Pilomina Cheruplavil : Prevention is Better than Cure
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- Title
- Pilomina Cheruplavil : Prevention is Better than Cure
- extracted text
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PREVENTION IS BETTER
THAN CURE
CHLP - FELLOWSHIP FINAL REPORT - 2022-23
--
By
PHILOMINA CHERUPLAVIL
INDEX
ACKNOWLEDGEMENT
Part A
4
4
A general outline on community based health action reflection
4
Module-1 Orientation
9
Module 2 Understanding Community Health
9
Module 2 Understanding Community Health ( Week-ll)
10
MODULE: 3
11
MODULE: 4 Right to health 4and Access to health care
11
MODULE – 5 & 6 Social Determinants of Health
12
MODULE-7- Comprehensive Primary Health Care (CPHC)
13
MODULE-8- Equity in Health
14
MODULE:-9 Health system in India
16
MODULE- 10 Pluralism in Health Care in India- Role of Local Health
Traditions and AYUSH
17
MODULE – 11 Universal Health Care & Universal Health Coverage
17
Module 12 Understanding Voluntary Health Sector
17
MODULE – 13 Food and Nutrition
18
MODULE 14 C- WASH
18
MODULE-15 Women’s health
18
MODULE-17 & 18 Mental Health
18
MODULE-19 Communicable Diseases
19
MODULE-20 Non Communicable Diseases
19
MODULE- 21 Palliative CAre
19
MODULE 22 Climate Change and Health
20
MODULE 23 Health and Technology and Innovation
20
MODULE 24 Communication for Health
20
MODULE 25 Globalization and Health
21
MODULE 26 Child Health
21
Part-B
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Community- Based Health Action- Reflection ProjectError! Bookmark not defined.
Background
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ANNEXURES
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CONSENT FORM
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Photographs
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References
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Project Scope
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Project Time Line
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Community volunteers
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Goal
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ACKNOWLEDGEMENT
Life is a journey and we meet many people on our journey. Some remains in our life, some
pass by, some touches our lives, some walk with us to reach the goals in life. I am humbled
and grateful to Dr. Ravi, Dr. Thelma, my Mentor Dr. Rajaram, all my facilitators and the
pillars of CHLP Mr. Karthikeyan, Radhika, Jenelle, Radhika, Uma, Ranjitha, Maria and my cofellows. It was unbelievable to think fellowship online program would happen with so much
impact. I dedicate this fellowship program to my only brother who left us for his heavenly
home, who always encouraged me to face challenges in life and work for the good of others.
SOCHARA- Community Health Cell is a powerhouse where everyone finds a home to enter,
to learn, interact, discuss, receptive people with open hands and hearts, eco-friendly place
attracts one again and again. This is the beginning of my new journey with SOCHARA to the
poor and marginalized. To become voice of the voiceless. I am ever grateful to the
government personnel who extended their hands with me, the frontline workers, village
community who cooperated with me. I am grateful to my beloved parents who always
taught me to be sincere and truthful, My spiritual guide and my best friend Fr. Abraham
Karukaparambil, Monsignor Joseph Antony, my sisters, my superiors ,friends and wellwishers who accept me as I am and help me to explore my hidden talents despite my
struggles and difficulties and they always stood at my side to achieve the goal in life.
Part A
A general outline on community based health action
reflection
Introduction
I, Philomina Cheruplavil hail from Thamarassery, Kerala. I am a religious sister since 1990.
Since 1989 I am in Odisha. So to say Odisha has become part of my life and the people of this
have become mine. In 1999 I have completed my General Nursing with Midwifery from
Christian Hospital, Berhampur and in 2004 completed the Diploma in HIV/AIDS and Family
Education from Indira Gandhi Open University (IGNOU). I had been rendering (health
care) my service in Cuttack, Balasore, and Gunupur in Odisha and Ranchi in Jharkhand. I
was also privileged to work in Vatican City for 7 years as the dining room in-charge of Santa
Martha. It was one of the greatest grace-filled years in my life to be closely associated with
Pope Francis. Past three years (2019-2022) I was associated with the social wing of the
diocese of Berhampur, Odisha. I was handling a project, “Community Health Promotion “in 7
gram Panchayath of Mohana Block in Gajapati District, Odisha. The project was covering 106
villages. Our focus was on:
Though I was working in the community with the “community health promotion” I was
never getting the satisfaction/ finding the impact on the lives of the community. At times
people were not interested, even sometimes they gave more importance to their routine
life. I was at the point of losing my hope and enthusiasm. It was in a way of compulsion
people responded. It was at that time I got the information about SOCHARA through my
Director, Fr, Joseph Valiaparambil. I then responded the mail of Karthik and there was the
positive response from him which helped me to join SOCHARA without any delay. When
I came to know what SOCHARA is and the objectives with which the organization work
I was impressed. I understood that SOCHARA work through community action and
partnerships, teaching and training initiatives research, knowledge dissemination, policy
advocacy and engagement with the public health system. Its focus on public health
system development, action on the social determinants of health and community action
for health with a social justice perspective was really inspirational.
What were my learning objectives and were they met
Life is a journey and every step in life we learn something new. Each of the members has
provided me extensive personal and professional guidance and taught me a great deal
about both scientific research and life in general I am humbled and grateful to Dr. Ravi, Dr.
Thelma, my Mentor Dr. Rajaram, all my facilitators and the pillars of CHLP Mr. Karthikeyan,
Radhika, Jenelle, Radhika, Uma, Ranjitha, Maria and my co- fellows. It was unbelievable to
think fellowship online program would happen with so much impact. I dedicate this
fellowship program to my only brother who left us for his heavenly home, who always
encouraged me to face challenges and work for the good of others. SOCHARA- Community
Health Cell is a powerhouse where everyone find a place to enter, can learn, interact,
discuss, the row of books, scientific data, receptive people with open hands and hearts, ecofriendly place attracts one again and again. This is the beginning of my new journey with
SOCHARA to the poor and marginalized To become voice of the voiceless. I am ever grateful
to the government personnel who extended their hands with me, the frontline workers, the
village community who cooperated with me. I am grateful to my beloved parents who
always encouraged me to do good for others without expecting anything in return, My
spiritual guide and my best friend Fr. Abraham Karukaparambil, Monsignor Joseph Antony,
my sisters, my superiors ,friends and well-wishers who accept me as I am and help me to
explore my hidden talents despite my struggles and difficulties. They always stood at my
side to achieve the goal in life.
The Society for Community Health Awareness Research and Action (SOCHARA) through
school of Public Health Equity and Action (SOPHEA) offers a unique community Health
programme (CHLP) It began in 2003. It has grown in strength More than 500 fellows have
transformed their lives and that of the community. The program is unique and encourages
the participants to explore the social paradigm of community and public health based on
community needs and community experiences. The mentorship and person centered
approach helps to open the potentialities of the person.
The fellows conduct Community Based activities or initiate action on areas of felt needs in
community health. These include:
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Child Health
Communicable Diseases
Non-Communicable diseases
Disability
Nutrition
Pandemics (Including Covid-19)
Health and environment
Rural Health
Urban Health
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Tribal health
Mental Health
Women’s Health
Sanitation
CHLP participants are equipped with rich experience and knowledge to work in
different organizations across the country with much enthusiasm on Community
Health. 2022 batch commence from May includes also the understanding of impact
of Covid-19 on communities and capacitate participants to build appropriate
strategies to tackle the emerging challenges. The program period is for 9 months
with learning modules delivered through live online sessions and a communitybased reflection Action project to enhance the learning experience.
Key features
• Part time- Fellows can continue their current employments
• Weekly live classes with recordings made available and accessible to
participants
• Continuous mentorship by experts on community health and community
health practitioners through the program and thereafter.
Community based field work.
I look forward to be part of all the community outreach programs in providing better
community health to the most poor & needy.
My primary concern is to provide sustainable relief and holistic development for
communities with the aim to empower them, so they can break the vicious cycle of poverty
and become contributing members of the society and nation at large.
As a public health worker my goal in community- focused care will be to enhance health
care services and patient outcomes in targeted populations. By applying public health
theory on a local, personalized level, community, I would like to cater services to a specific
demographic and bring a sense of wellness to communities that would otherwise lack
proper access to care.
I also would like to engage in community health and identify how variables related to
socioeconomic status- such as income levels, nutrition, crimes and other resources- impact
people and also determine how the community's medical and educational resources contribute to
people lifestyles and what improvements are called
Why did I join fellowship
Since 23 years I was working as a nurse taking care of the curative aspects of health. From
2020 I was coordinating a project on “Community Health Promotion” supported by
MISEREOR. Though I had finished one year of the project I didn’t get any satisfaction of
doing something effective for the community. I had a team of 26 members to run the
project in 7 gram panchayat consisting of 106 villages. At the end of 2020 while doing the
evaluation I couldn’t see the effectiveness of the work. It was then I got the chance of
knowing SOCHARA from my director Fr. Joseph Valiaparambil and he asked to join CHLP
fellowship. I consider it as God given opportunity to change my pattern of doing the things.
Chlp opened the door for me to enter in to the community. I understood the importance of
the community participation in planning, decision making and implementation. A pathway
to success. CHLP fellowship gave me the opportunity to widen my knowledge and the
method of getting in to the community and building rapport with them. Involvement of the
community enabled them to exercise collectively their responsibility to attain health and
demand for their health. The community health learning had strong impacts on me, how to
reach the community, how to address health socially, economically, politically, culturally
and environmentally, Understand the need of the community and help them to avail also
learn from them. I wish to know the government policies and help the community to profit
from the benefits of the government. During CHCC AS Dr. Denis said we need to unlearn and
learn many things. I want to be with the community, I want to learn from the community
and give back to the community , I wish to know the government policies and help the
community to get the benefits for them. Health is not only curative, health is above all, This
is the reason I chose CHLP.
My Contribution
Participating Community Health Change Maker Confluence on 23 rd to 27th May, 2022 was
memorable event having lot of new learning, meeting and becoming part of CHLP family, It
was my virgin trip to St. John’s. The peaceful atmosphere with the greenery added more
color to our stay. Indeed a great experience to begin the life with new perspectives, new
vision, new way of understanding about community health, power, politics, information and
knowledge. I chose community health because while working in the community a great
desire was born in me to do something for the marginalized where no one could reach.
I chose community health as a new pathway to travel. It’s a challenge and opportunity, A
journey of learning, experimenting
General learning objectives
1. choose a community for example the tribal / Adivasi community or nearby locality
who really needed community service and work on them efficiently in all aspects of
health like socially, mentally, physically, economically, culturally and politically
2. Communication skill, interacting with dynamic, intellectual personalities which will
improve my thinking, attitude and approach to the community
AREAS OF INTEREST- Objectives built at the beginning
1. To capacitate the village communities to plan and implement health care activities
especially in strengthening the Village Health Committees.
2. To have a deeper understanding about Community and Health
3. To learn from the life experience of the Co-fellows
4. Community health approaches to public health issues.
5. Communicable Diseases
6. Non-Communicable Diseases
7. Mental Health
Looking ahead
To strengthen the village community to make decisions and solve their health issues,
development programs and implementation, accessibility of health care facility for all.
Module-1 Orientation
My CHLP journey began on 4th May, learned about SOCHARA (Society for Community
Health Awareness Research and Action) and its activities. We were asked to write about
our personal learning objectives and areas of Interest. I was thrilled to learn the method
of teaching used by SOCHARA, study, reflection and action. I took the decision to actively
participate in live sessions, interaction with the facilitators and participants and to learn
more about community health.
Module 2 Understanding Community Health
The reflection of Rajeev about the vulnerable tribal community of Gudallur, Tamil Nadu.
The tribal community faced human rights violation, exploitation and alienation of land.
It was then ACCORD (Action for Community Organization Rehabilitation and
Development) an NGO came to their rescue. The main objective was to fight for their
land, promote health and health care entitlements, and promote health through
building the community within the community and empowering the community to
strengthen their health system, education and economy. Rajeev spoke about 10
Axioms:1. Rights and responsibilities
2. Autonomy over health - 4 A’s Accessibility, Affordability Adaptability Availability
3. Integration of Health and development activities- including education, agricultural
extension and income generation programs.
4. Quarterly meetings involving all the stakeholders
5. Respecting their culture. (Encouraging for their celebrations and giving chance for all
identity)
6. Equity empowering community (Formal and Informal participation of the
community)
7. Recognition and involvement of local resources like traditional healers, dais, and
allopathic system of medicine and herbal medicines.
8. Orient with the existing medical program towards preventive, promotive and
rehabilitative actions.
9. Effort to build a system where health care is inserted.
10. New community health care approach (Mobile clinic & Village visit)
According to these Axioms of community health ACCORD could attain the success of
their work. Village Health workers were selected from the community itself, developed
rights and responsibilities within the community, accessibility for the people within the
community were mobilized, health animators were trained and empowered, health
promoted, infrastructure improved, ANC & PNC clinics conducted health awareness
meetings conducted, Immunization done, Rights to health were demanded New adivasi
school opened, people became confident, Economic condition improved (Teaplantation), New hospital is constructed. Health for all is attained by the intervention of
ACCORD
My key learning of the community health from the Axioms of community health:
➢ Identify the need of the community
➢ Involve the community to plan, make decision and implement the program
➢ Build up rapport with the community
➢ Learned the power dynamics and cultural dynamics ( How power and caste
brings conflicts and how to deal to bring a sense of community
➢ Learned community health approach not only deals with health, it is an
orientation of policies insurance schemes, legal and hoe we align with
government
Module 2 Understanding Community Health ( Week-ll)
Janelle explained about the tool of SEPCE analysis…Social, Economical, Political,
Cultural and Ecological), Social determinants of health. Keep the community at the
centre
SEPCE determines where we are born, grow, work, live and age
People charter for Health 2000 by PHM
1. Socio, economic and political issues
2. Fundamental human right
3. Inequality, poverty. Illiteracy, exploitation, violence and injustice
4. Voices of the poor and marginalized
5. People develop their own solutions
6. Encourage people to hold accountable their own local authorities, national
governance, International organizations
7. Health for all – Challenging and changing political and economic priorities
MODULE: 3
Social paradigm of health SEPCE/SDH concepts of equity and social justice. Create equal
opportunities despite inequities, address barriers that exist which will lead to liberate
people. Commission on SDH is a broad partnership SDH influence inequality- barriers health
for all. Goal- advance health equity, reduce health differences within and between
countries. Framework for Action on SEPCE determinants.
➢ SCPCE analysis focuses on interrelationships and dependency between different
factors that impact health.
➢ CDH –created by WHO, SDH inequities and SDH- direct impact on health.
MODULE: 4 Right to health 4and Access to health care
Equity politics is right to health. It treats health as a human right fundamental right for all.
Right to freedom of speech, right to follow one’s own religion, right to movement. EquityUnequal treatment for unequal conditions to move in the path of fairness and justice.
Where we are born our dependency begins. Equity framework depends on education,
income, caste and wealth. Politics and health politics- Acts of government autonomy over
one’s own health. Politics is power, Politics to search for common good and just society
seeking justice. Rights- Fundamentals – sense of ownership, freedom to choose, fighting for
our own freedom, freedom to choose entitlement, Rights are always claimed, demanded
and not given
Rights are done through acts of parliament implemented by civil society whenever Act is
formed in parliament we need to frame rules. From Rules Policy is framed. Rights go with
responsibility
Fundamentals of human rights 1948- Legitimacy. Characteristics of human rights
➢ Rights of Individuals
➢ Right of being a human inherent
➢ Application to ALL people around the world
➢ Relationship between state and individual
➢ Right to legitimacy
Every individual should be respected, protected and fulfilled If any violations the court
intervenes Declaration of Alma Ata 1978 determinants of health. Health care is human right,
Health care preventive, promotive, curative and rehabilitative. Claim holders should be
responsible for nutrition, employment and should be the voice for the voiceless. Public
health action involves;
1 Assess health needs for that in need develop policies and implement and help the people
to claim for their rights
The employer and beneficiary are different; they should take forward the agenda of human
rights.
1. Essential standard of implementation
1. Availability
2. Affordability
3. Accessibility
4. Acceptability
5. Quality
State obligations rights and responsibilities
1. Social mobilization
2. Campaigns/ Innovations/ strategies
3. Engagement with state
4. Accountable and responsible health system
Article 21 –Right to life states that Supreme Court gave orders interpreting right to medical
facilities for workers. But every time it is denied. No right to health care ACT. Private sectors
can provide facilities if they really wish health for all.
MODULE – 5 & 6 Social Determinants of Health
Social determinants of health/ Action on social determinants of health/ social vaccine. There
are two types of social determinants of health.
Structural determinants-Includes context & Intermediary determinants
position, determine inequalities.
Socioeconomic, Socio-economic position
Life style, Psychological
political context
behavior, biological factors
Governance,
Policies, Education,
Occupation,
Values
Income, Gender, Ethnicity
factors
Understanding the power mechanism is very important. When health is affected socioeconomic and political context also gets affected. We need to look at the specific needs of
the population, reach to the isolate and unreached people with the SEPCE analysis, and cash
framework and community health approach.
Research documents on SDH
Social capital
Social network & Relationship
Structural Social capital
Cognitive social capital
Resources, Information, Funds, financial Norms, trust, quality, cohesiveness
support,
network,
community
participation
Cultural determinants of health- culture and role in promoting equitable access to health
and health care. My learning experience and how I applied them in my work in the
community. Being with them, understand their need and make them do by themselves. I
chose the community affected with Dengue fever.
MODULE-7- Comprehensive Primary Health Care (CPHC)
Comprehensive Primary Health Care by Thelma Narayan her. Her walk through history. She
shared about her experience in Mallur village, she worked in different levels. Also spoke
about counter bailing power which helped to become part of people’s movement local as
well as global level. She also strengthened the public infrastructure system. She briefed her
journey in community health and the emergence of primary health care and her role in
active participation in PHC and PHM. CPH ensures health care services, enabling its goal of
Health for All. PHC is universally accepted and accessible to all individuals and family
members through their active participation. The objective of this session is to enhance the
understanding of the CPHC approach in the Indian context. PHC is an approach is the key to
attain the goal. Strengthening of the infrastructure began in the public system. Cost of
medical health is gone up. Does Private sector has any role to play over the primary health
care? Health for all includes the determinants of health. Health care is a broader term it can
include and should include the determinants of health. Government doctors are with more
experience and they do lot of work. Public money goes to the private hospital. Primary
Health Care is not only for the middle class families but it is also the need of the developed
nations. PHC has lot of powers. A contractual appointment is the process of privatization. If
doctors are offered good service the quality of patient care also will go well.
She also explained about the patients’ charter which we can explore in wellness centers.
Primary health care principles include accessibility appropriate technology; inter-sectoral
coordination comprehensive relies on local and referral system equity prevention,
promotion and rehabilitation.
Components of PHC include:
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Education
Food and nutrition
Safe water and sanitation
Maternal and child care
Immunization
Prevention, Control of endemic
Appropriate treatment
Provision of economic drugs
Strengths of PHC
Comprehensive- address the main problem in the community, Equity- Acceptable to all
especially marginalized and vulnerable communities,
Community participation- Individuals and families are responsible for their own health.
Services should be empowering rather than providing. Appropriate health technology,
technique, equipment and inter-sectoral collaboration. Community health workers are
chosen from the community and given training. Supportive referral system is made
available. AYUSHMAN Bharat Program had 2 components
1. CPHC
2. Insurance Team
WHY CPHC
The Ayushman Bharat announced by the government in 2018 had to components
1. HWC to deliver CPHC
2. PMJAY Pradhan Mantri Jan Arogyaa yojana: Access to hospitalization services at
secondary and tertiary levels also insurance schemes.
3. The HWC component of ABP ensures CPSCs through upgrading existing PHC/ UPSC
goals-80% health care needs.
Reflection on health for all books. Health is a fundamental right Bhore committee reported
India’s charter on health that no citizen should be denied healthcare. The key principle of
PHC is health for all. After Alma Ata declaration there was a change in PHC but that was not
enough. PHC is fixed on targets, Health priorities were from distant bureaucracies, and there
was no community participation, no referral services, Fragmented health sectors. The
solution was to build people’s consciousness, intervention of people in decision making,
policy changes with minimum infrastructure. Opening of PHC with affordability,
acceptability, adaptability, accessibility and equity, drugs of minimum supply, stronger
referral system. Equip panchayat, community and local health officers to plan for the health
needs in their area and demand their needs. Resource support, monitoring, inter-sectoral
approach and capacity building. Horizontal approach to eradicate Malaria and filaria.
Implementing controlling the vector borne, controlling mosquito breeding, water sanitation,
removing stagnant waters
MODULE-8- Equity in Health
Equity In health: Cares worldwide- Dr. Aquinas- Equity is fairness. It is the recognition of
health as human right. Equity requires the elimination of unnecessary, unjust and avoidable
differences in the opportunity to enjoy health and having the similar opportunity to meet
the needs in case of being ill or incapacity. It is to remove all the barriers for the person to
enjoy good health. Accessibility of health to especially of women, marginalized, tribal,
persons with disabilities when we speak about access to health. Dr. Aquinas. People who are
passionate and committed can do a lot in primary health care shared her experience in St.
John’s medical college where the patients in general ward was neglected and the those in
private rooms even if they were not really very sick they were attended carefully. Usually
the patients in general ward are well examined only for their study/ research /identify
sickness for the students. She then turned her idea of rendering her service to the tribal
community. She came across with the women who lost one / two children due to various
reasons. She understood these are the people who need the health care but they are the
ones neglected the most. When they receive it is always sub-quality health care. Human
resource is on which we must focus more for health. Empower the community is very
important so that we can give best health care for the people. To gain the confidence of the
community is very important. The challenges faced by her was many, every moment was a
challenge, taking a decision was a challenge,. She said, “When we do the right things at the
right moment the entire world cooperates with you”. There is always a way to be opened.
More young doctors joined, fund flowed. Government health system has the infrastructure
but man power is limited. Huge gap in the tribal areas exist and this is to be developed.
When no electricity, no water, no communication. When this basic requirements are not
met the nurses doesn’t remain in the Centre. Traditional health healers also are active who
doesn’t exploit the people.
Dr. Nicholas session on disability took back me back to the years I spend with
physically challenged boys and girls in Ranchi, Jharkhand. Accessibility of services for them
was always a question. Since I was working in a Cheshire home which was cared by us
(Daughters of Charity) and the management was by MECON Company. So the children had
the accessibility for the medical assistance from MECON hospital. Management of some of
them was really challenging especially the adolescent boys. There was no difficulty in
getting them in school was not an issue. Some of them really excelled in school and two of
them are running a press with an offset machine supplying the books for all the schools in
Ranchi. Many of them got married and living well. It’s so happy to see that people with
disability living normal even better life than normal people. My key learning is to leave my
comfort zone to go to the peripheries to find the need of the people, have the multipronged
approach, understand the culture of the community and respect their culture and
involvement of the community. Empowering persons with disabilities is very important
especially in health, education, and livelihood. Empowering and enabling the community
also is very important. In front of the differently abled children I came to know about my
disability. This is what I was looking forward. Dr. Anil Patel, am touched by this video
because it is very much related to my family. My mother is sick since 1977 and since few
years my father too. Both of them are in their early eighties, my elder sister has dedicated to
care for them without expecting anything. She herself is with many health issues. None of us
ask her about her health, our only concern is parents. She plays a great role in the family
and community. Dr. Anil, your video on the caretakers gave me deep understanding of how
these caretakers in each family should be nurtured and taken care of
MODULE:-9 Health system in India
Health systems in India by Dr. N. Devadasan. System is a set of things interconnected and
organized to achieve something. Various elements of a health system include health cre
service, information, health staff, governance, infrastructure, medicine, education, job
opportunity, environment and community involvement. The purpose of the health care
system is accessibility to quality care, keeping health as a goal and responsible to the
community both socially and financially. Health system work in a comprehensive manner.
Quality health services assure availability of essential drugs, diagnostic services and human
resources. Primary health care comes under 3 categories: PHC, CHC & Sub Centres. In India
for 1 GP 30,000 population under one PHC, Workforce fall on GP. Primary Health Services
include primary care, Secondary care & Tertiary care. Primare care is comprehensive,
preventive, promotive and rehabilitative. Primary Health care includes hospitals and medical
colleges, clinics and dispensaries. Secondary Health Care Includes Hospitals and medical
colleges at district level where specialist doctors are available. Tertiary health care is
comprehensive and no focus on preventive or promotive aspects of health. Only specialists
and surgeons are available. Since PHC is a comprehensive 1 GP for 30,000 population, there
is a referral unit. PHCs conduct National Health program, connection with district health
teams, conduct ICDs for nutrition and NCD care, But the training remains robust. Private
sectors have one to one care for individual patients but the referral is decided by the
practitioner. National Health Policy in 2017, stated the need for strengthening the PHCs.
When the people demand, the PHCs also will increase and the PHC will be strengthened.
How many people are aware of the PHC services is a big question mark. Health workers
should be aware about the various schemes and policies in health sector and give
awareness to the community. Primary Health Care is comprehensive , increasing the fund in
primary health care is essential where many diseases need preventive and promotive care.
Health workers and community should build a cohesive trust among themselves. There is
great lacuna in this deal. Equipping and promoting traditional AYUSH practitioners in each
PHC level will be more comprehensive, efficient and less costly.
SWOC (Strengths, Weakness, Opportunity and Challenges
Strengths: Health services are available and affordable, Well-trained health workforce,
High quality medical specialists, and largest health insurance globally providing 500 million
poorest, Vulnerable administered by a separate national health authority.
Weakness: Shortage of medical professional, Lack of quality assurance, insufficient
financial allocation, outdated healthcare facilities and technology, Lack of funding and
resources, Poor accessibility for staff and patients, Staff turnover
Opportunity: Preventive and promotive services offered by hwcs, Limits efforts of
secondary, prevention and leads to increased care seeking from secondary facilities, Health
information technology, Health and wellness centre, Pradhan Mantri Jan Aarogya Yojana,
Clinical lab consulting services, Communication skills, Leadership, Lack of medical research,
Lack of preventive care, Low Budget, Shortage of Health care staffing and burnout of the
existing staff, patient safety.
Challenges: Does not support primary level facilities hwc, critical link between primary and
secondary still missing, Inadequate accessibility, Shortage of professionals, Lack of medical
research, Lack of preventive care, Low Budget, Shortage of Health care staffing and burnout
of the existing staff, Patient safety.
MODULE- 10 Pluralism in Health Care in India- Role of Local
Health Traditions and AYUSH
Pluralism in health care in India. I was interested in this session because I was dealing with
herbal treatment for the common diseases. I also used to give training to the SHG groups
and ASHA workers in different places. During my follow up sessions I was satisfied to hear
from the participants their success stories. The module gives a thorough study about the
local health traditions, traditional healers, codified and uncodified practitioners and the
AYUSH community. National health policy has given importance in the year 1983 for the
integration of traditional and modern medicines. AYUSH, SOCHARA and FRLHT has created a
social dialogue to strengthen AYUSH in community health situations. The dependency of
traditional medicine in our country is only 60-80%. There is a great fear of losing the vast
knowledge of traditional medicine practices. Giving them respect and recognizing them
today is a big question. Documentation is very important, it is to conserve traditions,
stimulate promotion of innovation, protection and conservation of cultural and biological
diversity.
MODULE – 11 Universal Health Care & Universal Health Coverage
Universal health coverage. Individual Assignment, Universal Health coverage is when all
individuals and communities receive the health services without any financial crisis. Context
of health for all. Second part focus on financing UHC. MODULE- 12Facilitator Dr. Ravi
Narayan about Civil society and role of voluntary organization.
Module 12 Understanding Voluntary Health Sector
Civil society is neither have ideas, value, we are not business motive. We are people with
idea there are people who need us . We are as an individual Reflect your role and what you
want do? We must get empowered to teach governments. Are you a catalyst. Is part of the
community. Are you moving to Jana swastya abhiyan.
MODULE – 13 Food and Nutrition
Food and Nutrition facilitators Dr. Ravi D’Souza and Nidhi Sukla Dr. Ravi explained about
ICDS- A National Programme from 0-6 years, It had one AWW and one helper. Which run 6
days in a week. I visited one of the anganwady in my operational area. 23 children were
registered and 20 were present on that day. Anganwady was kept very neat and clean
Children has got the play items. Got Register, growth chart and the weighing machine.
Bothe AWW and the Helper were present. The children are given midday meal,
immunization on every Wednesday, VHND every last Friday. Adolescent youth are given T T
injection, Iron tablets and deworming, pregnant mothers are given take home ration. 3 eggs
per week, 1 packet oil, suji. ANC checkup also is done. ANM visit monthly to the centre. In
my visit I spoke to them about anemia, healthy life style, intake of adequate life style.
MODULE 14 C- WASH
Dr. Prahlad and Dr. Prutvish facilitated this module. Lack of sanitation and toilets are social
determinant affecting the mental health of young adolescents with low school performance.
There is definitely a need for sanitation, Bio-Medical waste management, low costs methods
of safe drinking water using copper pot.
MODULE-15 Women’s health
Facilitators were Dr. Amitha, Dr. Subhasini, Dr. Bhuvaneswari and Dr. Padma. Women’s
health objectives discussed about the life cycle approach, rights perspectives and gender……
Reproductive health and health is far more than medical or health issues. What is family
planning & contraception, family planning program in India which is a target observed
program. Barriers to accessing safe abortion due to lack of information, lack of decision
making and power, stigma in unmarried women, poor service in public sector, Lack of
financial resources and so on. Raising awareness about violence against women, , women
health movement in India-women health care workers and gender.
The session was very interesting and the learning: Understood in deeper sense sexual and
reproductive health, right from birth through a life course approach and also community led
approach the issues involving the women’s movement in India
MODULE-17 & 18 Mental Health
A person’s mental status determines the health of a person. Since mental health is a public issue
community approach is needed. Self-care, personal relationships, work & life balance, staying
connected all contribute to the mental health. The facilitators were Dr. Rajaram, Dr and C. Naveen
Kumar. We had an overview of mental illness, understanding common mental disorders like
depression and anxiety and came to know about youth awareness mental health program.
Understanding about suicide was taken by the facilitator Dr. Kaustubb. Dr. Rajaram ‘s session on
counselling on mental health and mental illness, interaction with the participants were enriching
experience. Involvement of family, relatives, community and the doctor all play a great role in
treating persons with mental disorders. The story of Lalappa gave me lot of insight in dealing with
the persons with mental disorders. “If I change my family change, If my family changes the society
changes and if the society changes the world changes”. Anything that affects the thoughts,
emotions and behaviour can lead me to mental disorders. The sessions gave me the insight how to
deal with persons with mental illness/ mental disorders, and the person suffering from this should
me given confidence that they are not alone, and they can get treated and back to life and
community. Empowering the community is also important. The role of a counsellor is very important
& he / she should have skills, qualities, attitude, conduct and convictions.
MODULE-19 Communicable Diseases
Communicable diseases are always a major public health priority and even more so after Covidpandemic. Facilitaotrs were Dr. Ravi D’Souza and Dr. Ramani
We had a brief discussion about vector borne diseases at the session. This was very much applicable
to me as my project was Dengue fever- a vector borne disease. Social determinants include
overcrowding, education, socio-economic and nutritional causes. Community health approach in
VBD include behaviour change, personal protective measures, education, safe drinking water and
housing, sanitation and access to health care.
MODULE-20 Non Communicable Diseases
Non communicable diseases Dr. Pruthvish and Dr. Chandar. Dr. Ravi D’Souza was the
facilitators. NCDs are wider topics. Physical inactivity, Unhealthy lifestyle, Alcohol and
Tobacco use and stress are the cause for of NCDs. Most of the NCDs are preventable with a
healthy and disciplined life. The topics covered were very interesting and educative
Integration of AYUSH in a proactive way will reduce some extend the reduction of NCDs. The
most important strategy depends on the behaviour change and implementation at school
level is the best way to reduce NCDs. Alcohol and Tobacco has great impact on mental
health.
MODULE- 21 Palliative CAre
Palliative care provides holistic health care for individual. Its aim is to improve the quality
life of patients, their families and their caregivers. Palliative care is going beyond the
physical symptoms. It needed physical and psychological support. Quality care and quality of
service are very important to improve the health of the people. Palliative care is a crucial
part of integrated, people-centered health services. Relieving serious health-related
suffering, be it physical, psychological, social, or spiritual, is a global ethical responsibility.
palliative care should be made available for all those who suffer. To improve equitable
access to palliative care services, emphasis is given to a Primary Health Care approach.
Assessment tools are developed to measure progress made. Strong partnerships are in place
to develop and implement technical guidance, to strengthen capacity and to disseminate
information. Early identification, correct assessment and treatment of pain and other
problems, whether physical, psychosocial or spiritual, prevents & relieves.
MODULE 22 Climate Change and Health
Climate change and its impact on health. Environment is a determinant of health and
climate change influences the health. Dr. Aditya’s session was very interactive. Climate
change affects human health through increased frequency and intensity of heat waves, rise
in heat related illnesses and deaths, increased precipitation, floods and droughts. Climate
change affects the mental health; Climate sensitive illnesses are on increase due to climate
change and extremes of whether either through direct or indirect behavioural change and
covid, food security. Climate change affects seasonal migration. Covid 19 has slow down the
economy. Climate change affects social and environmental determinants of health like –
Clean water, safe drinking water, sufficient food & secure shelter. It also has lot os negative
impacts on human health-rise in illnesses and death.
MODULE 23 Health and Technology and Innovation
Equitable access to covid technology. Health technology and innovation should be.
affordable, accessible, affordable and acceptable. Technology and health care is a complex
matrix of issues and problems, which cannot all be covered, it is the beginning of
technological assessment. Technology is subject to glorification, high pressure cell, and
iniquitous investment. Its impact on Medical/ Health care is bond to affect the nature of
health care development, Appropriate Technology concept-ORS In diarrhoa treatment
MODULE 24 Communication for Health
Communication for health. Facilitator –Augustine Velliath ideas, values, methods, tools for
communication. Listening is the best art of communication. Developing communication
skills in advocacy, health development program and implementation is the major role of
community health volunteers.
MODULE 25 Globalization and Health
Mr. Prasanna was the facilitator. Market brings in competition. When there is market, there is
competition. When there is competition they compete with each other and the price goes
down. When supply increases the price goes down and when the demand increases the
prize goes up. When competition increases in the market we get the things in cheaper rate.
In monopoly the market decides the prize & the prize is always high.
Dealing with equity, political economy, politics and economics. Health is a market failure
MODULE 26 Child Health
Child and Adolescent health Facilitated by Dr. Antony. Lot of information were shared by Dr.
Antony, Right based approach to children on survival, development, protection and
participation. Children have the right to be born without discrimination having adequate
nutrition and immunization at the gestation to have healthy child. The critical period are the
first 1000 days and we needed to have Life Cycle approach rather than Vertical Approach
from womb to tomb. Two important growth spurt period 0-5 years for the children and 1018 years for the adolescents. National Health Mission RBSK- screening and treatment
happens at the gram panchayath and block level for the brighter future of the children.
Healthy lives of children- SDG 3 states (Sustainable Development Goal) 30 medical
conditions and 4 D’s Defects at birth, Deficiencies, Diseases & Development. The role of
local Gram Sabha to participate actively to ensure and promote child health, different
mechanisms and approaches to monitor the services provided by the government, child
centric planning to address child health issues. Poverty root cause for the survival, growth
and development of the children and their fundamental right to nutrition, health, safe
water, education, protection and shelter.
Balance between work, life and CHLP :
It was a challenge for me to manage my work life and the CHLP learning. There was lot of
work and demand from the office. Since I was working in the community with the
“Community Health Promotion” project I was already familiar with the life in the
community. I had lot of hurdles to reach to this day. Pressure on my work, routine life on my
congregation and the lessons to learn from CHLP and the ailments of my parents were
taxing too much. Since Community approach was part of my life I made it possible and the
support of my friends, companions and the CHLP fellows always gave me a push to go
forward. Each module and the facilitators made me feel more connected, creative,
energized and collaborative. All the barriers never took away my peace of mind rather gave
me courge to be strong . God’s grace was sufficient to keep a balance life.
Mentorship Process and reflections
I am humbled to see the gentleness, availability, the experiences and the advice of my
Mentors. Dr. Rajaram was my mentor. He guided me through virtual meeting along with
Zafia. We had few sessions of elaborative discussion about my objectives and he gave me
clarity about my project. He was always available and flexible in communication and had
phone conversations twice. I am grateful to CHLP for giving me such wonderful, intelligent
and wise mentor.
Project learning experience
The fellowship period was a time for me to learn & experience and reflect about the
community. CHLP changed my pattern of thinking and showed me the way to reach the
community. I learned about the Axioms of community Health which has changed my
approach. Involvement of the community in planning, decision making and implementation
brought great result. People took health in their hands. My frequent visit and interaction
with them gave me more knowledge about the life situation, their struggles, challenges,
problems, opportunities of the community. Helped me to build rapport with the community,
Government officials, line departments, youth and the PRI members. Also could motivate
people to demand for their rights & to avail the various provisions available from the part of
the government. The division in the community was very evident on the issue of the
cleanliness of the drainage. The collective strategy is the only hope for the future and is in
line with the principles of community health. I learned I could bring the community together
as I was better at one-to-one interaction. I could handle the issue comfortably.
My visits to them helped me to remove my preconceived ideas as why people were not
using the toilets. They didn’t have piped water connection and they had to go long way to
fetch the water or wait long to collect the supply water. Most of the toilets are used as store
house or to keep fouls/ firewood. Constant guidance of SOCHARA Core team, interactions
and experiences of all the fellows the proper guidance and timely support of my mentor
added colour to widen my knowledge.
Part-B
Community- Based Health Action- Reflection Project
Background
Odisha, formally called Orissa, is an Indian State located in the North-eastern part of
the country. It is bordered by the Indian States of Jharkhand and West Bengal to the North
and Northeast, by the Bay of Bengal to the east, Andhra Pradesh to the South and
Chhattisgarh to the West. District of Gajapati covers an area of 3850 sq. km. The District is
surrounded by Andhra Pradesh in its South, Ganjam District in its East, Rayagada in its
West and Kandhamal in its North. The soil and climate is suitable for plantation of crops
and there is a great potential of horticulture development in the District. More than 60 % of
lands are situated in hilly terrain and high lands.
The Community Based Action Project’ is implemented in Mohana Gram Panchayat of
Mohana Block in Gajapati District of Odisha State in India. As Gram Panchayat is the
political unit of local self-governance at the grassroots, at the villages falling under that
cluster is taken as a single unit of operation in the project. The operational area has 185
families with 1200 population consisting of all religion. The area is highly populated with
minimum facilities for the habitation. During the frequent informal meetings with the
community and families individually we came to know the plight of the community. They
were deprived of the many benefits from the government as most of them were living
without proper documents. Almost all the families were affected by dengue fever and 8
persons lost their life. In our enquiries we found the main problem was lack of ignorance
about the seriousness of dengue, financial crisis, superstitious belief and inability to take
decisions for their health. Men folk are mainly labourers and Consumption of Alcoholism
also is common among them. Women practically do nothing except few who goes for some
household works. The adolescent youth (Male) are migrated to other states for livelihood.
Early marriage is common among them.
Community Based Action Project in Mohana Panchayat of Mohana block of Gajapati
district, Odisha, India is from 1st August 2022 to October 2022. It is to streamline the
community based organizations to ensure health rights for the people, with the people, by
the people and for the people and thus realize the principle of ‘Health for All’. The goal of
the proposed project is to Improve the Health Status in the target area by strengthening the
community based organizations especially the village health committees to avail right based
approach in controlling the endemic diseases and periodic breaking out of epidemics, build
awareness among the adolescent boys and girls, strengthen the community based
organizations and to equip the families to acquire knowledge in a changing health scenario.
The projection of health hazards in the operational area is very high as it has brought a bad
reputation in the whole of district and it is alarming. Though many measures are taken from
the government side as per the data available from Vision 2022, of the district health
department, still there are incidents of high level mortality rate (8 deaths) due to Dengue
fever within two months out of 1200 population of 185 households of the village. The most
vulnerable section of the society is women, children and elderly people. However there need
to be urgent intervention from the part of Government to address this issue which otherwise
bring catastrophe to many of nearby villages. The Government (community Health centre)
after having a successful intervention in the areas of the district came with certain clear cut
road map to eradicate these health hazards. The CHC is now equipped with its findings
learned from the mistakes and experimentation and success stories will engage and
participate with the community more closely. The CHC has the competency and personal
to work for the proper implementation of the program. And it is expected to achieve this
goal. It will make sure there is 100% health awareness programmes conducted in the villages
and the participants seek health facilities with their own interaction with the government
having a right based approach.
Taking into consideration, the above factors, the CHC proposes to get involved with the
village communities and their organizations by accompanying them with awareness
generation, training programs, interface meetings and community meetings. The CHC will
also take the support of the government agencies and other local NGOs, PRI members, and
other health personals for the quality and commitment service delivery. The proposed project
is to improve health status in the target area by strengthening to avail health based
requirements in controlling the endemic diseases and periodic break-out of epidemics, build
awareness among women, adolescent boys and girls, frontline workers (ASHAs, &
Anganwadi) equip them by updating their knowledge in a changing health scenario.
Through this process it visualizes to reduce instances of health hazard which shall be
enumerated in the base line survey in the beginning of the project implementation in the
target area.
Context
The community chosen was Christian Sahi of Mohana because of the outbreak of dengue in
the community. Dengue is the burning issue in the area. Most men take alcohol and sleep in
open space, The women in the village are unemployed, the community is overcrowded, the
village’s drainage system is blocked with all the garbage, as People throw everything in the
drain, This increases the breeding of mosquitoes, Lack of cleanliness is the root cause of
illness, Safe drinking water is not available, With a span of 2 months, many were affected
with dengue 47 persons are admitted in different hospitals and 8 have lost their life with
other complications.
SWOC ANALYSIS
STRENGTHS:1. The community actively participates in the awareness programs and meetings.
2. The youth were enthusiastic, responsible & active to bring Health for All.
3. Health services are available and affordable.
4. Screening of the families done to detect Communicable diseases & NCDs eg.
Tuberculosis, , Malaria & Dengue.
5. Well-trained and competent frontline workers
6. Committed CBOs ( Community Based Organization)
WEAKNESS:1. Lack of education
2. Poverty
3. Lack of awareness about the availability of various Government schemes and
entitlements
4. Population increases
OPPORTUNITY
1.
2.
3.
4.
5.
6.
Building leadership among the SHG mothers and youths
Community Participation
Communication skills
Health information and technology
Accessibility of health & wellness centre
Building capacity
CHALLENGES
1.
2.
3.
4.
5.
6.
7.
8.
Poor unhygienic living condition ( open defecation)
The garbage accumulation in drainages
Attitude of women towards the cleaning of the drainages
Un employment,
Lack of infrastructure
Lack of safe drinking water & Sanitation
Migration for livelihood
Traditionalism
Situational analysis
Christian Sahi in Mohana block have 1200 population consisting of 185 households.
There were incidents of high level mortality rate (8 deaths) due to Dengue fever within
two months. The most vulnerable section of the society is women, children and elderly
people. The village is ill-planned. During rains, the drainage overflows on to the streets.
The community was deprived of the benefits from the government sector. Toilets are
poorly constructed with no water connectivity. People go for open defecation. Since the
community is situated near the river bank during the rainy season the water also get
polluted which is used for washing and cleaning. Community also doesn’t have safe
drinking water.
Objective of Community health initiative
1. Identify people affected by infectious diseases and refer them for treatment.
2. Promote community awareness.
3. Involve both community and Government stakeholders and take up participatory
measures to create healthy hygienic environment.
4. Dalit and marginalized youth and women are skilled for employment.
Community Health Action Initiative
As a community health provider understanding the burning issue of the health conditions of
the community the action plan was drawn. It was done after the informal meeting with the
community to access the health care facilities for them. The community was cooperative
and they took the initiative to join hands with us.
Community Participation and Rapport building
We made a visit to the village
with our staff and met few
mothers and youth and had an
interaction with them. This was
the starting point of building
the rapport with them. They
were happy and appreciated
our visit in this crucial time
when many of their dear ones
were either admitted in the
hospitals or sick at home. We
Meeting with VHC
paid a visit to the eight families
who lost their loved ones due
dengue fever and assured them that they are not alone. This gesture made us to build a
good rapport with the community and they were open to us by sensitized the groups on the
seriousness of the burning issue of dengue fever.
Description
of
the
intervention
and
implementation,
community
engagement process
Month of July the project area
was affected with heavy rainfall
leaving the community in chaos.
Due to poor/damaged drainage
system all the drains got blocked,
water along with the garbage was
floating right in front of the
houses. Habitation was beyond
Cleaning
imagination, People began to
the drainage
become sick with diarrhoea,
Malaria and dengue fever. Many people were affected with dengue fever and 8 persons in
two months lost their lives. Dengue fever became an endemic in the area. After studying the
situation we approached the CHC for their intervention.
We had the discussion with the CHC In charge, thereafter the CHC provided us with 50kg of
bleaching powder and 25 pairs of gloves and assured us the support to reduce the intensity
of dengue fever in the area. Our first meeting was with the village CBOs (Community Based
Organizations). There was a need to empower them. Instead of going directly with the
awareness sessions, as I learned from CHLP, we had informal meetings with ASHA workers,
Ward Members, SHG mothers, Youth representatives and Anganwadi worker.
We had the first formal meeting with the community; there were representatives of ASHA,
Anganwadi, youth, SHG mothers, NGOs (Conflict Transformation & Peace building Project
Staff). The participants shared their feelings with emotions. After their sharing immediate
action was taken to clean the drainages and the surroundings. Thereafter the drainages and
the surroundings were cleaned and spread the bleaching powder. This was highlighted at
block level and the government sector acknowledged our intervention to fight against
Dengue fever and they assured us their full support. Two days later, they had organized at
the block level an awareness program and we were invited to be part of the training along
Meeting organized
by government
with the community. This was an eye-opening for the participants. Two days later the BDO
(Block Development Officer) organized a rally with slogans through the town & the villages.
There was great participation.
Activities
We engage ourselves with the ASHA worker to do the basic survey of the village. After
gathering the knowledge about the problems and challenges faced by the community we
decided to give awareness programs for different groups of the community. The
community lacked the basic needs like proper drinking water, lack of toilets, lack of money
for their treatment.
Questionare session
1. No of households in the village?
2. No of population?
3. No of toilets in the village & How many are made use?
4. Do you have safe drinking water?
5. How many children are there (0-5year)?
6. How many children are malnourished in the village?
7. How many children are immunized?
8. How many school going children are there?
9. How many drops out students are there?
10. How many drop outs are re-enrolled in the school?
11. How many pregnant women are in the village?
12. No of pregnant women malnourished?
13. How many lactating women in the village?
14. How many are malnourished?
15. How many were affected with Covid?
16. No of death?
17. How many people have taken Covid- vaccination?
18. How many people received support from the government/ any other sources?
19. How many adolescent youth received skill training from the government?
20. How many youth are self-employed?
21. How many youth have received support through government schemes?
22. How many families grow backyard kitchen garden?
23. How many mothers practice herbal medicine?
24. No of migrants to other states?
25. Is there follow-up of the migrants?
From their responses to questionnaire we came to know, the division in the community
was more evident on the issue of cleaning of the drains in front of their houses. The
collective strategy is only hope for the future and is in line with the principles of
community health. I learned I could bring the community together as I was better at
one-to-one interaction. I would handle them comfortably. This visits helped me to
remove some pre-conceived ideas as why people do not use toilets even when
constructed by government, They do not have piped water connection and have to go
long to fetch the water. Most of the toilets are not used/ used as store house.
Sessions were given on different topics
1. Health & Hygiene
2. Safe drinking water and sanitation
3. Disposal of waste management system
4. Nutritional and traditional foods
5. Backyard kitchen garden
6. Pre-marital sex education, dangers of early marriage
7. Safe migration
8. Orientation on vocational training
9. Homemade Horlicks
10. Government schemes and entitlements
11. Awareness on Covid-19 pandemic measures & awareness on vaccination.
47 persons who were admitted in CHC were recovered.
The people cooperated with the CHC staff and this brought great success in treating the
patients.
Planning
meeting with the CHC
In charge helped us to
get the support &
collaboration from the
frontline workers. 60%
of the CBOs received
the training on health
related issues and the
government schemes
and entitlements &
maintenance of health
RALLY
diary. Training to
women,
frontline
workers, & the youth
were conducted various topics especially on health and hygiene, government schemes and
income generation activities. Adolescent youth received training on pre-marital sex
education, dangers of early marriage, health, hygiene & sanitation and safe migration. SHG
mothers were given training on income generation activities and two groups are engaged
in making washing soap, phenyl, Ujjala and homemade Horlicks. Women are motivated to
grow backyard kitchen garden. 50% of the community are aware about the benefits of
clean environment. Women understood the need for self-employment. 22 women from
the village learned tailoring and 20 women started earning money stitching at home or in
the town.
Impact of the community health action
1. Eradication of Dengue by 50%
2. 60% villages have functional CBOs to improve & manage the health issues of the
community
3. &0% of the Community becomes health conscious
4. Healthy environment is created by 60% of the families
5. 80% of Government personnel visit the village
6. 80% of the community become aware about the government schemes and
entitlements
7. 40% of women are self-employed and autonomous
learning and Reflection
➢ Collaboration with the government brought drastic change in the mind-set of people,
their behaviour and attitude.
➢ Unity is strength.
➢ Ability of Motivating and convincing of the community.
➢ Timely intervention to their issues brought better participation of the community.
➢ The community potentialities were brought out by their involvement in the actions,
acceptance and affection.
Reflection
1. The Community actively participated in the meetings by giving their opinions & making
decisions.
2. The Government officials and the frontline workers joined hands together in
eradicating dengue fever.
3. The emergency ambulance service was offered by SWAD (Society for welfare,
Animation and Development).
4. Strengthened the Involvement of youth especially in reaching the affected patients to
the CHC and the referral cases to the medical college, Berhampur
5. Open defecation is reduced
6. Intake of alcohol has reduced.
7. Financial condition of the family has improved as women started income generating
activities.
8. Backyard kitchen garden has begun by few families.
9. Government officials were inspired by our intervention in the dengue affected are.
10. Reconstruction of the damaged drainages started by the SWACH Bharath.
Meeting with PRI
members and
frontline workers
Axioms of community health applied in the project
1. Enabling the community to exercise their responsibility for their health and prioritize
their health needs.
2. Increasing the knowledge on health and hygiene and making the people aware about
the importance eradicating dengue fever with the community participation.
3. Integrating health & development activities with the experimentation of low cost
training to health workers, women and adolescent girls.
4. We had frequent interactions & evaluations with the community which has helped
them to become empowered and efficient.
5. The participants were from poor and marginalised community and every one was given
the chance to express their views, ideas and opinions - Equity in health.
6. Making them aware about their right to health and their participation for bringing
health for all. Sense of community spirit and oneness is enriched and increased. .
7. More participatory decision making system is created, Over emphasis given to SEPCE
analysis, and responsibilities divided,
8. Animators were chosen from the community were strengthened and capacitated
9. Making them aware about the public health facilities available not only in the hospitals
but in the community where door to door screening is done.
10. Increasing knowledge about their health and making them aware about the
importance of the community participation.
SEPCE analysis is important at every stage.
PARADIGM SHIFT
1. Physical , psychological , cultural, social, ecological
2. Individually – Community Participation
3. VHC (Village Health Committee) Catalyst, empowering, capacity building, Liaison
between government and community
4. Clinical- Social Determinants of health
SEPCE ANALYSIS
SOCIAL
1. Lack of awareness
2. Inadequate water supply
3. Open defecation
4. Consumption of Alcohol
ECONOMICAL
1. Unemployment
2. Ignorance to government schemes
3. Poverty
4. Inadequate financing
POLITICAL
1. No planning with the community
2. No information
3. No networking
4. Contract work
CULTURAL
1. Traditional beliefs
2. Creeping of modernization
3. Stigma/Taboos
4. Behavioural patterns
ENVIRONMENTAL
1. Water pollution
2. Lack of toilets
3. Over crowed cluster
4. No eco-friendly system
ANNEXURES
Idea Draft
Title of community based action project
Improved health status of the people of Mohana village of Mohana Block of Gajapati Dist.
Introduction / Background
Odisha, formally called Orissa, is an Indian State located in the Northeastern part of the
country. It is bordered by the Indian States of Jharkhand and West Bengal to the North and
Northeast, by the Bay of Bengal to the east, Andhra Pradesh to the South and Chhattisgarh to
the West. District of Gajapati Covers an area of 3850 sq km. The District is surrounded by
Andhra Pardesh in its South, Ganjam District in its East, Rayagada in its West and
Kandhamal in its North. The soil and climate is suitable for plantation of crops and there is a
great potential of horticulture development in the District. More than 60 percent of lands are
situated in hilly terrain and high lands.
The Community Based action Project’ is implemented in Mohana Gram Panchayat of
Mohana Block in Gajapati District of Odisha State in India. As Gram Panchayat is the
political unit of local self-governance at the grassroots, at the villages falling under that
cluster is taken as a single unit of operation in the project. The operational area has 185
families with 1200 population consisting of all religion. The area is highly populated with
minimum facilities for the habitation. During my frequent informal meetings with the
community and families individually we came to know the plight of the community. They
were deprived of the many benefits from the government as most of them were living
without proper document. Almost all the families were affected by dengue fever and 8
persons lost their life. In our enquiries we found the main problem was lack of ignorance
about the seriousness of dengue, financial crisis, superstitious belief and inability to take
decisions for their health. Men folk are mainly labourers and Consumption of Alcoholism
also is common among them. Women practically do nothing except who goes for some
household works. The adolescent youth (Male) are migrated to other states for livelihood.
Early marriage is common among them.
Cleaning the
Drainage
Community Based Action Project in Mohana Panchayat of Mohana block of Gajapati
district, Odisha, India is from 1st August 2022 to October 2022. It is to streamline the
community based organizations to ensure health rights for the people, with the people, by
the people and for the people and thus realize the principle of ‘Health for All’. The goal of the
proposed project is to Improve the Health Status in the target area by strengthening the
community based organizations especially the village health committees to avail right based
approach in controlling the endemic diseases and periodic breaking out of epidemics, build
awareness among the adolescent boys and girls, strengthen the community based
organizations to avail communities to have a healthy family and to equip the families
knowledge in a changing health scenario.
The projection of health hazards in the operational area is very high as it has brought a bad
reputation in the whole of district and it is alarming. Though many measures are taken from
the government side as per the data available from Vision 2022, of the district health
department, still there are incidents of high level mortality rate (8 deaths) due to Dengue
fever within two months. The most vulnerable section of the society is women, children and
elderly people. However there need to be urgent intervention from the part of Government
to address this issue which otherwise bring catastrophe to many of nearby villages. The
Government (CHC) after having a successful intervention in the areas of the district can
come with certain clear cut road map to eradicate these health hazards. The CHC is now
equipped with its findings learned from the mistakes and experimentation and success
stories will engage and participate with the community more closely. The CHC has the
competency and personal to work for the proper implementation of the program. And it is
expected to achieve this goal. It will make sure there is 100% health awareness programmes
conducted in the villages and the participants seek health facilities with their own
interaction with the government having a right based approach. Taking into consideration,
the above factors, the CHC proposes to get involved with the village communities and their
organizations by accompanying them with awareness generation, training programs,
interface meetings and community meetings. The CHC will also take the support of the
government agencies and other local NGOs, PRI members, and other health personals for the
quality and commitment service delivery. The proposed project is to improve health status in
the target area by strengthening to avail health based requirements in controlling the
endemic diseases and periodic break-out of epidemics, build awareness among women,
adolescent boys and girls, frontline workers (ASHAs, & Anganwadi) equip them by
updating their knowledge in a changing health scenario. Through this process it visualizes to
reduce instances of health hazard which shall be enumerated in the base line survey in the
beginning of the project implementation in the target area village.
Rationale
Dengue fever was the burning issue of the community. 47 persons were admitted in
different hospitals and 8 persons lost their lives in two months. The living condition of the
community was very pathetic. The community lacked proper drinking water, toilet facilities
medical assistance …etc. It was the urgent need of the hour to join hands to eradicate
dengue fever and bring back the community to normalcy.
Project Scope
❖ Enable the stakeholders to exercise collectively their responsibility to their health
and the health of the community.
❖ VHC- Village Health Committee.
❖ Strengthening the SHG mothers to take leadership in promoting health and
development.
❖ Adolescent boys and girls- promotion of health and health hazards.
❖ Involvement of individual and community autonomy over health and over the
organization, the opportunities, knowledge and supportive system that make the
health possible –CHC Axioms
❖ PRI members
Project Timeline
Meeting with the Community
Community initiative and participation
Meeting with the CHC in charge and staff
Interaction with the frontline workers
Community Volunteers
CBOs
Youth
SHG mothers
Frontline workers
PRI Members
Goal Of the project
•
•
•
Improved Health status of the people of Mohana Village Gajapati district
Promotion of Healthy life style practices
Covid Preparedness
Objectives
1. Identify the people affected with infectious diseases and refer them for treatment.
2. Involve both community and Government stakeholders and take up participatory
measures to create healthy hygienic environment.
3. Promote Community Health Awareness.
4. Dalit and marginalised youth and women are skilled for employment.
Community context
The project area is severely affected with the outbreak of dengue fever. The other issues
are highly populated, lack of drinking water, inadequate toilets, poor sanitation.
Unemployment, Socially and economically backward community with lack of knowledge
about the right for health and health care services available.
Stakeholders
ASHA
Anganwady worker
CHC Staff
PRI Members
NGO (Conflict transformation and peace building)
Youth
SHG Mothers
Community based action
Objective
Activity
Objective:1
Identify Baseline survey done
informal
people affected with with
infectious diseases and meetings
refer them for treatment
Involvement
of
community and
Government
stakeholders and take up
participatory measures to
create healthy hygienic
environment
Objective:2
output
Outcome
Understood
the 80% of the population
pressing needs of the recovered from dengue
community.
47 fever
persons
affected
with dengue are
admitted in CHC &
Medical College
Planning
meeting 60%
of
CBOs
with
the received training on
Government official. the outbreak of
dengue fever and
other
pandemic
Meeting with the diseases.
VHCs are capacitated
with the knowledge
about the prevention of
endemic diseases and
the promotion of health
for all.
frontline workers,
Organizing
community
meetings,
Awareness training Reconstruction of the
given to the front drainage.
line workers.
Door to door screening
Built good rapport began
by
ASHA
with
the
government
workers.
Training to CBOs on
government schemes representatives.
and entitlements,
Health care facilities
improved
(medicine,
infrastructure
and
Review meetings.
ambulance service).
Conducted rally in
collaboration with
the Block,
of
the Women
took
the
Promote Awareness meeting Women
with the women & village
gained leadership to clean the
community awareness
Youth.
knowledge.
drainage.
Objective
3:
Women
are Dustbins are kept in
empowered to take every street.
leadership in the
society.
The community are
sensitized to claim
for their health and
health
related
benefits.
once in a week common
cleaning
of
the
surroundings .
Improved
health
condition-Less visit to
the PHC/CHC .
People are sensitized
to keep clean the
Safe
migration
environment.
promoted.
Adolescent
clinic.
Adolescent
youth
are sensitized on sex Anganwady
education and the regularly.
dangers of early
and
health marriage
pregnancy
and
sexually transmitted
diseases.
Anganwady worker
takes responsibility
to care for the health
of the children.
Visit
to
the
is
function
Anganwadi centre.
Objective 4: Dalit and Development
of 22
women 40 women are
marginalized youth and training curriculum. completed tailoring. employed
women are skilled for
autonomous.
employment
selfand
Orientation
on 10 women purchased
vocational training tailoring machine.
Improved life style
skill training.
2 SHG group began Women got lot of scope
Theoretical
and selling
their for
self-employment
practical training on products.
(phenyl,
surf,
soap
tailoring,
making and homemade
Horlicks)
Assessment and
certification of all
trainees.
Conducted Income
generating activities
initiated. (Phenyl,
Surf, Soap making,
Homemade Horlicks
Participation information sheet
Community meeting Log
Sl no
Date
Catogory
Subject
No
of
participants
1
22.08.2022
Community
Informal meeting with
the
community.
Understood
their
priorities and needs
2
25.08.2022
CHC
charge
3
07.09.2022
Frontline
workers
Awareness program on 30
Dengue fever, Health
and sanitation, use of
safe drinking water, use
of toilets.
4
09.09.2022
women
Sensitization on health 25
and hygiene, adequate
nutritional diet, Intake
of homemade Horlicks,
awareness on dengue
fever, Orientation on
vocational
training,
Income
generating
activities
(making
phenyl, soap, surf and
homemade Horlicks)
5
22.09.2022
BDO, doctors, Awareness
rally 200
frontline
through the town and
workers,
the streets
NGOs,
community
5
23.09.2022
CBOs
Government schemes, 10
Government
skill
development program
6
24.09.2022
youth
Education, health & 50
hygiene, employment,
skill
development
program, Government
schemes and provisions,
In Information about the 7
outbreak of dengue
fever and the number of
deaths occurred.
Sex
education,
migration and human
trafficking
CONSENT FORM
Title of study:
Community health action oriented reflection project
Purpose of study
To create awareness about dengue fever among the villagers along with general health care
and pandemic preparedness.
Principal Investigator
Sr. Philomina Cheruplavil
E- Mail: philoplavil@gamil.com
Date:
I hereby acknowledge the initiatives of Sr. Philomina and her team to eradicate Dengue
fever from Mohana village of Mohana Block. I have studied the situation and I allow my
consent for the village community to allow them to work, among you and with you and I
assure you my full support and collaboration..
Signature:
Photograph
DDT
Spray
Planning meeting with
PRI, NGOs, & Govt.
Awareness meeting
with the youth
After the Implementation of the project
Tailoring class
Reconstructed Drainage
IMPACT OF COVID- PANDEMIC
The world has been in a state of shock in the face of a pandemic that no one ever imagined
would happen. Globalization has never been so concretely and violently evident. The whole
world is locked down in order to save life. During this locked down people faced many
problems; lack of food,
lack of medical assistance,
loss of employment, loss
of life, increase in mental
disorders,
plight
of
migrants,
schools
remained closed for longer
time, children and the
parents
suffered
psychologically. COVID-19
Pandemic is a time of great
suffering. The virus is
contagious but love can
also be contagious. In
every natural calamity our
organization SWAD reached to the unreached to enable everyone to lead a dignified life.
Caritas India and CRS came forward with their support and we joined hands together with
them Baseline survey was done and the main aim was to find out the people who were
deprived of the pro) visions from the government. Seven hundred fifty four families were
identified and the following items were distributed, Rice 10 kg, dal-1kg, salt-1kg, napkins,
masks, two soap per each individual. Door to door awareness also was given by our staff
especially to avoid the spread of corona virus. The community was instructed to use masks,
wash hands, and keep distancing and avoided crowded places. The people understood how
it spread from person to person and also became aware about safeguarding their lives.
PARISH BASED HOME CARE
From May 2022 February 2022 we joined the parish based home care from CBCI. The
objectives of Parish Based Home as follows;
•
•
•
•
•
•
Identifying Most Affected Reas- Dioceses
Identifying COVID-19 Positive Families
Distributing Medical Kits to Most Affected
Daily Follow up by Volunteers
Socio_ Psycho Support by Nurses & Volunteers
Connecting to the Doctors
40 medical kits were given to 4
parishes each. The volunteers were
chosen from the community and
were trained and they went from
door to door and checked the
temperature, oxygen level and those
who were having symptoms of
cough were given steam inhalation. From August 2021 to August 2022 we were part of
Sister Ambassadors for covid vaccination initiated by FADICA. This was in collaboration with
CHAI. This was carried out in 13 states in India and Odisha was one among them. We could
carry out this program in different districts of Berhampur, Cuttack-BBSR and Balasore. We
had 4 volunteers trained and the sister nurses from different convents were also part of this
program. We conducted awareness programs for the village community, front line workers
ASHA & Anganwady), youth, schools, home for the aged and hostels. video clip were
prepared in local languages
The time was very bad as there was a health emergency in the nation due to the pandemic,
and as a result the people belonging to every section, both in urban and rural areas were
affected adversely. The second wave of Covid-19 has wreaked the health care system and
related infrastructure in the country. Our area in the district of Berhampur diocese was also
very badly affected and there was a surge of cases in all these places. Almost everyone were
affected by the second wave in one way or other. Many were infected, some had lost their
life. Most of the people were living in fear with lot of anxiety and who literally struggled in
their daily lives. The infected people were suffering with fever, cold, cough, throat pain,
chest pain , diarrhoea.. etc both in the villages and slum areas and they were not able to get
any medical support in the given situation. And most of these cases were considered as mild
symptoms of Covid-19.
Training to ASHA
From August 2021 to August 2022 we were part of Sister Ambassadors for covid vaccination
initiated by FADICA. This was in collaboration with CHAI. This was carried out in 13 states in
India and Odisha was one among them. We could carry out this program in different
districts of Berhampur, Cuttack-BBSR and Balasore. We had 4 volunteers trained and the
sister nurses from different convents were also part of this program. We conducted
awareness programs for the village community, front line workers ASHA & Anganwady),
youth, schools, home for the aged and hostels. Video clip were prepared in local languages
➢
➢
➢
➢
➢
➢
➢
More people became aware about covid-19
Strict observation of Government rules by all.
video clip were prepared in local languages
Interrupted my outreach to the community.
More people received vaccination
Preventive and protection measures were taken.
Community developed sense of
Training to
Community
➢ Sharing
Community and Health facilitators and health facility
❖ Prepare to face the challenges
❖ Strict follow up of government protocol
❖ Make sure to avail the government provision
❖ Equipped with the knowledge
❖ Motivate people for vaccination.
❖ Make the people understand that corona can be prevented
❖ Strengthen the Family relationship
❖ Promote Safe migration
❖ Help the people to avail the provisions
The Changes I experienced professionally and personally
•
•
•
•
•
•
•
•
•
Difficulty to get permission to come out of my living cell
Pandemic affects all
Gained more knowledge about the pandemic
Disparity of vaccination among rich and poor
Inequitable access to vaccines
Build the confidence with the community
Built relationship with the government sector and got their support
Farmers risked their lives to feed the world
Prolonged lock-down had serious implication on mental health, leading
psychological problems including frustration, stress & depression.
Awareness program
for youth
Awareness for
Frontline workers
Training to village
Community
Training –State level
- Media
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