the-bteed. Treatment can start immediately as the drugs areQo be stocked with the health
worker. The malaria inspector is a key member of the team; he
tfe directs anti£jnosquito
anti£mosquito measures,
measures.

V
-\V‘

r

/

c

o i-14

iThe reality is that many ofrthese positions lie vacant/and many of thelexisting staff are not
pained in reading the slides^lCombined with a poor(work ethi&; these/excellent guidelines are
not put into practice. Thus if an your area mosquitoe^are plenty, you may have an outbreak at
^any time. This is particularly^ there has beenfmalaria in the past, oqthere are people coming in
from (Tar off places (where malaria is common) in search of work, especially at construction sites.
The season for the maximum cases is July to September
What is the situation of staff/Jrug availability in your districts? It will be useful to ask the
participants to visit their local PHCs and meet the staff there.
If these staff positions are vacant, can the women’s groups apply pressure through the
panchayat to see that action is taken?

In places where the -Givt-. PHC etc (does not function, people often go to the local vaid/hakim/
private doctor. What are the remedies\used by these practitioners? Some of tbb private doctors
unfortunately treat the fever^without^the blood tesfj with too many o^er^owerfuhdrugs.
? i Poorer families waste a lot of money on these treatments. If it is U^e/womanoOTeTamUy who is
7f
} sick, she may even delay treatment or not complete it in an effort to save the family money.
x
some places there are kpovwi herbal remedies (^ptapami-jMstonia scholaris or Lata
w
Karanja-3Daesalpinia) thesevrrfay be taken traditionally for the treatment of this fever. There is
literature"available on some herbal remedies/(See box). Are there any other remedies
available in your locality that people use for effective treatment of rgglaria?.
cvSfcce#
idrrcferthe allopathic system of medicine;,The treatment guidelines(are te-be found in thelnalaria
faebsheet Please make sure that^all women’s groups havaitavailable-in the local language.
if \ (2\l^\\obU Vi>
A major way of preventing malaria is to control the breeding of the mosquito and avoiding being
bitten by the insectH(See Fact Sheet on mosquitoes). There are at least three different types of 7 2 f
mosquitoes, each type causing a different disease^ Each eHhese type$ has different breeding sites/and biting times.|ltis important to note that insecticide spraying and impregnated bed-nets,
are not the only solutions to this oroblem. In fac^one of the weaknesses of the national
programme has been that it^ren^i too heavily on this approach and more ecofriendly, diverse
local methods have not been tried^ n is time now to explore these options with the community
so use this opportunity to listen tolhe women and their ideas on the subject. Look for ways in T;
which this information can be shared in the villages, especially with the children. The health
education methods should be as many as possible, including folk-theatre forms, exhibitions, etcj
Finally, an important issue to discuss with tne participants^is the key role that women play as
care-givers when any member of the family is sick. This includes all illnesses with fever such as
or dengue- If the womqn herself is the patienUhere is the burden of pending housework
(which otherwise falls on an adolescent daughter) and loss of wages if she is a working woman \
in addition to the suffering from the illness. If the patient is a family member, she sUU has to
\
shoulder the added responsibilities of nursing.
......
.
.

\
J

K

/■’

/-■

Should the woman go-erHe chronic malaria, the resulting aqpmia will add to the existing fatigue
Irofn under nutrition and overwork. Both as an equal member in family and society, and with the
. additional care-giver role, this disease places a burden of suffering on the women.

Prevent an epidemic
I When can you as a community expect a malaria epidemic in your area? These are some
' warning signals to lookout for, otherwise many lives may be lost before action is taken.
■

I.
II.
III.
IV.
I V.
I VI.
VII.

| VIII.

Intermittent rainfall with gaps of 5-7 days between downpours.
History of malaria in the area.
Increase of mosquitoes.
Increase of malaria cases-fevers with shivering or fevers relapsing on alternate day^
News offr^laha epidemic in neighbouring areas.
No insecticide spraying activity in the past six months or mor^. (^
The4afve^ef#^mosquito[[A^ collections of water, th&y looyike tiny dots followed
I k/ito dashes.
* ffignrever^ with shivering followed by death^r?

»

HomeJHerbaftAyurvedic remedies in the treatment of malarial fevers^ ;

.r: <

These remedies are being shared from a number of sources, along with the methods of.
• ‘'
preparation and administering. Most of these remedies are meant to abort the ^ttacKotfeyftt-Qrf
make_it mild, thus reducing suffering.
•
V
Boil 60 gfems of Chiretta in glasses of water and redi I it to l^/glass? Add 60
r%r an hour. '
gw of thulasi leaves to the hot decoction, cover and
Squeeze out the leaves into the decoction. Strain and drink.
Dose: 1 cup thrice a day for 3-5 days.
-

Chiretta
Andrographis;
f?aniculata

Thulasi
Holy &asil

Km <10 gm»of thulasi leases juice mUod-with 5 gwoffflack pepper(p5w3ere3 to:
be given to the patient in the cold stage of fever..TQ4hifrCQn be add^d jaggery .,
or suga^lhe decoction must be sipped slowly.
Six teaspoonfels of the juice must be given three times a

Guduchi
Tinospora
fiordifolia

Neem
.
is most useful>
Azadirachta v* pleem bark bruisedxJZ^unees, ((^domogrl teaspoonfcy [coriander/ water 20
Indica
z ■ounce^; boil forhew; dose 2 ounceSr-Givo bofeFeTeve^fiee&r•
Grind 2-3 fresh ineem leaves and 2-3 coms of black pepper with a few drops of
water. Gtvefbeforc tine feverrisesyg
■
; ; : .
;

5^

*

At) be

A-Vt Ceucz

3

/

3 a.FactSheet on malaria/ dengue/ filaria

/

MALARIA is an illness caused by a parasite^germ (Hindi - parjeevi) which is transmitted to
human beings and from one human to another by the bite ofjnosquitoesf.

r

When should you think a person has malaria?
A person who has high fever with chills or shivering, daily or on alternate days.may have
malaria. He or she m^glso complain of headache, bodyache and vomiting. The fever, after
lasting 2-6 hours comes-^ewTi with profuse sweating. There is a feeling of fatigue and
weakness.
°
In some types of malaria, the person has ajs^vere headache and becomes delirious drowsy
or unconscious because
the brain. This cerebral malaria is a
dangerous disease and if not promptly treated, the patient can die 1n 2-3 days.
<• How does malaria spread?
When a patient who has malaria is bitten by a female janopheles mosquito, the malarial
parasite enters the salivary glands of the mosquito ^fi^at'ures4i^eFe. Now when this,
mosquito bites a healthy person, the parasite enters his or her blood and within 2-3 weeks
he/gtarts havtag fever.
s To k a \)q

'> If someone in your community seems to have this fever, what should lyou do?
A person who has high, recurring fever, or severe headache with drowsiness/should seek
medical treatment from the nearest health worker, be it a malaria worker or/3octor.
1) A blood test (drop of blood on a glass slide) should be done. The parasite can be seen
blood^film on'a'slideo
health worker who does the test wil> make one thick and one thin

•

2) The health worker/(a malaria worker) will give treatment consisting of chloroquin tablets

gi've^rZferto^e^allen?''6"

3965 (See

ThiS Wi" deStr°y the parasite and

3) If the blood test shows that the patient has malaria, then another round of tablets will be
tr6?

patl,fnl by.the
worker under the supervision of a doctor/(seeTable 1). ..
This tablet .s called primaquin/This-is-to prevent the relapse of infection
t L)

TABLE 1: Age-wise dosage for the treatment of malaria - NMEP guidelines

Age in years
i------- - ----------------

' _<1_yr_______
1 -4 yr_____
5 -8 yr_____
9-14 yr
15 yr & above

Tablet chloroquin (150 mg/ base)
Dose
75__
150
300
450
600

No of tabs

Tablet/^rimaquin (2.5 mq/base)
Daily dose for 5 days
Dose
No of tabs

1
2 _______
3 _______
4

2.5
5.0
10.0
15.0

2
2
4
6

Chloroquin treatment can be given to infants and pregnant women.
Primaquin is not to be given to infants and pregnant women.

..:4

❖ Is it important to take the complete treatment ?
People can get malaria more than once^especially if they do not take the full treatment which
» will kill all the malaria parasites in their bodies.

Ji

If a woman has malaria, what are the problems she faces later on in life?
y Recurrent or chronic malaria in a woman can lead to abortion and stillbirths. These have
profound social implications in our sodejy, where j^wQman’s child-bearing capacity is very
Cimportant Jt can also lead to arjemia.^eakening^urth^ the member of the family who is
\ already anemic because of her diet. It will also lead to low birth weight babies, affecting the start
of their lives. Thus in addition to the suffering from the symptoms of malaria directly, she
indirectly suffers in a social context where her capacity to produce healthy living children is

How does malaria affect children, facts that women as chief care-givers in families
need to know?
Malaria affects children more severely than adults. Some children will get fits with the high fever,
Sometimes, newborn babies can Ibe bom with malaria germs in their blood if their mothers have
malaria. This will cause malaria and
. J arj^mia in them. Infants and children must always be taken
promptly for treatment.
Can malaria be prevented?
involve-Can be prevented by Protectin9 yourself from being bitten by mosquitoes. This might

'

preventing the breeding of mosquitoes near the house
other9|Se^seither inSeCtiC'deS (by the 90vemment health team) orjbuming neem or

Using rapcllantjbils that-are(locally usedjto protect the sldn from bites./Addition of a bit of
■ -

neem oil to the regularly^usedTocaroiThas this effect©
Using impregnated bed/iets;if this is financially viable and a culturally acceptable solution.

Why is it so difficult to get rid of malaria?
Malaria is not a problem of an individual or a family. It is the problem of a community. All
members of the community need to work together to tackle the malaria problem in an area
Groups like yours (Mahila ^andals^youth groups, farmers groups^ co-operatives.aed the
village panchayaf? school teachers and the village doctors&aidsChakims must all work together
to handle the problem.
a
They must all work together to reduce or remove places where the mosquito may breed

10 iden“y-a" 'h0SG wh0 are suf,erin9 ,rom malar'i*

i

a biood

The malaria programme is closely connected with the village development programme. Clean
surroundings without stagnant water; planting trees in marshy lands; putting fish in water tanks
pondsl and other collections used by the people; levelling land and filling pits that will prevent
GQlleGtion of waste water from homes; introducing herbal gardens^especially with neem and
thulasi; teaching children in village schools about malaria and the importance of village
sanitation are all programmes that the panchayat, women’s groups and youth groups can do to

t

5

tackle the problem. A village^with clean surroundings is a long-term health investment against
malaria and other mosquito^borne diseases.

What can YOU do about the malaria problem in your area?
As a member of the community, one of the major responsibilities you have is to educate your
family and friends on the ways of preventing malaria. Use every chance you have to impress on
them these points:
1. The way in which malaria is transmitted q
2. Every person with fever should see the health worker immediately for treatment©
3. All patients with fever should co-operate by allowing you to take blood films©
4. The community should co-operate in spraying operations and in preparing the houses for
spraying and after-spraying<g
5. Do not allow stagnant or slow moving water to collect near the house.
Everyone should protect themselves from mosquito^bites, especially in the evenings by covering
themselves and wherever possible, by using gauze screens or mosquito-nets.
W'.-Jhe following sections need only be taken up by the trainer if she feels that these diseases
are there in the area. Please omit if not relevant
7
■
'
------------- '
DENGUE FEVER
...

Dengue fever is also caysec^by a germ and transmitted by the bite of a mosquito but these are

sss

These ™squi,oes breed in

h?Ue/eVerJi alsof^l,ed break-bone feve^ starts with a high fever with chills, a severe
headache and painful muscles and joints which do not allow the patient to move A day later
ra!h8Xetheerene“?ew
eyes'espe“a"'' wl“1 eye movements. Often this is followed by a

uX™ a SSiapse"^ sSo"6" and VOmi,i"9’ ”i,h “«dinp
The main treatment for^pengue is to reduce the fever and rest the body.

Dengue fever in its severe forms must be treated by health facilities that can treat shock hence
»it becomes important that all patients with fever see the health worker.

FILARIA
Filaria infection is caused by germs transmitted by the bite of the mosquito. These mosquitoes
breed in dirt^stagnant water. In the early stages there may be repeated attacks of fever with

ss in s: le ;p

9e ls

It is important to take steps to get rid of mosquitoes because/this disease cannot even be
detected until repeated attacks of the symptoms occur. ■
6

I

i

3b. Fact sheet on mosquitoes
There are many types of mosquitoes. The type of mosquito that transmits malaria breeds in
clean water collections and streams. Other mosquitoes, responsible for the transmission of
dengugjfexerand filariabreed in dirty, stagnant water.
| Sites of breeding can be
4 i Wells
• Stagnant water near taps or hand pumps
• Paddy fields
• Rain water pools
• Roadside ditches and drains
• Canals
• Streams
• Irrigation channels
• Cartwheel ruts
• Hoofprints and footprints
• Tyre marks on kutcha roads
• Seepage water collections and so on
cAtAu'Xni rl
To check whether mosquitoes are breeding, you can spot them by checking the sites for larvae wiroh-efe small fish-like creatures which come fromMggs of mosquitoes and which come to the
^urface to breathe from time to timeQ

7;'

/

(Introduce the life cycle of the mosquito herg^
The malaria mosquito usually bites at night or at dusk. The mosquitoes transmitting dengue and
filaria bite in the early-morning hours.
The mosquito rests inside the house or outside the house in dark shady places and on the walls
before and after biting.
J
We can control mosquito breeding by eliminating^jeducing their breeding places b£?)
■ Draining water collections near hand pumps, taps and around the houses
• Filling and levelling roads to avoid hooLor carMvheel rutso
• Filling ditches by the side of roads and'candi^
When water cannot be drained, or when collections of water in tanks and ponds are necessary
for use, therQ
3
• Introduce mosquito larvae eating fishes called guppies and Gambusia©
• Spread kerosene oil or malariol on water surfaces which cannot be drained. This prevents
the larva from breathing and they die.
Mosquitoes in and around the house can also be killed by burning neem leaves or other locally
known leaves or incense whose smoke drives away the mosquitoes. Another possibility is to
screen doors and windows with juting or nettingQ
Insecticide sprays are available)[the government health team sendsjteams to spray the houses
You can help by allowing the malaria worker to spray the walls of$opr house^WitTrooms
including the store, kitchen, bathroom and cattle sheds with insecticides.
These insecbudes have a lasting effect for 2 to 2 % months. Do not plaster the sprayed surface
with mud, cov^iung or whitewash because this will prevent the insecticide from working.

7

r.

•seen*i

1

.

4'

burning

soulif to'Sway'temo'squtoM aXT"9 "Gem leaVeS °r

TRAINING MODULE
Objectives of this module

1.

Xn9"5 and S,mP,°mS °'malaria a"d be at>te» “nvey mis picture
pa‘fe">- "osquito-heaithy

3.
learning
fen bn S5*?at the mosquito after
felt iocal knowledge. ThesoXlJiXl
USin9
I

4.

5.
complications. They can raise these issued
? imPlications of the diseases or their
problems are expressed ,igroup aXSXsX”"1-"1e W0"’en' S°
arn ?nSrS
access to c°rrect treatment guidelines and with care-givers also.
.
car"1 give these to the women’s
group , who must also have these in
a written accessible form. Some discussion and
exposure to possible action they can
take when faced with irrational therapy must be
covered.

Duration of session
10 minutes
15 minutes
FA 5 minutes

20 minutes

1 day
combine with other
programmes
.30 minutes

■

Content of session
Review of fevers(with
a special name)
_ locally- link to Malaria
Malaria —signs and
symptoms________
Patient-mosquito
person cycle
How malaria spreads
Mosquitoes in the
area- behaviour,
breeding sites,
Possible interventions
Govt programme, key
team people

Malaria-anemiamotherhood-issues
Implications on
finances of the family

Methods that can be
used ________
Group discussion

Materials required

Question and
answers_____
Qs and Ans
Group discussion

Charts/ posters
blackboard
Charts/
board/microscope/slid^’
esNeem oil/ leaves,
impregnated bed-nets

Group discussion,

Visit to the PHC/
Local healers

Transport

Role play/
Case study

■[
8
t1

Duration of session

Content of session

Methods that can be
used

Materials required

15 minutes15 minutes

Correct treatment
guidelines/ role of
other health
practitioners

Group discussion/
Pamphlet in the local
language

Pamphlets/ posters

Adapted from and suggested further reading
-1
\ /L_l A I
I A r-> *
nCl-7 T
°
1. VHAI/SOCHARA
„ - i 1997 Towards an Appropriate Malaria control Strategy Chap Health
education
2 MRC
1996in RiS3113 COntr°l T/? Appendix: Messages for Health Education
o
1
Bioenvironmental Control of Malaria - A Holistic Approach
3. VHAI 19?6 Malaria Control

4.
5. Manual for Community Health worker 1978. Ministry of Heath and FaXwXS.

;rsr,aTaRak“

6. Health,landlFamily^/Velfarelaria aC“°n Pra£,ramme <MAP>

R

°OI. NMEP. Mlnlsky of

MoiabhaV EfXP^enCeS in health and immunity development Booklet on malaria

8. Malana control an attempt 1996, GOI.NMEP, Ministry of Health and Family Welfare
Material for the trainer

training.Z Awaem„XS

rainers to° use as resource material in the

rch Centre.1998

3. Life-cycles of the anopheles and the malarial parasites - Malaria Research Centre

I.

■

9

vo \A - \ t> A

TRAINING MODULE ON TUBERCULOSES
For Women’s Health Information Pack.

TUBERCULOSIS^'

Ko ■(-jJ

Oxo 'T

1. Introduction - TB in India
X

This disease also called 'Raj^a) Roga or Kshya Roga* affects large numbers of Indian
people. It is a major problem in our country. It is closely link :d to poverty, under-nutrition

and poor housing with overcrowding. Every minute, two people in India become ’sputum
positive’. 1 his means they have lung TB and the TB germs arc present in their sputum
1

(Ao/uot). (fhe$) can spread the disease to others through breathing, coughing, sneezing,

spitting etc. Every minute, TB kills one person. Although more men than women get IB,
Ever^ycar, more women in t/i^ag'e grlmp~^^35 yeais)die of TB than of causes
related to childbirth.,

Every year, out of 1,000 people, 2-3 new persons develop luny TB with heles-er cavities in
the lungs. This means that if there are 10,000 people in your area, about 25 new patients

will be ^luTcting from lung TB and requiring treatment. Is it possible for you to find out the
number of TB patients getting treatment from your local Primary Health Centres?

In India, about 14 million people suffer from all forms of TO. Patients are widely
distributed with 10-12 patieate-in every village. Patients are equally distributed in urban

and rural areas. Since 74% of India’s population is rural - 74% of TB patients arc also
rural. Thus, the TB programme needs to be strong in rural areas where it functions through
the Government Primary Health Centres. TB is more an adult disease, Out of 100 TB
patients, 92 are adults and 8 children e children. Every year, about 500,000 to 700,000

people needlessly die of this curable disease. The disease can be cured at a fairly low cost,

I he cost of medicines for one patient is only Rs. 1,500/-.(?)

1

2. Understanding more about TB and its treatment

a) '1'13 is an infectious disease. It is spread from one person to another.
b) Many people get infected with the TB germjbut only a few develop the disease.

Out of 100 people, about 30 will be infected, but only 2 will develop the active
disease.

TB becomes active when a person’s ability to fight germs, i.e. her

immunity is low. Tliis is the reason that women at greatest risk arc those in the

child-bearing group and poor women who bear the triple burden of overwork, under

nutrition and motherhood.

c) The TB germ enters through breathing into the lung. From there, it can spread through
the blood to other pajts pf the body and can affect different organs.

Lung TB is

common. Howeveiy^FB of the bones, joints, kidney and brain, etc., can occur. TB can
also affect the reproductive organs in girls and women and can cause infertility .later.

d) Cough is the most important symptom in lung TB and anyone with a cough of 2-3
weeks must be screened by a sputum test, (see fact she. t)^Chcst x-rays without a
sputum test are not reliable in diagnosing sputum positiveTB) If treatment with TB
drags has been started without a sputum test, a second Elector should be consulted If
r

TB has been diagnosed, it is very important that the drugs be taken correctly, regularly
and continuously for the six month period (see fact sheet). TB is completely curable
with good, regular and complete treatment.

e) The first step in the treatment of any disease is the recognition by the patient that s/he
is ill.

Tliis is influenced by many cultural factors. A woman will often deny the

presence or the seriousness of her symptoms, because in the overall battle for survival
in today’s world, her health is the least priority.

She is also socialised to accept pain

and suffering without complaining. Chronic over-work also makes a ceriain amount of
physical discomfort to be accepted as normal by many women. Thus, seeking help by

going to the health service is delayed. This situation is worse if she docs not have

2

financial independence or the freedom and ability to travel out on her own. These
attitudes have an important bearing on another aspect ol women TB patients a« well.

There is an additional social and inbuilt pressure to become “well” as soon as possible.
Hence as soon as her symptoms subside, she will discontinue treatment, especially if

there arc costs (often hidden) involved in collecting the medicines.

However, TB

treatment needs to be taken for a minimum of 6 months, though patients begin to feel

well after 1 or 2 months.

f) You may probably find that it is sometimes not easy to find out who has TB in the

community. Sometimes, people do not like it to be known that they suffer from this

disease.

Though TB can be completely cured, society does not always accept TB

patients on an equal footing. This is particularly so for young girls of a marriageable

age.

They often face difficulties in finding a partner.

Also, women who may be

infertile due to IB may get deserted by their husbands. Patients face problems in their
workplace too. Sometimes they are made to stop work, and an already poor family is

pushed even further into debt. In reality, with the drugs available for the treatment of
IB today, a patient becomes non- infectious within two weeks of starting the

treatment. Tliis information must be shared with as many people as possible. Changing
society’s attitudes is a slow and difficult process, but it has to be done for diseases like

TB, just like for leprosy and HIV/AIDS.

e

J

■'Z

g) TB medicines ate supposed to be available free of charge at primary health centres

through the National TB programme (TVTP and RNTP). However, it is frequently
reported that all the 3 or 4 medicines required are not always available. Often, one or
two may be available while the others are out of stock. When this occurs, the patient is

required to travel a great distance every month to the District TB Centres or other
hospitals. As this involves loss of wages and travel costs . treatment is discontinued or

becomes irregular as a result. Women leaders and others should ensure that this
should not happen by reporting TB medicine shortages to the Panchayat. The
^follow up of patients to ensure that treatment is completed Is very important.

3

h) Community leaders, health workers, trusted friends and family members can help to

support and encourage patients to complete the treatment. Supporting patients and their
families by baby-sitting for young children, by giving a helping hand with housework
and finding ways to provide travel money or financial support through Panchayat loans
and grants are ways in which women and families can support each other during this

illness crises. Leaders can also help by

trying to avail of loans or grants in

rehabilitating the patient. You can also approach voluntary organisations for help.

i) Even when TB affects men, it is commonly in the wage- earning adult group that the

disease strikes. Women in these families, who may have not worked outside the home,
arc now forced to do so for survival. This places them in a vulnerable position and they

are often victims of exploitation, doing the least comfortable jobs for the poorest pay.

Women who are already working have the additional burden cluing for the sick person
and looking after the home and children.

Prevention of TB
i

Unfortunately there is no vaccine that is fully effective in preventing TB. The BCG vaccine

that is given to all newborns as part of the immunisation programme helps in reducing
death and disability from severe forms of extrapulinonary TB in children under 5 years of
*)

age ( such as fB of the brain). However, it does not prevent TB of the lungs among adults,
which is the infectious form of the disease.

Hence, the spread of the disease in the

community does not decrease with the use of BCG. ?

The most useful preventive and promotive measures are those that improve the bodies'
resistance through better living conditions - good food, enough rest, fresh air and

ventilation in the house. These are inter-linked very closely with economic and
environmental issues such as poverty. With the present AIDS epidemic, TB has become an

even more important cause of death. The most important measure to reduce the spread of
TB in the community is to detect TB early in patients and to ensure that treatment is

completely taken.

4

I B Control Programme
■*x

a p
The government has a National IB Control Programme (NIP) and in some districts the

Revised NTP, for the control of TB in our country. Unfortunately, out of every 100 patients

with TB, only 30 are delected in government health centres and of those 30,only 12

complete the course of treatment. This is despite the fact that the services and drugs are

\V

entirely free.

Why only 30% detection? Low detection ofpatients occurs because:

•

7

Patients do not use the primary heath care system, as they have little confidence in it.
Primary Health Centres do not function well.

•

Often there are no facilities to check the sputum due to shortages of microscopes and
laboratory technicians.

9

•

Non-availability of doctors and shortages of drugs are common.

I •

The doctors and other health workers do not listen sufficiently to patients, in order to
be able to make a diagnosis of TB. Their behaviour may be rude.

o

Patients then go io private practitioners who are not aware of the guidelines of the
National IB programme. I hey may give treatment for the symptoms of fever, cough,

etc.

Hence, the IB treatment is delayed,

they also give wrong or unnecessary

treatment.

Why do people give up treatment too early or have irregular treatment?

4
•

Drug supply to the primary health centre is not regular due to poor management.

Doctors under prescribe drugs. The dose/strength of the tablets and the duration of
treatment may be wrong.
©

Health workers and doctors are indifferent and do not motivate the patient to complete

treatment.
Patients ate apathetic, cure seems too slow, they keep changing doctors and treatment.

5

Patients are tempted to stop treatment as they feel better, especially after two months.
•

Financial and other social problems make patients give up treatment.

Side-effects of the drugs such as nausea, loss of appetite, stomach irritation, etc. occur

in some patients? Due to this, medicines arc slopped.

Women leaders can play an important role. They can keep a watch on the quality of
service in the health centres. If problems mentioned above are found, they can report it to

the Gram Panchayat or the Zilla Parishad. The District TB officer should also be informed.

They can play a crucial supportive role to patients, especially on completion of treatment.

I Note Io Trainer
I t

~——-

- ----- - -------------------- 1

f h ts important that ail the above taois are shared with the participants so that they sec tite
links between the system and the patient, enabling them to intervene with the providers and

the receivers.

6

A J

/

15^

/J

1

. . [•.}; vV,

Vk I

o

<’ASE STUDY- HIE S TORY OE ARASINGA SA BAR

.

.

I

Source: “This One Child” - Dr. A.V. Ramani, Health Action, Vol.

11,

No.6,

June 1998.
I met Arsinga Sabar in July last year at the Gangabada 'Swast/iya Mela'. With much
fanfare, the state Government had organised this health camp, trumpeting this “special

attempt to deliver health care to remote areas”. The Gram Vikas staff had been asked to
inform people in the surrounding villages about the camp.

I had gone to the camp to help. Having spent the entire morning alone, trying to cope with
a crowd of over three hundred patients, I was both angry and relieved when the government

doctors arrived past noon. Angry that they could be so indifferent as to turn up so late for

this; relieved that the patients could now be seen faster and return home earlier.

But my relief was short-lived.

The government doctors were prescribing medicines

without even examining the patients - iuyou sec, there is no time to see each patient

properly”, they said. They prescribed injections for everyone -- “you see, this camp is for

the patient’s satisfaction”, they said.

And I felt like shouting, “No, I don’t see.”

So I walked out of the steaming hot classroom which was being used as the examination
room. I sat on the floor of the verandah of the school building and took my time to
examine patients that the field worker, Jaya, referred to me. She had asked several patients

with suspected tuberculosis to come for a check-up. One of them sat a short distance away,
on the edge of the verandah: a 7 year old boy.

By 2 pm, the sky was overcast with monsoon clouds. Soon, there was a heavy downpour
accompanied by thunder and strong gusts of wind. Everybody ran into the shelter of the

7

classrooms, but I did not move because I was quite dry and protected. And 1 noticed that

the little boy was still sitting there on the edge of the verandah, even though he was getting

drenched by the rain. Then, his father ran back out, picked him up and brought him to me.
saying he could not walk.

That was how I met Arsinga,

He was thin, pale, and wasted. In obvious pain, he was also hunched by TB of the spine. It

had caused his vertebrae to collapse and left him unable to use his legs. The disease had
also affected his lymph glands, so that the rignt side of his neck was full of sores.

My heart sank as I examined him, as I saw how weak he was, how severe the disease was
:n him. He was with Kutukudi, his grandmother, who had a hacking cough herself. I

weighed Arsinga, took a sputum sample from Kutukudi and went on with my
examinations. But I could not stop thinking of the boy and his grandmother. Both were
seriously sick and all that the government could offer them was this farce of a clinic.

We started them both on anti-TB drugs which Jaya used to deliver to their home each

month.

Kutukudi had sputum-positive TB and died in October last year.
year.

Arsinga

continued with the treatment.

I was in Gangabada again in February, examining malnourised children. The first child I
saw was Arsinga. But this was a smiling Arsinga. He walked towards me, steadily, on his

own two feet, while his proud father looked on. He still had a back deformity, but his neck
wounds had healed and he had put on weight.

“He even goes to the forest to fetch

firewood , Jaya told me happily.

I looked at Jaya, at Arsinga and at his father. And I realised once again that all the months
of hard work, the frustrations, were worth tills one moment. This one child, back on Ills

feet again, on the road to recovery.

8

information sheet on tb for women leaders

♦ Do you know anyone in your family, village or

basti who has or has had

TB?
o Have you heard of TB?
o What is TB?

n or bacteria. This disease spreads from one person to
It is a disease caused by a germ
another through droplets by breathing, coughing, sneezing, spitting.
It is not caused by bad karma, by the evil eye, or due to sin. It is not hereditary.

Anybody can get TB. But those whose body resistance is weak due to poverty, inadequate

food overwork and stress are at greater risk of getting TB. People doing certain work such
as in mines and those working in health care, especially with TB patients and doctors,

nurses and health workers are also at greater risk. The presence of certain other diseases
and infectious also make a person more likely 10 suffer from TB, eg. 111V/A1DS. Women

are more suscept.ble tn the reproductive age group due Io the strain of childbirth and
lactation, etc.

Is TB different among men and women?
O'

In India, more men than women get TB. But women who are in the young, child bearing

age between 15 to 35 years of ages get more TB. More women in tins age group die of I B

than due to any other cause.

These deaths need not happen and can be prevented.

9

IB can be completely cured. It needs to be detected early. Doctors and health workers

need to give the correct treatment and patients need to take the complete treatment. The

cost of medicines for each patient is only Rs. 1,500/-.

Facilities to detect and treat TB are supposed to be available at the Primary Health Centres

in villages.

The health worker form the sub-centre is supposed to refer persons with

symptoms suggestive of TB to the doctor in tlie Primary Health Centre. There, a sputum

test should be done and a diagnosis made. If additional investigations arc required, the
patient is referred to the Taluk General Hospital or the District TB Centre or other
hospitals. Once IB is diagnosed, the patient is supposed to collect the free TB medicines
from the nearest PHC.

Medicines have to be taken regularly for atleast 6 months

(sometimes more). A repeat sputum test has to be done at least twice during the treatment.

fo be able to provide good TB treatment, a Primary Health Centre (PIIC) should have
a doctor

a microscope
-

a microscopist/laboratory technician

-

good and regular supply of drugs

-

health workers who follow up patients.

Do you know what is the position regarding supply of drugs and availability of staff in your
PHC?

Please visit your PHC andfind out if these are available; if not, can you find out why?

We know that in many pails of India, women use Government health services less than

men. Does this happen in your area? Why does this happen? Women also tend to bear up
with their suffering and to delay going to a doctor.

Do people in your area tend to hide the knowledge that a girl has TB? Does this affect her

possibilities of getting married? Should this be so?

10

TB is like any other disease. It can be completely cured and it does not affect a person’s

health or strength later.

For this, TB needs to be dcteelcd early.

If a person has:
fever

cough

for more than 2 weeks

|

blood in the sputum
-

feeling of weakness, fatigue, loss of appetite, loss of weight,

they should go to the nearest health centre.

'1'hcy will test the ^afam \ if there is any, and may take an X-ray and do other tests.

They may refer you to the District TB Centre or the Taluk or District Hospital.

Several tablets will be given to be taken for a minimum of 6 months, These are free of
charge.

Except in certain cases, a person can be treated for TB al home. Women who have TB can

continue to breastfeed babies.

A person suffering from TB needs care, rest, support and a good diet to be able to recover

well. But, most important, the patient must take the complete treatment for 6 months, even
if they feel better after 2 months. For this, they need the support and encouragement of

their family members.

11

Note to the trainer : There are other forms of TB - which affect women
particularly - such as genital TB. ibis disease, though much loss common than
lung TB, causes infertility. This affects her position in the family and society, often

causing her to feel guilty, to be treated badly or even to be deserted.

As a woman leader, you can play an important role in supporting patients and their

families, by sharing the correct information and encouraging them. You should also keep
in touch with the health workers and health centre and be a link between your people and

the Government.

Sometimes, people suffering from TB become so weak that they cannot work. Often,

another member of the family has to look alter them and hence they too cannot work. 1 his
makes people, especially those who are poor, take loans and become indebted.

Sometimes, doctors and medical shops also give unnecessary and expensive medicines.
This is also one of the reasons

people lake loans. Often, the government Primary

Health Centre does not have the drugs, or the staff may not be helpful and the people are

forced to travel to the nearest town, incurring much expenditure for the purpose.

All this

need not happen. Do you think you and your group could do anything to reduce this?

There are certain developmental loans and grants available from Government through the
Panchayat. Perhaps, you could help these families who are in need and particularly the
women to make use of these loans and grants.

12

TRAINING MODULE

Objectives of this module
1.

trainers be able to visualise the picture of a patient with lung TB and share it with the
participants in order that they can guide suspects in their communities to the
appropriate centres.

2. Trainers internalise and share key messages in preventing the spread of this curable

disease like
0

Early detection

♦ Sputum testing
Regular and complete treatment - infectivity of germ lost within a month of starting

drugs.
with the participants so that these messages filler through the community.
3. Trainers are sensitised to the cultural and social factors that come in the way of

achieving the above due to certain gender dynamics in families and communities. These
must be articulated in the discussions with the women’s groups, so that they may think

of ways to handle these problems.

4. Tiaincrs can focus on the way this disease affects women, financially, socially, and that

deaths occur due to poor access to care and lack of support systems. They can then,
using examples, explore solutions with participants.
5. Trainers are exposed to the deficiencies in the implementation of the national TB

programme so that they can enable the women’s groups to act as pressure points as they
become aware of their rights.

j Duration of session

Content of session

Methods that can be Materials/
used
required

Experience with TO

Group discussion

patients , what is TB?

Case study from their

!______________________

experience

I Who gets TO?

l Qs and answer ,~role FI Charts/

1------------------------------------ L

Skills

.J

posters/

13

Symploms lhai should

play of a

WOHUHI

<|ueslioiis nnd aiisvvci

alert you to visit the seeking care

HC
Diagnosis of'113

Flashcards/ board

Microscope and slides
|

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of

Treatment

TB Lecture

Pamphlets

including drugs and

language

duration of therapy

Blackboard

in

local

Drugs

Why does treatment Brainstorming

fail? Cover factors
-

Group dynamic skills

Case study

related to system
related to patients

Women and TB-

Group discussion/' role

Special factors acting play
which

affect

a

Focus

the

on

finding

solutions

outcome of therapy in
a woman's life

What

can

participants

the Group

sharing Group dynamic skills

do- positive experiences

Follow-up

evolution of an action

I plan

14

References and further reading suggested

1. Tuberculosis, Still Killing, Health Action Vol 12, No 2
2. What you should know about TB , (1995) GOI -NTI pamphlet
3. TB its diagnosis and treatment (1985), NTI pamphlet

4. TB -A guide for the health provider (1998) RNTCP pamphlet from NTI
5. Better Care of TB (1998) - VHAI publication

The following material is suggested to be part of the trainers kit
1. TB Its diagnosis and treatment
2. Flashcard set on TB - CMC Vellore
3. A set of tablets of the drugs used in the treatment of TB
4. A treatment card

15

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Reproductive Health ~ Our Growth and Conception
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Introduction
The International Conference on Population and Development (ICPD) held in Cairo ip -—
1994 brought the world's attention to reproductive?Aan.d sexual health
health issues,--- ------—
RonrnHi
irfivo anH-Rh'iH
Reproductive
anddgjfJd Hpalth
Health fRftMt
(Rp(H) encbmpas's'e^hdolescent health
health, matarnal
maternal health
health,
child health, abortions, Sexually Transmitted Diseases (STDs)/HIV/AIDS,
contraceptives and reproductive cancers. In this chapter we will learn more abouFall >
these topics. Let us first briefly understand about our body.
Growing from Child to Woman

■

Every one goes through the process of growth, or "growing up”. To grow from a child to
a woman takes several years. It is the phase of change from childhood to adulthood.
We go through many changes, both physical and physiological, to become mature
enough to bear children. Many of us have given birth to a child. Some women prefer to
be single stay alone or not to give birth to a child. This is an individual choice.

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As we grow, our body grows bigger ahd stronger. Most girls attain puberty (when
secondary sexual characters develop and they become capable of sexual reproduction)
between 10-11 years of age. Various changes take place within and outside our body.
External Changes in Girls
> Height increases
> Hair begins to grow in genital area and under the armpits. This hair covers and
protects the outer genital organs.
> The breasts enlarge.
> The body becomes more curved, full and the voice becomes soft..
> Pimples may appear on face
Internal Changes in Girls

> The tissues and milk glands develop in the breasts. The milk glands produce milk
when the woman has a baby.
> The birth canal and womb gets enlarged.
> Egg cells mature and are released from the egg sac every month
Please refer Fact sheet 1 for details of female reproductive system

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State Level Training Module

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Reproductive IIeallh and Our Growth and Conception

1

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Menstruation
The appearance of underarm and pubic hair and development of the breasts are
indications that a girl will soon begin to menstruate to have periods. This usually
happens between the ages of 9 and 16 years (average age is 13.5 years).

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Menstruation is a normal, monthly process and a sign that a girl’s body is qrowinq uo
and is able to produce a baby.
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During menstruation, some blood aoEhflsid- come out of the vagina. This lasts for 3-7
days, and occurs every 28-30 days, but may vary from 21 to 35 days. During the first
year or two, the giri s periods may be irregular. Emotional stress or tension or sickness
can also make the cycle irregular.

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Most girls feel only a slight discomfort during their periods. Sometimes, a girl may have
hitTf?in^binS 'n h6r abdomen or iower back- a I'ttle nausea or tenderness of the
A -q 7~- --;gtb~-2LamPs are verV pamful, she should see her doctor. During menstruation
a 9|rl nee^ to wear samtafy padTSr’inapkins inside her underwear to absorb the
menstrual flow so that it does not soil her clothes.

DPrtnrtT^h3130 nOtiCG r°^e Clear °r whitish va9inal secretions between her menstrual

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representation of Menstruation

Care during menstruation

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daily 10 preven'infeclion- Wash

any infection easily

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Reproductive Health and Our Growth and Conception

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> Use a clean cloth to soak menstrual blood. After use, it should be washed and dried
in the sun and kept in clean place for use during next time. Chk(%^57c2>
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Atenstruol Disorders
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Painful menstruation is a common complaint, especially during adolescence. The
031186 18 no* v®7 clear, it has a strong psychological component. Most of the
mes, reassurance to the girl along with maintaining good general health and normal
Up e J 6ke care o(fthe problem^RS^ads’and hot water bag massage can Kelp
hprSmn ?h '°n mUS bS 3V0lded and ,!9ht exercises have known to reduce the pain
Generally there is no need to consult doctor.
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Too little or too much bleeding or irregular menstruation are other problems These mav
.a T" n 6 ° d,sturdance in sex hormone, pelvic diseases or some other probtems ?/
is advisa^_e{to consult medical persons in such situations.
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GrowingChild to Man

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contained in a milky, white liquid called semen p33'r6productlon- The sperm cells are
similar to a tiny fish
men’ Each tiny sPerm cel1 has a long tail,

External Changes in bovs
>

> Height increases
>
>
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Sophe oen',a,s'on ,he body and
Voice deepens
PimpleSf^ppear on face

-------- ---

Internal Changes in Boys
> Penis and testicles
grow in size
> Enlargement of penis and testicles, erection of penis
> Sperms (egg cells in man) production starts

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to know details

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State Level Training Module

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When the man’s sexual excitement reaches its nO l /
Th S IS ca,,ecl an erection.
- muscles around the penis work rhythmically and forc£r?hpSm
“climax”), the
is called ejaculation.
lymmicaily and forces the semen out of the penis. This

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Reproductive Health and Our Grovth and Conception

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Ejaculation happens in three different ways.
Sometimes the penis can get erect and ejaculate semen while the boy is sleeping
and dreaming. This is called a "wet dream” or “nocturnal emission”. When he wakes
up, he is embarrassed to find damp pajamas and sheets. The dampness is caused
by'the release of semen (not urine) during a wet dream. This is very normal. Wet
dreams are a sign that a boy’s body is growing up.
> When a boy masturbates, that is, stimulates his genitals by handling them, he may
have an orgasm and ejaculate.
> Ejaculation also occurs when a man has sexual relations with a partner.

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Circumcision

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Circumcision is the surgical removal of the loose skin that covers the tip of the penis.
This is usually done because of custom, or for religious or hygienic reason. A boy or
man with an uncircumcised penis should clean the tip of the penis by pulling back the
loose skin. This will prevent infection.

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Mental Development and Emotional Changes:
Along with physical growth, rapid emotional development also happens during
adolescence. Ability to think, abstract and question, difference between behaviors and
rules develop. Along with this there is rapid emotional development. A mood change is
a common phenomenon during adolescence.

More on adolescents emotional, sexual and mental development is given in
chapter Adolescence Health and Development
How doss conception take place?
The sex glands oTman (testes) produce sperm (male seed),’while the sex glands of the
woman (ovaries) produce eggs or ova. When the sperm and the ovum join together
inside the woman's body, a new life begins to grow.

The woman produces an egg cell once every month and this process is called ovulation.
The egg passes through the woman's fallopian tubes towards the womb (uterus). If a .
male sperm meets the egg at this time (as a result of sexual intercourse), they may join
together (called fertilization) and a pregnancy can take place. If the egg is not fertilized,
it just passes out of the woman's body unnoticed in the menstrual blood.

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1 From the time a girl starts ovulating, i.e. from the average age of 13.5 or so, until she is . r
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' grows; a new mucosal wall lining (along with blood
y^/ well past 45-50 years old,■ her
womb
___j ____
I vessels and glands);every
month or in
in about
aboi 28 days though the period varies from
f
woman to woman. If the egg is not fertilized, this wall lining breaks up and slowly leaves
(
the vagina. This shedding of the lining and the blood is called the monthly period or
menstruation. After the menstrual period is over, the womb starts growing a new wall
lining and the ovaries produce another egg. However, once the egg is fertilized then no
further egg is released from the ovaries and there is no menstruation until well after
childbirth. The period between the onset of menstruation (13-15 years) and its stoppage <

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State Level Training Module

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Reproductive Health and Our Growth and Conception
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(45-50) years) is called the reproductive span in the woman i.e. the period during which

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she can bear a child.
The male seeds produced by the testes pass through the spermatic duct and mix with
fluids produced by seminal vesicles and prostate glands. 7 his is called semen, which
contains sperms, is ejaculated from the penis into the vagina. 1 he sperms from the
semen
semen swim
swim up
up to
to the
the womb,
womb, where
where one
one of
of them
them can possibly meet the female egg and

3

fertilize it. This fertilized egg grows into a baby.

How is sex of the child determined?
The sex of the child is determined at the time of union of the male seed and female egg.
There are special bodies in a woman's egg cell and the man's seed cell, which are
called chromosomes. Out of 23 pairs of chromosomes the 23rd pair is the sex
chromosome. This pair of chromosome determines the sex of the baby. Men and
women have different sex chromosomes. The pair in man is known as XY and the one
in woman is known as XX. At the time of fertilization, if the X chromosome of the egg
cell meets Y chromosome of sperm the baby will be boy and if the X chromosome of
woman meets the X chromosome of man, the baby will be girl.

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Our Society and Sex determination
In our patriarchal society, extensive importance is given to a male child. Due to lack of
scientific knowledge, women are considered responsible for the sex of the child. If a
woman fails to give birth to a male child, the family members curse her and even
mentally torture her. There are cases where women have committed suicide because
their family members tortured them for not giving birth to a male child. As we all know, >
many men also divorce their wives if they do not give birth to a male child.
Let us join hands to create awareness about how the sex of the child is determined.

A few years ago, the amniocentesis test, which is primarily meant to detect congenital
(hereditary) disorders, began to be used to find out the sex of the unborn child. The sex
of the child can also be detected by sonography, the method by which sound waves are
used to visualize the growing foetus on a screen.
If the family members find out that it is a female child, they may ask the woman to abort
the child. A woman should not be forced against her wishes to undergo a Medical
Termination of Pregnancy (MTP) because the foetus is a female. Sometimes the
woman herself takes the initiative to abort the child.

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It is important to know that the Government of India has passed a bill banning the use of
these tests to determine the sex of the child. It is called the Pre-natal Diagnostic
Techniques Regulation and Misuse Act (1994). These tests are still being done illegally.
If you know that someone is doing these tests to determine the sex of your child, you
can inform the appropriate authority so a case can be filed against that person.

Reproduction is a very important function of our body. But there are many health
concerns related to reproduction and reproductive systems, which we need to know
3 r . how to prevent. Let us first leam about maternal health.
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State Level Training Module
Reproductive Health and Oar Gro^vth and Conception

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Fact Sheet I

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The Structure of Female Reproductive System

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Some parts of the female reproductive system are outside the body and some are
inside the body
> The outside body parts includes, outer lips, inner lips, clitoris (the sensitive part
openrng,e 961 pleaSUre^ There are two openings - vaginal opening and urinary

)

>■ Internal parts include the birth canal, womb, egg sacs and egg tubes. The eqq sacs
contain eggs, which start maturing between 10 and 18 years of age The eqq tubes
are narrow through which the mature egg passes to reach the womb

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SuXby) XXSXnXXHiS *0 "°UriSh a"d
,he °Uter rePrOdUC“Va Or9ans *° ,h0

organs, is oalied

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THE FEMALE SEX ORGANS

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Outer and inner lips '
Fatty folds of skin that
cover the clitoris, urethra
and the opening to the
vagina, also called the
vulva

Clitoris
small, pea-size organ full of
sensitive nerve endings

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Urethra
opening through wliich
urine passes out of the body

Opening to the vagina

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opening through which the menstrual flow
leaves the body
opening for sexual intercourse
opening through which the baby is delivered
generally (but not always) covered by a thin
membrane called hymen, which has an
opening for tlie menses to pass through

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\opening through which solid waste
phsses out of the body

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Reproductive Health and Our Growth and Conception

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MENSTRUAL CYCLE - average 28 days

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Day 6-13 .

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menstrual flow
^ginsranxgg-CclUntheovaxyTnpensJhc
uterine lining thickens with increased blood
supply to receive a possibly fertilized egg
cell.

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Day 14
Ovulation
The mature egg cell is released
from one of the ovaries into
fallonian tube

»
Days 1-5
Menstruation
ne blood-filled lining of tlie
terus1 es the body through the
agina.
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Days 15-28
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The egg cell travels through the
fallopian tube to the uterus. If it is
fertilized (united with a male sperm), it
attaches to the lining of uterus to
develop into an embryo. If it is
unfertilized, it passes out of the body
unnoticed with the next menstrual flow.

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Reproductive Health and Our Groivlh and Conception

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V.

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' Fact Sheet 2

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The structure of N\a\z Reproductive System

> The penis and testicles, hang^ouisIe^niaL^XJdy^Jbetween-the thighrs.
> Testicles are oval in shape and they hang inside the scrotum (a thin skin sac). One
testicle is lower than the other. This is normal. They begin to produce the male
sperm cells during puberty. Sperms are very tiny cells that can unite with the egg cell
in a woman’s body to start a pregnancy.
> Both urine and sperm pass out of the body through the penis, but never at the same
time. The size of the penis varies from person to person. The size is not related to
sexual function.
> The sperm travels through the vas deferens (a duct which carries sperms) to the
prostate gland (a gland surrounding the neck of urine sac and sperm duct). In the
prostate gland, fluid is added to it to make a milky-looking substance called the
semen.
Sperms are produced in the testicles. They travel through the vas deferens to the
seminal vesicles and the prostate gland. In both glands, fluid is added to the sperm to
make a milky substance called semen. The semen leaves the body through the penis.

/Scrotum
sack of loose skin that
holds and protects both
of the testicles

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Penis
> Organ through
which both
urine and sperm
pass out of the
body, but never
at the same time
> size of the penis
varies from
person to person
and is not
related to sexual
function

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MALE SEX ORGANS
Urethra
tube that carries urine and
sperm through the penis
and out of the body

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Vas deferens
Pair of tubes that carry
sperm from the testicles to
the urethra

Bladder
organ tliat stores
urine

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Prostrate gland
organ tliat adds fluid to the
sperm

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Seminal vesicles
A pair of organs that adds fluid
to the semen
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Testicles - The two oval shaped glands that
hand inside the scrotum. They begin to
produce the male sperm cells during puberty.
They also produce the male hormone.
Sperms are very tiny cells tliat can unite with
the egg cell in a woman’s body to start a
pregnancy.

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State Level Training Module
Reproductive Health and Our Growth and Conception

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ADOLESCENT HEALTH AND DEVELOPMENT
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State Level Training Manual

a

Introduction

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a time wh^iun^peoX^eveiop mSrraMdtvftJT1

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capability is established.

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1Ors sexua|iy defined and reproductive

Understanding Adokscence
By and large, the period between 10 tn io ,,
by certain rapid physical, emotional mental sol^

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dyn,amic period °f ,ife- » is

ado,escence. which is marked

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e pre-puberty years of (heir iife, which for son,: cS bX'S deaX^

11-19 years old) beg^toeamorefood* They^ls T '?raWir,£l up" <wh° a™ belween
clothes and other items like hairoins nnne^
° be9,n fo demand to have fancv

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and docile as children
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^tute Level Training Manual
^olescent Health and Development
Reproductive and Child Health

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^nremaUw? eve,! S^re obedSn

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iXsfe° n
a“rHCfon towards ,he 0PP°sile S9X
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and boys fllong WIth the typiSS"S! SpXTeSCen‘ 9'rtS

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Adolescence and Gender Discrimination

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control de JresdhTmosT’vVe couldnn?? fhlStW^S the time whsn we were asked to

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--and boys are made
women are stronqly and deeolv laid down h ' ■The Prescnbed gender roles for men and
suffer .bo

development1 h°W

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diOTiminafo" imPa«= adolescent girls’ and boys’ health and

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Nutrition

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State Level Training Manual

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Adolescent Health and Development
Reproductive and Child Health

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support. This becomes a “second chance” to make up for growth loss in the early years

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ebnough“ amo'” ‘“ll lha remaining ^en

^e^S^IS b^^VwXSn^re" %S in,ake °f fo°d a"d
inffctl0ris- Considering this

definition, girls, like women also suffer’hvofofd d?sr

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giving them less food to eat This leads to either fooL
°n V Way to do this is bV
married as early as oossihlo hpfnra eh
^Sr feediri9 ber less food or getting her
nutrition increase the risks of stillbirth
def^'171 Ma'nutrition and under
and death of the newborn.
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General Health

y-o pe

,e d0 nol get sick oten

vulnerable to disease than the very young or verv old th? h ^i?® hea'thier and less
Priority. Yet in recent years it hasten proVen
H.’.
ne6dS are 9iven ,ow
adult behaviour and relationships are established For t?9 ado,escence keY patterns of
major factor in public health and societal devetepment IHhTh^i’t?'5
36 °f 'ife iS a
people are not met, serious problems will arise altho. mhm h
h needs of young
’
m the short term.
e' a,though ^ey are not always apparent

and may evenhavemorSan oneST^Tp^ob^376 f^i^ enter6d motherhood
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motherhood are a prime heakh risk fT h.hb'emS °f early Pre9™nCy and
are the major risks along with accidents al^dLSrJ:tobacco' dru9 and a|cohol use

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State Level Training Manual

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Adolescent Health and Development
Aeproduciive am! Child Health

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injuries.

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Myths and Realkies
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sZeZ*f7■=»“< >»ysfun.

The questions that adolescents a^k manv fioin ite ,us h°wfar to 9° in a relationship,
should 0O beyond mere body knowledge^nd^nfomXSn.6^ Sh°W
SSX education
■ ZYurSXZurtbtt' al ZZ »VOaU 'na?urbate «en. I do not

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married? I don't know whom to ask for heto 'whL“''!l.ha.pper’ °ni:e 1 ?'='
just close my eyes and do it." (A boy shared
3 Str°n9 desire' 1
boys on achievement motivation by CHetna
3 trainin9 for
based in Gujarat.)
L 'NA’ a voluritary organisation

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SeZX^'iaZTn^, too.

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conducted seTZraZZa'X Sr X and "to

slum areas

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0lr|s and boys between 12-19 years in villages
and

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cllaraae^' We^el°PMlW (whose breasts

are well developed] “have a bad

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Sta!e Lex’cl TraininK Manual
Adolescent Health and Development

proa active and Child Health

5

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serious health hazards especially for girls younger than >7>*year's and living in poor
conditions where access to health services is inadequate. It is a well-known fact that
too early pregnancy increases the risk of maternal (mother) and child morbidity
(incidence of illness or ill health) and mortality (death), as well as the likelihood of
having too many children too close together. During pregnancy, there is a great need for
more nutritious food, but girls are kept away from certain foods due to traditional beliefs.
At the time a girl starts menstruating, she still has approximately 4 per cent growth in
height and 12-18 per cent of pelvic growth remaining. Thirty-six percent of married
adolescents aged 13-16 and 64 per cent of those aged 17-19 are already mothers or
are pregnant with their first child. This poses a great threat to the girls as well as the
newborn babies. Adolescents are also more likely to experience adverse pregnancy
outcomes than older women are. For example, the National Family Health Survey <
reports that 10 per cent of all adolescent pregnancies end in miscarriage or stillbirth.

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Similarly, an unusually large number of unmarried adolescents seek abortions. Most of
these abortions are unsafe and illegal. Another very disturbing fact is that unmarried
adolescents are considerably more likely than older women to delay seeking abortion
services and undergo abortions in as late as six to eight months of pregnancy Delays
in seeking services are largely the result of lack of awareness of pregnancy as well as
discredits
SerV'CeS and t0 3 9rSat eXtent fear °f S0Cial sti9™a (si9n of’disgrace or

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Awareness of and access to contraceptives is not only difficult, but almost impossible
rent? eSCen S ^ecause of the social sti9ma attached to contraceptives The physical
consequences of pregnancy, child bearing and abortion are grave but the psycho loo cal
damage it does to both girls and boys is rarely stated or studL Also many
raP8 °r toSt
*ich is a reEn of

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Violence

One of the most common, yet relatively hidden, issues in today’s world is violence
again^ women. Adolescent girls are especially vulnerable to violence of a £ds both
inside the home and outside, because of their relative lack ^ysicaf social and

I--

economic power. Before reaching adulthood, girls are vulnerableto
> sex-selective abortion and neglect of the female foetus
> female infanticide
> less food and care

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Stale Level Training Manual
7
Adolescent Health and Development
Reproductive and Child Health

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‘“ward^development of adolescent women and rn ? ‘W'1’' CHE™A works
S edu,cJ,ls<l.materlal to representatives of Nf-n? ?"
Provid'n9 draining, support
states of G*r^asthanPand' XyaS S°s and f d'-™ment or9anlsa?ons"X
cM£ENAalro started^sfn^onEaaX^ 0'8806"1

and d“e'opment

dXrtC8,drpra3rammss199M'i Reafsingthe ’
TOs ea™
®r,s' CamP This strXgyXXXvT 3
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^^’entOrganlsa^N^bXTh^m^T6'’683(CHETNA). « a Non

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ir life - like health,
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adults and be allowed to
^CCessful:l more often. This is the
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anc^ Care after Child Birth

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State Level Training Manual

Introduction

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There ara ham,ui a"d

aspects.
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Positive Practices
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The woman gives birth in squatting position

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Local beliefs and practices related to labour and care after childbirth.

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a baby g,rl ,s born, her mother is discriminated and tortured.

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Various Stages of Labour

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Harmful Practices

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irst Stage of Labour*
period^tter nin?h mlnff'theToetus begins to des/

thfter the laSt menstrua'

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feelSTWef-fiThefechEst^ea but finds itdX ?i/n
'Tthe pelvic cavitV< ime. The entire process of labour is completed in X/'afbout'and''slLGr'starid-for-a- leng'-labour comes, the woman has pain in her abdo/o
^ta9eS' When the time
9
^ax. As a result the mouth of the womb opentZ and he 7°Tb be9inS t0
and
woman is in labour for the first time thic er
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d the foetus 1is pushed down. If the
second or third time, for 8-10 hours'
° °9e 33 3 f°r 10"12;.hour^and
if it is for
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State Level Training

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( ni!d Birth and (,\ire

Child Birth

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Do_________ /
> Inform the DaWANM immediately
> Relax and keep moving. Rest when
you feel tired.
> Take the pains gradually as they
come. Do not apply force.
> Breathe deeply.
> Drink plenty of energy giving fluids
like jaggery, black pepper and
ginger decoction, tea, milk etc.
> Ask the Dai/other women tg
massage your backragdomea) X
thighs, etc.

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Do not
> Push or apply external pressure on
the abdomen to hasten the labour
> Break the amniotic sac with nails or
blade.
> Give injection to speed up the
labour.
> Insert hands/other substances in
vagina.

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The Second Stage of Labour

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Do

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> Sitting in squatting position would
help the baby to come out fast due
to gravitational force.
C Bear down when there is a
contraction
> Support the perineum with a cloth
pad-

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The pains become stronger and unbearable. The interval between two contractions
decreases. Many women scream at the top of their voices. This is good. It helps the
baby to come down. The mouth of the womb opens up and the bag of water breaks As
foZuhby Com.es down' Presses the bag of urine as well as stools and the woman may
feel the urge to pass it. The head of the child is visible at this stage. Along with time the
contractions become more severe and frequent and the baby comes out

■

Do not
Pull the baby out with force
> Cut the genitals of woman with a
blade to broaden the passage.
> Push or apply external force on the
abdomen
> Insert fingers to examine the vagina

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Wrap the baby in a'clothrand put it
-to breast immediately.
r- Cut the cord after the pulsation
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Stale Level Training.

: !d Birth and Care After Child Birth

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The Five Cleans

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Many women and children die and suffer a lot due to infection contracted during
childbirth. Keeping clean iis essential during this period. The following are the five crucial
things to be kept clean.

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J 3. Cut the cord with a clean blade

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|5. Keep the stump clean. (Avid puttinTanytfcng on ifand keep It dty)

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Ills Third Stage of Babour
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rdens^arKftheh/ord'behcon^es^ose 5^0 TT'fn
= ^sh of bipod, the
womb
hardens
and
the
cord
becomes
loose,'
contractions.
becomes loose. Gradually, the placenta comes out with the

Do~---------------placentato
'> WalTfor
w vun IUi The
ii it? piacenta
to come out

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Wait for moreTharT^O minutes for the
placenta to come out.
> Pull the placenta
> Push the abdomen
> Remove placenta by hand

> Ask the woman to push after the
placenta separates.
f See that the placenta is complete
z- Bury it in the ground
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Care of the Woman After She Gives Birth
has 0iving birth .At'thesXX8 sh“ eq^ires^"—

beC°me vu,nerable after

milk and look after the newborn. She needs aSeS food' a"nd
“ 9y to prepare for breast
ener
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■

Vari°,us r00ls’ oil' Ohee,

^He^lXaraTon8' like^oX^

sheera] and gradually take aUnLS.tur^1a^
rood from the Anganwadi. She should eat it

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State Level Training Manual
i:!it Birth and Care After Child Birth

°n' 3 Woman ls Provided nutritious

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Massage: The woman should be given an oil massage before taking a bath with warm
water. This relaxes her and provides strength.

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The woman should bathe daily with warm water and wash the genitals as well
as the cloth pad.

Fumigation: In many places, there is a practice of using herbs and giving smoke in the
vaginal area. This reduces the chances of infection in the genitals.

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Bpsi * The woman should lie in-bed at least for10 days./JThis helps..,the'womb to return
tQJtStnormal-ppsition?
______________
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Iron tablets: She should take 1 tablet daily after meals and complete the course of
100 tablets.
Breast-feeding: The child should be put to breast immediately after birth. This helps
the womb to contract and reduces the chances of heavy bleeding. Early sucking leads
to early flow of milk. The child should be given only breast milk upto four months of age.
After that, complementary foods should be introduced along with breas't milk Feed the
child breast milk for as long as possible.

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Eat plenty of foods that give energy Qaggery, ghee, sugar, cereals, etc.)
Drink plenty of fluids (10-12 glasses of water, buttermilk, milk, herbal decoctions
etc.)
> Special herbs and foods promote breast milk (bajri, coconut, poppy seeds, shatavari,
etc.
> Sleep adequately
Relax and do not worry

c Care of the Infant
.

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The first few days are crucial for the baby's survival. Give extra care to the baby
Breast-feed the baby frequently as and when it demands.
Keep the baby warm
Keep the baby near the mother. This provides warmth and strengthens the
emotional bond (Family members should help with housework).
> Keep the baby dry and clean.
X It is not necessary to bathe the baby for the first seven days. Wipe the baby clean
keep the stump dry.
> Give the baby massage and fumigation (shek) depending on the season

Child Birth and Care After Child Birth

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While breastfeeding:

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> Immunize the child as per the national schedule. Complete the schedule. Refer
Table-1.
> Talk, sing songs and play with the baby.
> Watch the baby carefully. Consult a health worker as soon as you see anv
risk/changes in the baby.

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I able 1: National Immunization Schedule

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Vaccine

Name of
disease it
prevents

Aga

Route

Tetanus

Pregnant women

Intra muscular Injection (IM)

BCG
(tuberculo
sis)
OPV

Tuberculosis

At birth
contact

Intradermal injection

Polio

Birth

DPT

Diphtheria,
6 weeks
whooping cough 10 weeks
and tetanus_____ 14 weeks
Polio
As above

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Oral
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Oral

Measles
DPT

Measles________ 9 months
Subcutaneous injection
Diphtheria,
IM ’
16-18 months
whooping cough
and tetanus
OPV
Polio
As above
Oral
"
DT
Diphtheria,
5 years
IM
-----------------Tetanus
10 years
IM
16
_____ years
_________ IM
________
TT for Pregnant woman: Si! 1163S S?on as wo™an suspects that she is
pregnant. Second injection at the interval Tone
—
.j month.

OPT: Diphtheria, Pertussis, u..„
and Tetanus Toxoids^
DT: Diphtheria, Tetanus Toxoid
ynirl
IM: Intramuscular Injection
OPV: Oral Polio Vaccine
/
TT: Tetanus Toxoid^

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5

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Child Birth and Care After Child Birth

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\ Nutrition of the newborn

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> It is important to put the baby to the breast asAoon as possible after birth to
begin
lac^a^on process and to provide theAhHd?with''-the;first Tiutritional
<y / and immunization components for a healthy baby.
1 he mother should feed as regularly as the child desires and should be
informed that the babies suckling will increase the production of milk. The
mother should not be concerned about her ability to provide enough milk for
the needs of her child during the first three days.
> Breast milk is sufficient for the child in the first fourrto six months and parents
must be told that no other foods are necessary. By consistently reinforcing
this key point, we can help to root out the myth about the child's need for
special and additional foods. This will decrease the newborns’ chances of
infection and malnutrition.

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Exclusive Breast-feeding:

c

Evidence suggests that mothers are aware of the importance of breast-feeding their
newborns but are not putting knowledge to practice. The preparation and motivation for f
breast-feed'ng should begin during the antenatal period and motivation should be c
provided for both parents
I

Antenatal care visits should place emphasis on the importance of exclusive breast c
feeding and the benefits the child will obtain from it. The health worker’s role is to
increase the knowledge and awareness of the benefits of breast-feeding and to (
decrease the rates of mortality and morbidity from infection and low birth weight It is (
very important to put the newborn to the breast as soon after birth as possible
(
(preferably within one hour of delivery) so as to initiate the sucking action which
stimulates lactation. Exclusive breast-feeding is recommended up to four to six months. f
No water is required. Giving water reduces milk intake and can also cause infections
Breast mi k has enough water to meet the hydration requirements of babies under four
months of age, even in hot and dry conditions. Pre-lacteal feeds such as honey and
glucose water rpysLnot be given for the same reasons.

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State Level Training

Child Birth and Care After Child Tirth

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IL^St|bet exp'aJnetd that the act of sucklin9 stimulatesjactation and that IhateVe
’
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he first fPwT fir secret'°n from the breast after giving birth) the child retei
ives
in
tne first few days is enough to meet the nutritional needs of a normal babv /
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SrnTnf ®uck,in?’ complete emptying of breasts, correct positing and supportive
care are all important to achieve successful lactation.

Introduction of semi solid food

?gSES~EESAES'=
and has J053
petite. The
breast-feeding, she should continue to d9o so Th? durinf9/ an lllness- lf the mother is
mcrease frequency of feeding, including breasf-feedmaato to s51"1"
aC’'''Sed

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mental and physical development of thechHd IfmtritSis3-6
'S Irriportant for the
.~e. The under nou Aed baby i! XerXe" io inlXTanX^ *

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Low Birth Weight (LBW)
is n^dlation^but0^re^nSef measLref

'?frCti°nS and risk factors- There

decreased if those pregnant ^menXZeal n^are^d

be

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I normal baby weight is 2.7 to 2.9 kg at birth,

birth^f91'?9 h^'63 dUr'n9 h°me
during home
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Illness in a newborn can be life threatenino The
l,,ness can be managed at home. *
be immediately referred to a quaEdoctor/JospTa^"3'
* * iS LBVV' must

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Stale Level Lraining. HquMJ
7

Child Birlh and Care After Child Birth

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Referral Symptoms:
)

> Prolonged and recurrent episodes of diarrhea
>■ Loss of appetite
Child passing small amounts of urine
> Deep or rapid breathing
> Dry lips, mouth and tongue
> Weak pulse rate
> Eye balls sunken
> Tears absent

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Nutrition of the mother

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> Tmhe°Sh°r ,hk m°the!' toO““^Xdri°nk to halSheallh US

m°'h^ " 'S

both parents on bow to eat better within the

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i Rest
sleep. This-will help the mother to recXe^and also h ?dfd
adequate rest and
child. It Ls.necessaryjp understgXTtZS9
successful|y breast-feed her
J rest may be hgrmful.Tmay caus^he Xs to
normal household work must be a qradual orn-SfThPai?U and SW°!len- Resuming /
for
at least six weeks. Her hu!banTmust
JOuld avoid sinuous work /
!
additional responsibilities.
G aware of thls so that he can take on .■

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R crr’al® Infantici de
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Son preference is c
be more or a bGrden d'e toTelXm of I™'0
more of a burden due to the r ‘
~
reponed .0Nadu.
be earned" o
ul in differe"'P^rts of the
andVamil
-

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in-lawS and soSimesTvenTbe mX^hXTkHHhe6"6^'111"the dai °r lhe molh8ror some kind of seed is inserted in the bp>bv’s mn th newborn. The baby is strangled
parents need to be made aware that a^girl chid h\S°
* Ch°keS t0 death' Both the
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9

Afier Child Birth

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Complications during Labour and After Child Birth

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Despite various precautions, complications can set in at any time during labour and
after the child is born. It is important to recognize the danger signs and refer, as at this
stage, it may result in grave consequences within a short time.

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The Following Conditions Are Risky
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During- Labour

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Labour continues for a long time. If there is no progress even after 12 hours or pain or
the womb's mouth does not open, it is risky.

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Cord Prolapse: If the cord comes out before the head of the foetus, the baby may
suffocate inside the womb.

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Hand Prolapse: If the hand comes out first, the foetus may be lying across the
abdomen, attempts to change the position may lead to suffocation or tearing of the
womb and heavy bleeding.

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Baby is upside down: In such cases, the head might get entangled at the mouth of the
vagina.

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Absence or reduction in fetal movements and heartbeats: This indicates
suffocation of the foetus and it may lead to death unless operated immediately.

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Convulsions: The woman may have convulsions due to toxemia or other psychosomatic
^disorder. This may lead to death of the foetus and the mother.

(■

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Excessive Bleeding: Excessive bleeding may occur due to a low-lying placenta, rupture C |
of the womb and some other causes. This could lead to death of the woman within
. -I
hours.

After Childbirth
Placenta does not come out: Usually, the placenta comes out within 15-30 minutes
after the baby is born. If there is a delay, the cord should be cut and women taken to the
hospital. Meanwhile, put the baby to mother’s breast, tickle the uvula and ask the
v/omen to squat and cough.

State Level Training
Child Birth and Care After Child Birth

10

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gxcessiv^blgeding; Bleeding occurs when some times, the womb forgets to return to
" lhe '“mb OT *he WOmb haS rUP'Ured

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gMfe; These occur duo lo eclampsia or emotional causes and risk to the mother

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the district levdhospka? or'FirstRefen'arUnir1'' aSpossibleandlhewc,manstiiftedto

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Stcte Level Training

( hila ILrth and Care After Child Birth

11

STATE LEVEL
The other organizations who have contributed are not mentioned.
Reproductive Health

Pages: 1, 2, 3, 4, 7, 9 & 10

Adolescent Health

Pages: 1, 3, 7, 11 & 14
Mal_emaJJHeahh

Pages: 1, 3, 4, 5, 6, /, 8, 9 & 10
Child^rtlL&jC^AfteLChild BirA

Pages: 1, 2, 3, 4, 5,6, 7, 8,10 & 11
Abortion — (Not well written)

Pages: 1, 2 & 3

Infertility
Pages: 1, 2 & 3
Contraception

Pages: 1, 4, 5, 6, 8 & 9
RTIs/STDs

Pages: 2, 8 & 10
Cancer

Pages: 2 & 3

- Simplify further by putting information in bullets

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In the social context, women are at a double disadvantage if they suffer from these
illnesses. As we know, in our male dominated society a woman cannot deny sex to her
partner, even when she is suffering from an RTI, nor can she ask about her partner’s
sexual contacts in the case of doubt Most women do not talk about their gynecological
behavior Th'S CU,tUrS °f silence is another barrier that discourages treatment-seeking

■

dirnensions 8ed t0 address the issue of RTls/STDs in social-cultural and economic
Prevalence of RTis/STDs

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RTIs, including STDs were not,recognized as a health problem until very recently
I
^ne in lnd!a durin0 ths past few years has highlighted this problem as a
public health concern. Epidemiological inquiries carried out in late 80s indicated that
t°f chlld bearin9 a9® In lndia earn/ an abnormally high burden of morbidities
related to reproductive systems.

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health care faci,ities are not
adequately equipped
equipped to
to diagnose
treat
not adequately
diagnose and
and treat
and energy
t0 mak<3 considerable efforts to sPend the time

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JvttrUad/oUndertaken Ln Gadchiro,li- district during 1990 showed that 86% women on an
baShe SZ tT °r m°rT 9ynecol°9ical Problem (lo^r abdominal pain and
backache excluded). The same study revealed that a more than half of these ailino
^"XaiPerceivsJhem as a"y health problem v^ich required treatment and only
8 /o ever sought any medical attention. It indicates that women accepted reproductive Y
act diseases as a reality of life. Some of the most prevalent reproductive health
S dele,cted in thls study w^re bacterial vaginitis, cervicalerosion leucorrhoea

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11

cervicitis and dysmenorrhoea. Among the STDs commonly found diseases were " '
SvnhT30!3’ monaliasis' and Wchomoniasis whereas some less common were like
Syphilis. Some-women of high parity suffered from partial or full prolapsed of uterus I
S<tM'^a^eC0'"in9 common a™n9 P^'ly “ak women owing to ’/w

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wing to poor hygiene of reproductive organs chiefly the external oanitaiia ana
cleanliness01"
ed^ti°n?o Tmen;and fTilitiesrt0 maintain reproductive
cleanliness.

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similar

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From the findings, it is amply clear that morbidities, relating to reproductive svstemc
among women of reproductive age group are alarmingly h^h. Many oi^the diseases are

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State Level Training Manual
2

Reproductive & Child Health
Reproductive Tract Infections/HIWAIDS

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Prevalence of HIV/AIDS
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It is estimated that as of the end of 1997, 30.6 million people worldwide
have been infected with HIV. In South and Southeast Asia there are
estimated to be 6 million people infected, which is 1 per cent of the
world total.
The total number of HIV infected adults has more than doubled since
the beginning of the decade. It was around 10 million in 1990 and by
mid 1996 it was 25.5 million.
By July 1996, 5.8 million people, 75 per cent of all people with AIDS,
are estimated to have died worldwide.
The HIV/AIDS cases among women are 30 per cent of the total AIDS
cases reported.

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It is important to note that estimates are revised from time to time based on
currently available information. The epidemic however continues to spread
and is not randomly distributed.

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Who Ts at Risk?
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Every one is at risk foebecoming infected wth HIV/AIDS. However, there are certain
/ categories of individuals and groups who are in the “high-risk” groups because their

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lifestyles make them especially more vulnerable to HIV infection. They are:
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Sex workers: have multiple sex partners. Due to economic hardships and social
factors, many times they are not in a position to insist that their clients use a
condom.
Migrant labourers: travel from place to place in search of work and end up having
multiple sex partners and visiting sex workers.
Truck Drivers/Cleaners: drive on the highway for days at a time and tend to visit
sex workers very often. They do not always use a condom. Many of them also
actively engage in Men having Sex with Men (MSM). This is known as
homosexuality.
Men having Sex with Men (MSM): frequently engage in anal sex, which puts them
at a greater risk of developing HIV infection. There are more chances of cuts and
abrasions in this kind of activity.
Intravenous drug users: tend to use the same needle among themselves. They
run a greater risk of developing HIV infection.
People suffering from STDs: have a higher risk of developing HIV infection since
HIV spreads more easily when there is genital ulcers and other forms of STDs.

State Level 7'rainbig Manual

Reproductive Sc. Child Health
Reproductive Tract Infections/HH'VAIDS

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Government of India
NATIONAL TUBERCULOSIS INSTITUTE
(Directorate General of Health Services)
‘AVALON’ No.8, Bellary Road, Bangalore 560 003.

Tele: 3441192

3441193
3447951
Shri Deepak Gupta
Joint Secretary
Govt, of India
Ministry of Health & Family Welfare
Room No. 146, ‘A’ Wing
Nirman Bhavan
New Delhi-110 Oil

Fax No : 080-3440952
Dir (oft) : 080-3362431
Dir (res): 080-3419875
email: ntiindia@blr.vsnl.net.in
F. A&C/
/99-2000 } /
°
22nd July, 1999

-v

Sir,

Sub: Document on Tuberculosis and Women’s Health - As a part
of the module for training women’s organized groups - reg.
-0-

We have gone through the above mentioned draft document sent to us for necessary
modifications.

It was felt essential to restructure the sub-headings to maintain a logical sequence.
Furthermore, some of the aspects, particularly regarding “Isolation” of TB patients which had
been wrongly emphasised has been corrected. Rest of the changes are mainly editorial.

■

With kind regards,

Yours faithfully,

3,b

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Dr (Mrs) P. Jagota
Director

Cc:
Dr G.R. Khatri
D.D.G.(TB)
Central TB Division
DGHS, Nirman Bhavan
New Delhi-110 011

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TUBERCULOSIS IN WOMEN AND ITS IMPLICATIONS
Tuberculosis (TB) is an infectious disease that usually affects the lungs.

suffering with TB of the lung have TB germs in their sputum (Kafam).

Persons

These patients are

infectious and spread the TB infection to others while coughing, sneezing etc. About one out of
ten who get infected with TB germs develop active TB disease during their life time.

TB could affect anybody irrespective 'of their class, caste, creed, age and gender.
However, TB is more common among the economically productive age group of 15-49 years.
The fear and stigma associated with TB seems to have a greater impact on women than on men

often placing them in an economically and socially disadvantaged position. Because the health

and welfare of the children are linked to that of their mothers, TB in women can have serious

implications for families and households. TB patients are equally distributed in urban and rural
areas. Approximately 35 lakh people suffer from infectious tuberculosis in India. One Indian

dies of TB every minute and 6 lakh die of tuberculosis every year.

Every year in India, about 600,000 people needlessly die of this preventable

disease. Death from TB can be stopped if we take appropriate preventive

steps.
In an Indian village of approximately 1,000 population, there are at least 2 sputum

positive cases and equal number of active cases of tuberculosis detected by X-ray. TB services
are available free of cost in all the government health centers. Out of every 100 people with TB,

approaching the government health centres only 30 are detected and of these 30, 12 complete the
course of treatment. This is despite the fact that the services and drugs are available entirely free

of cost from the Primary Health Centres.
Tuberculosis in women:

The occurrence of TB among men is relatively higher. However, in the childbearing age
of 15-44 years, women are more prone to get tuberculosis. The death among women due to

tuberculosis in this age group is higher compared to all causes related to childbirth. TB can also
affect the reproductive organs in women and may cause infertility. This may lead to hardships
resulting in their desertion by the family.

Socio Cu

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a”<' ,r'atam °f TB Prab*ly due to

ilfcacy and bJera' in
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the family, leading to

alnounshment and impaired immunity.
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In the event of a family member suffering from TJ3 the
caring for the sick.

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' woman takes up the responsibility of

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Most often women are accnrH^j
accorded a secondary status in thA r

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powa md ,ess

re,,“ve'y iess
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6 b'UldCn °f overwork, under nutrition and

motherhood.

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Poverty, inadequate food

' “■sionee due to teo75 nkT]

risk.

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^^-cttu,-.,! barrie„ retated

1C r'rsl slcP 111 the treatment of any disease is th

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by m“V eritunti factors.

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sertousness of her symptoms, because of her low seif o ,

from the horn

from "0,,K by

society.

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Socio-cultural change is a slow and

efforts have to star

(iifficult process, but

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Young girls of marriageable age or their parents do not want to expose their disease because

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they would face difficulties in finding suitable partner.
Persons face several problems in their work place too. Sometimes they are dismissed from

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work resulting in a poor family being pushed even further into debts. When men are deprived

of their employment due to TB disease, the women in these families have to shoulder the
additional responsibility of earning a livelihood for the family with lesser benefits. In the

process they are subjected to the stress and strain making them vulnerable to the disease.
It is more likely that women will discontinue the TB medicine as they tend to neglect

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themselves and family gives them less importance.

HIV & TB:
HIV infection lowers the immunity of the individual, thus making him/her more vulnerable

to develop tuberculosis. Existing socio-cultural practices not only increases the Susceptibility of
to tuberculosis, but also to HIV infection which aggravates situation in addition to the
women
stigma associated with HIV and the delay in seeking medical care. As.the association of TB and
HIV becomes increasingly known similar stigma and its consequences may apply to women with

TB.
What is TB?

TB is an infectious disease caused by small germs or bacteria. These germs present in the

sputum of a person with disease are discharged into the air by coughing or sneezing. They
are likely to be inhaled by other persons in close contact.
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Once these germs enter a person’s body they are lodged in their lungs. These persons-are
then known as “persons infected with TB bacilli” and will remain so for many years,
probably for life. Healthy people can usually fight the infection and only a small number of

people who are infected^one out often) actually get sick with TB in his/her life time.
.

But if a person is week malnourished, diabetic very young or very old or infected with HIV,
the germs may start to attack his/her body. From the lungs the germs multiply and spread

through the blood to other parts of the body. Usually, this happens in the lungs where the
germs make holes in the tissue and destroy blood vessels. As the body tries to fight the

disease the holes get filled with pus and small amounts of blood. Without treatment, the
body starts to waste and the person usually dies within two years.

3

TB can affect any organ in the body. But the most commonly lungs are affected. This is

0

known as “Pulmonary Tuberculosis”. When TB germs attack other body organs like the

lymphnodes or the bones and joints etc., it is called as “Extra Pulmonary TB”. In women TB
can affect reproductive organs leading to infertility.

TB is not caused by Bad deeds (results of bad deeds committed in past),
by the evil eye, or due to sin. TB is not hereditary.

TB becomes active when a person’s ability to fight the TB germs becomes low.

How TB is spread?
©

TB spreads from one person to another when someone who is sick with TB of lungs

coughs out germs into the air.
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People who are sick with TB of lungs and have TB germs in their sputum, can spread
the germs to others. People who are infected with TB but without disease and those

with TB in parts of the body other than lungs and those who do not have TB germ in
their sputum are not infectious.
9

If not treated, correctly, a person sick with TB will infect about 10 to 15 more persons

with TB germs each year. But once a person starts taking regular medicines he or she
will no longer remain infectious.

Women who are sick with TB disease but not diagnosed and started on

treatment can infect their children and others in their care.
How to know if a person has TB?
A person with following symptoms is likely to have TB of the lungs (pulmonary TB).
® Persistent cough for more than three weeks, especially if the cough brings up sputum

from the lungs. Cough may or may not be accompanied by blood in the sputum,
weight loss, rise of body temperature in evening/and sweating, loss of appetite etc.

The most important symptom of TB disease is cough of three weeks or more.
And all those with cough of three weeks or more should be suspected to be

having pulmonary TB and subjected for sputum examination.

4

The only way to know for certain that a person has TB is to get the sputum tested. To
get a sample of sputum-and not just saliva (spit) - a person must cough hard to bring
up material from deep within her lungs. The sputum is then examined in a laboratory
under a microscope to see if it contains TB germs. If TB germs are seen then she is

called “sputum positive” pulmonary TB patient.

A person should get at least Three sputum tests, done ideally in two days time. If
two of her sputum tests are positive, the woman should begin treatment. If only one of the

3 tests is positive, she should get a chest x-ray, if possible, to know whether she requires
treatment or not.
If someone with signs of TB in the lungs has three negative sputum tests, she
should see a doctor/healthworker for further guidance.

She may have

pneumonia, asthnia, or any other non-tuberculosis disease of the lungs.

How to treat TB?
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TB can almost always be cured if a woman has TB for the first time, and if she takes the
appropriate medicines in the correct amount for the full length of the treatment.
The treatment has two parts. In the first part, a woman takes four medicines for two months,

and then her sputum is tested. If it is tested negative, she begins her second part, in which
she takes 2 drugs for another 4-6 months (a total of 6-8 months of treatment). When the

treatment is completed, her sputum should be checked again to make sure that she has been

cured.
«

If sputum is still positive after 5 months of treatment, she should see doctor/ health worker
for more tests: These can- show if her TB germs are resistant to the medicines.

Birth Control Pills may become less effective when TB treatment is going on.
Women being treated for TB should adopt other family planning method.
TB Treatment during pregnancy:
©

Pregnant women should never be given injection streptomycin, because it may cause

deafness in her unborn baby.

5

Anyone who is being trenkd for TB should follow this:

They should consume all the medicines once a day (not in divided dose) after food.
They should never stop treatment when they feel better, if they stop, the illness will
return and they can infect others including their children.
C

they should learn to discriminate which side effects are harmless and which are

serious for the medicines they are consuming. If they have serious side effects, they
should stop taking the medicines and consult the health worker/doctor immediately

for further course of action.
o

Rest is not always essential. If required, the doctor will advise it.

o

They should prevent spreading TB germs to others. They must cover their mouth
whenever they cough and avoid indiscriminate spitting. There is an impression that a

1B patient needs to be isolated from others (sleeping & eating separately) otherwise
TB may spread. Spread of TB in most cases occurs before a person is diagnosed and

treated. A TB patient is practically non-infectious after starting on anti-TB-treatment.
/

Hence, there is no need to isolate a TB patient, once the treatment is started.
©

If they give birth to.a child during treatment for tuberculosis, their sputum should be
tested. If it is negative, their baby should be given BCG (Bacillus Calmette Guerin)

vaccination, but no medicines to prevent TB If the mothers’ sputum is positive, she

and her baby will need medicines.

They need not to be separated or stop

breastfeeding.

TB is curable provided the treatment is completed
Resistance to TB medicines:
®

If a person does not take enough of the right kind of medicine or takes medicines
irregularly or stops taking medicines before the treatment is finished, then not all the

TB germs will not be killed. The strongest germs will survive and multiply, and then

the medicine will be unable to kill them. This is called ‘resistance’. Anyone whose
sputum is still positive after 5 months of treatment may have TB germs that are

6

resistant to the medicines being taken. The patient should then see the doctor for

further guidance.
o

Germs that have become resistant to two most important drugs i.e., Isoniazid tablets

and Rifampicin capsule and can spread drug resistant TB, which is very difficult to
treat.

The treatment takes between 12-18 months. It is less successful and moie

expensive than the initial treatment of TB. The drugs also have serious side effects. A
person with drug resistant TB can spread the disease to others for several months after

beginning treatment.
Do’s and Don’ts for people suffering from tuberculosis
Don’ts

Do’s

Do mot stop medicines before your
discontinue
advises
to
physician
them even if you are feeling better

Use handkerchief while coughing or
sneezing .
A TB patient can also work with others

Do not discriminate against TB
Patients. After starting treatment TB
patient becomes non-infectious and
hence no form of isolation is required.

Spit in spittoons containing household
germicides. In a spittoon (or cup) keep
only household disinfectants like phenyl
containing either cresol or phenyl and
allow the cup to stand for an hour.
Contents can then be disposed off.

Special diet is not necessary for cure of
TB. Tonics will not help. Only anti-TB
drugs taken regularly for full duration
will cure TB.

Continue all the medicines prescribed for
Full prescribed period on regular basis.

Do
not
spit
in
piece/paper/handkerchief.

gauze/cloth

Traditional Remedies:
A person with diagnosed TB should meticulously follow the treatment prescribed

by the medical doctor. At present, it is not possible to cure TB through herbs but
they can be taken along with allopathic medicine to reduce Kafa and enhance the

body immunity.

7

Prevention of TB:
©

Improve the body resistance by ensuring nutritive food, enough rest, fresh air and proper
ventilation in the house.

These are inter-linked very closely with economic and

environmental issues such as poverty. With the present AIDS, epidemic, TB has become an
even more important cause of disease and death because HIV infection lowers the body’s

immunity making person more prone to TB infection and disease.
©

rhe BCG vaccine that is given to all newborns as part of the universal immunization
program helps in reducing death and disability from severe forms of extra pulmonary TB

(such as TB of the tissue covering the brain) in children under 5 years of age. However, it
does not prevent TB of the lungs among adults, which is the infectious form of the disease.
Q

The most important measure to prevent the spread of TB in"the community is to detect TB

eaily and to ensure treatment till the patient completes the full duration as per doctor’s advice
without interruption.

The best way to prevent the spread of TB is to promptly cure people who are sick with TB

Following measures can also help:
o

Motivate people to get tested for TB if they live with a person who is sick with TB in the

family and show signs, or if they have a cough for three weeks or more.

Let the sunlight in wherever possible. Sunlight helps to kill TB germs.
©

Immunize healthy babies and children with BCG vaccination to prevent the most deadly

forms of TB. But children sick with AIDS should not get BCG vaccination.
TB Control Programme:

The1 Government of India has a National TB Control Programme (NTP) and in some

districts the Revised National TB Control Programme (RNTCP), for the control of TB in our
country. TB services (diagnosis and treatment) are made available free of cost in the entire
government health centres in urban and rural areas.

The NTP reports reveal that only about 30% of the TB patients are being detected and

put on treatment in these centres.
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Why only 30% TB patients are detected?

People do not go to Primary Health Centre (PHC), as they have little confidence in the
services offered in these centres as:
Often there are no facilities to check the sputum for detection of TB due to shortages
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of resources such as laboratory technicians and microscopes.
Non availability of doctors.

Shortage of drug supply is common.
The doctors and health workers do not listen patiently to persons,in order to suspect

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TB. Sometimes their behaviour also is rude.

Often the working hours at these centres are not suitable to the patients or there is a long

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waiting period before they get due attention.
People usually consult private practitioners who may not be fully qualified and if
qualified, they may not be aware of the guidelines of the National TB Programme. They
may give symptomatic treatment for cough, without subjecting them for sputum
examination to rule out TB.

Hence, the TB diagnosis and treatment are delayed.

Sometimes incorrect or unnecessary treatment is also prescribed.
Although TB treatment is free of cost it is reported that only 40-50% of those

initiated on treatment complete the treatment period and are probably cured.

!

Why patients give up treatment?

Personal Reasons
©

People suffering from TB are apathetic, and feel cure seems too slow.They keep
changing doctors and treatment due to ignorance.

©

Patients start believing in traditional healers instead of proper medicines. On taking
Rifampicin, the colour of urine becomes reddish and they feel the treatment has
caused bleeding and stop taking the medicine without even consulting the doctor.

©

Patients are tempted to stop treatment or forget to take treatment as soon as they feel
better, especially after two months.

9

I.

©

Financial and other social factors may make patients give up treatment. This is more
in case of women/girls.

©

Side effects of the drugs such as nausea, loss of appetite, stomach irritation etc., occur
in some patients. Due to this, medicines are discontinued.

Reasons linked with health Systems
©

Health workers and doctors do not motivate the patient to complete treatment

o

Drug supply to the primary health centre is not regular clue to poor management.

0

Sometimes ’doctors do not prescribe drugs properly. The dose/strength of the tablets
and the duration of treatment may be wrong.
To overcome the problem of “non adherence” to treatment the Govt, of India has

advocated Directly Observed Treatment Short Course (DOTS) strategy in the Revised
National IB Programme(RNTCP) implemented throughout the country in a phased
manner.

Directly Observed Treatment-DOT

TB Treatment is given for the duration of 6 to 8 months (short course). Most of the TB

patients do not take regular medicines and/ do not complete treatment as prescribed by the doctor
The consequences of stopping treatment are serious; therefore extra care should be taken to

ensure that a person consumes all the medicines. A health worker or community volunteer

should watch the sick person take every dose and record what is consumed. This is called
‘Directly observed treatment, short-course’, or DOTS.

In tipis strategy, for the first two months of treatment known as Intensive Phase, patient
comes to the clinic thrice a week and consumes the drugs (all tablets) in the presence of a health

worker. In case patient fails to come for drug consumption the health worker makes a home visit
next day. In the remaining period of 4 months known as Continuation Phase of treatment,

patient visits the clinic once a week and takes one dose in the presence of health worker and the
remaining two on her own at home. The health worker ascertains the consumption of the 2 doses
during the next visit. In rural areas health workers/Anganwadi Workers/Dais are involved as a
DOT observes.

10

NGO participation:

NGOs can play a vital role in the NTP. They can organise the people through action
oriented health education. They can motivate patients to avail services under NIP and make
people more
more aware of the importance of their health, regular treatment and completion of

treatment as per the advice of the doctor. They can also participate in NTP activities helping

health workers in following up TB patient so as to reduce the irregularity on the part of the
patient and reduce the number of defaulters.
Sewa-Rural, an NGO has tried out an innovative approach to enable the completion of

the treatment of TB person. They observed that after two months of treatment, a person

usually feels better and stops the treatment. Now Sewa-Rural team members write and
send a post card to such persons to remind them. In villages to receive postcard is veiy

prestigious. Often, they are not able to read the letters themselves so; they tkke help from

others to read the letters. By seeing the organization’s symbol stamp they come to know

that the letter is from Sewa Rural and then approach the organization, where the health
worker gives them further course of medicines. Even if they fail to come, efforts are
made to contact them through letters or meeting personally. This method has proved

effective in the completion of treatment and ultimate cure of TB.
Support system by women’s groups:
Community leaders, panchayat leaders, women group health workers, trusted friends and
o
family members can help to support and encourage women to complete the treatment.

Support for women and their families may be given in the form of baby-sitting for young

©

children or by giving a helping hand with housework and finding ways to provide travel

money or financial support through Panchayat loans and grants. In this way women and

9

families can support each other during crisis of illness.
Charitable trusts and voluntary organizations'can be approached for assistance of free
medicines and medical check ups.

Working for change:
Creating effective TB-control in your community requires;
.

Community and family education about the signs of TB and how it is spread. Encourage

women to seek treatment for the signs of TB.

11

o

Train health workers or community volunteers to participate in the DOTS programme, and to

find and work with persons sick with TB if they stop treatment early.
o

A continual supply of medicines so that treatment does not get interrupted and availability of
trained workers and laboratory equipment for testing sputum.

o

A good system for keeping track of who has TB, how the treatment is going, and when a

person is cured.
In view of the socio-cultural situations encountered by women and its implications related

to TB, it is clear that attention to the problem of tuberculosis in women deserves special
attention in tuberculosis control.
References:
o

Where Women Have No Doctor: A Health Guide for Women, Editor, Sunday Niemann,

Published by The Hesperian Foundation, 1919 Addison Street, Suite 304, Berkeley,

California 94704,US A.
&

Curriculum Revision Development: Report of a Workshop, Women and Health Programme
1996.

Further reading suggested:

Tuberculosis, Still killing, Health Action Vol. 12, No 2
What you should know about TB, (1995) GOI-NTI Pamphlet.

TB its diagnosis and treatment (1985), NTI Pamphlet

0

A Guide for the health provider (1998) RNTCP pamphlet from Central TB Division,
Government of India.
1
of TB 1998)-VHAI Publication.
99

12

^aJ\A -1 b. 13

1

Building capacity for information dissemination regarding women’s health DRAFT

WORK AND WOMEN’S HEALTH

Occupational health of women in the unorganised sector
All of us work most of our life. We work at fields, at home collecting water, fuel and

fodder, cooking and cleaning, caring for children and family members. Most women also
earn money to support their families, in the fields and forests, in other peoples’ homes, in
factories, in construction sites etc. the list is a long one. And yet much of women’s work

is not valued or recognised, or perceived as being as important as that of men.

Only 4 out of 100 women work in the organised sector i.e. in factories, in the government

and in big companies. The rest work in the unorganised sector, i.e. in places and
occupations that are not covered by formal agreement or contract with employer and

hence do not receive any benefits whatsoever. Women work on farms, roll beedis, make

papads, stitch clothes, work on construction sites and so on. Many are self-employed.
Some work on a contract basis and others on a piece rate basis. There is a great variation
in the kinds of work women do both at home and outside.

All women are workers since they are producers or reproducers. Even when they are not
employed they are involved in socially productive work and reproductive labour, all of
which is necessary for social/economic production. For when women fetch water, gather

fuel and fodder, or look after children, they are performing services in the absence of
which they would have to be purchased

4

As stated earlier a majority of women are in the unorganised sector where they suffer

from low wages, no security of working days, no access to leave, rest or health care. The
health status of working woman has, therefore, to be understood within such context.

1

2

V
Bic health of a woman is affected by various factors. Poverty, the kinds of work one does

within the home apdput side, working conditions, working posture, nutritional and
mental statps, the recognition and value that women’s work as accorded by society and

by the woman herself, (and poor or inaccessible facilities for women.)

Since women’s work is varied and often not fully understood or recognised, it is
important to first know the types of work a woman does, both at home and outside, and
tfip time spent. One will find for instance that women themselves are often unaware of

their workload. A woman’s work affects her health, and a woman’s health in turn affects
her work- this is a vicious cycle in which women are caught of ill health-over work- ill

health

li

1 i

2

3

Health problems of women in different occupations
Occupation and some casual factors
1.MANUAL WORKERS

Health problems

Agricultural workers
(postural problems of bending for long hours,
exposure to chemicals/pesticides, unguarded
implements, working barefoot for long hours in
water, no securities of any kind)

Severe body aches, especially back aches;
respiratory allergies, skin infections, fungal
infection in feet
Injuries
Thresher accidents while crushing sugarcane
and ginning cotton; physical injuries from
outeredges of implements like sickles; due to
lack of first aid facilities small injuries lead to
tetanus
Prolonged exposure to chemical pesticides
leads to;
Pesticide poisoning, nausea, vomiting,
headaches, vertigo, blurred vision among
others

Plantation workers
(inhalation of dust; exhaustion due to heavy
workloads, lack of medical services, working
barefoot)
Mine workers
(exposure to mineral dusts, extremely
hazardous working conditions, lack of timely
diagnosis)

Construction workers
(heavy workload, exposure to dusts and
hemicals, accident prone working conditions,
pressures as contract labour)

Brick workers
( lack of personal protective equipment; no
precautions for work in very hot atmosphere;
contract and bonded labour; continuous heavy
workloads, even during preganacy)

Lung infections and bronchial problems,
malnutrition, contact dermatitis and other
contact diseases, heat strokes

Lung diseases, respiratory problems; cancer of
lungs, liver, kidneys and the central nervous
system are affected by toxic dusts, deaths due
to accidents

Physical stress and strain; numbness of hands
and fingers; blood pressure; muscular pain;
respiratory problems; skin diseases;
spontaneous miscarriages; a feelong of
rootlessness and isolation

Heat exhaustion; bums and wounds; aching
hands, back and shoulders; coughing, chest
pains, prolapse of the uterus; miscarriages, etc

3

4
Occupations and some causal factors______
Salt and kiln workers
(lack of personal protective equipment;
working in hot sun; unsafe working conditions)

Heat strokes;constant bleeding in tlie feet,
injuries due to accidents

Fuel and fodder gathering
(postural problems, long hours of walking and
carrying loads)

Physical strain and stress, bent backs, pain in
legs ,shoulders & amis; falls from heights,
sexual harrassment

Carrying water
(heavy physical strain, aggravated during
pregnancy)

Bent backs, intense pain in different parts of
the body, especially legs, waist,pin
bon es;prol apse of the uterus &miscarriages

All workers involved in manual labour
(lifting heavy weights; postural problems;
heavy workload; continuous heavy work from
childhood through illness, pregnancy, and in
tire post partuni period to old age, nutritional
deficiency, harrassment)

2. Service sector
Domestic workers
( postural problems; working with water and
with household chemical based products)
Washer women
(working in water; continuous use of chemical
based products)

Sweepers & Rag pickers
(working in open elements and with infectious
rubbish heaps)

All women in service sector
Uncovered parts of body in contact with water
for long periods of time; contact with dirt
infected with microbes viruses; exposure to
hazardous chemicals and elements; lifting
heavy weights; low nutritional status,
harrassment)

Health problems

Disturbances in blood circulation in pelvic
organs and lower limbs; menstrual disorders,
prolapse of uterus, miscarriages; flat and
narrow pelvic if carrying weights from
childhood; risk of injury to spinal column,
deformities; neuritic pains; paralysis

Frequent cold;bruises; acid bums and bums;
chronic bodyache; postural problems

i
Irritation of eyes and upper respiratory tracts;
cancer mainly of the kidneys, genitals, and
skin, chest pain, fatigue and drowsiness

Nausea, bums, rashes and sores on hands and
feet, viral infections, insect bites, headaches;
dog bites; glass cuts

Chronic body aches, chills, cold, respiratory
problems, insect bites, skin diseases; burning
sensation in hands and abdomen, eye problems,
injuries to hands and feet, etc

4

5
Occupations and some causal factors

Health problems

3.Home Based Workers

Beedi workers
(postural problems; exposure to tobacco dust
and nicotine; cuts due to injuries, repetetive
movements, constant friction on fingers)

Neck and low back pain; pain in hands and
fingers; abdominal pain, burning sensation in
throat, cough, asthma, eye problems, effect of
nicotine on reproductive functions, general
fatigue

Chikan workers
(postural problems;allergies;eye starin, poor
ventilation)

Back aches; spondylitis; poor eye sight;
tuberculosis; allergies.etc

Agarbatti workers
( postural problems, reaction to chemicals, no
protective equipment)

Low back pain, pain in hands, palms and
fingers, contact dermatitis, skin abrasions

Carpet weavers/weavers
(postural problems, poor ventilation, long hours
of minute work)
Readymade garment workers
(postural problems, heavy workload)

All women workers working in home based
occupations
(exposure to dusts such as tobacco, cement,
exposure to chemicals, drudgery, repaeted
movements of afew oarts of the body, strain on
eyes due to bad lighting)

Eye problems, back aches, joint pains

Low back pains, eye problems, urinary tract
infections

Respiratory problems, digestiive problems,
skin problems, low back pain, stiffness in
joints, weakening of eye sight, exhaustion,
dizziness,etc

4. Processing workers

Garment workers
(postural problems, eye strain, repetetive
movements, lack of facilities like toilets)

Coir workers
(sitting on wet ground,unprotected hands,,
exposure to coir dust)

Pain in arms and legs, low back aches, swelling
of limbs, muscular pain, eye problems,
dizziness, fatigue, leucorrhea etc

Respiratory problems, asthma, skin
problems,etc

5

6

Occupations and some causal factors
Wool workers
(exposure to dust and fibres)

Slate pencil workers
(exposure to fine silica dust)
Matches and fireworks workers

Health problems
Respiratory allergies like allergic rhinitis,
bronchitis, pulmonary tuberculosis

Dry cough, breathlessness, chest pain, weight
loss, fibrosis of the lung etc
chemical toxicity, explosive accidents,
dennatitis, back aches

Source: Shram Shakti: Report of the
National commission on self employed
women and women in the informal sector,
1988

The above list is not an exhaustive list. Obviously women in our areas may not be engaged in all
the occupations listed above. They may be involved in other occupations that are not indicated

above.

The common problems related to occupations in the unorganised sector can be
summarised as follows;
e

Problems related to posture

Constantly sitting in one position, backs bent, or stooping for long periods. They suffer
from pains in the back, shoulders and waist and stiffness in the joints. Eyes ache and

water from hours of strain

•

Problems of being in constant contact with hazardous material

Constant contact with woodsmoke, gases like carbon monoxide, chemical fumes, tobacco

and silica dust leads a host of respiratory and skin problems. Since protective gloves are
not given women’s hands often look as if they have been affected by leprosy

Problems related to work environment

These include lack of light, latrines, water, ventilation, space, small and poorly lit and

poorly ventilated homes. In small scale factories or karkhanas, women are affected by

6

I

7

extreme temperatures and often feel dizzy and faint. Since no toilet facilities are

provided, women and try to eat and drink very little water resulting in dehydration,
constipation and other health problems

o

Problems related to lifting weights

Lifting weights is one of the main jobs of women in construction sites or brick workers.

These give rise to health problems such as menstrual disorders, prolapse of the uterus,
miscarriages, back problems, etc. Accidents and injuries to children also occur since there
are no childcare facilities

®

Problems related to long hours of work

Long hours of work with bad posture and in hazardous surroundings worsen health
problems. This problem is compounded by continuous exposure and lack of rest

©

Problems of mental stress

In the unorganised sector women are frequently exposed to sexual harrassment from
landlords in the fields, from police, from male buyers and sellers and from supervisors,
employers and male colleagues at the workplace; and they are in no position to fight it.

At home the woman faces the problems of wife beating and alcoholism, and worries of

making ends meet. The different sources of stress/pressure on a woman are from the

family, her work and the community. This stress at the work place but also at home
results in continuous pressure on women which compounds all other health problems and

also leads to sleeplessness, loss of appetite, constipation and depressions
Mental stress is most often the least recognised occupational health hazard
The causes of women’s ill health are complex. As indicated above the work she does

affects it. What are the other factors? The whole range of socio cultural factors have an
impact. Society does not recognise or value a woman’s work. This stems from a general

societal attitude of not valuing the woman herself A woman herself has internalised this
attitude. She has neither the self-esteem, knowledge nor education to see the importance
of her work and the need to keep healthy to shoulder the work she does. Since the
majority of women in the unorganised sector are poor women, their problems and needs

7

8

are not brought within the ambit of policy and legislation. The women, themselves

disadvantaged by being women, poor and caught up in the task of survival and buiden of

work, do not have the strength to challenge this situation.
OCCUPATIONAL HEALTH HAZARDS CANNOT BE LOOKED AT IN ISOLATION

Occupational health hazards

Aggravated by household work; no rest;
mental stress, low access to water,fuel and
fodder,poor nutrition

Aggravated by social situation of the individual woman
Low self esteem, low income, low access to health and
support services, isolation, lack of education,low social
status

A
V

Insensitivity of larger system
to issues of women’s health; no insurance and secunty cover, absence ot
legislation for the unorganised sector; non implementation of existing laws
Socio-cultural discrimination of women

We need to understand the toterlinkages between the various factors that affect occupational health.

and larger societal level

8

9

Laws affecting status of women workers

Generally people believe that the laws and courts are not within the reach of the poor and

especially poor women. While this is largely true, it is nevertheless imperative that we
know what laws exist for women workers, if any attempt is to be made to make them

work. Some of the key laws affecting women workers are:
©

Factories Act, 1948, Mines Act, 1952 and Plantation Labour Act 1951, place
restriction on employment of women during night hours

o

The Minimum Wages Act, 1948. This is the most important Act for the unorganised
sector as it fixes minimum wages to be paid in the agricultural sector

©

Equal Remuneration Act, 1976 is to ensure payment of equal remenuration to men and
women in an establishment during the same kind of work Another important aspect

relates to avoidance of discrimination on grounds of sex against women in matters of
employment
©

Maternity Benefit Act, 1961 ensures maternity benefits like leave . This, Act however,
does not apply to the unorganised sector.

9

Bidi and Cigar Workers Act 1966. The existence of a law has encouraged workers in
this sector who are generally women, to unionise and struggle for better working

terms.

The recent Supreme court ruling on sexual harassment now provides an opportunity
for women to protest and fight sexual harassment at the workplace

What can we do?
G

Develop our own and women’s understanding of the complex set of factors that affect
women’s health. Draw upon our experiences as women themselves to establish these

linkages. There will be lots of experiences of mental stress, sexual harassment at

workplace, lack of support within the families, insensitivity if the community leaders

9

10

and employers and so on. Try and bring out the situations where these problems have

been successfully dealt with by individual women or by a group of women
Q

Enable women to recognise and understand the range and depth of their own
workload . This can be done through simple exercises. Ask them to make a list of all

their activities in detail from the time they get up to the time they sleep. Try and

estimate the time they spend on each work. Place a value on each piece of work the

woman does and total the amount. In all cases the woman’ contribution is very much
more than the money earned by the men of their household. This can lead to a
correlation between food intake and workload. Enable women to see that unless they
have a minimum intake of nutrition their health will be seriously impaired. The

discussion must stress that it is in the woman’s hand to ensure that she gets an equal
share of food. Field experiences have shown that this kind of visualisation has a very
dramatic impact on the women’s understanding
©

Initiate a discussion on how we can start bringing about change. One must remember

that even small changes can have a very positive impact. Since women are generally

poor and have no voice in their families and communities, we can suggest that if they
get together to discuss their problems, then collectively they can find solutions. Some

efforts can then be made to demand some rest period from employers/landlords;
drinking water and toilet facilities at workplace, demand some protective gloves in

occupations that require them. Most importantly they can support each other to fight

sexual harassment as well as develop mutual solidarity which may relieve mental

stress
As a collective they can pressurise their elected representatives for better medical

facilities and insurance cover
©

Women can retrieve any traditional health practices to deal with body aches and other
health problems. This is part of their own experience. They can also learn simple

exercises to relieve them of backaches and so on. For this we can network with local
women’s groups who are working in the area of women’s health
©

Important groups who can help the women are medical practitioners and medical
personnel. Draw them into the discussions with women so that not only will their

10

11

own sensitivity to the problems of poor women will develop but a close rapport can

be then built up

©

To explain the various laws, the legal system as well as to analyse why the legal
system has provided no real redress to women, involve district labour officers, local

lawyers as well as women’s groups. Through this a legal referral system could
perhaps be built up which is accessible to the women

11

..

0.

c
6

e
>
>
>
>
>

Chronic infection
Prolonged exposure to an rays/high temperature
Radiation including Ultraviolet radiation
Prolonged trauma/irritation
Some cancers to a some extent may be hereditary e.g. Breast cancer

C

c I

I

Healthy living can prevent many cancers,
gat nutritious foods and avoid smoking and chewing of tobacco, protect yourself
ffom sexuallyImnsmitted diseases. Also avoid harmful chemicals at home and at
the workplace,
-

j

i

c

■

c

Cancer of cervix

malignaCntyphaseriCer °f

&

C
C
G

IS 3 Sl°W 9rowiri9 disease- lf may take years in pre-

:

(

J

G |

Common signs for the cancer of cervix

(

I
i

>

'!

C

C

> Bleeding from vagina after menopause
> A pinkish or bad smelling discharge, or a bad
smell from
from vagina
vagina
bad smell
Si9nS may inClUde pain

(

passi"9 ur™. « pain in the

c

it

I
fl

|

c

Some facts of cancer of cervix

+

(.

>

risk for women older than 35 years, compared to than it is for younger

(-

> Cured easily if it is detected early
> Painless in its early stages
> Slow growing. It usually takes mc.-.y
many 7years to become advanced
Often not detected until it has spread, it is
J more difficult to cure in advanced stage.

l

Risk factors for cancer of the cervix
Women are more likely to get cancer of the cervix if they-

v,.

ct

e '|

cz-

; hlTanSi; SnX*°n'V 3 feWy“rS O,S,ar"n9feir m°",h'r ^edin3>nd
> has more than one sex partner
State Level Training Manual
Cancers

/

/
\

2

x />■ i

;e II
€

i

.)

J
')
J

> has had Sexually Transmitted Disease in the past
>-does not keep cleanliness of .their private parts
> has had viral infections such as genital warts
> has had many pregnancies

.5

1

j

Reducing Deg-|-hs bug to Cancer of Ce.rvix

»

e

ceHs taken from a women s cervix, which are then put on a slide and looked a under a
microscope for abnormalities.

)

J

: 1

)

It is suggested that -

9

>

)

afte.r.35 years of a9®’ every 3 years Pap test needs to be performed In
places where it is not possible, women should try to get a Pap test done every 5
andnuSg homes0' eXpenS,',e' " can be easil>'do™ a' P^«c ^<1 Private hospital

;I

>
>
contactStnr IfS Sexuall>'Tans,"',ted “sease- Refer ctl’P:'< on RTI/STD
contact doctor if there is any change in regular vaginal discharge.

I I *

Warning Signs

C '“I

mote ^.t te"Z.0Utaard

?■ i
I• 1

r1
•1

■. i
.. a
; J

1

J

°f ““'he “tvix until it has spread and is

3 ■

©

3

a

Hrding_ond treating cancer of the cervix

3

The Pap test

I

JoctoZIXn 0"test iS ,he Pap ,esl "is l’uick and simP'a Pte«dure For this test

'

■■

' ■■xfS-

e
’3

■5

> Pap test is not done during menstrual period
> rPap test should not be done within 48 hours of insertion of vaginal tablet
Do not
. -t use savlon or any other cream
Pap test should not be repeated earlier than six months
six months
State Level Training Manual
Cancers

3

I
IaJ YA —I G- '2-0

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A

WOMEN'S HEALTH STRENGTHENS WOMEN'S WORK
a short note by SEWA

The

L'j'idjZZsd

Woirr-n

f

vi o r k

^■Qr .1

court inc?s ,

On 1 y

47.

I nd ia

;t n

exists m<3inly in t.ie
women

work

employer-employee relationship
security

inc 1uding

workforce

is

1 nsuf f ic a.ent

hea1th

many

in for iv, a 1

the formal

in

n

£\;~

•..eve I np5.ng

unorganised

ssctor<

with

and access t o a 11

security, Tot-1 9 .$7.

in the informal sector j* w i t h
income

other

we?l 1

d :>? f i ■ wd

forms of

■■ .-'/c i a 1

the

of

insecure

and lack of access to al 1

shctar.

f r?n(a 1 e

employment

forms

of

S OC j,

j.

security.

The

progress

that

has been achieved

sc

far

in

improving

women's socio-economic and political status has contributed •Jj:

quality

of life and health status of women in general j,

in

the

■ : • d i. a .

However, women have not benefitted equally from such progress.
men

have .

What

is

disturbing is the

fact

t ha t

d i fferences

between women have become wider. and the

differences

have

women

become more pronounced. The

i. he

as

ads olute

qua .1 i tat iv ?

hea 1th

statu _•

of

m any country should be measured by the health

status

of

have a triple disadvantage:

as

their working c 1 ass women.
se 1 f

emp1oyed

■ jomen

se 1 f

emp 1 oyed <,

and as women. They

F’ocr

poor j,

as

d i s a d v a,-) t a g o

c3S

are

first,

in forma1 s ?c tor wor k ers . Along with

their

i rom low in com' s and insecu re wo r k in all

they

suf f er

the

economy—working as a - .ricu 1 tura 1

at

labourers or small

sector

Ci

men ?

•o 5

f ar i: ers 5

w'

Most
acuteness

of the workers face the general health problems and

the

the>

are

of

the occupational health problems because

Malnutrition,

poor -

•frequent

deficiencies,

basic

c amon

faced by women because of their poverty and

low

social

Shram Shakti Report further points out; The

Constitution

pregnancies,
problems

severe

anemia,

or

sexual harassment are some of the

status.

The
of

"make provision for
India directs the state to

and human conditions of work
under

ii

5

securing

j USt

however > workers continue to toil

environment that poses constan t threat to their health

a minimum wage.
are paid ^return much below
health is her only
In Sum, then for a poor woman <> her

and

wei* 1 th.

has health security.
She can only obtain work security if she
contribution to India's economy she
Given her very signi f icant
is entitled to health security.

raising

1ivestock or collecting minor forest produce•

contract workers5

homebased workers, casua1 workers or

account

workers.

A1 though

measure

to

the

Gross

share

in

adequate

opportuni ties.

these?

Domestic Product,

nation' s

the

Un like

workers

forma1

they

do

incomes

or

good

quality or reasonably

generally

have

to

priced

pay a large percentage

of

t' «•

^mai 1

cor^ tribute

sector workers they

to

access

working

large

in

not

rece.i ve

employment
do

not

have

heal th

care

and

their

reasonably

priced health care and generally have to pay a large percentage of
their incomes to access even minimal health care Tacilities.

When
mother,

to

women

the triple role of

worker«,

because of low access ,to support services,

for

housewife

■£U id

they are unable

any of the functions satisfactorily.

Lac k

example, means that they have a

productivi ty

perform

care,

play

workers

as

maternal

hea1th

1 ow

we 11 as poor care for the child. Lac k
care means that their

work

of

child

of

access

negatively

as
tD

affects

both 5 the pregnant mother and the unborn child.

Thirdly,

work

in

demanding

their

the

due

to unequal divisions of labour, women

paid ,

1 east

spheres

most

insecure

and

of the economy. Women rare’y

tend

physically

have

most

assets

own name, and are rarely organised enough to demand

to

in

socia1

security of any type.

■i,

WOMEN'S WORK AND WOMEN'S HEALTH
If health security is viewed in the context of poor women,
has

to

be seen in the light of their work. Health and

inextricably

linked

for

The

the poor.

work

in ter1 inkages

it

are

between

health and work are innumerable:
(a)

Her

work often affects her

sector

do

work

is

that

heal th. "Women

physically

various

mothers often

in

(b)

pos i tions

that

and

feeding

parts

of

work

in circumstances that lead to miscarriage

or affect v.he health

is

informal

demanding, often with

harmful substances. They work long hours
harm

the

in

of

their

body.

the child.

Pregnant

□ecupationa 1

hea1th

a maj or issue for poor women.

Her health
main 1 y

is

affects her work. Work in the informal sector

and

manual,

productivity

a

on

depends

body

^in

of

poor

‘‘if

peak

nutrition,
-

lack

of

pare

during

pregnancy

and

childbirth.

■

living in unsanitary
care, most women

are

conditions
in

into

a

vicious

and lack

‘—'access to health
often

-nentai )

productivity and income^

leading

poor physical

health.This pauses a fall in

■

because

Unfortunately ?

condition.

physical

( and

cycle of deteriorating health and increasing

'

poverty. Access to Social Security is essentiaP poor women.

Occupationa1 Hea1th
How

do these

women

perceive their own health problems? They

are we11 recorded in the Shram Shakti Report(1988) after listening
to hundreds of women s narration, all over the country.

Hama 1

head loaders

of Pune Grainmarket

pains in their legs and back.
on

the

experience

I just simply feel

f1oor all the time", one of them said to

incessant

like stretching
the

Commission

members

during the public hearings. Women stitching the

cemen t

bags

in their homes in Calcutta complained of

recyc1ed
very

• sore

lingers and burning eyes. They want their infants in the lap,

to be?

protected

f rom

frequently

hours.

The

who

have

vis i t

the hospital, complained of the

1 oss

of

woo 1

knitters

of

complained

among

the cement dust. Bombay slum women

Stone

cutters

in

suffer

Himachal

from

doc tors are very costly" they said.

public hospitals are far away,
we reach for treatment'.
Fisherwomen
feet,

ages,

asthma. Eye strain and backache

artisans.

^Private

of all

of

are

most

severe

common

backache .

In the hilly

areas,

'many of us die on the way

before

Orissa suffer from skin infections

'Blinding

wor!;

Pradesh,

on

because of constantly working in water filled with

ferti1izers.

to

headac hes'

a 1 so

their

chemical

plague them from endless

hours of work in the sun. Agriculture workers suffer giddiness ana
infections

from the high exposure to chemical

ferti1izers.

Coir

ropemakers

in

their

and

Kera1a

suffer deep cuts across

oalms

''
i; ■

fingers. Chi 11i-pickers from, fieldsiin Jodhpur, during the

season,

Y.C; "

cannot cook the evening meal because of the"burning palms. Cashew-

shel1ers
in
1 055

suffer eczema due to the oil the nutjpxudes.

Ca1cutta

suffer venereal disease, gastric

Prostitutes

trouble,

appetite

and fatigue. Cheap liquor in variably takes a tol 1 on

their

KJ) I
\

huyJ'TKS !'\JC|<(C r

^CiKC'A; }

■

l ■ Perpetuation of poor health and nutrition
in Self-employed Women and their Daughters.

j'fevl LTH

Poor Maternal Health
in Pregnancy.

S■ «

Poor^Health of <----- Self-Employed
Adult Women.
—^Women’s Work,

■>
—

Unhealthy
Daby at birth

' i,.-’

O'
Poor Growth &
Overall health
of Girls.

4

:r\ •

NOTE: At every stage of the life-cycle, the following
-.

factors have a profound impact on health and
nutritional status:
A.

Low Social Status(includes discrimination in
a^as-s^to food, health care - both within and
and outise the family).

D.

Few resources for health care,
(i.e. Women do not have these resources).

c.

Lack of access to health care (both government
and non-governmen ) ant[its 'Bppriirt-ene&s' for.

poor women.

D.

Low education.levels(although folk knowledge, and
skills exist),

*e

NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN
(2001)

Introduction
The principle of gender equality is enshrined in the Indian Constitution in its Preamble,
Fundamental Rights, Fundamental Duties and Directive Principles. The Constitution not only
grants equality to women, but also empowers the State to adopt measures of positive
discrimination in favour of women.

Within the framework of a democratic polity, our laws, development policies, Plans and
programmes have aimed at women’s advancement in different spheres. From the Fifth Five
Year Plan (1974-78) onwards has been a marked shift in the approach to women’s issues from
welfare to development. In recent years, the empowerment of women has been recognized as
the central issue in determining the status of women. The National Commission for Women
was set up by an Act of Parliament in 1990 to safeguard the rights and legal entitlements of
women. The 73rd and 74lh Amendments (1993) to the Constitution of India have provided for
reservation of seats in the local bodies of Panchayats and Municipalities for women, laying a
strong foundation for their participation in decision making at the local levels.

1.3 India has also ratified various international conventions and human rights instruments
committing to secure equal rights of women. Key among them is the ratification of the
Convention on Elimination of All Forms of Discrimination Against Women (CEDAW) in
1993.

1.4 The Mexico Plan of Action (1975), the Nairobi Forward Looking Strategies (1985), the
Beijing Declaration as well as the Platform for Action (1995) and the Outcome Document
adopted by the UNGA Session on Gender Equality and Development & Peace for the 21st
century, titled "Further actions and initiatives to implement the Beijing Declaration and the
Platform for Action” have been unreservedly endorsed by India for appropriate follow up.
1.5 The Policy also takes note of the commitments of the Ninth Five Year Plan and the other
Sectoral Policies relating to empowerment of Women.

1.6 The women’s movement and a wide-spread network of non-Govemment Organisations
which have strong grass-roots presence and deep insight into women’s concerns have
contributed in inspiring initiatives for the empowerment of women.
1.7 However, there still exists a wide gap between the goals enunciated in the Constitution,
legislation, policies, plans, programmes, and related mechanisms on the one hand and the
situational reality of the status of women in India, on the other. This has been analyzed
extensively in the Report of the Committee on the Status of Women in India, "Towards
Equality", 1974 and highlighted in the National Perspective Plan for Women, 1988-2000, the
Shramshakti Report, 1988 and the Platform for Action, Five Years After- An assessment"

I

1.8 Gender disparity manifests itself in various forms, the most obvious being the trend of
continuously declining female ratio in the population in the last few decades. Social
stereotyping and violence at the domestic and societal levels are some of the other
manifestations. Discrimination against girl children, adolescent girls and women persists in
in
parts of the country.
1.9 The underlying causes of gender inequality are related to social and economic structure,
which is based on informal and formal norms, and practices.

1.10 Consequently, the access of women particularly those belonging to weaker sections
including Scheduled Castes/Scheduled Tribes/ Other backward Classes and minorities,
majority of whom are in the rural areas and in the informal, unorganized sector - to education,
health and productive resources, among others, is inadequate. Therefore, they remain largely,
marginalized, poor and socially excluded.
Goal and Objectives

1.11 The goal of this Policy is to bring about the advancement, development and
empowerment of women. The Policy will be widely disseminated so as to encourage active
participation of all stakeholders for achieving its goals. Specifically, the objectives of this
Policy include
(i) Creating an environment through positive economic and social policies for full
development of women to enable them to realize their full potential
(n) The de-jure and de-facto enjoyment of all human rights and fundamental freedom by
women on equal basis with men in all spheres - political, economic, social, cultural and civil
(iii) Equal access to participation and decision making of women in social, political and
economic life of the nation
(iv) Equal access to women to health care, quality education at all levels, career and
vocational guidance, employment, equal remuneration, occupational health and safety, social
security and public office etc.
(v) Strengthening legal systems aimed at elimination of all forms of discrimination against
women
(vi) Changing societal attitudes and community practices by active participation and
involvement of both men and women.

(vii) Mainstreaming a gender perspective in the development process.

^Hld Eli™nati°n of discrimination and all forms of violence against women and the girl
(ix) Building and strengthening partnerships with civil society, particularly women’s
organizations.

Policy Prescriptions

Judicial Legal Systems
Legal-judicial system will be made more responsive and gender sensitive to women’s needs,
especially in cases of domestic violence and personal assault. New laws will be enacted and
existing laws reviewed to ensure that justice is quick and the punishment meted out to the
culprits is commensurate with the severity of the offence.
2.2 At the initiative of and with the full participation of all stakeholders including community
and religious leaders, the Policy would aim to encourage changes in personal laws such as
those related to marriage, divorce, maintenance and guardianship so as to eliminate
discrimination against women.

2.3 The evolution of property rights in a patriarchal system has contributed to the subordinate
status of women. The Policy would aim to encourage changes in laws relating to ownership of
property and inheritance by evolving consensus in order to make them gender just
Decision Making

3.1 Women’s equality in power sharing and active participation in decision making, including
decision making in political process at all levels will be ensured for the achievement of the
goals of empowerment. All measures will be taken to guarantee women equal access to and
full participation in decision making bodies at every level, including the legislative, executive,
judicial, corporate, statutory bodies, as also the advisory Commissions, Committees, Boards,
Trusts etc. Affirmative action such as reservations/quotas, including in higher legislative
bodies, will be considered whenever necessary on a time bound basis. Women-friendly
personnel policies will also be drawn up to encourage women to participate effectively in the
developmental process.

Mainstreaming a Gender Perspective in the Development Process
4.1 Policies, programmes and systems will be established to ensure mainstreaming of
women’s perspectives in all developmental processes, as catalysts, participants and recipients.
Wherever there are gaps in policies and programmes, women specific interventions would be
undertaken to bridge these. Coordinating and monitoring mechanisms will also be devised to
assess from time to time the progress of such mainstreaming mechanisms. Women’s issues
and concerns as a result will specially be addressed and reflected in all concerned laws,
sectoral policies, plans and programmes of action.
Economic Empowerment of women

Poverty Eradication
5.1 Since women comprise the majority of the population below the poverty line and are very
often in situations of extreme poverty, given the harsh realities of intra-household and social
discrimination, macro economic policies and poverty eradication programmes will
specifically address the needs and problems of such women. There will be improved
implementation of programmes which are already women oriented with special targets for
women. Steps will be taken for mobilization of poor women and convergence of services, by
offering them a range of economic and social options, along with necessary support measures

to enhance their capabilities
Micro Credit

5.2 In order to enhance women’s access to credit for consumption and production, the
establishment of new, and strengthening of existing micro-credit mechanisms and micro
finance institution will be undertaken so that the outreach of credit is enhanced. Other
supportive measures would be taken to ensure adequate flow of credit through extant financial
institutions and banks, so that all women below poverty line have easy access to credit.
Women and Economy

5.3 Women’s perspectives will be included in designing and implementing macro-economic
and social policies by institutionalizing theirjjarticipation in such processes. Their
contribution to socio-economic development as producers and workers will be recognized in
the formal and informal sectors (including home based workers) and appropriate policies
relating to employment and to her working conditions will be drawn up. Such measures could
include:

Reinterpretation and redefinition of conventional concepts of work wherever necessary e.g. in
the Census records, to reflect women’s contribution as producers and workers.

Preparation of satellite and national accounts.
Development of appropriate methodologies for undertaking (i) and (ii) above.
Globalization

Globalization has presented new challenges for the realization of the goal of women’s
equality, the gender impact of which has not been systematically evaluated fully. However,
from the micro-level studies that were commissioned by the Department of Women & Child
Development, it is evident that there is a need for re-framing policies for access to
employment and quality of employment. Benefits of the growing global economy have been
unevenly distributed leading to wider economic disparities, the feminization of poverty,
increased gender inequality through often deteriorating working conditions and unsafe
working environment especially in the informal economy and rural areas. Strategies will be
designed to enhance the capacity of women and empower them to meet the negative social
and economic impacts, which may flow from the globalization process.
Women and Agriculture
5.5 In view of the critical role of women in the agriculture and allied sectors, as producers,
concentrated efforts will be made to ensure that benefits of training, extension and various
programmes will reach them in proportion to their numbers. The programmes for training
women in soil conservation, social forestry, dairy development and other occupations allied to
agriculture like horticulture, livestock including small animal husbandry, poultry, fisheries
etc. will be expanded to benefit women workers in the agriculture sector.

Women and Industry

Y

5.6 The important role played by women in electronics, information technology and food
processing and agro industry and textiles has been crucial to the development of these sectors. 1
They would be given comprehensive support in terms of labour legislation, social security
and other support services to participate in various industrial sectors.
5.7 Women at present cannot work in night shift in factories even if they wish to. Suitable
measures will be taken to enable women to work on the night shift in factories. This will be
accompanied with support services for security, transportation etc.
Support Services

5.8 The provision of support services for women, like child care facilities, including creches ’
at work places and educational institutions, homes for the aged and the disabled will be
expanded and improved to create an enabling environment and to ensure their full cooperation
in social, political and economic life. Women-friendly personnel policies will also be drawn
up to encourage women to participate effectively in the developmental process.
Social Empowerment of Women

Education
6.1 Equal access to education for women and girls will be ensured. Special measures will be
taken to eliminate discrimination, universalize education, eradicate illiteracy, create a gender
sensitive educational system, increase enrolment and retention rates of girls and improve the
quality of education to facilitate life-long learning as well as development of
occupation/vocation/technical skills by women. Reducing the gender gap in secondary and
higher education would be a focus area Sectoral time targets in existing policies will be
achieved, with a special focus on girls and women, particularly those belonging to weaker
sections including the Scheduled Castes/Scheduled Tribes/Other Backward
Classes/Minorities. Gender sensitive curricula would be developed at all levels of educational
system in order to address sex stereotyping as one of the causes of gender discrimination.
Health

6.2 A holistic approach to women’s health which includes both nutrition and health services
will be adopted and special attention will be given to the needs of women and the girl at all
stages of the life cycle. The reduction of infant mortality and maternal mortality, which are
sensitive indicators of human development, is a priority concern. This policy reiterates the
national demographic goals for Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR)
set out in the National Population Policy 2000. Women should have access to comprehensive,
affordable and quality health care. Measures will be adopted that take into account the
reproductive rights of women to enable them to exercise informed choices, their vulnerability
to sexual and health problems together with endemic, infectious and communicable diseases
such as malaria, TB, a- d water borne diseases as well as hypertension and cardio-pulmonary
diseases. The social, developmental and health consequences of HIV/AIDS and other sexually
transmitted diseases will be tackled from a gender perspective.
6.3 To effectively meet problems of infant and maternal mortality, and early marriage the
availability of good and accurate data at micro level on deaths, birth and marriages is

required. Strict implementation of registration of births and deaths would be ensured and
registration of marriages would be made compulsory.

6.4 In accordance with the commitment of the National Population Policy (2000) to
population stabilization, this Policy recognizes the critical need of men 2nd women to have
access to safe, effective and affordable methods of family planning of their choice and the
need to suitably address the issues of early marriages and spacing of children. Interventions
such as spread of education, compulsory registration of marriage and special programmes like
BSY should impact on delaying the age of marriage so that by 2010 child marriages are
eliminated.

6.5 Women’s traditional knowledge about health care and nutrition will be recognized
through proper documentation and its use will be encouraged. The use of Indian and
alternative systems of medicine will be enhanced within the framework of overall health
infrastructure available for women.
Nutrition

6.6 In view of the high risk of malnutrition and disease that women face at all the three
critical stages viz., infancy and childhood, adolescent and reproductive phase, focussed
attention would be paid to meeting the nutritional needs of women at all stages of the life
cycle. Tliis is also important in view of the critical link between the health of adolescent girls,
pregnant and lactating women with the health of infant and young children. Special efforts
will be made to tackle the problem of macro and micro nutrient deficiencies especially
amongst pregnant and lactating women as it leads to various diseases and disabilities.
6.7 Intra-household discrimination in nutritional matters vis-a-vis girls and women will be
sought to be ended through appropriate strategies. Widespread use of nutrition education
would be made to address the issues of intra-household imbalances in nutrition and the
special needs of pregnant and lactating women. Women’s participation will also be ensured in
the planning, superintendence and delivery of the system.
Drinking Water and Sanitation

6.8 Special attention will be given to the needs of women in the provision of safe drinking
water, sewage disposal, toilet facilities and sanitation within accessible reach of households,
especially in rural areas and urban slums. Women’s participation will be ensured in the
planning, delivery and maintenance of such services.
Housing and Shelter
6.9 Women’s perspectives will be included in housing policies, planning of housing colonies
and provision of shelter both in rural and urban areas. Special attention will be given for

providing adequate and safe housing and accommodation for women including single women,
heads of households, working women, students, apprentices and trainees.

Environment
6.10 Women will be involved and their perspectives reflected in the policies and programmes

for environment, conservation and restoration. Considering the impact of environmental
factors on their livelihoods, women’s participation will be ensured in the conservation of the
environment and control of environmental degradation. The vast majority of rural women still
depend on the locally available non-commercial sources of energy such as animal dung, crop
waste and fuel wood. In order to ensure the efficient use of these energy resources in an
environmental friendly manner, the Policy will aim at promoting the programmes of nonconventional energy resources. Women will be involved in spreading the use of solar energy,
biogas, smokeless chulahs and other rural application so as to have a visible impact of these
measures in influencing eco system and in changing the life styles of rural women.
Science and Technology

6.11 Programmes will be strengthened to bring about a greater involvement of women in
science and technology. These will include measures to motivate girls to take up science and
technology for higher education and also ensure that development projects with scientific and
technical inputs involve women fully. Efforts to develop a scientific temper and awareness
will also be stepped up. Special measures would be taken for their training in areas where
they have special skills like communication and information technology. Efforts to develop
appropriate technologies suited to women’s needs as well as to reduce their drudgery7 will be
given a special focus too.
Women in Difficult Circumstances
6.12 In recognition of the diversity of women’s situations and in acknowledgement of the
needs of specially disadvantaged groups, measures and programmes will be undertaken to
provide them with special assistance. These groups include women in extreme poverty7,
destitute women, women in conflict situations, women affected by natural calamities, women
in less developed regions, the disabled widows, elderly women, single women in difficult
circumstances, women heading households, those displaced from employment, migrants,
women who are victims of marital violence, deserted women and prostitutes etc.

Violence against women
7.1 All forms of violence against women, physical and mental, whether at domestic or
societal levels, including those arising from customs, traditions or accepted practices shall be
dealt with effectively with a view to eliminate its incidence. Institutions and
mechanisms/schemes for assistance will be created and strengthened for prevention of such
violence , including sexual harassment at work place and customs like dowry; for the
rehabilitation of the victims of violence and for taking effective action against the perpetrators
of such violence. A special emphasis will also be laid on programmes and measures to deal
with trafficking in women and girls.
Rights of the Girl Child

8.1 All forms of discrimination against the girl child and violation of her rights shall be
eliminated by undertaking strong measures both preventive and punitive within and outside
the family. These would relate specifically to strict enforcement of laws against prenatal sex
selection and the practices of female foeticide, female infanticide, child marriage, child abuse
and child prostitution etc. Removal of discrimination in the treatment of the girl child within

the family and outside and projection of a positive image of the girl child will be actively
fostered. There will be special emphasis on the needs of the girl child and earmarking of
substantial investments in the areas relatir, to food and nutrition, health and education, and in
vocational education. In implementing programmes for eliminating child labour, there will be
a special focus on girl children.

Mass Media

9.1 Media will be used to portray images consistent with human dignity of girls and women.
The Policy will specifically strive to remove demeaning, degrading and negative conventional
stereotypical images of women and violence against women. Private sector partners and
media networks will be involved at all levels to ensure equal access for women particularly in
the area of information and communication technologies. The media would be encouraged to
develop codes of conduct, professional guidelines and other self regulatory mechanisms to
remove gender stereotypes and promote balanced portrayals of women and men.
Operational Strategies

Action Plans

10.1 All Central and State Ministries will draw up time bound Action Plans for translating the
Policy into a set of concrete actions, through a participatory process of consultation with
Centre/State Departments of Women and Child Development and National /State
Commissions for Women. The Plans will specifically including the following: i) Measurable goals to be achieved by 2010.
ii) Identification and commitment of resources.

iii) Responsibilities for implementation of action points.
iv) Structures and mechanisms to ensure encient monitoring, review and gender impact
assessment of action points and policies.

v) Introduction of a gender perspective in

budgeting process.

10.2 In order to support better planning and programme formulation and adequate allocation
of resources, Gender Development Indices < GDI) will be developed by networking with
specialized agencies. These could be analyzed and studied in depth. Gender auditing and
development of evaluation mechanisms wfl also be undertaken along side.
10.3 Collection of gender disaggregated dan by all primary data collecting agencies of the
Central and State Governments as well as Research and Academic Institutions in the Public
and Private Sectors will be undertaken. Dan and information gaps in vital areas reflecting the
status of women will be sought to be filled in by these immediately. All
Ministries/Corporations/Banks and financhi institutions etc will be advised to collect, collate,
disseminate and maintain/publish data reland to programmes and benefits on a gender
disaggregated basis. This will help in meanugful planning and evaluation of policies.
Institutional Mechanisms

11.1 Institutional mechanisms, to promote the advancement of women, which exist at the
Central and State levels, will be strengthened. These will be through interventions as may be
appropriate and will relate to, among others, provision of adequate resources, training and
advocacy skills to effectively influence macro-policies, legislation, programmes etc. to
achieve the empowerment of women.

11.2National and State Councils will be formed to oversee the operationalisation of the
Policy on a regular basis. The National Council will be headed by the Prime Minister and the
State Councils by the Chief Ministers and be broad in composition having representatives
from the concerned Departments/Ministries, National and State Commissions for Women,
Social Welfare Boards, representatives of Non-Govemment Organizations, Women’s
Organisations, Corporate Sector, Trade Unions, financing institutions, academics, experts and
social activists etc. These bodies will review the progress made in implementing the Policy
twice a year. The National Development Council will also be informed of the progress of the
programme undertaken under the policy from time to time for advice and comments.
11.3 National and State Resource Centres on women will be established with mandates for
collection and dissemination of information, undertaking research work, conducting surveys,
implementing training and awareness generation programmes, etc. These Centers will link up
with Women’s Studies Centres and other research and academic inst tutions through suitable
information networking systems.

11.4 While institutions at the district level will be strengthened, at the grass-roots, women will
be helped by Government through its programmes to organize and strengthen into Self-Help
Groups (SHGs) at the Anganwadi/Village/Town level. The women’s groups will be helped to
institutionalize themselves into registered societies and to federate at the Panchyat/Municipal
level. These societies will bring about synergistic implementation of all the social and
economic development programmes by drawing resources made available through
Government and Non-Govemment channels, including banks and financial institutions and by
establishing a close Interface with the Panchayats/ Municipalities.

Resource Management
12.1 Availability of adequate financial, human and market resources to implement the Policy
will be managed by concerned Departments, financial credit institutions and banks, private
sector, civil society and other connected institutions. This process will include:

(a) Assessment of benefits flowing to women and resource allocation to the programmes
relating to them through an exercise of gender budgeting. Appropriate changes in policies will
be made to optimize benefits to women under these schemes;
(b) Adequate resource allocation to develop and promote the policy outlined earlier based on
(a) above by concerned Departments.

(c) Developing synergy between personnel of Health, Rural Development, Education and
Women & Child Development Department at field level and other village level functionaries’
(d) Meeting credit needs by banks and financial credit institutions through suitable policy
initiatives and development of new institutions in coordination with the Department of

Women & Child Development

12.2 The strategy of Women’s Component Plan adopted in the Ninth Flan of ensuring that not
less than 30% of benefits/fimds flow to women from all Ministries and Departments will be
implemented effectively so that the needs and interests of women and girls are addressed by
all concerned sectors. The Department of Women and Child Development being the nodal
Ministry will monitor and review the progress of the implementation of the Component Plan
from time to time, in terms of both quality and quantity in collaboration with the Planning
Commission.
12 3 Efforts will be made to channelize private sector investments too, to support programmes
and projects for advancement of women

Legislation

13.1 The existing legislative structure will be reviewed and additional legislative measures
taken by identified departments to implement the Policy. This will also involve a review of all
existing laws including personal, customary' and tribal laws, subordinate legislation, related
rules as well as executive and administrative regulations to eliminate all gender
discriminatory references. The process will be planned over a time period 2000-2003. Tire
specific measures required would be evolved through a consultation process involving civil
society, National Commission for Women and Department of Women and Child
Development. In appropriate cases the consultation process would be widened to include
other stakeholders too.
13.2 Effective implementation of legislation would be promoted by involving civil society
and community. Appropriate changes in legislation will be undertaken, if necessary.

iff3 tT ajdditi°n’ followinS other specific measures will be taken to implement the legislation
(a) Strict enforcement of all relevant legal provisions and speedy redressal of grievances will
be ensured, with a special focus on violence and gender related atrocities.
(b) Measures to prevent and punish sexual harassment at the place of work, protection for
women workers in the organized/ unorganized sector and strict enforcement of relevant laws
such as Equal Remuneration Act and Minimum Wages Act will be undertaken,
(c) Crimes against women, their incidence, prevention, investigation, detection and
prosecution will be regularly reviewed at all Crime Review fora and Conferences at the
Central, State and District levels. Recognised, local, voluntary organizations will be
authorized to lodge Complaints and facilitate registration, investigations and legal
proceedings related to violence and atrocities against girls and women.

(d) Women’s Cells in Police Stations, Encourage Women Police Stations Family Courts,
Mahila Courts, Counselling Centers, Legal Aid Centers and Nyaya Panchayats will be
strengthened and expanded to eliminate violence and atrocities against women.
(e) Widespread dissemination of information on all aspects of legal rights, human rights and

(7)

other entitlements of women, through specially designed legal literacy programmes and rights
information programmes will be done.

Gender Sensitization
14.1 Training of personnel of executive, legislative and judicial wings of the State, with a
special focus on policy and programme framers, implementation and development agencies,
law enforcement machinery and the judiciary, as well as non-governmental organizations will
be undertaken. Other measures will include:

(a) Promoting societal awareness to gender issues and women’s human rights.
(b) Review of curriculum and educational materials to include gender education and human
rights issues

6?; Removal of all references derogatory to the dignity of women from all public documents
and legal instruments.
(d) Use of different forms of mass media to communicate social messages relating to
women’s equality and empowerment.

Panchayati Raj Institutions

15.1 The 73 and 7^ Amendments (1993) to the Indian Constitution have served as a
breakthrough towards ensuring equal access and increased participation in political power
structure for women. The PRIs will play a central role in the process of enhancing women’s
participation in public life. The PRIs and the local self Governments will be actively involved
in the implementation and execution of the National Policy for Women at the grassroots level.
Partnership with the voluntary sector organizations

16.1 The involvement of voluntary organizations, associations, federations, trade unions, nongovermnental organizations, women’s organizations, as well as institutions dealing with
education, training and research will be ensured in the formulation, implementation,
monitoring and review of all policies and programmes affecting women. Towards this end,
they will be provided with appropriate support related to resources and capacity building and
facilitated to participate actively in the process of the empowerment of women.
International Cooperation

17.1 The Policy will aim at implementation of international obligations/commitments in all
sectors on empowerment of women such as the Convention on All Forms of Discrimination
Against Women (CEDAW), Convention on the Rights of the Child (CRC), International
Conference on Population and Development (ICPD+5) and other such instruments.
International, regional and sub-regional cooperation towards the empowerment of women will
continue to be encouraged through sharing ot experiences, exchange of ideas and technology,
networking with institutions and organizations and through bilateral and multi-lateral
partnerships.

h

h

empowering WOMEN FOR HEALTH
A brief report of Phase One of the
Women’s Health Empowerment Training Programmeme
in Karnataka (1998-2000)
by Community Health Cell

Health is a personal and social,
state of balance and well being,

woman

in which a
feels strong, active, creative, wise and worthwhile,
where
her body's vital power of functioning and healing is intact,
where
her diverse capacities and rhythms are valued,
where
she may decide and choose, express herself
and move about freely.
WAH! Programmeme* ;

Background

During the 1980s and early 1990s there was growing recognition, analysis and
concern regarding the lower social and health status of women in different parts of the
world.
This derived from grassroot involvement of activists, voluntary and
government agencies. It resulted in action being initiated at national and international
levels.
The Women’s Health and Development unit of WHO-SEARO had
brainstorming sessions with NGOs to develop concepts in this regard in India, in
1993.
In 1998, the Ministry of Health and Family Welfare initiated planning through a
collaborative partnership with NGOs towards empowering women for health. This
was initiated as a pilot project in 15 states, with financial assistance from WHOSEARO.
*

The Women & Health (WAH!) Programme is a partnership of persons representing a number
of organizations, working from 1994 onwards. Regional interventions are being undertaken
in Gujarat & Rajasthan, Karnataka & Tamilnadu, Maharashtra and Nepal at the level of
primary health care, focusing, on the concerns and roles of women. Training middle level
women health managers is an important strategy.

F Women's Health Trg.Papers\Empowering WomenForHealth.doc

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The project aimed to address important
physical and emotional health
problems, faced particularly by disadvantaged and marginalized women.
Causative factors underlying the situation of ill health of women were identified
as, poor access to early diagnosis, treatment and cure; lack of information; lack
of decision making power; and lack of resources. It built on micro-experience
that women empowered with information on the “why’s and what’s” of illnesses,
and the “where’s and how’s” of finding assistance and services, became
proactive agents of change for betterment of health. It was assumed that this
approach used at a larger level, with a planned approach and a gender
perspective, could enable women to lead healthier, happier lives.

The project was to cover 5 districts in each of the 15 selected states*, with a minimum
of 72 self help groups or women sanghas represented by 144 women leaders from
each district. It was envisaged that in 75 districts of the country, 375 core trainers
would receive special training and they in turn would train 10,800 community based
women leaders.

Translating ideas to action
The idea of a multi-level phased
yvonten's health empowerment training
programme took concrete shape in the course of three meetings of a core group, of
which CHC was member [November 1998, January 1999 and March 1999 held in
New Delhi and Ahmedabad]. The WAH! perspective, which emphasizes the
empowerment of women and communities by encouraging local health traditions and
health directed initiatives, was instrumental in inspiring this women’s health training
programme. Women’s health concerns in their entirety would be addressed rather than
just issues of reproductive and child healthcare. This perspective took shape by
developing a women’s health programme set in a multi-sectored framework. Four
government departments of Health & Family Welfare, Rural Development &
Panchayati Raj, Education and Women & Child Development are jointly engaged in
this project along with partner NGOs (Non Governmental Organizations) from
various parts of the country. A cascade approach is used, where a State level resource
group trains district trainers, who in turn train women sangha leaders from whom
the message spreads to sangha members and the community.
Vais programme’s main objectives are to enhance women’s capacities to handle their
own and their families health problems by generating a certain level of self
sufficiency and self confidence. And, importantly, to create pressure on the existing
government facilities to deliver services more effectively, by raising women’s
awareness concerning facilities that should be available from the government health
care system. A decision to develop a training module was taken. A module that
would include technical information through manuals which would also highlight
communication methods and training skills. It was put together in a user- friendly
*

States invited were Gujarat, Rajasthan, Maharashtra, M.P., U.P., Bihar, H.P., Assam, A.P.,
Karnataka, W.Bengal, Orissa, Tamilnadu and urban slums in Delhi. Ten states finally participated
in Phase-I.

FAWomen's Health Trg.Papers\Empowering Women For Health.doc

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manner by a core group of individuals from participating NGOs & Government
Departments while CHETNA [Center for Health Education Training and Nutrition
Awareness], Ahmedabad was the secretariat. Three training manuals were developed
— one for the core Trainers at State level', the second for the District Level Trainers
and the third for Community Leaders at the village level. 25 core Trainers per State
were trained in 15 days, by lead NGOs, over two sessions. There were four
NGO representatives from each of the five districts per state. Four to five persons
were to represent the involved Government Departments, facilitating collaboration
between these two sectors. The trained women would then conduct a seven day
training programme at the village level. With this as a backdrop, 15 states were given
the mandate to initiate the project with financial supportfrom WHO-SEARO

The planning process for Karnataka State *

Community Health Cell (CHC) was selected as the lead NGO for Karnataka state to
devise and conduct the training programme with Mahila Samakhya (MS) as one of the
major collaborators. A participatory, non confrontational approach was adopted.
CHC was clear that the training programme’s focus would be on women as
individual persons and not as mere participants or programme functionaries. The
women should think and act upon health related issues rather than just being
recipients of information. Acknowledging that the present health situation was
problematic, the emphasis was on changing the perspective of dealing with health in a
negative way and creating an awareness of the various positive dimensions of health.
The objective was to be constructive and creative. The solution did not lie only in
wresting away power and control from men, but by helping women develop an inner
strength to change present conditions and also to take responsibility with maturity. It
was decided that promoting a single ideology was to be avoided and the resource
people selected were to represent a plurality of approaches.
A range of training methods were employed to give the participants maximum
exposure. Moving beyond the mandate, a session on community building and
participation was included as being critical to the programme. The entire programme
was based on eliciting what the participants were already aware of, building on their
existing knowledge. Time was allocated for introspection, yoga and meditation.
Through field visits, the organizers established links with the trainees prior to the
programme. Besides Mahila Samakhyas in Bidar, Koppal and Bellary, NGOs from
Bangalore Rural and Chamrajnagar were involved. However the Government
participation was small with only two persons attending from Bangalore Rural. The
main criteria adopted, in the selection of participants was a commitment to the cause
of women’s empowerment and a commitment to initiate and evolve training
programmes for women sangha leaders. This required institutional support from the
trainers’ respective organisations. It meant maintaining a working relationship with
that tier of the organisation.

*

This draws on a concurrent review report of the Training of Trainers by Ms. Vinalini
Mathrani.

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CHC initiated an ongoing concurrent review of the Training of Trainers. There was
a feedback discussion session and also written feedback. Two social scientists also
undertook an objective review. They attended several sessions and had separate
interviews with participant trainers and resource people.

State Level Training of Trainers
This was undertaken in 3 spells of 5 days in October 1999 (25
November 1999(22nd-27th) and 3 days in February 2000.

30th), 5 days in

The first spell began with building awareness among the group of the different
dimensions of health. Topics taught and discussed upon ranged from food, nutrition
and health to personal hygiene, sanitation and water supply systems. From Gram
Panchayats to community participation and building; gender and self esteem to mental
health, violence and women’s health. Sessions were conducted on various aspects of
health, NGO participation, effective implementation of government programmes, the
essentials for trainers, including communication skills. Subjects like reproductive and
child health care and pregnancy evoked much interest and a number of tabooed myths
were dispelled. Sessions were taken to inform the women about the numerous
government schemes they could access and this raised quite a few questions. They
were also encouraged to communicate with villagers and social workers on how
women could be empowered through Panchayati Raj institutions.
A session was also held on Malaria, TB and HIV/AIDS. In this session a question
and answer method was adopted, charts and posters were displayed and the women
instructed on symptoms, causes, spread and methods of prevention. Access to
Government services and the available schemes were explained. The women raised
quite a few questions on the actual existence and access to these schemes. They were
advised to build a rapport with the government and the people, and where necessary
to demand services. Throughout the programme, participants were encouraged to
analyze and summarize what they were learning. Preparatory planning sessions for
the village training programmes were held in which the main points included
information on the duration and objectives of the programme; the subjects to be
covered and how to approach these topics. Formation of women’s groups were
suggested in the absence of existing ones. The group was encouraged to develop
courage of conviction so that the manuals given to them would be used as guidelines
instead of as textbooks.

There was an additional emphasis on personal growth, using various exercises. The
group was asked to recollect happy and sad episodes in various phases of their life.
During this it was noticed that unhappy episodes outnumbered happy ones.
However, the women were extremely articulate and this sharing enabled them to
introspect, relax and identify with each other. Games and role plays were used in quite
a few of the sessions and riddles were shared among the group. This helped relax and
encourage the group.
During the programme, the spiritual aspect of life was reflected upon and on the last
day, cultural programmes were also included to give the participants a sense of well
being and leisure. The eventual outcome was that the entire group had become quite
articulate and had acquired a good measure of self confidence.
F:\Women s Health Trg.Papers Empowering Women For Health.doc

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Feedback from the participants in these group-sharing sessions was extremely
encouraging. The morning self growth sessions were sincerely appreciated by all.
Some needed more information on sexuality and gender, others stated that the
participation of different organizations had helped expand their horizons. The general
feeling was that the training had enhanced their personal lives as they had got a
chance to understand their position in society. Most importantly the group felt
equipped and confident about conducting sessions in the villages.

The second phase of the Training of Trainers (TOT) emerged from the participants
response andfeedback to the first phase, including their field experience of training
in the field. It was a programme that evolved rather than being preconceived. An
effort was made to focus on areas the women stated they wanted further details on.
The emphasis therefore was on RCH [Reproductive & Child Health]. The
methodology focused on more participatory activities. As the resource people had
already worked with the group - they were able to structure their sessions more
effectively. The topics dealt with included sharing of field experiences and
presentations, women’s empowerment and the problems of women earning a
livelihood. This session included two videos and a discussion. The first video was on
the invisible work done by women including multiple responsibilities, distribution of
work in the family, importance of taking care of health etc.

Growth and Adolescence and preparation of daughters was also discussed. The
women’s own recollected expenences were related to how women’s development is
hindered . Aspects of pregnancy were also reflected upon and discussed and how to
deal effectively with crises were explained. Songs and games were regularly indulged
in to make the programme more lively and participation more interesting. The
Childbirth and Post Natal Care session brought up both indigenous and modem
methods of care and the women were divided into four regional groups to look into
bananthana [post partum] practices and traditional practices and medicines.
Contraception and abortion were also discussed. Further sessions involved a look at
Reproductive Tract Infections and Sexually Transmitted Diseases and a look at
Government services about which a number of questions were raised specially about
problems encountered. The most enjoyable and informative part of this phase,
according to the participants, was the field visit to Aikya. This organization’s focus is
on promoting herbal medicine and organic farming with a view to increasing self
sufficiency. Their approach fitted into one of the primary objectives of the
programme, that of building on indigenous knowledge to promote self sufficiency.
The fact that a research organization was promoting local traditions, helped to
establish the credibility of indigenous knowledge. A session on Preparation of
Visual Aids for communication was also conducted. The importance on methodology
in training, preparing effective visual aids and the need for brevity was emphasized in
this session. Finally a practical session was held in which the women were divided
into four groups. Each was given a topic with which they had been familiarized.
Discussions were held, action pians were developed and finally these were presented
at the end of the session.

The third and concluding spell of Training of Trainers took place in Bellary, so that
all participants could gain from learning from a different environment. It was based
at the Bellary Diocese Development Society (BDDS), one of the participating
NGOs.
P550\t\Women's Health Trg.Papers Empowenr.z Women For Heaith.doc

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The external reviewer felt that the entire programme was a success. The interactive
planning process helped the organizers to a large extent. This was reflected in the
assessment of what the women had managed to assimilate during course of the
programme. They all felt they had acquired enough inputs to answer questions that
came up in the village level training. They felt empowered after having learnt about
certain issues. They were able to relate micro issues with macro situations and each
participant was able to locate herself within the power structure. She was thus in a
position to assess whether she herself was empowered, which would help in
empowering others. During this second phase the participant’s response was more
personal as compared to the first. And they all felt confident and eager to get on with
the remaining part of the programme. On the whole, given the constraints, both these
phases of training managed to be sensitively implemented, having been well
conceived. The feedback received from some of the participants reiterated this. They
maintained that these programmes will provide a foundation to their work and that the
impact would only increase over time.

Afterword:
At a follow up meeting in Delhi, with all ten participating States, the enthusiastic
response of women to the programme was found to be a shared experience. It was
felt that issues concerning women \ emotional health needed to be tackled more
specifically. There was also need for greater involvement of men. Government
NGO collaboration had been at a relatively low level, bordering on being inadequate.
The trainers while very enthusiastic, needed more inputs, as health was a complex
subject to deal with and training skills develop through practice. It was decided
therefore, not to expand but to consolidate with the same groups, covering
particularly the topics mentioned above.

In the meanwhile, there have been a range of initiatives at field level following the
training. Mahila Samakhya, on its own, expanded the programme from 3 districts to
all the seven districts in which it works. Some groups focussed on sanitation, making
use of existing government schemes. Others started work with adolescent girls. Yet
others were more interested to follow up with herbal medicines. A number of trainers
took an active part in the Jan Arogya Sabhe campaign after undergoing a 3 day State
level training. This expanded their understanding further on issues relating to primary
health care, globalisation and health, and the commercialization of health care. The
trainers could interact with many other organizations and persons involved with
health care. They could learn about different approaches adopted and also about the
advantages of networking around an issue. Thus the trainers have become change
agents for health and we are confident that with encouragement and support, they
will make a positive difference to the lives of many women they work with.
**********

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BMPOWIEMNG WOMEN FOK HEALTH
A Meir IK®]pwt ®im Etas® H ®ff (th®
W®m®m’§ H®alltti Em]p®wffimii®inL Tratamg FTOgrrnmi®
Im Karnataka (
= 2001}
toy COMMUNITY HEALTH CELL
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ASneiir iriigMs sussS
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_______________________________________ I
Lower socio economic status of women has been a great cause of concern for
all the people involved in development activities all over the world. This will
have serious impact on her health status also. This is the practical
experience of all the activists , government and voluntary agencies Involved
in women development activities. Given this background Govt of India with
financial support from WHO- SEARO
initiated Women’s health
empowerment training program in 1998.
Phase I ( WOfllW)

Community Health Cell was nodal agency to implement the program, cl
Karnataka. This program was aimed to address important physical and
emotional health problems especially of marginalized and poor women.
Factors responsible for poor health and social status were identified and
addressed in the training program. Since the community leaders trained are
from already existing SHGs .sustainability of the project could also be .
thought at the initiation of the project.
Program’s main objectives were to enhance women’s capacities to handle
their own and family health problems by increasing the self confidence ana
sufficiency . And more importantly , to create pressure on the existing
government facilities to the deliver the service more effectively.
Programme was implemented in 5 districts ( Bangalore -Rural.
Chamarajanagar. Koppal, Bidar and Bellairy districts). As agreed 144 women

were trained in each district. Community Health Cell coordinated in

1

Bangalore-Rural and Chamarajanagar district, while Mahila Samakhya
coordinated women leaders training in Koppal, Bidar and Bellaiy districts.
Various training methods were employed to give maximum opportunities to
discuss- and demonstrate. Session on team building, group participation was
also done as it was found critical for this programme. Session on Yoga,
introspection too was a part of the training. Entire training activities was
based on trainer’s experience at grass root level, which formed base for the
discussion on various issues during thetraining. Main criteria for selection of
trainers was their commitment to women issues. State level Training of
Trainers was Community Health Cell’s responsibility which conducted 13
days training in 3 spells in Phase I of the programme. This phase of training
programme ended in February 2000 with last spell of Training of Trainers.
Pltes® UH (^dDdDOdDOD

As women’s health and empowerment cannot be separate issues for training
.during this phase of training efforts were made to bring four government
departments which are directly involved in development programmes in
state viz, Rural Development and Panchayat Raj, Health, Education and
Women and Child Development. Converged efforts ( Government and NGOs
together) and concerted approach ( Health and Development together) was
key in this phase of activities.
Activity in this phase started with H state level werlkslhep at
Commisstommimte ©IT Health and. Family Welfare , Bangalnreo Government
officials and participant NGOs from 5 participant districts participated in
the workshop. All the state level officials shared about their departmental
activities which are aimed at Women’s Health and Empowerment. This was
followed by discussion by district officials and representatives from
participating NGOs. Trainers and resource persons also shared about their
experiences in this project. Special session on Women’s Mental Health was
also done as this formed critical part of training in this phase as it was
identified by trainers in phase I of training. In the afternoon session, district
wise group discussions were held and action plans were developed for .all the
districts to carry this project forward.

gatete LewH Traiunimi^ olT Timmers:
Training of trainers was held in 2 spells of 4 days each.
f welOLpg Trainmgf cdIT Timmers was held in Bangalore between 26th February
and 1st March 2001. topics in this training ranged from Training skills to
Women’s mental Health. During the session on Training skills they were told
on how to use Audio visual aids also, along with community organisation,
use of folk media etc.

Topic on Mental Health was critical as trainers themselves felt it has to be
dealt during the II phase of training. In put in this session included Women’s
Self Confidence, Self Esteem, her coping abilities etc. Another interesting
topic trainers requested is role of Water Supply and Sanitation in
Community Health. Women’s role in ensuring safe drinking water for family
and clean environment in the community was also emphasized during the
training. Natural Family Planning session was repeated as trainers felt this
topic would be useful at their field working areas. Session on Women and
alcoholism was also dealt during the training. More emphasis was given to
how women can cope with alcoholic family members in family. Session on
Community Organisation was also taken as a part of improving the skills of
trainers.
Session on Counseling was important and very crucial as trainers have to
deal with community members with difficulty as a part of their regular
activity. Session on Panchayat Raj system was dealt with more emphasis on
women members of Panchayat and their role in improving the community
through Panchayat system. Provisions for Health activities in panchayat
system was also dealt in the training.

Methodology adapted was participatory and encouraged discussion.
Lectures, Usage of Audio Visual Aids, Role Play and Group work are the
various methods used for training purpose. Sharing of experiences by
trainers was also the part of the programme. Cultural programme was also
organized to create more personal and informal relationship between
trainers and resource persons.
lit speHfl Trannmg cpIT Trainers was held in Bangalore between 29th May and
1st June 2001.Topics in this spell of training emerged out of the feedback
given by trainers during the I spell of training. Few of topics were included in
this spell of training which trainers felt very important for the community
level functioning, while some of the topics were repeated as trainers felt they
wanted more clarity on those issues. Among the new topics added spiritual
health was one of the topics which trainers felt very important for individual
person’s health.
Topic on RTI/STI and AIDS was also repeated as the trainers requested for
the same. Communicable diseases were another topic which was included at
the behest of the trainers. Another interesting topic which was discussed
was Community Mental Health. In this session role of women in identifying
and supporting the person with mental difficulties in their own families.
Women specific cancers , how to recognize and take appropriate action was
another interesting and enriching topic for the trainers.

Health Songs as a supportive measure to community organization was also
taught to them. Training and community Organization skills also dealt •
during the workshop. Family Life Education and preparation of adolescent '
girls for the marriage was also dealt as trainers felt that this is one of the
important issues.

As si jpsurt 'ssDllidlmfy
iMkpsiirt m Annti-nibsi^d]) mUBy m the streets
in Bm^siiere Msy 3is\ whieh hsppenedl te be WorM Anti nbsieee JD)sy.

Methodology adapted for the training were very participatory, which
included lecture with discussions, Puppet Shows, and Field Visits. This type
of mix of methodologies helped trainers to understand various methods of
communication also. Topics and methodologies employed were veiy
appropriate to the fulfillment of the objectives of the programme viz,
promoting the Self Confidence and Self reliability of women involved A r.
project and the women in large community. There was a special session on
sharing of experiences by trainers. This allowed them to share about their
innermost feelings of their involvement in the programme. Their experiences
was also shared which were very valuable and added lot of inputs of
improving the training programme from time to time.
Trainers felt they all feel very confident and can handle even difficult
situation in community. They have expressed enthusiasm and willingness to
support the community leaders. However they need to be evaluated and
suitable support needs to be given for some more time before they could
really support the community women leaders. If otherwise cascading effect
of the programme may not take place at grass root level.
estate Heveli worksltw g was held in Bellary Diocese Development Society
on nthjDctober 2001. Objective of this workshop was to bring various
Government departments and Non Governmental Organizations together.
Officials and NGOs from participating districts were involved in this
workshop. Preparation of Action Plan was more emphasized during this
workshop. AU the speakers, emphasized importance of dealing health and
empowerment together. Any efforts whether, Government or NGOs should
happen jointly. They all stressed the importance of converged efforts .
Proper community organization and sustainability was also stressed.
Karnataka Health Task Force’s recommendation for Women’s health in the
state was also presented to the audience. Special package for North
Karnataka was also discussed. Trainers and Resource persons also shared
about the experiences in this programme.

In the afternoon session district level small group discussion and
preparation of action plan was done. This was more important for
sustainability of the programme.

As a part off promoting concept off Women’s Health and Empowerment k
' an areas Community Health Cell initiated a training programme on these
concepts with urban groups. For two days( 16-17 July
M)
programme was held in Bangalore involving grass root workers belonging to
three different NGOs working in slums in Bangalore. Topics discussed
: ,' eg the training are same as mentioned above with little modiOca’.'.
the urban settings. Special session on facilities available for slu m popular
was also discussed.

FORWARD; Govt and NGO understanding has been developed in
■'.Kamatafea not only because off state level workshop., This kind off efforts to
bring various departments has happened even at district level
trainers ano women community leaders are enthusiastic to carry this
programme forward. This level off networking and interest should r
allowed to go waste. But in future activities more efforts to involve mer in
the programme should step up. Moreover 9 both trainers and women leaders
needs to be supported on more regular basis for some more period. ' '
. ra tiers and women community leaders to be real change age r .
. not only for women but for entire community..

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