Nivetha Sakthivel : Breaking Barriers on Sexual Health Seeking Behaviour among Early Adolescence
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- Title
- Nivetha Sakthivel : Breaking Barriers on Sexual Health Seeking Behaviour among Early Adolescence
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Society for Community Health Awareness Research and Action
School of Public Health Equity and Action
(SOPHEA)
A Report on Community Health Learning Experience
Community Health Learning
Programme
2021-2022
Fellow Name:
Nivetha Sakthivel
Acknowledgements
Firstly, I would like to thank my Professors Dr. Smitha Nair and Brinallue Ma’am from Center
for Health and Mental Health, School of Social Work, TISS, Mumbai, for sharing CHLP
application form and explaining its benefits.
Secondly, I would like to extend my sincere gratitude to Mr. Suresh Dhandapani,
Communication Manager, SOCHARA, for being my constant support from the beginning till
the time of report submission irrespective of many hard situations.
This journey of CHLP won't happen without so many pushing of Mr. Indhira Dharshan (Life
Partner now) and Miss. Aliya Thasnima (So called bestie cum co-worker emotionally, mentally
and physically).
My Special hearty thanks to Dr. Denis Xavier, Programme Director, CHLP, SOCHARA & Dr.
Radhika Kaulgud Programme Director, CHLP, SOCHARA for being so receptive and
understanding to my situation in my hard times. Both were so receptive and understandable
during the journey.
I thank each and every co fellows, Abu, Uma, for traveling with me in this wonderful journey.
Last but not Least, It won't be complete without thanking the SOCHARA team for this
wonderful project and its execution.
2
Contents
S.No
Topic
Page No.
1
Abstract
4
2
Introduction
5
3
Why did I join the fellowship?
5
4
What were my learning objectives and were they met?
6
5
Learning from modules and how I applied the learning in my work.
6
6
Reflections on use of the LMS, videos and participation in live
online sessions.
7
7
How was a balance between work, life and the CHLP maintained?
9
8
Mentorship process and reflections
9
9
Project learning experience
9
10
Take away from CHLP and Looking Ahead -Where do I go from
here?
10
11
Community Action Project -Introduction
11
12
Need of the project
11
13
Aim & Objectives
11
14
Description
12
15
Impact of Community Health action
15
16
Annexures
16
17
Photographs
18
3
Abstract
The Community Health Learning Program from SOCHARA is precisely a great turning point in
my professional journey. The learning experience was so effective amongst the uncertain
situation. Usage of multiple teaching tools helps us to get the core concept even in the online.
The Course module even with the minimal time spent on the course gave a great knowledge and
perception in the community health field. Personally as a public health social worker, this course
changed the public health perception in a proper systematic approach. It taught us how
community health works in practice with respect to equality, affordability, accessibility and
accountability. Understanding the determinants help me to look at the project which I work with
the same lens which improved the project effectiveness and quality. Best highlight of the course
is the networking it does in the overall journey. Looking at colleagues from multiple fields helps
me to learn in multiple dimensions of community health. The learning didn’t stop just in a
theoretical way, there was a chance to explore and apply the learned techniques in the field
through projects. I choose Community Action Project to get an idea about articulating the action
project and it does meet my objective at the end. Topic of the project was Breaking Barriers on
Sexual Health Seeking Behaviour among Early Adolescence which I did in the Nilgiris District.
In short it is the best learning experience amidst the Pandemic in an effective way.
4
PART A
Introduction:
“ Health is a HUMAN RIGHT ”, this simple sentence has a lot of background stories and
struggles of many people. For a normal person health is an individual thing, but It is not. Health
is the community's prospect and we as social animals must work together to be better in the
community health. Community Health Learning Program is one such unique program where we
could experience the learning in community health. From the layman view community health
may not be seen as having nothing to do with our lifestyles. But it is not. It has a connection with
each and every day of our daily routine.
With the knowledge of public health, this course has molded my inner knowledge with lots of
multidimensional reflections which is helping me each and everyday in my professional life. I
believe that these learnings and experiences are going to give a great change in my future
journey in public health. In this report, I have included my experience detailed in my throughout
journey along with my reflections on the module, live sessions, mentor, overall team and project.
Why did I join the fellowship?
CHLP advertisement came to my knowledge through two of professors who are the pioneers in
the field and experiential teaching and learning. Once I got to know about it, I started looking for
the seniors who have already completed it. With the belief that it would give us great experiential
learning, which is my need by now, I joined the course.
Along with this, by the time I learnt about CHLP and SOCHARA, I was familiar with few
personalities like Ameer khan, Suresh, Naresh, Dr. Sundharaman, who was all impressed with
their knowledge in National Health Assembly 3 held in Raipur, Chhattisgarh. I came to know
that they are all part of SOCHARA in some way. Thus, I believe that working with all of these
would enrich my knowledge in the community health field.
Once I got the advertisement, the methodology of teaching accordingly and flexibility during the
pandemic attracted me to learn more about it. The remote learning method and self pacing study
allowed me to choose this course even while I was working.
As a whole, the overall comments from the seniors, professors and the professionals about the
quality and the experience they gain from the course, gave me the curiosity to learn about it and I
had a quest on learning about community health during my work experience in the POSHAN
ABHIYAN project.
5
What were my learning objectives and were they met?
1. To understand the different paradigms and multiple perceptions in community Health
approaches.
Yes, the course fulfilled the objective. Throughout the fellowship we got introduced to
different perspectives and determinants of health avail in the community. Also each
module helps us to understand how the community health approach differs for every
different disease
2. To learn more on community health and its interventions planning, and effective
executions.
In my previous work on the Poshan Abhiyan project, I experienced strategy planning
but I struggled a lot on execution of the same. The practical examples showed in the
program and the real models. For example projects like ASHWINI, WASH,
Ramakirshna mission, helped me to understand the factors for execution like systematic
planning.
3. To understand how Community health approaches exist in the real field.
Each and Every module had a real example which was explained by the same project
member itself. This allowed us to clarify the doubts then and there. From the time I
started the course, I have come across many real time examples of each theory and
principles.
Overall, my learning objectives have been met more than my expectations. But I always regret
that I couldn’t put in much time. Every time I watch a live session recording, I feel that I could
have been there.
Learning from modules and how I applied the learning in my work.
From the modules, live sessions and discussions, I got to learn the systematic approach towards
the field work. Before I had an idea but CHLP helped me to look at it in a different perspective
and articulate it in a professional way. I got an opportunity to work on sexual and reproductive
health of tribal women. I applied to women health, sexual and reproductive health module
learning to teach about sexual rights, reproductive rights and abortion rights.
Specifically the module project management, fundraising and proposal writing gave me a timely
hand for the NGO which we started. It was not the same in theory but the module project
management followed up by the practical example and assignment to us gave me an effective
understanding of the same.
6
Reflections on use of the LMS, videos and participation in live online sessions.
Understanding Community health
SEPEC determinants of the community health along with axioms of community health with the
example of ASHWINI and C-WASH program was so effective. The step by step Explanation
helps to understand the axioms. SEPEC determinants analysis helps the project planning and for
effective execution. The PPT with Indian models of Community health Projects gave us a great
insight and willingness to learn more practically on possible organizations.
Mental Health
This module covered from basic and gave slight insights on methods to handle mental illness
such as sucide, addiction along with mental health of child, adolescent, and women the flow
worked well. Case studies on mental illness gave a great understanding on how the illness affects
the individual.
Right to Health
Prasanna’s way of teaching the right to health as a storyline with the explanation of why along
with the case studies give me a deeper understanding for the rights based approach in the health
cader. Article Schuftan_Turiano_Shukla- Right to Health, PHM -Perspective and Case Study
provides the clear interlinkages between the necessity of other rights such as education, housing,
clean environment and so on for the achievement of right to health. Parallelly working with
People Health Movement from the ground level through MNI and HSO projects gives a different
perspective lens. It spots light on even more focused root causes for health problems.
Voluntary Health Sector
I have been introduced to private and public sector contributions in health care. But this module
gave me a different perspective to look at the voluntary health sectors. I have been to Christian
fellowship hospital near my town so many times. But truly, after this session I started noticing
the management method, how they manage the crowds through systems, and how the effective
treatments given in the cheapest way are understood. Their experience in health care services are
reflected in their work and management. I could study the same with other hospitals and could
compare and analyze. This was a great perspective and great learning on health systems for me.
Social Determinant of health
Critical analysis of social determinants of health decide the effectiveness of the implementation
of the intervention along with quality. Understanding the target group health determinants gives
us a clear idea on the major root cause of the health problem and to plan interventions
accordingly.
7
Women and Child Health
The readings provided for women's health beyond SRH were insightful. I could recollect my
professor's words that women’s health is more of reproductive oriented health. But even
considering other health issues is also an equality perspective for women's health. Comparison of
vulnerable groups such as women, child and adolescent in the COVID 19 gave a message to
intervene on that immediately in a systematic way. Especially, Video lectures on Gender based
violence by CEHAT team introduced a different perspective of gender based violence and
healthcare and their intervention work for health care workers. They sensitize the health care
workers on gender violence and intervene on the violence as earliest as possible.
Comprehensive Primary Health Care
Comprehensive Primary health care is the key point to achieve universal health care. It enables
community participation and effective service provision. Decentralization of the health care
covers many populations for health care.
Health and Health care in India
Medical Pluralism is the major point to consider in Indian health care. Acknowledging and
regonosing of traditional healers or medical practitioners should be provided.
Project Management , Fundraising and Proposal writing, Monitoring and Evaluation
Planning the Interventions in the practically executable way is the major skill needed for the
community health worker. This module gives knowledge on preparing the intervention as the
plan. Gantt chart preparation highlights any overlaps if available among the activities. Also, it
indicated the activities which need the pre preparation if needed. Fundraising is the major
challenge for each project.
Health Movements, Social movements and social change
As a participant of the National Health Assembly 3, I could understand how the social
movements cause the social changes around us in health. While attending the assembly I couldn't
understand many concepts and why it happens. But now I could understand the down to the top
approach in which the issues in health are voiced out and got changed at the policy level. For
example, I was part of the MNI meeting in which regularization of the private sector was
highlighted as a part of the agenda. Learning this module clears the need for the same and the
process of how the movement agenda is created and summarized.
8
How was a balance between work, life and the CHLP maintained?
Balancing work, life and CHLP was a highly tough call for myself. As for everyone, Pandemic
didn’t leave me with any option other than depression. I got married in between the fellowship
with many hardships. I still regret that I couldn’t give much time to the CHLP program. During
my first of the course I struggled a lot to attend live sessions and complete the tasks. At one point
I gave up a bit. But through continuous followup of Dr. Denis, Radhika and mentor Suresh I was
able to complete the course with a better level of learning. I highlight that Follow Up of the
fellows by the head team in different levels and aspects helped me to sustain throughout the
course. I could add on the same that this online mode of course was both a boon and curse to me.
If it was not online, maybe I wouldn't avail this course. But If it were a physical course My
learning efficiency would have been high. From a family setup attending the live sessions and
concentrating on the video lectures was hard to me. In the end, I understand that CHLP gave me
double the amount of time I invested. I was not on the proper work setup, So work didn't bother
me much, I struggled with life and the CHLP program only.
Mentorship process and reflections
One of the best things in the CHLP is the mentorship. My mentor is Mr. SURESH, luckily I am
familiar with him before the course through the National Health Assembly. I really appreciate
the team who gave a thought to match our profiles and set the mentor. We were in touch from the
assembly still this mentorship gave us a chance to explore more committed in the public health
field. My relationship with my mentor is beyond the CHLP program. I got an opportunity to
work with him in the MNI ( Makkal Nalvazhvu Iyakkam) which is part of SOCHARA who
works for Right to Health, a Social movement. During the course period, I got the chance to
attend a two day program of MNI in Trichy district, which pushed me more to work on
community health. In my visit to Trichy, I keenly observed the new project in the movement
called Health System Observatory. This was a step by the movement to strengthen the public
health care system. Now, I am going to be part of the same HSO in Coimbatore district. This
journey is gonna be a different learning experience to me. I always have meaningful
conversations and clarify myself a lot. His constant support strongly helped me to complete the
project and report too. Most importantly he guided me in molding and framing my raw ideas
into the executable plans in a systematic way. Thus, this mentorship is going to be my lifetime
takeaway from the CHLP as this learning journey for both of us is going to continue.
Project learning experience
There were two options for the project: one is research and another is community action project.
I had experience in research already during my masters, so I wanted to explore the Community
Action Project. I choose Sexual health as a broader category and focused to intervene on the
taboo around genetilia. I choose the target group as Early adolescence as we can follow up with
puberty related information after the session.
9
The major challenge for me in the project was articulation of the idea. Planning it previously
with different levels of analysis such as micro, macro and mezzo was challenging. But it does
have a larger context for the project to scale up or analysis documentation. I learned the
articulation of outcomes, assumptions and step by step breakdown of the objectives and
interlinking micro, mezzo and macro level goals. This articulation process refined the content in
a more focused and deliverable way. The purpose and the deliverable part are matched once we
set and connect the steps properly. I found it difficult to understand the plan of analysis but yet to
learn it more with the help of a mentor. While preparing the gantt chart it highlighted the
overlapping time frames and helped to figure out the needs beforehand. I couldn't follow the
timeline prepared due to many personal situations. Somehow managed to get an extension and
finish it before the extended time.
Take away from CHLP and Looking Ahead -Where do I go from here?
● Main take away for me from CHLP is a group of colleagues who are health professionals
through networking. I could feel a sense of being in the community of health
professionals with whom I could travel along.
● A systematic approach to each and every step we do in the field. Starting from the pilot
study or even framing the objectives, systematic approach always supports us to achieve
the goals easily.
● Articulation and documentation of every step is very important for the progress of any
planned intervention or research.
● Plan should be prepared from the beginning till the expected outcomes along with time
frame and all.
I keenly look forward to meaningful collaborations, mutual learnings, and thoughtful discussions
with the circle. I have registered with the company in which I work as a Director already. It
works mainy on Sexual and Reproductive health literacy for vulnerable population. I would push
myself maximum to get in hand with the fellows and facilitators hereafter.
The relationship with my mentor is already in a positive direction and we have planned a few
works for the future too like working in MNI. As a whole, CHLP is a great booster to my career
path in the right direction. From the beginning of the course it is a part of my life and certainly it
would be the same hereafter too.
10
PART B
Community Health Action Project
Title: Breaking Barriers on Sexual Health Seeking Behaviour among Early Adolescence
Introduction:
Sexual health is the major part in the overall health of an individual. Especially during
puberty it gains the main focus among the early adolescence. Even Though it plays an important
role in health, due to the taboo and stereotype around the sexual parts and sex. Thus, we could
assume that there are several barriers for early adolescents to seek information about the sexual
health during puberty. This projects focus on one of the barriers for seeking sexual health during
puberty.
Need for the Project:
Adolescents from marginalized communities, especially tribal communities, face numerous
challenges to their physical and mental health due to a lack of access to information, resources,
guidance, and services. The COVID-19 pandemic has exacerbated these challenges with
significant learning and nutrition loss (Population Foundation of India, 2022). Teenage
pregnancy is one of the major concerns in the tribal population. In order to impart health literacy
for teenage pregnancy, it is mandatory to form a basic knowledge about sexual and reproductive
organs among the adolescent population. Also, puberty is the first major phase of sexual
developement, Children are more curious to learn about the changes happen to them. Knowledge
transfer during this time is very crucial for their overall self care and health. But in reality, there
are many taboo and stereotypes around sexual health exists in the society. Because of this, the
efficiency of the knowledge transfer is very less and thus there forms a gap in seeking sexual
health for adolescence and ultimately reduce the level of health literacy. Thus, the study aims to
intervene on one of the barriers to learn about reproductive parts and its characteristics.
Aim:
To improve sexual health seeking behaviour among early adolescents by removing one of the
barriers to achieve it.
Objectives:
● To break taboo and stereotypes around sex organs
● To sensitize parents of the early adolescents to create comfortable environment
11
Demographic Area:
The community Action Project is planned to be conducted in the Puthukaadu Village,
Burliyaar, Nilgiris District.
The Health background of the village is with high incidence of anemia, Teenage pregnancy and
Infant Mortality rate. The session for children is planned to be conducted through the village in
their living areas. After the sessions with children parents are also to be approached to sensitize
about the need for health literacy in sexual health.
Physical Area:By locality and their living area (Village Name: Puthukaadu, Burliyaar)
Target Group: Early Adolescents of age 10years to 13 years old in the village
Intervention Description:
Methodology:
Participatory training methodology is applied in the intervention. The participants are included in
the activity with high participation to transfer the knowledge about the parts of the body.
Community Health Principles:
● 2- Autonomy over Health
● 3-Integration of Health and development activities
● 5. Building equity and empowering community beyond social conflicts
● 7. Confronting the biomedical model with new attitudes skills and approaches
● 10. An effort to build a system in which Health For All can become a reality
SDG goals:
Goal 3: Good Health & Well-Being:
Target 3.7: ensure universal access to sexual and reproductive health-care services, including for
family planning, information and education, and the integration of reproductive health into
national strategies and programmes.
Goal 5: Gender Equality:
Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female
genital mutilation
Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as
agreed in accordance with the Programme of Action of the International Conference on
12
Population and Development and the Beijing Platform for Action and the outcome documents of
their review conferences
Goal 10: Reduced Inequalities:
Target 10.2: empower and promote the social, economic and political inclusion of all,
irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status
Partners/ Stakeholders:
NGO partner - Astitiva works on the overall community health mainly focusing on malnutrition
of the children and anemia.
Parents of adolescents: Parents of the participants are approached separately either individually
or as a group.
LFA:
Objectively
Verifiable
Indicator
Goals
To trigger health seeking behaviour
towards their Sexual health particularly
puberty related issues.
Important
Means of
Verification Assumptions
Post
No. of.
session
Enquiries to
feedback
the parents and from
other
stakeholder
stallholders.
s and
parents
Identify the barriers to talk about puberty
and genitals
1. To break the streotype around sex
Positive
organs and private area
No. of.
Response
feedback
2. To sensitize the community about
Enquires about
from parents
from the
Purpose importance of breaking taboo around
the session
or stallholders
parents and
seeking preventive measures in sexual
from stalk
may not be
stakeholder
health
holders
positive
s
3. Dispel knowledge about each part of the
body and its functions.
13
Output
1. Barriers to learn about genital organs
and puberty will be identified.
2. Activity on body mapping will be
delivered.
3. Session for parents to understand social
impacts about Adolescent behavior and
health seeking and rights (puberty) will be
delivered.
4. Report, IEC and Knowledge transfer
materials will be produced based on
learning experience
5. Dialogue will be initiated with
stakeholders for streamline/mainstream
programmes and its implications
Group
Discussion
/
Individual
interview
1. Identify the target group and get
informed concerns.
2. Build rapport with community and
stakeholders.
2. Barriers to learn about genital organs
and puberty will be identified.
2. Activity on body mapping will be
1.How many
delivered.
Discussions
The
3. Session for parents to understand social conducted and Minutes of community
Activity impacts about Adolescent behavior and
its duration
the
may not open
health seeking and rights (puberty) will be 2. No. of
meeting
up to the
delivered.
Person
researcher
4. Report, IEC and Knowledge transfer
attended.
materials will be produced based on
learning experience
5. To initiate Dialogue/communication
with stakeholders for
streamline/mainstream programmes and its
implications
14
Gantt Chart:
Tasks
Start
Date
End
date
12/ 12/ 12/
1/1
1/2
Days 24 29 30 1/4 1/5 1/10 1 1/16 5 2/15
Identification of the
Community, rapport
with stakeholders
12/24/21 12/29/21
5
Focused group
discussion for
problem
identification
12/30/21
1/4/22
4
Session for Children
1/5/22
1/10/22
5
Session for Parents
1/11/22
1/16/22
5
Report Writing
1/25/22
2/15/22
20
Culmination process
Details of the session are attached as annexure I.
Impact of Community Health Action:
Observations:
● Students were hesitant in the beginning to talk about armpits, pubic hair, breasts and
private areas. Gradually, they are comfortable with group learning.
● One of the participants confessed to the researcher that she was scared of the pubic hair
which started growing recently and now she got relaxed with the information that it is
normal and nothing to worry about.
● Parents are not yet ready to talk about puberty or changes around it to the children
directly.
● Further sessions on the information of puberty, reproduction and details about genetilia
would give them a holistic understanding about their sexual health.
15
Annexure - I
Session Details:
Part I: 15 min: Ice breaker
Part II: 25 min: Understanding our body
Part II
Time: 25 minutes
Material Required: Board and chalk
Instructions:
● Draw an outline of the human body on the board.
● Ask the students about parts of the body one by one from the head. For example: Point at
the head part and ask them about the parts over there.
● As they mention one by one add the details given below for each part of the body.
Part of
the body
Do’ s
Don’ts
Hair
1. Should not let the hair tangle but
1. Wash it with Shampoo/ Herbal Powder
remember that having naturally curly
weekly twice 2. Comb it regularly
hair is also normal. 2. Should not allow
3. Check for lice 4. Apply oil
split hairs by oiling ends of the hair.
Eyes
Before sleeping and after you wake up,
your eyes should be washed with fresh
water.
Don't use too many cosmetics on the
eyes.
Nose
Clean the nose daily while bathing
Should not use any sticks or sharp
objects to clean the nose.
Mouth,
Tongue &
Teeth
1. Brush your teeth twice a day( before
sleeping and after waking up)
2. Clean your tongue using a tongue
cleaner to avoid bad breath
3. Wash your mouth after every meal
Don't use hard bristles because they
might damage the enamel or gum.
Ears
Clean your ears using buds weekly once
Avoid using hairpins/ safety pins for
cleaning your ears.
16
Hands
1. Wash your hands using soap/ hand
wash especially before meals and after
using the toilet using proper
handwashing techniques. 2. Wash hands
after returning home from school, work
or playground.
Don't eat without washing your hands.
Nails
Cut your nails using a nail cutter weekly
once.
Don’t bite your nails
Armpits
Armpits should be washed daily while
bathing. Hair growth in the armpits is
normal and needs to be cleaned.
Don’t use very sharp materials to
shave/ clean underarm hair. Instead,
use mildly blended razors/ scissors for
hair removal. These scissors/razors
should not be used for other things.
Feet
Wash your feet every day before going to
bed. Use footwear whenever you go out.
Don’t wear shoes/socks that are too
tight.
Toes
Cut your toenails weekly once.
Don't allow dirt to settle in the corners
of your toenails. While cutting nails
clean the corners of the nails also.
1. Wash it with water thrice a day.
2. Use soap only once a day.
3. Hair in the genitalia is normal and it is
your personal choice to cut/keep them.
Do not forget to pat the area dry after
washing because leaving it damp
increases the chances of bacterial
growth.
Genitalia
Session Concluding Points:
● Each part of the body should be taken care of daily and properly for better health.
● Introduce the term puberty and mention it as the process of their growth. Highlight major
changes like pubic hair growth, Breast or chest development and so on.
17
Photographs
Some of the pics I got to click on this journey even if is online program.
A memorable Pic. From the left- Aravind, Abirami, Dr. Shilpa, Nivetha and Dr.
Denis Xavier
Location: Aravind & Abirami Home, Coimbatore.
18
Pics from my Field for Community Health Action
Location: Puthukaadu, Nilgiris District
19
Pics from Trichy Visit along with mentor Suresh Sir for the MNI
Activity
Location: Trichy
20
- Media
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